Assessment of procedure related anxiety and depression in oncologic patients before F-18 FDG PET-CT imaging

Background: The aim of this study was to study objectively the level of anxiety and depression in patients undergoing positron emission tomography-computed tomography (PET-CT).One hundred and forty four oncologic out-patients (76 male, 68 female) were included in this study. Methods: All patients were referred to Nuclear Medicine Department for Fluorine-18 fluorodeoxyglucose (F-18 FDG) PET-CT imaging for the assessment of their malignant or possibly malignant diseases. The Hospital Anxiety Depression Scale and the State and Trait Anxiety Inventory I and II were used to evaluate the anxiety and depression levels in these patients. Results: The mean anxiety and depression scores of The Hospital Anxiety Depression Scale prior to F-18 FDG PET-CT were 9.2 ( ± 3.8) and 6.6 ( ± 3.4), respectively. The mean state and trait anxiety scores of the State and Trait Anxiety Inventory I and II prior to F-18 FDG PET-CT were 40.4 (± 8.5) and 46.62 ± 7.8, respectively. The Hospital Anxiety Depression Scale and the State and Trait Anxiety Inventory I and II anxiety scores were found to be significantly higher in female patients, smokers and in patients with higher stage disease. Conclusion: Our results suggest that F-18 FDG PET-CT imaging may at least contribute to patient's baseline anxiety which is already generated by being an oncology patient, and thus nuclear medicine physicians should handle the patients with extra care to minimize this affect. © 2015, Umut Elboga, et al

Heterotopic Ossification in the Paraplegic Patients

Heterotopic ossification is a process characterized by the formation of genuine new bone in soft tissues especially between muscle and joint capsule and frequently encountered after spinal cord and traumatic brain injury. A 35-year-old woman who had developed severe pain and decrease in range of motion in her bilateral hip after 11 months following a spinal cord injury referred to our department for bone scintigraphy is presented

Regional Distributions of Distant Metastases Detected in Differentiated Thyroid Cancers

Aim: The aim of our multicenter study is to determine retrospectively the regional distributions of distant metastases which are detected in differentiated thyroid cancers (DTC). Material and Method:Thirty-two of 960 patients with distant metastases who were given radioiodine (RAI) treatment in Gaziantep University School of Medicine and Mustafa Kemal University School of Medicine were included to study. Six of patients were male, 26 of them were female. Mean age was 52 15.4. Hystopathological diagnoses were reported as papillary thyroid cancer in 23 patients and folliculary thyroid cancer in 9 patients. The distant metastasis ratio, metastasis regions and distributions were determined. Results: It was observed only lung metastasis in 18 (56.25 b), only bone metastasis in 6 (18.75 To), combination of lung and bone metastases in 3 (9.4 %), other organ metastases accompanying to bone and lung metastases in 5 (9.4 %) (liver, soft tissue, mediastinum) and multipl organ involvoment in 2 (6.2 96) of patients. It was determined single metastasis region in 24 (75 To), 2 metastasis regions in 6 (18.75 glo) and multipl metastasis regions in 2 (6.25 WO of patients. Discussion: Distant metastases are the biggest problem in treatment and follow-up of DTCs. It is very important to diagnosis of metastases and determine the regions of involvoment in these patients

Utility of F-18 fluorodeoxyglucose positron emission tomography/computed in carcinoma of unknown primary

Carcinoma of unknown primary (CUP) is a heterogeneous group of tumors with various clinical features causing diagnostic and therapeutic challenges. The aim of this study was to evaluate the ability of F-18 FDG PET/CT for localizing the primary tumor, disclosing additional metastases, and changing the treatment in patients with CUP. One hundred and twelve metastatic patients (female = 40, male = 72, median age = 60.5 years) in whom conventional diagnostic work-up failed to disclose the primary tumor were included in the study. F-18 FDG PET/CT imaging was performed in a standard protocol (patient supine, arms on patient's side, vertex to thigh, 369.3 MBq (296-444 MBq) F-18 FDG, a 60-minute uptake period, 6-7 bed position). Histopathology was taken as the only reference standard. F-18 FDG PET/CT correctly detected primary tumor in 37 of 112 (33.03%) patients. The most common site of primary tumor detected by F-18 FDG PET/CT was lung (n = 18), which was followed by nasopharynx (n = 7), pancreas (n = 5), tonsil (n = 2), breast (n = 2), thyroid (n = 1), uterus (n = 1) and colon/rectum (n = 1). F-18 FDG PET/CT imaging disclosed additional previously undetected metastases in 32 (28.5%) and changed the treatment in 33 (29.4%) of 112 patients. There were false positive F-18 FDG PET/CT results in 21 (18.5%) patients. F-18 FDG PET/CT is able to disclose the primary tumor, disclose new metatases and change the treatment in about one third of patients with CUP

Empiric I-131 Treatment of High Thyroglobulin Levels in Differentiated Thyroid Carcinoma After Remnant Ablation

Aim: The objective of this study is to establish the efficacy of empiric 1-131 treatment (EIT) given for patients whose thyroglobulin(Tg) levels remained high after ablative 1-131 treatment (AIT). Methods: Fifty-six patients (46 women, 10 men; mean age 47.4 +/- 16.8), without distant metastasis, who were treated empirically for high Tg levels after AIT in our clinic, were retrospectively studied. In all patients stimulated Tg levels before AIT (Tg I) and 6 months after AIT (Tg II) were measured. After EIT, post-therapeutic whole-body scintigraphy (PWBS) was performed to all patients. 18F-FDG PET CT was performed to patients who had negative PWBS but continued to have high Tg II levels. Results: PWBS was positive in 28 patients (50%) and negative in 28 patients (50%). Twenty-eight patients did not respond to EIT (50%), and 28 patients (50%) responded to EIT at different rates. Sixteen patients (28.6%) responded to EIT completely, and 12 patients (21.4%) responded to EIT partially. Tg I was 60.7 +/- 40 ng/ml and Tg H was 31 +/- 20.4ng/ml in responding patients, whereas Tg I was 87 ng/ml and Tg II was 114.3 +/- 106 ng/ml in unresponding ones. 18F-FDG PET CT was positive in 22 patients and negative in 6. Conclusion: Our findings, suggested that the EIT is not beneficial in patients who have higher Tg II than Tg land the cure rate is low in increasing Tg levels. The patients who have high Tg II but lower than Tg I can be treated empirically with 1-131

Clinical Significance of Incidental FDG Uptake in the Prostate Gland Detected by PET/CT (Meeting Abstract)

Annual Meeting of the Society-of-Nuclear-Medicine-and-Molecular-Imaging -- JUN 06-10, 2015 -- Baltimore, MD[No Abstract Available]Soc Nucl Med & Mol Imagin

Clinical Significance of Incidental FDG Uptake in the Prostate Gland Detected by PET/CT

The value of FDG-positron emission tomography/computed tomography (PET/CT) for detecting prostate cancer is unknown. We aimed to investigate the clinical value of incidental prostate FDG uptake on PET/CT scans. We reviewed 6128 male patients who underwent FDG-PET/CT scans and selected cases that reported hypermetabolic lesion in the prostate. The patients who have prior history of prostate carcinoma or prostate surgery were excluded from the study. We have analyzed the correlation between PET/CT findings and serum prostate-specific antigen (PSA) levels, imaging (USG), urological examinations and biopsy. Incidental 18F-FDG uptake of the prostate gland was observed in 79 patients (1.3%). While sixteen of them were excluded due to inadequate clinical data, the remaining 63 patients were included for further analysis. The patients were divided into two groups; 8 patients (12.7%) in the malignant group and 55 patients (87.3%) in the benign group. The SUVmax values were not significantly different between the two groups. In 6 (75%) patients with prostate cancer, FDG uptake was observed focally in the peripheral zone of the prostate glands. There was no significant correlation between the SUVmax and the PSA levels. Incidental 18F-FDG uptake in the prostate gland is a rare condition, but a substantial portion of it is associated with the cancer. Benign and malignant lesions of the prostate gland in FDG-PET/CT imaging could not be reliably distinguished. The peripheral focally FDG uptake of prostate glands should be further examined with the clinical and labaratory evaluations

Empiric 131I treatment of high thyroglobulin levels in differentiated thyroid carcinoma after remnant ablation

Aim: The objective of this study is to establish the efficacy of empiric I-131 treatment (EIT) given for patients whose thyroglobulin(Tg) levels remained high after ablative I-131 treatment (AIT). Methods: Fifty-six patients (46 women, 10 men; mean age 47.4±16.8), without distant metastasis, who were treated empirically for high Tg levels after AIT in our clinic, were retrospectively studied. In all patients stimulated Tg levels before AIT (Tg I) and 6 months after AIT (Tg II) were measured. After EIT, post-therapeutic whole-body scintigraphy (PWBS) was performed to all patients. 18F-FDG PET CT was performed to patients who had negative PWBS but continued to have high Tg II levels. Results: PWBS was positive in 28 patients (50%) and negative in 28 patients (50%). Twenty-eight patients did not respond to EIT (50%), and 28 patients (50%) responded to EIT at different rates. Sixteen patients (28.6%) responded to EIT completely, and 12 patients (21.4%) responded to EIT partially. Tg I was 60.7±40 ng/ml and Tg II was 31±20.4 ng/ml in responding patients, whereas Tg I was 87.6±96 ng/ml and Tg II was 114.3±106 ng/ml in unresponding ones. 18F-FDG PET CT was positive in 22 patients and negative in 6. Conclusion: Our findings, suggested that the EIT is not beneficial in patients who have higher Tg II than Tg I and the cure rate is low in increasing Tg levels. The patients who have high Tg II but lower than Tg I can be treated empirically with I-131

FDG PET in the Follow-up of Medullary Thyroid Carcinoma Patients

Amaç: Çalışmanın amacı cerrahi sonrası yüksek kalsitonin seviyelerine sahip medüller tiroid karsinomlu (MTK) hastaların takibinde florodeoksiglikoz pozitron emisyon tomografisinin (FDG PET) etkinliğini değerlendirmektedir. Gereç ve Yöntemler: Çalışmaya yüksek kalsitonin seviyeleri nedeniyle kliniğimize FDG PET görüntüleme için yönlendirilen MTK tanılı 6 hasta dahil edildi. Bütün hastalar erkekti. Yaş ortalaması 52±8 idi. Bulgular: Kalsitonin seviyeleri sırasıyla75 pg/ml, 90pg/ml, 94 pg/ml ve 127 pg/ml olan 4 hastada FDG PET görüntülemede MTKnın rekürrens ya da metastazını düşündürecek bulgu izlenmedi. Kalsitonin seviyeleri 1300 pg/ml ve 2110 pg/ml olan 2 hastada ise FDG PET bulguları pozitifti. Bu hastalarda lenf nodu ve kemik metastazları saptandı. Tartışma: Öyle görünüyor ki MTKnın rutin görüntülemesinde FDG PETe yer yoktur. Ancak burada kalsitonin seviyeleri önem arz etmektedir. Kalsitonin seviyeleri 1000 pg/mlden yüksek hastalarda FDG PET oldukça faydalı olabilmekte ve birçok lezyon odağını tespit edebilmektedir. Ayrıca tüm vücut görüntülemeye olanak sağlaması da önemli bir avantajıdır.Objective: The aim of study is to evaluate the impact of fluorodeoxyglucose positron emission tomography (FDG PET) in the follow-up of medullary thyroid carcionma (MTC) patients who had elevated calcitonin levels after surgery. Materials and Methods: Six patients diagnosed with MTC who referred to our clinic for FDG PET imaging because of the elevated calcitonin levels were included. All were male. Mean age was 52±8 years. Results: In 4 patients whose calcitonin levels were 75 pg/ml, 90pg/ml, 94 pg/ml and 127 pg/ml respectively, there was no evidence for recurrence or metastasis of MTC on FDG PET. FDG PET findings were positive in 2 patients whose calcitonin levels were 1300 pg/ml and 2110 pg/ml respectively. In these patients lymph node metastases and bone metastases were detected. Conclusion: It seems that there is no place to FDG PET for routine imaging of MTC. But here calcitonin levels are important. In patients who have calcitonin levels higher than 1000 pg/ml FDG PET can be very useful and detect a lot of lesion foci. Also allowing to whole body imaging is a significant advantage of it

The Evaluation of Patients with Hyperthyroidism Treated with Radioactive Iodine-131

Aim: Hyperthyroidism is a condition in which the thyroid gland produces and secretes excessive amounts of the thyroid hormones into circulation. It is one of the common endocrinologic disorders. There are three methods in treatment of hyperthyroidism. These are antithyroid medication, radioactive iodine-131 (RAI) therapy and surgery. In this study, we aimed to evaluate RAI treatment efficacy in patients with hyperthyroidism in the light of laboratory results and clinical pictures. Material and Method: Two hundred and seventy six patients with hyperthyroidism (average age: 50.9 years, age range: 1882 years) who received RAI treatment and then followed up for at least 6 months were included in the study. Patients' medical recordings were analysed retrospectively. Results: Seventy one patients were men (average age: 51.2 years, age range: 18-80 years), the rest were women (average age: 50.7 years, age range: 18-82 years). According to thyroid ultrasound or physical examination findings, 102 patients had diffuse thyroid hyperplasia, the other patients had nondiffuse hyperplasia (nodular or multinodular). RAI was given to the patients once or twice, or three times if necessary. In first RAI treatment, average 13.1 mCi, in second, average 16.6 mCi, in third, average 25 mCi RAI were given orally. Treatment was accepted as successful if the patients had become hypothyroid or euthyroid. Success rate of RAI treatment was 76%. The highest success rate was obtained in patients who have diffuse thyroid hyperplasia. Serious side-effects were not observed in our patients. Discussion: In treatment of hyperthyriodism with RAI in our clinic we observed approximately similar success rates with the reported results in the literature, and also side-effects of RAI treatment were low. We believe that RAI treatment should be first choice for treatment of hyperthyroidism in selected patients, because it is easy to perform and its side- effects are very low