INTERESTING IMAGE Solitary Hepatic Metastasis From Medullary Thyroid Carcinoma Mimicking Atypical Hemangioma Insights From Multimodality Diagnostic Approach by MRI, F-18 FDG and F-18 FDOPA PET/CT Alessio Imperiale, MD,* Michel Greget, MD,† Ge ´rard Chabrier, MD,‡ Julie Keomany, MD,* Edmond Rust, MD,* Julien Detour, PharmD,§ Patrick Pessaux, MD, PhD,¶ and Bernard Goichot, MD, PhD‡ Abstract: Medullary thyroid carcinoma (MTC) is an uncommon malignant endocrine tumor. Distant metastases occur frequently in patients with ele- vated serum calcitonin values. Surgery remains the mainstay of treatment, so the early detection of metastatic involvement is crucial for patient outcome. F-18 FDOPA PET/CT seems to be a promising diagnostic tool for disease recurrence detection. We report the results of multimodality diagnostic approach by MRI, F-18 FDG, and F-18 FDOPA PET/CT in a patient with a solitary hepatic metastasis from MTC mimicking atypical hemangioma. Key Words: medullary thyroid carcinoma, liver metastasis, atypical hemangioma, F-18 FDOPA PET, F-18 FDG PET (Clin Nucl Med 2010;35: 434 – 437) REFERENCES 1. Roman S, Mehta P, Sosa JA. Medullary thyroid cancer: early detection and novel treatments. Curr Opin Oncol. 2008;21:5–10. 2. Giraudet AL, Vanel D, Leboulleux S, et al. Imaging medullary thyroid carcinoma with persistent elevated calcitonin levels. J Clin Endocrinol Metabol. 2007;92:4185– 4190. 3. Vilgrain V, Boulos L, Vullierme MP, et al. Imaging of atypical hemangiomas of the liver with pathologic correlation. Radiographics. 2000;20:379 –397. 4. Dromain C, de Baere T, Baudin E, et al. MR imaging of hepatic metastases caused by neuroendocrine tumors: comparing four techniques. Am J Roentge- nol. 2003;180:121–128. 5. Soyer P, Gueye C, Somveille E, et al. MR diagnosis of hepatic metastases from neuroendocrine tumors versus hemangiomas: relative merits of dynamic gad- olinium chelate-enhanced gradient-recalled echo and unenhanced spin-echo images. Am J Roentgenol. 1995;165:1407–1413. 6. Rubello D, Rampin L, Nanni C, et al. The role of 18F-FDG PET/CT in detecting metastatic deposits of recurrent medullary thyroid carcinoma: a prospective study. Eur J Surg Oncol. 2008;34:581–586. 7. Ong SC, Schoder H, Patel SG, et al. Diagnostic accuracy of 18F-FDG PET in restaging patients with medullary thyroid carcinoma and elevated calcitonin levels. J Nucl Med. 2007;48:501–507. 8. Koopmans KP, de Groot JW, Plukker JT, et al. 18F-dihydroxyphenilalanine PET in patients with biochemical evidence of medullary thyroid cancer: relation to tumor differentiation. J Nucl Med. 2008;49:524 –531. Received for publication November 30, 2009; revision accepted December 26, 2009. From the *Service de Biophysique et Me ´decine Nucle ´aire and †Service de Radiologie 1, Ho ˆpitaux Universitaires de Strasbourg, Strasbourg, France; ‡Service de Me ´dicine Interne, Endocrinologie et Nutrition, Ho ˆpitaux Univer- sitaires de Strasbourg, Strasbourg, France; §Radiopharmacie, Ho ˆpitaux Uni- versitaires de Strasbourg, Strasbourg, France; and ¶Service de Chirurgie Ge ´ne ´rale, He ´patique et Endocrinienne, Ho ˆ pitaux Universitaires de Strasbourg, Strasbourg, France. Reprints: Alessio Imperiale, MD, Service de Biophysique et de Me ´decine Nucle ´- aire, Ho ˆpital de Hautepierre, 1, Avenue Molie `re, 67098 Strasbourg Cedex, France. E-mail: alessio.IMPERIALE@chru-strasbourg.fr. Copyright © 2010 by Lippincott Williams & Wilkins ISSN: 0363-9762/10/3506-0434 Clinical Nuclear Medicine • Volume 35, Number 6, June 2010 434 | www.nuclearmed.com