Nuclide Notes

Nuclide Notes 🩻 Nuclear Medicine & Hybrid Imaging
🎯 Education • Cases • Clinical Tips
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22/11/2025

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☢️ Intracortical osteoid osteoma ☢️ 23-year-old female with history of vague right thigh pain, the wholebody planar imag...
22/11/2025

☢️ Intracortical osteoid osteoma ☢️ 23-year-old female with history of vague right thigh pain, the wholebody planar imaging did not show any abnormality, the early dynamic scan images were normal. Immediate blood pool phase and delayed SPECT/CT images show a 2 mm intracortical lucent lesion of mild blood pool activity and delayed tracer uptake in the proximal posterior femoral cortex with surrounding sclerosis.
🗓️ Osteoid osteomas comprise 10-12% of all benign osseous neoplasms and 2-5% of all primary bone tumors, its generally a condition of adolescents but it can affect a wide range of individuals 8 months - 70 years, males are affected more than females. The most characteristic clinical presentation is pain (typically deep, aching, and intense), which is worse at night and relieved by aspirin or other nonsteroidal antiinflammatory drugs. In bone scan osteoid osteomas have been described by being positive in all phases. Planar bone scan’s sensitivity is low in detecting small lesions due to its limited spatial resolution. However, the sensitivity can be improved with SPECT, while CT improves specificity. The reported accuracy of SPECT/CT bone scan in detecting osteoid osteoma is above 95% (100% accuracy has been reported).

🎨 Non-case-related. Procreate experimentation continues, this time inspired by the visuals of an FDG PET/CT scan of gast...
22/11/2025

🎨 Non-case-related. Procreate experimentation continues, this time inspired by the visuals of an FDG PET/CT scan of gastric linitis plastics !

☢️ 18F-NOTA Paraganglioma ☢️ 18F-NOTA-TIDE (FOC) scan shows infra renal retroperitoneal circumscribed soft tissue mass o...
21/11/2025

☢️ 18F-NOTA Paraganglioma ☢️ 18F-NOTA-TIDE (FOC) scan shows infra renal retroperitoneal circumscribed soft tissue mass of intense FOC uptake with lobular margins and cystic degeneration in the precaval compartment. Regional aortocaval prominent sized lymph nodes of intense FOC uptake. Multiple lytic deposits of intense FOC uptake in the spine and sacrum, right 6th and left 5th ribs, and bilateral ischium. The deposit in D2 right posterior column is associated with destructive soft tissue component invading the spinal canal and protruding through the right neuronal foramina.
🗓 18F-NOTA-TIDE (18F-OC) is fluorine labeled somatostatin receptor tracer with high affinity to SSRT2 (weaker to SSTR5 and 3) and performs excellently is paragangliomas especially in SDHx related disease. Compared to 68Ga analogues it has a longer half life, shorter distance with comparable or better target to background contrast. Typical biodistribution includes high spleen and pituitary activity, renal/urinary excretion, and moderate liver uptake.

🦴 READ WITH ME | Unilateral Hot Bones☢️ Delayed bone scan shows multifocal uptake limited to the right hemipelvis, femor...
20/11/2025

🦴 READ WITH ME | Unilateral Hot Bones

☢️ Delayed bone scan shows multifocal uptake limited to the right hemipelvis, femoral shaft, and fibula with a lucent focus in the right anterior ilium.

🎯 Top DDx: benign lesions (polyostotic fibrous dysplasia), traumatic injury, less likely malignancy.

Next step? I’d add SPECT/CT or CT pelvis & RLL.

☢️ Infected TKR ☢️ FDG PET/CT scan shows prior left total knee replacement with hypermetabolic fluid collection in a syn...
19/11/2025

☢️ Infected TKR ☢️ FDG PET/CT scan shows prior left total knee replacement with hypermetabolic fluid collection in a synovial pattern prominent in the supra patellar recess. There is a large periprosthetic femoral cystic lesion with sclerotic rims and hypermetabolic peripheral multifocal areas prominent laterally. A focal area of intense FDG uptake in the lateral anterior inferior femoral compartment. There is hypermetabolic extensive osteolysis of intense FDG uptake involving the tibial tray bone-prosthesis interface at the medial and lateral compartments and extending along the tibial stem, the most prominent uptake is located anterior to the tibial stem. There are enlarged hypermetabolic left popliteal, inguinal and pelvic lymph nodes as well. Biopsy and aspiration confirmed Staphylococcus hominis.
🗓️ FDG PET has fairly high specificity and sensitivity in diagnosing infected knee prosthesis which makes a reliable alternative to WBC scans. Diagnostic criteria relies mainly on intense uptake at the bone-prosthesis interface. Compared to WBC scan, it does not rely on leukocyte migration so treatment does not affect the sensitivity.

14/11/2025

✋ Stop scrolling past nuclear medicine cases you could actually learn from.

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• 3+ hours of focused lectures and case discussions
• 27+ scrollable interactive cases with MCQs
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🔎 READ WITH ME | Ectopic Parathyroid 🗓 58-year-old female with prior right thyroid lobectomy for parathyroid adenoma and...
14/11/2025

🔎 READ WITH ME | Ectopic Parathyroid

🗓 58-year-old female with prior right thyroid lobectomy for parathyroid adenoma and persistent elevated PTH. ☢️ Dual-phase sestamibi SPECT/CT: thyroid washes out, lesion persists → right paraesophageal adenoma at the thoracic inlet (~1.8 cm).

❓Which of the following is diagnostic of acute cholecystitis?
12/11/2025

❓Which of the following is diagnostic of acute cholecystitis?

💧 READ WITH ME | Dynamic Renogram14-year-old with incidental unilateral hydronephrosis and cortical thinning. Diuretic r...
10/11/2025

💧 READ WITH ME | Dynamic Renogram
14-year-old with incidental unilateral hydronephrosis and cortical thinning. Diuretic renogram shows delayed extraction (Tmax 14 min) with >50% activity fall post-Lasix → good drainage = not obstructed.
Take-home: Hydronephrosis ≠ obstruction.
Swipe the curves & drop your call: obstructed or not—and why?

☢️ D4/jejunal adenocarcinoma ☢️ FDG PET/CT shows hypermetabolic duodenal D4/proximal jejunum focal asymmetrical concentr...
09/11/2025

☢️ D4/jejunal adenocarcinoma ☢️ FDG PET/CT shows hypermetabolic duodenal D4/proximal jejunum focal asymmetrical concentric mass like thickening with subsequent luminal narrowing. There is nodular infiltration and stranding of the regional fat planes. There are associated regional prominent sized and rounded lymph nodes.
🗓 Small bowel adenocarcinoma is a rare malignancy (

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