Effects of Metformin Therapy on Thyroid Volume and Functions in Patients with Newly Diagnosed Type 2 Diabetes Mellitus: A Single-center Prospective Study.

OBJECTIVE: Patients with impaired glucose metabolism have increased thyroid volume and a higher prevalence of nodules. Yet, some studies show that there is an improvement in these thyroid parameters after diabetes treatment. Our observational study aimed to reveal the effect of treatment on thyroid function, thyroid volume, and the presence of nodules in newly diagnosed type 2 diabetes mellitus (T2DM) patients who were started on metformin treatment. METHODS: Euthyroid and subclinically hypothyroid patients with a serum TSH level of <10 mU/L, who were newly diagnosed with T2DM and started on metformin as an antidiabetic treatment and not used any thyroid medication previously, were included in our study. Patients' characteristics were recorded. Baseline and 6th-month serum thyroid function tests were scheduled. Baseline and 6th-month thyroid gland characteristics were examined by thyroid ultrasonography. RESULTS: A total of 101 (37 males, 64 females) newly diagnosed T2DM patients with euthyroid (n=95) or subclinical hypothyroidism (n=6) were included in the study. The mean age of the patients was 53.02 ± 11.9 years, and the mean BMI was 29.60 ± 3.9 kg/m2. Fifty-two (52%) patients were classified as obese. Body weight, BMI, serum TSH, ALT, Anti-TPO levels, and thyroid volume decreased significantly in the 6th-month compared to baseline values (p = 0.000; p = 0.000; p = 0.011; p = 0.022; p = 0.000, respectively). Serum anti-Tg, fT4, fT3 levels, and thyroid nodule count did not change significantly. A high agreement was found between the baseline and 6thmonth nodule counts (gamma= 0.886; p < 0.001) and the presence of multi-nodularity in the thyroid (gamma= 0.941; p < 0.001), but no significant change was observed. Anti-TPO levels showed a significant decrease in both with and without obesity groups at the end of 6 months (p = 0.003, p = 0.009, respectively). Serum TSH level decreased significantly only in non-obese subjects (p = 0.004), and thyroid volume decreased significantly only in obese subjects (p = 0.000). CONCLUSION: Our results suggest that metformin treatment significantly reduces body weight, BMI, thyroid volume, and serum TSH, ALT, and Anti-TPO levels in patients with newly diagnosed T2DM. Moreover, serum TSH levels showed a significant decrease in non-obese subjects, while thyroid volume showed a significant decrease in obese subjects.

Can pretreatment hepatic artery perfusion scintigraphy in patients with liver malignancies predict the treatment response of the selective internal radiation therapy with 90Y resin microspheres?

PURPOSE We aimed to evaluate whether the perfusion pattern from pretreatment hepatic artery perfusion scintigraphy (HAPS) in patients with liver malignancies can predict response to selective internal radiation therapy (SIRT). METHODS This retrospective study analyzed 152 consecutive patients treated with yttrium-90 (90Y) resin microspheres between April 2015 and July 2017. HAPS using single-photon emission computed tomography/computed tomography (SPECT/CT) with 99mtechnetium macroaggregated albumin (99mTc-MAA) was performed before SIRT. Investigators visually classified perfusion patterns of tumors as heterogeneous or diffuse in HAPS. Between diffuse and heterogeneous pattern group, positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) were performed in third and sixth month after SIRT, and tumor response assessed and compared by using RECIST 1.1 or mRECIST. Overall survival (OS) and progression-free survival (PFS) were also compared with Kaplan-Meier/log-rank analyses. RESULTS Of 216 SIRT procedures, 172 were classified as heterogeneous and 44 as diffuse. Diffuse 99mTc- MAA uptake was associated with longer median OS than heterogeneous (22.2 vs. 14.4 months, respectively; P = .047). Subsegmental infusion was associated with longer OS than either lobar or segmental infusion (P = .090). Mean estimated OS was longer in patients with hepatocellular carcinoma (HCC) (34.2 months) than with colorectal carcinoma (CRC) (16.4 months) (P = .044). Patients with both diffuse and heterogeneous patterns were able to show complete response after SIRT. No statistically significant differences were observed between perfusion patterns and PFS or response rates to SIRT. CONCLUSION Although tumor perfusion patterns from preplanning HAPS analyses are useful for estimating tumor uptake of 90Y, they may not reliably predict hepatic treatment response, as patients with different perfusion patterns can show clinical response to SIRT.

Trans-Arterial Radioembolization with Yttrium-90 of Unresectable and Systemic Chemotherapy Resistant Hepatoblastoma in Three Toddlers.

The aim of this short communication was to report the results of transarterial radioembolization (TARE) with Yttrium-90 (Y90) loaded resin microspheres in three toddlers with unresectable and systemic chemotherapy-resistant HB hepatoblastoma (HB). Six TARE procedures were performed on the patients. The dose required for treatment was calculated using partition model. Administered doses of Y90 were 1.369, 0.851, and 1.147 GBq. Complete radiological response in two patients and partial response enabling liver resection in one patient were achieved. Neither life-threatening nor minor complications developed after the treatment. These results demonstrates that HB is a radiosensitive neoplasm, and TARE-Y90 can be used as the primary, neoadjuvant and palliative treatment method in patients with unresectable and systemic chemotherapy-resistant HBs. However, studies with higher number of patients and long-term results are required.

The importance of anatomical localization of non-small cell lung carcinoma in predicting mediastinal lymph node metastasis.

Bronchopulmonary segmental location of non-small lung carcinomas is closely related to metastatic lymph node foci in the mediastinum. Our aim was to investigate the relationship between the anatomical locations of pulmonary masses on the bronchopulmonary segmental base and metastatic lymph node regions in non-small cell lung cancer using preoperative 18F-FDG PET/CT images. Ninety patients newly diagnosed with non-small cell lung carcinoma and referred to PET/CT imaging for staging were included in the study. Tumoral masses that could be evaluated visually and mediastinal node metastases were identified in 18F-FDG PET/CT images, then the relationship between them was investigated statistically. The diagnostic power of 18F-FDG PET/CT of mediastinal nodes was also revealed. Seventy-four males (82.2%) and sixteen females (17.8%) were enrolled in the study. Half of the patients were diagnosed as adenocarcinoma (50%). Investigation of the tumor location and mediastinal metastatic nodes revealed a statistically significant relationship between the apicoposterior segment of the left superior lobe and the left upper and lower paratracheal, subaortic, paraaortic, and left hilar regions according to the IASLC map. The sensitivity, specificity and accuracy of 18F-FDG PET/CT in the mediastinal nodes were 69.2%, 66.6%, and 68%, respectively. There was no statistically significant relationship between tumor location and 8th TNM Stage. Anatomical locations of non-small cell lung carcinomas can affect the disease stage and prognosis because of their tendency to metastasize to some mediastinal regions. However, this relationship needs to be investigated in larger study groups.

Should tall cell thyroid cancers be evaluated differently from well-differentiated thyroid cancers?

OBJECTIVE: In this study, we aimed to investigate the clinical features of Papillary thyroid carcinoma(PTC) Tall cell variant(TCV), long-term outcomes and surgical experience in papillary thyroid carcinoma. MATERIAL-METHOD: 33 patients who were operated in our clinic between August 2012 and March 2018 and diagnosed as TCV in their pathology evaluation were included in the study. The demographic and clinical features of the patients, pathological features of the tumor and long-term results were examined. RESULTS: A total of 33 patients were included in our study. The mean age was 55.2(18-85) years. The female sex was more dominant (75.8%). The most common presenting complaint was swelling in the neck (75.7%).Total thyroidectomy was performed in 84.8% and completion thyroidectomy after lobectomy was performed in 15.2%. Neck dissection was performed in 33% of the patients. The mean tumor diameter was 3.6 (1-10) cm. The tumor was multifocal in 36.3% of the patients. The capsule invasion rate of the tumors was present in 69.7% of the patients, extrathyroidal rate was 39.4%, Metastatic lymph nodes were detected in 30.3% of the cases. The mean follow-up duration was 39.3+22.4(5.25-78.63) months. 39.4% of patients had distant metastasis during follow-up. Disease free survival rate was 57.6%, total survival was 42.4 + 3.8 (34.7-50.0) months. CONCLUSION: TCV is closely associated with larger tumor diameter, multifocal location, extrathyroidal spread and lymph node involvement, We believe that more aggressive surgery should be performed in the treatment of TCV cases and it is important to follow up the patients more closely. KEY WORD: Esophagus cancer, Neutrophil/lymphocyte ratio, Preoperative lymphocyte /neutrophil ratio, Prognosis.

The efficacy of 18F-FDG PET/CT in the preoperative evaluation of pancreatic lesions.

PURPOSE: Since the treatment strategy for benign and malignant pancreatic lesions differ, we aimed to evaluate the clinical value of PET/CT in the diagnosis and management of pancreatic lesions. METHODS: Ninety patients who had a histologically confirmed pancreatic lesion were studied. Receiver operating characteristic (ROC) curve analysis was used to investigate the ability of PET/CT to differentiate malignant lesions from benign tumors. RESULTS: The malignant and benign groups comprised 64 and 26 patients, respectively. Despite the similarity in the size of primary tumors (P = 0.588), the mean maximum standardized uptake values (SUVmax) obtained from PET/CT imaging were significantly higher in malignant lesions (9.36 ± 5.9) than those of benign tumors (1.04 ± 2.6, P < 0.001). ROC analysis showed that the optimal SUVmax cutoff value for differentiating malignant lesions (to an accuracy of 91%; 95% confidence interval, 83%-98%) from benign tumors was 3.9 (sensitivity, 92.2%; specificity, 84.6%). CONCLUSION: PET/CT evaluation of pancreatic lesions confers advantages including fine assessment of malignant potential with high sensitivity and accuracy using a threshold SUVmax value of 3.9.

A prospective comparative study of ultrasonography, contrast-enhanced MRI and 18F-FDG PET/CT for preoperative detection of axillary lymph node metastasis in breast cancer patients.

AIM: We aimed to evaluate; (i) the accuracy of ultrasonography (US), contrast-enhanced magnetic resonance imaging (cMRI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for detection of axillary lymph node metastases (ALNMs), (ii) the role of late prone imaging, and (iii) the effect of PET/CT on preoperative staging of breast cancer. MATERIAL AND METHODS: From June 2015 to January 2019, 236 breast cancer patients were preoperatively exam ined using US, cMRI, and PET/CT and whom underwent pathological evaluations of axillary lymph nodes were analyzed. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy (ACC) of US, cMRI, and PET/CT for ALNMs were determined. RESULTS: There were 235 female and one male in our study. The mean age was 55,6±11,3 years. Of 158 patients who were histopathologically evaluated, 85 patients (36%) were negative and 73 patients (30.9%) were positive for ALNMs. The remaining 78 patients who were only radiologically evaluated with US and/or cMRI, 24 patients (10.2%) were negative and 54 patients (22.9%) were positive for ALNMs. The sensitivity, specificity, PPV, NPV, and ACC of PET/CT were 80.0%, 92.2%, 92.0%, 80.3%, and 85.7%, re spectively. The axillary lymph node, which was suspicious in supine imaging, remained in the suspicious group again in prone imaging in PET/CT. CONCLUSIONS: There is no single absolute modality for de tecting ALNMs in breast cancers to replace sentinel lymph node biopsy or axillary lymph node dissection. If ALNM is suspected based on PET/CT, axillary lymph node dissection without sentinel lymph node biopsy might be a better option because it is related to high possibilities of ALNM. KEY WORDS: Axillary lymph node metastasis, Magnetic resonance imaging, Ultrasonography, 18F-FDG PET/CT.

A prospective comparative study of contrast-enhanced CT, contrast-enhanced MRI and 18F-FDG PET/CT in the preoperative staging of colorectal cancer patients.

AIM: In patients with colorectal cancer an accurate diagnostic work-up is mandatory in order to perform the most specific treatment. In this study, we aimed to evaluate the accuracy of computed tomography (CT), magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for detection of regional lymph node metastases (RLNMs) and the additional value of PET/CT in the preoperative staging of colorectal cancer. MATERIAL AND METHODS: From June 2015 to May 2018, 72 colorectal cancer patients were preoperatively examined using CT, MRI, and PET/CT. Histopathological examination of regional lymph nodes were performed in 53 patients who underwent colorectal surgery. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy (ACC) of CT, MRI, and PET/CT for RLNMs, and the additional value of PET/CT in distant metastases were determined. RESULTS: There were 44 male and 28 female in our study. The mean age was 61±11 years. Histopathologically, 27 patients (51%) were negative and 26 patients (49%) were positive for RLNMs. The sensitivity, specificity, PPV, NPV, and ACC of PET/CT were 88.5%, 59.3%, 67.6%, 84.2%, and 73.6%, respectively. PET/CT changed the patient management with diagnostic contribution to the suspicious lesions identified by radiological imaging modalities. CONCLUSION: PET/CT is a useful tool in the evaluation of colorectal cancer, and it allows to metabolically characterize undetermined lesions suspected for recurrence of disease, to perform a complete pre-surgical staging and to identify occult metastatic disease. PET/CT should be considered an essential diagnostic tool in the management of patients with colorectal cancer, especially in the preoperative staging. KEY WORDS: Colorectal Cancer, Computed tomography, Magnetic resonance imaging, Positron emission tomography.

Splenogonadal Fusion in Children: A Rare Entity Mimicking Inguinal Tumor.

Splenogonadal fusion (SGF) is a rare congenital malformation, which can be of a continuous or discontinuous type. It is characterized by splenic tissue fused with gonadal tissue. Because it lacks characteristic features, very few cases of SGF have been diagnosed preoperatively. Herein, we present a case with left side SGF who was diagnosed by Tc-nanocolloid spleen scintigraphy.

Performance of Positron Emission Tomography-Computed Tomography and Bone Marrow Biopsy in Detecting Bone Marrow Infiltration in Lymphoma Cases

Objective: Bone marrow infiltration (BMI) affects the stage diagnosis, and treatment of lymphoma. We aimed to evaluate the performance of bone marrow biopsy (BMB) and positron emission tomography-computed tomography (PET/CT) in detecting BMI in lymphoma patients. Materials and Methods: A total of 269 non-Hodgkin's lymphoma (NHL) and 110 Hodgkin's lymphoma (HL) patients were evaluated retrospectively. Sensitivity, negative predictive value (NPV), and accuracy were calculated for PET/CT and BMB in detecting BMI.ensitivity, negative predictive value (NPV) and accuracy were calculated for PET/CT and BMB in detecting BMI. Results: Sensitivity, NPV, and accuracy for PET/CT in detecting BMI in NHL cases were 65%, 78%, and 84.4%, respectively, while they were 55%, 73.4%, and 79.9% for BMB. PET/CT performance for diffuse large B-cell lymphoma and follicular lymphoma was better than that of BMB, whereas the performance of BMB was better for mantle-cell lymphoma, Burkitt's lymphoma, and primary mediastinal B-cell lymphoma. Sensitivity, NPV, and accuracy for PET/CT in HL cases were 91.3%, 97.75%, and 98.18%, respectively, while they were 56.52%, 89.69%, and 90.91% for BMB. Due to BMB, 43 (15.9%) patients in the NHL group and 2 (1.8%) patients in the HL group were protected from downstaging. Conclusion: Although their results vary according to NHL subtypes, PET/CT and BMB are complementary methods in determining BMI. In HL, PET/CT is an important diagnostic tool for detecting BMI, and BMB is not necessary in a significant proportion of cases.

The role and effect of FDG-PET/CT on patient management and restaging of bladder carcinoma.

OBJECTIVE: To compare the diagnostic role of Florine-18 2-fluoro-2-deoxy-D-glucose-Positron emission tomography/computed tomography (FDG-PET/CT) in the restaging of bladder cancer with other radiological methods and to determine its effect on the treatment management of patients with bladder cancer. MATERIAL AND METHODS: A total of 83 patients who showed suspicious lesions with radiologic methods and FDG-PET/CT images were enrolled in the study. Positive lesion sites were detected and compared in all imaging modalities. Positive lesions were confirmed by biopsy or serial radiological imaging. Furthermore, the rate of change of the management and treatment modalities of patients after FDG-PET/CT were noted. RESULTS: The most frequent metastasis was observed in lymphatic localizations in all imaging methods. Lymph node metastases was detected with FDG-PET/CT in 37/83 patients, with computed tomography in 28/80 patients, and with magnetic resonance imaging in 6/19 patients. Lymph node metastasis was detected most commonly in the pelvic region with all modalities. Following lymphatic localization in FDG-PET/CT and CT, metastases were found most frequently in the lung and bone regions. FDG-PET/CT also revealed 8 of the 12 local lesions that were detected by radiological methods and showed additional lesions in four patients that could not be demonstrated by radiological methods. FDG-PET/CT changed the treatment approaches in 34.9% (29/83) of patients. In 16 patients, it caused upstaging and commencement of advanced treatment methods. In 13 patients, malignancy was excluded in suspicious lesions and unnecessary advanced examination and treatment were avoided. FDG-PET/CT also caused three radical cystectomies, one partial cystectomy, and one urethrectomy in patients who had not undergone any operational procedure previously. CONCLUSION: Despite physiological urinary tract uptake, FDG-PET/CT is superior to other imaging modalities not only in distant localizations but also in evaluating pelvic lesions and lymph nodes. In addition, the use of FDG-PET/CT during the restaging process contributes to the management of maximum number of patients.

Diagnostic efficacy of 18F-FDG PET/CT in patients with adrenal incidentaloma.

BACKGROUND: The management of adrenal incidentaloma is still a challenge with respect to determining its functionality (hormone secretion) and malignancy. In this light, we performed 18F-FDG PET/CT scan to assess the SUVmax values in different adrenal masses including Cushing syndrome, pheochromocytoma, primary hyperaldosteronism and non-functional adrenal adenomas. METHODS: Total 109 (73 F, 36 M) patients with adrenal mass (incidentaloma), mean age of 53.3 ± 10.2 years (range, 24-70) were screened by 18F-FDG PET/CT. Data of 18F-FDG PET/CT imaging of the patients were assessed by the same specialist. Adrenal masses were identified according to the calculated standardized uptake values (SUVs). Clinical examination, 24-h urine cortisol, catecholamine metabolites, 1-mg dexamethasone suppression test, aldosterone/renin ratio and serum electrolytes were analyzed. RESULTS: Based on the clinical and hormonal evaluations, there were 100 patients with non-functional adrenal mass, four with cortisol-secreting, four with pheochromocytomas and one with aldosterone-secreting adenoma. Mean adrenal mass diameter of 109 patients was 2.1 ± 4.3 (range, 1-6.5 cm). The 18F-FDG PET/CT imaging of the patients revealed that lower SUVmax values were found in non-functional adrenal masses (SUVmax 3.2) when compared to the functional adrenal masses including four with cortisol-secreting adenoma (SUVmax 10.1); four with pheochromcytoma (SUVmax 8.7) and one with aldosterone-secreting adenomas (SUVmax 3.30). Cortisol-secreting (Cushing syndrome) adrenal masses showed the highest SUVmax value (10.1), and a cut-off SUVmax of 4.135 was found with an 84.6% sensitivity and 75.6% specificity cortisol-secreting adrenal adenoma. CONCLUSIONS: Consistent with the similar studies, non-functional adrenal adenomas typically do not show increased FDG uptake and a certain form of functional adenoma could present various FDG uptake in FDG PET/CT. Especially functional adrenal adenomas (cortisol secreting was the highest) showed increased FDG uptake in comparison to the non-functional adrenal masses. Therefore, setting a specific SUVmax value in the differentiation of malignant adrenal lesion from the benign one is risky and further studies, including a high number of functional adrenal mass are needed.

Unexpected Hepatic Uptake of Tc-99m-MAA in Lung Perfusion Scintigraphy in a Patient with End-stage Renal Disease

Extra-pulmonary accumulation of Tc-99m-macroaggregated albumin (MAA) is described as uptake areas out of the lung in perfusion scintigraphy. If the particles spread throughout the body before reaching the lung via venous collaterals or due to right-to-left shunt, or if the particles are too small to occlude the pulmonary capillaries, then the agent can be seen at different locations of the body. Extra-pulmonary accumulation of Tc-99m-MAA can be detected mostly in the liver as well as in the brain, kidney, thyroid, myocardium, spleen and vertebra. Herein, we present lung scanning images with unexpected hepatic accumulation of Tc-99m-MAA. This pulmonary perfusion scintigraphy was performed in a patient with end-stage renal disease due to dyspnea in the post-operative period of kidney transplantation

Prognostic significance of neutrophil/lymphocyte ratio (NLR) and correlation with PET-CT metabolic parameters in small cell lung cancer (SCLC).

PURPOSE: The aim of this study is to detect the prognostic significance of neutrophil/lymphocyte ratio (NLR) in SCLC and to evaluate the relation with 18F-FDG PET-CT metabolic parameters (PET-CT MPs). METHODS: Demographic parameters, laboratory values including NLR and other clinical variables were analyzed in 112 patients with small cell lung cancer (SCLC) and 54 of these patients had results of metabolic parameters detected with 18 FDG PET-CT [including SUVmax, SUVmean, metabolic tumor volume (MTV), whole body MTV (WBMTV), TLG (total lesion glycolysis), whole body TLG (WBTLG)] were evaluated for survival analyses. RESULTS: Mean and median overall survival (OS) and progression-free survival (PFS) were found to be significantly longer in cases with NLR < 4 compared with NLR > 4 in totally. Also stage, performance status, response to first-line therapy, LDH, and lymphocyte count were found to be prognostic for OS and PFS. MTV, WBMTV and WBTLG were found to be prognostic for both OS and PFS, while SUVmax found to be significant for OS. Patients with NLR ≥ 4, MTV ≥ 60.1, WBMTV ≥ 120 and WBTLG ≥ 1000 points had lower OS and PFS. A moderate positive correlation was found between NLR and SUVmean (r: 0.36), SUVmax (r: 0.34), TLG (r: 0.39), MTV (r: 0.51), WBMTV (r: 0.40), and WBTLG (r: 0.46). CONCLUSION: There is relationship between PET-CT metabolic parameters and NLR in SCLC. Highest correlation was found with NLR and MTV, WBMTV, and WBTLG, and evaluation of NLR together with these parameters predicts survival times and tumor biology more clearly in SCLC.

Super Scan Caused by Parathyroid Carcinoma Observed Both in18F-FDG PET/CT Scan and Tc-99m MDP Bone Scintigraphy.

Super scan is a well-known finding described in skeletal scintigraphy characterized by uniform symmetrically increased radiopharmaceutical uptake by bones and consequently diminished renal parenchymal activity. Sy et al. hypothesized that the faint visualization of renal cortex in bone scintigraphy might be the result of increased uptake of radiopharmaceutical by pathologic bones and reduced phosphate excretion. The super scan on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has been observed in various conditions such as prostate cancer, lung cancer, renal adenocarcinoma, gastric cancer and primitive neuroectodermal tumor of the kidney. Herein we report the first case of super scan in a 68-year-old-woman with parathyroid carcinoma observed both in 18F-FDG PET/CT and Tc-99m methylene diphosphonate bone scintigraphy. There were extensive hypermetabolic lesions throughout the skeleton in 18F-FDG PET/CT. In contrast to the intense hypermetabolism of the skeleton; the liver, skeletal muscles of the limbs, mediastinum, bowel and especially the brain showed very low FDG uptake. Additionally, there was increased skeletal radiotracer uptake relative to soft tissue, and faint genitourinary tract activity in bone scintigraphy.

Evaluation of vascularized graft reconstruction of the mandible with Tc-99m MDP bone scintigraphy.

AIM: The aim of this study was to evaluate the value of bone scintigraphy for the assessment of graft viability following vascularized bone grafts in patients with mandibular reconstruction. METHODS: We investigated 16 patients with vascularized grafts from the fibula (13 patients) and iliac crest (3 patients) in the last 8 years. For the follow up of all these patients, Tc-99m MDP bone scintigraphy was performed between 2-10 days postoperatively. SPECT study was included in 5 patients. For the evaluation of the grafts, a six-grade scoring system was used. The grading system was based on a comparison of tracer uptake between graft and the cranium. The uptake was defined as increasing from grade 6 to grade 1. RESULTS: Thirteen of the 16 grafts had an uncomplicated clinical course. Complications in the graft occurred in three patients. In the analysis of planar scintigrams, patients with uncomplicated healing showed increased uptake in 12 of the 13 grafts (grade 1-3) and 1 showed the same level tracer uptake compared to cranium (grade 4). In the failed 3 grafts, decreased uptake was observed (grade 5 and 6). In 5 patients, SPECT was performed in addition to planar imaging. In these patients, 4 of the 5 grafts had an uncomplicated clinical course and 1 had a complicated one. In the analysis of SPECT images, while all the grafts with an uncomplicated clinical course exhibited increased uptake (grade 1-3), the failed graft showed decreased uptake (grade 6). CONCLUSION: Three-phase bone scintigraphy performed within 10 days after the mandibular reconstruction is a useful tool to monitor the viability and early complications of vascularized mandibular bone grafts. SPECT is also recommended. It may contribute to interpretation of the bone scans and to precise assessment of graft viability.

Role of technetium-99m N,N-ethylenedicysteine renal scintigraphy in the evaluation of differential renal function and cortical defects.

PURPOSE: This study was performed to evaluate the effectiveness of technetium-99m N,N-ethylenedicysteine (Tc-99m EC) in comparison to technetium-99m dimercaptosuccinic acid (Tc-99m DMSA) scintigraphy. Differential renal function (DRF) was calculated by both methods and the cortical-phase images of dynamic Tc-99m EC scintigraphy were evaluated for parenchymal defects. MATERIALS AND METHODS: A total of 62 patients with various kidney disorders ranging in age from 1 to 44 years underwent both Tc-99m DMSA and Tc-99m EC scintigraphy. Tc-99m EC summed images of the cortical phase and Tc-99m DMSA images were evaluated visually and quantitatively. Visual analysis was used to define renal parenchymal abnormalities. Quantitative analysis was used in the calculation of DRF. The Tc-99m DMSA scan was taken as the gold standard, and the summed Tc-99m EC scan findings were compared against it. RESULTS: The images obtained with Tc-99m DMSA and Tc-99m EC scintigraphy revealed 99 and 97 focal defects, respectively. The 2 renal parenchyma defects located in the ventral middle sections remained undetected with Tc-99m EC scintigraphy. DRF of the kidneys in each patient was compared using both radiopharmaceuticals. Highly positive correlation between the differential function of these 2 investigations was found (R = 0.91, P = 0.001). The values of mean DRF of the left kidney on Tc-99m EC and Tc-99m DMSA images were 45.8 +/- 19.1 and 45.0 +/- 20.4, respectively. There were no significant differences (P > 0.05). CONCLUSION: This study suggests that although Tc-99m DMSA scintigraphy remains the gold standard method for evaluating parenchymal abnormalities, Tc-99m EC scintigraphy can be a reliable single-modality study to evaluate renal cortical defects, DRF, perfusion, drainage of the urinary system, and indirect evidence of vesicoureteric reflux with the added advantage of low radiation exposure to the patient.

Effectiveness of diuretic injection on the measurement of differential renal function using Tc-99m DMSA in patients with a dilated renal pelvis.

AIM: The aim of this study was to evaluate the effectiveness of diuretic injection for the measurement of differential renal function (DRF) with technetium-99m dimercaptosuccinic acid (Tc-99m DMSA) scintigraphy in patients with a dilated pelvis. MATERIALS AND METHODS: A total of 46 patients who were referred for both technetium-99m-L,L-ethylenedicysteine (Tc-99m L,L-EC) and Tc-99m DMSA imaging and found to have a dilated collecting system on Tc-99m EC scintigraphy were studied. Four to 5 hours after intravenous injection of Tc-99m DMSA, imaging was performed in the supine position, and posterior, anterior, left and right lateral, and left and right posterior oblique views were taken. After this study, furosemide was administered intravenously and 30 minutes later, additional images in the anterior and posterior views were obtained. RESULTS: The kidneys were evaluated into 2 groups. Group 1 comprised 12 kidneys that had an obstructive curve pattern on Tc-99m EC scans. Group 2 comprised 34 kidneys that had a nonobstructive dilated renogram curve pattern. DRF of the kidneys in each patient were calculated, and the values obtained from the standard and diuretic DMSA scans were compared with each other for all patients and each group. Considering all the patients, the values of mean DRF on both standard and diuretic DMSA images were 55.4%+/-21.2% and 55.4%+/-21.5%, respectively. There were no significant differences between DRF values of each kidney obtained by the 2 methods. When we compared the DRF values in groups 1 and 2, there were again no significant differences. In group 1, the values of mean DRF on standard and diuretic images were 51.7%+/-13.7% and 51.6%+/-13.9%, respectively, and in group 2, the values of mean DRF were 56.7%+/-23.4% and 56.7%+/-23.6%, respectively. CONCLUSION: In view of our study, diuretic administration seems to be an unnecessary intervention because it has no effect on the accuracy of DRF measurements using DMSA scintigraphy in patients with a dilated collecting system whether it is obstructed or not.