GİRİŞ ve AMAÇ: Bu çalışmanın amacı yeni tanı konmuş prostat kanseri (PKa) hastalarında volümetrik 68Ga-PSMA PET/BT parametreleri, Gleason Skoru (GS), PSA düzeyleri, histopatolojik veriler ve metastatik durum arasındaki ilişkileri ve prediktif faktörleri değerlendirmektir.
YÖNTEM ve GEREÇLER: 68Ga-PSMA PET/BT taramaları yapılmış toplam 78 yeni tanı PKa hastası çalışmaya dahil edildi. Klinik parametreler, histopatolojik veriler ve metastatik durum belgelendi ve prostat bezindeki primer tümörden elde edilen volümetrik parametreler ölçüldü. Elde edilen tüm veriler istatistiksel olarak karşılaştırıldı.
BULGULAR: GS ve primer prostat tümöründen elde edilen SUVmax, serum PSA düzeyleri ile anlamlı olarak ilişkiliydi (p<0.05). PSA düzeyleri ve SUVmax değerleri lenf nodu metastazı olan hastalarda olmayanlara göre anlamlı olarak daha yüksekti. GS metastatik hastalarda anlamlı olarak yüksek bulundu. Primer lezyonun PSMA-TV (PSMA-tümör volümü) ve TL-PSMA (total lezyon-PSMA) değerlerinin PSA değeri, GS ve bölgesel lenf nodu metastazları ile anlamlı ilişkisi vardı. Metastatik ve lokalize hastalığı olan hastalarda yapılan ROC analizi, SUVmax için kesim değerini 10,85 olarak belirlemiştir. Lojistik regresyon analizi sonuçlarına göre, PSMA-TV progresyon için prediktif bir faktör olarak bulunmuştur.
TARTIŞMA ve SONUÇ: 68Ga-PSMA PET/BT, klinik ve histopatolojik verilerle üstün uyumluluğu nedeniyle PKa evrelemesinde ilk olarak düşünülmesi gereken çok değerli bir görüntüleme yöntemi olmaya devam etmektedir. 68Ga-PSMA PET/BT'nin klinik yeri ve önemi, sadece tanısal doğruluğu ile sınırlı değildir. 68Ga-PSMA PET/BT’den elde edilen primer prostat lezyonunun PSMA-TV değeri tedavi başarısını öngörebilecek potansiyel bir gösterge olarak önem taşımaktadır. Bu bilgi, hasta tedavisini kişiselleştirmek, prognostik doğruluğu artırmak ve klinik sonuçları tahmin etmek için değerlidir.

INTRODUCTION: To evaluate the relationships between volumetric 68Ga-PSMA PET/CT parameters, Gleason Score (GS), PSA levels, histopathological data, and metastatic status in newly diagnosed prostate cancer (PCa) patients, as well as to assess the predictive factors for progression despite treatment.
METHODS: A total of 78 newly diagnosed PCa patients who had 68Ga-PSMA PET/CT scans were included. Clinical parameters, histopathological data, and metastatic status were documented, and volumetric parameters of primary prostate lesions were measured. All the obtained data were compared statistically.
RESULTS: Primary prostate tumor SUVmax and GS were significantly related to serum PSA levels (p<0.05). PSA levels and SUVmax values were significantly higher in patients with lymph node metastases than those without. GS was found to be significantly increased in metastatic patients. PSMA-derived tumor volume (PSMA-TV) and total lesion PSMA (TL-PSMA) of the primary lesion had a significant relationship with PSA value, GS, and regional lymph node metastases. ROC analysis, conducted in patients with metastatic and localized disease, identified the cutoff value for SUVmax as 10.85. According to the results of the logistic regression analysis, PSMA-TV was found to be a predictive factor for progression despite treatment.
DISCUSSION AND CONCLUSION: 68Ga-PSMA PET/CT remains an invaluable imaging modality that should be considered first in PCa staging due to its superior compatibility with clinical and histopathologic data. The importance of this method goes beyond diagnostic accuracy; it also extends into the predictive domain where the PSMA-TV value of primary prostate lesions is a potential predictor of treatment efficacy. This information is valuable for personalizing patient treatment, improving prognostic accuracy, and predicting clinical outcomes.

INTRODUCTION: Primary liver tumors constitutes one of the most common tumors. These are aggressive tumors with poor survival. Fluorodeoxy Glucose PET/CT, most commonly used functional imaging shows limited tracer retention and poor tumor to background ratios. Novel 68Ga-fibroblast-activation-protein inhibitor (FAPI) PET/CT has shown better tracer uptake and detection efficacy in liver tumors. However, most of the available literature is from single center studies with limited no of patients. So, we tried to review and analyse the head to head comparison of 18F FDG PET/CT and FAPI PET-CT in evaluation of Liver tumors.
METHODS: Literature available on head to head comparison of diagnostic accuracy of 18F FDG PET-CT and 68Ga FAPI PET-CT was searched in databases like PubMed, SCOPUS, EMBASE and Google Scholar for published original studies till April 2023. The relevant studies were selected and assessed using the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS – 2) checklist. A random-effect model was used for calculating pooled sensitivity and specificity. They were represented with 95% confidence intervals (95% CI) and demonstrated in Forest plots. I-square statistic was used to assess heterogeneity in the studies.
RESULTS: Pooled sensitivity and specificity of FAPI PET-CT and 18F-FDG PET-CT for detection of primary liver tumors was 94.3% (95%CI: 90.6%-96.8%); 89.3% (95%CI: 71.8%-97.7%) and 56.1 (95%CI: 49.7%-62.5%); 96.4% (95%CI: 81.7-99.9%) respectively. Pooled sensitivity for detection of extrahepatic metastatic disease was 92.2% (range: 88.1-100%; 95%CI: 87.8%-95.4%) and 72.4 % (range: 69.8-76.5; 95%CI: 65.9%-78.2%) respectively. Also, the SUVmax and TBR was higher for FAPI PET-CT than 18F-FDG PET-CT in all the included studies.
DISCUSSION AND CONCLUSION: Overall, FAPI PET-CT showed higher sensitivity for detection of liver tumors with better SUV max as well as TBR than 18F-FDG PET-CT.

GİRİŞ ve AMAÇ: Meckel divertikülü tanısında Meckel sintigrafisi kullanılmaktadır. Önceleri sintigrafi doğruluğunu arttırmak amacıyla ranitidin ile premedikasyon en sık kullanılan yöntemdi. Ancak ranitidin FDA tarafından yasaklandığı için artık kullanılamamaktadır.
Bu çalışmanın amacı Meckel sintigrafisinde ranitidin yerine pantoprazolün premedikasyon amacıyla kullanılabilirliğini araştırmaktır.

YÖNTEM ve GEREÇLER: Bu deneysel çalışmada 12 Yeni Zelanda tavşanı kullanıldı. Tavşanlar pantoprazol ve kontrol grubu olmak üzere iki gruba ayrıldı. Altı tavşana üç gün boyunca pantoprazol ile premedikasyon uygulandı. Hem kontrol grubu hem de pantoprazole grubu tüm tavşanlara Meckel sintigrafisi yapıldı. Mide duvarından ilgi alanları çizilerek sayımlar yapıldı ve karşılaştırıldı.
BULGULAR: Bu deneysel çalışmadan elde ettiğimiz bulgulara göre pantoprazol, görsel ve kantitatif değerlendirme sonucunda tavşan midesinde 99mTc-perteknetat alımını önemli ölçüde artırmaktadır.
TARTIŞMA ve SONUÇ: Pantoprazol tavşanlarda 99mTc-perteknetatın mide duvarına alımını arttırır ve Meckel sintigrafisinde premedikasyon için kullanılabilecek potansiyel bir ilaçtır.

INTRODUCTION: Meckel scintigraphy is used in the diagnosis of Meckel's diverticulum. Previously, premedication with ranitidine was the most frequently used method in order to increase the accuracy of scintigraphy. However, ranitidine can no longer be used since it is banned by the FDA.
The aim of this study is to investigate the usability of pantoprazole for premedication instead of ranitidine in Meckel scintigraphy.

METHODS: Twelve New Zealand rabbits were used in this experimental study. Rabbits were divided into two groups as pantoprazole and control. Six rabbits were premedicated with pantoprazole for three days. Meckel scintigraphy was performed on all rabbits. Counts were made and compared by drawing region of interest from stomach walls.
RESULTS: According to the findings we obtained from this experimental study, pantoprazole significantly increases 99mTc-pertechnetate uptake in the stomach of rabbits as a result of visual and quantitative evaluation.
DISCUSSION AND CONCLUSION: Pantoprazole increases the gastric wall uptake of 99mTc-pertechnetate in rabbits and is a potential drug for premedication in Meckel scintigraphy.

INTRODUCTION: To evaluate performance of mostly used colormaps in image display quantitatively using perceptual metrics as well as to what extent these measures are congruent with true intensity or uptake of pixels in different levels of defect severity in simulated cardiac images.
METHODS: Six colormaps, labeled as “Gray”, “Thermal”, “Cool”, CEqual”, “Siemens” and “S Pet” are included. Colormap are converted CIELAB colorspace. Perceptual metrics for measuring “color difference” are calculated including difference (∆E76) and “speed”. Curves are plotted for each colormap and are compared. Simulated short-axis cardiac slices with incremental defect severity (10% grading) are employed. The circumferential profile curves of true pixel intensity, lightness or luminance and color difference are plotted simultaneously.
RESULTS: In the phantom with 10% defect, discrepancies among curves appear. In “siemens”, the ∆E76 drops sharply. In “siemens” colormap, the ∆E76 drops sharply. In 80% defect, ∆E76 curve, in “gray” colormap drops more slowly than other the curves of other colormaps. In 70% defect, again curves are in good agreement in “thermal”, “siemens” and “cequal”. But consistent lag exists in “gray”. Up to 50% defect, curves maintain their expected pattern, but in defects more severe than 40%, lightness and ∆E76 curves in “cool” and “cequal” rises paradoxically and in “thermal” it starts to slow down in descent.
DISCUSSION AND CONCLUSION: Of 6 colormaps investigated for estimating defect severity, “grayscale” is less favorable than others and “thermal” performs slightly better. “s pet” or rainbow which are used traditionally by many practitioners is strongly discouraged. The “siemens” colormap suffers from decreased discriminating power in the range of mild to moderate/severe. In contrast, the “cool” and “cequal” colormaps outperform other colormaps employed in this study to some extent, although they have some shortcomings.

99mTc-MDP is a bone imaging agent used for skeletal staging but can also be localized in extra osseous calcifying lesions. We report a case of an 84-year-old woman with breast carcinoma underwent surgery followed by radiotherapy 10-years back, now presented with right axillary mass referred for 99mTc-MDP to exclude bone metastasis. 99mTc-MDP shows intense tracer uptake is seen in the right thoracic region corresponding to the site of calcified soft tissue mass in right lateral chest wall. Subsequent ultrasonography showed ill-defined lesion contains coarse calcifications. Biopsy showed radiation induce sarcoma. Extra osseous 99mTc-MDP uptake may provide important diagnostic information that might alter patient management.

58 yaşında kadın hastaya nefes darlığı, kilo kaybı ve gece terlemesi şikayetleri ile malignite şüphesi nedeniyle 18F-FDG PET/BT çalışması yapıldı. 18F-FDG PET/BT’de nazal, krikoid, trakeobronşiyal ağaç kıkırdaklarında ve kostovertebral bileşkelerde ve hafif orta düzeyde tutulumlar gözlendi. Hastanın tanısı nadir görülen, multisistemik bir hastalık olan ve kıkırdakların enflamasyonu ile karakterize tekrarlayan polikondrit ile uyumlu idi. Tedavi sonrası yapılan 18F-FDG PET/BT çalışmasında tam metabolik yanıt görülmekte idi.

A 58-years-old man presenting with dyspnea, weight loss and night sweating underwent 18F-FDG PET/CT due to suspicion of malignancy. 18F-FDG PET/CT demonstrated mild to moderate uptake on nasal, cricoid, tracheobronchial tree cartilages and costovertebral junctions. Diagnosis was confirmed as relapsing polychondritis, which is a rare multisystem disease characterized by inflammation of cartilage. Besides, subsequent 18F-FDG PET/CT after treatment showed complete metabolic response.

We present a case of a patient with a newly diagnosed high-risk prostate cancer. The patient had nephrectomy for renal cell carcinoma in 2009. The PSMA scan revealed primary tumor with seminal vessels involvement, PSMA positive regional lymph nodes, as well as several nodular lung lesions with mild PSMA uptake, PSMA positive mediastinal lymph nodes and a PSMA positive mass in the pancreatic head. An ultrasound guided biopsy was performed for the pancreatic lesions revealing metastasis from a renal cell carcinoma. Simultaneous treatment for prostate cancer and metastatic RCC was started. In order to separate metastatic sites for both primaries we attempted to use FDG PET CT - moderately positive for the pancreatic mass but not for the other locations.
RCC is a 68Ga PSMA positive tumor; the synchronous combination of RCC with prostate cancer can be confusing and requires more complex clinical interpretation.

In a 55-year-old woman with sigmoid colon cancer, a subcutaneous mass in the left lower abdomen was incidentally found and gradually enlarged. For further diagnosis and staging, an 18F-FDG PET/CT scan was performed, revealing a subcutaneous mass in the left lower abdomen with mild uptake of 18F-FDG, suggesting the possibility of metastasis. However, post-surgery and pathological confirmation, this mass was diagnosed as a drain-site hernia containing fallopian tube fimbria, which is extremely rare but should be taken into consideration in the differential diagnosis of subcutaneous mass in the lower abdomen.

A 52-year-old female patient with metastatic breast cancer receiving denosumab for 7 years presented with marked diffuse tracer uptake in the mandible on 99mTc-methylene diphosphonate bone scintigraphy, resembling the Lincoln sign. Diagnosis of medication-related osteonecrosis of the jaw (MRONJ) was confirmed, leading to immediate discontinuation of denosumab. Conservative therapy, including limited debridement and oral rinses, was initiated. MRONJ, a potential complication of bone modifying agents, is more prevalent in advanced malignancy cases. The Lincoln sign has not been previously reported in MRONJ, emphasizing its consideration in cancer patients under bone modifying agent treatment.

Nowadays, the utility of positron emission tomography/computed tomography (PET/CT) is well-established in nasopharyngeal carcinoma (NPC). The incidence of NPC in the occidental population, especially in the pediatric age, is very low. We present the first Italian case of a pediatric patient with NPC followed-up by means of [18F]Fluorodeoxyglucose ([18F]FDG) PET/CT scan in addition to the standard follow-up imaging methods, including CT and magnetic resonance imaging (MRI) scans. The [18F]FDG PET/CT scan was helpful in discriminating between metastatic and benign osseous lesions, helping clinicians address the most appropriate therapeutic regimen. These findings support the clinical utility of [18F]FDG PET/CT scan in the diagnostic work-up of pediatric patients with NPC.

Epitelyal-miyoepitelyal karsinom (EMK), nadir görülen düşük gradlı tükürük bezi neoplazmıdır. Uzak metastazlar nadir görülmekte olup EMK'de metastatik hastalığı tespit etmek için 18F-FDG PET/BT kullanılmaktadır. 68Ga-fibroblast aktivasyon proteini inhibitörleri (FAPI) PET/BT, çeşitli malignitelerde tanıda ve teranostik amaçla kullanılan umut verici bir görüntüleme yöntemidir. 18F-FDG PET/BT ile karşılaştırmalı yapılan çalışmalar 68Ga-FAPI PET/BT’nin rolünü araştırmaktadır. Bu vakada parotisin eks pleomorfik adenomundan kaynaklanan metastatik EMK tanılı 51 yaşında kadın hastanın 18F-FDG ve 68Ga-FAPI-04 PET/BT bulgularını sunuyoruz.

Epithelial-myoepithelial carcinoma (EMC) is a rare low-grade salivary gland neoplasm. Distant metastasis is rare and 18F-FDG PET/CT has been used to determine the metastatic disease in EMC. 68Ga-fibroblast activation protein inhibitors (FAPI) PET/CT is a promising imaging modality for diagnostic and theranostic purposes in various malignancies. Comparison studies with 18F-FDG have investigated the role of 68Ga-FAPI PET/CT. Herein, we present 18F-FDG and 68Ga-FAPI-04 PET/CT findings of a 51 years-old woman with metastatic EMC arising from ex-pleomorphic adenoma of the parotid.

Spindle cell sarcoma is malignant tumor with low incidence. They can occur in soft tissue, bone, or viscera. The characteristics of morphology, density, and metabolic about spindle cell sarcoma are related to the location where the lesion is. A 61-year-old woman presented with vomiting after eating for 2 weeks. Signs of peritoneal irritation involved but no response for symptomatic treatment included antiemetic and antispasmodic therapy. Abdomen CT indicated that there was a mass in the intestinal tract in the pelvic cavity. Then 18F-FDG PET/CT was performed and interestingly detected a jejunal malignancy mass in left upper abdomen with annular high uptake of 18F-FDG, which complicated with intussusception and intestinal obstruction. And finally, jejunal mass was clarified pathologically as undifferentiated spindle cell sarcoma.

A 71-year-old female patient with a known history of signet-ring cell carcinoma presented with diffuse bone pain and anemic symptoms. An 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography study was performed, revealing the presence of diffuse heterogeneous hypermetabolic sclerotic lesions in the axial and proximal appendicular skeleton. No other FDG-avid lesion was detected. Subsequent bone marrow biopsy confirmed the diagnosis of metastatic carcinoma, originating from the gastric primary site. Palliative treatment was initiated; however, the patient's condition deteriorated, and she succumbed to the disease two months later.

Memenin NET'leri, meme karsinomlarının %1'inden daha azını temsil eder. Meme NET'inin histopatolojik olarak yanlış tanı alması yaygındır. Meme kitlesi histopatolojik inceleme ile başlangıçta İDK tanısı alan bir kadın hastayı sunuyoruz. FDG-PET/BT’de 2 ametabolik hipodens karaciğer lezyonu saptandı. Akabinde hastaya FAPi-PET/BT tetkikinde karaciğer lezyonlarında FAP ekspresyonu saptanmazken mezenterik kökteki yumuşak doku kitlesinde artmış FAP ekspresyonu izlendi. Bunun üzerine, sağ memedeki nodülden alınan biyopsinin patolojisi revize edildi ve 2. derece NET tanısı konuldu. FAPi-PET/BT'nin NET'ler üzerindeki faydası daha önce literatürde gösterilmiştir. FAPi-PET/BT'nin NET'lerin yönetimindeki rolünün ortaya konması için daha fazla prospektif çalışma gerekmektedir.

NETs of the breast represent less than 1% of breast carcinomas. Histopathological misinterpretation of a breast NET is common. We present you a case of a female patient who had a breast mass diagnosed as IDC initially by histopathological examination. The FDG-PET/CT revealed 2 ametabolic hypodense liver lesions. Subsequently, the patient underwent FAPi-PET/CT which did not reveal any FAP expression of the liver lesions but increased FAP expression was observed in the soft tissue mass of mesenteric root. Consequently, the pathology of the biopsy taken from the nodule in the right breast was revised and a diagnosis of grade 2 NET was established. The benefit of FAPi-PET/CT on NETs has been previously investigated. Further prospective studies are required to establish the role of FAPi-PET/CT in the management of NETs.