Comparison of body iodine pool assessment methods before radioiodine therapy.

INTRODUCTION AND OBJECTIVES: Radioactive iodine therapy (RAIT) is recommended to reduce the risk of recurrence and metastasis in patients with intermediate-high risk differentiated thyroid cancer (DTC). In preparation for RAIT, stimulation of thyroid-stimulating hormone and reduction of body iodine pool are important for treatment success. For this purpose, patients are asked to reduce their iodine intake before RAIT, and the body iodine pool can be evaluated by measuring iodine excretion in urine before treatment. The aim of our study is to compare the methods used to measure the body iodine pool in the evaluation of the restricted iodine diet (RID) effectiveness applied in the RAIT preparation. PATIENTS AND METHODS: Eighty DTC patients discontinued levothyroxine three weeks before RAIT and followed up with a RID two weeks before treatment. After two weeks of RID, all patients collected their 24-h urine the day before the RAIT date. Patients completed 24-h urine samples on the morning of the RAIT date and also provided a spot urine sample. The estimated 24-h creatinine excretion of the patients was calculated. Estimated 24-h urinary iodine excretion (UIE) was calculated using the spot urine iodine/creatinine (I/C) ratio of the patients. 24-h UIE, iodine concentration in spot urine, I/C ratios in spot urine and estimated 24-h UIE of the patients were analyzed by comparing with each other. RESULTS: In 99% of the patients, RID efficiency was sufficient according to 24-h UIE before RAIT. The mean 24-h UIE was 48.81 micrograms/day (mcg/day) in 24-h urine samples taken from the patients to evaluate the body iodine pool. The patients' iodine concentrations in spot urine, I/C ratios in spot urine, and estimated 24-h UIE were all statistically significantly lower than actual 24-h UIE, which was the reference method (p: 0.026 vs <0.001 vs 0.041). Moderate positive correlation between 24-h UIE and iodine concentration in spot urine (r: 0.440), I/C ratio in spot urine (r: 0.493), and estimated 24-h UIE (r: 0.560) found. The strongest correlation was obtained with the estimated 24-h UIE. CONCLUSION: The estimated 24-h UIE obtained by using the I/C ratio in spot urine can be used practically and safely as an alternative to UIE in 24-h urine, which is the gold standard method for evaluating body iodine pool.

The variation of quantitative parameters and Deauville scores with different reconstruction algorithms in FDG PET/CT imaging of lymphoma patients.

INTRODUCTION AND OBJECTIVES: 18F-FDG PET with the Deauville score (DS) is a unique semiquantitative method for lymphoma. However, type of standard uptake values (max, mean, and peak) reconstruction algorithms could affect DS. We compared the Bayesian Penalized Likelihood reconstruction algorithm (BPL) with Ordered Subsets Expectation Maximization (OSEM) on quantitative parameters and DS in lymphoma. We investigated the effect of the size of the lymph node on quantitative variation. PATIENTS AND METHODS: Raw PET data of 255 lymphoma patients were reconstructed separately with Q.Clear (GE Healthcare), a BPL, and SharpIR (GE Healthcare), an OSEM algorithm. In both images, each patient's liver, mediastinal blood pool, and SUVs (SUVmax, SUVmean, and SUVpeak) of a total of 487 lesions selected from the patients were performed. DSmax, DSmean, and DSpeak were compared. RESULTS: In our study, DS increased significantly with BPL (p < 0.001), and the DS increased to 4-5 in thirty patients evaluated as 1-2-3 with OSEM. It was found that the quantitative values of the lymph nodes increased statistically with BPL (p < 0.001), and the liver from the reference regions were significantly decreased (p < 0.001). In addition, difference in lymph node was independently associated with size of lesion and was significantly more pronounced in small lesions (p < 0.001). The effects of BPL algorithm were more pronounced in SUVmax than in SUVmean and SUVpeak. DS-mean and DS-peak scores were less changed by BPL than DS-max. CONCLUSION: Different reconstruction algorithms in FDG PET/CT affect the quantitative evaluation. That variation may affect the change in DS in lymphoma patients, thus affecting patient management.

Analysis of the descriptive characteristics of female victims of violence applying to the domestic violence office of a court of law.

INTRODUCTION AND PURPOSE: Intimate partner violence is a worldwide problem violating fundamental human rights. The aim of this study was to analyse the sociodemographic characteristics of women who have experienced intimate partner violence, the type and prevalence of violence, the mechanisms of injury as determined by forensic reports, the characteristics of the perpetrator, and the women's statements. MATERIALS AND METHODS: This was a single-site descriptive study conducted at the Office of Domestic Violence and Violence Against Women of a Court of Law located in the city of Izmir in western Turkey. The researchers reviewed forensic medicine case reports and prosecutorial writs in this office's files for women over 18 who had experienced violence over the period 2016-2019. The study sample consisted of the judicial application files of women who had experienced intimate partner violence and met the inclusion criteria (n = 350). The data in the files were entered into a standard form prepared by the researchers according to the file content. Written permission was obtained from the Ministry of Justice and Ege University Ethics Committee, and the verbal consent of the Prosecuting Officer was also obtained for the research. RESULTS: The ages of the women ranged from 19 to 80 years (mean age 35, SD 9.6), with 43.1% ranging from 30 to 39 years old. Of the women, 46.6% had a maximum primary school education, and 65.4% were homemakers. Incidents of intimate partner violence mainly occurred at home for 89.1% of women. A combination of verbal and physical violence was the most frequent form of violence affecting 303 women (83.4% of cases). The facial area was predominantly the target of attack for 59 (16.9%) victims, only the upper extremity for 55 (15.7%) and the face and upper extremity for 36 (10.2%) women. The statements of the victims of violence who described their experience were evaluated, and it was determined that the reasons for the emergence of violence were frequently alcohol and substance use, financial problems, jealousy, sexual problems, communication problems, and cheating. CONCLUSION AND SUGGESTIONS: Most of the women in the study who had applied to law enforcement due to intimate partner violence were victims of physical violence. The descriptive information obtained from these files constitutes essential data for health professionals in their efforts to deliver primary healthcare to women who are victims of intimate partner violence. Health professionals can provide immediate protection by identifying women at high risk of violence, monitoring them more frequently, and activating the support mechanisms they need.

Is a strict restricted-iodine diet necessary for preparation of radioactive iodine therapy?

OBJECTIVE: A restricted-iodine diet (RID) increases the effectiveness of radioiodine therapy (RAIT) by decreasing the body's iodine pool, especially in iodine-rich regions. However, there is no consensus on the RID that should be applied in iodine-deficient areas. This study aims to assess the effect of strict and flexible RID before RAIT. METHODS: For the study, 144 patients were randomized into the strict or flexible RID group. All patients stopped levothyroxine before RAIT and followed a RID. After 2 weeks of RID, 24-h urine samples were taken. The urinary iodine excretion was compared. In 52 of 144 patients, the spot urine samples were taken before and after RID. The reduction in urinary iodine excretion was compared according to the iodine/creatinine ratio. RESULTS: Our study included 47 males and 97 females with a mean age of 45 years. After RID in the 24-h urine samples, the mean iodine level was 47.9 µg/day, and both protocols were sufficient to reduce the body iodine pool. There was no significant difference between the strict and the flexible group, 43.06 and 52.89 µg/day (P:0.147). The reduction in urinary iodine excretion was not statistically different in both groups according to spot urine samples (68.20 vs. 60.53%; P:0.377). CONCLUSION: The flexible RID protocol that less disrupts the patient's quality of life can be preferred for RAIT preparation in iodine-deficient countries.

Quantitative 99mTc-MDP SPECT/CT as an alternative to 18F-NaF PET/CT for objective assessment of osteoblastic bone metastases.

OBJECTIVE: To investigate the correlation between the standardized uptake value (SUV) metrics derived from technetium-99m (99mTc) methylene diphosphonate (MDP) single photon emission computed tomography/computed tomography (SPECT/CT) and fluorine-18 (18F) sodium fluoride (NaF) positron emission tomography (PET)/CT. SUBJECTS AND METHODS: A total of 129 metastatic lesions from 14 patients who underwent both 99mTc-MDP SPECT/CT and 18F-NaF PET/CT within one month were included in the analyses. The lesions with markedly increased uptake were semi-automatically segmented into a volume of interest in both SPECT and PET images by taking the 42% of maximum uptake as a threshold. Maximum, average and minimum SUV (namely, SUVmax, SUVmean and SUVmin) were recorded for each lesion. The strength of correlation was evaluated with Pearson's correlation analysis. RESULTS: The correlation coefficitients for SUVmax, SUVmean and SUVmin derived SPECT and PET images were 0.652, 0.653 and 0.635, respectively (all P<0.001). Lesions with a volume of at least 5cm3 demonstrated a stronger correlation, increasing the correlation coefficients to 0.714, 0.724 and 0.686, respectively (all P<0.001). The strongest correlation was seen in the lesions of the appendicular skeleton, with coefficients for SUVmax, SUVmean and SUVmin being 0.769, 0.791 and 0.761, respectively (all P<0.001). CONCLUSION: The SUV metrics derived from 99mTc-MDP SPECT/CT strongly correlate with 18F-NaF PET, especially for relatively large lesions located in the appendicular skeleton. Technetium-99m-MDP SPECT/CT could potentially be used as an alternative method to 18F-NaF PET/CT for quantitative evaluation and objective follow-up of bone metastases.

The efficiency of hybrid perfusion SPECT/CT imaging in the diagnostic strategy of pulmonary thromboembolism.

OBJECTIVE: Ventilation/perfusion single photon emission computed tomography (V/Q SPECT) is recommended as a reference radionuclide method in pulmonary thromboembolism (PTE) diagnosis. However, there is some logistic, economic, and infectious concern about the study's ventilation part. This study aimed to evaluate the effectiveness of hybrid perfusion SPECT with a low dose CT method in the diagnostic strategy of PTE. MATERIAL AND METHODS: Two physicians reviewed 305 patients' data for this retrospective study. All patients had Q SPECT/CT data as initial imaging, and Ventilation SPECT was added to the selected patients' algorithm. The diagnostic performance and inter-observer agreement were determined for both Q SPECT and Q SPECT/CT methods. The final diagnosis was made by clinical decision with all tests and follow-up for at least 6-month. RESULTS: The majority (92%) of our study group were correctly diagnosed with the Q SPECT/CT method with excellent inter-observer agreements (κ=0.914). The sensitivity, specificity, and accuracy of methods were as follows; 92.2%, 76.3%, and 80.3% for Q SPECT; 96.1%, 94.5%, and 98.8% for Q SPECT/CT (P<0.001). The ventilation scan was applied to 29% (n=88) of the study group. It is prominent in 21/88 patients whose Q SPECT/CT result was non-diagnostic or discordant with clinical probability. CONCLUSION: Q SPECT/CT recommended as the initial radionuclide imaging in PTE diagnosis, with high diagnostic accuracy and inter-observer agreement. Ventilation scans can be optimized according to Q SPECT/CT results avoiding unnecessary irradiation and other potential adverse effects, including infectious risk in the current pandemic context.

FDG Hepatic Superscan Due to Metastatic Infiltration of Prostate Cancer.

A 69-year-old man with prostate cancer presented to the hospital with 2 weeks' history of fever, abdominal distension, and fatigue. Laboratory findings showed signs of acute liver failure, and marked elevation of lactate dehydrogenase and tumor marker levels. Abdominal CT showed hepatomegaly with multiple hypodense lesions in both lobes, suggesting metastases. FDG PET/CT scan shows hypermetabolism unusually in the liver with significantly suppressed heart and brain activity, reminiscent of an FDG hepatic superscan. The hypermetabolic lesions confirmed with Tru-Cut needle biopsy of the liver as metastasis of prostate cancer.

Comparison of 99mTc-MIBI planar scintigraphy, SPET/CT and ultrasonography in detection of parathyroid adenoma in patients with primary hyperparathyroidism.

OBJECTIVE: Primary hyperparathyroidism (PHPT) is a common endocrine disease that is caused by a single adenoma in most of the cases. Surgical management is the mainstay and definitive treatment for parathyroid adenoma (PA). Minimally invasive surgical techniques are as effective as bilateral neck exploration with a lower risk of complications and better cosmetic results in patients with solitary PA. Accurate preoperative localization with imaging modalities is paramount for determining patients candidate for minimally invasive surgery. In this study we aimed to evaluate the diagnostic performance of technetium-99m-methoxyisobutylisonitrile ( 99mTc-MIBI) planar scintigraphy (PS), single photon emission tomography/computed tomography (SPET/CT) and ultrasonography (US) in patients with PHPT. MATERIAL AND METHODS: Fifty-eight patients with biochemical evidence of PHPT who underwent pre-operative imaging with parathyroid scintigraphy and US for detection and localization of PA and proceeded to surgery were included in the study. All patients underwent dual phase 99mTc-sesta MIBI parathyroid scintigraphy (early and delayed planar images and delayed SPET/CT). Data analysis was performed to evaluate the sensitivity, specificity, diagnostic accuracy and PPV of planar images, SPET/CT and US alone and combined US and SPET/CT. Histopathology was used as gold standard. RESULTS: Sensitivity, specificity, PPV and diagnostic accuracy for detection of PA, 80,4%, 42,8%, 91,1% and 75,8% for PS; 80,4%, 57,7%, 91,1% and 77,5% for delayed SPET/CT; 88,2%, 85,7%, 97,8% and 87,9% for US and 94,1%, 71,4%, 96% and 91,3% for SPET/CT+US. Combined US and SPET/CT has been shown to increase sensitivity and diagnostic accuracy. The overall sensitivity of PS and SPET/CT didn't vary however additional information which is helpful for planning minimally invasive surgery gained from tomographic images. CONCLUSION: The combined use of US and SPET/CT has incremental value in accurately localizing PA over either technique alone. In the preoperative assessment of patients with PHPT combination of imaging methods allows selection of patients who would be suitable for minimally invasive surgery.

Evaluation of ultrasonographical and cytological features of thyroid nodules in patients treated with radioactive iodine for hyperthyroidism.

BACKGROUND: In this study, we aimed to evaluate ultrasonographical and cytological features of thyroid nodules in patients who were treated with radioactive iodine (RAI) for hyperthyroidism years ago. METHODS: Patients who had a history of RAI treatment for hyperthyroidism and had thyroid nodules that were evaluated with fine-needle aspiration biopsy (FNAB) were included in the study. RESULTS: There were 27 patients (22 female and 5 male) with a mean age of 59.3 ± 13.5. The indication for RAI treatment was Graves in 5 (18.6%), toxic nodular or multinodular goiter in 16 (69.2%), and unknown in 6 (22.2%) patients. A total of 48 thyroid nodules were evaluated with FNAB and cytological diagnosis were benign in 24 (50.0%), nondiagnostic in 15 (31.2%), atypia of undetermined significance in 5 (10.4%), suspicous for malignancy in 2 (4.2%), and malignant in 2 (4.2%) nodules. Thyroidectomy was performed in 10 patients, 5 were benign (50.0%), and 5 (50.0%) were malignant histopathologically. Ultrasonography features of 31 cytologically/histopathologically benign and five cytologically/histopathologically malignant nodules were compared. Prevalence of isoechoic nodules was higher in benign nodules (P = .025). Macrocalcification was observed in 4 (80.0%) of malignant and 10 (32.3%) of benign nodules (P = .042). CONCLUSION: In patients with a history of RAI treatment for hyperthyroidism, thyroid nodules with suspicious ultrasonography features, particulary hypoechoic appearence and macrocalcification, should be evaluated with FNAB irrespective of the time elapsed after RAI treatment.

Toxic nodular goiter and thyroid cancer: Is hyperthyroidism protective against thyroid cancer?

BACKGROUND: The suppressive effect of the increase in thyroid hormone in patients with toxic nodular goiter is thought to protect the extranodular thyroid tissue from thyroid malignancy. In this study, we aimed to evaluate the prevalence and features of thyroid cancer in patients with toxic nodular goiter who underwent thyroidectomy. METHODS: Medical data of patients who had solitary toxic or nontoxic nodules and underwent total thyroidectomy were reviewed retrospectively. We reviewed the clinical, laboratory, and histopathologic features of patients with toxic nodular goiter and nontoxic solitary nodules. RESULTS: There were 73 patients with toxic nodular goiter and 366 patients with nontoxic solitary nodules. Median age was greater in the toxic nodular goiter compared with nontoxic solitary nodules patients (50 years; range: 18-73 vs 42 years; range: 18-83, P < .001). Median nodule diameters were 40.9 mm (range: 11.0-98.0) and 23.3 mm (range: 4.9-99.0) in patients with toxic nodular goiter and nontoxic solitary nodules, respectively (P < .001). Histopathologic examination revealed thyroid cancer in 14 patients (19%) with toxic nodular goiter and 132 (36.1%) patients with nontoxic solitary nodules (P = .008). Median tumor diameters were 6 mm (range: 1-50) in toxic nodular goiter and 14 mm (range: 1-80) in nontoxic solitary nodules (P = .150). The malignant nodule was the hyperfunctioning nodule in 7 patients with toxic nodular goiter; 4 were follicular and 3 were papillary thyroid cancer. The other 7 malignant foci were located in the suppressed contralateral lobe, and all were papillary microcarcinomas. The incidence of thyroid cancer outside the main nodule was similar in 2 groups (P = .934). CONCLUSION: Thyroid cancer in patients operated for toxic nodular goiter was 19%, which is not as rare as previously thought. A careful histopathologic examination of both the hyperfunctioning nodule and the extranodular thyroid tissue might help to disclose an unexpected tumor foci when thyroidectomy is performed in patients with toxic nodular goiter.

Knowledge About Cervical Cancer Risk Factors and Practices of Pap Testing Among Turkish Immigrant Women in the United States.

The objective of this study was to examine knowledge about cervical cancer risk factors and practices of Pap testing among female Turkish immigrants in the state of Florida in the United States of America (USA). This descriptive study was conducted between April and September 2012. The study sampling was consist of 156 Turkish women living in the state of Florida. A questionnaire-based survey was conducted among the population of Turkish immigrant women. On the survey form comprised of a total of 37 questions and three sections there are questions pertaining to the socio-demographic characteristics of the individuals, their knowledge on the cervical cancer risk factors and their approach to getting Pap smear tests. Statistical Package for Social Sciences (version 16.0) was used to compute frequency and descriptive statistics related to demographic data. The average age of the women is 35.67 ± 10.0. More than half of women (66%) women reported cervical cancer screening at least one. Over two-thirds knew that having abnormal vaginal bleeding (85.8%) and vaginal infections (78.2%), having sexual activity with a man who has had multiple sexual partners (61.5%), and having multiple sexual partners (61.5%) increase the risk of cervical cancer. The result of the multivariate regression analysis have determined that the age of immigrant women (OR 11.3, 95 % CI 5.1-25.2, p:0.000) and the number of children ( OR 3.4, 95 % CI 1.7-6.9, p:0.000) are factors that impact pap smear testing behavior. Our study findings confirm low levels of Pap testing and show important knowledge deficits about cervical cancer risk factors and the importance of Pap testing among Turkish immigrant women. It is recommended that the immigrant women be educated about cervical cancer by means of organizing conferences in their own language and preparing informative materials.

Prognostic Significance of Standardized Uptake Value on 18Fluorine-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Patients with Nasopharyngeal Carcinoma.

The aim of this study was to investigate the prognostic significance of standardized uptake value (SUV) on 18 fluorine-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in patients with nasopharyngeal carcinoma (NPC). Thirty-four patients who have histologically proven NPC and underwent 18F-FDG PET/CT were included in this study. After 18F-FDG PET/CT, all the patients received radiation therapy and 32 of them received concomitant weekly chemotherapy. The maximum SUV (SUVmax) at the primary tumor and the SUVmaxof the highest neck nodes were determined. The SUVmax-T ranged from 5.00 to 30.80 (mean: 15.37 ± 6.10) and there was no difference between SUVmax-T values for early and late stages (P = 0.99). The SUVmax-N ranged from 3.10 to 23.80 (mean: 13.23 ± 5.76). There was no correlation between SUVmax-T and SUVmax-N (r = 0.111, P = 0.532). There was no difference between the SUVmax-T and the positivity of neck lymph nodes (P = 0.169). The ability of SUVmaks-N to predict stage was obtained by a receiver operating characteristic (ROC) analysis. The area under the curve is 0.856 and the best cut-off value is 7.88. There was a good correlation between SUVmax-N and stage. While the mean SUVmax-T for the alive patients was slightly lower than that for the dead (14.65 ± 5.58 vs. 20.30 ± 7.92, P = 0.061), the difference between the groups was not statistically significant. Furthermore, there was no statistically significant difference for SUVmax-N between these two groups (P: 0.494). Cox-regression analysis showed that an increase in SUVmax-T and SUVmax-N was associated with death risk (relative risk [RR]: 1.13, P = 0.078 and RR: 1.052, P = 0.456, respectively). SUVmax-T and SUVmax-N were independent prognostic factors for survival in NPC patients. This will help the clinicians in choosing suitable candidates for more aggressive treatment modalities.

Concomitant thyroid lesions in patients with primary hyperparathyroidism.

BACKGROUND: Concomitant thyroid pathologies in patients with primary hyperparathyroidism (PHPT) present a challenge in the clinical and surgical decision-making for these patients. In this study, we aimed to evaluate concomitant thyroid pathologies in patients who underwent operations for PHPT to determine the sensitivity (Sn) of neck ultrasonography (US) and Tc99m sestamibi scintigraphy in detecting parathyroid adenoma. We also aimed to determine the clinical impact of preoperative neck US in patients with PHPT. METHODS: One hundred thirty-eight patients with PHPT were included in this retrospective study. All patients underwent preoperative Tc99m sestamibi scintigraphy and/or thyroid US. Nodules of ≥1 cm or <1 cm with suspicious US features underwent fine needle aspiration biopsy (FNAB). RESULTS: Preoperative thyroid US revealed that 93.5% of patients with PHPT had thyroid abnormalities and 66.7% of patients had at least one thyroid nodule. Postoperative histopathology results showed that 79.2% of patients had benign thyroid disease and 20.8% of patients had malignant thyroid disease. In the detection of parathyroid adenoma, US had 89.1% Sn and Tc99m sestamibi scintigraphy had 82.6% Sn. CONCLUSION: We recommend the routine use of US in combination with Tc99m sestamibi scintigraphy, especially in endemic goiter regions, to detect any concomitant thyroid disease and thus determine the best surgical strategy for patients with PHPT.

Parents' and teachers' expectations of school nurse roles: A scale development study.

OBJECTIVES: Many studies concerning the roles and functions of school nurses exist, however, such studies are very limited in Turkey and there is any research on a comprehensive measuring tool that can evaluate teachers' and parents' perceptions and expectations of school nurses roles. The purpose of this study is to develop a valid and reliable assessment tool that can be used to determine parents' and teachers' expectations of school nurse's roles. METHODS: For the methodological research "Parents' and Teachers' Expectations of School Nurse's Roles" scale was designed and administered at primary and high schools in Turkey. To assess the data, assessment of item variability, internal consistency, factor analysis, correlations between the scale and subscales, and test-retest reliability were utilized. RESULTS: The content validity index for the scale was 0.94. As a result of core components analysis varimax rotation, 7 factors were obtained from 54 items. Cronbach's α coefficient for the factors ranged from 0.82 to 0.92. The intra-class correlation coefficient for the test-retest reliability was 0.859, P < 0.001. CONCLUSIONS: The scale was a rather valid and reliable assessment tool in determining the parents' and teachers' expectations of school nurses' roles.

Evaluation of Silent Myocardial Ischemia with Single-Photon Emission Computed Tomography/Computed Tomography in Asymptomatic Subjects with Diabetes and Pre-Diabetes.

OBJECTIVE: The aim of this study was to disclose the prevalence of myocardial ischemia, as detected by adenosine stress myocardial perfusion imaging (MPI) with hybrid single-photon emission computed tomography/computed tomography (SPECT/CT), in asymptomatic diabetic and pre-diabetic patients and to find out whether ischemia predicted the occurrence of adverse cardiac/cerebrovascular events (ACCE) at follow-up. METHODS: Forty-three diabetic and thirty-five pre-diabetic asymptomatic patients without any history of coronary artery disease, underwent MPI and were followed-up for a 12.8±2.2 (8-19) months for the occurrence of ACCE. Baseline variables that would predict the presence of ischemia and the value of ischemia on MPI for predicting the occurrence of ACCE at follow-up were evaluated by logistic regression analysis. RESULTS: Ischemia was detected in ten (23.3%) of the diabetic and in four (11.4%) of the pre-diabetic patients. The presence of diabetes was the only independent predictor of myocardial ischemia [odds ratio (OR): 12.31, 95% confidence interval (CI): 1.83-82.66; p<0.01]. During 12.8±2.2 (8-19) months of follow-up, ACCE was observed in five out of 78 (6.4%) patients. Patients with ischemia were significantly more likely to have ACCE during follow-up as compared to those with normal MPI scans (event rates: 21.4% vs. 3.1%, OR: 8.455 95% CI: 1.264-56.562, p=0.038). CONCLUSION: Myocardial ischemia as detected by adenosine stress SPECT/CT in a population of asymptomatic patients with diabetes mellitus or pre-diabetes appeared to predict the occurrence of ACCE at follow-up.

The correlation of sodium iodide symporter and BRAF(V600E) mutation in classical variant papillary thyroid carcinoma.

BRAF(V600E) mutation was analyzed by real-time polymerase chain reaction in 96 consecutive cases with classical variant papillary thyroid cancer, and immunohistochemical staining of Na+/I- symporter (NIS) protein was evaluated. Localization (intracellular or membranous), density, and the intensity of cytoplasmic staining were characterized semiquantitatively. Extrathyroidal invasion, surgical margin positivity, and lymph node metastasis were compared with BRAF(V600E) mutation and NIS expression. Eighty-eight patients who had at least 24-month follow-up were also included in survival analysis. BRAF(V600E) mutation was determined in 78.1% (75/96) and functional NIS activity in 74% (71/96) of the cases. There were statistically significant differences in mean ages between BRAF(V600E) mutation-positive (48.6) and BRAF(V600E) mutation-negative cases (37.3; Levene test, P=.419; Student t test, P=.001). The surgical margin positivity (46.7%) and extrathyroidal extension percentage (54.7%) in the BRAF(V600E) mutation-positive group were higher than the negative (28.6% and 33.3%, respectively) group, without statistical significance (P=.138 and P=.084, respectively). Functional NIS activity was higher in BRAF(V600E) mutation-positive cases (78.1%) than mutation-negative ones (57.1%; P=.047). The possibility of moderate and intense cytoplasmic staining in BRAF(V600E) mutation-positive cases (72%) was 6.3 times higher than the possibility of weak staining (28%) in the mutation-positive cases (95% confidence interval, 2.2-18.8; P=.001). Functional NIS expression is higher in patients with classical variant papillary thyroid cancer with BRAF(V600E) mutation. However, the clinical features were not found to be associated with NIS expression. There may be different mechanisms determining the outcome of therapy.

The evaluation of hypermetabolic mediastinal-hilar lymph nodes determined by PET/CT in pulmonary and extrapulmonary malignancies: correlation with EBUS-TBNA.

BACKGROUND/AIM: We aimed to define the optimal SUV(max) cut-off value in determination of mediastinal-hilar lymph node metastasis, by comparing positive PET/CT results with the results of endobronchial ultrasound guided transbronchial needle aspiration biopsy (EBUS-TBNA). MATERIALS AND METHODS: Thirty-one patients with malignancy whose PET/CT imaging revealed a hypermetabolic mediastinal and/or hilar lymph node and who had undergone EBUS-TBNA were evaluated retrospectively. Histopathology was regarded as the gold standard. The diagnostic role of PET/CT in mediastinal/hilar lymph node metastasis was investigated and compared with the results of contrast-enhanced CT. RESULTS: When a SUV(max) value of 2.5 was used, the sensitivity, positive predictive value (PPV), and diagnostic accuracy of the PET/CT were 100%, 65.4%, and 65.4% respectively. In the ROC analysis, the SUV(max) cut-off value with the highest diagnostic accuracy (75%) was calculated as 6.3, and when this value was considered, the sensitivity, specificity, PPV, negative predictive value, and diagnostic accuracy of the PET/CT were determined as 70.6%, 83.3%, 88.9%, 60%, and 75% respectively (AUC: 0.779). The sensitivity, PPV, and diagnostic accuracy of the thorax CT were calculated as 91.1%, 72%, and 71.1%, respectively. CONCLUSION: When determining mediastinal-hilar lymph node metastasis via PET/CT, although a SUV(max) cut-off value of 6.3 increases specificity and diagnostic accuracy, we think that a SUV(max) cut-off value of 2.5 and above give more optimal results in routine practice.

Diagnostic value of endoscopic ultrasonography for preoperative localization of parathyroid adenomas.

The most common cause of primary hyperparathyroidism (PHPT) is a single, sporadic parathyroid adenoma. Ultrasonography (US) and (99m)Technetium methoxyisobutylisonitrile ((99m)Tc-MIBI) scintigraphy are the imaging methods most widely used to localize parathyroid adenomas. The purpose of the present study was to determine the diagnostic value and accuracy of endoscopic ultrasonography (EUS) for localizing parathyroid adenoma compared with those of US and (99m)Tc-MIBI scintigraphy. Forty-seven patients with a PHPT diagnosis and who were recommended for surgery were enrolled in this study. An endoscopist who was blinded to the previous US and (99m)Tc-MIBI scintigraphy results performed the EUS in each patient. Thirty-nine female and eight male patients with PHPT were evaluated. The presence of adenoma was confirmed by subsequent postsurgical pathology results. One case was excluded because the histopathological evaluation was compatible with a lymph node, although the lesion was detected using three different imaging modalities preoperatively. The locations of the parathyroid adenomas were correctly documented by US in 39 patients (84.7 %) by (99m)Tc-MIBI scintigraphy in 35 (76.0 %), and by EUS in 44 (95.6 %) of 46 patients. EUS located all 31 adenomas detected previously with US and (99m)Tc-MIBI scintigraphy. EUS also successfully located three adenomas that could not be identified by US and (99m)Tc-MIBI scintigraphy. The positive predictive value and diagnostic accuracy of EUS, US, and (99m)Tc-MIBI were 97.7, 97.7, and 95.6 %; 88.6, 97.5, and 86.9 %; and 77.7, 97.2, 76.0 %, respectively. EUS was preferred as the second step imaging tool for detecting parathyroid adenomas that could not be localized by US and (99m)Tc-MIBI scintigraphy.

The coexistence of multiple sclerosis and hereditary spastic paraparesis in a patient.

Multiple sclerosis (MS) is a chronic disease characterized by multiple areas of central nervous system inflammation, demyelination and axonal loss. Hereditary spastic paraparesis (HSP) is characterized clinically by progressive spasticity and weakness of the lower limbs and pathologically by retrograd axonal degeneration of the corticospinal tracts and posterior columns. We identified a patient with clinical history and investigation findings consistent with the concurrence of both MS and HSP. Laboratory and radiological investigations, cognitive tests were performed. Genetic confirmation for spastin gene mutation has been completed. If this coexistence is not coincidence the mutation in the spastin gene may be a strong susceptibility locus for MS.