Impact of FDG-PET/CT for the Detection of Unknown Primary Tumours in Patients with Cervical Lymph Node Metastases

Objective: Because the detection of the primary tumour is of importance to optimize the patient’s management and allows a targeted therapy, the performance of hybrid positron emission tomography–computed tomography (PET/CT) using fluorodeoxyglucose (FDG) in the detection of primary tumors and unrecognized metastases with cervical lymph node metastases were evaluated in a retrospective study. Material and Methods: Twenty patients with cervical lymph node metastases of unknown primary tumors underwent staging with FDG-PET/CT. All underwent head and neck examinations, computed tomography (CT), and/or magnetic resonance imaging (MRI), panendoscopies, and biopsies of head and neck mucosal sites. The diagnostic accuracy of FDG-PET/CT in detecting primary tumors was compared with that of histopathology and clinical follow-up. The ability of FDG-PET/CT to detect distant metastases was also tested. Results: PET/CT was positive with an increased FDG uptake suggesting the potential primary site in 45% of patients (9/20). PET/CT findings were true positive in 7, true negative in 10, false positive in 2, and false negative in 1 patients, resulting in a sensitivity of 87%, a specificity of 83%, an accuracy of 85%, a positive predictive value of 77% and a negative predictive value of 90%. Also, PET/CT showed distant metastases in seven patients. Conclusion: FDG-PET/CT can be successfully used for the identification of the primary site and distant metastases in patients with cervical lymph node metastases from an unknown primary cancer. (MIRT 2012;21:63-68

Clinically Occult Pituitary Adenoma Can Appear as a Hypermetabolic Lesion on Whole Body FDG PET Imaging in a Patient with Lymphoma

We report a case with Non-Hodgkin Lymphoma with a focus of intense hypermetabolism in the sellar region in the primary staging and posttreatment whole body F-18 FDG PET. Further evaluation with magnetic resonance imaging after posttreatment FDG PET revealed a pituitary adenoma. Endocrinologic workup was normal consistent with nonfunctioning pituitary adenoma and endocrinologists decided to follow up the patient by yearly magnetic resonance imaging. This case demonstrates a nonfunctioning pituitary adenoma by whole body FDG PET and emphasizes the importance of pursuing incidental findings detected in the sella on PET imaging

Comparison of Adenosine Stress Myocardial Perfusion Scintigraphy and Oral Dipyridamole Stress Myocardial Perfusion Scintigraphy for Hemodynamic Changes and Adverse Effects

Amaç: Miyokard perfüzyon sintigrafisinde (MPS) kardiyak stres oluşturmak için egzersiz uygulanamayan hastalarda farmakolojik ajanlar kullanılarak benzer etkiler sağlanabilir. Çalışmamızda MPS farmakolojik stres ajanı olarak adenozinin oluşturduğu hemodinamik değişiklikler ile yan etkileri göstermeyi ve elde edilen sonuçları oral dipiridamollü stres MPS ile karşılaştırmayı amaçladık.Gereç ve Yöntemler: Koroner arter hastalığı şüphesi olan 65 hasta çalışmaya dahil edildi. İntravenöz adenozin ile MPS uygulanan 50 hasta (grup A), oral dipiridamollü MPS yapılan 15 hasta (grup B) geriye dönük olarak incelendi. İşlem sırasında tüm hastaların kan basıncı ve elektrokardiyografi takipleri yapıldı, gelişen yan etkiler not edildi.Bulgular: Adeozin uygulanan grubun %68'inde, oral dipiridamol uygulanan grubun ise %46'sında en az bir yan etki ortaya çıktı. Her iki grup arasında farmakolojik stres sırasında oluşan yan etkiler açısından istatistiksel olarak anlamlı fark saptanmadı. Maksimum stres sırasında kalp atım sayısı adenozin verilen grupta 15,80±11,60 atım/dk, oral dipiridamol uygulanan grupta ise 5,53±4,54 atım/dk artmış olup, iki grup arasındaki fark istatistiksel olarak anlamlı bulundu. Ancak maksimum stres sırasında sistolik kan basınçları ve diyastolik kan basınçlarındaki azalmalar karşılaştırıldığında iki grup arasında istatistiksel olarak anlamlı farklılık saptanmadı.Sonuç: Adenozin ile stres sırasında oluşan yan etki sıklığı fazla görünse de adenozin infüzyonu kesildiğinde şikayetlerde hızla gerileme görülmesi ve kısa yarı ömrü nedeniyle takip gerektirmemesi adenozinin klinik pratikte kullanımını.Objective: Similar effects can be achieved during stress myocardial perfusion scintigraphy (MPS) using pharmacological agents to create cardiac stress for patients who are unable to exercise. In our study, we aimed to show the hemodynamic changes and adverse effects caused by adenosine and to compare the results with dipyridamole stress MPS. Materials and Methods: Sixty-five patients with suspected coronary artery disease were included in our study. Fifty patients in whom stress MPS with intravenous adenosine was performed (group A) and 15 patients who underwent oral dipyridamole stress MPS (group B) were retrospectively evaluated. During the test, blood pressure measurements and electrocardiographic follow-up were performed in all patients and side effects were noted. Results: At least one side effect occurred in 68% of the group A and in 46% of the group B patients. There was no statistically significant difference between the two groups in terms of side effects that occurred during the pharmacological stress. During the maximum stress, there was an increase of 15.80±11.60 beats/min in heart beats in group A and 5.53±4.54 beats/min in group B. There was a statistically significant difference between the groups in terms of heart rate increase per minute. When we compared reduction in systolic blood pressure and diastolic blood pressure, there was no statistically significant difference between the two groups. Conclusion: Although side effects are more often seen with adenosine, rapid decline in complaints was observed when adenosine infusion was terminated and there was no need for patient follow-up due to short half life of adenosine. We believe that these favourable advantages will increase the use of adenosine in clinical practice

Künt travmanın erken döneminde sternum ve kaburga kırıklarının saptanmasında direkt grafi ve sintigrafi arasındaki tanısal uyumun değerlendirilmesi

OBJECTIVE: To evaluate the diagnostic accordance between scintigraphy and radiography in the early period following blunt thoracic trauma. DESIGN: Double-blind, prospective clinical study. METHODS: Thirty-four adult patients with blunt thoracic trauma were examined by plain radiography and scintigraphy within 24 hours of trauma. RESULTS: Radiography displayed pathologies in 25 (73.5%), while scintigraphy suggested pathologies in 24 (70.5%) patients. Rib fractures were identified radiographically in 16 (47%) and scintigraphically in 17 (50%) patients. Lateral radiograph of the sternum showed fracture in 10 (52.6%), while scintigraphy suggested fracture in 14 (73.6%) patients with suspected sternal trauma. CONCLUSION: Scintigraphy gave better results in the evaluation of sternal fractures during the early period of thorax trauma. Conventional plain radiography is thought to be the initial imaging modality, because it saves time and shows hemothorax or pneumothorax besides the osseous abnormality.OBJECTIVE: To evaluate the diagnostic accordance between scintigraphy and radiography in the early period following blunt thoracic trauma. DESIGN: Double-blind, prospective clinical study. METHODS: Thirty-four adult patients with blunt thoracic trauma were examined by plain radiography and scintigraphy within 24 hours of trauma. RESULTS: Radiography displayed pathologies in 25 (73.5%), while scintigraphy suggested pathologies in 24 (70.5%) patients. Rib fractures were identified radiographically in 16 (47%) and scintigraphically in 17 (50%) patients. Lateral radiograph of the sternum showed fracture in 10 (52.6%), while scintigraphy suggested fracture in 14 (73.6%) patients with suspected sternal trauma. CONCLUSION: Scintigraphy gave better results in the evaluation of sternal fractures during the early period of thorax trauma. Conventional plain radiography is thought to be the initial imaging modality, because it saves time and shows hemothorax or pneumothorax besides the osseous abnormality

Diferansiye Tiroit Karsinomunda Rekürrens Sıklığı ve Klinik İzlemde Tanısal İyot-131 Sintigrafisinin Önemi

Objective: Differentiated thyroid cancers (DTC) are tumors with good prognosis. However, local recurrence or distant metastasis can be observed. In our study, we aimed to investigate the incidence of recurrence and the importance of diagnostic iodine-131 whole body scan (WBS) in clinical follow-up in patients with DTC. Methods: The clinical data of 217 patients with DTC who were followed-up more than 3 years were reviewed retrospectively. The incidence of recurrence was investigated in a group of patients who had radioactive iodine (RAI) treatment and showed no sign of residual thyroid tissue or metastasis with diagnostic WBS that was performed at 6-12 months after therapy and had a thyroglobulin (Tg) level lower than 2 ng/dl. Results: At the time of diagnosis, ten cases had thyroid capsule invasion, 25 cases had extra-thyroid soft tissue invasion, 11 patients showed lymph node metastasis and four patients had distant organ metastasis. One hundred forty-five patients had RAI treatment at ablation dose (75-100 mCi), whereas 35 patients had RAI treatment at metastasis dose (150-200 mCi). Thirty-seven patients with papillary microcarcinoma did not receive RAI treatment. In 12 (%7.5) of the 160 patients who were considered as ;quot;successful ablation;quot;, a recurrence was identified. Recurrence was detected by diagnostic WBS in all cases and stimulated Tg level was ;lt;2 ng/dL with the exception of the two cases who had distant metastasis. Conclusion: Identification of pathological findings with WBS in patients who developed local recurrence in the absence of elevated Tg highlights the importance of diagnostic WBS in clinical follow-up.Amaç: Diferansiye tiroit karsinomları (DTK) iyi prognoza sahip tümörlerdir. Ancak lokal rekürrens ve uzak metastaz izlenebilmektedir. Çalışmamızda DTK'lı olgularda rekürrens sıklığının ve tanısal iyot-131 (I-131) tüm vücut tarama sintigrafisinin klinik izlemdeki öneminin araştırılması amaçlandı.Yöntem: İzlem süresi 3 yılın üzerinde olan iki yüz on yedi DTK'lı olgunun klinik verileri retrospektif olarak incelendi. Radyoiyot (RAI) tedavisi alan hastalardan tedavi sonrası 6. ay-1. yıl tanısal I-131 tarama sintigrafisinde rezidüel tiroit dokusu ve metastaza ait bulgu saptanmayan, tiroglobulin (Tg) düzeyi 2 ng/dl'nin altında olan grupta rekürrens sıklığı araştırıldı. Bulgular: Tanı anında on olguda tiroit kapsülü, 25 olguda ekstratiroidal yumuşak doku invazyonu, 11 hastada lenf nodu metastazı ve dört hastada uzak metastaz mevcuttu. Yüz kırk beş olgu ablasyon dozunda (75-100 mCi), 35 olgu metastaz dozunda (150-200 mCi) RAI tedavisi almıştı. Papiller mikrokarsinom tanılı 37 hasta ise RAI tedavisi almamıştı. Tedavi başarısına karar verilen 160 hastanın 12'sinde rekürren hastalık saptandı (%7,5). Olguların tümünde rekürrens I-131 tarama sintigrafisi ile saptanmış olup uzak metastazı olan iki hasta dışında stimüle Tg değerleri 2 ng/dL idi. Sonuç: Lokal rekürrens gelişen tüm olgularda stimüle Tg yüksekliği olmaksızın I-131 tarama sintigrafisi ile patolojik bulguların saptanması klinik izlemde tanısal I-131 taramanın önemini vurgulamaktadır