Unusual Presence of Synchronous Primary Ovarian and Thyroid Extranodal Non-Hodgkin Lymphoma Without Lymph Node Involvement.

ABSTRACT: Extranodal lymphomas without lymph node involvement are rarely observed and create diagnostic challenges. We present the case of a 33-year-old woman who was admitted with abdominal swelling. Ultrasonography findings suggested bilateral ovarian masses. 18 F-FDG PET/CT revealed intense uptake on the bilateral pelvic mass and thyroid gland. Following excisional surgery and thyroid fine-needle aspiration biopsy, the patient was diagnosed with diffuse large B-cell lymphoma. This case is exceptionally rare, as it presents 2 synchronous extranodal involvements in the ovaries and the thyroid gland independently while not presenting any lymph node activity, which has not been reported before.

Artificial intelligence technologies in nuclear medicine.

The use of artificial intelligence plays a crucial role in developing precision medicine in nuclear medicine. Artificial intelligence refers to a field of computer science aimed at imitating the performance of tasks typically requiring human intelligence. From machine learning to generative adversarial networks, artificial intelligence automized the workflow of medical imaging. In this mini-review, we encapsulate artificial intelligence models and their use in nuclear medicine imaging workflow.

A Rare Case of Differentiated Thyroid Carcinoma with Liver Metastases.

Papillary thyroid carcinoma (PTC) is the most frequent type of differentiated thyroid cancers (DTCs) and commonly metastasizes to regional lymph nodes. Distant metastases of DTC typically occur in the lungs and bones. Liver metastases of DTC are very rare and difficult to diagnose. We present a case of a 52-year-old woman who had a previous history of PTC treated by total thyroidectomy and lymph node dissection. The patient received two radioactive iodine-131 (I-131) treatments. The second postradioiodine therapy whole-body scan (WBS) revealed intense iodine uptake in the neck region and in the lungs. After 2 months, during the follow-up period, increase in serum thyroglobulin (Tg) level was detected. Positron-emission tomography-computed tomography (PET-CT) with 18F-fluorodeoxyglucose (FDG) revealed increased FDG uptake in the mass lesion that invaded the muscles in the neck area, lung, bone, and liver. The uptake in liver was interpreted as suspicion of malignancy. The trucut biopsy of the liver masses demonstrated metastases of the thyroid carcinoma with the immunohistochemical thyroid transcription factor-1 and PAX8 positivity observed in these tumor cells. In DTC patients with progressive rapid rise of Tg level, the diagnostic value of I-131 WBS will decrease as the differentiation of the tumor decreases. The combined use of I-131 WBS and FDG PET-CT as diagnostic modalities in these patients will be important in treatment planning in detecting locoregional or distant metastases, especially in patients with negative diagnostic I-131 WBS.

The Evaluation of Preoperative 18F-FDG PET/CT in Patients with Endometrial Cancer and the Correlation Between PET Parameters and Postoperative Pathology Results.

OBJECTIVES: Endometrial cancer (EC) is the most common gynecological malignancy. The 18fluorine-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is used for initial staging, evaluating treatment response, and detecting recurrence. This study aimed to investigate the diagnostic value of preoperative PET/CT in EC staging and determine the volumetric PET parameters that are accurate predictors of histopathological tumor characteristics. METHODS: Preoperative PET/CT data of 66 patients with EC were retrospectively analyzed. Patients were divided into low and high-risk groups according to the European Society for Medical Oncology criteria. The maximum standardized uptake value (SUVmax), SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary lesion and pathological lymph nodes were noted. The International Federation of Gynecology and Obstetrics (FIGO) classifications, histopathology, the depth of myometrial invasion (MI), lymph node metastasis (LNM), cervical stromal invasion (CSI), and tumor sizes were noted. RESULTS: The SUVmax, TLG, and MTV values of high and low-risk groups were significantly different. TLG was the most useful parameter in differentiating risk groups. PET/CT had 90% sensitivity, 96.3% specificity, 81.8% positive predictive value, 98.1% negative predictive value, and 95.45% accuracy in assessing LNM. MTV and TLG values in patients with non-endometrioid pathology were higher than those with endometrioid. The SUVmax, MTV, and TLG of patients with deep MI were higher than those with superficial MI. TLG values of patients with CSI were higher than those without CSI. Patients with LNM had higher MTV and TLG values than those without LNM. A significant difference was found in TLG, MTV, and SUVmax values between patients with FIGO stage I-II and patients with FIGO stage III and above. CONCLUSION: SUV and volumetric parameters obtained from PET/CT, especially TLG, are strong predictors of tumor characteristics, such as MI and CSI, FIGO stages, and LNM, and are useful in noninvasively defining the risk groups in the preoperative period.

A case of soft tissue hematoma detected incidentally on 99m TC-labelled RBC gastrointestinal bleeding SPECT/CT.

We report an incidental finding on 99mTc-labelled RBC gastrointestinal bleeding scintigraphy of a 49-year-old female patient referred to our clinic in order to localize the bleeding site. The patient has also been suffering from chronic renal insufficiency and received several interventions of femoral catheterization. During the follow-up, an intense uptake was observed at the right inguinofemoral area which is evaluated as a large soft tissue hematoma and confirmed by SPECT/CT subsequently. On the 24th h delayed image an activity accumulation along the bowel trace on the right side of the abdomen was seen as evidence of lower gastrointestinal bleeding.

Correlations of 68Ga-PSMA PET/CT in the initial staging of prostate cancer patients.

OBJECTIVE: The aim of this study was to evaluate the correlations between the different risk groups of prostate cancer (PCa) regarding the presence of metastasis and the gallium-68 prostate specific membrane antigen (68Ga-PSMA) uptake patterns in the prostate gland. MATERIALS AND METHODS: One hundred thirty nine patients with newly diagnosed, untreated PCa who underwent 68Ga-PSMA PET/CT imaging for staging between July 2017 and March 2019 were enrolled in this retrospective study. Maximum standardized uptake values (SUVmax) were determined by manually placing the region of interest to the primary tumor in the prostate gland. Patients were divided into groups according to their prostate-specific antigen (PSA) values, International Society of Urological Pathology (ISUP) grade groups, Gleason Scores (GS), D'Amico risk stratification criteria and the presence of metastasis. Mann Whitney U test was used in the comparison of two groups of data. In multivariate analysis, logistic regression was used to determine independent predictors for the presence of metastasis. RESULTS: There were statistically significant differences between D'Amico risk groups in terms of prostate SUVmax levels. The SUVmax levels of the patients in the high risk group were significantly higher than the SUVmax levels of the patients in the low-medium risk groups (P<0.001). Maximum standardized uptake value levels of the patients with PSA level 20ng/mL and above were significantly higher than those with PSA level below 20ng/mL (P<0.001). The metastatic rate of patients with 68Ga-PSMA uptake on two lobes of the prostate gland was significantly higher (42.6%) than the metastatic rate of patients with 68Ga-PSMA uptake on only one lobe (7.9%) (P<0.001).The median SUVmax of tumours in patients with metastasis was statistically significantly higher than in patients with no metastasis. In multivariate analysis; bilobar involvement, PSA value 20ng/mL, prostate SUVmax value 8.6 and GS 8 were determined as independent predictors for the presence of metastasis. CONCLUSION: The strong correlation between PSA values and/or Gleason score/Grade and SUVmax values suggests that the SUVmax value of the prostate gland might be a valuable determinant in risk classifications.

THE COMPARISON OF THE EXTERNAL DOSE RATE MEASUREMENT OF CHILDREN AND ADOLESCENT PATIENTS WITH ADULT PATIENTS TREATED WITH RADIOIODINE THERAPY.

The aim of this study is to evaluate the radiation safety of caregiving people contacting the child and adolescent patients with thyroid cancer who received radioactive iodine-131 (RIT) treatment by comparison with external dose rate measurements of adult patients according to their administered activities and days of hospitalization. We retrospectively evaluated external dose rate measurement of 158 children and adolescent patients and 158 adult patients. During the RIT, the hospitalization time were grouped as 2, 3 and 4 d, and the administered activities as <3700, 3700 and >3700 MBq. The values of external dose rate measurements of children and adolescents were statistically significantly higher than the adult group. Different approaches in radiation safety rules are required for children and adolescents. In terms of radiation safety, we suggest that more specific regulations for family members and caregivers should be established and informed.

Differentiation of incidental intestinal activities at PET/CT examinations with a new sign: Peristaltic segment sign / Signo del segmento peristáltico: un nuevo signo del examen PET/TAC para el diagnóstico diferencial de las actividades intestinales incidentales

Purpose. The aim of this study was to present the effect of the peristaltic segment sign for the differential diagnosis between malignant, physiological and gastrointestinal focal fluorodeoxyglucose (FDG) uptakes as an alternative method to maximum standardized uptake value (SUVmax). Materials and methods. Gastrointestinal tract (GIT) sections of 823 FDG positron emission tomography/computed tomography (FDG-PET/CT) performed in our center were reviewed retrospectively. Images of these cases that have been reported for positive intestinal focal FDG uptake areas were included. Through the sectional images, any accompanying short segment expanded with air just after or before the uptake area was marked as “positive peristaltism sign”. The cases were confirmed with endoscopy plus biopsy (n:42), endoscopy (n:5), laparotomy (n:1), transabdominal biopsy (n:1), enteroclysis (n:1), CT-colonoscopy (n:5), rectal contrast enhanced CT (n:4). Distinguishing features of the sign were analyzed statistically compared to the conventional method for differentiation of malignity. Results. Localized FDG uptake was reported in 59 of 823 cases. A SUVmax greater than 2.5 with intestinal wall thickening allowed the diagnosis of malignity with sensitivity 33%, specificity 65%, positive predictive value 69% and negative predictive value 46%. The peristaltic segment sign, considered as a benign finding, increased the statistical values to 68%, 80%, 82% and 65%, respectively. Conclusion. In case of gastrointestinal increased focal FDG uptake, the new parameter of peristaltic segment sign may differentiate the physiologic uptakes from the malignant ones more accurately than the conventional SUVmax (AU)

Objetivo. El objetivo de este estudio fue presentar el efecto del signo del segmento peristáltico en el diagnóstico diferencial, maligno o fisiológico, de las captaciones focales de FDG detectadas en el tracto gastrointestinal (GIT) como un nuevo parámetro alternativo al SUVmax. Material y métodos. Se revisaron retrospectivamente las secciones del GIT de 823 estudios PET/TAC con FDG en los que se informaron la presencia de una captación focal intestinal de FDG. Se identificó como “signo peristáltico positivo” cualquier segmento intestinal que contenía aire antes o después del área de captación de FDG. Los casos se confirmaron por endoscopia con biopsia (42), endoscopia (5), laparotomía (1), biopsia transabdominal (1), enteroclisis (1), colonoscopia virtual (5) y TAC abdominal con contraste rectal (4). Los rasgos característicos del signo se analizaron estadísticamente comparados al método convencional para diferenciar malignidad. Resultados. La captación localizada de FDG se informó en 59 de los 823 casos. Un SUV mayor de 2.5 con engrosamiento de la pared intestinal permitió el diagnóstico diferencial de malignidad con sensibilidad 33%, especificidad 65%, valor predictivo positivo 69% y valor predictivo negativo 46%. El signo del segmento peristáltico, considerado como un hallazgo benigno, aumentó significativamente los valores a 68%, 80%, 82% y 65%, respectivamente. Conclusión. Cuando se detecta un aumento focal de captación de FDG en el GIT, el signo del segmento peristáltico, como un nuevo parámetro, puede diferenciar la captación fisiológica de la captación maligna de forma más exacta que el SUV (AU)

Differentiation of incidental intestinal activities at PET/CT examinations with a new sign: peristaltic segment sign.

PURPOSE: The aim of this study was to present the effect of the peristaltic segment sign for the differential diagnosis between malignant, physiological and gastrointestinal focal fluorodeoxyglucose (FDG) uptakes as an alternative method to maximum standardized uptake value (SUVmax). MATERIALS AND METHODS: Gastrointestinal tract (GIT) sections of 823 FDG positron emission tomography/computed tomography (FDG-PET/CT) performed in our center were reviewed retrospectively. Images of these cases that have been reported for positive intestinal focal FDG uptake areas were included. Through the sectional images, any accompanying short segment expanded with air just after or before the uptake area was marked as "positive peristaltism sign". The cases were confirmed with endoscopy plus biopsy (n:42), endoscopy (n:5), laparotomy (n:1), transabdominal biopsy (n:1), enteroclysis (n:1), CT-colonoscopy (n:5), rectal contrast enhanced CT (n:4). Distinguishing features of the sign were analyzed statistically compared to the conventional method for differentiation of malignity. RESULTS: Localized FDG uptake was reported in 59 of 823 cases. A SUVmax greater than 2.5 with intestinal wall thickening allowed the diagnosis of malignity with sensitivity 33%, specificity 65%, positive predictive value 69% and negative predictive value 46%. The peristaltic segment sign, considered as a benign finding, increased the statistical values to 68%, 80%, 82% and 65%, respectively. CONCLUSION: In case of gastrointestinal increased focal FDG uptake, the new parameter of peristaltic segment sign may differentiate the physiologic uptakes from the malignant ones more accurately than the conventional SUVmax.

Intraocular and orbital metastasis as a rare form of clinical presentation of insular thyroid cancer.

Insular carcinoma of thyroid is a rare tumor, which accounts for 4 to 6% of thyroid malignancies. Clinically and morphologically it is considered to be in an intermediate position between well-differentiated carcinoma of the thyroid (papillary or follicular) and undifferentiated or anaplastic carcinoma of the thyroid. Capsular and blood vessel invasion is seen frequently, and metastases to regional lymph nodes, lungs and bones are common. The initial presentation of distant metastasis in patients with thyroid cancer is rare. Thus metastatic thyroid carcinoma rarely involves the orbit. We report a rare case of choroidal metastasis from insular thyroid carcinoma.

Evaluation of anxiety and depression in patients prior to myocardial perfusion scintigraphy.

OBJECTIVE: In myocardial perfusion scintigraphy (MPS) negative results indicate coronary artery diseases which might cause prominent anxiety and other psychological reactions. The aim of this study was to determine anxiety and depression levels of patients prior to MPS procedures. METHODS: The Hospital Anxiety Depression Scale(HADS) and the State and Trait Anxiety Inventory I and II were used to evaluate the anxiety and depression levels of the patients. Descriptive analyses and independent sample t-test were used for statistical assessment. RESULTS: The mean score of HADS-anxiety score prior to MPS was 8.1 ± 4.2, whereas the mean HADS depression score was 6.1 ± 3.7. The mean state anxiety score prior to MPS was 39.7 ± 10.6 and the mean trait anxiety score was 45.02 ± 9.1. HAD and state and trait anxiety scores were found to be significantly higher in female patients than male patients and non-smoker patients than smoker patients. Other risk factors such as having bypass operation, myocardial infarction, hypercholesterolemia, diabetes and hypertension were not related to depression and anxiety scores. CONCLUSION: The results in this study suggest a role for MPS as a risk factor for higher state anxiety. The MPS procedures might lead to an increase in anxiety levels of patients which is possibly associated with anticipation anxiety felt during waiting period and expectation life-threatening.

Tc-MDP bone scintigraphy in a case with sporodical tumoral calcinosis.

Tumoral calcinosis is an uncommon and benign condition characterized by the presence of large calcific soft tissue deposits occurring predominantly in a periarticular location. It generally occurs as a complication of renal dialysis or trauma, and is rarely seen in familial and sporadic cases. Bone scintigraphy is a sensitive method for diagnosing tumoral calcinosis. A 28-year-old female patient with a history of operation due to tumoral calcinosis located bilateral hips, referred to our department. She had a tender palpable mass in the right knee and a fistulized incisional scar overlying the bilateral hip joints. A sporadic case of tumoral calcinosis with relapses was presented.

The evaluation of the external dose measurement of the patients treated with radioiodine therapy.

The aim of the study is to compare the results of the external exposure and the range of the dose spread by the patients, hospitalized in two different groups of 3-4 d receiving radioiodine therapy because of having hyperthyroidism (HT) and thyroid cancer (TC). A total of 1989 patients were evaluated retrospectively. Of the total 1517 patients had TC and 472 had HT. External exposure value was taken at hospital discharge and the distance for external measurement was 1 m at the abdominal level. External exposure values of 99.7 % patients were <30 µSv h(-1) and of 0.3 %, >30 µSv h(-1). The results between patient groups with TC and HT at third and fourth days, and the dissimilarity of measurement results within third and fourth days in total patients, without discriminating the day difference, are statistically meaningful. Although 3-d isolation period for 30 µSv h(-1) limit is generally enough, it can be insufficient for some patients. Besides hospitalisation, the radiation safety training must be emphasised by establishing good communication with patients in order to protect their relatives and other people against radiation risk.