Betül Vatankulu

Incidental Detection of Follicular Thyroid Carcinoma in 68Ga-PSMA PET/CT Imaging

Prostate-specific membrane antigen (PSMA) is a type II transmembrane protein. It has been shown to be expressed in various solid malignant neoplasms. We report a case of a prostate cancer patient who underwent 68Ga-PSMA PET/CT imaging. There is a large thyroid nodule in the right thyroid gland, which had intense PSMA accumulation. Follicular thyroid lesions can be seen on 68Ga-PSMA PET/CT imaging.

Evaluation of radiation safety in (177)Lu-PSMA therapy and development of outpatient treatment protocol.

The aim of this study is to investigate the outpatient treatment protocol and radiation safety of a new-emerging lutetium-177 ((177)Lu) prostate specific membrane antigen (PSMA) therapy. This work analyzed the dose rate of 23 patients treated with 7400 MBq (177)Lu-PSMA at different distances (0, 0.25, 0.50, 1.0 and 2.0 m) and variable time marks (0, 1, 2, 4, 18, 24, 48 and 120 h) after the termination of infusion. Blood samples were withdrawn from 17 patients within the same group at 3, 10, 20, 40, 60 and 90 min and 2, 3, 24 h after termination of infusion. Seven different patients were asked to collect urine for 24 h and a gamma well counter was used for counting samples. Family members were invited to wear an optically stimulated luminescence dosimeter whenever they were in the proximity of the patients up to 4-5 d. The total dose of the medical team including the radiopharmacist, physicist, physician, nurse, and nuclear medicine technologist was estimated by an electronic personnel dosimeter. The finger dose was determined using a ring thermoluminescent dosimeter for the radiopharmacist and nurse. The mean dose rate at 1 m after 4 h and 6 h was 23  ±  6 μSv h(-1) and 15  ±  4 μSv h(-1) respectively. The mean total dose to 23 caregivers was 202.3  ±  42.7 μSv (range: 120-265 μSv). The radiation dose of the nurse and radiopharmacist was 6 and 4 μSv per patient, respectively, whereas the dose of the physicist and physician was 2 μSv. The effective half life of blood distribution and early elimination was 0.4  ±  0.1 h and 5  ±  1 h, respectively. Seven patients excreted a mean of 45% (range: 32%-65%) from the initial activity in 6 h. Our findings demonstrate that (177)Lu-PSMA is a safe treatment modality to be applied as an outpatient protocol, since the dose rate decreases below the determined threshold of  <30 μSv h(-1) after approximately 5 h and degrades to 20 μSv h(-1) after 6 h.

An unknown pregnancy at term detected by a FDG-PET/CT study in a patient with Hodgkin's lymphoma: A case report

FDG-PET/CT is a well-established imaging modality in many cancer types, as for staging, restaging and evaluation of therapy response in lymphoma. However, in PET/CT scanning, radiation exposure to patients has become an important issue, particularly for pregnant patients, because its each component (PET and CT) is an independent source of ionizing radiation and consequently causes radiation dose burden for the patients. A 35-year-old woman was diagnosed with nodular sclerosing type Hodgkin’s lymphoma and given four cycles of chemotherapy. After completion of chemotherapy, the patient was referred for FDG-PET/CT for restaging. Patient signed a given informed consent form in which she also stated that she had no pregnant but irregular menstrual periods and the last one was 1 week ago. Ninety minutes after injection of 555 MBq 18F-FDG, a PET/CT study with a non-contrast enhanced, low dose (120 kVA, 61 mAS) CT component was obtained from the head to midthigh. During evaluation of PET/CT images, we noticed a bombshell gross mass appearance in the lower part of abdomen and pelvis representing a fetus in uterus, in spite of no detection of any abnormal FDG uptake related to residual primary disease (Fig. 1). The patient was questioned for possibility of pregnancy. However she answered negatively but she had irregular menstrual periods after the chemotherapy. When the CT report for initial staging was reevaluated, no pregnancy was reported possibly due to early weeks of pregnancy. Also the patient, who had somewhat lower social and

Prognostic significance and predictive performance of volume-based parameters of F-18 FDG PET/CT in squamous cell head and neck cancers

AIM It has been previously reported that metabolic tumor volume on positron emission tomography-computed tomography predicts disease recurrence and death in head-and-neck cancer. In this study, we assessed the prognostic value of metabolic tumor volume measured using F18-Fluorodeoxyglucose PET/CT in patients with head and neck squamous cell carcinoma. MATERIALS AND METHODS We analyzed the imaging findings of 74 patients (age 57±16) retrospectively, with head and neck cancer who underwent PET/CT scan for staging and after treatment. Forty-tree patients had nasopharynx, 15 patients had hypopharynx, 9 patients had larynx, and 7 patients had oropharynx cancer. The MTVs of primary sites with or without lymph nodes were measured, and outcomes were assessed using the treatment response evaluation by the Response Evaluation Criteria in Solid Tumors and recurrence events during follow-up. RESULTS A total of 48 patients had complete response or no recurrence was detected as of in the last follow-up. Of the first PET/CT scan, the median primary tumor SUVmax was 18.8 and the median nodal SUVmax was 13.4. The median primary tumor MTV% 50s ranged from 11.12 cm3 to 16.28 cm3, and the MTV after the therapy ranged from 1.18 cm3 to 3.51 cm3. CONCLUSION Metabolic tumor volume (MTV) represents tumor burden, which shows F18-Fluorodeoxyglucose uptake and has a potential value in predicting short-term outcome and disease-free survival in patients with head and neck cancer.

Compatibility of MRI and FDG-PET findings with histopathological results in patients with focal cortical dysplasia

PURPOSE The present study aimed to determine if the specific characteristics of fluorodeoxyglucose-positron emission tomography (FDG-PET) analyses of the FCD subgroups were compatible with the magnetic resonance imaging (MRI) and clinical findings of the patients in these subgroups. METHODS This study included 71 patients who had a presurgical evaluation workup performed due to drug-resistant seizures, who underwent epilepsy surgery, and who were histopathologically diagnosed with FCD. Relationships involving MRI and FDG-PET findings and clinical data from pathological subgroups and patients were assessed. RESULTS According to the International League Against Epilepsy (ILAE) classifications of FCD, 28 of the patients were type I and 43 were type II. FCD was visible on the MRI scans of 53 patients, and a majority of this group was classified as type II FCD (n=34). Of these 53 patients, FCD was located in the temporal area of 21 patients, the extratemporal area of 29 patients. Of the patients who exhibited FDG-PET hypometabolism (PET-positive), 23 were classified as temporal, 17 as frontal, 11 showed involvement of the posterior cortex. The age of seizure onset was younger in PET-positive patients (p=0.032), and histopathological analyses revealed that 23 patients had type I FCD and 30 patients had type II FCD. CONCLUSION PET scans reveal a lesion by showing hypometabolism in patients who have refractory epilepsy and an early age of onset with FCD. The lesions of MRI-negative/PET-positive FCD patients tend to be localized in the temporal lobe and that FCD may be localized in the frontal lobe of MRI-negative/PET-negative patients. However, the histopathological examinations of MRI-positive/PET-positive, MRI-negative/PET-positive, and MRI-negative/PET-negative patients did not exhibit a particular histopathological subtype.

Accuracy of FDG-PET/CT and paraneoplastic antibodies in diagnosing cancer in paraneoplastic neurological syndromes

OBJECTIVE There is still no consensus about whether to perform PET/CT to detect carcinoma in paraneoplastic neurological syndromes (PNS) in patients with or without antibodies. The aim of this study is to determine the diagnostic accuracy of PET/CT and antibodies in patients with PNS. MATERIAL AND METHODS A retrospective study was conducted on patients with clinically suspected PNS between 2008 and 2013. The association between histopathological findings, paraneoplastic antibodies, and PET/CT findings were evaluated. Sensitivity and specificity for the detection of underlying malignancy were calculated for PET/CT and paraneoplastic antibodies. RESULTS A total of 42 patients were analyzed. Of these 42 patients, 32 (75%) had a classical PNS, 6 (14%) had positive PET/CT findings, and 34 were tested for the presence of antibodies (anti-Hu Ab, anti-Yo Ab, and anti-Ri Ab). Twenty one of 34 patients had positive antibodies. Of the 6 patients with positive PET/CT findings, 6 had positive histopathological results. Among 21 patients with positive biomarkers, carcinoma was confirmed only in 5 patients. One patient with negative antibodies, but positive PET/CT findings, was diagnosed with a tumor. Gastric carcinoma was detected in 1 patient with negative PET/CT findings and antibodies during follow-up. Based on the results, PET/CT was found to have 85.71% sensitivity, 100% specificity, 100% positive and 97.22% negative predictive values in the detection of tumors. CONCLUSION PET/CT has a certain diagnostic accuracy for detecting underlying malignancy in patients with PNS, regardless of the presence of paraneoplastic antibodies.

Hyperostosis frontalis interna presenting as depression and parkinsonism in an older woman.

Dear Editor, Hyperostosis frontalis interna (HFI) is a well-described entity from ancient times that occurs in 24% of women and 5.2% of men. Although meaningful association between HFI and neurological disorders has not been proven, HFI frequently accounts for neuropsychiatric symptoms including frontal executive dysfunctions, epilepsy, cognitive impairments, parkinsonism, and frontal headache. Here, we present an HFI case involving a woman with symptoms of depression and parkinsonism.

Primary Psammomatous Melanotic Schwannoma of the Spine

Schwannoma is an easily identifiable and frequently diagnosed lesion of the spinal column. However, if the schwannoma contains a melanin component, the diagnosis is challenging. Our purpose in this case report is to discuss the imaging and histopathologic findings of a rarely seen psammomatous type of melanotic schwannoma diagnosed in a 31-year-old woman.

Bilateral breast uptake of radioiodine in a male patient with gynecomastia: A case report.

A 56-year-old male patient with papillary thyroid carcinoma was given radioiodine for the treatment of persistent disease. Post radioiodine whole body scan revealed uptake at the thyroidal region and bilateral uptake at the upper thoracic region. Single photon emission computed tomography/computed tomography (SPECT/CT) confirmed uptake at the left thyroid lobe, and additional symmetrical mammary gland uptake was observed at both breasts. The patient had obesity-related gynecomastia, but he did not have any history of breast cancer, mastitis, hyperprolactinemia, or galactorrhea. Although breast uptake of radioiodine is a common finding in postpartum or lactating women, it is uncommon in male patients. To our knowledge, this is the first case of a male patient with breast uptake of radioiodine documented with SPECT/CT. SPECT/CT is useful in male patients in the differentiation of benign breast uptake with lung metastases or axillary metastases of thyroid cancer.

FDG PET/CT Imaging of an Isolated Recurrence in the Eyelid of a Patient With Follicular Lymphoma.

An 80-year-old woman had a history of follicular lymphoma diagnosed by biopsy of the inguinal lymph node 4 years prior. After systemic chemotherapy, she achieved complete remission. She presented with painless swelling on the left side of the eyelid. She also had suspicious lymph node enlargement in the cervical and axillary regions. FDG PET/CT showed an isolated FDG-avid lesion on the eyelid that was confirmed by biopsy to be compatible with lymphoma recurrence.