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Background. The aim of the study was to retrospectively evaluate radiographic and metabolic changes in bone metastases in response to systemic therapy with 18FDG-PET/CT and determine their roles on the evaluation of therapy response.

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The increased use of radionuclides such as I-131, Sr-89, Y-90, Sm-153, Ra-223 in the treatment of benign and malignant diseases may also increase the probability of radioactive corpse contact if the patient dies in the hospital or outside the hospital. This article aims to summarize the radiation safety process and the related radiation protection measures for employees not engaged in radiation before the burial procedures of radioactive patients who died just after a radionuclide treatment. [ABSTRACT FROM AUTHOR]

Resumen Objetivo La gammagrafía paratiroidea (GP) puede ser negativa o equívoca (N/E) en un número considerable de casos con alta sospecha clínica y bioquímica de adenoma de paratiroides (AP). Los objetivos de este estudio fueron investigar el papel complementario de la determinación de paratohormona en punción con aguja fina (PTH en PAAF) con la GP en pacientes con hiperparatiroidismo primario (HPTP) y evaluar los aspectos histopatológicos de los AP en comparación con los resultados de GP. Material y métodos Fueron incluidos en el estudio 38 pacientes con HPTP remitidos para realizar GP. Diecisiete pacientes tuvieron resultados gammagráficos y ecográficos concordantes con AP (grupo A). Veintiún pacientes con GP N/E pero sospecha de AP en la ecografía formaron el grupo B. Se realizó PTH en PAAF en todos los pacientes y todos fueron operados. Se extirpó un adenoma en cada uno de ellos y en todos los casos se establecieron las características histopatológicas. Resultados El tamaño del tumor en la ecografía fue mayor en aquellos pacientes cuyos adenomas se vieron en la GP (p < 0,001). Los porcentajes de células principales, oxífilas y claras en AP no fueron estadísticamente diferentes entre los grupos. El nivel de paratohormona sérica y PTH en PAAF no fueron estadísticamente significativos entre los grupos A y B (p = 0,095 y p = 0,04, respectivamente). Conclusión Aunque no existe un valor umbral definitivo, la sensibilidad de la GP aumenta con el tamaño de la lesión. Mientras que el contenido de células principales y oxífilas tiende a reducirse en los AP con GP N/E EP, la tasa de células claras aumenta sustancialmente. La combinación de GP con la ecografía y la PTH en PAAF aumenta la sensibilidad de detección y localización de los AP. Objective Parathyroid scintigraphy (PS) can be negative or equivocal (N/E) in a considerable number of cases with highly suspicious clinical findings and biochemical results for parathyroid adenoma (PA). The aims of this study were to investigate the complementary role of parathormone washout test (PWT) to PS in patients with primary hyperparathyroidism (PHPT) and evaluate histopathologic aspects of PAs in comparison with PS results. Material and methods Thirty-eight patients with PHPT referred for PS were included in the study. Seventeen patients had both scintigraphic and ultrasonographic findings concordant with PA (Group A). Twenty-one patients having N/E PS, but suspected lesions for PA on ultrasonography (US) formed Group B. PWT was performed for all patients and they underwent the surgical intervention. An adenoma was removed in all patients and the histopathologic cell characteristics were established. Results The tumor size on US was larger in those patients whose adenomas were seen on the PS ( P < .001). The percentages of chief (or principal), oxyphilic and clear cells in PAs were not statistically different between the groups. Serum parathormone level and PWT were not statistically significant between Group A and Group B ( P = .095 and P = .04, respectively). Conclusion Although there is not a definitive threshold value, the sensitivity of PS increases with lesion size. While chief cell and oxyphilic cell content of PAs tend to deplete in N/E PS, clear cell rate increases substantially. Combining PS with both US and PWT increases the sensitivity of detection and localization of PAs. [ABSTRACT FROM AUTHOR]

Ionizing radiation causes excitation or ionization of atoms or molecules in biological tissues. Depending on the dose of radiation being exposed and the changing biochemical processes, damage can occur within minutes or months. These may be classified as dependent dose-independent or based on the susceptibility of the exposed tissues to the deterministic or stochastic as well as the effects of late radiation on biological tissues such as somatic, genetic, teratogenic, and hereditary. Late somatic effects can lead to necrosis, fibrosis in skin and muscles, loss of taste sensation, immunodeficiency, aplastic anemia, cataracts, and increased incidence of cancers due to somatic mutations or damage. Cancer is the most important late somatic effect of lowdose radiation exposure. Information on cancers caused by radiation exposure is obtained by comparing survivors after atomic bombardments, treatments containing medicalpurpose radiation, occupational exposures, and regions with high background radiation compared to those that do not. Exposure to radiation causes DNA damage, mutations, chromosomal disorders, and on the other hand, if the affected cell group is somatic, germ cell, or fetal cells, leads to carcinogenesis, hereditary genetic effects, or developmental disorders, respectively. [ABSTRACT FROM AUTHOR]

Background. The aim of the study was to retrospectively evaluate radiographic and metabolic changes in bone metastases in response to systemic therapy with 18FDG-PET/CT and determine their roles on the evaluation of therapy response. Patients and methods. We retrospectively evaluated radiographic and metabolic characteristics of bone metastases in 30 patients who were referred for the evaluation of response to systemic therapy with 18FDG-PET/CT. All patients underwent integrated 18FDG-PET/CT before and after treatment. Results. The baseline radiographic patterns of the target lesions in responders group were lytic, sclerotic, mixed and CT negative; after treatment the radiographic patterns of all target lesions changed to a sclerotic pattern and attenuation increased (p = 0.012) and metabolic activity decreased (p = 0.012). A correlation was found between decreasing metabolic activity and increasing attenuation of the target lesions (r = -0.55) (p = 0.026). Ho wever, in nonresponders group, the baseline radiologic patterns of the target lesions were lytic, blastic, mixed and CT negative; after treatment all lytic target lesions remained the same and one CT negative lesion turned to lytic pattern and the attenuation of the target lesions decreased (p ± 0.12) and metabolic activity increased (p = 0.012). A correlation was found between increasing metabolic activity and decreasing attenuation (r = -0.65) (p = 0.032). An exception of this rule was seen in baseline blastic metastases which progressed with increasing in size, metabolic activity and attenuation. Conclusions. This study shows that the metabolic activity of lesions is a more reliable parameter than the radiographic patterns for the evaluation of therapy response. [ABSTRACT FROM AUTHOR]

Amaç: Florodeoksiglukoz (FDG) pozitron emisyon tomografi/bilgisayarlı tomografi (PET/BT) tetkikinde metabolik aktivite tutulumu gösteren poröz göz protezlerini tartışmayı amaçlıyoruz. Yöntem: Yetmiş sekiz yaşında kadın hastaya ilerleyici görme kaybı nedeniyle muayene edilmiş ve yapılan manyetik rezonans tetkikinde koroidal malign melanom saptanarak enükleasyon sonrası, göz protezi konulmuştur. Cerrahiden 8 ay sonrasına dek bir tedavi almayan olguya yeniden evreleme amacıyla kliniğimizde FDG PET/BT tetkiki yapılmıştır. Bulgular: Sol orbitada göz protezi çevresinde ortası ametabolik periferinde yoğun artmış metabolik aktivite (SUVmax: 8,1) dikkati çekmiştir. Ayrıca her iki akciğerde multipl odakta (SUVmax: 5,5) ve iskelet sisteminde en belirginleri, T12 vertebrada (SUVmax: 6,7), kostalarda (SUVmax: 4,0), sakrumda ve sol iliak kanatta (SUVmax: 4,3) olmak üzere multipl metastaz ile uyumlu fokal artmış FDG tutulumları gözlendi. Sonuç: Göz; malign melanomun deriden sonra ikinci sıklıkla yerleştiği bölgedir. Gözü tutan malign melanomlar sonrası cerrahi tedavi enükleasyondur. Çeşitli nedenlerle yapılan enükleasyonlar sonrasında orbital kaslara bağlanan hareketli poröz orbital implantlar üzerinde en çok çalışılan implantlardandır. Yerleştirilmelerinden 4-6 ay sonrasında implant tamamen fibrovasküler doku tarafından kaplanırlar. Yoğun fibroblast aktivitesi nedeniyle protez çevresinde, olgumuzda izlendiği gibi artmış FDG tutulumu izlenmektedir. Poröz implantlarda majör komplikasyonlar enfeksiyon, migrasyon, açılma, atılma, piyojenik granülom, implantın yetesiz kanlanması olarak sıralanabilir. Bu protezlerde erken yamalı FDG tutulumu veya FDG tutulumunun olmaması protezin yetersiz kanlanması lehine değerlendirebilir. Ancak mevcut görünüm orbital malign histopatolojiye sahip olgularda nüks ile karıştırılabilir. Hastamızda orbital alanda tanımlanan metabolik aktivite artışı, orbital yumuşak dokuya invazyon bulgusu olmaması nedeniyle; nüks lehine değerlendirilmemiştir. Olgunun takiplerinde belirgin orbital nüks bulgusu saptanmamıştır. [ABSTRACT FROM AUTHOR]

Aim: Our aim is to express the utility of single photon emission computed tomography (SPECT)/computerized tomography (CT) as a useful tool to demonstrate a surprising cause of unilateral renal stasis. Case: A 20 years old man, with a history of lower back pain for two months, underwent a lumbar magnetic resonance imaging (MRI) and the findings waere reported as signal loss in L4-L5 intervertebral disc contrast enhancement in T1A sequences, which may be consistent with spondylodiscitis. Lumbar MRI also revealed conglomerated left paravertebral lymph nodes at L2-L3 level. The three phase bone scan was performed. Bone scan showed normal skeletal system findings. However, left renal stasis accompanied with left proximal ureteral stasis were detected (Figure 1). Subsequent imaging showed a soft tissue mass, which is approximately 35 mm in diameter and located at L3 vertebra level. The mass borders could not be differentiated from left ureter. The caudal sections of CT images also demonstrated round lymph nodes in left groin, which were also shown by an ultrasound examination. The patient underwent left inguinal lymph node biopsy, which reported as Non-Hodgkin lymphoma. Up to the bone scan findings confirmed with US evaluation, a nephrostomy catheter placed to restore the urinary flow. Conclusion: Obstructive uropathy is a common finding due to renal stones, vesicouretheral reflux and posterior ureteral valve. The solid tumors and retroperitoneal fibrosis may also are common causes of renal stasis and hydronephrosis, but primary lymphomas are rare. The bone scan finding of renal stasis, and SPECT/CT findings together explained the obstructive etiology and the reason for lower back pain. Early reporting of renal stasis demonstrated by bone scan and SPECT/CT resulted in a nephrostomy in order to preserve renal function in the patient. In cases with no previous history of urinary tract pathology, SPECT/CT may provide additional benefits for bringing the etiology into the open. [ABSTRACT FROM AUTHOR]

Amaç: Tümör trombüsü, bazı kanser türlerinde karşılaşılan, malign tümörün intravasküler uzanımıdır. Hepatoselüler karsinomlar (HSK) malign trombüsün en sık nedenlerinden biridir. HSK'ya bağlı malign bir trombüsün varlığı, tedavi seçeneklerini etkileyen, kötü prognoza sahiptir. Bu çalışmada amacımız HSK tanısı konularak, primer evreleme için florodeoksiglukoz (FDG) pozitron emisyon tomografi (PET)/bilgisayarlı tomografi (BT) tetkiki yapılan olgularda; majör vasküler malign trombotik hastalık (MVTH, portal konfluens ve sağ-sol porta, hepatik venler ve vena cava inferior) görünümünü ve metabolik aktivitelerini değerlendirmektir. Yöntem: Ağustos 2016-Şubat 2020 tarihleri arasında kliniğimize yeni tanı HSK nedeniyle FDG PET/BT tetkiki için primer evreleme amacıyla 27 olgu (6 Kadın, 21 Erkek, yaş 63,7±9,71) başvurmuştur. Olguların hepatit markerları, AFP, GGT, LDH, AST, ALT değerleri, radyolojik değerlendirmeleri (US, BT ve MRG), FDG PET/BT görüntüleri retrospektif olarak değerlendirilmiştir. Sonuç: FDG PET/BT görüntüleri yeniden değerlendirildiğinde olgularda HSK 15/27 olguda sağ lob, 7/27 olguda sol lob, 5 olguda ise her iki loba taşan yerleşimdeydi. On sekiz olguda multifokalite saptandı. 12/27 olguda malign tromboz ile uyumlu olabilecek vasküler traseye uyan metabolik aktivite alanı izlenmedi. 9/27 olguda portal malign vasküler tromboz (PMVT) (SUVmax=6,86±4,21) (sağ portal 2/9 (SUVmax=5,0%±2,12), sol portal 2/9 (SUVmax:4,1) portal konfluenste izlenen tromboz görünümüne ek) izlendi. 3/27 olguda ise suprahepatik vena kava içerisinde (SUVmax=5,2±2,8) malign trombüs ile uyumlu metabolik aktivite artışları saptandı. Dört olguda hepatik venöz trombüslerin ikisi VCİ, biri ise portal venöz trombüse eşlik ederken, bir olgu izoleydi. Malign trombüs saptanan 12 olgunun 8'inde bulgularımız radyodiagnostik görüntüleme ile örtüşürken üç olguda ileri evre hastalık nedeniyle radyolojik çalışma yapılmamıştı. Tartışma: MVTH, HSK tanısı konulan olgularda prognozun ana belirteçlerinden birisidir. Radyolojik görüntüleme yöntemleri trombozu dolma defekti şeklinde gösterebilirken, benign/malign vasküler tromboz ayrımında yetersiz kalabilir. Çevre dokuya invazyon bulgusu yoksa F-18- FDG PET/BT malign ve benign vasküler trombozu ayırt etmede önemli olabilir. Trombüste metabolik aktivitenin saptanmaması ile olgu rezeksiyontransplantasyon şansı kazanılabileceği gibi, metabolik aktivite saptanması halinde gereksiz cerrahi müdahalelere engel olunabilir. FDG PET/BT tetkiki ile trombüste metabolik aktivitenin saptanması, diğer radyodiyagnostik görüntüleme yöntemleri üzerinde bir avantaj olabilir. [ABSTRACT FROM AUTHOR]

Aim: Oncocytic variant (OV) is an unusual subtype of papillary thyroid cancer whose histopathologic diagnostic criteria, clinicopathologic features and biological behavior are different and have not been comprehensively studied, characterized in literature. Previous studies present conflicting results upon its prognosis. We investigated demographic and clinicopathologic risk factors effecting its prognosis while presenting our clinical experience. Method: This is a retrospective cohort study reviewing 101 patients of OV from an archive of 4500 well-differentiated thyroid cancer treated with I-131 between 1991 and 2017. Predefined parameters of age, gender, tumor size (TS), total I-131 dose, time to recurrent disease, overall survival, extrathyroidal extension, multifocality, vascular invasion, accompanying other variants, capsular status of thyroid gland, initial cervical lymph node (LN) metastasis, preablation stimulated thyroglobulin level, background thyroiditis, stage were evaluated by statistical comparison between metastatic and nonmetastatic groups. Results: Seventeen cases (17%) developed metastasis/recurrence, 70% of the recurrences occured before 24 months. Four patients (4%) died during the follow-up. Metastatic sites were usually cervical LNs, local recurrence in thyroid bed and lungs. Multivariate analysis revealed stage (4) and TS were the main parameters impacting recurrence/metastasis. In the follow-up, isolated cervical LN metastasis was found in 41% of metastatic cases, while 12% had sole recurrence in thyroid bed. 88% of the metastatic disease included locoregional (cervical) and/or remote LNs. The recurrences were associated with initial thyroid masses greater than 3.5 cm in diameter. Conclusion: We found that the prognosis of OV is not poor in our series. Stage (4) and TS are the main risk factors in metastatic development. [ABSTRACT FROM AUTHOR]

Objective: Oncocytic variant (OV) is an unusual subtype of papillary thyroid cancer whose histopathologic diagnostic criteria, clinicopathologic features and biological behavior are different and have not been comprehensively studied, characterized in literature. Previous studies present conflicting results upon its prognosis. We investigated demographic and clinicopathologic risk factors affecting its prognosis while presenting our clinical experience., Subjects and Methods: This is a retrospective cohort study reviewing 101 patients of OV from an archive of 4500 well-differentiated thyroid cancer patients treated with iodine-131 ( 131 I) between 1991 and 2017. Predefined parameters of age, gender, tumor size (TS), total 131 I dose, time to recurrent disease, overall survival, extrathyroidal extension, multifocality, vascular invasion, accompanying other variants, capsular status of thyroid gland, initial cervical lymph node (LN) metastases, preablation stimulated thyroglobulin level, background thyroiditis and stage were evaluated by statistical comparison between metastatic and nonmetastatic groups., Results: Seventeen cases (17%) developed metastases/recurrence, 70% of the recurrences occured before 24 months. Four patients (4%) died during the follow-up. Metastatic sites were usually cervical LN, local recurrence in thyroid bed and lungs. Multivariate analysis revealed stage (IV) and TS were the main parameters impacting recurrence/metastases. In the follow-up, isolated cervical LN metastases were found in 41% of metastatic cases, while 12% had sole recurrence in thyroid bed. Eighty eight percent of the metastatic disease included locoregional (cervical) and/or remote LN. The recurrences were associated with initial thyroid masses greater than 3.5cm in diameter., Conclusion: We found that the prognosis of OV is not poor in our series. Stage (IV) and tumor size are the main risk factors in metastatic development.

Objective: In nearly 20%-30% of patients with differentiated thyroid carcinoma (DTC) relapse and 7% of them die during the next 10 years after initial diagnosis. In 10%-30% of patients with DTC after ablation therapy during the follow-up show a negative iodine-131 ( 131 I) whole-body screening test ( 131 I WBS) and increased serum thyroglobulin (Tg) level. Loss of ability of DTC metastatic lesions to trap 131 I is associated with pure survival and often aggressive disease. Several studies have shown that in DTC cases non trapping 131 I, fluorine-18-fluorodeoxyglucose positron emission tomography ( 18 F-FDG PET) can detect recurrence or metastases with high sensitivity (80%-90%). The purpose of this study was to investigate the clinicopathologic features and other related risk factors of patients with DTC having elevated Tg levels and negative 131 I WBS in which recurrence was detected by 18 F-FDG PET/CT. We tried to study and stratify patients in this grey zone who could benefit from 18 F-FDG PET/CT for the detection of metastases/recurrence according to predefined risk factors not investigated by other researchers., Subjects and Methods: We studied retrospectively 165 DTC patients with elevated Tg levels and a negative 131 I WBS during their follow-up between 2004-2015. Metastases/recurrence was found in 49% of the patients on restaging with 18 F-FDG PET/CT and were compared with nonmetastatic group according to predefined risk factors. These factors were also evaluated in true positive and false negative cases., Results: The sensitivity and specificity of 18 F-FDG PET/CT for detecting recurrent/metastatic disease were 90% and 98.5%, respectively. No apparent predefined risk factor impacting a false negative 18 F-FDG PET/CT was found. Findings in follicular carcinoma, Hürtle cell carcinoma and papillary carcinoma were not different from positive PET findings. The variants of papillary carcinoma also had no statistically difference with regard to 18 F-FDG results., Conclusion: The most important factors affecting a true positive 18 F-FDG PET/CT study were: ETE, high total 131 I dose and the SUVmax values over 4.5.