Lymphangioleiomyomatosis revealed by ⁶⁸Ga-NOTA-Evans Blue PET/CT

Excerpt

A 50-year-old woman presented with a 5-year history of progressive dyspnea underwent a lung HRCT (a, b), which showed multiple thin-walled air-filled cysts in bilateral lungs. The HRCT findings were consistent with the characteristic of lymphangioleiomyomatosis (LAM). The patient was clinically diagnosed with LAM, which is a disease associated with lymphatic disorder. ⁶⁸Ga-NOTA-Evans Blue (⁶⁸Ga-NEB) is a new albumin-binding PET radiotracer for lymphoscintigraphy [1], so ⁶⁸Ga-NEB PET/CT scanning was performed to evaluate the lymphatic system disorder in LAM. PET/CT acquisition for visualizing lymphatic circulation draining from the injection sites to the left venous angle was performed at 20 to 40 min after subcutaneous injection of ⁶⁸Ga-NEB into the first interdigital spaces of both feet (0.3 ml, 37 MBq/ft). The MIP (a) demonstrated widened right lymphatics of abdomen with increased uptake and mild uptake on chest. The axial and coronal images of the chest revealed diffuse increased ⁶⁸Ga-NEB uptake of bilateral lungs (c–g). The abnormal intense ⁶⁸Ga-NEB uptake in the abdomen was located in the enlarging lymph nodes and dilated lymphatics (h–j, arrows). The increased uptake of ⁶⁸Ga-NEB in bilateral lung suggests the disturbance of pulmonary lymphatic circulation, which is a novel finding on lymphoscintigraphy in LAM. …