Primary idiopathic chylopericardium is a rare clinical entity characterized by the accumulation of chyle within the pericardial cavity without a definitive cause. The aim of this study was to assess the clinical presentation, etiology, diagnosis, treatment and follow-up of primary idiopathic chylopericardium. We retrospectively reviewed 9 cases of patients who suffered from primary idiopathic chylopericardium at our hospital from January 1993 to November 2013. There were two males and seven females among our patients. Their ages ranged from 13 to 55 years. The most common clinical presentation was dyspnea. The etiology was idiopathic. All patients were diagnosed by pericardiocentesis, computed tomography of the chest and lymphoscintigraphy. Non-surgical therapy was adopted in all nine patients and failed in six, who underwent subsequent successful surgery. Thoracic duct ligation with the creation of a pericardial window was the most common surgical procedure. All patients were followed up from 3 months to 9 years, and no recurrence occurred. In assessing patients with an enlarged cardiac silhouette, one should be aware of primary idiopathic chylopericardium. The most effective treatment is ligation of the thoracic duct and the creation of a pericardial window.

Whole-body bone scintigraphy (WBBS) and MRI are widely used in assessment of patients with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. However, the value of F-18 fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG PET/CT) in SAPHO syndrome was unclear. The aim of this study was to characterize the manifestation of SAPHO syndrome on 18F-FDG PET/CT and explore its relationship with clinical symptoms and WBBS. Twenty-six patients who suffered from SAPHO syndrome and had undergone whole-body 18F-FDG PET/CT were recruited in Peking Union Medical College Hospital from 2004 to 2016. Clinical manifestations and laboratory findings were recorded for all patients. Imaging data on 18F-FDG PET/CT and WBBS were collected and analyzed retrospectively. All the 26 patients (20 females and 6 males) exhibited skeletal abnormalities on 18F-FDG PET/CT. Multiple skeletal lesions affecting the anterior chest wall or spine with low to moderate 18F-FDG uptake and coexistence of osteolysis and osteosclerosis presented as the typical features of SAPHO syndrome. Sixteen (61.5%) patients had abnormal 18F-FDG uptake outside the osteoarticular system. PET scan had moderate to substantial agreement with CT and WBBS in revealing lesions in the anterior chest wall and axial skeleton. Nonetheless, the correlation between increased 18F-FDG uptake and clinical symptoms was weak. SAPHO syndrome exhibits characteristic features on 18F-FDG PET/CT. It showed comparable capacity in revealing skeletal lesions with bone scintigraphy.

A 7-year-old girl with known brain metastasis from neuroblastoma developed new onset of severe headache. A brain MRI confirmed known metastasis in the right frontal lobe of the brain without new abnormalities. The patient was enrolled in a clinical trial using ¹⁸F-MFBG PET/CT to evaluate patients with neuroblastoma. The images confirmed abnormal activity in the known lesion in the right frontal lobe. In addition, the PET showed additional foci of abnormal activity in the left cerebellopontine region. A follow-up brain MRI study acquired 4 months later revealed abnormal signals in the same region.

Purpose: The current guidelines state that the functional imaging choice in the evaluation of metastatic pheochromocytoma and paraganglioma (PPGL) is ⁶⁸Ga-DOTATATE PET/CT. ¹⁸F–meta-fluorobenzylguanidine (¹⁸F-MFBG) is a new PET tracer and an analog of meta-iodobenzylguanidine (MIBG). This study aimed to compare ¹⁸F-MFBG and ⁶⁸Ga-DOTATATE PET/CT in patients with metastatic PPGL. Patients and Methods: Twenty-eight patients with known metastatic PPGL were prospectively recruited for this study. All patients underwent both ¹⁸F-MFBG and ⁶⁸Ga-DOTATATE PET/CT studies within 1 week. Lesion numbers detected were compared between these 2 studies. Results: ¹⁸F-MFBG PET/CT was positive for detecting metastases in all patients, whereas positive results of ⁶⁸Ga-DOTATATE PET/CT were in 27 (96.4%) patients. A total of 686 foci of metastatic lesions were detected by both ¹⁸F-MFBG and ⁶⁸Ga-DOTATATE imaging. In addition, 33 foci of abnormal activity were only detected by ¹⁸F-MFBG, whereas 16 foci were only shown on ⁶⁸Ga-DOTATATE PET/CT. Conclusions: Our data suggest that ¹⁸F-MFBG PET/CT is an effective imaging method in the evaluation of metastatic PPGL and could be alternative of ⁶⁸Ga-DOTATATE PET/CT in this clinical setting.