Muge Tamam

Diagnostic spectrum of congenital hypothyroidism in Turkish children

Background:  Congenital hypothyroidism (CH) is classified as transient or permanent. Transient CH can be treated with short‐term thyroxine replacement therapy or followed up without therapy, whereas lifelong thyroxine replacement is needed in permanent CH. Determination of the underlying etiology is essential for determination of follow‐up strategy. The purpose of the present study was therefore to assess the role of color Doppler ultrasonography (CDU) in etiologic diagnosis of CH together with radionuclide method and grayscale ultrasonography (GSU).

Small bowel metastases from primary carcinoma of the lung: presenting with gastrointestinal hemorrhage.

Upper gastrointestinal system bleeding should be first taken into account when a patient complains of melena. On rare occasions, gastrointestinal bleeding may be due to primary or metastatic tumors of the gastrointestinal system. Here, we present a case in which the localization of bleeding was demonstrated by Tc-99m red blood cell labeled scintigraphy with the final diagnosis of metastases of non-small cell lung cancer to the small bowel.

Intraocular and orbital metastasis as a rare form of clinical presentation of insular thyroid cancer

Insular carcinoma of thyroid is a rare tumor, which accounts for 4 to 6% of thyroid malignancies. Clinically and morphologically it is considered to be in an intermediate position between well-differentiated carcinoma of the thyroid (papillary or follicular) and undifferentiated or anaplastic carcinoma of the thyroid. Capsular and blood vessel invasion is seen frequently, and metastases to regional lymph nodes, lungs and bones are common. The initial presentation of distant metastasis in patients with thyroid cancer is rare. Thus metastatic thyroid carcinoma rarely involves the orbit. We report a rare case of choroidal metastasis from insular thyroid carcinoma.

The evaluation of the external dose measurement of the patients treated with radioiodine therapy

The aim of the study is to compare the results of the external exposure and the range of the dose spread by the patients, hospitalized in two different groups of 3-4 d receiving radioiodine therapy because of having hyperthyroidism (HT) and thyroid cancer (TC). A total of 1989 patients were evaluated retrospectively. Of the total 1517 patients had TC and 472 had HT. External exposure value was taken at hospital discharge and the distance for external measurement was 1 m at the abdominal level. External exposure values of 99.7 % patients were <30 µSv h(-1) and of 0.3 %, >30 µSv h(-1). The results between patient groups with TC and HT at third and fourth days, and the dissimilarity of measurement results within third and fourth days in total patients, without discriminating the day difference, are statistically meaningful. Although 3-d isolation period for 30 µSv h(-1) limit is generally enough, it can be insufficient for some patients. Besides hospitalisation, the radiation safety training must be emphasised by establishing good communication with patients in order to protect their relatives and other people against radiation risk.

False-positive findings in post-treatment iodine-131 whole-body scintigraphy in a nasolacrimal sac cyst, confirmed with SPECT/CT and MRI.

A case of a patient with papillary thyroid carcinoma with falsepositive iodine-131 accumulation in a nasolacrimal sac cyst has been reported. A 63-year-old woman underwent total thyroidectomy for multifocal papillary thyroid carcinoma. After the treatment, iodine-131 whole-body scintigraphy revealed uptake in the neck consistent with thyroid remnant tissue and focal uptake in the head. SPECT/CT revealed focal uptake in the anterior lateral wall of right nasal cavity. Magnetic resonance imaging demonstrated the area of radioiodine accumulation corresponded to cystic enlargement of the right lacrimal sac.

Incidental diagnosis of struma ovarii detected with 99mTc SPECT/CT.

We describe a case of asymptomatic struma ovarii in a 61-year-old woman who presented with elevated thyroglobulin level during checkup. Tc-99m pertechnetate whole-body scintigraphy showed a normal thyroid uptake, and an increased uptake localized on the upper left side of the urinary bladder corresponding to the ovary. Pelvic SPECT/CT confirmed increased uptake localized in left adnexal area. Histopatologic verification confirmed the diagnosis of struma ovarii. We report an unusual case of incidental diagnosis of struma ovarii with Tc pelvic SPECT/CT imaging.

Isolated adrenal metastasis of small cell neuroendocrine carcinoma of the ovary detected with FDG-PET/CT

The small cell neuroendocrine subtype of ovarian carcinoma is a are malignant tumor, representing less than 2% of all gynecologic alignancieswith a highmetastatic potential and the possibility to etastasize to practically any tissue. Although the adrenal gland is common site for metastasis, metastases from the ovary are very are.1–3 A 71-year-old woman with small cell neuroendocrine carcioma of the ovary confined to the ovary was treated with total abdominal hysterectomy with bilateral salpingo-oophorectomy (Fig. 2A), and adjuvant chemotherapy. Six months later during follow-up, FDG-PET/CT imaging was carried out. Prior to the examination, 40ml of ionic iodinated contrast agent diluted in 1500ml of water was given to patient orally. The examination started 60–90min after the intravenous injection of 350MBq of [18F]FDG. No iv contrast material was used for the CT scans.

Tc-MDP bone scintigraphy in a case with sporodical tumoral calcinosis

Tumoral calcinosis is an uncommon and benign condition characterized by the presence of large calcific soft tissue deposits occurring predominantly in a periarticular location. It generally occurs as a complication of renal dialysis or trauma, and is rarely seen in familial and sporadic cases. Bone scintigraphy is a sensitive method for diagnosing tumoral calcinosis. A 28-year-old female patient with a history of operation due to tumoral calcinosis located bilateral hips, referred to our department. She had a tender palpable mass in the right knee and a fistulized incisional scar overlying the bilateral hip joints. A sporadic case of tumoral calcinosis with relapses was presented.

The Accuracy of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Evaluation of Bone Lesions of Undetermined Origin.

The aim of the current study was to determine the diagnostic accuracy of whole-body fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in detecting carcinoma of unknown primary (CUP) with bone metastases. We evaluated 87 patients who were referred to FDG-PET/CT imaging and reported to have skeletal lesions with suspicion of malignancy. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. The median survival rate was measured to evaluate the prognostic value of the FDG-PET/CT findings. In the search for a primary, FDG-PET/CT findings correctly diagnosed lesions as the site of the primary true positive (TP) in 64 (73%) cases, 4 (5%) findings diagnosed no site of a primary, and none were subsequently proven to be true negative (TN); 14 (16%) diagnoses were false positive (FP) and 5 (6%) diagnoses were false negative (FN). Life expectancy was between 2 months and 25 months. Whole-body FDG-PET/CT imaging may be a useful method in assessing the bone lesions with suspicion of bone metastases.

Diagnostic value of single-photon emission computed tomography combined with computed tomography in relation to MRI on osteochondral lesions of the talus.

BACKGROUND Osteochondral lesion of the talus (OLT) involves the separation of a fragment of articular cartilage, as defined by Kappis in 1922. MRI is the current standard for noninvasive diagnosis of OLT. Single-photon emission computed tomography combined with computed tomography (SPECT/CT) provides both morphologic and functional information. The purpose of the study was to compare SPECT/CT with MRI for image interpretation and treatment decision making in talar osteochondral lesions. MATERIALS AND METHODS A total of 21 patients (four bilateral) were evaluated with MRI and SPECT/CT. Diagnostic arthroscopy was performed to validate the indication by identifying unstable cartilage areas. Activation was assessed in nine regions of interest, as described by Elias and colleagues. SPECT/CT findings were assessed by the modified scoring system of Hart and colleagues, and MRI findings with the modified classification system of Hepple and colleagues. Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated for SPECT/CT and MRI. RESULTS A total of 25 lesions were identified. Seventeen lesions were located on the medial third of the talar dome, eight on the lateral third, and seven on the central third. Four patients revealed diffuse uptake on more than one zone on SPECT/CT. SPECT/CT identified two subchondral lesions, which were not visualized on MRI. CONCLUSION MRI is the current standard for OLT diagnosis. SPECT/CT allows a three-dimensional localization of scintigraphic osteoblastic activity in the area of interest, providing additional information about the involvement of the subchondral bone and the vitality of the osteochondral lesion and the location of multiple lesions. We recommend the use of SPECT/CT and MRI together for comprehensive diagnostic assessment of OLT.