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🩻 Nuclear Medicine & Hybrid Imaging
🎯 Education • Cases • Clinical Tips
🏅 FASNC | FEBNM | CBCCT Certified
📚 Online Nuclear Medicine Academy ⬇️

06/01/2026

🫀 SPECT Myocardial Perfusion Case

🗓 Stress-rest SPECT/CT shows a large, completely reversible perfusion defect in the anterior, inferior and inferolateral walls (base to apex), with normal perfusion elsewhere.
📊 SSS: 24 | SRS: 1 | SDS: 23 | TPD: 18%
Gated images show hypokinesia in the inferior and septal regions with normal LV function (LVEF: 50%).

📝 Interpretation:
✅ Significant reversible stress induced ischemia
✅ Hypokinesia in the inferolateal region
✅ Normal systolic function
✅ Dilated LV cavity

05/01/2026

❓Which PET viability pattern predicts the highest likelihood of LV functional recovery after revascularization?

04/01/2026

🧠 Mini-Masterclass | Gastric Anatomy on FDG PET/CT

This carousel maps the stomach step-by-step (cardia → fundus → body → antrum → pyloric canal → pylorus) so you can name the segment confidently and avoid false alarms.

Quick reporting pearls:
✅ Always localize uptake to a gastric segment (not just “stomach”).
✅ Uptake: focal vs diffuse? mucosal vs mural? does CT show wall thickening?
✅ Perigastric fat plans: clear vs. nodular infiltration or fat stranding.

📌 Save this for your next PET/CT read.
🧩 Quiz: Which segment do you mislabel most often — cardia vs fundus or antrum vs pylorus?

03/01/2026

☢️ Osteochondroma ☢️ FDG PET/CT scan shows a well defined pedunculated bony lesion arising from the left 7th rib anteriorly with medullary continuity and projecting posteriorly indenting the pericardial surface. There is no associated cortical destruction or soft tissue component, pneumothorax, pleural effusion or parenchymal lung changes. Osteochondromas are non FDG avid unless there is malignant transformation, in bone scan there is increased tracer uptake during the growth period until they show normal bone activity. Presence of activity in adulthood should raise the concern of underlying complication such as malignant transformation or fracture.
🗓 Osteochondromas (Exostosis) are usually asymptomatic benign lesions (10-15%) that can qpresent at any age. They can be symptomatic if there’s a fracture , if causing mass effect or associated with malignant transformation (1%). Most commonly they arise in the lower limbs (30% in femurs), upper limbs and in the posterior elements of the spine. Osteochondormas of the ribs are rare and almost always arise near the anterior end of the rib.

02/01/2026

☢️ FDG PET/CT scan shows suppressed LV FDG uptake with a focal area of moderate FDG uptake in the apex and anterior apical segment which is deviating from the physiological expected pattern of uptake. SPECT/CT MPI show fixed severely reduced perfusion abnormality in the apex.
🗓 Myocardial FDG uptake can follow a continuum that mirrors regional energy demand, starting from minimal or absent activity, then small foci near the aortic root, progressing to involvement of the basal ring, then extending gradually along the ventricular walls toward the apex, with the apical septum typically being the last regions to show uptake. Here we see global LV suppression with a focus of moderate FDG uptake in the apex and anterior apical segment, which does not fit this expected physiological gradient. This finding on FDG PET should raise the suspicion of underlying hibernating myocardium/ischemia.

01/01/2026

☢️ Meningioma ☢️ 18F-PSMA scan shows hyperdense extra axial mass with coarse calcifications of low PSMA expression in the left frontal lobe. The appearance and location are most consistent with a PSMA avid meningioma (incidental finding) rather than metastatic disease.
🗓️ In PSMA PET scans, meningiomas are well recognized pitfall of intracranial PSMA avid lesions, typically appearing as a focal low to high PSMA avid dural based lesion/mass. The avidity is largely related to PSMA expression in the tumor’s neovasculature and endothelial cells. Unregulated PSMA expression in meningiomas is correlated with higher grades tumors and incidence of recurrence.

22/12/2025

☢️ Ulnar fixation infection ☢️ The early and delayed SPECT/CT images demonstrate metallic hardware spanning the proximal left ulnar shaft. There is left proximal forearm antebrachial fascia superficial and subdermal thickening and fat infiltration corresponding to diffuse intense perfusion tracking along the fixation plate and olecranon process of left ulna. There is intense delayed tracer uptake involving the left ulnar olecranon process and proximal fixation screws. Hardware infection and bone infection were confirmed intraoperatively.
🗓️Hardware infection develops when the bacteria adheres to metalwork and form a biofilm. Clinically presents as pain, swelling, erythema. On bone scintigraphy/SPECT/CT, infection is suggested by a hyperemic pattern on early phase, with focal or intense delayed uptake at the bone–prosthesis interface or screws in the delayed phase. Prompt tracer asymmetry in the early frames of the dynamic phase supports infection. CT correlation (fat infiltration, fascial thickening, soft tissue collection, periosteal reaction, lucencies, bone destruction) increases confidence.

20/12/2025

☢️ Tuberous sclerosis ☢️ on CT quick spotters: Brain with subependymal nodules (coarse calcifications), cortical/subcortical tubers ± calcification, and SEGA at/near the foramen of Monro; Chest showing diffuse thin-walled cysts of LAM; Kidneys with multiple bilateral angiomyolipomas containing macroscopic fat and renal cysts (watch for acute hemorrhage); Liver/Spleen may show extra-renal AMLs/cysts; Bones with sclerotic enostoses; Heart with classic rhabdomyomas and especially in adults focal intramyocardial macroscopic fat foci.

19/12/2025

☢️ Pancreatic neck NET ☢️ 18F-NOTA scan demonstrate relatively hyperdense soft tissue lesion of intense FOC uptake in the pancreatic neck, consistent with biopsy proven NET. The remainder of pancreatic parenchyma demonstrate low grade physiological FOC uptake.
🗓️ Pancreatic NET are 40% non functioning, 60% functioning, may secrete several peptide hormones leasing to diverse symptoms. Insulinomas are small benign and functioning, gluconomas cause DM and rash (necrolytic migratory erythema), vipomas are large tumors commonly associated with metastases at time of diagnosis, gastrinomas are less than intestinal carcinoids but usually malignant. ACTH/GHRH/PTHrP/SS are rare and difficult to diagnose.

17/12/2025

How to describe a cavitary lung mass on FDG PET/CT (quick reporting checklist 🫁🔥)

When you see a cavitary lung mass on PET/CT, don’t just say “FDG-avid cavity.” Describe it like this:

✅ Where + size: lobe/segment, maximum dimension (MPR)
✅ Cavity morphology: single vs multiloculated, wall thickness (thin/thick/intermediate), smooth vs irregular, inner margin (shaggy/nodular)
✅ Content: air–fluid level? debris? intracavitary soft-tissue component?
✅ FDG pattern: rim/wall uptake vs intracavitary uptake, focal nodular “hot spot,” SUVmax
✅ CT behavior: spiculation, pleural tags, chest wall invasion, necrosis, bronchial obstruction/atelectasis, surrounding GGO/consolidation, regional satellite nodules
✅ Most helpful line: malignancy vs infection/inflammation clues

Save this for your next lung case ✅

16/12/2025

❓Which of the following statement is true when a LEHR (low energy high resolution) collimator is used instead of HE (high energy) collimator in imaging I131 whole body scan?

15/12/2025

☢️ Paget disease ☢️ 46-year-old female diagnosed with metastatic breast tumor, previously reported as metastatic lesions in the sternum, spine and left pelvic bone. On serial imaging all the lesions were almost resolved after treatment except for the left pelvic lesion. She was referred to do a third follow up whole body bone scan after her last CTx cycle. There is still persistent activity in the left iliac bone and acetabulum which did not change in intensity or pattern of involvement. Fused SPECT/CT images revealed intense uptake in coarse trabeculations and cortical thickening of the left iliac bone, features of paget disease. Biopsy confirmed Paget disease.

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Monday	09:00 - 17:00
Tuesday	09:00 - 17:00
Wednesday	09:00 - 17:00
Thursday	09:00 - 14:00
Saturday	09:00 - 17:00
Sunday	09:00 - 17:00

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