Ebuzer Kalender

Evaluation of conventional imaging techniques on preoperative localization in primary hyperparathyroidism

We aimed to evaluate the diagnostic and preoperative localization capacity of 99mTc methoxyisobutylnitrile (MIBI) parathyroid scintigraphy and ultrasonography (USG) in enlarged parathyroid glands in the primary hyperparathyroidism (pHPT) as well as the relationship between the success rate of these techniques and biochemical values. In this study, we retrospectively evaluated 39 patients with clinical and biological evidence of pHPT who referred to the university hospital for MIBI parathyroid scintigraphy. Patients were examined with USG and double-phase MIBI parathyroid scintigraphy for the detection of enlarged parathyroid glands. Preoperative serum intact parathyroid hormone (iPTH) levels, calcium (Ca), phosphate and alkaline phosphatase measurements were obtained. A total of 45 parathyroid lesions in 39 patients were reviewed. Thirty-four patients had a single adenoma and 5 patients with multi-gland disease had 11 abnormal parathyroid glands including three adenomas, whereas the remaining 8 glands showed hyperplasia. The overall sensitivities of MIBI parathyroid scintigraphy, USG and combined techniques were 85.3%, 72.5% and 90.4%, respectively; the positive predictive values (PPV) were 89.7%, 85.2% and 92.6%, respectively. The most successful approach for detection of enlarged parathyroid glands in hyperparathyroidism is the concurrent application of USG and MIBI parathyroid scintigraphy modalities. The concomitancy of thyroid diseases decreases the sensitivity of both MIBI parathyroid scintigraphy and USG in enlarged parathyroid glands.

Bilateral cutaneous diffuse large B-cell lymphoma on FDG PET/CT.

Abstract: Primary cutaneous diffuse large B-cell lymphoma is an uncommon type of non-Hodgkin lymphomas. A 51-year-old man had 2 gradually enlarging reddish, firm, and painless cutaneous-subcutaneous masses surrounded with some erythematous patches on his back for 3 years. Skin biopsy result was consistent with diffuse large B-cell lymphoma. FDG PET/CT was performed for staging and demonstrated bilaterally increased FDG uptake in the cutaneous masses with hypermetabolic left axillary lymph nodes. After chemotherapy, FDG PET/CT demonstrated that all FDG-avid lesions resolved, and there is a complete response to therapy.

Lung metastases in patients with differentiated thyroid carcinoma and evaluation of response to radioiodine therapy

INTRODUCTION The most common site of metastases in differentiated thyroid carcinomas is the lungs. In our study, we aimed to determine the ratios of lung metastases in patients with differentiated thyroid carcinoma and response to radioiodine therapy. MATERIAL AND METHODS A total of 542 patients with differentiated thyroid carcinoma who were admitted to our clinic were included in the study. High doses of (131)I were administered to the patients with lung metastases. Response to therapy were evaluated with (131)I scans and stimulated serum Tg levels were examined at least 6 months after therapy. RESULTS Lung metastases were detected in 17 (3.1%) of 542 patients with differentiated thyroid carcinoma. Of these patients to whom high doses of (131)I therapy were administered, complete response to therapy was obtained in 5 (29.4%), partial response was obtained in 3 (17.6%) and no response could be obtained in 9 (53%) patients. CONCLUSION Although lung metastases from differentiated thyroid carcinomas are rare, those are more common in advanced ages and in males. High doses of (131)I therapy may be partially beneficial in these patients. Thus repetition of therapy is frequently required.

Axillary lymph node metastasis of papillary thyroid carcinoma detected by FDG PET/CT in a thyroglobulin-positive patient with negative whole-body 131I scan.

Axillary metastasis is not a common finding in papillary carcinoma. 18F-FDG can detect foci of metastasis in patients with negative 131I scan. We report a case of a 64-year-old man who had undergone thyroidectomy and 131I ablation due to classic type of papillary carcinoma 14 years ago. Follow-up examination revealed high serum thyroglobulin and negative whole body 131I scan. 18F-FDG PET/CT showed focally increased uptake in right axillary as well as supraclavicular and bilateral cervical lymph nodes. Histopathological examination of the surgically removed lymph nodes confirmed the metastasis of papillary thyroid carcinoma.

The relationship between thyroglobulin (Tg) levels and distant metastases before radioiodine (RAI) treatment in differentiated thyroid carcinomas

The aim of our study is to determine the relationship between distant metastases and thyroglobulin (Tg) levels measured before radioiodine (RAI) treatment in differentiated thyroid carcinomas. Sixty seven patients with near total or total thyroidectomy were included in the study. Fifty patients did not have lymph node or distant metastases (Group 1), and 17 patients had distant metastases (Group 2). Tg and anti-Tg levels of these patients were measured before RAI treatment when TSH>30 mU/l. Serum Tg levels were found 8,5±10,6 ng/ml and 307±142 ng/ml in Group 1 and Group 2, respectively. There was a significant difference between the mean Tg levels of Group 1 and 2 (p

Radyoaktif İyot Tedavisi Sonrası Diferansiye Tiroid Kanserlerinin Takibi-The Follow-up of Differentiated Thyroid Cancers After Radioactive Iodine Treatment

Differentiated thyroid cancerc (DTC) which have very good prognosis are the most common endocrine malignancies. Radioactive iodine treatment (RIT) applied to selected patients after thyroidectomy is a highly effective treatment method. Post-treatment follow-up of these patients exhibits a great importance because of the higher relapse rates and development of distant metastases in some cases. In this review, the methods used in the follow-up DTC patients after RIT are reported

Pulmonary arteriovenous malformation mimicking a pulmonary tumour on (18)F-fluorodeoxyglucose positron-emission tomography/computed tomography.

Pulmonary arteriovenous malformations are rare congenital abnormal connections between the pulmonary arteries and veins. The patients are usually asymptomatic [1]. Although their aetiology is unclear, it is presumed that genetic abnormalities constitute a predisposition [1, 2]. An arteriovenous malformation might cause serious complications if it remains undiagnosed and untreated [3]. We report a unique case of focal 18F-fluorodeoxyglucose (18F-FDG) uptake in a pulmonary arteriovenous malformation mimicking a mass lesion. A 74-year-old female patient with cyanosis and clubbing in her fingers and toes was referred to the Nuclear Medicine Department for positron-emission tomography (PET)/computed tomography (CT) imaging to assess a solitary pulmonary nodule with irregular margins in the right upper lobe detected on CT (Figure 1A). The CT appearance suggested a malignant lesion. On 18F-FDG PET/CT, there was increased focal uptake in the pulmonary nodule, suggesting a mass lesion, possibly malignant (Figure 1B). There is no described typical uptake pattern for arteriovenous malformations in FDG PET/CT images. 18F-FDG accumulation in a pulmonary mass suggests malignancy in most cases, although FDG accumulates in several benign conditions. Pulmonary angiography revealed afferent and efferent vessels with high contrast accumulation. Based on these findings, a pulmonary arteriovenous malformation was diagnosed. Subsequently, the patient underwent right video-assisted thoracoscopic surgery, a mini-thoracotomy, and wedge resection. The specimen confirmed the diagnosis of pulmonary arteriovenous malformation (Figure 2). Figure 1 A – CT image showing a solitary pulmonary nodule in the anterior segment of the upper pole of the right lung. B – On 18F-FDG PET/CT, increased focal uptake was seen in the pulmonary nodule, suggesting a malignancy (SUVmax 4.2 kBq/ml) Figure 2 The specimen was stained with (A) haematoxylin and eosin and (B) Elastica van Gieson, which showed large and small vessels, confirming the diagnosis of pulmonary arteriovenous malformation Pulmonary arteriovenous malformations are often diagnosed radiologically [4–6]. A chest X-ray might reveal a solitary nodule or be completely normal. Thorax CT is usually the second diagnostic tool in a patient with a suspected pulmonary arteriovenous malformation [7, 8], which causes dyspnoea and cyanosis in most cases [1, 3]. Pulmonary angiography gives the ultimate diagnostic information [4, 8]. The CT appearance of our patients arteriovenous malformation suggested a malignant solitary mass. The moderately increased FDG uptake also caused diagnostic confusion. There is no typical uptake pattern of arteriovenous malformations in FDG PET/CT images.

Overview of 99m Tc-anti-TNF-α scintigraphy: diagnostic applications

License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Reports in Medical Imaging 2014:7 1–4 Reports in Medical Imaging Dovepress

Is it necessary to perform control diagnostic 131I whole body scan after remmant ablation in differentiated thyroid carcinoma patients who have stimulated Tg levels under 2 ng/ml?

Abstract Background: The aim of this retrospective study is to evaluate whether diagnostic I-131 whole body scan (DWBS) performed 6-12 months after thyroid remnant ablation is necessary or not in differentiated thyroid

Stimulated Tg level measurements may be avoided in differentiated thyroid carcinoma patients who have undetectable basal Tg levels

Abstract Background: The aim of this retrospective study is to evaluate the diagnostic value of undetectable basal thyroglobulin (Tg) levels measured 6 months after ablative 131I treatment (AIT) in patients