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. 2020 Aug 3;44(3):403–419. doi: 10.1007/s40618-020-01374-7

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© The Author(s) 2020

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 5 — Case presentation of a 68-year-old male patient with metastatic PTC. He underwent total thyroidectomy (pT3mN1bMx) and two consecutive RAI treatments (cumulative activity 11.1 GBq). After the second RAI treatment, 18F-FDG PET/CT demonstrated three FDG-avid lesions: a left cervical lymph node (black arrow on a image; see also g and i), a lytic bone lesion in D10 (blue arrow on a image; see also c and e) and a focal intestinal uptake (asterisk on a image; see also m and o). So, the patient underwent a cervical lymphadenectomy that confirmed the thyroid origin of the lesion, and a Cyberknife radiosurgery of the D10 bone lesion (24 Gy). The subsequent follow-up 18F-FDG PET/CT scan demonstrated a complete metabolic response of the D10 bone lesion (blue arrow on b image; see also f), even if its radiological aspect was unchanged on CT (d); moreover, no further pathological radiotracer uptake was detected in the left cervical region (black arrow on b image; see also h and l). The focal intestinal uptake was stable (asterisk on b image; see also n and p) and was diagnosed as an adenomatous polyp at the subsequent polypectomy. The 18F-FDG PET/CT findings were further validated by the concomitant reduction of serum Tg levels. PTC papillary thyroid cancer, RAI radioactive iodine, 18F-FDG PET/CT 18F-fluorodeoxyglucose positron emission tomography/computed tomography, Tg thyroglobulin