Fig. 1.

a Maximum intensity projection image revealed evidence of hypermetabolic malignant large left thyroid lobe lesion (arrowhead), associated with few hypermetabolic metastatic mediastinal lymphadenopathy (curved arrow), several hypermetabolic bone marrow lesions (asterisks), and hypermetabolic massive hepatomegaly (i.e., hepatic superscan, arrow). b Axial PET/CT images of the neck revealed evidence of a large left thyroid lobe lesion with a maximum standardized uptake value (SUVmax) of 6.3 (arrowheads). c Axial PET/CT images of the thorax revealed evidence of a few hypermetabolic mediastinal lymph nodes (SUVmax up to 5.1; curved arrows). d Coronal PET/CT image demonstrating evidence of hepatic super scan (SUVmax 19.8; arrow) visualized concurrently with the hypermetabolic malignant left thyroid lobe tumor (arrowhead). e Axial PET/CT images demonstrating evidence of several hypermetabolic bone marrow lesions involving the left humeral shaft, S1 vertebra, and right proximal femur (SUVmax up to 8.1; asterisks). f Histopathologic examination of the ultrasound-guided liver biopsy sample revealed evidence of metastatic medullary thyroid carcinoma evidenced by positive expression for chromogranin, thyroid transcription factor-1 (TTF-1), and calcitonin immunostains