Zeki Celen

Frequency of silent myocardial ischemia in type 2 diabetic patients and the relation with poor glycemic control

Abstract.The aim of the study was to investigate the frequency of silent myocardial ischemia in type 2 diabetic patients without any clinical or laboratory findings of myocardial ischemia and to examine the related factors for silent myocardial ischemia. A total of 116 type 2 diabetic patients (82 women) with a disease duration of 5–20 years were included in the study. All patients underwent stress and resting myocardial perfusion single-photon emission computed tomographic (SPECT) study with 99mTc-MIBI. Coronary angiography was performed in patients with ischemia established at myocardial perfusion SPECT. Ischemia was determined in 18 (15.5%) patients by myocardial perfusion SPECT. Coronary angiography performed in 17 of these patients confirmed coronary stenosis >50% in 11 patients. Thus, the prevalence of silent myocardial ischemia was 9.6%. Significant relations were found between silent myocardial ischemia and male sex, high HbA1C level and retinopathy. Type 2 diabetic patients (especially men) with poorly controlled diabetes mellitus or retinopathy should be screened for silent myocardial ischemia.

Multiple muscle metastases from lung cancer detected by FDG PET/CT.

A 71-year-old man with right lung mass, who was recently diagnosed histopathologically with pulmonary adenocarcinoma, was referred for staging of the primary tumor. Whole-body F-18 fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET/CT) demonstrated multiple hypermetabolic foci in various skeletal muscle localizations, suggesting extensive metastatic muscle involvements in addition to increased FDG uptake in the primary tumor. Subsequent biopsy and histopathological study confirmed muscle metastasis from lung adenocarcinoma. Skeletal muscle metastasis from lung cancer is rare, but multiple muscle metastases are even more unusual. FDG PET/CT is able to detect unexpected metastatic involvements such as multiple muscle metastases in lung cancer patients.

FDG PET-CT in cervical cancer: relationship between primary tumor FDG uptake and metastatic potential.

ObjectiveWe retrospectively evaluated the relationships between primary tumor 18F-fluorodeoxyglucose (FDG) uptake measured as the maximum standardized uptake value (SUVmax) and local extension, and nodal or distant metastasis in patients with cervical cancer on pretreatment FDG positron emission tomography–computed tomography (PET-CT). MethodsForty-three patients (mean age, 55.14 years; range, 34–90 years) with cervical cancer who underwent FDG PET-CT scans for staging before the initiation of treatment were included in the study. Primary tumor SUVmax was calculated; clinical tumor stages, presence of local extension, sites of lymph node and distant organ metastases were recorded. The patients were divided into low and high SUV groups by using the median primary tumor SUVmax. The low SUV group consisted of 21 patients with SUVmax less than 13.5, the high SUV group consisted of 22 patients with SUVmax ≥13.5. Their data were compared statistically. ResultsThe average SUVmax was 9.6±2.6 and 19.9±4.9 in the low and high SUV groups, respectively. In the low SUV group, six patients (29%) had a local extension, eight (38%) had pelvic and/or para-aortic lymph node metastasis, and one had distant organ metastasis (4.7%). In the high SUV group, 10 patients (45%) had a local extension, 16 (73%) had pelvic and/or para-aortic lymph node metastasis, and two (9%) had distant organ metastases. There was a significant difference in the lymph node metastasis rate between the two groups (P<0.05), but differences in local extension and distant organ metastasis were not statistically significant (P>0.05). In addition, there was a moderate correlation between SUVmax and clinical tumor stages (r=0.40, P=0.0075). ConclusionHigher primary tumor FDG uptake predicts higher nodal metastatic potential in cervical cancer patients. Patients with higher SUVmax in cervical tumor may need a close follow-up because of their higher metastatic potential.

FDG uptake in abdominal mesh implant on FDG PET/CT.

A 50-year-old man with peritoneal angiosarcoma underwent total tumor excision along with removal of the total right rectus and medial part of the left rectus muscles 1 year earlier. F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) was performed for suspected recurrence. In the anterior abdominal wall extensive subcutaneous FDG uptake showing linear hypermetabolic zone on PET slices was noted. The patient had a history of a dual mesh implant, which consists of polypropylene and polyvinylidene fluoride for the reinforcement of the abdominal wall during the operation. PET/CT fusion image demonstrated that the finding was due to the dual mesh implant in the anterior abdominal wall most likely representing a foreign body reaction.

Widespread metastases in small cell carcinoma of the prostate on FDG PET/CT.

A 72-year-old man recently diagnosed with a small cell carcinoma of the prostate was referred for staging of the primary malignancy. F-18-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography and computed tomography (PET/CT) revealed extensive hypermetabolic metastatic involvement of the liver, multiple small metastatic nodules in the lungs, and a solitary bone metastasis to the left scapula, in addition to increased FDG uptake in the enlarged prostate. Serum prostate-specific antigen level was within normal limits. Although FDG PET is not a helpful imaging method for evaluating prostatic adenocarcinoma, it may be useful in staging of small cell carcinoma of the prostate.

A correlative study of FDG PET, MRI/CT, electroencephalography, and clinical features in subacute sclerosing panencephalitis.

Objective: To describe F-18 fluorodeoxyglucose positron emission tomography (FDG PET) profile in patients with subacute sclerosing panencephalitis (SSPE) and to investigate its possible correlation with clinical, electroencephalography (EEG) or magnetic resonance imaging/computed tomography (MRI/CT) findings. Methods: EEG recording, MRI/CT and FDG PET imaging were performed in 16 patients with SSPE (1.9–15.6 years). FDG PET scans were assessed visually and in standardized uptake values. Finally, all the findings including clinical data were compared. Results: MRI was abnormal in 10 patients. It was normal in 6 of 10 patients in earlier clinical stages. Nonspecific T2-weighted white matter findings were the most consistent MRI finding (10 patients). No thalamic lesion was detected in MRI/CT. FDG PET imaging was abnormal in 14 patients (8/10 patients in earlier stages). Glucose metabolism was decreased in thalamus, cerebellum or cerebral cortex in 12, 12, and 9 patients, respectively. Frontal cortex metabolism was preserved in earlier clinical stages. FDG PET imaging revealed putaminal hypermetabolism in 7 patients. However, MRI indicated striatal abnormality only in 2 patients with prolonged disease and later clinical stage. Three patients with putaminal hypermetabolism experienced a more rapid clinical deterioration. Onset age of SSPE, age of measles infection and EEG findings were not correlated with the imaging findings. Conclusions: Our findings suggest that FDG PET imaging can indicate affected brain regions in SSPE more confidently and earlier than MRI. FDG PET imaging would provide new insights into the pathogenesis of SSPE and help to develop new approaches to the patients with SSPE.

Bilateral cutaneous diffuse large B-cell lymphoma on FDG PET/CT.

Abstract: Primary cutaneous diffuse large B-cell lymphoma is an uncommon type of non-Hodgkin lymphomas. A 51-year-old man had 2 gradually enlarging reddish, firm, and painless cutaneous-subcutaneous masses surrounded with some erythematous patches on his back for 3 years. Skin biopsy result was consistent with diffuse large B-cell lymphoma. FDG PET/CT was performed for staging and demonstrated bilaterally increased FDG uptake in the cutaneous masses with hypermetabolic left axillary lymph nodes. After chemotherapy, FDG PET/CT demonstrated that all FDG-avid lesions resolved, and there is a complete response to therapy.

Asymmetric FDG uptake in the extraocular muscles resulting from oculomotor nerve paralysis.

A 28-year-old woman complaining of headache, double vision, and drooping of the right upper eyelid for a week was admitted to the hospital. She had given birth 40 days earlier. She had a right blepharoptosis and diplopia, which are findings of right oculomotor nerve paralysis, and abnormal cerebellar function tests on physical examination. Cranial magnetic resonance imaging showed a 1 cm in diameter tumor in the mesencephalon. She was referred for FDG PET-CT study for differential diagnosis of a primary brain tumor and unknown brain metastasis, and to detect the primary tumor if any. FDG PET-CT scan showed decreased FDG uptake in the tumor region and asymmetric, more prominent FDG uptake in the left extraocular muscles. There was no evidence of hypermetabolic focus suggesting a primary malignant tumor outside the brain on a whole-body FDG PET-CT scan and the tumor in the mesencephalon was considered as a primary brain tumor. We report a case of asymmetric FDG uptake in the extraocular muscles resulting from unilateral third cranial nerve paralysis.

Bilateral symmetrically increased Tc-99m MDP cranial uptake in Hurler syndrome.

The authors describe a bone scan of a 9-year-old boy with Hurler syndrome (mucopolysaccharidosis, type I). Bilateral and symmetrically increased activity of Tc-99m MDP was seen in both maxillae and supraorbital regions of the frontal bone. The anterior image of the cranium was interesting and unusual, with a moustache and eyebrow like appearances. The scintigraphic findings may be secondary to the deposition of mucopolysaccharides and new bone formation in these regions.