Submandibular glands in the metabolic syndrome

In addition to their stimulatory action on neuronal differentiation and survival, a variety of neurotrophic factors, such as nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and ciliary neurotrophic factor, exert metabotrophic effects, including improvement of glucose, lipid and energy homeostasis. It was recently reported that plasma levels of both NGF and BDNF are reduced in patients with advanced metabolic syndrome and with acute coronary syndromes, and that NGF tissue content is decreased in human atherosclerotic coronary arteries. Since NGF and BDNF are synthesized, stored, and released by submandibular salivary glands, we investigated the structure and function of these glands. Here we present our scintigraphic and echographic results of submandibular glands of patients with advanced stage of metabolic syndrome: (i) scintigraphic analysis using the radiotracer (99m)Tc-pertechnetate showed an inhibition of salivary gland excretory activity, and (ii) echographic evaluation revealed a parenchymal destruction and a prominent fibrosis of the glands. Both suggestive for the involvement of submandibular glands in decreased secretion of NGF and BDNF as implicated in the pathogenesis of metabolic syndrome.Biomedical Reviews 2007; 18: 65-67

Dual-time point 18FDG-PET/CT imaging may be useful in assessing local recurrent disease in high grade bone and soft tissue sarcoma

BACKGROUND: Sarcomas comprise 1% of malignant tumors in adults but represent a significant diagnostic and therapeutic challenge. Molecular imaging with 18FDG PET/CT is a powerful modality in oncology. Its use for initial assessment, evaluation of response to therapy and recurrent disease in most tumors is essential for therapeutic decisions. Its indication in sarcomas is still controversial. One of the indications for PET/CT in sarcomas is detection of recurrences. Nowadays magnetic resonance tomography (MRT) has a crucial role in identification of local recurrences in soft tissue and bone sarcoma. 18FDG-PET/CT may serve as a complementary method. Dual time point imaging (DTPI) has been studied for most tumors as a method for differentiating benign from malignant lesions. There is limited data on DTPI in sarcomas. Therefore we studied prospectively patients with suspected local recurrences in the treated area and used DTPI as a method for differentiating benign from malignant tissue. The aim of this study was to evaluate the ability of dual-time point PET/CT to enhance sensitivity, specificity, PPV, NPV and accuracy of 18FDG PET/CT in high grade and low grade sarcomas. MATERIAL AND METHODS: We conducted a dual-time PET/CT in 15 patients with suspected locally recurrent disease. The delayed scan was conducted on the 120th min in the suspected region. The interpretation of PET/CT was made both upon CT scan and metabolic scans. The percentage change over time per lesion was calculated (%DSUV). The increase in SUVmax with %DSUV > 10% in the late scanning was considered as indicative for malignancy. We assessed the sensitivity, specificity, accuracy, positive and negative predicting value of the interpretation of PET/CT at 60 min and 120 min. All of the patients were followed up for a period of 1–3 years after our examination, either with histologic results, or with an MRT scans. RESULTS: The received sensitivity, specificity and accuracy of 18FDG PET/CT interpretation at 120 min in high grade sarcomas were respectively 100%, 80% and 89%. By comparison, in low grade tumors at 120 min scan, these parameters were 50%, 75% and 66%. CONCLUSION: These preliminary data suggests that dual-time imaging in sarcomas improves sensitivity and accuracy in identification of local recurrent disease in high grade sarcomas and have limited role in low grade sarcomas. Further research is necessary to confirm these results.BACKGROUND: Sarcomas comprise 1% of malignant tumors in adults but represent a significant diagnostic and therapeutic challenge. Molecular imaging with 18FDG PET/CT is a powerful modality in oncology. Its use for initial assessment, evaluation of response to therapy and recurrent disease in most tumors is essential for therapeutic decisions. Its indication in sarcomas is still controversial. One of the indications for PET/CT in sarcomas is detection of recurrences. Nowadays magnetic resonance tomography (MRT) has a crucial role in identification of local recurrences in soft tissue and bone sarcoma. 18FDG-PET/CT may serve as a complementary method. Dual time point imaging (DTPI) has been studied for most tumors as a method for differentiating benign from malignant lesions. There is limited data on DTPI in sarcomas. Therefore we studied prospectively patients with suspected local recurrences in the treated area and used DTPI as a method for differentiating benign from malignant tissue. The aim of this study was to evaluate the ability of dual-time point PET/CT to enhance sensitivity, specificity, PPV, NPV and accuracy of 18FDG PET/CT in high grade and low grade sarcomas. MATERIAL AND METHODS: We conducted a dual-time PET/CT in 15 patients with suspected locally recurrent disease. The delayed scan was conducted on the 120th min in the suspected region. The interpretation of PET/CT was made both upon CT scan and metabolic scans. The percentage change over time per lesion was calculated (%DSUV). The increase in SUVmax with %DSUV > 10% in the late scanning was considered as indicative for malignancy. We assessed the sensitivity, specificity, accuracy, positive and negative predicting value of the interpretation of PET/CT at 60 min and 120 min. All of the patients were followed up for a period of 1–3 years after our examination, either with histologic results, or with an MRT scans. RESULTS: The received sensitivity, specificity and accuracy of 18FDG PET/CT interpretation at 120 min in high grade sarcomas were respectively 100%, 80% and 89%. By comparison, in low grade tumors at 120 min scan, these parameters were 50%, 75% and 66%. CONCLUSION: These preliminary data suggests that dual-time imaging in sarcomas improves sensitivity and accuracy in identification of local recurrent disease in high grade sarcomas and have limited role in low grade sarcomas. Further research is necessary to confirm these results

(18F)-FDG pet imaging and Neuro-ophthalmological findings in diagnosis of progressive Supranuclear palsy: Case report

Introduction: Progressive supranuclear palsy is a neurodegenerative disorder, described as a tauopathy. The neuroimaging and visual symptoms are among the most important in the diagnosis of this disease. The ophthalmoparesis mainly concerns voluntary eye movements. Patients mostly present with vertical palsy, involuntary eye movements, convergence insufficiency, and diplopia.Case report: A 62-year-old female patient was admitted to the hospital because of the gait disturbance and frequent falls. She had impaired memory, handwriting and speech for one year. On neurological and neuro-ophthalmological examinations, the patient presented with vertical gaze palsy, involuntary eye movements, dysarthria, tremor in the right hand, and cerebellar ataxia. Blood tests were normal. (18F)-FDG PET revealed bilateral zones of moderate hipometabolism in the regions of posterior frontal cortex, anterior cingulum, left thalamus, head of left striatum, and left temporal lobe. Neuropsychological tests revealed cognitive impairment (MMSE-26; IADL-1).Conclusion: Based on the literature review and our own notices, we suggest that (18F)-FDG PET scanning and neuro-ophthalmological examination in addition to structural neuroimaging and clinical findings play a crucial role in the differential diagnosis of PSP and other parkinsonian syndromes

The usefulness of FDG-PET/CT in the diagnosis of head and neck squamous cell carcinoma (HNSCC) of unknown primary with cervical lymph node metastasis

Introduction: Carcinoma of unknown primary is uncommon, estimated to represent only 3–5% of all head and neck cancers.Aim: The aim of our study was to estimate the role of FDG-PET/CT in the detection of the occult primary tumor in patients with histologically proven squamous cell carcinoma and cervical lymph node metastasis.Materials and Methods: We retrospectively reviewed a total of 18 patients with unknown primary and head and neck squamous cell carcinoma (HNSCC) presented as cervical lymph node metastasis. They were referred to the Department of Nuclear Medicine in the period 2015–2017. All patients presented fine-needle biopsy proven squamous cell carcinoma metastasis of the neck lymph nodes. The patients underwent PET/CT for detection of unknown primary head and neck cancer after endoscopic/physical examination and computer imaging (contrast-enhanced CT of neck, thorax/abdomen).  The final results were obtained from the histopathologic reports of tissue samples from anatomical regions suspected for primary tumor, additional imaging exams and clinical follow-up data.Results: There were FDG-PET/CT identified sites suggestive of primary tumor location in 12 patients. Subsequent directed biopsy of these sites yielded positive results in 11 cases (61%): hypopharynx—1 (9%), nasopharynx—3 (27%), oropharynx—5 (42%), larynx—1 (9%), skin of the face—1 (9%). Тhere was 1 false positive result (5.5%). Six out of 18 patients (33%) remained without evidence of a primary tumor.  In 1 case (5.5%) we did not reveal any pathology within the localizations indicated by FDG-ET/CT on directed biopsy.  In 1 case (5.5%) we obtained histological confirmation of neoplasm despite the negative results of the PET/CT scan. FDG-PET/CT had a sensitivity of 92%, a specificity of 83%, a positive predictive value of 92%, a negative predictive value of 83%, and accuracy of 89% in the identification of head and neck squamous cell carcinoma of unknown primary with cervical lymph node metastasis.Conclusion: Non-invasive FDG-PET/CT offers a great likelihood of successfully identifying the location of head and neck squamous cell carcinoma of unknown primary with cervical lymph node metastasis

The usefulness of follow-up 18F-FDG-PET/CT for patients with malignant epithelial head and neck cancer

Aim: The aim of our study was to evaluate the use of follow-up noninvasive FDG-PET/CT in patients with malignant epithelial head and neck cancer (MEHNC).Materials and Methods: We reviewеd 29 patients and analyzed 19 with MEHNC with curative-intent non-surgical treatment who underwent baseline, response assessment and follow-up FDG-PET/CT in the period 2015–2017. Patients with positive findings of FDG-PET/CT were histologically verified.Results: We analyzed 19 patients (13 males and 6 female). The FDG-PET/CT results showed remission in 58% and recurrence in 42%: local (n = 5), nodal (n = 2) and systemic recurrence (n = 1).  There were 5 true positive FDG-PET/CT results, 14 true negative and no false positive or false negative results. The histopathological result confirmed local recurrence in 5 patients in the following localizations: larynx, hard palate, soft palate, tonsils and gingiva. FDG-PET/CT had a sensitivity of 100%, specificity of 100%, PPV of 100%, NPV of 100%, and accuracy of 100%. The Kaplan-Meyer analyses determined survival of 21.8 months until the onset of the first local recurrence established with control FDG-PET/CT.Conclusion:  The 18F-FDG PET/CT is an effective method for monitoring the period after treatment in patients with MEHNC and may reliably detect a local recurrence

Parameters of the Hybrid Method [68Ga]PSMA PET/CT in Different Diagnostic Groups of Patients

Introduction/ Aim: The aim of our study was to assess the parameters of the hybrid imaging method 68Ga-prostate-specific membrane antigen (PSMA) positron emission tomography (PET/CT): detection rate, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy in different diagnostic groups of patients.Materials and Methods: We analyzed retrospectively and included in the study a total of 386 patients diagnosed with prostate cancer (PC) in the period 07.2019–01.2021, based on defined inclusion criteria. The patients were divided into four groups: 133 with biochemical recurrence (BHR) after radical therapy (group I); 144 with biochemical progression after radical prostatectomy (RP) (group II); 109 referred for staging of primary PC (group III); and 61 with high-risk PC (group IV).Results and discussion: We reported high specificity (from 97.7% to 100.0%) and PPV (from 98.9% to 100.0%) in all studied diagnostic groups of patients. We reported high values for the sensitivity of the hybrid imaging method in all diagnostic groups of patients (from 92.3% to 98.9%), with lower values found in patients with ISUP grade 5 (group IV) (92.3%) compared to other groups (from 95.3% to 98.9%). NPV was reported from 69.2% to 97.7%, with lower values shown by patients in group IV (69.2%) compared to the first three groups of patients (from 97.1% to 98.8%). The accuracy of the method in all studied groups of patients was reported as high: from 93.4% to 99.3%. Patients with ISUP grade 5 had relatively lower values (93.4%) when compared to other groups (98.2%–99.3%).Conclusion: 68Ga-PSMA PET/CCT is a highly promising imaging modality for PC detection in BHR and staging of primary PC, demonstrating high parametric data in all studied groups of patients. Patients with ISUP grade 5 have the highest detection rate, while other parameters in the same group (NPV, sensitivity, and accuracy) have relatively lower values

18F-FDG PET/CT in Pathological Fractures from Multiple Myeloma

Introduction/Purpose: Multiple myeloma (MM) is a malignant disease of plasma cells, characterized by their uncontrolled proliferation in the bone marrow, leading to bone destruction. In MM, the interaction between malignant plasma cells and the bone microenvironment leads to osteoclast bone destruction, reduced osteoblast function, and blockage of bone regeneration. This imbalance, together with decreased bone mineral density and treatment-related factors such as glucocorticoid therapy, can lead to MM fractures. The aim of our study was to evaluate the characteristics, distribution, and frequency of pathological fractures in patients diagnosed with multiple myeloma.Materials and methods: We retrospectively analyzed the laboratory tests and the results of 29 patients with a total of 45 PET/CT tests, which revealed pathological fractures in 16 (55.18%) men and 13 (44.82%) women. Based on the mean values of SUVmax, the correlation with both laboratory results and clinical stage was examined.Results and discussion: The distribution of pathological fractures by location was as follows: vertebrae: 12 (41.37%), ribs: 9 (31.03%), clavicles: 2 (6.9%), humerus: 2 (6.9%), femurs: 2 (6.9%), pubic bones: 2 (6.9%). In 14 (48.28%) patients, one pathological fracture was found, and in 15 (51.72%), two or more were found as well. In the comparison, no significant correlation was found between laboratory values (hemoglobin, lactate dehydrogenase, creatinine, and alkaline phosphatase) and the value of SUVmax in pathological fractures in patients referred for staging (p-value = 0.9932). In the comparison, no significant correlation was found between the clinical stage and the value of SUVmax in pathological fractures (p-value = 0.9840).Conclusion: The study found that the most common pathological fractures are in the vertebrae. No correlation was found between the clinical stage, laboratory results (hemoglobin, lactate dehydrogenase, creatinine, and alkaline phosphatase), and SUVmax values in pathological fractures. The study was retrospective and based on a small cohort of patients. We cannot be sure whether our conclusions are applicable to other or larger cohorts. More research is needed to confirm our findings

PET-CT visualization of intracranial lipomas

Intracranial lipomas are rare lesions, infrequently indicated for neurosurgical treatment due to their benign course and significant surgery-related complications rate. The aim of this study was to collect, describe and analyze the patients with intracranial lipomas verified by PET-CT and reported in the literature up to date. The literature search was performed through Pub Med using the combination of the terms intracranial lipomas, CT, MRI and PET-CT. The thorough review of the relevant papers did not find even one case with PET-CT images of intracranial lipomas. The first two personal illustrative cases were demonstrated by our report. The value of PET-CT in the primary and differential diagnosis of intracranial lipomas was analyzed, in comparison with CT, MRI and PET-MRI

Free thyroxine in needle washout after fine needle aspiration biopsy of toxic thyroid nodules

The main diagnostic tool for toxic adenomas (TA) is radionuclide imaging indicated in patients with evidence of thyroid nodules in combination with thyrotoxic syndrome. Thyroid ultrasound and fine-needle aspiration biopsy (FNAB) are widely used for the valuation of thyroid masses. There is no literature data concerning the utility of FNAB and related tests for the diagnosis of hyperfunctioning thyroid nodules. The purpose of this study is to determine the levels of free thyroxine (FT4) in the needle washout after FNAB of hot thyroid nodules. The results of our study show that the FT4 levels in needle washout from TA were significantly higher than the surrounding parenchyma and correlated with the hormonal changes in patients with thyroid hyperfunctioning nodules. Further studies on a large number of patients are needed to refine the diagnostic value of this method and evaluate its importance in quantitative risk assessment of thyroid autonomy.The main diagnostic tool for toxic adenomas (TA) is radionuclide imaging indicated in patients with evidence of thyroid nodules in combination with thyrotoxic syndrome. Thyroid ultrasound and fine-needle aspiration biopsy (FNAB) are widely used for the valuation of thyroid masses. There is no literature data concerning the utility of FNAB and related tests for the diagnosis of hyperfunctioning thyroid nodules. The purpose of this study is to determine the levels of free thyroxine (FT4) in the needle washout after FNAB of hot thyroid nodules. The results of our study show that the FT4 levels in needle washout from TA were significantly higher than the surrounding parenchyma and correlated with the hormonal changes in patients with thyroid hyperfunctioning nodules. Further studies on a large number of patients are needed to refine the diagnostic value of this method and evaluate its importance in quantitative risk assessment of thyroid autonomy

18F-FDG PET/CT in the diagnosis of an extranodal relapse of diffuse large B-cell lymphoma (DLBCL): a clinical case with a literature review

Extranodal lymphoma, secondary to or accompanying nodal disease is uncommon, but not unusual finding. 18-Fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT) imaging has an essential role in the staging of lymphoma, in treatment response monitoring, and in detection of recurrence. We present a case of a 52-year-old man with generalized diffuse large B-cell lymphoma (DLBCL) with multiple extranodal sites involvement detected by 18F-FDG PET/CT. With this clinical case we demonstrate that 18F-FDG PET-CT is a more effective technique than CE-CT for the evaluation of viable extranodal involvement of the diffuse large B-cell lymphoma (DLBCL) and should be combined in the monitoring of DLBCL