The Poké ball sign in a mature ovarian cystic teratoma

The Poké ball sign in a mature ovarian cystic teratoma | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report The Poké ball sign in a mature ovarian cystic teratoma Sheila Alfonso-Cerdán, Alejandro Villalba-Cortés, María Magdalena Menso, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5005171/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract We present the case of a 32-year-old woman with a mature ovarian cystic teratoma exhibiting the "Poké ball" sign, pathognomonic for this tumour. Nuclear Medicine & Medical Imaging Poké ball Teratoma Ovary Figures Figure 1 Figure 2 Figure 3 Clinical history A 32-year-old female without prior significant medical or familial history presented with mild hypogastric pain. Laboratory tests were unremarkable, showing normal hormonal levels and no signs of inflammation. Imaging findings Magnetic resonance imaging (MRI), both non-contrast and contrast-enhanced, revealed a well-defined, rounded lesion in the pelvis, originating from the right ovary. The lesion had a distinct capsule and smooth margins. T1-weighted (T1W) axial images (Figure 1A) and T2-weighted (T2W) sagittal and coronal images (Figure 1B-C) without contrast agent demonstrated a cyst with a fluid-fluid level and a central nodule floating between two fluid layers, as well as an anterior parietal nodule. T1W images revealed hyperintensity in the upper layer and hypointensity in the lower layer, whereas T2W images demonstrated similar hyperintensity in the upper layer but a less pronounced hypointensity in the lower layer. The upper layer of the cyst showed low signal intensity on T2 STIR-weighted axial images, before and after contrast enhancement, indicating that consisted of fat, while the lower layer had a proteinaceous composition. This appearance is known as the Poké ball sign. There was no significant enhancement of the lesion, except for mild enhancement of the parietal nodule (Figure 2A-B). The lesion showed no signs of haemorrhage, mass effect on adjacent structures, or other complications. Discussion - Background: Ovarian teratomas are the most common type of germ cell tumours[1–4]. Mature ovarian cystic teratomas (MOCTs) are the most common type of ovarian teratoma, accounting for over 95% of these[4], and are the most prevalent benign ovarian neoplasms[2]. They constitute 10-20% of all ovarian neoplasms[5], typically occurring in women of reproductive age, with a mean patient age of 30 years. Bilateral involvement is observed in approximately 10% of cases[2]. Malignant transformation is rare, occurring in only 0.2-2% of MOCTs[4]. The "Poké Ball sign" is a characteristic finding in MOCT, named after the Pokémon® device (Figure 3), which is depicted as a round ball with two hemispheres: the red upper hemisphere represents the fat-fluid component, while the white lower hemisphere represents the proteinaceous fluid component. The central "button" of the device corresponds to the floating nodule seen in MOCT located between the two hemispheres, composed of sebum, keratin, fibrin, hair, and fat from the three germinal layers, which confers it an intermediate density[5]. While the Poké Ball sign is specific to MOCT, it is observed in only 25-30% of cases but is pathognomonic when present[5]. - Clinical perspective: MOCTs are often asymptomatic and are usually detected incidentally during imaging performed for other reasons[5]. However, some patients may experience abdominal pain or other nonspecific symptoms[2]. Complications, such as haemorrhage within the lesion or ovarian torsion triggered by the teratoma, can arise, with the latter being the main complication associated with MOCT[6]. The presence of the Poké Ball sign strongly suggests the diagnosis of MOCT. - Imaging perspective: MOCTs are most commonly identified incidentally on computed tomography (CT) or MRI, which are essential for their characterization. On CT, MOCTs typically appear as homogeneously fat-dense masses with peripheral calcifications and a Rokitansky nodule projecting into the cyst cavity[2]. When the Poké Ball sign is present, a fluid-fluid level is observed, with the fat-fluid density in the upper layer and soft tissue-fluid density in the lower layer, along with a nodule floating between these two layers. MRI findings include a fluid-fluid level on both T1W and T2W images, with the upper layer showing low signal intensity on STIR-weighted images, indicating the fat-fluid component. - Outcome: MOCTs that cause symptoms may require surgical intervention, such as cystectomy. Although malignant transformation is rare[4], it should be suspected if follow-up imaging shows changes in the size or characteristics of the lesion, being necessary excisional surgery. - Take Home message / Teaching points: Recognition of the Poké Ball sign is crucial for diagnosing MOCT, as it is pathognomonic for this tumour. Final diagnosis: Mature ovarian cystic teratoma. Differential diagnosis list: Mature ovarian cystic teratoma. Ovarian torsion. Ovarian cyst. Declarations Written informed patient consent for publication has been obtained References Saleh M, Bhosale P, Menias CO, Ramalingam P, Jensen C, Iyer R et al (2021) Ovarian teratomas: clinical features, imaging findings and management. Abdom Radiol 46:2293–2307 (PMID: 33394097) Outwater EK, Siegelman ES, Hunt JL (2001) Ovarian teratomas: tumor types and imaging characteristics. Radiographics 21:475–490 (PMID: 11259710) Tehranian A, Ghahghaei-Nezamabadi A, Seifollahi A, Kasraei S, Dehghani-Nejad H, Maleki-Hajiagha A (2021) Ovarian mature cystic teratoma with malignant transformation: two case reports. J Med Case Rep 15:23 (PMID: 33499917) Wu CY, Wu JD, Chen CC (2021) The association of ovarian teratoma and anti-n-methyl-d-aspartate receptor encephalitis: An updated integrative review. Int J Mol Sci 22:10911 (PMID: 34681570) Giambelluca D, Caruana G, Cannella R (2020) The Poké Ball sign in mature ovarian cystic teratoma. Abdom Radiol 46:396–397 (PMID: 32500238) Lešková J, Kříž JT, Štichhauer R (2022) Bilateral mature ovarian teratoma with torsion in a premenarchal girl. Acta Med 65:33–36 (PMID: 35793507) Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5005171","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":374843375,"identity":"66174e9d-3634-4c81-b8ee-7e1fa1f89a90","order_by":0,"name":"Sheila Alfonso-Cerdán","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIiWNgGAWjYDACZuYGGJPxMboIDi2McAXMxgwMBigiOABCAZs0WAsDAS0GxxkbPzDm2OTzSzc/qy6o+BPN3w7U8qNiG04tks2MzRKM29IsZ845ZnZ7xhmD3BmHGRsYe87cxqmFH+hyoJbDBgY3Esxu87YZ5DYAtTAztuHWwsbM2PwDpMX+Rvq3YpCW+YS0AG1pg9gikWPGDNKygZAWoF/aLIB+MZC4kVMszXPGOHcjUMtBfH4xOH/48A3GbTYG/DPSN37mqZDLnXf+8MEHPypwawEB5j/oIgfwqh8Fo2AUjIJRQBAAAGU/Uf1EKK5NAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0009-0006-1838-1448","institution":"Hospital de la Santa Creu i Sant Pau","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Sheila","middleName":"","lastName":"Alfonso-Cerdán","suffix":""},{"id":374844060,"identity":"d75f5bbb-dfe4-44d2-8177-97f0d389da75","order_by":1,"name":"Alejandro Villalba-Cortés","email":"","orcid":"","institution":"Hospital de la Santa Creu i Sant Pau","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Alejandro","middleName":"","lastName":"Villalba-Cortés","suffix":""},{"id":374844061,"identity":"df571376-607f-48ab-ab18-50e84e1eda6a","order_by":2,"name":"María Magdalena Menso","email":"","orcid":"","institution":"Hospital de la Santa Creu i Sant Pau","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"María","middleName":"Magdalena","lastName":"Menso","suffix":""},{"id":374844062,"identity":"731791ed-9591-47a6-850a-0b46b6044721","order_by":3,"name":"Nicolás Martínez-Ruiz","email":"","orcid":"","institution":"Hospital de la Santa Creu i Sant Pau","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Nicolás","middleName":"","lastName":"Martínez-Ruiz","suffix":""},{"id":374844063,"identity":"ddd02079-38a0-48bd-893c-e586e960c27a","order_by":4,"name":"Berta Novel-Olivé","email":"","orcid":"","institution":"Hospital Clínic","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Berta","middleName":"","lastName":"Novel-Olivé","suffix":""},{"id":374844064,"identity":"dc4ec07e-a55d-4de9-9088-1abd462f0010","order_by":5,"name":"Juan Carlos Pernas-Canadell","email":"","orcid":"","institution":"Hospital de la Santa Creu i Sant Pau","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Juan","middleName":"Carlos","lastName":"Pernas-Canadell","suffix":""}],"badges":[],"createdAt":"2024-08-30 16:28:44","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":true,"vertebrateSubjectEthicalGuidelines":false,"coiExplicitlySet":false},"doi":"10.21203/rs.3.rs-5005171/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5005171/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":68564443,"identity":"9a1b411e-1657-4ac0-ae60-1234b6d9de8b","added_by":"auto","created_at":"2024-11-08 14:53:01","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":84054,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e(A-C)\u003c/strong\u003e Axial T1-weighted \u003cstrong\u003e(A)\u003c/strong\u003eand sagittal and coronal T2-weighted \u003cstrong\u003e(B-C)\u003c/strong\u003e MRI scan depicting the well-defined, rounded and encapsulated cystic lesion arising from de right ovary, with a fluid-fluid level and a central nodule floating between the two layers of fluid. An anterior parietal nodule is also observed.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5005171/v1/333909a850371457739a1cc2.jpg"},{"id":68563621,"identity":"413eddb2-6d24-4ca2-807d-1ba0cd9fd40f","added_by":"auto","created_at":"2024-11-08 14:45:01","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":67060,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e(A-B)\u003c/strong\u003e Noncontrast and contrast-enhanced axial T2 STIR-weighted \u003cstrong\u003e(D-E)\u003c/strong\u003e images shows the low signal intensity of the upper layer demonstrating the fat-fluid component.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5005171/v1/0204886f75322d31d61a74a0.jpg"},{"id":68563623,"identity":"99b3e2c0-7c92-4db8-9e7b-9750fc86de2f","added_by":"auto","created_at":"2024-11-08 14:45:01","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":69561,"visible":true,"origin":"","legend":"\u003cp\u003eIllustration of a Pokémon® device representing the fat-fluid component in the red upper part and the proteinaceous component in the white lower part. The central \"button\" of the device corresponds to the floating nodule seen in MOCT.\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5005171/v1/1915801f7c29441676a61f00.jpg"},{"id":68564444,"identity":"9c9637b4-b0c3-4f00-9390-0ae36ebb18bd","added_by":"auto","created_at":"2024-11-08 14:53:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":448758,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5005171/v1/38c0e36c-c518-424c-9205-037505d6f12b.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eThe Poké ball sign in a mature ovarian cystic teratoma\u003c/p\u003e","fulltext":[{"header":"Clinical history","content":"\u003cp\u003eA 32-year-old female without prior significant medical or familial history presented with mild hypogastric pain. Laboratory tests were unremarkable, showing normal hormonal levels and no signs of inflammation.\u003c/p\u003e"},{"header":"Imaging findings","content":"\u003cp\u003eMagnetic resonance imaging (MRI), both non-contrast and contrast-enhanced, revealed a well-defined, rounded lesion in the pelvis, originating from the right ovary. The lesion had a distinct capsule and smooth margins. T1-weighted (T1W) axial images (Figure 1A) and T2-weighted (T2W) sagittal and coronal images (Figure 1B-C) without contrast agent demonstrated a cyst with a fluid-fluid level and a central nodule floating between two fluid layers, as well as an anterior parietal nodule. T1W images revealed hyperintensity in the upper layer and hypointensity in the lower layer, whereas T2W images demonstrated similar hyperintensity in the upper layer but a less pronounced hypointensity in the lower layer. The upper layer of the cyst showed low signal intensity on T2 STIR-weighted axial images, before and after contrast enhancement, indicating that consisted of fat, while the lower layer had a proteinaceous composition. This appearance is known as the Pok\u0026eacute; ball sign. There was no significant enhancement of the lesion, except for mild enhancement of the parietal nodule (Figure 2A-B). The lesion showed no signs of haemorrhage, mass effect on adjacent structures, or other complications.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003e- Background:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOvarian teratomas are the most common type of germ cell tumours[1–4]. Mature ovarian cystic teratomas (MOCTs) are the most common type of ovarian teratoma, accounting for over 95% of these[4], and are the most prevalent benign ovarian neoplasms[2]. They constitute 10-20% of all ovarian neoplasms[5], typically occurring in women of reproductive age, with a mean patient age of 30 years. Bilateral involvement is observed in approximately 10% of cases[2]. Malignant transformation is rare, occurring in only 0.2-2% of MOCTs[4].\u003c/p\u003e\n\u003cp\u003eThe \"Poké Ball sign\" is a characteristic finding in MOCT, named after the Pokémon® device (Figure 3), which is depicted as a round ball with two hemispheres: the red upper hemisphere represents the fat-fluid component, while the white lower hemisphere represents the proteinaceous fluid component. The central \"button\" of the device corresponds to the floating nodule seen in MOCT located between the two hemispheres, composed of sebum, keratin, fibrin, hair, and fat from the three germinal layers, which confers it an intermediate density[5]. While the Poké Ball sign is specific to MOCT, it is observed in only 25-30% of cases but is pathognomonic when present[5].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e- Clinical perspective:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMOCTs are often asymptomatic and are usually detected incidentally during imaging performed for other reasons[5]. However, some patients may experience abdominal pain or other nonspecific symptoms[2]. Complications, such as haemorrhage within the lesion or ovarian torsion triggered by the teratoma, can arise, with the latter being the main complication associated with MOCT[6]. The presence of the Poké Ball sign strongly suggests the diagnosis of MOCT.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e- Imaging perspective:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMOCTs are most commonly identified incidentally on computed tomography (CT) or MRI, which are essential for their characterization. On CT, MOCTs typically appear as homogeneously fat-dense masses with peripheral calcifications and a Rokitansky nodule projecting into the cyst cavity[2]. When the Poké Ball sign is present, a fluid-fluid level is observed, with the fat-fluid density in the upper layer and soft tissue-fluid density in the lower layer, along with a nodule floating between these two layers. MRI findings include a fluid-fluid level on both T1W and T2W images, with the upper layer showing low signal intensity on STIR-weighted images, indicating the fat-fluid component.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e- Outcome:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMOCTs that cause symptoms may require surgical intervention, such as cystectomy. Although malignant transformation is rare[4], it should be suspected if follow-up imaging shows changes in the size or characteristics of the lesion, being necessary excisional surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e- Take Home message / Teaching points:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRecognition of the Poké Ball sign is crucial for diagnosing MOCT, as it is pathognomonic for this tumour.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinal diagnosis:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMature ovarian cystic teratoma.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDifferential diagnosis list:\u003c/strong\u003e\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eMature ovarian cystic teratoma.\u003c/li\u003e\n \u003cli\u003eOvarian torsion.\u003c/li\u003e\n \u003cli\u003eOvarian cyst.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Declarations","content":"\u003cp\u003eWritten informed patient consent for publication has been obtained\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSaleh M, Bhosale P, Menias CO, Ramalingam P, Jensen C, Iyer R et al (2021) Ovarian teratomas: clinical features, imaging findings and management. Abdom Radiol 46:2293\u0026ndash;2307 (PMID: 33394097)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOutwater EK, Siegelman ES, Hunt JL (2001) Ovarian teratomas: tumor types and imaging characteristics. Radiographics 21:475\u0026ndash;490 (PMID: 11259710)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTehranian A, Ghahghaei-Nezamabadi A, Seifollahi A, Kasraei S, Dehghani-Nejad H, Maleki-Hajiagha A (2021) Ovarian mature cystic teratoma with malignant transformation: two case reports. J Med Case Rep 15:23 (PMID: 33499917)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu CY, Wu JD, Chen CC (2021) The association of ovarian teratoma and anti-n-methyl-d-aspartate receptor encephalitis: An updated integrative review. Int J Mol Sci 22:10911 (PMID: 34681570)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGiambelluca D, Caruana G, Cannella R (2020) The Pok\u0026eacute; Ball sign in mature ovarian cystic teratoma. Abdom Radiol 46:396\u0026ndash;397 (PMID: 32500238)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeškov\u0026aacute; J, Kř\u0026iacute;ž JT, Štichhauer R (2022) Bilateral mature ovarian teratoma with torsion in a premenarchal girl. Acta Med 65:33\u0026ndash;36 (PMID: 35793507)\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Poké ball, Teratoma, Ovary","lastPublishedDoi":"10.21203/rs.3.rs-5005171/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5005171/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eWe present the case of a 32-year-old woman with a mature ovarian cystic teratoma exhibiting the \"Poké ball\" sign, pathognomonic for this tumour.\u003c/p\u003e","manuscriptTitle":"The Poké ball sign in a mature ovarian cystic teratoma","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-08 14:44:56","doi":"10.21203/rs.3.rs-5005171/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b9272b02-c464-4c78-94fb-f30a62ffa22d","owner":[],"postedDate":"November 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":39899755,"name":"Nuclear Medicine \u0026 Medical Imaging"}],"tags":[],"updatedAt":"2024-11-08T14:44:56+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-08 14:44:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5005171","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5005171","identity":"rs-5005171","version":["v1"]},"buildId":"omnImTCwR2MFx8CMYfrG7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}