F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Images of Severe Primary Lung Lymphoma.

Primary lung lymphoma is one of the rarest forms of lymphoma and pulmonary space-occupying lesions. This case report represents the F-18 fluorodeoxyglucose positron emission tomography/computed tomography images of the most severe form of the primary pulmonary lymphoma reported in the literature.

The influence of post-diuretic late phase imaging in visual and quantitative evaluation of urothelial tumors by F-18 fluorodeoxyglucose positron emission tomography/computed tomography.

OBJECTIVE: Although F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is a valuable imaging method in most of the malignant tumors, it is considered to have limited diagnostic ability in urothelial tumors due to high physiologic urine activity. The aim of the present study was to evaluate the effect of post-diuretic late phase imaging to the visual and quantitative evaluation of urothelial tumors in the staging and restaging of the patients. MATERIAL AND METHODS: Two patients with ureter and 40 patients with bladder tumors (6 females and 36 males, mean age: 67.12±8.79 years) who were referred for staging or restaging or treatment response evaluation to the F-18 FDG PET/CT were included in the study. Late phase (at the second hour after FDG injection) images including the renal pelvis and bladder region after the administration of approximately 40 mg furosemide were obtained after standard oncologic F-18 FDG PET/CT imaging. The images were evaluated by visual and quantitative interpretation, and index values were calculated. Paired samples T test was used to decide the significance of the difference between the early and late phase images. A p value <0.05 was considered significant. RESULTS: The activity accumulation in the primary or recurrent lesions in the bladder or ureter in the early and late phase images was statistically significantly different. Additionally, in 15/41 (37%) patients, the primary tumor in the bladder was only determined in late phase images, and additional lymph node metastases adjacent to the bladder or ureter were only observed in diuretic late phase images in some of the patients. The sensitivity, specificity, and diagnostic accuracy of the PET/CT with this methodology for N staging and M staging were 67%, 78%, and 82% versus 80%, 91%, and 82%, respectively. CONCLUSION: Late phase imaging after diuretic administration should be performed in case of non-visualization of primary tumor in the bladder region. The late phase post-diuretic imaging revealed significant improvement in the visual and quantitative diagnostic performance of the FDG PET/CT and has high diagnostic accuracy for the staging of urothelial tumors.

Detection of unknown primary tumor in patients presented with brain metastasis by F-18 fluorodeoxyglucose positron emission tomography/computed tomography.

AIM: F-18 fluorodeoxyglucose (FDG) PET/CT has several advantages in diagnosis of cancer of unknown primary with reported incremental diagnostic value. In this study, we evaluated the patients who were presented with multiple brain metastasis and unknown primary tumor. MATERIALS & METHODS: 31 patients (17 males, 14 females; mean: 56.1 ± 14.22 years old) with diagnosis of brain metastasis according to histopathology and/or MRI were included into this retrospective study. RESULTS: The patients presented with hypermetabolic (n = 17; mean SUVmax: 11.6 ± 6.9) or hypometabolic brain lesions with additional different metastatic sites in 13 patients (mean SUVmax: 9.03 ± 4.02). The primary tumor was determined by FDG PET/CT in 20/26 patients (77%) (lung [n = 6], primary brain [n = 9], renal cell carcinoma [n = 2], skin [n = 1], breast [n = 1] and neuroendocrine tumor [n = 1]). CONCLUSION: New generation multislice scanners may provide higher detection ratios. The detection rate of FDG PET/CT might be higher than previously reported according to this study.

A Rare Cause of Abdominal Pain in Childhood: Cardiac Angiosarcoma.

Cardiac angiosarcomas are extremely rare in childhood, they are rapidly progressive tumours that often present themselves as diagnostic dilemmas, resulting in delayed diagnosis. Also, extracardiac manifestations, including abdominal pain, are extremely rare in patients with intracardiac tumors. We herein present the case of a 15-year-old girl who presented with abdominal pain. Echocardiography and thoracic computed tomography showed right atrial mass. The patient underwent surgery, chemotherapy, and radiotherapy. Eight months after treatment, abdominal recurrence was detected. The abdominal mass was resected, and radiotherapy and new chemotherapy protocol were given. The present case illustrates a rare case of primary cardiac angiosarcoma posing a diagnostic dilemma in an adolescent girl.

A rare cause of abdominal pain in childhood: cardiac angiosarcoma

Abstract Cardiac angiosarcomas are extremely rare in childhood, they are rapidly progressive tumours that often present themselves as diagnostic dilemmas, resulting in delayed diagnosis. Also, extracardiac manifestations, including abdominal pain, are extremely rare in patients with intracardiac tumors. We herein present the case of a 15-year-old girl who presented with abdominal pain. Echocardiography and thoracic computed tomography showed right atrial mass. The patient underwent surgery, chemotherapy, and radiotherapy. Eight months after treatment, abdominal recurrence was detected. The abdominal mass was resected, and radiotherapy and new chemotherapy protocol were given. The present case illustrates a rare case of primary cardiac angiosarcoma posing a diagnostic dilemma in an adolescent girl.

Rare Endobronchial Inflammatory Myofibroblastic Tumor in Pediatric Patient Detected on PET/CT Imaging.

Inflammatory myofibroblastic tumor (IMT) can be seen in all age groups, although it is more common in children and adolescents. We report the FDG PET/CT findings in an 8-year-old boy with endobronchial IMT. Endobronchial IMT is more commonly seen in young adults.

Prostate-specific antigen decline pattern in advanced prostate cancer receiving androgen deprivation therapy and relationship with prostate-specific antigen progression.

INTRODUCTION: The aim of this study is to evaluate prostate-specific antigen decline pattern including prostate-specific antigen kinetics following androgen deprivation therapy on prostate-specific antigen progression in the patients with advanced prostate cancer. MATERIALS AND METHODS: Ninety-seven advanced prostate cancer patients receiving maximum androgen deprivation therapy were enrolled in case-control study. Baseline prostate-specific antigen, Gleason Score, bone metastase, nadir prostate-specific antigen, time to nadir prostate-specific antigen, declining slope to nadir prostate-specific antigen, estimated baseline prostate-specific antigen half-time, current prostate-specific antigen, post-nadir prostate-specific antigen time, estimated prostate-specific antigen, estimated decline of baseline prostate-specific antigen as quantitative, and ratio were recorded and calculated. RESULTS: The ratio of prostate-specific antigen progression was significantly lower at the patients who had slower declining slope to prostate-specific antigen, longer time to nadir prostate-specific antigen, and lower estimated decline ratio of baseline prostate-specific antigen (p: .016, p: .020, and p: .026, respectively). CONCLUSIONS: The shorter time to nadir prostate-specific antigen following androgen deprivation therapy, faster declining slope to nadir prostate-specific antigen and higher estimated decline ratio of baseline prostate-specific antigen are associated with higher risk of disease progression in patients with hormone-sensitive prostate cancer.

Undescended testis in inguinal canal detected incidentally on fluorodeoxyglucose PET/CT imaging.

The differential diagnosis at the inguinal region is very important for hypermetabolic foci because of the possibility of metastasis at this level in cancer patients ongoing PET imaging for detection of metastases. It is important to distinguish this activity from other possible malignant and benign conditions such as lymph node activity, testicular cancer, metastatic disease activity, inflammation and urine skin contamination artefact. A 66-year-old male patient with operated colon cancer and liver metastasis was referred for PET/CT examination for re-staging because of suspicious metastases. Findings of PET/CT imaging with undescended testis detected incidentally was presented.

FDG Uptake Pattern on PET/CT Imaging in Non-Infectious Graft of a Patient with Operated Abdominal Aortic Aneurysm.

UNLABELLED: Positron emission tomography using fluorodeoxyglucose is a well known diagnostic tool for routine assessment of the patients with carcinoma. Fluorodeoxyglucose uptake, as a marker of glucose metabolism, is increased in malignant conditions as well as infectious and inflammatory processes. In this case report, findings of postoperative changes in the graft on FDG PET/CT were presented in a patient on follow-up for operated renal cell carcinoma and aortic aneurysm graft surgery. The importance of the FDG uptake pattern has been pointed out for differential diagnosis of infectious and non-infectious conditions. CONFLICT OF INTEREST: None declared.

Evaluation of FDG uptake in pulmonary hila with FDG PET/CT and contrast-enhanced CT in patients with thoracic and non-thoracic tumors.

OBJECTIVE: Fluorine-18 fluorodeoxyglucose (FDG) uptake is frequently observed in lung hilus. This finding causes difficulties during the interpretation. Our objective was to evaluate the features of FDG uptake in lung hilus associated with benign or malignant etiology in patients with thoracic and non-thoracic tumors. METHODS: We retrospectively evaluated the files of 1172 patients who had undergone FDG positron emission tomography (PET)/computed tomography (CT) examination between January 2008 and June 2009. Forty-eight patients (21 males, 27 females, age range 12-80 years, mean 60.9 ± 15.82 years) with either unilateral or bilateral hilar FDG uptake and who had thorax contrast-enhanced computed tomography (CECT) performed within 1 month of the FDG PET/CT scan were enrolled in the study. Characteristics of FDG uptake were classified according to the pathology and CECT or PET/CT follow-up over 12 months. RESULTS: The characteristics of 71 hilar regions with FDG uptake could be classified. In 30 of 71 (42.3%) hilar regions, FDG uptake was considered to be physiological because no lymph node was observed on CECT. In 19 of 71 (26.8%), FDG uptake was secondary to benign lymph nodes and in 22 (30.9%) to malignant lymph nodes. Significant differences were observed between benign and malignant lymph nodes for SUVhilus and SUVhilus/SUVliver ratio. Using 4.49 as the cut-off value for SUVhilus, a sensitivity of 85.7% and a specificity of 86.4% were achieved (area under curve, AUC: 0.956). For SUVhilus/SUVliver ratio, sensitivity and specificity to detect malignant lymph nodes were 77.6 and 77.3% (AUC: 0.885), respectively, at a cut-off value of 1.75. CONCLUSION: SUVhilus and SUVhilus/SUVliver ratio were found to be significant parameters for determining malignancy in lung hilus. Combined interpretation with CECT is warranted during the evaluation of lung hilus with FDG PET/CT.

In vivo characterisation of parathyroid lesions by use of gamma probe: comparison with ex vivo count method and frozen section results.

OBJECTIVE: In this study we hypothesized that if timing of gamma probe-guided parathyroidectomy were individualized according to an optimal-time-to-surgery technique, in vivo characterization of parathyroid lesions would be possible. We compared our findings with an ex vivo counting method ("20% rule") and frozen section results. STUDY DESIGN AND SETTINGS: Thirty-five patients who were referred for surgical treatment of hyperparathyroidism were studied. Maximum parathyroid to thyroid sestamibi uptake ratio (UR(max)) was measured by use of preoperative dynamic scintigraphy. The interval between sestamibi injection and UR(max) was defined as the optimal time to surgery. On the day of surgery, the patients received the same dose of sestamibi and were taken to the operating room at UR(max) as determined by preoperative scintigraphy. Intraoperative in vivo gamma probe counts from parathyroid lesions were compared with in vivo contralateral background thyroid counts (in vivo/Bkg) and to ex vivo parathyroid counts relative to postexcision background of the adjacent normal tissue (ex vivo/Bkg). RESULTS: A total of 70 excised lesions were evaluated. In vivo/Bkg counts obtained from parathyroid adenoma were significantly different from parathyroid hyperplasia (z = -3.093, P = 0.002) and other lesions (z = -3.958, P = 0.0001). By receiver operating characteristic curve (ROC) analysis, we found the cutoff value for the in vivo/Bkg counts ratio to be 103% to differentiate parathyroid adenoma from hyperplasia with a sensitivity, specificity, and accuracy of 82.5, 65, and 74.4%, respectively. On the other hand, sensitivity, specificity, and accuracy of the ex vivo/Bkg method to differentiate parathyroid adenoma from hyperplasia with a cutoff value of 34.7 was found to be 70.8%, 60%, and 65.9%, respectively. The difference between the accuracy of these 2 tests was not significant statistically (P = 0.137). Sensitivity of frozen section to differentiate parathyroid adenoma and hyperplasia was 76.2% and 33.3%, respectively. CONCLUSIONS: Patient-specific optimal protocol for timing of sestamibi injection together with in vivo/Bkg method is a useful alternative method in guiding the surgeon to differentiate parathyroid adenoma from parathyroid hyperplasia and other tissues and may help surgeons' decisions during the operation. Combined use of in vivo/Bkg and ex vivo/Bkg methods may give more accurate results than frozen section.