Tunc Ones

Comparison of direct radionuclide cystography and voiding cystourethrography in detecting vesicoureteral reflux.

Background: Fluoroscopic voiding cystourethrography (VCUG) is a widely used imaging test for the diagnosis of vesicoureteral reflux (VUR). However, high gonadal radiation and intermittent imaging are the main disadvantages of VCUG. Direct radionuclide cystography (DRC) has been advocated for the detection of VUR with increased sensitivity and low radiation doses, however, having the disadvantage of providing less anatomical details for urethral evaluation. In this study, DRC has been compared with standard fluoroscopic VCUG for detection of VUR.

Association between the presence of brown adipose tissue and non-alcoholic fatty liver disease in adult humans.

Aliment Pharmacol Ther 2011; 34: 318–323

Orlistat accelerates gastric emptying and attenuates GIP release in healthy subjects

Orlistat, an inhibitor of digestive lipases, is widely used for the treatment of obesity. Previous reports on the effect of orally ingested orlistat together with a meal on gastric emptying and secretion of gut peptides that modulate postprandial responses are controversial. We investigated the effect of ingested orlistat on gastric emptying and plasma responses of gut peptides in response to a solid mixed meal with a moderate energy load. In healthy subjects, gastric emptying was determined using scintigraphy and studies were performed without and with 120 mg of orlistat in pellet form in random order. Orlistat shortened t lag and t half and decreased the area under the gastric emptying curve. Orlistat significantly attenuated the secretion of glucose-dependent insulinotropic polypeptide (GIP) but did not alter the plasma responses of cholecystokinin (CCK), glucagon-like peptide-1 (GLP-1), pancreatic polypeptide (PP), and insulin. There was no peptide YY (PYY) response. Area under the curve of gastric emptying was positively correlated with integrated secretion of GIP (r=0.786) in orlistat and was negatively correlated with integrated plasma response of GLP-1 (r=-0.75) in control experiments, implying that inhibition of fat absorption modifies determinants of gastric emptying of a meal. Orlistat administered similar to its use in obesity treatment accelerates gastric emptying of a solid mixed meal with a moderate energy load and profoundly attenuates release of GIP without appreciably altering plasma responses of CCK, GLP-1, and PP. Since GIP is being implemented in the development of obesity, its role in weight control attained by orlistat awaits further investigation.

Patients with Takayasu's arteritis having persistent acute-phase response usually have an increased major vessel uptake by 18F-FDG-PET/CT

Abstract Objectives. Although not uniformly accepted, an increased uptake by 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) in large vessels is accepted to be a sign of active disease in Takayasus arteritis (TAK). We aimed to investigate the value of 18F-FDG-PET/CT for clinical assessment in a subset of TAK patients having a persistent acute-phase response (APR) without any signs or symptoms of clinical disease activity. Method. We studied 14 patients (mean age: 38.6 ± 13.9 years, Female/Male: 11/3, and disease duration: 5.7 ± 5 years). Patients were clinically inactive (according to the definition of activity by Kerr et al.), while categorized as having “persistent” disease activity by physicians global assessment due only to APR. 18F-FDG uptake was graded using a four-point scale from grade 0 (no uptake present) to grade 3 (high grade: uptake higher than that of liver). Any uptake in major vessels with a grade ≥ 2 was accepted to be “active.” Results. Mean erythrocyte sedimentation rate was 50.8 ± 13.2 mm/hour and mean C-reactive protein level was 28.5 ± 22.1 mg/L. Active vasculitic lesions were observed by 18F-FDG-PET/CT in 9 of 14 (64.3%) patients. The median number of active vascular lesions was 2 (range: 1–5). A step-up treatment change was decided in 8 patients according to 18F-FDG-PET/CT results. Conclusion. We observed increased 18F-FDG uptake in the majority of TAK patients with an increased APR, but clinically silent disease. 18F-FDG-PET/CT showed the presence and localization of active inflammation in the aorta and its branches. Although specificity for observed lesions is not clear, 18F-FDG-PET/CT imaging may influence physicians assessment of clinical activity and treatment choices in TAK.

B-type natriuretic peptide levels in patients with COPD and normal right ventricular function

IntroductionEvidence suggests that elevated plasma levels of B-type natriuretic peptide (BNP) are found in patients with chronic obstructive pulmonary disease (COPD) and right ventricular dysfunction. We examined the effects of exercise on plasma BNP levels in patients with COPD who have normal right ventricular functionMethodsSeventeen patients with a diagnosis of COPD and normal right ventricular function demonstrated by radionuclide ventriculography, and 17 age-and sex-matched healthy subjects underwent a treadmill exercise test. Plasma BNP levels were measured sequentially before, immediately after, and 1 hour after the exercise testResultsThe mean plasma BNP±standard deviation levels of the COPD and control groups before exercise were 21.3±16 pg/ml and 13.4±11 pg/ml, respectively (P>0.05). Mean plasma BNP level measured immediately after exercise was 37.9±31 pg/ml in the COPD group, reflecting a statistically significant increase when compared with the initial value (P<0.05). The control group did not show any significant change in plasma BNP levels after the exercise testConclusionsExercise induces an increase in plasma BNP levels in patients with COPD who do not have right ventricular dysfunction at rest. Measurement of exercise-induced BNP levels may be a useful alternative to pulmonary artery catheterisation in identifying the patients who are likely to benefit from long-term oxygen therapy

False positivity of FDG-PET/CT in a child with Hodgkin disease

Role of Positron Emission Tomography (PET) with F‐18‐2‐fluoro‐2‐deoxy‐D‐glucose (FDG) in staging of Hodgkin disease is well established despite several controversies. We report a Stage III Hodgkin lymphoma patient with false positive FDG‐PET/CT results. Seven‐year‐old male with Hodgkin lymphoma was in remission at end of chemotherapy. At third and fourth month of postchemotherapy follow‐up, increased Gallium uptake and positive FDG‐PET/CT in right lower quadrant of abdomen was observed. Open biopsy revealed lymphoid hyperplasia. He has been followed for 21 months without any evidence of disease. Despite its documented benefit, we believe that results of FDG‐PET/CT should be interpreted with great caution in order to avoid unnecessary interventions. Pediatr Blood Cancer 2008;50:881–883.

The role of active brown adipose tissue in human metabolism

PurposeThe presence of activated brown adipose tissue (ABAT) has been associated with a reduced risk of obesity in adults. We aimed to investigate whether the presence of ABAT in patients undergoing 18F-FDG PET/CT examinations was related to blood lipid profiles, liver function, and the prevalence of non-alcoholic fatty liver disease (NAFLD).MethodsWe retrospectively and prospectively analysed the 18F-FDG PET/CT scans from 5,907 consecutive patients who were referred to the Nuclear Medicine Department of the Marmara University School of Medicine from outpatient oncology clinics between July 2008 and June 2014 for a variety of diagnostic reasons. Attenuation coefficients for the liver and spleen were determined for at least five different areas. Blood samples were obtained before PET/CT to assess the blood lipid profiles and liver function.ResultsA total of 25 of the 5,907 screened individuals fulfilling the inclusion criteria for the study demonstrated brown fat tissue uptake [ABAT(+) subjects]. After adjustment for potential confounders, 75 individuals without evidence of ABAT on PET [ABAT(−) subjects] were enrolled for comparison purposes. The ABAT(+) group had lower total cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase, and aspartate transaminase levels (p < 0.01), whereas we found no significant differences in the serum triglyceride and high-density lipoprotein cholesterol levels between the two groups. The prevalence of NAFLD was significantly lower in ABAT(+) than in ABAT(−) subjects (p < 0.01).ConclusionOur study showed that the presence of ABAT in adults had a positive effect on their blood lipid profiles and liver function and was associated with reduced prevalence of NAFLD. Thus, our data suggest that activating brown adipose tissue may be a potential target for preventing and treating dyslipidaemia and NAFLD.

Comparison of WHO, RECIST 1.1, EORTC, and PERCIST criteria in the evaluation of treatment response in malignant solid tumors.

AimTo compare response assessment according to the WHO, RECIST 1.1, EORTC, and PERCIST criteria in patients diagnosed with malignant solid tumors and who had received cytotoxic chemotherapy to establish the strength of agreement between each criterion. Materials and methodsSixty patients with malignant solid tumors were included in this retrospective study. The baseline and the sequential follow-up fluorine-18-fluorodeoxyglucose PET/computed tomography (CT) of each patient were evaluated according to the WHO, RECIST 1.1, EORTC, and PERCIST criteria. PET/CT images were used for both metabolic and anatomic evaluation. The concurrent diagnostic CT and MRI images (performed within 1 week of PET/CT) were also utilized when needed. The results were compared using the &kgr;-statistics. ResultsThe response and progression rates according to the WHO criteria were 37 and 38%, respectively. The same ratios were also found for RECIST 1.1 (&kgr;=1). The response and progression rates according to the EORTC criteria were 47 and 40%, respectively. When PERCIST criteria were used, one patient with progressive disease was upgraded to stable disease (&kgr;=0.976). As we found the same results with WHO and RECIST 1.1 criteria, we used WHO criteria to compare the anatomic and metabolic criteria. When we compared the WHO and EORTC criteria, there was an agreement in 80% of the patients (&kgr;=0.711). With WHO and PERCIST criteria, there was an agreement in 81.6% of the patients (&kgr;=0.736). ConclusionSignificant agreement was detected when the WHO, RECIST 1.1, EORTC, and PERCIST criteria were compared both within as well as between each other.

Serum thymidine kinase 1 levels correlates with FDG uptake and prognosis in patients with non small cell lung cancer

Context: TK1 found to be elevated biomarker in many solid cancers. Objectives: The study aimed to assess the prognostic significance of a serum TK1 in patients with metastatic NSCLC. Methods: The study included 48 consecutive patients, newly diagnosed with metastatic NSCLC, and 10 healthy volunteers. Serum TK1 activity determined by ELISA method. Results: Patients with a bTK1 level >156 Du L–1 had significantly shorter survival. TK1 level showed a strong correlation with primary tumor SUVmax. Discussion and conclusion: The magnitude of maximum fluorodeoxyglucose uptake in primary tumors and the serum TK1 level in patients with metastatic NSCLC were found to be independent prognostic predictors of overall survival.

False Positive FDG PET/CT Resulting from Fibrous Dysplasia of the Bone in the Work-Up of a Patient with Bladder Cancer: Case Report and Review of the Literature

Fibrous dysplasia of the bone (FDB) is a common, genetic, developmental disorder with a benign course. FDB can be seen anywhere throughout the skeleton. It is usually asymptomatic and found incidentally on imaging studies that are performed for other purposes. Although whole body 18 F-flourodeoxyglucose PET/CT (FDG PET/CT) is widely used in tumor imaging, infections and benign pathologies like FDB may cause false positive results. Herein we report the case of a 48-year-old FDB patient with transitional cell carcinoma of the urinary bladder. Restaging FDG PET/CT showed multiple mild to moderate hypermetabolic bone lesions which were initially misinterpreted as bone metastases. In this case report, we aimed to guide physicians in evaluating bone lesions in cancer patients with FDB in the light of the literature.