Ozdes Emer

Combination of preoperative ultrasonographic mapping and radioguided occult lesion localization in patients with locally recurrent/persistent papillary thyroid carcinoma: a practical method for central compartment reoperations.

Purpose: To improve the surgical success and reduce the complication rates, we combine our routine preoperative ultrasound (US) mapping technique with radioguided occult lesion localization (ROLL) in patients with papillary thyroid cancer recurrences in central compartment. Materials and Methods: In the morning of surgery, biopsy proven recurrent/persistent tumoral lesions were plotted on a sketch and injected with Tc-99m labeled macroaggregated albumin under US guidance. Thyroid bed exploration was carried out based on the location of biopsy proven lesion with the guidance of intraoperative gamma probe and neck map. The lymphoadipose tissues showing high count rates were resected and labeled separately for histopathologic study. Results: Despite extensive scarring in some patients probe safely guided to lesions. Noninjected tumor foci were searched and successfully resected in the light of neck map that showing topographic relation of injected and noninjected lesions. Among total of 41 excised lesions, 28 metastatic foci ranging from 3 to 38 mm in largest diameter were recognized at final histologic examination. Combination of preoperative mapping with ROLL was found helpful by the operating surgeons in all patients, respectively. Except 2 patients with known distant metastases, undetectable thyroglobulin levels were reached 6 weeks after surgery. Conclusions: The use of preoperative US-mapping with ROLL in patients with nonpalpable recurrent/persistent papillary thyroid cancer in central compartment is technically safe and effective method. Combination of techniques provides better information about topographical relations of recurrent/persistent lesions during surgery.

Diagnostic accuracy of whole-body diffusion-weighted magnetic resonance imaging with 3.0 T in detection of primary and metastatic neoplasms

To discuss the accuracy of the whole‐body diffusion‐weighted imaging with background body signal suppression (WB‐DWIBS) technique performed in the 3.0‐T system.

Initial experience of 3 tesla apparent diffusion coefficient values in differentiating benign and malignant thyroid nodules

To evaluate the role of diffusion‐weighted magnetic resonance imaging (DWMRI) in differentiating benign and malignant thyroid nodules using a 3 Tesla (T) MRI scanner.

Clinicopathologic features and prognostic factors of tall cell variant of papillary thyroid carcinoma: comparison with classic variant of papillary thyroid carcinoma.

ObjectiveTall cell variant (TCV), an aggressive form of papillary thyroid carcinoma (PTC), frequently presents with extrathyroidal disease and recurrence. The aim of this study was to evaluate the clinicopathologic features and outcomes of patients with TCV by comparing them with a larger group of patients with classic variant of papillary thyroid carcinoma (cPTC). Patients and methodsA total of 2500 patients with differentiated thyroid carcinoma were treated and monitored during a 23-year period (1992–2015). Of them, 2250 (90%) had PTC and 235 (9.5%) had follicular thyroid carcinoma. Of the 2250 patients, 862 (38.3%) and 70 (3.1%) had cPTC and TCV, respectively. Cases of TCV and cPTC of PTC were compared on the basis of risk factors. ResultsPatients with TCV were significantly older compared with cPTC patients (P<0.001). Tumor size was significantly bigger (P=0.01) and preablation thyroglobulin level was significantly higher (P<0.001) in TCV patients than in cPTC patients. The incidence of capsule invasion, extrathyroidal extension, and vascular invasion was significantly higher in TCV (P=0.003, <0.001, and 0.011, respectively). The incidence of initial lymph node metastasis was significantly higher in TCV (P<0.001). Patients with TCV were mostly at an advanced stage compared with patients with cPTC (P<0.001). Development of local or distant metastasis during the follow-up was significantly higher in TCV than in cPTC. Sex and multifocality were not statistically significant. ConclusionTCV has a higher incidence of local or distant metastasis and mortality rate. Thus, it must be treated with the highest possible 131I ablation doses and followed up carefully.

Can single cIMT measurement during echocardiography affect further investigation decision for coronary artery disease

OBJECTIVEnThis study was aimed to evaluate whether there is any potential role of the measurement of the carotid intima-media thickness (cIMT) in patients with suspected coronary artery disease (CAD) during the echocardiography session on decision-making to refer patients for further diagnostic evaluation such as gated myocardial perfusion imaging (gMPI).nnnMETHODSncIMT of 199 consecutive patients was measured during the echocardiography session and all patients underwent gMPI. According to gMPI results, patients were divided into two groups as CAD and normal groups and according to cIMT measurements patients were divided into four subgroups.nnnRESULTSnAlthough, there was a good correlation between the age and cIMT values of the patients (r=0.546, p<0.001), the correlation between the summed stress scores and the age of the patients was very weak (r=0.142, p=0.045) and the correlation between the summed stress scores and the cIMT values was very weak (r=0.107, p=0.131). The cIMT measurements of the CAD group (0.74±0.17 mm) were significantly higher than those of the normal group (0.67±0.16 mm) (p=0.012), but after the age correction, the significance between the cIMT measurements of the CAD and the normal groups was not found (p=0.131). Besides, the relationship between the categorical cIMT values of both the CAD and the normal groups was insignificant (p=0.059) and the correlation between the increasing cIMT values and the presence of detectable CAD was also very weak (r=0.187, p=0.08).nnnCONCLUSIONncIMT can predict occurrence of cardiovascular events in subjects, but single cIMT measurement during echocardiographic examination does not seem to have potential role on decision making for further investigation in patients with suspected CAD.

Sphenoid Bone Fibrous Dysplasia Detected Incidentally on Bone Scintigraphy by the Contribution of SPECT/CT Hybrid Imaging

Fibrous dysplasia (FD) is a benign fibroosseous bone disorder. It has poliostotic and monostotic patterns. Monostotic FD is frequently asymptomatic and is usually discovered incidentally by radiologic imaging performed for other reasons. Bone scintigraphy is valuable for identifying disease extent. Craniofacial FD (CFD) is a form of the disease where lesions are limited to contiguous bones of the craniofacial skeleton. We presented a case with monostotic CFD who was detected incidentally on bone scintigraphy single-photon emission computed tomography/computerized tomography while being investigated for inflammatory arthropaties.

Angiographic results of the patients with positive transient ischemic dilatation on their gated myocardial perfusion imaging scans

Objectives: Gated myocardial perfusion imaging (gMPI) is an established tool for the diagnosis and risk stratification of patients with coronary artery disease (CAD) providing a variety of parameters regarding to perfusion and function of left ventricle (LV). Transient ischemic dilation (TID) is one of them. The presence of TID has been shown as a marker of severe and extensive CAD. The aim of this study was to correlate scintigraphic and angiographic findings of patients with positive TID on their gMPI scans.

Total Eclipse of FDG-PET Scan Caused by Hyperphysiological FDG Uptake of Masticatory Muscles Due to Chewing

In routine oncological 18F-fluorodeoxyglucose positron emission tomography (FDG-PET/CT) scan, the patients rest in a quite, dimly lit room for 60 minutes after intravenous (IV) injection of FDG and they are instructed not to move during this time (uptake phase) before FDG-PET/CT scanning to prevent and decrease unwanted FDG accumulations on muscle traces caused by muscle movements. In conditions of patient inconsistency, undesirable activities can be seen and reach high levels making difficult or even impossible to interpret the images. Different muscle groups form various physiological or over- physiological uptake patterns depending on their specific motion. Herein we represent a good didactic example to this phenomenon.