GİRİŞ ve AMAÇ: Bu prospektif çalışmada neoadjuvan kemoterapi (NAK) alan lokal ileri meme kanseri hastalarda (LABC) dinamik 18FDG-PET/BT'nin NAK yanıt öngörüsünü araştırdık.
YÖNTEM ve GEREÇLER: LABC'li 27 hastaya [medyan yaş: 47, (26-66)] NAK öncesi ve 2-3 kür kemoterapi sonrası dinamik 18FDG PET çalışması uyguladık. Dinamik çalışmanın 2., 5. ve 30. dakikalarında SUVmax değerleri, SUV oranları ile dinamik eğri eğim (SL) değerleri ve eğim oranları, 18FDG dinamik verileri kullanılarak ölçüldü. Ayrıca ilk 2 dakika için SUVmean (2minSUVmean), SULpeak (2minSULpeak), metabolik volume (2minVol), and total lezyon glikoliz (2minTLG) değerlerini hesapladık. Parametrelerin tedavi öncesi ve interim çalışma arasındaki yüzde değişimlerini hesapladık ve patolojik sonuçlar ile karşılaştırdık; Patolojik tam yanıt (PCR) olan ve olmayan (non-PCR). Parametrelerin patolojik yanıtı (PCR ve non-PCR) ayırt edebilmesi için ROC eğrisi kullanarak en uygun eşik değerleri hesapladık.
BULGULAR: Tedavi öncesi SUV30 (p=0.044), SUV30/2 (p=0.041), SUV 30/5 (p=0.049), SUV 30/10 (p=0.021), SL 30/2 (p=0.029) ve SL 30/5 (p=0.027) değerleri PCR ve non-PCR hasta grupları arasında istatistiksel anlamlı farklı idi. % değişim 2minVol, PCR ve non-PCR hasta grupları arasında istatistiksel olarak anlamlı şekilde farklıydı. 2minVol'deki -%67,6 değişim eşik değeri için duyarlılık %87.2, özgüllük: %77.8, pozitif öngörü değeri: %63.6, negatif öngörü değeri: %93.3 ve doğruluk %80.7 idi (Eğrinin altındaki alan= 0.826, p =0.009).
TARTIŞMA ve SONUÇ: Dinamik FDG PET parametreleri NAK sonrası patolojik yanıtı öngörebilir. 2minVol'deki % değişiklikler, non-PCR hastaları diğer parametrelerden daha iyi belirleyebilir.

INTRODUCTION: This prospective study was planned to compare the predictive value of dynamic 18FDG-PET/CT in locally advanced breast cancer patients (LABC) receiving neoadjuvant chemotherapy (NAC).
METHODS: 27 patients with LABC [median age: 47, (26-66)] underwent a dynamic 18FDG PET study at baseline, and after 2-3 cycles of (NAC) were included (interim). SUVmax values and SUVratios for the 2nd, fifth and 30th minutes and dynamic curve slope (SL) values and slope ratios were measured using 18FDG dynamic data. In addition, the values of SUVmean (2minSUVmean), SULpeak (2minSULpeak), metabolic volume (2minVol), and total lesion glycolysis (2minTLG) were measured for the first 2 minutes. Baseline and interim studies calculated percentage changes and compared the pathological results; complete pathological response (PCR) -non-complete pathological response (non-PCR). Receiver Operating Characteristic curves were obtained to calculate the area under the curve to predict a PCR. Optimal threshold values were calculated to discriminate between PCR and non-PCR groups.
RESULTS: Baseline study SUV30 (p=0.044), SUV30/2 (p=0.041), SUV 30/5 (p=0.049), SUV 30/10 (p=0.021), SL 30/2 (p=0.029) and SL 30/5 (p=0.027) values were statistically significant different between PCR and non-PCR groups. % change 2minVol were statistically significantly different between PCR and non-PCR groups. For the threshold value of -67.6% change in 2minVol, the sensitivity was 87.2%, specificity: 77.8%, positive predictive value: 63.6%, negative predictive value: 93.3%, and accuracy 80.7% (Area under the curve= 0.826, p=0.009).
DISCUSSION AND CONCLUSION: Semiquantitative parameters for dynamic 18 FDG PET can predict PCR. % changes in 2minVol can identify nonresponding patients better than other parameters.

INTRODUCTION: Detection of a sentinel lymph node (SLN) in patients with endometrial cancer (EC) reduces the rate of unnecessary systemic lymph dissection. The aim of this study was the appraisal of SLN detection rate, accuracy of the method using 99mTc-SENTI-SCINT and the rate of metastatic nodal involvement in patients with preoperative first stage of EC.

METHODS: A prospective study of SLN biopsy of 41 patients with stage I EC was performed after cervical application of 4mCi 99mTc-SENTI-SCINT. Planar lymphoscintigraphy and SPECT/CT of the pelvis were made, followed by site-specific lymphadenectomy in intermediate-risk patients if no SLN was detected per hemipelvis and pelvic lymphadenectomy in all high-risk patients.

RESULTS: Preoperative detection rate of planar lymphoscintigraphy was 80.49 (95% CI 68.36 - 92.62) and of SPECT/CT 95.12 (95% CI 88.52 - 101.7). The total intraoperative SLN detection rate was 95.12 (95% CI 88.52 - 101.7) per patient, 26.83 (95% CI 19.91 - 33.75) bilaterally. The average number of SLNs removed was 1.6 ± 0.8. The most common anatomical location of SLN was the right external iliac region. SLN metastatic rate was 17%. Both sensitivity and negative predictive value regarding metastatic involvement were 100%.

DISCUSSION AND CONCLUSION: The SLN detection rate, sensitivity and negative predictive value using 99mTc-SENTI-SCINT in patients with EC in our study were high. The application of ultrastaging in the histopathological analysis of the SLN increases the detection of nodal metastases and improves the staging in these patients.

GİRİŞ ve AMAÇ: Bu çalışmanın amacı, ATA 2015 kriterlerine göre düşük risk grubunda olup radyoaktif iyot ile ablasyon (RAİ) tedavisi almış olan diferansiye tiroid kanseri (DTK) hastalarında, 30 veya 50 mCi RAİ ile 100 mCi RAİ ile ablasyon sonrası tedavi yanıtlarının karşılaştırılmasıdır.
YÖNTEM ve GEREÇLER: Şubat 2016-Ağustos 2018 tarihleri arasında kliniğimizde total tiroidektomi sonrası RAİ tedavisi alan ve düşük risk grubu DTK olan 100 hasta bu retrospektif çalışmaya dahil edildi. Bu hastalar düşük doz(30-50 mCi)(Grup 1) ve yüksek doz(100 mCi)(Grup 2) olarak 2 gruba ayrıldı. 54 hasta düşük doz ile tedavi edilirken, 46 hasta yüksek doz RAI aldı. 2 grup 1. ve 3. yıl tedavi yanıt durumuna göre karşılaştırıldı.
BULGULAR: Birinci yıl takibine göre 15 hasta belirsiz yanıt, 85 hasta mükemmel yanıt olarak kabul edildi. İndetermine yanıt olarak kabul edilen hastaların 3'ü(%5.5) Grup 1'de, 12'si(%26) Grup 2'deydi.3. yıl takibine göre Grup 1'de 1, Grup 3'te 2 hasta indetermine yanıt olarak kabul edildi. Hiçbir hastada biyokimyasal yetersiz yanıt veya nüks hastalık saptanmadı. Birinci yıl tedavi yanıtı ile RAI dozları arasındaki ilişkiyi araştırmak için yapılan Ki-kare analizinde anlamlı ilişki bulundu(p: 0,004). Tedavi yanıtında etkili olabilecek parametreleri araştırmak için yapılan Mann-Whitney U testinde sadece preablatif serum Tg değerinin mükemmel yanıt ve indetermine yanıt gösteren hasta grupları arasında anlamlı fark gösterdiği tespit edildi(p: 0.01). Hastaların uzun dönem takiplerinde üçüncü yıl tedavi yanıt verilerine göre iki grubu tedavi yanıtları açısından değerlendirmek için Ki-Kare analizi yapıldı ve istatistiksel olarak anlamlı bir ilişki bulunamadı(p: 0.73).
TARTIŞMA ve SONUÇ: ATA 2015 düşük risk grubunda yer alan ve RAI ablasyon tedavisi planlanan DTK hastalarında 30-50 mCi ile ablasyon güvenle uygulanabilir.

INTRODUCTION: The aim of this study is to compare the treatment responses after ablation with 30-50 mCi RAI and 100 mCi RAI in patients with differentiated thyroid cancer (DTC) who are in the low-risk group according to ATA 2015 criteria.
METHODS: Between February 2016 and August 2018, 100 patients who received RAI treatment in our clinic after total thyroidectomy and who were in the low-risk group DTC were included in this retrospective study. These patients were divided into 2 groups as low-activity(30-50 mCi)(Group 1) and high-activity(100 mCi)(Group 2). While 54 patients were treated with low-activity, 46 patients received high-activity RAI. The 2 groups were compared according to the 1st and 3rd-year treatment response status.
RESULTS: According to the first-year follow-up, 15 patients were accepted as indeterminate response and 85 patients as excellent response. 3(5.5%) of the patients who were accepted as indeterminate response were in Group 1,and 12(26%) were in Group 2.According to the 3rd year follow-up, 1 patient in Group 1, and 3 patients in Group 2 were accepted as indeterminate response. No biochemical incomplete response or recurrent disease was detected. In the Chi-square analysis performed to investigate the relationship between the first-year treatment response and RAI activities, a significant relationship was found(p: 0.004).In the Mann-Whitney U test performed to investigate the parameters that may be effective in the treatment response, only the preablative serum Tg value was shown to have a significant difference between the two groups(p: 0.01).In the long-term follow-up of the patients, based on the third year treatment response data, Chi-Square analysis was performed to evaluate the two groups in terms of treatment responses, and no statistically significant relationship was found(p: 0.73).
DISCUSSION AND CONCLUSION: Ablation with 30-50 mCi can be safely applied in DTC patients who are in the ATA 2015 low-risk group and are planned for RAI ablation treatment.

INTRODUCTION: To investigate added diagnostic value of delayed imaging at 3 and 4 hours compared to 2-hour imaging as well as scanning up to 4 hours in comparison to 3, and by this means, diagnosis reclassification or changes in diagnosis across various time points.
METHODS: Seventeen patients clinically suspected of gastroparesis underwent a gastric emptying scintigraphy after ingesting standard meal. One-minute static images in anterior and posterior projections were acquired immediately after ingestion and then, at 1-, 2-, 3- and, 4-hour time points. For image analysis, a manual region-of-interest was drawn, and then, count of stomach in each projection was used to calculate geometric mean for each time point. Decay correction was applied. At 2-, 3- and 4-hour time points, percentage of retained activity was compared to standard values and therefore, each patient was labeled as normal or delayed.
RESULTS: Value of hour 3 shows extremely strong correlation with value of hour 4 (r= 0.951, p<0.001). In hour 2, of 17 participants, 11 (64.7%) were diagnosed as normal and 6 (35.3%) as delayed. In hour 3, the diagnosis made as delayed rose to 9 (52.9%), whereas normal was 8 (47.1%). Finally, in hour 4, results were 10 (58.8%) as delayed and 7 (41.2%) as normal. All subjects who were labeled as delayed in hour 3, remained with the same diagnosis and 1 out of 8 subjects categorized as normal in hour 3, changed to delayed. For testing agreement, coefficient of kappa was computed between each pair. Agreement between diagnosis in hour 2 with hours 3 or 4 was not strong (kappa<0.6 for both pairs). But a strong agreement was found between diagnosis in hours 3 and 4 (kappa=0.881).
DISCUSSION AND CONCLUSION: Extending acquisition from 3 hours to 4 hours adds little to the final diagnosis and may not be noticeably meaningful, especially in the clinical setting.

INTRODUCTION: This study was conducted to detect atherosclerotic plaques with somatostatin receptor scintigraphy (SRS) using 99mTc-Octreotide that binds to somatostatin receptor 2.
METHODS: Of 783 patients referred for MPI, 52 cases underwent additional chest SPECT with 99mTc-octreotide and participated in this study. In addition, 43 patients that underwent 99mTc-octreotide scan for NET also received cardiac SPECT. Angiography was performed within 1 month after SRS for 19 patients that showed intensive uptake in SRS and had cardiac risk factors.
RESULTS: Of 52 patients that underwent MPI and SRS, 15 patients showed intensive cardiac uptake in SRS. Moreover, of 43 patients that were referred for NET, 4 patients had marked cardiac uptake in SRS in the heart. Nineteen patients including 12 women and 7 men aged 28 to 84 (58±8.04) years old underwent coronary angiography. The SRS and angiography in the LAD territory were concordant in 15/19 (79%) patients while only 7/15 (46%) cases had concordant MPI and angiography results. In the RCA territory, the SRS and angiography were concordant in 16/19 (84%) cases while MPI and angiography were concordant in 11/15 (73%) cases. In the LCX territory, SRS and angiography were concordant in 15/19 (79%) cases while MPI and angiography were concordant in 6/15 (40%) cases. In the remaining 76 patients who did not undergo coronary angiography based upon cardiovascular profile and SRS, no cardiac events occurred in a follow-up of 2-11 months (7.52±2.71).
DISCUSSION AND CONCLUSION: 99mTc-octreotide uptake was more concordant with coronary plaques relative to MPI findings suggesting a potential role for 99mTc-octreotide in the evaluation of atherosclerosis.

INTRODUCTION: The pharmacological stress test with vasodilator agents is an alternative cardiological diagnostic tool for patients with contraindications to the classical stress test provided by physical activity during the single photon emission computed tomography myocardial perfusion imaging. The aim of our study was to compare the frequency of the side effects of regadenoson and dipyridamole during single photon emission computed tomography myocardial perfusion imaging.
METHODS: This retrospective study included data of consecutive 283 patients who underwent pharmacological stress tests in years 2015-2020. The study group consisted of 240 patients who have received dipyridamole and 43 patients who have received regadenoson. The collected data included the patients’ characteristics, the occurrence of side effects (divided into mild: headache, vertigo, nausea, vomiting, dyspnea, chest discomfort, hot flushes, general weakness and severe: bradycardia, hypotension, loss of consciousness) and blood pressure values/measurements.
RESULTS: Overall, complications occurred relatively often (regadenoson: 23.2%, dipirydamol: 26.7%, p=0.639). Procedure discontinuation was necessary in 0.7% of examinations, whereas pharmacological support was necessary in 4.7%. There was no difference in prevalence of mild (regadenoson: 16.2%, dipirydamol: 18.3%, p=0.747) and severe complications (regadenoson: 11.6%, dipirydamol: 15.0%, p=0.563). However, regadenoson has been found to cause a significantly smaller average decrease of systolic blood pressure (regadenoson: -2.6±10.0mmHg, dipirydamol: -8.7±9.6mmHg, p=0.002), diastolic blood pressure (regadenoson: -0.9±5.4mmHg, dipirydamol: -3.6±6.2mmHg, p=0.032), as well as mean arterial pressure (regadenoson: -1.5±5.6 mmHg, dipirydamol: -5.4±6.5mmHg, p=0.001).
DISCUSSION AND CONCLUSION: Regadenoson and dipyridamole presented a similar safety profile during single photon emission computed tomography myocardial perfusion imaging. However, regadenoson has been found to cause significantly smaller decreases in systolic blood pressure, diastolic blood pressure, mean arterial pressure.

Abstract | Full Text PDF

GİRİŞ ve AMAÇ: Myokard perfüzyon görüntülemede, atenüasyon artefaktları tetkik spesifitesini etkilemektedir. Çalışmamızda single photon emission computed tomography/computed tomography (SPECT/CT) sistemi ile elde edilen atenüasyon düzeltmesi yapılmış görüntüler, düzeltme yapılmamış görüntüler ile karşılaştırıldı. Bilgisayarlı tomografi (BT) bazlı atenüasyon düzeltmenin klinik pratiğe katkısı araştırıldı.
YÖNTEM ve GEREÇLER: Tek gün protokolü ile strest-rest Tc-99m sestamıbı SPECT/CT yapılan ve ±3 ay içinde koroner anjiyografi (CAG) sonuçları mevcut olan 53 kadın, 71 erkek 124 hastanın datası retrospektif olarak incelendi. Atenüasyon düzeltmesi yapılmış ve yapılmamış görüntüler iki nükleer tıp uzmanı tarafından vizüel olarak değerlendirildi. Bulgular referans standart kabul edilen CAG sonuçları ile karşılaştırıldı.
BULGULAR: Atenüasyon düzeltmesi yapılmış ve yapılmamış görüntüleme için sırasıyla tüm grupta, spesifite %66, %60; sensitivite %71, %79 ve doğruluk %69, %70 olarak hesaplandı (p>0.05). Kadın ve erkek subgruplarında da atenüasyon düzeltmesi yapılmış ve yapılmamış görüntüler arasında, spesifite, sensitivite ve doğruluk için istatistiksel olarak anlamlı fark saptanmadı. Sağ koroner arter (RCA) hastalığının dedekte edilmesinde BT ile atenüasyon düzeltmesi, spesifiteyi % 87'den % 96' ya yükseltti. Ancak sol ön inen arter (LAD) alanında BT bazlı atenüasyon düzeltme ile spesifitenin %95'ten %77 ye gerilediği görüldü (p=<0.0001).
TARTIŞMA ve SONUÇ: BT bazlı atenüasyon düzeltmesi, RCA alanı için artan spesifite dışında tüm hasta grubunda tanısal performansa anlamlı bir katkı sağlamamış, LAD alanında da spesifiteyi azaltmıştır. Bu nedenle atenüasyon düzeltmesi yapılmış görüntüler, düzeltme yapılmamış görüntüler ile yan yana, klinik veriler eşliğinde değerlendirilmelidir.

INTRODUCTION: Attenuation artifacts affect the specificity of the Myocardial perfusion imaging. We compared CT-based attenuation-corrected images (AC) with non-attenuation-corrected images (NAC) obtained by single photon emission computed tomography/computed tomography (SPECT/CT).We investigated the role of CT-based attenuation-correction (CT-AC) in clinical practice.
METHODS: The data of 124 patients, who were applied one-day stress-rest Tc-99m sestamibi SPECT/CT MPI and who had coronary angiography (CAG) results within ± 3 months, were retrospectively reviewed. AC and NAC images were visually evaluated by two nuclear medicine specialists in a consensus. CAG results were used as the reference standard.
RESULTS: Specificity, sensitivity, and accuracy were calculated as 66%, 60%; 71%, 79% and 69%, 70% for AC and NAC imaging in the whole group, respectively. There was no statistically significant difference between AC and NAC images for the specificity, sensitivity and accuracy in the male and female subgroups. In the diagnosis of right coronary artery (RCA) disease, CT-based attenuation-correction increased the specificity from 87% to 96% significantly. However, in the left anterior descending artery (LAD) region, the specificity was reduced from 95% to 77% significantly.
DISCUSSION AND CONCLUSION: CT-based attenuation-correction did not significantly contribute to diagnostic performance except for increased specificity for the RCA, and also reduced specificity in the LAD region. Therefore, AC images should always be evaluated side by side with NAC images to benefit different advantages of both techniques.

Fibroblast aktivasyon proteini (FAP), karaciğer sirozunda ve tümör mikroçevresinde fibröz dokudan proinflamatuar bir ajan olarak eksprese edilir. Siroz, herhangi bir kronik karaciğer hastalığının son aşamasını gösterir ve sirozun doğal seyri, asit gelişimi ile asemptomatik fazdan semptomatik dekompanse faza ilerlemedir. Kronik karaciğer hastalığı olan hastalarda çeşitli klinik özellikler sirozu düşündürse de, kesin tanıdan önce invaziv olmayan yöntemler klinik yaklaşımı takip etmelidir. Burada, sirozda 68Ga-FAPI-04 PET/CT taramasının yararlılığını göstermek için FAPI tutulumu olan üç karaciğer sirozu vakasını sunuyoruz.

Fibroblast activation protein (FAP) is expressed as a pro-inflammatory agent from fibrous tissue in liver cirrhosis and in the tumor microenvironment. Cirrhosis indicates the last stage of any chronic liver disease, and the natural course of cirrhosis is the progression from the asymptomatic phase to the symptomatic decompensated phase with the development of ascites. Although various clinical features suggest cirrhosis in patients with chronic liver disease, non-invasive methods should follow the clinical approach before a definitive diagnosis. Herein, we present three cases of liver cirrhosis with FAPI uptake to demonstrate the usefulness of 68Ga-FAPI-04 PET/CT scan in cirrhosis.

Prostat kanseri dünyada en sık görülen kanserlerden biridir. Radikal prostatektomi operasyonu sonrasında PSA düzeyleri genellikle prostat kanseri rekürrens için tümör belirteçi olarak kullanılmaktadır. Yüksek PSA düzeylerinde ise 68Ga-PSMA PET/BT veya daha yeni bir alternatifi olan 18F-PSMA PET/BT rekürrensin tespitinde kullanılabilmektedir. Artan PSA düzeyleri tespit edilen ve 8 yıl önce opere edilmiş olan 49 yaşında prostat kanseri tanılı bir hastayı sunduk. Her ne kadar 68Ga-PSMA PET/BT’de belirgin bir patolojik aktivite tutulumu izlenmese de, 18F-PSMA PET/BT görüntülemesi sonucunda mesane duvarında patolojik tutulum gösteren lezyon tespit edildi.

Prostate cancer is one of the most prevalent cancers in the world. After radical prostatectomy procedure PSA levels are usually used as a marker of recurrence for prostate cancer. In case of increased PSA levels a 68Ga-PSMA or 18F-PSMA, a new alternative, can be performed for detection of recurrent disease. We report a case of 49-year-old male patient with increasing PSA levels who was previously operated 8 years ago. Although no apparent pathological uptake can be detected in 68Ga-PSMA PET/CT, 18F-PSMA PET/CT revealed lesion with pathological uptake on the urinary bladder wall.

Rektal nöroendokrin karsinomlar, tüm nöroendokrin karsinomların <%1'ini ve tüm gastrointestinal sistem malignitelerinin <%1'ini oluşturur. Rektal nöroendokrin karsinomun deri metastazı, viseral metastazlardan daha nadirdir. 1 yıl önce rektum kaynaklı nöroendokrin tümör grade 3 tanısı konan 71 yaşında bir erkek hastayı sunuyoruz. Hasta 6 kür kemoterapi ve radyoterapi sonrası yeniden evreleme için 18F-FDG PET/BT'ye yönlendirildi. Sağ kasık bölgesindeki deride yoğun artmış 18F-FDG tutulumu aynı bölgeden alınan biyopsi sonucuyla birlikte nöroendokrin karsinom metastazı ile uyumluydu.

Rectal neuroendocrine carcinomas constitute <1% of all neuroendocrine carcinomas and <1% of all gastrointestinal tract malignancies. Cutaneous metastase of rectal neuroendocrine carcinoma is rare than visceral metastases. We represent a 71 year-old man who was diagnosed with neuroendocrine tumor grade 3 originating from rectum 1 year ago. He was referred for 18F-FDG PET/CT for restaging after 6 cycles of chemoterapy and radiotherapy. Intensely increased 18F-FDG uptake in the right cutaneous inguinal region was consistent with neuroendocrine carcinoma metastasis with biopsy from the same region.

İnce barsak nöroendokrin tümörleri (NET); intestinal mukozadaki serotonin eksprese eden enterokromoffin hücrelerden köken alan, tüm gastrointestinal tümörlerin %1’inden daha azını oluşturan tümörlerdir. İnce barsak nöroendokrin tümörlerinin çoğu iyi diferansiye (G1-G2) tümörler olup en sık mezenterik lenf nodlarına, paraaortik lenf nodlarına ve karaciğere metastaz yaparlar. Jejunal nöroendokrin tümörlerin bilateral testise metastazı nadirdir. Testiküler nöroendokrin tümörler tüm testiküler neoplazmların %1’inden azını oluşturur.Nöroendokrin tümör tanılı 61 yaşında erkek hastaya ait testis metastazı görüntüleri sunulmuştur.

Neuroendocrine tumors are slow-growing tumors originating from neuroendocrine cells and capable of metastasis. The majority of them are found in the gastrointestinal tract; however, they can also be rarely seen in other organs. Testicular neuroendocrine tumors account for less than 1% of all testicular neoplasms. They may present as primary testicular tumors or secondary tumors from extratesticular sources. Jejunal neuroendocrine tumor metastasis to the testis is extremely rare. We present a 61-year-old man with a jejunal neuroendocrine tumor and metastases to bilateral testicles revealed on 68Ga-DOTATATE PET/CT.

Over kanseri, kadınlar arasında en ölümcül tümörlerden biridir. Çoğunlukla karaciğer, plevra, akciğer ve kemiklere metastaz yapar. 66 yaşında kadın hasta deri lezyonlarıyla başvuruyor. Deri lezyonları sebebiyle biyopsi yapılan hasta over kanseri tanısı alıyor. Metastaz arama amacıyla yapılan FDG PET/MR’da özellikler alt batın ve bacaklarda yaygın deri tutulumları izleniyor. Over kanserinde deri tutulumları nadir olarak görülebilmektedir, bu yazıda over kanserinin deri tutulumunun FDG PET/MR görüntülerini paylaşmak istiyoruz.

Ovarian cancer is one of the most deadly tumors among females. It mostly metastasizes to liver, pleura, lung and bones. We describe a case of a 66-year-old female with skin lesions. Patient was diagnosed as ovarian cancer after skin biopsy. FDG PET/MRI showed diffuse skin uptake especially around lower abdomen and legs. Skin metastasis is a rare finding of ovarian cancer. Our case presents this rare finding’s PET/MRI image.

A 69-year-old male was admitted to our hospital because of left facial trauma with bone fractures, including the maxillary sinus, the zygomatic arch, and the ethmoid and sphenoid bones. Brain CT was unremarkable but regional cerebral blood flow withHMPAOSPECT showed hypoperfusion of the left hemisphere, which was reversible since a repeat SPECT 4 months later was unremarkable. Brain perfusion SPECT may provide information on cerebrovascular statusin some cases of facial injury.

Menenjiomlar, primer santral sinir sistemi tümörlerinin %37'sini oluşturur ve kadınlarda daha sık görülür. Ayrıca, diğer primer malignitelere eşlik edebildiğinden Tüm Vücut Kemik Taraması (TVKT) görüntülerinde, metastaz ile karışıklığa neden olabilir.58 yaşında meme kanseri tanısı konulan kadın hasta, olası kemik metastazlarının araştırılması amacıyla TVKT için nükleer tıp departmanına sevk edildi.Planar görüntülerde, kafa tabanının anteriorunda ve verteks bölgesinin posteriorunda multiple radyotraser akümülasyonları tespit edildi. Olası metastatik lezyonların anatomik lokalizasyonu için SPECT/BT çalışması yapıldı ve saptanan radyotraser tutulumlarının kemik metastazlarına ait olmadığı, tutulumların serebral parankime ve lezyonların falks serebriye ait olduğu ortaya çıktı. Hastanın veri geçmişi, bu çalışmadaki kemik metastazlarını taklit eden bulguların, beş yıl önce konmuş olan menenjiom tanısı ile uyumlu olduğunu gösterdi.

Meningiomas are 37% of primary central nervous system (CNS) tumors and are more common in women. Also may occur with other primary malignancies, which can cause confusion with the metastasis in whole body bone scan (WBBS) imaging. A 58-year-old female patient diagnosed with breast cancer was referred to the WBBS for the investigation of possible bone metastases. In the planar images, radiotracer uptake at multiple sites were detected on the anterior side of the skull base and the posterior side of the vertex of the cranium. SPECT/CT study was performed for anatomical localization of possible metastatic lesions and it revealed that detected accumulations of radiotracer didn’t belong to the bone metastases; uptakes were located at the cerebral parenchyma and the lesions in falx cerebri. Patient history explained that she had been diagnosed with meningioma five years ago, which was mimicking bone metastases in this study.

The fever of unknown origin represents a complex diagnostic challenge due to the wide range of etiologies that could cause it including neoplastic, infectious, rheumatic/inflammatory and miscellaneous disorders. There are several nuclear medicine techniques that have proven to be valuable tools for guiding etiologic diagnosis in the setting of fever of unknown origin. One of these is the Technetium-99m (Tc-99m)-hexamethylpropylene amine oxime (HMPAO)-labeled leukocytes scintigraphy, which is a diagnosis method that allows in most cases the localization and evaluation of the extension of an occult infection. This paper is aimed to present an uncommon case of pseudomembranous colitis without diarrhea as etiology of fever of unknown origin diagnosed by Tc-99m-HMPAO-labeled leukocytes.

Bone scintigraphy with Tc99m- diphosphonate analogues is widely used in staging, restaging and monitoring therapy effectiveness of various cancer types. Bone seeking agents are excreted through urination, resulting in visualization of either anatomical abnormalities or pathological conditions of kidneys and bladder. We present a case of a 63 year old-man with urinary bladder carcinoma depicted on Whole Body planar and SPECT/CT images.

Diferansiye tiroid kanserinde, radyoaktif iyot tedavisi ve tüm vücut tarama sintigrafisi hastalık yönetiminin ayrılmaz bir parçasıdır. Radyoaktif iyot ile tedavi edilen multifokal tiroid karsinomlu 33 yaşında kadın hastayı sunuyoruz. Tedavi sonrası tüm vücut tarama sintigrafisinde, dalakta fokal artmış I-131 tutulumu saptandı. Ancak uyarılmış tiroglobulin düzeyi uzak metastaz ile uyumlu değildi. Daha sonra karaciğere yönelik yapılan dinamik MRG, bulgunun rastlantısal bir dalak kisti olduğunu ortaya çıkardı. Radyoaktif iyot tutulumu tiroid dokusuna özgü değildir. Radyoaktif iyot ile tüm vücut taramada dalakta aktivite tutulumu saptanan olgularda artmış radyoiyot tutulumu gösteren benign patolojiler de düşünülmelidir.

In differentiated thyroid cancer, radioiodine therapy and whole body scan are an integral part of disease management. We present the case of a 33-year-old female with multifocal thyroid carcinoma who was treated with radioiodine. Her post-treatment whole-body scintigraphy showed focal increased I-131 uptake in the spleen, although stimulated thyroglobulin level was not suggestive for distant metastasis. Dynamic MRI performed later on revealed that the finding was an incidental splenic cyst. Radioiodine uptake is not specific to thyroid tissue. Benign pathologies showing increased radioiodine uptake should be considered in cases with splenic radioiodine accumulation in whole body scan.

Intravenous tumor extension is a well-recognized phenomenon occurring in various malignancies but is a relatively rare entity in thyroid carcinoma. In patients with poorly differentiated thyroid cancer, I-131 Avid Superior Vena Cava tumor (SVC) thrombus at initial presentation is infrequent and potentially life threatening. Tumor thrombus can form either due to direct vascular extension of the primary mass or by hematogenous spread. Hybrid nuclear imaging can potentially differentiate the two entities which can impact treatment plan of the patient. We present images of an interesting case of evolution of SVC thrombus in a 46-year-old female with diagnosed pDTC over the span of two years.

42 yaşında, invaziv duktal meme kanseri tanısı alan, evreleme için FDG PET/CT taraması yapılan kadın hastada, sağ meme alt iç kadranda primer tümörle uyumlu 1.5 cm çaplı hipermetabolik lezyon izlendi (SUV max: 10.5). Sağ aksillada yağlı hilusu görülen lenf nodlarında patolojik FDG tutulumu izlenmedi.
Ancak sol aksilla ve sol derin aksillada yağlı hilusu gözlenen 19 mm çaplı hipermetabolik lenf nodları mevcuttu (SUV max: 8.0). Ayrıntılı BT değerlendirmesinde, bu lenf bezlerinin duvarları sağ aksilladakilerden daha kalındı.
Hasta tekrar sorgulandı ve 5 gün önce sol koluna uygulanan Covid aşısı öyküsü (BNT162b2, COVID-19 mRNA aşısı ile) belirlendi. Sol aksiller lenf nodlarından yapılan tru-cut biyopsi sonucu reaktif lenfoid doku olarak geldi ve primer veya metastatik tümör izlenmediği rapor edildi.
Hastaya neoadjuvan kemoterapi verildi. İlk FDG PET/CT'den 4,5 ay sonra, tedaviye yanıt değerlendirmesi için ikincisi yapıldı. Bulgularda belirgin regresyon gözlendi. Hastaya sağ total mastektomi yapıldı. Hasta KT ve RT ile takip ediliyor.
Sonuç olarak, pandemi günlerinde meme kanserli hastalarda aksiller hipermetabolik lenf nodları Covid aşısı açısından sorgulanmalıdır. FDG PET/BT taramasında aşılı kolun aynı tarafında gözlenen hipermetabolik lenf nodları, aşıya bağlı reaktif lenfadenomegali ile ilişkili olabilir. Özellikle memedeki kitleye göre kontralateral ancak aşı yapılan kol ile aynı taraftaki aksillada görülen yağlı hilusu korunmuş hipermetabolik lenf nodları, reaktif olarak değerlendirilerek lenf nodu metastazı dışlanabilir. Vakada aşıya bağlı reaktif (aktif) lenf nodlarının zamanla inaktif hale dönüşmesi gözlenmektedir.

A 42-year-old female patient diagnosed with invasive ductal breast ca, undergone FDG PET/CT scan for staging, 1.5 cm diameter hypermetabolic lesion was observed in the lower inner quadrant of the right breast that was compatible with primary tumor (SUV max: 10.5). No pathological FDG uptake was observed in lymph nodes whose fatty hilum were seen in the right axilla.
However, in left axilla and left deep axilla, hypermetabolic lymph nodes with a maksimum diameter of 19 mm having fatty hilum, were observed (SUV max: 8.0). These lymph nodes have thicker walls than the ones in the right axilla in a detailed CT evaluation.
The patient was questioned again and Covid vaccination history (with BNT162b2, COVID-19 mRNA vaccine) was determined that was administrated to the left arm 5 days ago. Tru-cut biopsy was performed from the left aksillary lymph nodes and proved to be reactive lymphoid tissue and it is noted that there was no primary or metastatic tumor in these axillary lymph node tissues.
The patient was given neoadjuvant chemotherapy 4.5 months after the first FDG PET/CT, the second one was performed for treatment response evaluation. Significant regression was determined with the findings. The patient undergone right total mastechtomy. She was being followed-up with adjuvant chemotherapy and radiotherapy.
In conclusion, hypermetabolic lymph nodes in the axillas should be interrogated about the vaccination in patients with breast cancer. Hypermetabolic lymph nodes observed on the same side of the vaccinated arm in FDG PET/CT scan may be related to vaccine-induced reactive lymph node enlargement. Lymph node metastasis may be excluded, especially if there are hypermetabolic lymph nodes with preserved fatty hilum in the contralateral axilla on the same side as the vaccinated arm. Active lymph nodes that are reactive to the vaccine becomes inactive after a while.

Fibrous dysplasia (FD) is a rare congenital benign bone disease, that is manifested as a defect in the bone remodeling process, affecting the function, differentiation and maturation of the osteoblasts. This process is located in the bone marrow, where the normal marrow tissue is being replaced with immature bone islands and fibrous stroma. The etiology is unclear so far, but it is known to be connected with a point mutation of the gene that encodes Gs α protein in the time of embryogenesis, and as result of that, all of the affected somatic cells become dysplastic. It is important whether the mutation occurred earlier in the process of embryogenesis, so that there will be more mutant cells and the disease will appear in a more severe form. The clinical presentation of FD is variable, so there are plenty of potential differential diagnosis. The most common include Paget disease, nonossifying fibroma, osteofibrous dysplasia, aneurysmal bone cyst, adamantinoma, giant cell tumor, fracture callus and low-grade central osteosarcoma