The role of CD98 heavy chain in cancer development.

The glycoprotein CD98, or CD98 heavy chain (CD98hc), encoded by the SLC3A2 gene, plays a crucial role in cancer development and progression. CD98hc, forming heterodimeric complexes with various light chains, regulates neutral amino acid transport across cell membranes. The intricate interplay between CD98hc, integrins, and amino acid transporters shapes the tumor microenvironment and contributes to tumor growth. Elevated expression of CD98hc in various cancers correlates with poor prognosis, making it a potential prognostic marker. In colorectal cancer, CD98hc emerges as a potential therapeutic target, along with its partner LAT1, and inhibitors like JPH203 exhibit promise in preclinical studies. Targeting CD98hc/LAT1, alone or with conventional therapies, shows promise in inhibiting tumor growth. This review focuses on elucidating the multifaceted roles of CD98hc and its partner LAT1 in cancer, particularly its involvement in amino acid transport, signaling pathways, and its prognostic relevance in cancer.

Effects of alcohols and dissolved gases on sonochemical generation of hydrogen in a 300 kHz sonoreactor.

The sonochemical generation of hydrogen (H2) was investigated using various water/alcohol solutions under argon (Ar) 100 % in a 300 kHz sonoreactor. Five types of alcohols-methanol, ethanol, isopropanol, n-propanol, and n-butanol-were used at various concentrations (0 - 100 % v/v). The H2 generation rate in water was 0.31 µmol/min in the absence of alcohols. The H2 generation rate increased, peaked, and then decreased as the alcohol concentration increased. The concentrations used for the peak H2 generation were 5 %, 1 %, 0.5 %, 0.5 %, and 0.1 % for methanol, ethanol, isopropanol, n-propanol, and n-butanol, respectively. The highest generation rate (5.46 µmol/min) was obtained for methanol 5 % among all conditions in this study, and no H2 was detected for 100 % alcohol concentrations. The reason for the enhancement of the sonochemical H2 generation by the addition of alcohols might be due to strong scavenging effect of alcohols for sonochemically generated oxidizing radicals and vigorous reactions of alcohol molecules and their derivatives with H radicals. No significant correlations were found between the H2 generation rates and physicochemical properties of the alcohols in any of the data in this study. As alcohol concentration increased, the calorimetric power decreased. This indicates that the calorimetric power does not represent the degree of sonochemical reactions in the water/alcohol mixtures. The effect of oxygen (O2) content in the dissolved gases on the generation of H2O2 (representing sonochemical oxidation activity) and H2 (representing sonochemical reduction activity) was investigated using Ar/O2 mixtures for water, methanol 5 % and n-propanol 0.5 %. In water, the highest H2O2 generation was obtained for Ar/O2 (50:50), which is similar to previous research results. However, the H2O2 generation increased as the O2 content increased. In addition, H2 generation decreased as the O2 content increased under all liquid conditions (water, methanol, and n-propanol).

Case Report: Acute Kidney Injury Due to Chronic Milk-Alkali Syndrome in a Patient With Colon Cancer.

BACKGROUND: Common causes of hypercalcemia include primary hyperparathyroidism and paraneoplastic syndrome of malignancy. Because of this, physicians can easily miss extrinsic causes of hypercalcemia such as milk-alkali syndrome in patients with cancer. We successfully treated a case of acute kidney injury due to severe hypercalcemia caused by milk-alkali syndrome due to long-term milk drinking in a patient with colon cancer. CASE DESCRIPTION: A 62-year-old man was referred to nephrology for hypercalcemia and azotemia that was found during preoperative evaluation for colon cancer surgery. The patient had experienced several months of dizziness and anorexia. We started hemodialysis because hypercalcemia and azotemia were not improved despite large amounts of hydration and diuretics. We suspected paraneoplastic syndrome because of concomitant colon cancer and low intact parathyroid hormone (PTH). Renal microcalcifications were observed on ultrasonography. Metastatic calcifications of the lung and stomach were present, but no malignant metastasis appeared on bone scans. There was no evidence of metastatic malignant lesions on chest or abdominal enhanced computed tomography. PTH-related peptide was not detected. Thus, other causes of hypercalcemia beyond malignancy were considered. On history-taking, the patient reported consuming 1,000 to 1,200 mL of milk daily for the prior 3 months. Hypercalcemia was due to chronic milk-alkali syndrome. We advised withdrawal of milk and nutritional pills. Hemodialysis was stopped after 2 weeks since azotemia and hypercalcemia were resolving. Acute kidney injury was improved, and mild hypercalcemia remained when he underwent hemicolectomy after 1 month. Thereafter, serum calcium and creatinine remained normal at discharge and follow-up for 1 year in the outpatient clinic. However, lung calcifications still remained on bone scan after 1 year. CONCLUSIONS: Chronic milk-alkali syndrome is a rare condition resulting from excessive calcium and alkali intake through various routes, like milk, nutritional supplements, and medicines for osteoporosis. Therefore, early management for hypercalcemia should include precise history taking including diet, previous diagnoses, and current medications.

Automated Brain Volumetry in Patients With Memory Impairment: Comparison of Conventional and Ultrafast 3D T1-Weighted MRI Sequences Using Two Software Packages.

BACKGROUND. Isotropic 3D T1-weighted imaging has long acquisition times, potentially leading to motion artifact and altered brain volume measurements. Acquisition times may be greatly shortened using an isotropic ultrafast 3D echo-planar imaging (EPI) T1-weighted sequence. OBJECTIVE. The purpose of this article was to compare automated brain volume measurements between conventional 3D T1-weighted imaging and ultrafast 3D EPI T1-weighted imaging. METHODS. This retrospective study included 36 patients (25 women, 11 men; mean age, 68.4 years) with memory impairment who underwent 3-T brain MRI. Examinations included both conventional 3D T1-weighted imaging using inversion recovery gradient-recalled echo sequence (section thickness, 1.0 mm; acquisition time, 3 minutes 4 seconds) and, in patients exhibiting motion, an isotropic ultrafast 3D EPI T1-weighted sequence (section thickness, 1.2 mm; acquisition time, 30 seconds). The 36-patient sample excluded five patients in whom severe motion artifact rendered the conventional sequence of insufficient quality for volume measurements. Automated brain volumetry was performed using NeuroQuant (version 3.0, CorTechs Laboratories) and FreeSurfer (version 7.1.1, Harvard University) software. Volume measurements were compared between sequences for nine regions in each hemisphere. RESULTS. Volumes showed substantial to almost perfect agreement between the two sequences for most regions bilaterally. However, most regions showed significant mean differences between sequences, and Bland-Altman analyses showed consistent systematic biases and wide limits of agreement (LOA). For example, for the left hemisphere using NeuroQuant, volume was significantly greater for the ultrafast sequence in four regions and significantly greater for the conventional sequence in three regions, whereas standardized effect size between sequences was moderate for four regions and large for one region. Using NeuroQuant, mean bias (ultrafast minus conventional) and 95% LOA were greatest in cortical gray matter bilaterally (-50.61 cm3 [-56.27 cm3, -44.94 cm3] for the left hemisphere; -50.02 cm3 [-54.88 cm3, -45.16 cm3] for the right hemisphere). The variation between the two sequences was observed in subset analyses of 16 patients with and 20 patients without Alzheimer disease. CONCLUSION. Brain volume measurements show significant differences and systematic biases between the conventional and ultrafast sequences. CLINICAL IMPACT. In patients in whom severe motion artifact precludes use of the conventional sequence, the ultrafast sequence may be useful to enable brain volume-try. However, the current conventional 3D T1-weighted sequence remains preferred in patients who can tolerate the standard examination.

Intracranial Cisternal Lipoma Associated with Cerebellar Cortical Dysplasia Diagnosed Using Dixon Technique: A Case Report and a Review of Literature.

BACKGROUND: Intracranial lipomas are very rare congenital malformations. Previous studies have shown various brain anomalies related to intracranial lipomas, most of which are agenesis or dysgenesis of the adjacent structures. To the best of our knowledge, cortical dysplasia related to intracranial lipoma has yet to be reported. CASE REPORT: We present a rare case of intracranial lipoma in the quadrigeminal and superior cerebellar cisterns with combined cerebellar cortical dysplasia. A 43-year-old female underwent brain MRI to identify possible cause of headache. We made a confident diagnosis based on MR findings using Dixon technique, which is a fat-water separation method based on chemical shift. We also identified unique combined abnormalities of the right cerebellar hemisphere near the cisternal lipoma that showed an abnormal vertical orientation of the cerebellar folia and disorganized parenchymal pattern. CONCLUSION: This case exhibits the rareness of the intracranial lipoma related cerebellar cortical dysplasia by reviewing relevant literature and also highlights the usefulness of Dixon techniques in daily clinical practice.

Neurocomputational mechanism of controllability inference under a multi-agent setting.

Controllability perception significantly influences motivated behavior and emotion and requires an estimation of one's influence on an environment. Previous studies have shown that an agent can infer controllability by observing contingency between one's own action and outcome if there are no other outcome-relevant agents in an environment. However, if there are multiple agents who can influence the outcome, estimation of one's genuine controllability requires exclusion of other agents' possible influence. Here, we first investigated a computational and neural mechanism of controllability inference in a multi-agent setting. Our novel multi-agent Bayesian controllability inference model showed that other people's action-outcome contingency information is integrated with one's own action-outcome contingency to infer controllability, which can be explained as a Bayesian inference. Model-based functional MRI analyses showed that multi-agent Bayesian controllability inference recruits the temporoparietal junction (TPJ) and striatum. Then, this inferred controllability information was leveraged to increase motivated behavior in the vmPFC. These results generalize the previously known role of the striatum and vmPFC in single-agent controllability to multi-agent controllability, and this generalized role requires the TPJ in addition to the striatum of single-agent controllability to integrate both self- and other-related information. Finally, we identified an innate positive bias toward the self during the multi-agent controllability inference, which facilitated behavioral adaptation under volatile controllability. Furthermore, low positive bias and high negative bias were associated with increased daily feelings of guilt. Our results provide a mechanism of how our sense of controllability fluctuates due to other people in our lives, which might be related to social learned helplessness and depression.

Prevalence and Clinical Implications of Incidentally Detected Parotid Lesions as Blind Spot on Brain MRI: A Single-Center Experience.

Background and objective: This study was conducted to assess the prevalence and clinical implications of parotid lesions detected incidentally during brain magnetic resonance imaging (MRI) examination. Materials and Methods: Between February 2016 and February 2021, we identified 86 lesions in the brain MRI reports of 84 patients that contained the words "parotid gland" or "PG". Of these, we finally included 49 lesions involving 45 patients following histopathological confirmation. Results: Based on the laboratory, radiological or histopathological findings, the prevalence of incidental parotid lesions was low (1.2%). Among the 45 study patients, 41 (91.1%) had unilateral lesions, and the majority of the lesions were located in the superficial lobe (40/49, 81.6%). The mean size of the parotid lesions was 1.3 cm ± 0.4 cm (range, 0.5 cm-2.8 cm). Of these, 46 parotid lesions (93.9%) were benign, whereas the remaining three lesions were malignant (6.1%). Conclusions: Despite the low prevalence and incidence of malignancy associated with incidental parotid lesions detected on brain MRI, the clinical implications are potentially significant. Therefore, clinical awareness and appropriate imaging work-up of these lesions are important for accurate diagnosis and timely management.

Rosai-Dorfman disease with infiltration of IgG4-bearing plasma cells presenting as laryngeal-nasal masses and cervical lymphadenopathy: A case report.

RATIONALE: Rosai-Dorfman disease (RDD) is a rare and self-limiting condition caused by the non-neoplastic proliferation of histiocytes/phagocytes in the sinusoids of lymph nodes and in extranodal tissues. Of the extranodal involvement, laryngeal involvement is extremely rare. Because of its rarity and nonspecific clinicoradiologic features, RDD is often difficult to differentiate from other benign or malignant lymphoproliferative diseases. We present a case of RDD with infiltration of IgG4-bearing plasma cells manifesting laryngeal and nasal masses with cervical lymphadenopathy. PATIENT CONCERNS: A 45-year-old male patient presented with recurrent epistaxis and airway disturbance. DIAGNOSES: On endoscopy, there were submucosal masses in both nasal cavities and both sides of subglottic larynx. On neck CT, there were well-defined, enhancing soft tissue masses in both nasal cavities and both sides of subglottic larynx, resulting in mild airway narrowing. In addition, multiple enlarged lymph nodes showing homogeneous enhancement were noted in both parotid glands and both internal jugular chains. All lesions demonstrated marked FDG-uptake on PET/CT. Therefore, the initial radiologic differential diagnoses included lymphoma and IgG4-related disease. Biopsy was performed on the nasal and laryngeal lesions, and they revealed RDD with infiltration of IgG4-bearing plasma cells. INTERVENTION: The patient underwent surgical resection of the masses in the nasal cavity and larynx to relieve airway narrowing. OUTCOMES: After surgery, airway obstruction was much improved and the patient was asymptomatic. On outpatient follow-up, he exhibited a stable condition and had no dyspnea on exercise. LESSONS: Clinical awareness and suspicion are important for the accurate diagnosis and management of patients with homogeneous masses in the larynx or nasal cavity, even if there is no combined cervical lymphadenopathy.

Epstein-Barr virus-positive diffuse large B-cell lymphoma with human immunodeficiency virus mimicking complicated frontal sinusitis: A case report.

BACKGROUND: Primary non-Hodgkin's lymphoma of the frontal sinus is extremely rare. In addition, Epstein-Barr virus (EBV) has been reported to play a role in the development of human immunodeficiency virus (HIV)-related malignant lymphomas. To the best of our knowledge, there is no report for the HIV-associated, EBV-positive primary diffuse large B-cell lymphoma (DLBCL) in the frontal sinus. CASE SUMMARY: We present a unique case of HIV-associated, EBV-positive DLBCL in the frontal sinus in a 46-year-old man. Computed tomography of paranasal sinuses revealed dense opacification of the right frontal sinus with combined soft tissue swelling. Based on the clinical and radiological findings, the initial diagnosis was complicated frontal sinusitis, presenting Pott's puffy tumor. Unexpectedly, HIV testing was positive on preoperative laboratory test, and the frontal sinus lesion was confirmed as EBV-positive DLBCL on biopsy. CONCLUSION: Through this article, we suggest that EBV-positive DLBCL should be considered as possible diagnosis for patients with nonspecific space-occupying lesion of the paranasal sinuses. We also highlight an importance of clinical suspicion in diagnosing HIV infection because HIV serology is not routinely tested in patients with paranasal sinus problem.

Cervical Lymph Nodes Detected by F-18 FDG PET/CT in Oncology Patients: Added Value of Subsequent Ultrasonography for Determining Nodal Metastasis.

Background and Objectives: To investigate the diagnostic performance of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and subsequent ultrasonography (US) for determining cervical nodal metastasis in oncology patients. Materials and Methods: Fifty-nine cervical lymph nodes (LNs) initially detected by PET/CT with subsequent neck US were included in this retrospective study. All LNs were subjected to US-guided fine-needle aspiration or core needle biopsy. The maximum standardized uptake value (SUVmax) and sonographic features were assessed. Results: Forty-three of 59 cervical LNs detected by PET/CT were malignant. PET/CT alone showed a highest diagnostic value for metastatic LNs with 81.4% sensitivity, 68.8% specificity, and 78% accuracy when SUVmax ≥5.8 was applied as an optimal cut-off value. Combined PET/CT and subsequent US diagnoses for determining nodal metastasis showed the following diagnostic performance: 81.4% sensitivity, 87.5% specificity, and 83.1% accuracy. There was a significant difference in the diagnostic performance between the two diagnostic imaging approaches (p = 0.006). Conclusions: Combined diagnosis using subsequent US showed a significantly higher diagnostic performance for determining nodal metastasis in the neck. Therefore, we believe that our proposed diagnostic strategy using subsequent US can be helpful in evaluating cervical LNs on PET/CT. Moreover, our results clarify the need for US-guided tissue sampling in oncology patients.

Risk Stratification for Avascular Necrosis of the Femoral Head After Internal Fixation of Femoral Neck Fractures by Post-Operative Bone SPECT/CT.

PURPOSE: Avascular necrosis (AVN) of the femoral head is a major complication after internal fixation of a femoral neck fracture and determines the functional prognosis. We investigated postoperative bone single-photon emission computed tomography/computed tomography (SPECT/CT) for assessing the risk of femoral head AVN. METHODS: We retrospectively reviewed 53 consecutive patients who underwent bone SPECT/CT within 2 weeks of internal fixation of a femoral neck fracture and follow-up serial hip radiographs over at least 12 months. RESULTS: Nine patients developed femoral head AVN. In 15 patients who showed normal uptake on immediate postoperative SPECT/CT, no AVN occurred, whereas 9 of 38 patients who showed cold defects of the femoral head later developed AVN. The negative predictive value of immediate postoperative SPECT/CT for AVN was 100 %, whereas the positive predictive value was 24 %. Among 38 patients with cold defects, 1 developed AVN 3 months postoperatively. A follow-up bone SPECT/CT was performed in the other 37 patients at 2-10 months postoperatively. The follow-up bone SPECT/CT revealed completely normalized femoral head uptake in 27, partially normalized uptake in 8, and persistent cold defects in 2 patients. AVN developed in 3.7 % (1/27), 62.5 % (5/8), and 100 % (2/2) of each group, respectively. CONCLUSIONS: According to the time point of imaging, radiotracer uptake patterns of the femoral head on postoperative bone SPECT/CT indicate the risk of AVN after internal fixation of femoral neck fractures differently. Postoperative bone SPECT/CT may help orthopedic surgeons determine the appropriate follow-up of these patients.

Comparison of Diagnostic Performance Between Visual and Quantitative Assessment of Bone Scintigraphy Results in Patients With Painful Temporomandibular Disorder.

This retrospective clinical study was performed to evaluate whether a visual or quantitative method is more valuable for assessing painful temporomandibular disorder (TMD) using bone scintigraphy results.In total, 230 patients (172 women and 58 men) with TMD were enrolled. All patients were questioned about their temporomandibular joint (TMJ) pain. Bone scintigraphic data were acquired in all patients, and images were analyzed by visual and quantitative methods using the TMJ-to-skull uptake ratio. The diagnostic performances of both bone scintigraphic assessment methods for painful TMD were compared.In total, 241 of 460 TMJs (52.4%) were finally diagnosed with painful TMD. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the visual analysis for diagnosing painful TMD were 62.8%, 59.6%, 58.6%, 63.8%, and 61.1%, respectively. The quantitative assessment showed the ability to diagnose painful TMD with a sensitivity of 58.8% and specificity of 69.3%. The diagnostic ability of the visual analysis for diagnosing painful TMD was not significantly different from that of the quantitative analysis.Visual bone scintigraphic analysis showed a diagnostic utility similar to that of quantitative assessment for the diagnosis of painful TMD.

Relation Between F-18 FDG Uptake of PET/CT and BRAFV600E Mutation in Papillary Thyroid Cancer.

BRAFV600E mutation and F-18 fluorodeoxyglucose (FDG) uptake are potential prognostic factors of papillary thyroid cancer (PTC). This study was performed to investigate the relationship between the BRAFV600E mutation and F-18 FDG uptake in PTC.We retrospectively included 169 PTC patients who underwent F-18 FDG positron emission tomography/computed tomography (PET/CT) before thyroidectomy from May 2009 to August 2012. Subjects were classified into overt PTC (>1 cm, n = 76) and papillary thyroid microcarcinoma (PTMC, n = 93) groups. Univariate and multivariate analyses were performed to assess the relationship between maximum standardized uptake value (SUVmax) of the primary tumors and clinicopathologic variables.The BRAFV600E mutation was detected in 82.2% (139/169). In all subjects, the BRAFV600E mutation and tumor size were independently related to SUVmax by multivariate analysis (P = 0.048 and P < 0.001, respectively). SUVmax was significantly higher in tumors with the BRAFV600E mutation than in those with wild-type BRAF (9.4 ± 10.9 vs 5.0 ± 4.1, P < 0.001). Similarly, in overt PTC group, the BRAFV600E mutation and tumor size were independently correlated with SUVmax (P = 0.032 and P = 0.001, respectively). By contrast, in PTMC group, only tumor size was significantly associated with SUVmax (P = 0.010). The presence of the BRAFV600E mutation is independently associated with high F-18 FDG uptake on preoperative PET/CT in patients with overt PTC, but this relationship was not evident in PTMC. This study provides a better understanding of the relationship between F-18 FDG uptake and BRAFV600E mutation in patients with PTC.

Physiologic facial muscle uptake on 18F-FDG PET/CT by chewing-like habitual movement in patient with Sjögren syndrome.

An 84-year-old female patient with known Sjögren syndrome underwent 18F-FDG PET/CT to detect recurrence of uterine cervix cancer. Sjögren syndrome is autoimmune disease that typically produces symptoms of dry mouth and eyes. We report a case of physiologic 18F-FDG uptake on facial muscles by chewing-like habitual movement, which was confused with salivary retention at first. The physiologic FDG uptake in oral cavity and facial muscles has to be reviewed carefully not to be confused with abnormal uptake.

Significance of Salivary Gland Radioiodine Retention on Post-ablation (131)I Scintigraphy as a Predictor of Salivary Gland Dysfunction in Patients with Differentiated Thyroid Carcinoma.

PURPOSE: We investigated whether (131)I whole-body scintigraphy could predict functional changes in salivary glands after radioiodine therapy. METHODS: We evaluated 90 patients who received initial high-dose (≥3.7 GBq) radioiodine therapy after total thyroidectomy. All patients underwent diagnostic (DWS) and post-ablation (TWS) (131)I whole-body scintigraphy. Visual assessment of salivary radioiodine retention on DWS and TWS was used to divide the patients into two types of groups: a DWS+ or DWS- group and a TWS+ or TWS- group. Salivary gland scintigraphy was also performed before DWS and at the first follow-up visit. Peak uptake and %washout were calculated in ROIs of each gland. Functional changes (Δuptake or Δwashout) of salivary glands after radioiodine therapy were compared between the two groups. RESULTS: Both peak uptake and the %washout of the parotid glands were significantly lower after radioiodine therapy (all p values <0.001), whereas only the %washout were significantly reduced in the submandibular glands (all p values <0.05). For the parotid glands, the TWS+ group showed larger Δuptake and Δwashout after radioiodine therapy than did the TWS- group (all p values <0.01). In contrast, the Δuptake and Δwashout of the submandibular glands did not significantly differ between the TWS+ and TWS- groups (all p values >0.05). Likewise, no differences in Δuptake or Δwashout were apparent between the DWS+ and DWS- groups in either the parotid or submandibular glands (all p values >0.05). CONCLUSION: Salivary gland radioiodine retention on post-ablation (131)I scintigraphy is a good predictor of functional impairment of the parotid glands after high-dose radioiodine therapy.

Link-based similarity measures using reachability vectors.

We present a novel approach for computing link-based similarities among objects accurately by utilizing the link information pertaining to the objects involved. We discuss the problems with previous link-based similarity measures and propose a novel approach for computing link based similarities that does not suffer from these problems. In the proposed approach each target object is represented by a vector. Each element of the vector corresponds to all the objects in the given data, and the value of each element denotes the weight for the corresponding object. As for this weight value, we propose to utilize the probability of reaching from the target object to the specific object, computed using the "Random Walk with Restart" strategy. Then, we define the similarity between two objects as the cosine similarity of the two vectors. In this paper, we provide examples to show that our approach does not suffer from the aforementioned problems. We also evaluate the performance of the proposed methods in comparison with existing link-based measures, qualitatively and quantitatively, with respect to two kinds of data sets, scientific papers and Web documents. Our experimental results indicate that the proposed methods significantly outperform the existing measures.

Isolated splenic metastasis of ovarian cancer detected with 18F-FDG PET/CT.

We report a case of isolated splenic metastasis from ovarian cancer detected with 18F-FDG PET/CT. A 66-year-old woman with ovarian cancer was referred for 18F-FDG PET/CT to determine the cause of elevated serum CA-125 levels about 48 months after surgery. 18F-FDG PET/CT showed focal, intense uptake in the spleen, with no other abnormal findings. A splenectomy was performed, and the lesion was confirmed as metastasis from ovarian cancer pathologically.

Inflammatory pseudotumor in the mediastinum: imaging with (18)F-fluorodeoxyglucose PET/CT.

Mediastinal inflammatory pseudotumor is a rare benign disease with its capability for local invasion and rapid growth. We present a case of middle-mediastinal inflammatory pseudotumor and report its contrast-enhanced chest computed tomography, (18)F-fluorodeoxyglucose positron emission tomography/computed tomography and pathologic findings.

Incidental focal uptake in oropharynx due to lingual thyroid on diagnostic 131I whole-body scan after total thyroidectomy.

After total thyroidectomy for papillary thyroid carcinoma, a 37-year-old woman underwent a 2-mCi (131)I whole-body scan which demonstrated focal uptake in the anterior neck and in the oropharynx. Preoperative contrast-enhanced neck computed tomography demonstrated a small enhancing nodule typical for ectopic thyroid at the tongue base. She was then treated with 150 mCi (131)I. Small asymptomatic lingual thyroid remnants typically do not affect high-dose (131)I therapy.

Ultrashort-acting insulin may improve on 18F-FDG PET/CT image quality in patients with uncontrolled diabetic mellitus.

OBJECTIVE: It is known that the poor image quality of (18)F-fluorodeoxyglucose ((18)F-FDG) PET scans leads to interpretation difficulty in patients with uncontrolled diabetes mellitus (DM). We usually delay (18)F-FDG PET examination when patients show high glucose levels. This study was performed to evaluate the usefulness and effects of ultrashort-acting insulin on (18)F-FDG PET/computed tomography (CT) imaging in DM patients. MATERIALS AND METHODS: A total of 105 DM patients (68 men and 37 women) were included. Ultrashort-acting insulin was intravenously injected when patients showed high glucose levels (>190 mg/dl). (18)F-FDG was injected 60 min after ultrashort-acting insulin injection, and PET/CT images were acquired. Image quality was graded by consensus using the following scale: 1, good; 2, moderate; and 3, poor. The mean standardized uptake value (SUV(mean)) of the liver, gluteal muscle, and brain was assessed to evaluate the effects of ultrashort-acting insulin. RESULTS: The group administered ultrashort-acting insulin (n=52, blood glucose level: 243.7 ± 46.2 mg/dl) showed a significantly higher glucose level compared with the group not administered ultrashort-acting insulin (n=53, 177.1 ± 5.2 mg/dl). Nevertheless, the image quality of the group with ultrashort-acting insulin was not significantly different from that of the group without ultrashort-acting insulin (χ(2) -test, P=0.47). No significant differences were seen in SUV(mean) in the liver (P=0.13), gluteal muscle (P=0.71), and brain (P=0.16) between groups. CONCLUSION: Ultrashort-acting insulin can be used to improve the image quality of F-FDG PET/CT in uncontrolled DM patients without significant differences in SUV.