Metin Erkiliç

Regional cerebral blood flow in schizophrenia before and after neuroleptic medication

In order to investigate cerebral perfusion changes induced by neuroleptic drugs, we performed 99Tcm hexamethyl propyleneamine oxime (HMPAO) single-photon emission computed tomography (SPET). Fifteen patients (nine drug naive, six non-naive) diagnosed by using the DSM-III-R criteria, and 10 right-handed age and sex matched normal volunteers were included in this study. The SPET study was performed with 740 MBq 99Tcm-HMPAO by using a 128×128 matrix, 30 s/frame for a total 64 view over 360° before and after 1 month of neuroleptic treatment. A semiquantitative method was used for the analysis. Patients were clinically assessed using the Brief Psychiatric Rating Scale (BPRS). There was no significant regional cerebral blood flow (rCBF) difference between the patient group and control group in whole-brain regions except in the left temporal lobe. Although clinical scores of the patients improved after neuroleptic treatment no statistically significant difference was found in the rCBF between pre- and post-treatment. Moreover, there was no statistically significant correlation between the rCBF and BPRS in any region. These results suggest that there was a discrepancy between the clinical situation and rCBF in schizophrenia and the lateralized temporal lobe blood flow, which may have important implications for the evaluation of patients with schizophrenia.

Quantitative sacroiliac joint scintigraphy in normal subjects and patients with sacroiliitis

The aim of this study is to determine the sacroiliac index (SII) of healthy subjects and to compare these values with patients having sacroiliitis (SI). Quantitative sacroiliac scintigraphy (QSS) was performed with Tc-99m hydroxy methylene diphosphonate (HMDP) and whole sacroiliac joint-to-sacrum ratio was calculated as a SII by the region of interest (ROI) method. Forty-seven nonarthritic healthy subjects and 13 patients with SI were studied. Effects of aging, gender and laterality on SII were evaluated in 47 healthy subjects.The sacroiliac index was higher in men than women (p < 0.05). SII did not change significantly in aged men, but it decreased significantly in aged women (p < 0.05). Eleven of 13 patients with SI had a higher SII than healthy subjects (> mean + 2SD). In the other two cases by using small ROIs, SIIs were found to be higher than the normal range. Our results suggest that QSS is a sensitive method for the diagnosis of early stage SI and every institution should establish its own normal SII.

Tc-99m MDP bone scintigraphy in relapsing polychondritis

A 62-year-old man was wheezing and had chest pain for 2 months. He had a history of bilateral ear swelling, for 3 years. Physical examination showed edematous and red auricles and a saddle nose deformity. Computerized tomography showed tracheal calcifications and tracheobronchial narrowing was observed on bronchoscopy. Tc-99m MDP bone scan performed for chest pain showed diffusely increased uptake in the costochondral junctions. The biopsy showed relapsing polychondritis. He underwent prednisolone therapy for 2 months and his symptoms and scintigraphic findings were improved. This report indicates that MDP bone scintigraphy may be a valuable method in follow-up of relapsing polychondritis.

CERULOPLASMIN AND VITAMIN E LEVELS IN TOXIC MULTINODULAR GOITER

The effect of the enhanced metabolic rate over antioxidant status was investigated in hyperthyroid individuals. Serum total T3 and T4 levels were measured by radioimmunoassay in 45 patients and 25 controls. The serum vitamin E was assayed fluorometrically in the hexane extract of serum. Serum ceruloplasmin activity was measured spectrophotometrically. Statistical significance was asessed by correlation regression analysis and paired t-test. The serum vitamin E levels decreased significantly as the levels of the thyroid hormones increased. For ceruloplasmin the opposite changes were observed: mean serum ceruloplasmin of hyperthyroid patients was greater than that of control group. Although the changes in vitamin E and ceruloplasmin concentrations did correlate with the levels of thyroid hormones in hyperthyroid patients, we observed no associations between these parameters in the euthyroid state. As these two parameters are the measure of oxidation potential, it may be suggested that raised free radical activity in hyperthyroidism cause the increased oxidative stress and increased general radical scavenging. The present data may indicate a direct effect of thyroid hormones on vitamin E and ceruloplasmin metabolism.

Densitometric analysis of the human first tarsometatarsal joint

The first tarsometatarsal (TMT) joint has a complex role in regulating joint pressure in the midfoot. Despite its importance, there have been only a few studies of the functional morphology and biomechanical function of this joint. Here we report about the densitometric pattern of the subchondral bone layer of the articulating elements of the human first TMT joint. We studied dry bones of the first metatarsal and medial cuneiform bones in 64 human cadavers to establish the pattern of the density distribution and to correlate it with the biomechanical function of the joint. The articular surfaces of both the bones were analyzed planimetrically. Half of the specimens (n=32) were sectioned in the sagittal plane and the other 32 articulations were in the transverse plane. In all the sections, the subchondral bone density of the first TMT joint was measured. We found that in sagittal slices the dorsal area of the lateral parts and intermediate parts in females and the dorsal area of the lateral parts, the medial parts and intermediate parts in males were denser than the plantar area and that its density decreased towards the plantar area. The dorsal parts of transverse slices in males were the densest and its density decreased towards the plantar part. In the dorsal, middle and plantar parts in females in transverse slices, the lateral and intermediate areas were denser than the medial areas (P<0.05). There was no significant difference between the bone densities of females and males.

Comparison of Tc-99m HIG and Ga-67 citrate in the evaluation of bacterial abscess in a rat model

Tc-99m labeled polyclonal human immunoglobulin (HIG) has been shown to be able to localize an inflammatory site. There are several possible explanations for HIG accumulation at focal infection sites such as increased vascular permeability, binding of the Fc part of Ig to Fc receptors of leucocytes and binding directly to bacteria. In this study, we compared Tc-99m HIG and Ga-67 citrate scintigraphy in localizing acute bacterial abscesses induced byE. coli andS. aureus. Serial scintigrams were performed at 1, 4, 24 hr after injection. Tc-99m HIG showed greater accumulation at all times with both infectious agents than Ga-67 citrate (p < 0.05). While Tc-99m HIG showed greater accumulation inS. aureus thanE. coli (p < 0.05), there was no statistically significant difference betweenE. coli andS. aureus (p > 0.05) by Ga-67 citrate. Our study suggests that Tc-99m HIG is a superior agent to Ga-67 and bacterial affinity can be a factor responsible for HIG accumulation at focal sites of inflammation.

Evaluation of factors affecting tumor response and survival in patients with primary and metastatic liver cancer treated with microspheres.

Objective Radioembolization with the yttrium-90 (Y-90) microspheres is being used increasingly more often in the treatment of patients with primary or metastatic liver cancer. Although technetium-99m macroaggregated albumin (Tc-99m MAA) scintigraphy performed following diagnostic angiography has an important role in predicting the effectiveness of treatment and in dose estimation, the number of studies using quantitative assessment of Tc-99m MAA scintigraphy is limited in this field. In the present study, the aim was to assess whether a tumor dose is required to obtain objective tumor response and to check whether this threshold value is predictive in terms of tumor response, survival, and liver toxicity by using Tc-99m MAA single-photon emission computed tomography (SPECT) images. Materials and methods Overall, 54 patients (20 women and 34 men; median age: 60 years) who underwent Y-90 Resin (SIR-Spheres) and Glass (TheraSphere) microsphere treatment with a diagnosis of unresectable liver cancer between August 2010 and April 2013 were included in the study. The mean doses to normal liver and tumor were estimated for each patient using Tc-99m MAA SPECT images and the medical internal radiation dosimetry method. The responses were assessed according to Response Evaluation Criteria In Solid Tumors (RECIST) and European Organisation for Research and Treatment of Cancer (EORTC) criteria. Kaplan–Meier survival curves and univariate Cox regression analysis were used in survival analysis. The relationship between treatment response and other parameters included was assessed using logistic regression analysis. The variables with a P value less than 0.01 in univariate analysis were assessed with multivariate analysis. Results Fifty-four Y-90 microsphere treatments (eight by using a Y-90 glass microsphere and 46 by using a Y-90 resin microsphere) were performed. In the multivariate analysis, the only parameter related to response was tumor dose (P<0.01). With a tumor dose of 280 Gy or higher, objective tumor response was observed in 59 and 77% of the patients according to RECIST and EORTC criteria, respectively, and the tumor control rate was found to be 95% according to both criteria. In addition, it was found that only tumor dose was correlated with progression-free survival (PFS) (P<0.001) and overall survival (OS) (P=0.018). When the tumor dose was 280 Gy or higher, median PFS increased from 2 to 10.7 months (P<0.001), whereas median OS increased from 9 to 17.6 months (P=0.018). However, reversible ≥G2 liver toxicity was observed in 3.7% (2/54) of the patients within 3 months after radioembolization with a median normal liver dose of 40 Gy (10–102 Gy). There was reversible ≥G3 liver toxicity in 3.7% (2/54) of patients, but no G4 liver toxicity was observed. Clinical radiation hepatitis and treatment-induced liver failure were not observed in any of these patients. Conclusion Tc-99m MAA SPECT has a predictive value in terms of response to radioembolization, PFS, and OS. Dosimetry based on Tc-99m MAA SPECT images can be used in the selection of patients and, in particular, to adaptation of treatment plan in selected patients.

Ischemia modified albumin levels cannot predict stress induced ischemia shown by myocardial perfusion scintigraphy

PURPOSE Ischemia modified albumin (IMA) is a new marker of ischemia which is used in especially emergency room. Aim of this study is showing the association of IMA with stress induced ischemia on Tc-99m 2-methoxyisobutyl-nitrate (MIBI) myocardial perfusion scintigraphy (MPS). METHODS 56 patients (23 F, 33 M; 56.04 ± 8.45 years old) were included in our study. Stress-rest two days protocol Tc-99m MIBI MPS single photon emission tomography (SPECT) was performed to all patients. IMA levels from the blood samples which were taken before and after the treadmill test were measured. Thirty patients additionally underwent coronary angiography. RESULTS The difference of IMA levels of ischemia between positive and negative groups was not statistically significant. Also, there was not statistically significant difference between IMA levels of patients who have narrowing in the coronary arteries and not. CONCLUSION Although IMA is an important marker of ischemia, probably because of other ischemic process during stress; it cannot reflect stress induced ischemic changes on MPS.

Evaluation of Bone or Soft Tissue Infection with Tc-99m Hmpao White Blood Cell Scintigraphy: Semiquantitative Method

Objective: Aim the aim of this study was to investigate semiquantitatively the diagnostic performance of Tc-99m hexamethypropylene amine oxime labeled white blood cell (Tc-99m HMPAO-WBC) scintigraphy in patients with suspected bone or soft tissue infections. Methods: Material and Method twenty one patients who applied to Nuclear Medicine Departmant (for suspected prosthesis infection, diabetic foot, bone infection, graft infection) were evaluated retrospectively. Tc-99m HMPAO WBC scintigraphy imaging were performed to all patients. Planar images were taken 1., 2., and 4. hours after injecting the labeled leukocytes. Evaluation of infection with Tc-99m HMPAO WBC scintigraphy was done semiquantitatively. Relative uptake was determined by setting the region of interest (ROI) of lesion area on the anterior view. Rectangular ROI was set on the against limb (nonlesion). The ratio of the average pixel count in the lesion (L) to that in the non-lesion (NL) (L/NL ratio) was calculated at 1., 2., and 4. hours images. Final diagnosis was based on histopathology, microbiologic assays, or clinical and imaging follow-up. Results: 0.55 and 1.55±0.74, 1.42±0.55, 1.40±0.55 in positive and control groups, respectively. Positive group revealed a statistically significant increase L/NL values in the data 3 hours images (p=0.002). However, no statistically significant was found between L/NL values in 3 hours imaging data in control group (p=0.223). All the data in the positive group found Zehra Pinar Koc1, Yasemin Bulut2, Sinan Canpolat3, Ayhan Uysal4, Mehmet Sarac5 1Firat University Faculty of Medicine, Department of Nuclear Medicine, Elazig, Turkey 2Firat University Faculty of Medicine, Department of Clinic Microbiology, Elazig, Turkey 3Firat University Faculty of Medicine, Department of Phsiology, Elazig, Turkey 4Firat University Faculty of Medicine, Department of Cardiovascular Surgery, Elazig, Turkey 5Firat University Faculty of Medicine, Department of Pediatric Surgery, Elazig, Turkey Evaluation of Pulmonary Infection in Rabbits by Tc-99m Hmpao Labeled Leukocyte Scintigraphy

Basic and clinical immunology – 3031. The correlation between serum protemics patterns of sTRAIL and CXCL8 with FDG-PET/CT findings in bevacizumab treated colon cancers

Methods The measurements were taken before and after treatment for comparison purposes. The study population comprised 17/29 patients with MCRC, undergoing PET/CT scanning prior to treatment. We were able to perform a follow up PET/CT examination three months after onset of therapy in 15/17 patients.Patients were instructed to fast for at least 6h before an injection of 18F-FDG (5 MBq/kg)(GeminiPET/CTsystem). Images were reconstructed using the maximum-likelihood 3-dimensional algorithm according to standard clinical protocol: 2 iterations,relaxation parameter of 0.05,5-mm,3-dimensional gaussian postfiltering, a4·4·4mm-voxel grid sampling, and attenuation correction based on a low-dose CT scan.All images were visually interpreted by consensus between two experienced nuclear physicians and standardized uptake values(SUVmax) were calculated from the image data. Results There were significant changes prior to treatment and three months later for sTRAIL(p=0.0080) and CXCL8 (p=0.0001). Generally, sTRAIL values were increasing during therapy, while a decrease was observed for CXCL8. Correlation analysis was applied to the data and revealed significant correlations for the SUVmax in the primary tumor prior to treatment and CXCL8 prior to therapy (p=0.0303). Furthermore, significant correlations were observed for the SUVmax and sTRAIL(p=0.0237) as well as CXCL8(p=0.0002) three months after treatment initiation. CXCL8 prior to treatment was also correlated with the SUV three months after onset of treatment (p=0.0072). A significant correlation was noted for one combination of two variables, the SUVmax in the metastases and CXCL8 prior to treatment (p=0.0175). These results are supported when we group the SUVmax in the metastases following treatment into two groups with SUVmax 5. There is a significant difference for both groups regarding overall survival, with a lower survival associated with SUVmaxs exceeding.