Thyroid Embolization for Nonsurgical Treatment of Nodular Goiter: A Single-Center Experience in 56 Consecutive Patients.

PURPOSE: To investigate the safety and efficacy of thyroid artery embolization (TAE) in the treatment of nodular goiter (NG). METHODS: During a 5.5-year period, 56 consecutive patients with a NG underwent TAE. In Group A, there were 20 patients with a solitary/dominant 5-11-cm nodule, and in Group B, there were 36 patients with numerous nodules. Of the 56 patients, 47 (84%) had a retrosternal goiter and 25 had hyperthyroidism. In all patients, clinical and radiological evaluations were made at baseline and 6 months after TAE, and these parameters were statistically compared. RESULTS: In 56 patients, 145 of the 146 thyroid arteries were successfully embolized. The 30-day mortality rate was 1.8%. Minor and major complications occurred in 25 and 2 patients, respectively. Six months after the TAE, the mean nodule volume was reduced from 80.2 mL to 25.0 mL, the mean thyroid volume was reduced from 147.0 mL to 62.6 mL, and the mean intrathoracic extension was reduced from 31.7 mm to 15.9 mm (P < .001). Of the 22 patients with non-Graves hyperthyroidism, 19 (86%) became euthyroid. The mean thyroid-related patient-reported outcome scores improved from 155.4 to 70.4 (P < .001). Of the 51 patients, 50 (98%) declared that they would recommend TAE to other patients with NG. CONCLUSIONS: TAE is safe and effective for the treatment of NG, with a significant volume reduction of the nodule(s) and thyroid gland.

Primary splenic angiosarcoma diagnosed after splenectomy for spontaneous rupture.

Primary splenic angiosarcoma is a rare abnormality and has a bad prognosis. It has unknown pathogenesis. This abnormality is usually presented by splenic rupture. Surgery is the most promising treatm Surgery is the most accepted and accurate method for diagnosis and treatment. Surgery before rupture increases the life expectancy. A 65-year-old woman who presented to the emergency room with abdominal pain, abdominal distension, and anemia was found to have a splenic mass and massive ascites. After getting a hemorrhagic sample from the abdomen, the patient was operated with splenic rupture prediagnosis. The spleen material was reported as splenic angiosarcoma. The staging 18F-FDG-Positron Emission Tomography-Computed Tomography did not show any metastasis. Five months later, paclitaxel treatment was initiated upon liver and bone metastasis, and the treatment still continues. Splenic angiosarcoma has a place among splenic parenchymal lesions. The splenectomy material names the diagnosis. Pathologic examination of splenectomy material is revealed certain diagnosis.

Efficacy of 18F-2-fluoro-2-deoxy-D-glucose Positron Emission Tomography/Computerized Tomography for Bone Marrow Infiltration Assessment in the Initial Staging of Lymphoma.

OBJECTIVE: Currently 18F-2-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computerized tomography (PET/CT) is being successfully used for staging and follow-up of Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL). Various studies have demonstrated that PET/CT effectively detects bone marrow involvement (BMI) and is concordant with bone marrow biopsy (BMB) findings, thus it is deemed as a complementary method. This study was aimed to evaluate18F-FDG-PET/CT efficiency for detection of BMI in HL and NHL. METHODS: The study included 172 lymphoma cases who were admitted to Akdeniz University Medical School Department of Nuclear Medicine for initial staging with PET/CT. Visual and semiquantitative assessments were performed for PET/CT scan findings of the cases. The maximum standard uptake (SUVmax) value was the quantitative parameter used for 18F-FDG-PET scan. In visual assessment, bone marrow metabolic activity that is greater than the liver was considered as pathologic. For semiquantitative assessment, regions of interest were drawn for SUVmax estimation, which included iliac crest in cases with diffusely increased metabolic activity and the highest activity area in cases with focal involvement. BMB was considered as the reference test. RESULTS: On visual assessment of all the cases, PET/CT was found to yield 31% sensitivity and 85% specificity rate for detection of BMI. On visual assessment of HL cases, sensitivity rate was determined as 80%, and specificity as 78%, while in NHL cases the corresponding values were 24% and 90%, respectively. On semiquantitative assessment of HL cases, considering SUVmax≥4, sensitivity was found as 80% and specificity as 68%. In NHL patients, considering SUVmax≥3.2, sensitivity rate was detected as 65% and specificity as 58%. CONCLUSION: In this study, a moderately high concordance was observed between PET/CT and BMB findings. PET/CT appears to be a significant method for detecting BMI. Although PET/CT is not a substitute for BMB, we suggest it can be used as a guide to biopsy site and a complementary imaging technique for BMB.

Use of cryoablation beyond the prostate.

UNLABELLED: Cryoablation has been used for many years as a surgical ablation technique in the prostate and kidney. However, since the introduction of high-intensity focused ultrasound (HIFU) and robotic surgery for prostate tumours, its popularity in the urologic community has declined. In the early 2000s, innovations in cryoablation technology allowed the use of thinner probes, which were suitable for percutaneous application. As a result, radiologists began using cryoablation, first in the liver, and then in other organs or tissues such as the kidney, lung, breast, pancreas, bone, and soft tissue. In most of these locations, cryoablation has great potential given its inherent advantages, including the use of local anaesthesia, little or no pain during and after the procedure, real-time monitoring of the ablation area on US, CT or MRI, the potential for ablation of large tumours with multiple probes, and the ability to change the shape of the ablation in non-spherical tumours. Yet despite these advantages, the use of percutaneous cryoablation among radiologists appears to be far lower than that of heat-based ablation techniques. The aim of this article is to outline specific aspects of cryoablation and to illustrate its potential clinical applications with case presentations. KEY POINTS: • Recent advances have made cryoablation suitable for percutaneous use by radiologists with image guidance. • Cryoablation has distinct advantages over heat-based ablation techniques. • Cryoablation is becoming increasingly popular for lung, breast, kidney, bone, and soft tissue tumours.

68Ga- and 177Lu-Labeled PSMA I&T: Optimization of a PSMA-Targeted Theranostic Concept and First Proof-of-Concept Human Studies.

UNLABELLED: On the basis of the high and consistent expression of prostate-specific membrane antigen (PSMA) in metastatic prostate cancer (PC), the goal of this study was the development, preclinical evaluation, and first proof-of-concept investigation of a PSMA inhibitor for imaging and therapy (PSMA I&T) for (68)Ga-based PET and (177)Lu-based endoradiotherapeutic treatment in patients with metastatic and castration-resistant disease. METHODS: PSMA I&T was synthesized in a combined solid phase and solution chemistry strategy. The PSMA affinity of (nat)Ga-/(nat)Lu-PSMA I&T was determined in a competitive binding assay using LNCaP cells. Internalization kinetics of (68)Ga- and (177)Lu-PSMA I&T were investigated using the same cell line, and biodistribution studies were performed in LNCaP tumor-bearing CD-1 nu/nu mice. Initial human PET imaging studies using (68)Ga-PSMA I&T, as well as endoradiotherapeutic treatment of 2 patients with metastatic PC using (177)Lu-PSMA I&T, were performed. RESULTS: PSMA I&T and its cold gallium and lutetium analog revealed nanomolar affinity toward PSMA. The DOTAGA (1,4,7,10-tetraazacyclododecane-1-(glutamic acid)-4,7,10-triacetic acid) conjugate PSMA I&T allowed fast and high-yield labeling with (68)Ga(III) and (177)Lu(III). Uptake of (68)Ga-/(177)Lu-PSMA I&T in LNCaP tumor cells is highly efficient and PSMA-specific, as demonstrated by competition studies both in vitro and in vivo. Tumor targeting and tracer kinetics in vivo were fast, with the highest uptake in tumor xenografts and kidneys (both PSMA-specific). First-in-human (68)Ga-PSMA I&T PET imaging allowed high-contrast detection of bone lesions, lymph node, and liver metastases. Endoradiotherapy with (177)Lu-PSMA I&T in 2 patients was found to be effective and safe with no detectable side effects. CONCLUSION: (68)Ga-PSMA I&T shows potential for high-contrast PET imaging of metastatic PC, whereas its (177)Lu-labeled counterpart exhibits suitable targeting and retention characteristics for successful endoradiotherapeutic treatment. Prospective studies on larger cohorts of patients are warranted and planned.

Measurements of tumor size using CT and PET compared to histopathological size in non-small cell lung cancer.

PURPOSE: In this study, we aimed to compare the tumor sizes determined by maximum morphological computed tomography (CT) and functional positron emission tomography (PET) with the histopathological size to determine which method provides the best correlation with the histopathological size in lung carcinoma patients. MATERIALS AND METHODS: Forty lung carcinoma patients (39 males, one female) diagnosed histopathologically from surgical resection materials were included in this retrospective study. The mean age (±standard deviation, SD) of the patients was 67.8±10.3 years with a range of 44 to 81 years. The PET scans were performed within the same week as the CT scan. In the CT scans, the morphological tumor sizes were measured three-dimensionally by the longest transaxial section in the parenchymal and mediastinal screening window. The functional tumor sizes were also measured three-dimensionally in the PET scans. These two measurement values were compared with the histopathological size using Bland-Altman plotting. Bland-Altman plotting was also performed to define the 95% limits of agreement, which was presented as the bias ±1.96 SD. RESULTS: The histopathological sizes were measured in a range of 1.2 to 7.5 cm. The maximum measurement of the tumors on the CT scans showed a lower concordance (mean difference, -0.30) than that obtained from PET, and the SD was found to be larger than the PET (1.96 SD was 3.50 for CT and 2.50 for PET). CONCLUSION: The PET measurements of tumor size were more compatible with the histopathological sizes than the CT measurements in patients with non-small cell lung cancer.

Analysis of TPO gene in Turkish children with iodide organification defect: identification of a novel mutation.

The objective was to determine molecular genetic analysis of the TPO gene in Turkish children with iodide organification defect (IOD). Patients with a diagnosis of primary hypothyroidism were evaluated. Subjects having a definite diagnosis of autoimmune thyroiditis, thyroid gland dysplasia and, or iodine deficiency were excluded. A total of 10 patients from nine unrelated Turkish families, with an unknown etiology of hypothyroidism, and with a presumptive diagnosis of IOD were included in the study. A perchlorate discharge test (PDT) was performed to all subjects, and sequence analysis of TPO gene was applied in patients with a positive PDT. Five out of 10 patients have a total IOD, while the five remaining patients have a partial IOD according to PDT results. In two sisters, one has a partial and the other one has a total IOD a novel homozygous nonsense p.Q315X mutation was found in exon 8. Additionally, a previously known homozygous missense p.R314W mutation was detected in the same exon in another patient with a total IOD. No TPO gene mutation was detected in any of the seven remaining patients. Two different TPO gene mutations were found to be responsible for IOD in two unrelated Turkish families from the same ethnic background. More subjects should be screened for detecting the prevalence and spectrum profile of TPO mutations in our population that might be helpful for understanding the pathophysiology of congenital hypothyroidism.

Final diagnosis in children with subclinical hypothyroidism and mutation analysis of the thyroid peroxidase gene (TPO).

AIM: To determine the final diagnosis of patients with subclinical hypothyroidism (SCH), and to perform mutation screening of the thyroid peroxidase gene (TPO). METHODS: Infants with SCH without an identified etiology were included in the study. Patients with thyroid dysgenesis were excluded. Children > or = 2 years of age, and still on L-thyroxine (LT4) treatment underwent a diagnostic algorithm. After LT4 was discontinued for 4 weeks, thyroid function tests (TFT) were obtained. A perchlorate discharge test (PDT) was performed in patients with normal thyroid ultrasound but abnormal TFT. Sequence analysis of TPO was studied in all children who underwent a PDT. RESULTS: Forty-eight patients (23 males and 25 females) completed the trial. Among these children, 19 (39.5%) had transient SCH, and 29 (60.5%) had permanent SCH. Among patients with permanent SCH, 19 had thyroid hypoplasia, six had partial iodide organification defect with positive PDT, and four had other dyshormonogenesis with negative PDT. Mean LT4 dose before the medication ceased was 1.2 +/- 0.5 microg/kg/day in transient cases, and 1.7 +/- 0.4 in those with permanent SCH (p < 0.05). No TPO mutation was detected. However, in five patients, seven different previously known TPO polymorphisms were detected: c.102C > G, L4L; > A, A576A; c.2088C > T, D666D; c.2263A > C, T725P; c.2630 T >C, V847A. CONCLUSIONS: LT4 treatment should be stopped after the age of 2 years in infants with SCH without a definite pathology of the thyroid gland to exclude cases with transient hypothyroidism. Additionally, we should consider particularly thyroid gland hypoplasia, and also partial defects in iodide organification in infants with SCH.

Technetium-99m hexamethyl propylene amine oxime-labeled leukocyte scintigraphy at three different times in active ulcerative colitis: comparison with colonoscopy and clinico-biochemical parameters in the assessment of disease extension and severity.

OBJECTIVE: In this study, our objective was to define the usefulness of technetium-99m hexamethyl propylene amine oxime (Tc-99m HMPAO)-labeled leukocyte scintigraphy at three different time points in the assessment of disease extension and severity in patients with active ulcerative colitis (UC). METHODS: Twenty-one consecutive patients (10 women, 11 men; mean age 42.4 +/- 12 years) with active UC were prospectively studied. All patients were diagnosed by colonoscopy and histopathology prior to inclusion. Scintigraphy was performed at 1 h, 2 h, and 4 h after Tc-99m HMPAO-labeled leukocyte injection. Clinic-biochemical activity score, total colonoscopic activity score, and total scintigraphic activity score at 1 h, 2 h, and 4 h were calculated for each patient. RESULTS: Sensitivity, specificity, and accuracy values of Tc-99m HMPAO-labeled leukocyte scintigraphy were calculated as follows, respectively: 1 h imaging 86%, 73%, and 83%; 2 h imaging 89%, 74%, and 86%; 4 h imaging 90%, 58%, and 83% in the detection of active inflammatory segments. Even though no statistically significant difference was found between 1 h, 2 h, and 4 h imaging with respect to the sensitivity, specificity of labeled leukocyte scintigraphy, the largest area under the curve value was found for 2 h imaging. CONCLUSIONS: Tc-99m HMPAO-labeled leukocyte scintigraphy has been found to be correlated well with colonoscopy in the assessment of both the extension and severity of UC. We recommend 2 h scintigraphic imaging because it provides the largest area under the curve value and decreases the number of false-positive results.

Tc-99m HMPAO brain SPECT findings in mild and moderate Alzheimer's disease: correlation with event related potentials.

We investigated whether brain SPECT findings show any differences between patients with mild and moderate Alzheimer's disease (AD) and to compare results with event related potentials (ERPs). Twenty-two patients with mild to moderate AD diagnosed according to NINCDS-ADRDA criteria and 10 age-matched control subjects were included in this prospective study. All subjects underwent ERP recordings and Tc-99m HMPAO brain SPECT study. Cortical perfusion index (CPI) was calculated as the ratio of cortical activity to the cerebellum activity. CPI was found to be statistically lower in bilaterally posterolateral temporal cortex and precuneus in the moderate AD compared to the control group. There was no statistically significant difference between the mild AD and control groups for CPI in any cortical areas. The mean P300 latency was statistically prolonged in the mild and moderate AD compared to the control group. In addition, in moderate AD P300 latency was longer than in mild AD. While the mean P300 amplitude was statistically reduced in moderate AD compared to the control and mild AD, there was no statistically significant difference between the mild AD and control groups. There was a strong negative correlation between P300 latency and CPI in the right and left precuneus in the moderate AD group. The present study suggested that Tc-99m HMPAO SPECT study is the more appropriate technique for patients with moderate AD rather than mild AD. Our results indicated that alterations in ERPs, especially prolongation of P300 latency could be a finding that occurred earlier than the deterioration in cerebral blood flow. We thought that precuneus is closely related to cognitive function and may have an important role in the pathophysiology of AD.

Unilateral spermatic cord torsion without ipsilateral spermatogenetic material: effects on testicular blood flow and fertility potential.

This experiment was planned to answer the question of how the elimination of ipsilateral spermatogenetic material, which is necessary for contralateral testicular damage caused by an autoimmune response, affects contralateral testicular blood flow and fertility potential in unilateral spermatic cord torsion (USCT). Thirty-four male and 68 female adult albino rats were divided into three groups. Group 1 rats underwent a control operation, group 2 rats underwent subepididymal orchiectomy to eliminate spermatogenetic material, and group 3 rats underwent USCT after subepididymal orchiectomy. Testicular blood flows of the rats were measured by (133)Xe clearance technique. Additionally, to determine fertility potential, each male rat was housed with two female rats. Numbers of impregnated and delivered rats were recorded. Both mean testicular blood flow and fecundity of group 3 were significantly lower than those of groups 1 and 2. When compared with groups 1 and 2, fertility and mean number of the impregnated rats of group 3 were lower but the differences were not significant. These findings suggest that absence of spermatogenetic material in USCT reduces contralateral blood flow and fertility potential. Therefore, contralateral testicular damage originating from blood flow alterations rather than autoimmune mechanism should be considered to explain fertility problems encountered following USCT.

Helicobacter pylori seropositivity and atherosclerosis risk factors.

Certain viral and bacterial infections may contribute to the initiation and progression of atherosclerosis. The aim of this study is to determine whether Helicobacter pylori (HP) seropositivity contributes to conventional atherosclerosis risk factors in the development of an early sign of atherosclerosis: intima-media thickness (IMT) of the carotid artery. Eighty-four patients who had at least two conventional atherosclerosis risk factors and a control group of 50 patients having no risk factors for atherosclerosis were enrolled in the study. None of the patients had ever received HP eradication treatment. HP IgG antibodies were determined by enzyme-linked immunosorbent assay. Carotid artery IMT was measured 1 cm before the carotid bifurcation. Seventy-five percent of the study group was HP seropositive. HP seropositive (n=64) and seronegative (n=21) groups were identical in terms of sex distribution, smoking pattern, mean age, hemoglobin, leukocyte, platelet, C-reactive protein, erythrocyte sedimentation rate, glucose, cholesterol, triglyceride, low-density lipoprotein, high-density lipoprotein, systolic blood pressure and diastolic blood pressure levels. There was no significant difference between the mean carotid IMT of HP seropositive (0.8+/-0.3 mm) and negative (0.8+/-0.3 mm) patients in the study group. Similar to the study group, there was no statistically significant difference between mean carotid IMT of HP seropositive (0.56+/-0.19 mm) and negative patients (0.67+/-0.13 mm) in the control group (p=0.2). Future studies concerning virulent strains are needed to determine the probable role of HP in atherosclerosis.

The effects of solid food in prevention of intestinal activity in Tc-99m tetrofosmin myocardial perfusion scintigraphy.

BACKGROUND: The aim of this study was to investigate the effect of a standardized meal on intestinal activity in technetium 99m tetrofosmin myocardial perfusion scintigraphy. METHODS AND RESULTS: The study population consisted of 60 patients (42 men and 18 women; mean age, 56 +/- 8 years) referred for myocardial perfusion imaging. All patients underwent same-day exercise-rest Tc-99m tetrofosmin single photon emission computed tomography (SPECT) imaging. All patients were given 200 mL of milk 15 minutes after the injection for the exercise SPECT study and just after the injection for the first rest SPECT study. None of the patients ate or drank between the exercise and the first rest SPECT studies. After the first rest SPECT study, 30 patients (meal group) were given a standardized meal of solid food and liquid to increase the volume of the stomach, and a second rest SPECT image was obtained 30 minutes after the end of the first rest SPECT study. In 30 patients (control group) a second rest SPECT image was obtained 30 minutes after the end of the first rest SPECT study, but this group did not eat or drink in this interval. The effect of the meal on intestinal activity was evaluated both visually and quantitatively. Frequency of intestinal activity was assessed visually on SPECT images. Inferior myocardial wall and abdominal activity adjacent to the myocardium was quantitatively assessed on 3 different planar projections in the rest studies, and the mean inferior wall-to-abdomen count ratio was calculated. In the meal group, inferior wall-to-abdomen count ratios in the first and second rest studies were 1.48 +/- 0.3 and 2.09 +/- 0.4, respectively (P <.0001), and in the control group, 1.41 +/- 0.2 and 1.40 +/- 0.2 (P >.05), respectively. The frequency of intestinal activity was 63% (n = 19) in the first rest SPECT study and 10% (n = 3) in the second study in the meal group (P <.0001); it was 66% (n = 20) in the first rest SPECT study and 76% (n = 23) in the second study in the control group (P >.05). CONCLUSIONS: Our results indicate that filling of the stomach with a meal of solid food and liquid before rest acquisition may provide a high target-to-nontarget ratio. This simple modification may reduce the frequency of intestinal activity of Tc-99m-labeled radiopharmaceuticals in myocardial perfusion imaging.