Kerem Ozturk

Pretreatment quantitative 18F-FDG PET/CT parameters as a predictor of survival in adenoid cystic carcinoma of the salivary glands

PURPOSE The aim of this study was to determine the unique prognostic value of quantitative 18F-FDG PET/CT parameters to assess progression-free survival (PFS), distant metastasis-free survival (DMFS), and overall survival (OS) in patients with salivary gland adenoid cystic carcinoma (ACC). METHODS We performed a retrospective study including 23 patients (15 men, 8 women; median age, 58 years; range, 21-91 years) with salivary gland ACC between January 2009 and October 2017 who underwent 18F-FDG PET/CT scan prior to treatment. Maximum, mean, peak, tumor-to-mediastinal blood pool and tumor-to-liver standardized uptake values (SUVmax, SUVmean, SUVpeak, SUVratio[med] and SUVratio[liver]), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were obtained from 18F-FDG PET/CT. The prognostic value of quantitative 18F-FDG PET/CT parameters and other clinicopathological variables were evaluated utilizing the Cox proportional regression analysis. RESULTS The 3-year and 5-year OS for all the patients were 90.9%, and 62.3%, respectively. Log rank test determined that the SUVratio[med], SUVratio[liver], MTV and TLG were predictive factors of DMFS, PFS, and OS (p < 0.05), furthermore, SUVmax, minor salivary gland tumors and DM at initial diagnosis (M1 stage) were predictor for PFS; M1 stage and overall stage 3-4 predicted DMFS (all p < 0.05). Cox regression analyses confirmed that the higher SUVratio[med], SUVratio[liver], MTV, and TLG values predicted DMFS, PFS and OS independently, whereas SUVmax was an independent predictor of only PFS (p < 0.05). CONCLUSIONS The pretreatment metabolic 18F-FDG PET/CT parameters may reflect tumor aggressiveness in patients with salivary gland ACC and may potentially be utilized as a prognostic biomarker.

Risk factors of pneumothorax and chest tube placement after computed tomography-guided core needle biopsy of lung lesions: a single-centre experience with 822 biopsies

Purpose To determine the risk factors of pneumothorax and chest tube placement after computed tomography-guided core needle lung biopsy (CT-CNB). Material and methods Variables that could increase the risk of pneumothorax and chest tube placement were retrospectively analysed in 822 CT-CNBs conducted with 18-gauge non-coaxial CT-CNB in 813 patients (646 men and 167 women; range: 18-90 years; mean: 59.8 years). Predictor variables were age, gender, patient position, severity of pulmonary emphysema, lesion size and localisation, contour characteristics, presence of atelectasis, pleural tag and fissure in the needle-tract, length of the aerated lung parenchyma crossed by the needle, needle entry angle, number of pleural punctures, experience of the operator, and procedure duration. All variables were investigated by ×2 test and logistic regression analysis. Results The overall incidence of pneumothorax was 15.4% (127/822). Chest tube placement was required for 22.8% (29/127) of pneumothoraxes. The significant independent variables for pneumothorax were lesions smaller than 3 cm (p = 0.009), supine and lateral decubitus position during the procedure (p < 0.001), greater lesion depth (p = 0.001), severity of pulmonary emphysema (p < 0.001), needle path crossing the fissure (p < 0.001), and a path that skips the atelectasis (p < 0.001) or pleural tag (p < 0.001); those for chest tube placement were prone position (p < 0.001), less experienced operator (p = 0.001), severity of pulmonary emphysema (p < 0.001), and greater lesion depth (p = 0.008). Conclusions The supine and lateral decubitus position, a needle path that crosses the fissure, and a path that skips the atelectasis or a pleural tag are novel predictors for the development of pneumothorax.

Imaging features of sinonasal tumors on positron emission tomography and magnetic resonance imaging including diffusion weighted imaging: A pictorial review

INTRODUCTION Sinonasal inflammatory conditions account for a major component of head and neck pathologies, whereas neoplasms involving the sinonasal region make up only 2-3% of all head and neck lesions. The symptoms of sinonasal tumors are nonspecific; imaging plays a critical role in distinguishing benign and malignant disease and may illustrate characteristic radiological features of specific sinonasal tumors. OBJECTIVE Aim was to determine the utilization of multimodality imaging, specifically the metabolic information provided by 18-fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT) and diffusivity characteristics seen with diffusion weighted images (DWI) of magnetic resonance imaging (MRI), in a wide range of benign and malignant sinonasal tumors drawn from over 200 sinonasal lesions from our institution and supplemented by the literature. CONCLUSION In this pictorial essay, we have reviewed common imaging characteristics of frequently encountered in sinonasal tumors and divided them into benign and malignant categories to facilitate creation of focused differential diagnoses.

Concomitant cutaneous squamous cell carcinoma and chronic lymphocytic leukemia in a patient: The utility of 18F-FDG PET/CT in differentiation of nodal metastasis

Department of Radiology, Uludag University Faculty of Medicine, Bursa, Turkey; Division of Hematology, Oncology and Transplantation, University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota; Department of Otolaryngology-Head and Neck Surgery, University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota; Department of Pathology and Laboratory Medicine, University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota; Department of Radiology, University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota

Spontaneous occlusion of cerebral arteriovenous malformation following partial embolization with Onyx.

Management options for brain arteriovenous malformations (AVMs) are surgery, radiosurgery, and endovascular embolization. The aim of partial embolization in endovascular treatment is to make total resection possible. However, increased risk of bleeding in partial embolization creates some controversies about treatment options. Spontaneous total occlusion of cerebral AVMs following partial obliteration with embolization agents is a rarely seen condition. We present a case with an AVM vanishing from right posterior cerebral artery which spontaneously occluded following partial embolization with Onyx liquid agent.

Selective bilateral renal artery embolization with tris-acryl microspheres in focal segmental glomerulosclerosis

Renal artery embolization (RAE) was originally used only in patients with symptomatic hematuria and palliation of metastatic renal cancer. Nowadays, RAE is used for the treatment of renal medical diseases, renal lesions such as angiomyolipoma [1,2] and vascular malformations and for preoperative reduction of vascularization of renal masses. RAE is getting more popular due to its minimally invasive nature. Various embolization agents are used in RAE; the most frequently used are metallic microcoils. Additionally polyvinyl alcohol (PVA), ethanol, gelatin sponge and trisacryl gelatin microspheres can be used as well [2]. Primary focal segmental glomerulosclerosis (PFSGS) is the cause of 20—30% of nephrotic syndrome in the adult population. It is the most common cause of idiopathic glomerular diseases and nephrotic proteinuria. More than 50% of these may progress to end-stage renal disease (ESRD) in 5—10 years

Opacification of nondilated bile ducts through the gallbladder as an aid to percutaneous transhepatic biliary drainage

PURPOSE The purpose of this study was to retrospectively assess the potential of percutaneous transhepatic biliary drainage (PTBD) in patients with nondilated bile ducts (NDBD) using a transgallbladder opacification of the bile ducts. PATIENTS AND METHODS Eight patients with NDBD (7 men, 1 women; median age, 65 years; Q1-Q3, 35-69 years; range, 22-77 years) who underwent PTBD after opacification of the bile ducts through the gallbladder were evaluated. Opacification of NDBD was performed using a retrograde injection of contrast material through the gallbladder. The opacified peripheral NDBD was punctured percutaneously and a drainage catheter was introduced under fluoroscopy guidance. The success and safety of the procedure were assessed. RESULTS PTBD could be achieved in 6/8 patients (75%) and no significant complications were observed. The biliary tree opacification was attempted but could not be achieved due to biliary sludge that obstructed the cystic duct in 2/8 patients (25%). Two minor complications in two different patients were observed consisting of transient hemobilia and chills. CONCLUSION Opacification of the bile ducts using a transgallbladder approach appears to be a safe and successful procedure for PTBD in patients with NDBD.