UTERUSTA DIAGNOSTIK KÜRETAJA SEKONDER ARTMIŞ F-18 FDG TUTULUMU OLGUSU

Endometrial cancer is one of the most common malignant tumors of the women, and if it can be detected in the earlier stages, the curability and the prognosis of the endometrial cancers can be better. A 52 year-old female patient, as part of ongoing research project in our clinic on endometrial carcinoma, was referred to our clinic with a suspicion of endometrial carcinoma with increased serum CA-125 measurement. Increased F-18 FDG uptake in uterine cavity that was secondary to the diagnostic curettage was demonstrated on F 18 FDG PET images. This uptake might be secondary to benign inflammatory changes or hemorrhage arising from diagnostic curettage that patient underwent ten days ago. According to our knowledge, this is the first case demonstrating increased F-18 FDG uptake secondary to diagnostic curettage Endometrium kanseri kadınlarda en çok görülen malign tümörlerden birisidir. Erken teşhis edildiğinde tam tedavi şansı yüksektir ve prognozu çok iyi seyirlidir. Bölümümüzde endometrium kanseri ile ilgili olarak devam eden bir proje kapsamında, serum CA-125 yüksekliği ile endometrium kanseri şüphesi olan 53 yaşında kadın hasta bölümümüze refere edildi. PET görüntülerinde uterusda artmış F-18 FDG tutulumu izlenmiştir. Bu bulgunun hastanın öyküsünde 10 gün önce geçirilmiş diagnostik küretaja bağlı benign inflamatuar değişiklikler veya hemoraji ile ilgili olduğu düşünülmüştür. Bu olgu sunumunda diagnostik küretaja sekonder olduğu düşünülen F-18 FDG tutulumu muhtemelen literatürde ilk kez gösterilmektedi

CD4+CD25+CD127loFOXP3+ cell in food allergy: Does it predict anaphylaxis?

Background: Food allergy (FA), hence the incidence of food anaphylaxis, is a public health problem that has increased in recent years. There are still no biomarkers for patients with FA to predict severe allergic reactions such as anaphylaxis. Objective: There is limited information on whether regulatory T (Treg) cell levels are a biomarker that predicts clinical severity in cases presenting with FA, and which patients are at a greater risk for anaphylaxis. Methods: A total of 70 children were included in the study: 25 who had IgE-mediated cow’s milk protein allergy (CMPA) and presented with non-anaphylactic symptoms (FA/A−), 16 who had IgE-mediated CMPA and presented with anaphylaxis (FA/A+) (a total of 41 FA cases), and a control group consisting of 29 children without FA. The study was conducted by performing CD4+CD25+CD127loFOXP3+ cell flow cytometric analysis during resting at least 2 weeks after the elimination diet to FA subjects. Results: When the FA group was compared with healthy control subjects, CD4+CD25+CD127loFOXP3+ cell rates were found to be significantly lower in the FA group (p < 0.001). When the FA/A− and FA/A+ groups and the control group were compared in terms of CD4+CD25+CD127loFOXP3+ cell ratios, they were significantly lower in the FA/A− and FA/A+ groups compared to the control group (p < 0.001). Conclusions: Although there was no significant difference between the FA/A+ group and the FA/ A− group in terms of CD4+CD25+CD127loFOXP3+ cells, our study is important, as it is the first pediatric study we know to investigate whether CD4+CD25+CD127loFOXP3+cells in FA p redict anaphylaxis

The relationship between the alveolar-capillary membrane clearance of aerolized Tc-99m DTPA and Ga-67 uptake in the diagnosis of sarcoidosis

AMAÇ: Sarkoidoz kronik enflamatuar hücrelerin vücudun değişik yerlerinde akümülasyonu ile karakterize granülomatöz bir hastalıktır. Akciğer tutulumu olduğunda enflamatuar hücreler akciğer dokusuna ve özellikle alveolar-kapiller membrana (AKM) zarar verebilirler. Bu çalışmada AKM klirensi ile Ga-67 tutulumu arasındaki ilişkiyi değerlendirmeyi amaçladık. YÖNTEMLER: 26 sarkoidoz hastası çalışmaya dahil edildi(ort yaş 43 ±12;9erkek ve 17kadın).26 hastanın AKM klirensi için inhale Tc-99m Diethylenetriamine pentaacetate (DTPA), aktif sarkoidoz ve hastalığın yaygınlığı için ise Ga-67 sintigrafisi yapıldı. Ga-67 tutulumlarının akciğer/karaciğer oranları 48. ve 72. saatler için hesaplandı. Akciğer/karaciğer oranları ile AKM klirensi ve bronkoalveolar lavaj (BAL) sonuçları arasındaki ilişki, ayrıca AKM klirensi ve BAL sonuçları arasındaki ilişki spearman korelasyon testi ile analiz edildi. BULGULAR: 23 hastada Ga-67 sintigrafisi ile aktif sarkoidoz saptandı. Ortalama AKM klirensi 1,01± 0,3 %/dk olarak hesaplandı. Ortalama 48.saat Ga-67 akciğer/karaciğer oranı 1,18±0,45, ortalama 72.saat Ga-67 akciğer/karaciğer oranı 1,15±0,51 olarak hesaplandı. Yapılan istatiksel analizde 48 ve 72. saat Ga-67 akciğer/karaciğer oranları ve AKM klirensi arasında (p=0,71;0,49), 48. ve 72. saat Ga-67 akciğer/karaciğer oranları ile BAL makrofaj yüzdesi (p=0,84; 0,77), lenfosit yüzdesi (p=0,85; 0,88) ve CD4/CD8 oranları (p=0,098; 0,17) arasında korelasyon saptanmadı. AKM klirensi ile makrofaj yüzdesi arasında (p=0,69), lenfosit yüzdesi (p=0,58), CD4/CD8 oranları (p=0,60) arasında korelasyon saptanmadı. SONUÇ: Çalışmamızın sonuçlarına göre akciğer Ga-67 tutulum miktarı AKM permeabilite bozukluğunu öngörememiştir. Literatürde sarkoidozlu hastalarda AKM klirensinin hızlandığı gösterilmiştir. Bizim çalışmamızda hesaplanan ortalama klirens değeri literatür ile uyumludur. Ancak Ga-67 tutulumu ile ilişkisinin saptanamamasının nedeni hasta grubunun evresi ve hasta sayısının az olması ile ilgili olabileceği düşünülmüştür. Literatürde de bu konuda farklı sonuçların görülmesi hala bu konuda çalışmalara ihtiyaç olduğunu göstermektedir. OBJECTIVE: Sarcoidosis is characterized with abnormal accumulation of chronic inflammatory cells in the differnet areas of the body. Inflammatory cells may damage the lung tissue, especially alveolar-capillary membrane. In this study, we aimed to evaluate the relation between alveolar-capillary membrane (ACM) clearance and Galyum-67 (Ga-67) uptake. METHODS: 26 patients with sarcoidosis were examined for this study. (average age 43±12; 9 men 17 women). Aerolize Tc-99m Diethylenetriamine pentaacetate (DTPA) was performed in order to find ACM clearance and Ga-67 scintigraphy was performed in order to evaluate the state of the sarcoidosis. Ga-67 uptake for Lung/ liver ratio in 48 and 72 hours was calculated. The correlation between Ga-67 uptake for Lung/ liver ratio, the ACM clearance and the result of BAL (Bronchoalveolar Lavage), furthermore, the correlation between ACM clearance and the result of BAL were analysed RESULTS: Active sarcoidosis was detected in 23 patients with Ga-67 scintigraphy. The average ACM clearance was found 1.01 ±0.3 %/dk. The average Ga-67 uptake for Lung/ liver ratio in 48 and 72 hours was 1.18±0.45 and 1.15±0.51 respectively. We could not found a correlation between Ga-67 uptake for Lung/ liver ratio and ACM clearance (p=0.71;0.49). CONCLUSION: According to our results, The amount of Ga-67 uptake did not predict the disorder of the ACM clearance. It might be due to the stage of the patients and the small number of patients. Since there are different results about the alveolar-capillary membrane clearance in the literature, the studies with more patients are still necessary

The diagnostic role of Dual phase F-18 FDG PET-CT and lymphoscintigraphy for the detection of sentinel lymph node in the patients with T1-4 N0-3 M0 oral cavity cancers

Amaç: Bu çalışmada oral kavite kanserli hastalarda primer tümör alanının ve lenfatik metastazların değerlendirilmesinde dual faz F-18 FDG PET-BT'in tanısal rolü, sentinel lenf nodunun (SLN) saptanması, F-18 FDG PET-BT ile metastatik lenf nodlarının saptanabilirliğinin bölgesel farklılıkları, primer tümör alanındaki F-18 FDG tutulum miktarı ile lenf nodu metastazı arasındaki ilişki, konvansiyonel görüntüleme yöntemleri ile karşılaştırıldığında F-18 FDG PET-BT ve sentinel lenf nodu biyopsisinin (SLNB) tedavi yaklaşımında değişikliğe yol açıp açmadığı araştırıldı. Yöntem: Bu retrospektif çalışmaya 16 hasta (4 kadın; 12 erkek, yaş aralığı, 29-81 yaş) dahil edildi. 16 hastaya operasyon öncesi F-18 FDG PET-BT ve operasyondan 2 saat önce lenfosintigrafi yapıldı. F-18 FDG enjeksiyonundan 1 (erken) ve 2 saat (geç) sonra F-18 FDG PET-BT görüntüleri elde edildi. Tanısal BT veya MR görüntüleri radyoloji uzmanı tarafından değerlendirildi. PET/BT görüntülerinde lenf nodunda malignite yorumu 3 kritere göre değerlendirildi. 1: Görsel olarak, 2: Tümör/komşu kas dokusu SUVmax (T/M) oranı, 3: Tümör boyutuna göre düzeltilmiş SUVmax değerleri. Bu üç kriter için 1. ve 2. saat çekimler alınarak ayrı ayrı değerlendirme yapıldı. Operasyon sonrası histopatolojik değerlendirme boyun seviyelerine göre kaydedildi. Ayrıca lenf nodlarında erken görüntülerde tümör/karaciğer SUVmax oranına (T/Kc) bakıldı, SUVmax değeri, T/M ve T/Kc oranlarında malignite için cut off değerleri araştırıldı. Bulgular: Histopatolojik sonuçlar ile 5 hastada boyunda metastatik lenf nodları saptanırken (N+), 11 hastada lenf nodu metastazı saptanmadı (N-). F-18 FDG PET-BT'nin BT'sinde 43 lenf nodundan 14 tanesi malign, 29 tanesi benign olarak değerlendirildi. N(+) ve N(-) hastalar arasında yaş, tümör derinliği ve mitoz sayısı için fark bulunmazken primer tümör alanı için erken ve geç SUVmax değerleri arasında anlamlı değişiklik saptandı (P=0,011). Görsel olarak malign olarak değerlendirilen lenf nodlarının ortalama SUVmax değeri, T/M oranı ve T/Kc değeri sırasıyla erken çekimde ortalama 7,67±4,95, 7,10±3,18, 2,85±1,83 iken geç çekimde SUVmax değeri ve T/M oranı 8,0±5,68 ve 9,08±4,31; benign olarak değerlendirilen lenf nodlarının erken çekimde ortalama SUVmax değeri, T/M oranı ve T/Kc değeri 1,69±0,43, 1,49±0,48 ve 0,59±0,22 iken geç çekimde SUVmax değeri ve T/M oranı 1,66±0,36 ve 1,66±0,69 olarak saptandı. Histopatolijik metastatik lenf nodu saptanan bölgelerdeki lenf nodlarının erken ve geç çekim arasında SUVmax değeri için (p=0.00) ve T/m oranı için (p=0.01) anlamlı fark saptanırken, benign lenf nodları için anlamlı değişiklik saptanmadı. En yüksek sensitivite, spesifisite, NPV ve PPV değerler T/M oranına göre hem erken hem de geç çekimler için elde edildi. ROC analizi sonucunda benign-malign lenf nodu ayrımında erken çekimde SUVmax 3,4 ve T/m oranı 3,2 eşik değeri için; geç çekimde SUVmax 4,0 ve T/m oranı 3,8 eşik değeri için sensitivite % 93, spesifisite % 96 olarak saptandı. T/Kc oranı için 1 eşik değeri için sensitivite ve spesifisite % 93 olarak saptanmıştır. Lenfosintigrafi ile 40 adet, gama probe ile 31 adet sentinel lenf noduna ait olabilecek aktivite tutulumu saptandı. N(+)hastalığı olan 5 hastada 32 adet metastatik lenf nodu saptandı. 3 hastada lenfosintigrafi ve gama probe ile saptanan 5 adet lenf nodunda metastaz saptandı. SLNB'si metastaz açısından pozitif olan 5 lenf nodunun 2'sinde Hematoksilen-Eozin boyaması (H&amp;E) ile metastaz saptanırken, 3'ünde immunohistokimya ile metastatik odak saptanmıştır. SLNB 2 hastada yanlış negatif olarak saptandı. SLNB ile yanlış değerlendirilen iki hastada skip metastazlar F-18 FDG ile saptandı. SLNB ile metastaz saptanan F-18 FDG PET-BT'de atlanan lenf nodu metastazı saptanmadı. Sonuç: F-18 FDG PET/BT oral kavite kanserlerinde boyun evrelemesinde tanı değerini güçlendiren, skip LN metastazlarını yakalayabilen bir modalite olarak değerlendirilebilir. Çalışmamızda geç çekimlerin LN metastazlarının degerlendirilmesinde sensitivite ve spesifisiteyi düşürdüğünü saptadık. Ayrıca N(+) ve N(-) hastalar arasında primer tümör maksimum derinlikleri ve primer tümördeki mitoz sayısı arasında anlamlı bir fark bulunmamasına rağmen N(+) hastalarda primer tümör alanındaki F-18 FDG tutulumu N(-) hastalara göre anlamlı şekilde daha yüksek olarak tespit edildi. Bu bulgu ile SUVmax yüksekliğinin tümör agresifliğini bağımsız bir faktör olarak gösterdiği ve N(+) hastalığı öngördüğü söylenebilir. Çalışmamızda tespit edilen eşik değerleri malign ve benign lenf nodlarını ayırt etmekte yüksek ayırım gücüne sahip eşik değerler olarak kabul edilebilir. T/M oranı lenf nodunda malignite değerlendirilmesinde en yüksek tanı değerine sahip krıter olarak saptandı. Ancak, hasta sayısının fazla olduğu çalışmalar gerekmektedir. &nbsp; Aim: Our objective was to evaluate the diagnostic role of F-18 FDG PET-CT in the patients with oral cavity cancer. We also investigated the diagnostic accuracy of the lymphoscintigraphy for the detection of sentinel lymph node (SLN) in the patients with oral cavity cancer. In terms of the diagnostic role of F-18 FDG PET-CT, we investigated the F-18 FDG uptake difference in metastatic lymph nodes according to regional neck levels, the correlation between F-18 FDG uptake in the primary tumor and lymph node metastases, comparison with the conventional imaging methods, and cutoff values for detection of malignant lesions, and the additional diagnostic value of dual phase imaging.We also searched that the impact of F-18 FDG PET-CT and sentinel lymph node biopsy (SLNB) together in decision making of the patients with oral cavity cancer. Methods: 16 patients (4 female; 12 male, age range, 29-81 years) were included in this retrospective study. F-18 FDG PET-CT and lymphoscintigraphy (2 hours before the surgery) were performed for all the patients before surgery. PET-CT scans were performed one (early) and two hours (delayed) after injection 8-12mCi (296-444 MBq) of F-18 FDG. Diagnostic CT or MR was evaluated by an experienced radiologist on head and neck radiology. In the PET-CT, malignancy in the lymph nodes was evaluated according to 3 criteria: 1: Visual assessment 2: The ratio of SUVmax in tumor/ adjacent muscle tissue (T/M), 3: SUVmax adjusting to the size of lymph nodes. The evaluation of malignancy in the lymph nodes was done separately for early and delay scans. The histopathological evaluation of the surgey was recorded according to the neck levels. Furthermore, the ratio of SUVmax in tumor/liver uptake (T/L) in the lymph nodes was calculated. The sensitivity, specificity, negative (NPV) and positive predictive values (PPV) in F-18 FDG PET-CT for early and delay scans were calculated for each malignancy criteria expect T/L. T/L ratios were calculated just for early images. ROC curves were obtained for SUVmax, T/M and T/Kc. The threshold values were calculated in the terms of highest sensitivity and specificity points. Results: Histopathological evaluations revealed 5 patients had metastatic lymph nodes (N+) whereas 11 patients had benign lymph nodes (N-). 14 of 43 lymph nodes that were visualized in CT of F-18 FDG PET-CT were evaluated as malignant whereas 29 of 43 lymph nodes were evaluated as benign. There was no statistical difference between the N(+) ve N(-) patients in the terms of age, depth of primary tumor and the number of mitosis. However, there was significant difference in the terms of early and delay F-18 FDG uptake of primary tumors between the N(+) ve N(-) patients (P=0,011). The average of SUVmax, T/M and T/L ratios of visually malignant lymph nodes were 7,67±4,95, 7,10±3,18, 2,85±1,83 in early scan respectively. The average of SUVmax and T/M ratio were 8,0±5,68 and 9,08±4,31 in delay scan. The average of SUVmax, T/M and T/Kc ratios of visually benign lymph nodes were 1,69±0,43, 1,49±0,48 ve 0,59±0,22 respectively in early scan. The average of SUVmax and T/M ratios were 1,66±0,36 and 1,66±0,69 in delay scan. There was significant difference in the value of SUVmax (p=0.00) and in the T/M ratios (p=0.01) between early and delay scans for the lymph nodes. There was no statistical difference in the value of SUVmax and T/M ratios between early and delay scans for the benign lymph nodes. The highest sensitivity, specificity, NPV and PPV were obtained in the criteria of T/M ratios for both early and delay scan. With the treshold value of early SUVmax as 3,4 and early T/M ratio as 3,2; delay SUVmax as 4,0 and delay T/M ratios as 3,8 which is obtained from our population using ROC curve, 93% sensitivity, 96% specificity were calculated. With the treshold value of T/L ratios as 1,0 we found 93% sensitivity and specificity. 40 lymph nodes were displayed with lymphoscintigraphy, 31 lymph nodes were detected with gama probe. There were 32 metastatic lymph nodes in 5 N(+) patients. 5 lymph nodes were detected with lymphoscintigraphy and gama probe in 3 patients. Metastasis were proven with hematoxylin-eosin (H&amp;E) in 2 of 5 metastatic lymph nodes and metastatis were proven with immunohistochemistry in 3 of 5 metastatic lymph nodes. SLNB was false negative in 2 patients. F-18 FDG showed skip lymp node metastases in these SLNB negative patients. Conclusion: This study indicates that F-18 FDG PET-CT is a reliable method for the correct evaluation of primary tumor and N staging in oral cavity cancers. It might catch skip metastasis in lymph nodes which can be missed with SLNB. We found that delay scans may cause to decrease the sensitivity and specificity in our study. In addition, since there was significant difference in the terms of early and delay F-18 FDG uptake of primary tumors between the N(+) ve N(-) patients, FDG uptake in primary tumor might be an independent factor showing the aggressivity of primary tumor and might predict N(+) disease. This study showed that T/M ratios in the lymph nodes can be used to evaluate malignancy with a high diagnostic accuracy. The further studies with the high number of patients are needed

THE COMPARISON OF THREE DIFFERENT MALIGNACY EVALUATION CRITERIA OF CERVICAL LYMPH NODES IN ORAL CAVITY CANCER USING F-18 FDG PET-CT

Aims: Our aim was to evaluate the diagnostic role of Fluorine-18 fluorodeoxyglucose Positron emission tomography-computed tomography (F-18 FDG PET-CT) using three different criteria published in the literature and to compare the diagnostic value of these three parameters in patients with oral cavity cancers (OCC)

Brain scintigraphy in brain death: The experience of nuclear medicine department in dokuz eylul university, school of medicine

© 2014, Yuzuncu Yil Universitesi Tip Fakultesi, Universitas Indonesia. All rights reserved.We investigated the propriety between the findings of brain death scintigraphy and the patient outcomes after the scan. We figured out the benefits of scintigraphic findings to the diagnosis. This study was performed in our department between 2006-2011 and patients were evaluated retrospectively. Pre-diagnosis of brain death and final diagnosis were compared. 24 patients were referred to our nuclear medicine department between 2006-2011. All patients underwent brain scintigraphy following IV injection of 20 mCi of Tc 99m DTPA or 10 mCi Tc 99m HMPAO with one-second dynamic images in 128x128 matrix for a period of 60 seconds. Anterior, posterior, right and left lateral static images were obtained with 5-minute in 256x256 matrix after dynamic images. Patients were referred by the departments of internal medicine intensive care and anaesthesiology intensive care. No blood flow into the middle, anterior and posterior cerebral arteries and no activity in the venous sinuses were accepted as showing the brain death. 22 of 24 patients were reported that findings in brain scan were consistent with brain death as in the prediagnosis. Brain death was not reported in two patients with Tc-99m HMPAO scan and brain death was suspicious in one patient with Tc-99m DTPA scan. Two patients with Tc-99m HMPAO scan were died two weeks after the brain scan and the patient with Tc-99m DTPA was died one day after the brain scan. Brain scintigraphy is a non-invasive procedure supporting the clinical diagnosis and it can be also easily performed and can exclude the negative and suspicious patients

Rest Myocardial Perfusion Scintigraphy Showing the Invasion of the Hydatid Cyst in the Myocardium

A cardiac hydatid cyst is a rare complication of the Echinococcus infection, and it is seen in just 0.5% to 2% of all cases. Because it can cause sudden death, removing the cyst is recommended. It is important to determinate the relationship between the cyst and the intra/extracardiac structures before the operation because it is of vital importance during the operation. In our case, we showed that rest myocardial perfusion scintigraphy provided an additional contribution to anatomic imaging in that it showed the invasion of the cyst in the myocardium, which was effectively directing the course of the operation

Is Imaging Time Between two Tc 99m DMSA Scans Sufficient for Reporting as Renal Parenchymal Scarring? Healed Parenchymal Renal Defect After 6 Years

We aimed to report a healed renal parenchymal defect after 6 years in a 9-year-old girl who was being followed for recurrent urinary tract infection (UTI). The first UTI was at the age of two. She was being followed with ultrasonography, urine analysis and urine culture since the first UTI. Technetium-99m dimercaptosuccinic acid (DMSA) scintigraphy was repeated four times up to the present day. She had a renal parenchymal defect reported as parenchymal scarring, which healed 6 years after the first DMSA scintigraphy