Anar Aliyev

Correlation of 18F-fluorodeoxyglucose uptake with histopathological prognostic factors in breast carcinoma.

ObjectiveThis study investigated the prognostic value of [18F]-fluorodeoxyglucose (18F-FDG) uptake in breast carcinomas by comparing 18F-FDG PET/computed tomography (CT) images with histopathological and immunohistochemical prognostic factors. MethodsThis study included 136 women and four men with positive biopsy breast carcinomas who underwent 18F-FDG PET/CT imaging for initial staging. Maximum standardized uptake values (SUVmax) and tumour-to-background SUVmax ratios were calculated and compared with histopathological and immunohistochemical tumour characteristics, patient properties and axillary lymph node involvement. Calculations of SUVmax for men were performed separately. ResultsFor the tumours in women, the mean SUVmax was 10.06±6.91 and the median SUVmax was 9.05 (0.7–35.0). Primary tumour 18F-FDG uptake and tumour-to-background SUVmax ratios were correlated with tumour size (P<0.001), histological type (P<0.001), histological grade (P=0.004), pleomorphism (P=0.010), mitosis count (P<0.001), lymphatic invasion (P=0.009), necrosis (P=0.005), oestrogen negativity (P=0.004), high Ki-67 level (P<0.001), axillary lymph node involvement (P<0.001) and triple negativity (P=0.002). High Ki-67 level (odds ratio=16; 95% confidence interval=1.6–160; P=0.016) and tumour size (odds ratio=4; 95% confidence interval=1.5–11; P=0.007) were determining factors for high 18F-FDG uptake values. Other clinicopathological and immunohistopathological parameters including progesterone receptor (P=0.211), CerbB2 overexpression (P=0.170), perineural invasion (P=0.053), intratumoural calcification (P=0.438), desmoplasia (P=0.112), tubular formation (P=0.768) and age (P=0.675) were not significantly correlated with 18F-FDG uptake. No significant relationship was observed between the tumour/contralateral breast SUVmax ratio and mitotic count, oestrogen receptor status or triple negativity. Conclusion18F-FDG uptake may serve as a prognostic indicator for biological behaviour in breast tumours.

Positron emission tomography/computed tomography imaging of brown tumors mimicking multiple skeletal metastases in patient with primary hyperparathyroidism

Brown tumors of bone are highly vascular, lytic bone lesions representing a reparative cellular process rather than a neoplastic process usually seen in patients with hyperparathyroidism. These tumors can behave aggressively and be destructive. We report a 49-year-old male patient who was admitted to our hospital with a long-term history of right shoulder and right hip pain. Multiple lytic and destructive bone lesions were found in X-ray graphy and CT images. These bone lesions mimicked multiple skeletal metastatic lesions and seemed to be those of the terminal stage of malignancy. PET scan was requested for the evaluation of FDG uptake of these lesions and to search the unknown primary tumor site. Positron emission tomography/computed tomography (PET/CT) images showed multiple hypermetabolic malignant or metastatic FDG avid bone lesions in skeletal system. However the biopsy results revealed no signs of malignancy and laboratory data showed elevated serum calcium, alkaline phosphatase, parathyroid hormone, low serum phosphate and parathyroid scintigraphy was performed. Adenoma in the left parathyroid gland was seen with Tc-99m MIBI parathyroid scintigraphy. Pathological results confirmed the diagnosis of parathyroid adenoma. Brown tumor is the potential cause of false-positive result in evaluation of a patient for unknown primary tumor or skeletal metastases with PET/CT imaging.

FDG PET/CT in the detection of metastases in a patient with Tg and 131I WBS negative follicular thyroid cancer.

After a total or near total thyroidectomy and radioiodine ablation therapy for differential thyroid cancer (DTC), routine follow-up methods are (131)I or (131)I whole-body scanning (WBS) as well as serum thyroglobulin (Tg) and anti-thyroglobulin (anti-Tg) levels. We describe a case of a 41-year-old woman with follicular thyroid cancer. Although serum Tg level and (131)I WBS were negative after radioiodine ablation therapy, she had pain around her left medial clavicle. FDG PET/CT was performed for any undetected metastases. FDG PET/CT showed hypermetabolic bone metastases in the left medial clavicle. Biopsy confirmed metastases of the thyroid follicular carcinoma.

Ectopic parathyroid adenoma localized with MIBI scintigraphy and excised with guide of macroaggregated human serum albumin injection.

Primary hyperparathyroidism is caused by an excessive amount of parathyroid hormone secreted by one or more enlarged parathyroid glands. Most commonly primary hyperparathyroidism is caused by a parathyroid adenoma. Ectopic parathyroid adenomas are rare, but they can complicate the surgical treatment and have an increased morbidity and poorer success rate. Thus, preoperative imaging is particularly valuable in this group of patients with hyperparathyroidism. Preoperative imaging has opened up a new era of minimally invasive parathyroid surgery procedures. The radioguided occult lesion localization technique has become the preferred approach to preoperative localization of nonpalpable breast lesions in several breast units. In this report, we investigated the usefulness of the radio-guided occult lesion localization technique in the identification of ectopic parathyroid adenomas. We describe the case of a 66-year-old woman who was diagnosed to be hypercalcemic. Tc-99m methoxy-isobutyl-isonitrile scintigraphy identified an ectopic parathyroid adenoma. The patients cervical region was scanned with the probe to localize an area of maximal radiotracer uptake and the hot area was identified by a gamma probe. Careful dissection was then carried out and an enlarged ectopic parathyroid gland was removed. In conclusion, the preoperative imaging of an ectopic parathyroid adenoma and the excision of this tissue with radioguided occult lesion localization technique can open up a new era of minimally invasive parathyroid surgery.

The different distribution patterns of FDG and FDG-labelled WBC in inflammatory and infectious lesions

A 56-year-old woman with a 1 year history of right knee prosthesis and right ankle cyst resection was referred for right ankle pain and skin lesion on the right ankle. The patient also had an iliac bone graft operation for talar bone defect. The patient underwent whole-body fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT and FDG-labelled white blood cell (WBC) scan for diagnosis of the infection. The interval between the two studies was 1 day. FDG PET/CT images showed a soft tissue lesion

Simultaneous excision of ipsilateral nonpalpable multiple breast lesions using radioguided occult lesion localization

The purpose of this study was to determine the feasibility and effectiveness of ROLL technique for the identification and excision of ipsilateral nonpalpable multiple breast lesions. Between August 2005 and August 2010, eight women, aged 40-61 years, with a radiographic evidence of two separate nonpalpable lesions within the same breast underwent ROLL, as we termed it, double-ROLL. Each lesion was localized with Tc-99m-labeled human serum albumin macroaggregate under ultrasonography or mamography control. A gamma probe was used to guide surgical excisions. There was no radiotracer overlapping or extravasation in any case. Out of the 16 resected specimens, histopathologic examination revealed benign findings in 13 lesions and malignancy in 3. There was no lesion involvement at the surgical margins, and no residuals were detected in any of the benign cases during follow-up. Double-ROLL technique is feasible and safe for the identification and excision of such multiple ipsilateral breast lesions.

Primary spinal leptomeningeal gliomatosis in a 3-year-old boy revealed with MRI and FDG PET/CT mimicking tuberculosis meningitis.

A 3-year-old boy was referred to neurologist for inward devition of his left eye, weakness, lack of appetite, headache and ehavioral change. On physical examination, the findings of ilateral abducens nerve paralysis were noted. Cranial magnetic esonance imaging (MRI) revealed diffuse leptomeningeal contrast nhancement at the supra-infratentorial regions predominantly nvolving the basal cisterns and also hydrocephalus and initially uggesting basilar meningitis. Cerebrospinal fluid (CSF) studies howed normal glucose and elevated protein levels but no tumor ells. No growth was detected in any of the bacterial cultures ncluding acid-resistant bacteria. The patient was started on oral nti-tuberculosis medication and corticosteroid treatment with he presumed diagnosis of tuberculosis meningitis and a ventricuoperitoneal (VP) shunt was inserted due to hydrocephalus. After months of treatment, the patient was re-admitted to hospial with vomiting, convulsion and confusion. Cranial MRI showed he similar findings to previous one, and spinal MRI depicted iffuse leptomeningeal contrast enhancement as well as microystic changes along the spinal cord (Fig. 1). Histopathology of the ural biopsy material revealed widespread glioma infiltration of he subarachnoid space suggestive of leptomeningeal gliomatosis. his patient with unknown primary was referred for FDG PET/CT. nder child sedation, brain and whole body non-contrast enhanced ET/CT images were obtained 90 min after the intravenous injecion of 148MBq (4mCi) 18F FDG using a Biograph 6 PET/CT. The can depicted slightly increased FDG uptake (SUVmax 2.1)along the pinal cord without any other FDG-avid primary tumor. The patient as started on chemotherapy including vincristine and carboplatin Figs. 2 and 3). His symptoms were relieved after completion of hemo. Primary diffuse leptomeningeal gliomatosis (PDLG) is a rare isease thought to arise from isolated astrocytic cell nests also nown as heterotropic neuroglial tissue within the leptomeninges HLNT) in the subarachnoid space. The HLNT can transform into two

Intraoperative localization of recurrent medullary carcinoma of the thyroid using Tc-99m HYNIC-TATE and a surgical gamma probe.

Preoperative octreotide scintigraphy imaging has opened up a new era to approach recurrent medullary thyroid carcinoma (MTC). We describe the case of a 53-year-old woman who was diagnosed with recurrent MTC and elevated serum calcitonin level 2000 pg/mL. Preoperatively, Tc-99m HYNIC-TATE scintigraphy was used in identifying 2 focal abnormalities in the right upper cervical and left upper mediastinal regions, and a hand-held gamma probe was used intraoperatively to identify the hot areas. Six months after intraoperative dissection, serum calcitonin level and Tc-99m HYNICTATE scintigraphy were found normal. This case demonstrates the proper localization for recurrent MTC using Tc-99m HYNIC-TATE and a surgical gamma probe.