Diagnostic benefits of 18F-FDG PET/CT in cases of prosthetic infective endocarditis.

Infective endocarditis (IE) is a difficult-to-diagnose provocative disease that causes significant morbidity and mortality. The first-line imaging test for the diagnosis of IE is echocardiography. However, in cases of prosthetic IE or IE associated with intracardiac devices, its sensitivity is limited. A new diagnostic tool, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT), improves diagnosis in these difficult cases. The most recent European guidelines for IE (2015) include this imaging modality as a primary diagnostic criterion. We present a case of culture-negative prosthetic IE diagnosed with 18F-FDG PET/CT.

The role of 18F-FDG PET/CT and single isotope 99mTc-tetrofosmin scintigraphy combined with SPECT in diagnosis of multiple endocrine neoplasia type 1 syndrome.

We present a case of a 47-year-old woman with type 1 multiple endocrine neoplasia, primary hyperparathyroidism, insulinoma, and nonfunctioning pituitary adenoma. In July 2017, the patient was referred to the Department of Nuclear Medicine of St George University Hospital in Plovdiv for a PET/CT scan because of persistent hypoglycemic episodes and high serum insulin levels. A whole-body PET/CT examination was performed 65 min after intravenous application of 188 MBq 18F-FDG on a hybrid PET/CT scanner (Biograph mCT 64, Siemens). We detected a low metabolically active lesion 10 mm in diameter (SUVmax - 2.00), located below the left thyroid lobe suspicious for parathyroid adenoma. In the remaining scanned areas there were no PET/CT data for other areas with increased glucose metabolism with malignant characteristics that could be associated with the underlying disease.

Nuclear Medicine Methods for Evaluation of Abnormal Parathyroid Glands in Patients with Primary and Secondary Hyperparathyroidism.

Considered rare disease in the past, primary hyperparathyroidism (PHPT) has dramatically increased in incidence over the past thirty years with the introduction of routine calcium measurements; it is now approximately 42 per 100 000 persons. By far, the most common lesion found in patients with PHPT is the solitary parathyroid adenoma, occurring in 85%-90% of patients, while in the rest 10%- 15% primary hyperplasia of the parathyroid glands is present. Currently, the most widely used surgical approach is minimally invasive parathyroidectomy which is associated with less post-surgery complications and shorter operation time. To be successful this procedure needs to rely on a precise preoperative localization of the abnormal parathyroid glands, hence preoperative parathyroid imaging gained so large importance. The rationale for locating abnormal parathyroid tissue prior to surgery is that the glands can be notoriously unpredictable in their location. There is a general consensus that the best imaging procedure identifying abnormal parathyroid glands is the preoperative scintigraphy with 99mTc-sestamibi or 99mTc-tetrofosmin. It is characterized with high sensitivity and specificity exceeding those of ultrasound, CT or MRI. Combining scintigraphy with the other imaging techniques increases the precision for topic localization.

Evaluation of the immunomodulatory activity of Aronia in combination with apple pectin in patients with breast cancer undergoing postoperative radiation therapy.

The aim of the present study was to evaluate the immunomodulatory activity of Aronia in combination with apple pectin in patients with breast cancer in the course of postoperative radiation therapy. Monoclonal antibodies were used to assay specific T cell subsets. Tests were performed prior to and after 26 and 50 Gy of irradiation. The study comprised 42 women (19 to 65 years of age) receiving 15 g of apple pectin in combination with 20 ml of Aronia concentrate (Bioactive Substance Laboratory--Plovdiv) twice daily during postoperative irradiation. Irradiation was performed by a 60Co-Rokus according to individualized treatment schedules. The following T lymphocyte populations were tested--CD3 total T lymphocytes, CD4 helper and inducer T cells, CD8 suppressor and cytotoxic T cells and NK cells. The levels of the polypeptide tissue antigen (TPA), an oncofetal protein, were tested in parallel. The TPA was used to assess treatment outcome in our patients. A group of 25 age-matched women with breast cancer served as controls. Immune status analysis of controls was performed prior to and following postoperative radiation. A total of 880 serum samples were tested. Assays of immunity parameters in the patients receiving Aronia in combination with apple pectin showed that CD4 and CD8 T cell counts increased significantly (P < 0.01 and P < 0.05 respectively). In control patients CD3 T cell levels lowered, the other T cell levels remained unchanged. Initially the number of NK cells was increased in both groups of patients. It remained constant throughout the course of the study. The normal levels of TPA in both groups of patients indicated a good treatment outcome due to the adequacy of surgery and in combination with radiation therapy.