The Relationship of SUV Value in PET-CT with Tumor Differentiation and Tumor Markers in Gastric Cancer.

OBJECTIVE: We aimed to investigate the relationship between the use of fluoro-2-deoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT), maximized standardized uptake value (SUVmax) values of tumors, and tumor differentiation and tumor markers during the initial staging of patients with gastric cancer. MATERIALS AND METHODS: The study included 50 patients (14 women and 36 men; mean age: 63±11 years; age range: 31-80 years) who had undergone initial staging with FDG-PET/CT after the diagnosis of gastric cancer with endoscopic biopsy between January and June 2013. Serum alpha fetoprotein (AFP), carcinogenic antigen 19-9 (CA 19.9), carcinoembryonic antigen (CEA), and C-reactive protein (CRP) levels were measured in patients prior to imaging. PET/CT images were evaluated for primary tumors, locoregional spread, and distant organ metastases, and classified by tumor-node-metastasis staging. Semiquantitative data were collected by SUVmax measurements in pathological regions of involvement. Data were analyzed statistically. RESULTS: FDG-PET/CT showed primary gastric cancer with a sensitivity of 87%. Imaging findings were normal in 3 patients (1/3; mucinous adenocarcinoma, 2/3; signet-ring cell adenocarcinoma). With FDG-PET/CT, 3/50 patients were classified into Stage 1B, 3/50 patients into Stage 2, 5/50 patients into Stage 3A, 5/50 patients into Stage 3B, 5/50 patients into 3C and 29/50 patients into Stage 4. The mean SUVmax was calculated as 11.35±4.3 (poorly differentiated adenocarcinoma: 5.4±1.7; moderately differentiated adenocarcinoma: 10.3±4.8) for the primary tumor and 14.9±6.3 for tumor metastasis. A positive correlation was evident between the measured SUVmax and stage and the grade of primary tumor (p<0.05). While the relationship between SUVmax and levels of serum AFP and CRP was statistically significant (p<0.05), the relationship between SUVmax and levels of serum CA 19-9 and CEA was not statistically significant (p>0.05). CONCLUSION: The SUVmax of primary tumors was associated with the degree of differentiation of primary tumors and the biochemical tumor markers CRP and AFP. The fact that SUVmax of primary tumors is high supplies clues about the presence of the factors affecting prognosis of the disease.

Evaluation of radiolabeled curcumin-loaded solid lipid nanoparticles usage as an imaging agent in liver-spleen scintigraphy.

Curcumin-loaded solid lipid nanoparticles (C-SLNs) were prepared using micro emulsion and ultrasonication methods in the first stage of this study to determine the role of C-SLN on liver-spleen scintigraphy. It was concluded that the curcumin that was encapsulated in solid lipid nanoparticles had a ß' polymorph structure according to the X-ray diffraction (XRD) analysis. It was concluded that these particles were at nano scale according to the laser diffraction (LD) analysis. Fourier transform infrared spectroscopy (FT-IR) analysis suggested an interaction between the curcumin and the solid lipid matrix, and the curcumin was loaded on the solid lipid nanoparticles. Moreover, the particles were concluded to be spherical and at nanoscale according to the scanning electron microscopy (SEM) and transmission electron microscopy (TEM) images. On the other hand, thermogravimetric analysis (TGA) suggested that the curcumin loaded solid nanoparticles were stable against the temperature. C-SLNs were labeled with Technetium-99m (99mTc) radioisotope in the second stage of the study, then using scintigraphic methods in-vivo studies were performed on New Zealand rabbit and made a comparison with Phytate colloid, routinely used in liver-spleen scintigraphy. After analyzing the images and the biological distributions obtained from the experiments, uptake was observed in the liver and the spleen. Following from the experiment results, 99mTc-labeled C-SLNs was concluded to be a possible imaging agent. In particular, it could be a new radiopharmaceutical alternative to 99mTc-labeled compounds that are used in liver and spleen imaging in colloid scintigraphy.

Value of dynamic MRI using the Ktrans technique for assessment of native kidneys in pre-emptive renal transplantation.

Background Different non-invasive imaging techniques such as Doppler ultrasonography and renal scintigraphy are commonly employed to assess allograft function and associated complications. However, all such methods lack sufficient specificity to discriminate between residual renal function of native kidneys. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) evaluates signal dynamics during the passage of contrast material through the renal cortex, medulla, and collecting system. Purpose To investigate the value of DCE 3T MRI using a quantitative pharmacokinetic parameter (Ktrans) for the assessment of native kidneys before and after pre-emptive renal transplantation. Material and Methods Twenty-five consecutive patients with end-stage renal disease underwent DCE MRI before and 6 months after kidney transplantation. MRI was performed using a 3T scanner. Regions of interests were drawn over each kidney, encompassing the cortex and medulla but excluding the collecting system and any coexisting cysts. Parametric Ktrans values were automatically generated. Results In the pre-transplantation group, mean Ktrans values for the right and left kidneys were 0.55 ± 0.09 min-1 and 0.44 ± 0.15 min-1, respectively. In the post-transplantation group, mean Ktrans values of the right and left kidneys were 0.27 ± 0.07 min-1 and 0.25 ± 0.10 min-1, respectively. There were statistically significant differences between right and left kidneys in terms of mean Ktrans values in the pre- and post-transplantation groups ( P < 0.001). Conclusion Our preliminary results show that native kidneys were still functioning 6 months after transplantation. MR perfusion using Ktrans may constitute a non-invasive means of determination of the viability of native kidneys after renal transplantation.

Comparison of glomerular filtration rate measurements with the two-plasma sample technique using Tc-99m DTPA and other methods in donor candidates for renal transplantation.

BACKGROUND/AIM: Accurate measurement of glomerular filtration rate (GFR) in the evaluation of renal functions in potential kidney donors is associated with important outcomes for both the donor and recipient. We intended to determine the efficacy of various methods while estimating GFR in potential living kidney donors. MATERIALS AND METHODS: Fifty-three potential kidney donors (31 females, 22 males; mean age: 50.1 years) were included in this study. GFR was estimated simultaneously using the following methods: Gates' method, Cockcroft-Gault (CG) and modification of diet in renal disease (MDRD) prediction equations, and the two-plasma sample (TPS) technique. Using TPS as the reference method, the estimations of GFR with the other methods were compared with that of TPS. RESULTS: The mean ± SD GFR was 86.43 ± 11.37 mL min-1 1.73 m-2 with TPS. GFR values calculated using Gates' method and MDRD 1, MDRD 2, reexpressed MDRD, and CG prediction equations were 105.25 ± 16.12 mL min-1 1.73 m-2, 114.63 ± 32.51 mL min-1 1.73 m-2, 113.2 ± 35.23 mL min-1 1.73 m-2, 104.23 ± 23.12 mL min-1 1.73 m-2, and 99.35 ± 20.01 mL min-1 1.73 m-2, respectively. While there was a strong statistically significant correlation between the TPS and Gates' methods, moderate correlation was found between TPS and the MDRD 1, MDRD 2, and reexpressed MDRD prediction equations. CONCLUSION: Our results indicated that the performance of Gates' method in total GFR estimation was better than the prediction equations in potential kidney donors.

Evaluation of the effect of isotretinoin on salivary gland function by Tc-99m pertechnetate imaging in acne vulgaris patients.

BACKGROUND/AIM: Isotretinoin is an effective drug utilized in the management of acne vulgaris and is known to cause dry mouth. In this study, we aimed to evaluate this effect of isotretinoin on the salivary gland function in patients with acne vulgaris using technetium-99m (Tc-99m) pertechnetate imaging of the salivary glands. MATERIALS AND METHODS: The study population consisted of 28 patients with acne vulgaris (6 males and 22 females, mean age 20.2 ± 2.3 years), who were treated with isotretinoin for 6 months. We performed radionuclide imaging of the salivary glands pretreatment and at months 3 and 6 of treatment. After 185 MBq (5 mCi) of Tc-99m pertechnetate was intravenously administered, imaging of the salivary glands was performed over a 25-min period. We measured the following glandular function parameters for the parotid and submandibular salivary glands via time-activity curves: uptake ratio, maximum accumulation, and ejection fraction. RESULTS: Statistically significant differences were observed in the values obtained at months 3 and 6 of treatment, compared with the pretreatment values. CONCLUSION: This study demonstrated that radionuclide imaging of the salivary glands can clearly show the glandular functions that are affected by drugs such as isotretinoin.

Treatment with Carnitine Enhances Bone Fracture Healing under Osteoporotic and/or Inflammatory Conditions.

The aim of this study was to examine the effects of carnitine on bone healing in ovariectomy (OVX) and inflammation (INF)-induced osteoporotic rats. The rats were randomly divided into nine groups (n = 8 animals per group): sham-operated (Group 1: SHAM); sham + magnesium silicate (Mg-silicate) (Group 2: SHAM + INF); ovariectomy (Group 3: OVX); ovariectomy + femoral fracture (Group 4: OVX + FRC); ovariectomy + femoral fracture + Mg-silicate (Group 5: OVX + FRC + INF); ovariectomy + femoral fracture + carnitine 50 mg/kg (Group 6: OVX + FRC + CAR50); ovariectomy + femoral fracture + carnitine 100 mg/kg (Group 7: OVX + FRC + CAR100); ovariectomy + femoral fracture + Mg-silicate + carnitine 50 mg/kg (Group 8: OVX + FRC + INF + CAR50); and ovariectomy + femoral fracture + Mg-silicate + carnitine 100 mg/kg (Group 9: OVX + FRC + INF + CAR100). Eight weeks after OVX, which allowed for osteoporosis to develop, INF was induced with subcutaneous Mg-silicate. On day 80, all of the rats in groups 4-9 underwent fracture operation on the right femur. Bone mineral density (BMD) showed statistically significant improvements in the treatment groups. The serum markers of bone turnover (osteocalcin and osteopontin) and pro-inflammatory cytokines (tumour necrosis factor α, interleukin 1ß and interleukin 6) were decreased in the treatment group. The X-ray images showed significantly increased callus formation and fracture healing in the groups treated with carnitine. The present results show that in a rat model with osteoporosis induced by ovariectomy and Mg-silicate, treatment with carnitine improves the healing of femur fractures.

The Importance of FDG-PET/CT in Cogan's Syndrome.

The present study gives a detailed report of a patient with atypical Cogan's syndrome with uveitis and sensorineural hearing loss. Cogan's syndrome is characterized by nonsyphilitic interstitial keratitis and audiovestibular dysfunction. This syndrome can be divided into two groups, typical and atypical, based on the presence of interstitial keratitis. It may sometimes be associated with systemic vasculitis. Fluoro-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) scanning was used to investigate the presence of vasculitis. With FDG-PET/CT scanning, there is no pathological involvement in the walls of the arteries; thus the patient is protected from aggressive and long term immunosuppressive treatment's side effects. Hence, we can conclude that FDG-PET/CT may play an important role in excluding the presence of vasculitis.

Vesicoureteral reflux in a nonfunctioning kidney detected by 99mTc-DTPA study.

Vesicoureteral reflux (VUR) is a well-recognized condition in the pediatric population, but is less well described in the adult population, and its prevalence decreases with increasing age. We describe the case of a 53-year-old male with nonfunctional kidney in which accumulation of radioactivity was observed in the ureter and renal pelvis owing to VUR, which was detected by technetium-99m diethylenetriamine pentaacetic acid dynamic renal scintigraphy.

Evaluation of bone metastasis as the first presentation of hepatocellular carcinoma using 18-fluorodeoxyglucose positron emission tomography-computed tomography.

We report a case of a patient with hepatocellular carcinoma (HCC) who presented with back pain related to bone metastasis. HCC metastasizes by hematogenous and lymphatic routes commonly to the lungs, regional lymph nodes, kidney, bone marrow and adrenals. In this extremely rare case, the patient had no known liver disease, but presented with liver lesions and multiple bone lesions involving vertebrae, ribs, pelvic bones and left femur with associated expansile soft-tissue components. These bone lesions were first detected from a positron emission tomography scan. Pathological examination of biopsy material taken from the left eighth rib confirmed metastatic HCC. In conclusion, if a patient has expansile osteolytic bone lesions, bone metastasis from HCC should be included in the differential diagnosis.

The role of carnitine on ovariectomy and inflammation-induced osteoporosis in rats.

This study was carried out to assess the protective bone-sparing effect of carnitine with anti-inflammatory properties on chronic inflammation-induced bone loss in ovariectomised (OVX) rats. A total of 64 rats were divided into eight groups. Sixteen rats were sham-operated (SH) while the others were ovariectomised (OVX). (1) SH, (2) sham + inflammation (SHinf), (3) OVX, (4) ovariectomy + inflammation (OVXinf), (5) OVX + CAR1, (6) OVX + CAR2, (7) OVXinf + CAR1, (8) OVXinf + CAR2. After the ovariectomy surgery, all the groups (3, 4, 5, 6, 7, and 8) were allowed to recover for two months. Sixty days after the OVX, inflammation was induced by subcutaneous injections of talc in groups 2, 4, 7, and 8. Group 5 and 7 were given 50 mg/kg CAR; Group 6 and 8 were given 100 mg/kg CAR from the 60th to the 80th day. Serum levels of TNF-α, IL-1, IL-6, OP, and OC were assessed to determine inflammation and to evaluate osteoblastic activity. Bone mineral density (BMD) was assessed by dual energy X-ray absorptiometry in femur bones of rats. Carnitine administration was able to restore BMD up to values measured in both the OVX and the SH animals. The serum levels of TNF-α, IL-1ß, and IL-6 were increased significantly in the OVXinf rats compared with the SH group. In OVX rats, inflammation which is evaluated by serum cytokine levels exacerbated this bone loss, as supported by values of BMD of the total femur. The two different doses of carnitine reduced bone loss and improved inflammatory biomarkers.

Assessment of salivary gland function in patients after successful kidney transplantation using (99m)Tc-pertechnetate salivary gland scintigraphy.

Chronic renal failure and its treatment can induce oral health problems and salivary glands dysfunction. The purpose of this study was to assess salivary glands function in patients with kidney transplantation using technetium-99m pertechnetate ((99m)Tc-P) salivary glands scintigraphy. We prospectively studied 34 patients with kidney transplantation (30 males and 4 females,mean age 39.76±11.6 years) and 28 healthy controls (12 males and 16 females, mean age 36.1±9.5 years). Salivary gland scintigraphy was performed nearly 4.4±2.9 years after successful kidney transplantation. Dynamic salivary glands scintigraphy was performed during 25min after the intravenous administration of 185MBq of (99m)Tc-P. Time-activity curves and glands functional parameters were calculated for the parotid and submandibular salivary glands: uptake ratio, maximum accumulation of the radionuclide, and excretion fraction. Statistical analysis of the functional parameters showed no significant differences between patients with kidney transplantation and healthy controls (P>0.05). In conclusion, this study showed that using (99m)Tc-P salivary gland scintigraphy, salivary glands function of patients with successful kidney transplantation do not differ statistically from those in healthy controls.

Evaluation of the genotoxic effects of chronic low-dose ionizing radiation exposure on nuclear medicine workers.

INTRODUCTION: Nuclear medicine workers are occupationally exposed to chronic ionizing radiation. It is known that ionizing radiation may have damaging effects on chromosomes. In the present study, we investigated the genotoxic effects of ionizing radiation on nuclear medicine workers. We used two different indicators of genotoxicity methods: sister chromatid exchange (SCE) and micronucleus (MN). METHODS: The present research was carried out using 21 nuclear medicine workers (11 females and 10 males) during two periods: during normal working conditions and after a 1-month vacation. The radiation dose varied from 1.20 to 48.56 mSv, which accumulated during the occupational exposure time between two vacations. Peripheral blood samples were taken from each subject for two distinct lymphocyte cultures (SCE and MN) in each period. RESULTS: In nearly all subjects, SCE values increased significantly during radiation exposure compared to the postvacation period (P<.05). Similarly, MN frequencies in most of the subjects increased significantly during radiation exposure compared to the postvacation period (P<.05). CONCLUSIONS: This study revealed that both SCE and MN frequencies in most of the subjects were significantly higher during exposure to ionizing radiation than after a 1-month vacation period. However, this genotoxic effect was reversible in most of the subjects.