Retrospective analysis of thyroid incidentalomas detected by [68Ga]Ga-PSMA-11 PET/CT.

BACKGROUND: Prostate cancer patients, undergo imaging procedures, with [68Ga]Ga-PSMA-11 PET/CT (prostate-specific membrane antigen based positron emission tomography/computed tomography) utilized for primary and secondary staging. PSMA thyroid incidentalomas (PTI) are discovered in the thyroid gland while imaging prostate cancer patients with [68Ga]Ga-PSMA-11 PET/CT. AIMS: The aim of the study was to determine the clinical significance of PTIs detected on [68Ga]Ga-PSMA-11 PET/CT. Another goal was to identify a possible threshold for the maximum standardized uptake value (SUVmax), above which a malignant growth could be suspected. STUDY DESIGN: A retrospective cross-sectional study. METHODS: 769 patients with prostat cancer who underwent [68Ga]Ga-PSMA-11 PET/CT scans in the nuclear medicine department of a tertiary care hospital between January 2020 and December 2022 were retrospectively screened in this study. We analyzed 67 patients in whom PTI was detected. Patients who exceeded the inclusion criteria had their thyroid ultrasonography and ultrasonography -guided fine needle aspiration findings analyzed. RESULTS: PTI was discovered in 67 patients (8%). 42 patients who met the inclusion and exclusion criteria were included in the study. Of the 4 malignant patients (9.5%) in the study population, 2 were classified as TIRADS 3 and 2 were classified as TIRADS 4. The cut-off SUVmax value was found to be 5.6. With 100% sensitivity and 47.37% specificity, a cutoff SUVmax of 5.3 was determined through receiver-operator characteristic analysis in order to predict malignant cytology. CONCLUSION: PTI is a significant clinical finding; most of diffuse and focal uptakes are frequently related to benign diseases. Each center should establish its own a possible SUVmax cut-off over which a malignant lesion should be suspected.

Multiple Nervous System Involvement of Erdheim-Chester Disease With Responsive Perinephritic Hypermetabolism.

ABSTRACT: A 36-year-old man who was at follow-up for histiocytosis had sudden-onset symptoms of unilateral ophthalmic increased pressure. The patient was referred to the FDG PET/CT for determination of involvement with suspicion of Erdheim-Chester disease. The reduction of the FDG uptake in all of the lesions (medial temporal lobes, nasal septum, medulla spinalis in sacral region, as well as perinephritic infiltrations), which were determined by the first PET/CT, was achieved at second imaging.

Axillary Lymph Nodes in Breast Cancer Patients After COVID-19 Vaccine.

One of the side effects of vaccines used to end the COVID-19 epidemic is non-specifically enlarged axillary lymph nodes. Such lymphadenopathy detected during clinical examination of breast cancer patients may require additional imaging or interventional procedures that should not normally be performed. This study has been designed to estimate the incidence of palpable enlarged axillary lymph node in breast cancer patients who had received COVID-19 vaccination in the past 3 months in the same arm as compared to those without vaccination. Breast cancer patients admitted to M.U. Medical Faculty Breast polyclinic between January 2021 and March 2022 were screened, and clinical staging was performed after thorough clinical examination. Among these patients with suspected enlarged axillary lymph node and those undergoing sentinel lymph node biopsy (SLNB), they were divided into two groups as vaccinated and unvaccinated. Age, menopausal status, tumor size, tumor location, surgery, pathology results, hormonal receptor status, and SLNB results were statistically compared with groups. There was no significant difference between groups in terms of age, menopause, tumor size, tumor location, surgery, pathological results, and hormone receptor status. The SLNB being reported as reactive only was 89.1% in the vaccinated group and 73.2% in the non-vaccinated group which was statistically significant different. Reactive lymph nodes were commonly found with an excess of 16% in patients who had received COVID-19 vaccination in the past 3 months. This required caution and additional examination of the axillary lymph nodes in this period.

The Relationship between Pathological Features and 18 F-FDG PET/CT that Changed the Surgeon's Decision as Neoadjuvant Therapy in Breast Cancer.

Objective Patients diagnosed with breast cancer and decided to undergo surgical treatment can undergo neoadjuvant therapy following their 2-deoxy-2-[fluorine-18]fluoro-D-glucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) findings. The present study aims to determine the statistical significance of these patients whose treatment plan was changed and the reasons for the change in the plan. Materials and Methods The demographic features and treatment plans of 151 cases who were diagnosed with any stage of breast cancer were evaluated. These patients consist of those who admitted to Mersin University Hospital Breast Outpatient Clinic between January 2016 and December 2019. All of these patients aged between 41 and 85 years were examined with 18 F-FDG PET/CT after the decision for surgical treatment is made. The analysis included tumor pathology, side, type, subtype, size, and centricity in this study. Results About 18.5% ( n = 28) of patients' treatment plan was changed after 18 F-FDG PET/CT. They received neoadjuvant therapy. About 81.5% ( n = 123) of patients did not receive neoadjuvant therapy. Significant differences were observed between patients changed treatment plan and not changed concerning age, lymph node involvement, tumor size, centricity, and subtypes parameters. Conclusion Conventional imaging examinations are used in patients with breast cancer. These examinations may not be sufficient to determine advanced disease requiring neoadjuvant treatment. With 18 F-FDG PET/CT examination, these advanced stage patients are not overlooked. In our study, approximately one in five patients, treatment plan changed after 18 F-FDG PET/CT examination.

Cancers and Benign Processes on 68 Ga PSMA PET-CT Imaging Other than Prostate Cancer.

Background Imaging plays an important role in the evaluation of prostate cancer patients. In recent years, much attention has been focused on gallium 68 prostate-specific membrane antigen positron emission tomography-computed tomography ( 68 Ga PSMA PET-CT) in prostate cancer patients and has been widely used for staging, restaging, and therapy response for these patients. The aim of this study was to report 68 Ga PSMA PET-CT in other cancers and benign processes incidentally detected on 68 Ga PSMA PET-CT in patients with prostate cancer. Materials and Methods A total of 600 68 Ga PSMA PET-CT scans were performed for initial staging, restaging, detection of suspected recurrence, and therapy response in prostate cancer patients between December 2018 and June 2020. A total of 38 patients with histopathologically proven prostate cancer were included in the current study with other malignancies and benign processes. Mainly histopathology in most of cases and clinical and radiological follow-up in few cases after PET/CT scanning served as the standard of reference. Results A total of 38 patients (age range: 52-85 years; mean age: 68.6) with prostate cancer final histopathology results were included in the study. A total of 51 lesion sites were evaluated in 38 patients. Forty-one lesion regions of these 51 regions were based on histopathological diagnosis, whereas 10 of them were based on clinical follow-up and conventional radiological follow-up as differential criteria. Thirty of 51 lesion regions were evaluated as malignant and 21 were benign lesions. The most common 68 Ga PSMA ligand avid malignancy was lung adenocarcinoma (6/38). Conclusions Prostate-specific membrane antigen (PSMA) is a cell surface glycoprotein and mainly expressed in prostate epithelium. 68 Ga PSMA PET-CT imaging is very sensitive and specific imaging modality in prostate cancer patients. However, other malignancies and some benign processes may also have 68 Ga PSMA ligand avidity and some prostate cancer metastases may imitate other malignancies.

Diagnostic Performance of 99mTc-Methoxy-Isobuty-Isonitrile (MIBI) for Risk Stratification of Hypofunctioning Thyroid Nodules: A European Multicenter Study.

99mTc-MIBI (MIBI) imaging is able to exclude malignancy of hypofunctioning thyroid nodules (TNs) with high probability but false positive results are frequent due to low specificity. Therefore, pre-test selection of appropriate TNs is crucial. For image evaluation visual and semiquantitative methods (Washout index, WOInd) are used. Aim of this study was to evaluate the diagnostic performance of MIBI imaging in hypofunctioning TNs with indeterminate fine-needle aspiration cytology results in a multicentric European setting. Patients with hypofunctioning TNs, EU-TIRADS 4 or 5, Bethesda III/IV and MIBI imaging were included. For visual evaluation the intensity of MIBI uptake in the TN was compared to normal thyroid tissue. 358 patients with 365 TNs (n = 68 malignant) were included. Planar imaging (SPECT) showed a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 96% (94%), 21% (22%), 22% (15%), 96% (96%), and 35% (32%). The WOInd (38.9% of all cases, optimal cutoff: -19%) showed a sens 100% (spec 89%, PPV 82%, NPV 100%, ACC 93%). For hypofunctioning TNs at intermediate or high risk with indeterminate cytology, a MIBI negative result on visual evaluation is an effective tool to rule-out thyroid malignancy. The semi-quantitative method could considerably improve overall diagnostic performance of MIBI imaging.

Superscan Appearance of 68Ga PSMA PET/CT in a Patient with Refractory Prostate Cancer.

A 64-year-old male patient with metastatic prostate carcinoma diagnosis received lutetium-177 prostate-specific membrane antigen (PSMA) treatment; however, his disease progressed. Herein, presented the final images of the patient that demonstrated a superscan appearance in the Gallium-68 PSMA positron emission tomography/computed tomography, which is a rare phenomenon.

Perineum and penile invasion of recurrent prostate carcinoma shown by Ga-68 PSMA PET/CT.

Imaging of prostate cancer has recently had new modalities. Ga-68 Prostate Specific Membrane Antigen (PSMA) Positron Emission Tomography/Computed Tomography (PET/CT) has gained important diagnostic role in the management of the patients with prostate cancer. Patients with progressively elevated serum prostate specific antigen (PSA) level may be evaluated by Ga-68 PSMA PET/CT imaging. This case report presents a seventy five year old man with diagnosis of prostate cancer and progressive serum PSA increase. Local recurrence of the tumor as well as spread to the penis, perineum and skeleton was determined by Ga-68 PSMA imaging. This case illustrates that Ga-68 PSMA imaging may show unexpected sites of disease spread.

Metabolic Characterization of Anterior Mediastinal Masses by 18F-FDG PET/CT

Objectives: To evaluate the role of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for the diagnosis of anterior mediastinal masses. Methods: The oncological 18F-FDG PET/CT images of 41 patients (17 women, 24 men; age: 16-83 years, mean age: 50.5±19.5 years) who attended the nuclear medicine department between November 2016 and September 2017 were retrospectively evaluated for the metabolic characterization of their anterior mediastinal masses. Results: Based on our results, the lesions of 4 patients were benign [maximum standard uptake value (SUVmax) <3] and that of 2 patients were non-tumoral (i.e., tuberculosis and sarcoidosis). The mean dimensions and the SUVmax levels of the malignant lesions were 6.4±3.7 cm and 11.9±9.6, respectively. The pathological results for the malign tumors were thymus tumors (n=8), lymphoma (n=8), lung cancer (n=11), carcinoid metastasis (n=2), thyroid carcinoma (n=2), germ cell carcinoma (n=1), schwannoma (n=1), and sarcoma (n=1). The degree of 18F-FDG accumulation could precisely identify the malign and benign tumors. Conclusion: Thus, contrary to the known causes, it is possible that anterior mediastinal masses originate from structures other than the anterior mediastinal structures. In this study, the lymphoma and lung carcinoma pathology were more frequent than thymic lesions.

Bone marrow involvement in pediatric malignancies: a comparison study of Positron emission tomographycomputed tomography and bone marrow biopsy.

BACKGROUND AND OBJECTIVES: The comparison of Positron emission tomography- computed tomography (PETCT) and bone marrow biopsy (BMB) modalities in detecting bone marrow disease is an up to date research topic. In this study, we aimed to compare the results of PET-CT and BMB procedures in detecting bone marrow involvement in pediatric malignancies. METHOD: At the time of diagnosis, PET-CT imaging and BMB performed patients` data were evaluated, retrospectively. Malign diagnoses were Hodgkin's lymphoma in 23 (30.7%), non-Hodgkin's lymphoma in 20 (26.7%), neuroblastoma in 11 (14.7%), Ewing sarcoma in 10 (13.7%), Langerhans cell histiocytosis in 6 (8%), and rhabdomyosarcoma in 5 (6.6%) patients. RESULTS: Bone marrow involvement was detected in 39 (52%) of 75 patients. Bone marrow involvement was identified by both PET-CT and BMB in 18 (46.1%) patients, by only PET-CT in 12 (30.7%) patients, by only BMB in 9 (23%) patients. The sensitivity of PET-CT was 66%, specificity was 75%, positive predictive value was 60%, and negative predictive value was 80%. Sensitivity, spesificity, positive and negative predictive values of PETCT were different in before mentioned malignancy groups. CONCLUSION: PET-CT may not have high sensitivity and specificity to identify bone marrow involvement for each type of cancer. The approach of using bone marrow biopsy and PET-CT as complementary modalities seems reliable.

Amyloidosis Associated Kidney Failure with Gross Hypermetabolic Intra-abdominal Mass

A 23-year-old male patient who presented with impaired kidney function tests attended to hospital for hemodialysis and underwent 18F-FDG positron emission tomography/computed tomography (PET/CT) examination for the metabolic characterization of the intra-abdominal mass which was found in the ultrasonography. 18F-FDG PET/CT revealed a mass lesion adjacent to the liver which was hypermetabolic and the pathology of the lesion was determined as amyloidosis. To the best of our knowledge, the case with 18F-FDG PET/CT images of a huge amyloid mass is the first in the literature.

Estimation of Cardiac Systolic Function Based on Mitral Valve Movements: An Accurate Bedside Tool for Emergency Physicians in Dyspneic Patients.

OBJECTIVES: The purpose of this study was to determine the success of mitral valve movements in the estimation of left ventricular ejection fraction (LVEF). METHODS: Adult patients whose principal symptom was dyspnea were included in this prospective observational study. The distance from the anterior mitral valve (AMV) to the interventricular septum (IVS) during early diastole was measured first in B-mode in the parasternal long axis (PLAX) named parasternal long axis-anterior leaflet septal separation. Second, the AMV-IVS distance was measured in M-mode in the PLAX named E-point septal separation. Third, AMV-IVS distance was measured in B-mode in the apical 4-chamber view named apical 4-chamber view-anterior leaflet septal separation. Finally, maximum distance between the 2 mitral leaflets in the apical 4-chamber view was measured and named mitral valve leaflet separation. Comprehensive echocardiography was performed by an experienced cardiologist. Correlation was calculated between mitral valve measurements and LVEF. Cutoff values were determined using receiver operating characteristic curves and the chi-square test. RESULTS: A total of 118 patients were included in the study. Parasternal long axis-anterior leaflet septal separation, E-point septal separation, and apical 4-chamber view-anterior leaflet septal separation were highly correlated with LVEF (correlation coefficient, -0.848, -0.833, and-0.822 [P < .001]). Parasternal long axis-anterior leaflet septal separation values less than 2.30 mm, E-point septal separation values less than 2 mm, and mitral valve leaflet separation values greater than 25.15 mm exhibited a 100% negative predictive value in excluding reduced LVEF. Parasternal long axis-anterior leaflet septal separation values less than 4.95 mm, EPSS values less than 5.85 mm, apical 4-chamber view-anterior leaflet septal separation values less than 6.95 mm, and mitral valve leaflet separation values greater than 24.05 mm exhibited a 100% negative predictive value in excluding severe reduced LVEF. CONCLUSIONS: Mitral valve measurement methods may be useful in predicting LVEF or values thereof as a complementary method of diagnosing challenging patients on echocardiographic images.

First experience with a new technique: Portable gamma camera usage for sentinel lymph node identification in a patient with breast cancer.

The newest development in sentinel lymph node imaging is portable gamma probe imaging. In this case report, results of all SLN detection methods were analyzed. The patient was imaged using a large field-of-view gamma camera with additional blue dye administration and intraoperative localization of sentinel lymph node using both gamma probe and portable gamma camera was performed. In this case report, the value of additional portable gamma camera imaging was analyzed.

Effective predictors for surgical decision in antenatal hydronephrosis: a prospective multiparameter analysis.

OBJECTIVE: The majority of antenatal hydronephrosis disappears spontaneously. In our study, we have investigated the effective predictors for surgical decision in antenatal hydronephrosis. MATERIAL AND METHODS: Forty-four patients found to have renal pelvic anteroposterior (AP) diameter more than 10-mm on antenatal ultrasonograpy were followed after birth. The study groups were divided into two groups: follow-up and surgery group. On follow-up, longitudinal diameter of the kidney, parenchymal thickness of the kidney, AP diameter of renal pelvis, AP diameter of middle calyces on ultrasonograpy, and differential renal function, 20th minute clearance, half-life of radionuclide tracer (T1/2), Tmax, Tmax-T1/2, normalised residual activity (NORA) on diuretic renography were evaluated. Ultrasonograpy and diuretic renography measurements were compared in patients whose hydronephrosis resolve or proceeded to surgery. RESULTS: Forty-four patients were diagnosed as antenatal hydronephrosis, spontaneous resolution occurred in 23 (52%), and surgery was performed in 21 patients (48%). Mean age at operation was 8.5±6.5 months (3-24 months). Mean AP diameter of renal pelvis was 29.5±14.2 mm for surgery group, 13.6±4.2 mm for follow-up group (p<0.001). Univariate analyses showed significance for all ultrasonographic measurements and only the differential renal function by diuretic renography. Multivariate logistic regression analysis showed significance for AP diameter of renal pelvis (odds ratio 1.37; 95% Cl 1.13-1.66), and differential renal function (odds ratio 1.14; 95% Cl 1.01-1.29). CONCLUSION: AP diameter of renal pelvis and differential renal function were the most effective parameters for surgical decision. These parameters can be used for appropriate management of antenatal hydronephrosis.

The role of inferior vena cava diameter in volume status monitoring; the best sonographic measurement method?

OBJECTIVES: This study aims to determine the site of and the best sonographic method for measurement of inferior vena cava (IVC) diameter in volume status monitoring. METHODS: This observational before-and-after study was performed at the intensive care unit of the emergency department. It included hypotensive adult patients with suspected sepsis who were recommended to receive at least 20 mg/kg fluid replacement by the emergency physician. The patients were fluid replaced at a rate of 1000 mL/h, and maximum and minimum IVC diameters were measured and the Caval index calculated sonographically via both B-mode and M-mode. Hence, IVC's volume response was assessed by a total of 6 parameters, 3 each in M-mode and B-mode. Freidman test was used to assess the change in IVC diameter with fluid replacement. Wilcoxon test with Bonferroni correction was used to determine which measurement method more sensitively measured IVC diameter change. RESULTS: Twenty-eight patients with a mean age of 71.3 were included in the final analysis.The IVC diameter change was significant with all 6 methods (P < .001). The IVC minimum diameter change measured on M-mode during inspiration (M-mode i) was the only measurement method that significantly showed diameter change with each 500-mL fluid replacements. The initial and the subsequent M-mode i values after each 500 mL of fluid were 5.65 ± 3.34; 8.05 ± 3.66; 10.16 ± 3.61, and 11.21 ± 2.94, respectively (P < .001, P < .002, and P < .003, respectively). CONCLUSION: Inferior vena cava diameter was changed by fluid administration. The M-mode i method that most sensitively measures that change may be the most successful method in volume status monitoring.

The role of inferior vena cava diameter in the differential diagnosis of dyspneic patients; best sonographic measurement method?

STUDY OBJECTIVE: We aimed to determine the role of inferior vena cava (IVC) diameter in making a differentiation between dyspnea of cardiac (acute heart failure [AHF]) and pulmonary origin. We also attempted to determine the best sonographic method for the measurement of IVC diameter. METHODS: This prospective observational study was conducted at the intensive care unit of the emergency department of a training and research hospital. This study enrolled patients with the main symptom of dyspnea who were categorized into 2 groups, cardiac dyspnea and pulmonary dyspnea groups, based on the final diagnosis. All patients underwent sonographic measurement of minimum and maximum diameters of IVC, and the caval index (CI) was calculated in both M-mode and B-mode. The sensitivity, specificity, and likelihood ratios (LR) of the IVC values for the differentiation of the 2 groups were calculated. RESULTS: This study included a total of 74 patients with a mean age of 72.8 years. Thirty-two patients had dyspnea of cardiac origin, and 42 patients had dyspnea of pulmonary origin. The IVC diameter measured with B-mode during inspiration (B-mode i) was the most successful method for differentiation of the 2 groups. B-mode i values greater than 9 mm predicted dyspnea of cardiac origin with a sensitivity of 84.4% and a specificity of 92.9% (+LR: 11.8, LR: 0.16). CONCLUSION: Sonographic assessment of the IVC diameter may be used as a rapid, readily, nonexpensive, complication-free, and reproducible technique for the differentiation of cardiac and pulmonary causes of dyspnea. B-mode i measurement may be more successful in the differentiation of dyspnea compared with other IVC diameters and calculations.

Decreased serum fetuin-A levels are associated with coronary artery diseases.

BACKGROUND: To analyze Fetuin-A levels and soluble cellular adhesion molecules in patients with acute coronary syndrome. METHODS AND RESULTS: Serum Fetuin-A and intercellular adhesion molecule-1 (sICAM-1), vascular cellular adhesion molecule-1 (sVCAM-1) levels were examined in 127 patients who presented with chest pain. These patients were classified in three groups: stable angina (SA, n=51), myocardial infarction (MI, n=34) and non-cardiac group (n=42). Logarithmic transformations were made for Fetuin-A levels. Log-Fetuin-A levels were higher in non-cardiac subjects compared to MI and SA patients (p<0.05). Patients with SA showed lower levels than controls but higher levels as compared to MI patients. After controlling for age and gender, levels of sVCAM-1 and sICAM-1 in patients with coronary atherosclerosis were not different from those in non-cardiac subjects. CONCLUSION: Serum levels of soluble VCAM-1, ICAM-1 were not related to coronary artery disease (CAD), but fetuin-A levels seems to be decreased in SA and MI patients. Low fetuin-A may play a role in the pathophysiology of CAD.

Foot and ankle injuries and time lost from play in professional soccer players.

BACKGROUND: Ankle and foot injuries are common in professional soccer players, but the relation among diagnosis, severity and time lost from play is not well known. OBJECTIVE: The aim of this study is to investigate the relationship among diagnosis, injury severity and time lost to play of professional soccer players with severe ankle and foot injuries with reviewing the recent literature. DESIGN: Retrospective descriptive study. PATIENTS AND METHODS: Collected data of 66 players with severe ankle and foot injuries were included in the study. Type of injury, diagnosis, treatment, injury severity and finally, time lost from play were evaluated from the medical records. Injury severity ('severe' if >28 days, 'moderate' if between 8 and 28 days) and time lost from play were calculated from medical records and by telephone interviews with the players. RESULTS: Most injuries (n=20, 32%) occurred during player-to-player contact. The most common diagnosis was ankle sprain (30.3%) with anterior talofibular ligament injury. Most (55%) hindfoot injuries were Achilles tendinopathy with or without rupture. Treatment was surgical in 23 patients (35%). The mean time lost from play for players with severe foot and ankle injuries was 61 days (range 21-240 days); after Achilles tendon ruptures, the mean time lost was 180 days. Injury severity was severe (>28 days lost from play) in 64% patients and moderate (8-28 days lost from play) in 36% patients. CONCLUSION: Time lost to play can dramatically increase by the presence of severe ankle and foot injuries. Serious ankle and foot injuries in this study resulted in players being out of professional competition for about 2 months.

Pain and affective distress before and after ACL surgery: a comparison of amateur and professional male soccer players in the early postoperative period.

Pain thresholds and levels of distress before and in the early postoperative period after anterior cruciate ligament surgery were measured in professional and amateur male soccer players and compared. Between June 2005 and March 2007, 30 soccer players (10 amateur, 20 professional) with acute or chronic tears of the anterior cruciate ligament who were scheduled for a bone-tendon-bone ACL reconstruction procedure were enrolled in the study. Measures of pain intensity, depression and anxiety were assessed 1 day pre-operation and 1 week and 3 weeks post-operation (T1 T2 and T3). Pain was assessed using a visual analog scale (VAS), depression with the Beck Depression Inventory (BDI), and anxiety with both the state and trait forms of the State-Trait Anxiety Inventory (STAI). Scores on the VAS, BDI, and STAI in both groups were analyzed. The mean VAS scores at T1 and T2 in professional players were not significantly higher than those in amateur players (P>0.05). Professionals had significantly higher BDI scores at T1 and T2 (P<0.05), but this difference was not significant at T3 (P=0.12). High depression scores did not correlate with high pain scores. Pain scores between professional and amateur soccer players with ACL injuries were not significantly different pre-op or in the early post-op period. Depression was more common in professionals before and after their ACL surgery, but anxiety levels were not significantly different between the two groups.