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A 20-year-old male had Ewing’s sarcoma of the right paraspinal region (T12–L2 vertebra level) and was treated with chemotherapy and radiation therapy (RT). 99mTc hydroxydiphosphonate bone scan was performed 4 months after the end of treatment. Intense uptake was noted in both kidneys (Fig. 1). On the fluorodeoxyglucose (FDG) positron emission tomography/ computed tomography (PET/CT) for response evaluation, mild uptake was also seen in both kidneys (Fig. 2A and 2B). On 99mTc dimercaptosuccinic acid (DMSA) scan, photon defects were noted in both kidneys (Fig. 2C). When we reviewed the RT plan, the medial aspect of both kidneys was included in the radiation field (Fig. 2D and 2E). On contrast-enhanced CT, low-densities were noted in both kidneys (Fig. 2F). We thus diagnosed radiation nephritis (RN). On 6-month follow-up bone scan, the previously noted intensity on both kidneys was decreased. RN is commonly seen following RT of intra-abdominal tumors or bony metastasis of spine. The histologic findings are vascular sclerosis with tubular ischemic change. Tubular dysfunction and ischemic change explain the photon defect on DMSA scan and the delayed enhancement and retention of contrast on CT. Delayed excretion of radiopharmaceuticals could cause increased uptake on bone scan. CT and bone scan findings were previously reported, but PET/CT findings were reported in only one case. Although the exact mechanism of increased activity on PET/CT remains uncertain, delayed tracer excretion via parenchymal injury could be a major cause. Radiation-induced inflammation can also cause. However, the lack 1Division of Nuclear Medicine, Department of Radiology, 2Department of Radiation Oncology, 3Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Radiation nephritis: 99mTc hydroxydiphosphonate bone scan, 99mTc dimercaptosuccinic acid renal scan, and 18F-FDG PET/CT findings