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Background Prognostic markers in metastatic renal cell cancer (mRCC) are still insufficient. Any prognostic model objectively determines disease burden. Purpose To investigate the relationship between 18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) parameters and outcomes in mRCC, and to define a revised International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model for the intermediate-risk group. Material and Methods A retrospective study of mRCC was conducted. To investigate the prognostic significance of 18F-FDG PET/CT parameters, maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG), and metabolic tumor volume (MTV) were determined in pre-treatment images. Cutoff values were defined by ROC curve analyses and their association with outcomes was analyzed. Additionally, a TLG-adjusted IMDC model was created by stratifying intermediate-risk group patients according to TLG levels. Results The study included 52 patients. The disease control rate (DCR) was 61.5% and median overall survival (OS) was 18 months (95% confidence interval=9.2–25.8). In the univariate analyses, IMDC score, MTV, and TLG were prognostic factors for Disease Control Rate (DCR), and Eastern Cooperative Oncology Group (ECOG)-Performance Status (PS), IMDC score, lactate dehydrogenase (LDH), treatment option, MTV, and TLG were prognostic factors for OS ( P Conclusion Pretreatment MTV was independent prognostic factor for DCR and ECOG-PS, LDH, IMDC score, and TLG were independent prognostic factors for OS. Revised-IMDC model could identify patients with a worse prognosis among the IMDC intermediate-risk group.

Objective Transarterial radioembolization (TARE) with Yttrium-90 (90Y) labeled microspheres is an efective locoregional treatment option for patients with primary and metastatic liver cancer. However, TARE is also associated with radiationinduced lung injury due to hepatopulmonary shunting. If a large proportion of the injected radionuclide microspheres (more than 15%) is shunted, a rare but lethal complication may develop: radiation-induced pneumonitis (RP). Difusion capacity of the lungs for carbon monoxide (DLCO) is a valuable test to assess lung function and a decrease in DLCO may indicate an impairment in gas exchange caused by the lung injury. Some previous researches have been reported the most consistent changes in pulmonary function tests after external beam radiotherapy are recorded with DLCO. This study aimed to examine the changes in DLCO after TARE with glass microspheres in newly treated and retreated patients with relatively higher lung shunt fractions. Methods We prospectively analyzed forty consecutive patients with liver malignancies who underwent lobar or superselective TARE with 90Y glass microspheres. DLCO tests were performed at baseline and on days 15, 30, and 60 after the treatment. All patients were followed up clinically and radiologically for the development of RP. Results A statistically significant decrease was found in the DLCO after the first treatment (81.4 ± 13.66 vs. 75.25±13.22, p=0.003). The frequency of the patients with impaired DLCO at baseline was signifcantly increased after the frst treatment (37.5 vs 57.5% p0.05 for all). None of the patients developed RP. Conclusion Our study showed that a signifcant reduction in DLCO after TARE may occur in patients with relatively higher lung shunt fractions. Further studies with larger sample sizes are needed to better investigate the changes in DLCO in patients with high lung shunt fractions.

Objective We aimed to evaluate whether baseline Ga-68-PSMA PET/CT-derived whole-body volumetric parameters could be used as predictive biomarkers for survival in metastatic castration-resistant prostate cancer (mCRPC) patients receiving first-line treatment. Materials and methods This retrospective study included 54 mCRPC patients, who underwent baseline Ga-68-PSMA PET/CT imaging within 1 month before starting first-line treatment. Pre-treatment prostate-specific antigen (PSA) levels and treatments were recorded. SUVmax, SUVmean, whole-body PSMA-derived tumor volume (wbPSMA-TV), and whole-body total lesion PSMA (wbTL-PSMA) were calculated for all patients. PSA response was defined as a decline of >= 50% from pre-treatment value at 12 weeks. Overall survival (OS) was measured from the start of the first-line treatment for mCRPC. Results Docetaxel and abiraterone/enzalutamide were administered to 32 and 22 patients in the first-line setting, respectively. wbPSMA-TV (rho = 0.582, p = 0.004) and wbTL-PSMA (rho = 0.564, p = 0.007) showed moderate positive correlations with PSA levels. Older age (p = 0.02), higher wbPSMA-TV (p = 0.007), higher PSA (p = 0.01), higher number of bone metastases (p = 0.02), and lack of PSA response (p = 0.03) were significantly associated with an increased risk of mortality. Multivariate analysis determined wbPSMA-TV (HR: 1.003, 95% CI 1.001-1.004, p = 0.001) and PSA response (HR: 2.241, 95% CI 1.189-4.222, p = 0.01) as independent predictors of OS. Conclusion The wbPSMA-TV may be a useful tool to reflect tumor burden and predict survival outcomes in patients with mCRPC.

Resumen Objetivo Investigamos la correlacion entre los indices de PET/TC con 18F-FDG y la respuesta patologica en el cancer de mama tratado con quimioterapia neoadyuvante (QNA), que se puntuo con el sistema de carga de cancer residual (RCB) despues de la cirugia. Nuestro objetivo es detectar antes una carga extensa de cancer residual mediante el uso de los indices de PET/TC. Metodos Se recuperaron las caracteristicas de las pacientes de forma retrospectiva. Se calculo el valor maximo de captacion estandar (SUVmax), el volumen metabolico del tumor (MTV) y los indices de glucolisis total de la lesion (TLG), asi como la tasa de reduccion (RR) entre la linea de base y la evaluacion intermedia, con la exploracion FDG PET/TC. Todos los pacientes fueron evaluados segun las puntuaciones RCB despues de la cirugia. Las respuestas patologicas y los resultados de las mediciones de PET/TC se analizaron con parametros demograficos y clinicos. Resultados Un total de 95 pacientes fueron incluidos en el estudio. Segun las respuestas patologicas, la distribucion de RCB-0, -1, -2, -3 fue de 13 (13,7%), 11 (11,6%), 30 (31,6%) y 41 (43,2%), respectivamente. La supervivencia libre de enfermedad fue significativamente menor en el grupo RCB-3 en comparacion con el grupo de respuesta patologica (p = 0,01). Segun el analisis multivariante, se determino que el RR del SUVmax era una variable independiente que predecia la RCB extensa con un valor de corte optimo del 86% (p Conclusiones Determinamos el RR de SUVmax como un factor independiente para predecir la carga tumoral residual extensa. Creemos que el RR de SUVmax es suficiente para predecir la respuesta patologica en la practica diaria. Ademas, las mediciones de MTV y TLG no contribuyen adicionalmente al SUVmax por si solas y pueden causar una perdida de trabajo innecesaria.

Resumen Objetivo El hiperparatiroidismo primario (HPP) es una de las enfermedades endocrinas mas frecuentes. La mayoria de los pacientes con HPP son asintomaticos, y solo el 20% de ellos se vuelven sintomaticos con niveles crecientes de calcio (Ca). Se ha informado que el hiperparatiroidismo primario normocalcemico puede ser el periodo incipiente de HPP en el que los niveles de Ca estan en un rango normal, y puede avanzar a HPP abierto. El diagnostico temprano de la HPP es importante para prevenir sus complicaciones. En este estudio retrospectivo, nos propusimos evaluar el papel de la gammagrafia paratiroidea 99mTc-MIBI en la deteccion de lesiones en pacientes con HPP normocalcemico. Material y metodos La base de datos de gammagrafia paratiroidea fue revisada retrospectivamente en pacientes con HPP. 117 pacientes que se sometieron a la gammagrafia 99mTc-MIBI fueron reclutados para el estudio. El nivel de Ca serico superior a 10,5 mg/dl se considero como hipercalcemia. Resultados Los niveles medios de PTH serica (media ± DE) de un total de 117 pacientes (mujeres/mujeres: 98/19) fueron de 149 ± 97 pg/ml en el grupo normocalcemico (Ca: 9,6 ± 0,6 mg/dl, n = 38) y de 189 ± 135 pg/ml en el grupo hipercalcemico (Ca: 11,4 ± 0,6 mg/dl, n = 79) (p = 0,072). El sexo y la edad no fueron diferentes entre los grupos de gammagrafia positiva y negativa, pero las tasas de deteccion de lesiones con gammagrafia paratiroidea fueron del 42% en el grupo normocalcemico y del 81% en el grupo hipercalcemico (p Conclusiones Varios factores, entre los que se incluyen el Ca serico, el protocolo de imagenes, la existencia de enfermedad multiglandular, el tamano y la biocinetica MIBI del adenoma pueden influir en la detectabilidad de la lesion en la gammagrafia paratiroidea. Aunque un alto nivel de Ca en suero es un parametro importante para predecir su exito, la gammagrafia paratiroidea sigue siendo un metodo de diagnostico valioso incluso en pacientes con HPP normocalcemico.

Objective Primary hyperparathyroidism (PHPT) is one of the most frequent endocrine diseases. Most of the patients with PHPT are asymptomatic, and only 20% of them become symptomatic with increasing levels of calcium. It has been reported that normocalcemic primary hyperparathyroidism (NPHPT) may be the incipient period of PHPT where calcium (Ca) levels are in normal range, and it may advance to overt PHPT. Early diagnosis of PHPT is important in order to prevent its complications. In this retrospective study, we aimed to evaluate the role of 99mTc-MIBI parathyroid scintigraphy on lesion detection in patients with NPHPT. Material and methods The parathyroid scintigraphy database was reviewed retrospectively in patients with PHPT. 117 patients who underwent 99mTc-MIBI scintigraphy were recruited to the study. Serum calcium level above 10.5 mg/dl was considered as hypercalcemia. Results A total of 117 patients (female/male:98/19) mean serum PTH levels (mean ± SD) were 149 ± 97 pg/ml in normocalcemic group (Ca:9.6 ± 0.6 mg/dl, n:38) and 189 ± 135 pg/ml in hypercalcemic group (Ca:11.4 ± 0.6 mg/dl, n:79) (p:0.072). The sex and ages were not different between the scintigraphy positive and negative groups, but the lesion detection rates with parathyroid scintigraphy were 42% in normocalcemic group and 81% in hypercalcemic group (p Conclusions Several factors including serum Ca, the imaging protocol, existence of multiglandular disease, the size and MIBI biokinetics of the adenoma may influence lesion detectability in parathyroid scintigraphy. Although high serum Ca level is an important parameter in predicting its success, parathyroid scintigraphy remains a valuable diagnostic method even in patients with NPHPT.

Background/aim The aim of this study was to evaluate the value of PET Vascular Activity Score (PETVAS) during the follow-up of patients with Takayasu arteritis. Materials and methods Takayasu arteritis patients who underwent 18F-Fluorodeoxyglucose (FDG) PET imaging were evaluated retrospectively. In 8 patients both 1 and 2-hour imagings were also performed prospectively. For PETVAS, 9 arterial areas were scored between 0-3 according to the FDG uptake. Results Forty-six images of 34 patients were evaluated. PETVAS was higher in patients with clinically active disease (p=0.03) and in C-reactive protein (CRP) elevated group among clinically inactive patients (p=0.0015). PETVAS correlated with CRP (p=0.003, r=0.53) and erythrocyte sedimentation rate (p=0.005, r=0.41), whereas age, disease duration, immunosuppressive and glucocorticoid (GC) treatments were not associated with PETVAS. First vs 2nd-hour PETVAS was similar in patients who had both 1st and 2nd hour PET scans (p=0.67). Conclusion We observed higher PETVAS in patients with active disease and elevated acute phase reactants. Although scores in our study (performed at one-hour) were lower compared to the original PETVAS study performed at two hours, PETVAS seems to be a reliable tool to quantify FDG PET scores in routine practice.

Optimal scoring system for clinical prognostic factors in patients with unresectable hepatocellular carcinoma (HCC) is currently uncertain. We aimed to develop and externally validate an easy to use tool, particularly for this population, and named it the unresectable hepatocellular carcinoma prognostic index (UHPI). We evaluated the data of patients with treatment-naive unresectable HCC who were diagnosed in the training center from 2010 to 2019 (n = 209). A simple prognostic model was developed by assigning points for each covariate in proportion to the beta coefficients in the Cox multivariable model. Predictive performance and distinction ability of the UHPI were further evaluated in an independent European validation cohort (n = 147) and compared with 11 other available models. A simple scoring system was derived, assigning 0.5/1/2 scores for six independent covariates including, the Child-Pugh score, Eastern Cooperative Oncology Group performance status, maximum tumor size, vascular invasion or extrahepatic metastasis, lymph node involvement, and alpha-fetoprotein. The UHPI score, ranging from 0 to 6, showed superior performance in prognosis prediction and outperformed 11 other staging or prognostic models, giving the highest homogeneity (c-index, 6-month and 1-year area under the receiver operator characteristic curves), lowest Akaike information criterion, and -2 log-likelihood ratio values. The UHPI score allocated well the risk of patients with unresectable HCC for mortality within the first year, using two cut-off values (low-risk, 2). Conclusion: The UHPI score can predict prognosis better than other systems in subjects with unresectable HCC and can be used in clinical practice or trials to estimate the 6-month and 1-year survival probabilities for this group.

Purpose To prevent hemorrhagic complications, hemostatic agents (HAs) have been widely used in recent years. The use of HAs can lead to false-positive results on postoperative imaging. There exists only 1 study in the literature evaluating these applications during surgical procedures. Therefore, we aimed to evaluate the postoperative imaging features of polysaccharide-based HAs in thoracic surgery patients who have had F-18-FDG PET/CT scans. Patients and Methods Two hundred nine consecutive patients who underwent thoracic surgery were enrolled in this study. A topical polysaccharide-based HA was applied to the surgical bed for all of the patients. The patients diagnosed with cancer were followed up with subsequent thoracic CT scans, and 42 of these patients were also imaged with F-18-FDG PET/CT, which then comprised the main study group. Due to suspicion of metastasis, 19/42 patients were reoperated or rebiopsied. The latest histopathological findings were accepted as criterion standard, and previous FDG PET/CT images were retrospectively reevaluated. Results Polysaccharide-based HAs that appear as amorphous basophilic material were identified in histopathological samples of 11/19 patients. Lymphocytes, plasma cells, and histiocytes, which formed foreign body reaction and/or foreign body granuloma, indicating the presence of chronic inflammation, were seen in all of the samples. F-18-FDG PET/CT showed increased FDG uptake in all of these lesions. Conclusions Despite the inconsistency of the literature, polysaccharide-based HAs can be demonstrated in human surgical specimens as amorphous basophilic materials even after a long time from the initial surgical procedure. These agents almost always cause chronic inflammatory changes. In addition, these agents may mimic \"false-positive\" findings on postoperative FDG PET/CT scans.

Objectives Somatostatin is an endocrine peptide hormone that regulates neurotransmission and cell proliferation by interacting with G protein-coupled somatostatin receptors (SSTRs). SSTRs are specific molecular targets of several radiotracers for neuroendocrine tumor (NET) imaging. Gallium-68 (68Ga)-DOTA-TATE is widely used for positron emission tomography/computed tomography (PET/CT) imaging of SSTRs and has shown a higher affinity for SSTR2, the most common SSTR subtype found in NETs. We aimed to analyze the distribution pattern of 68Ga-DOTA-TATE in normal subjects. Methods A total of 617 consecutive 68Ga-DOTA-TATE PET/CT whole-body scans performed in our department from May 2015 through April 2020 with known or suspected neuroendocrine malignancies, mostly to evaluate adrenal adenomas, were retrospectively analyzed by 2 nuclear medicine physicians. One hundred eighteen subjects without a diagnosis of NET, with no tracer avid lesion of NET on 68Ga-DOTA-TATE PET/CT, and followed up for at least 6 months (average 2-3 years) without any biochemical, clinical, or imaging findings suggestive of NET were included in this study. Results The highest uptake of 68Ga-DOTA-TATE was noted in the spleen followed by the kidneys, adrenal glands, liver, stomach, small intestine, prostate gland, pancreas head, pancreas body, thyroid gland, and uterus, in descending order. Minimal to mild uptake was detected in the submandibular glands, parotid glands, thymus, muscles, bones, breast, lungs, and mediastinum. Conclusion Our study shows the biodistribution pattern of 68Ga-DOTA-TATE in normal subjects and the ranges of the maximum standard uptake value (SUVmax) and SUVmean values of 68Ga-DOTA-TATE obtained in several tissues for reliably identifying malignancy in 68Ga-DOTA-TATE PET/CT studies.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a type of pulmonary hypertension with persistent pulmonary vascular obstruction and exercise intolerance, which may benefit from pulmonary endarterectomy (PEA). Ventilation/perfusion (V/Q) scan is the preferred screening test of CTEPH, which can be used to assess the anatomical extent of the disease. This study aimed to analyze the correlation between the extent of mismatched Q defects in V/Q single photon emission computed tomography/computed tomography (SPECT/CT) with preoperative clinical and hemodynamic parameters in patients with CTEPH.A total of 102 patients with CTEPH prior to PEA having V/Q SPECT/CT scans were retrospectively reviewed. Age, gender, New York Heart Association classification, intraoperative right-sided heart catheterization (mPAP and PVR), and 6-minute walk test (6MWT) findings were obtained from clinical records of patients.Linear regression analysis showed a significant but weak correlation between the preoperative mPAP and PVR with the extent of mismatched Q defects in V/Q SPECT/CT (rs=0.09474 with p=0.0016 and rs=0.045 with p=0.045, respectively). No significant correlation was found between 6MWT and extent of mismatched Q defects in V/Q SPECT/CT (p0.05).A quantitative assessment of Q defects on V/Q SPECT/CT might provide information about hemodynamic parameters in patients with CTEPH.Kronik tromboembolik pulmoner hipertansiyon (KTEPH), kalıcı pulmoner vasküler obstrüksiyon ve egzersiz intoleransı ile karakterize bir pulmoner hipertansiyon grubudur ve pulmoner endarterektomiden (PEA) fayda görebilir. Ventilasyon/perfüzyon (V/Q) sintigrafisi, hastalığın anatomik yaygınlığını değerlendirmek için kullanılabilen KTEPH’nin tercih edilen tarama testidir. Bu çalışmanın amacı, KTEPH tanılı hastalarda ameliyat öncesi klinik ve hemodinamik parametreler ile V/Q tek foton emisyon tomografisi/bilgisayarlı tomografideki (SPECT/BT) Q defektlerinin yaygınlığı arasındaki korelasyonu araştırmaktır.PEA ile tanısı doğrulanmış 102 KTEPH hastasının PEA öncesi V/Q SPECT/BT görüntüleri retrospektif olarak incelendi. PEA öncesi yaş, cinsiyet, New York Kalp Derneği sınıfı, intraoperatif sağ kalp kateterizasyonu sonuçları [ortalama pulmoner arter basıncı (OPAB), pulmoner vasküler rezistans (PVR)] ve 6 dakikalık yürüme testi (6DYT) gibi klinik parametreleri hastaların klinik kayıtlarından elde edildi.Doğrusal regresyon analizi, preoperative OPAB ve PVR ile V/Q SPECT/BT’deki eşleşmeyen Q defektlerinin yaygınlığı ile anlamlı ancak zayıf bir korelasyon gösterdi (rs=0,09474, p=0,0016; rs=0,045, p=0,045). 6DYT mesafesi ile eşleşmeyen Q defektlerinin yaygınlığı arasında ise anlamlı bir ilişki bulunmadı (p0,05).V/Q SPECT/BT’de saptanan Q defektlerinin kantitatif değerlendirilmesi, KTEPH tanılı hastalarda hemodinamik parametreler hakkında fikir sağlayabilir.

Aim: We investigated the correlation between 18F-FDG PET/CT indices and pathological response in breast cancer treated with neoadjuvant chemotherapy (NACT) which was scored with Residual Cancer Burden (RCB) system after surgery. Our aim is to detect extensive residual cancer burden earlier by using PET/CT indices. Methods: Characteristics of patients were retrieved retrospectively. Baseline maximum Standart Uptake Value (SUVmax), Metabolic Tumor Volume (MTV) and Total Lesion Glycolysis (TLG)indices and reduction rate (RR) between baseline and interim evaluation were calculated with FDG PET/CT scan. All patients were evaluated according to RCB scores after surgery. Pathological responses and PET/CT measurement results were analyzed with demographic and clinical parameters. Results: A total of 95 patients were included in the study. According to pathological responses, the distribution of RCB -0, -1, -2, -3 were 13 (13.7%), 11 (11.6%), 30 (31.6%), 41 (43.2%), respectively. Diseasefree survival was significantly lower in the RCB3 group compared to the pathological responder group (p = 0.01). According to multivariate analysis, RR of SUVmax was determined as an independent variable predicting extensive residual cancer burden with an optimal cut-off value of 86% (p < 0.05). Conclusions: We determined RR of SUVmax as an independent factor for predicting extensive residual tumor burden. We believe that RR of SUVmax is sufficient to predict pathological response in daily practice. In addition, MTV and TLG measurements do not contribute additionally to SUVmax alone and can cause unnecessary labor loss. Objetivo: Investigamos la correlación entre los índices de PET/TC con 18F-FDG y la respuesta patológica en el cáncer de mama tratado con quimioterapia neoadyuvante (NACT), que se puntuó con el sistema de carga de cáncer residual (RCB) después de la cirugía. Nuestro objetivo es detectar antes una carga extensa de cáncer residual mediante el uso de los índices de PET/TC. Métodos: Se registraron las características de las pacientes de forma retrospectiva. Se calculó el valor máximo de captación estándar (SUVmáx), el volumen metabólico del tumor (MTV) y los índices de glucólisis total de la lesión (TLG), así como la tasa de reducción (RR) entre la línea de base y la evaluación intermedia, con la exploración FDG PET/TC. Todos los pacientes fueron evaluados según las puntuaciones RCB después de la cirugía. Las respuestas patológicas y los resultados de las mediciones de PET/TC se analizaron con parámetros demográficos y clínicos. Resultados: Un total de 95 pacientes fueron incluidos en el estudio. Según las respuestas patológicas, la distribución de RCB -0, -1, -2, -3 fue de 13 (13,7%), 11 (11,6%), 30 (31,6%), 41 (43,2%), respectivamente. La supervivencia libre de enfermedad fue significativamente menor en el grupo RCB3 en comparación con el grupo de respuesta patológica (p = 0,01). Según el análisis multivariante, se determinó que el RR del SUVmax era una variable independiente que predecía la carga de cáncer residual extensa con un valor de corte óptimo del 86% (p < 0,05). Conclusiones: Determinamos el RR de SUVmax como un factor independiente para predecir la carga tumoral residual extensa. Creemos que el RR de SUVmax es suficiente para predecir la respuesta patológica en la práctica diaria. Además, las mediciones de MTV y TLG no contribuyen adicionalmente al SUVmax por sí solas y pueden causar una pérdida de trabajo innecesaria.

Nasal-type extranodal natural killer/T-cell lymphoma is an aggressive rare type of lymphoma that mostly affects the nasal cavity and adjacent areas. However, some patients can present with distant nodal or extranodal involvement including the Waldeyer ring, gastrointestinal tract, genitourinary organs, lung, thyroid, skin, or adrenal glands. Herein, we present a unique case of extranodal natural killer/T-cell lymphoma with widespread cutaneous and subcutaneous involvement on 18 F-FDG PET/CT.

We aimed to evaluate whether baselineThis retrospective study included 54 mCRPC patients, who underwent baselineDocetaxel and abiraterone/enzalutamide were administered to 32 and 22 patients in the first-line setting, respectively. wbPSMA-TV (rho = 0.582, p = 0.004) and wbTL-PSMA (rho = 0.564, p = 0.007) showed moderate positive correlations with PSA levels. Older age (p = 0.02), higher wbPSMA-TV (p = 0.007), higher PSA (p = 0.01), higher number of bone metastases (p = 0.02), and lack of PSA response (p = 0.03) were significantly associated with an increased risk of mortality. Multivariate analysis determined wbPSMA-TV (HR: 1.003, 95% CI 1.001-1.004, p = 0.001) and PSA response (HR: 2.241, 95% CI 1.189-4.222, p = 0.01) as independent predictors of OS.The wbPSMA-TV may be a useful tool to reflect tumor burden and predict survival outcomes in patients with mCRPC.

Behcet disease is a rare multisystemic vasculitis that can affect all sizes and types of blood vessels. Recurrent painful erythematous nodular lesions called erythema nodosum are the most common skin lesions of Behcet disease. Herein, we present 18F-FDG PET/CT images of erythema nodosum lesions in a patient with Behcet disease.

The importance of 68Ga-DOTATATE PET/CT in the evaluation of neuroendocrine tumors is well established. However, false-positive results can occur due to inflammatory pathologies. We report a 47-year-old man who was diagnosed with a neuroendocrine tumor of the stomach. Initial 68Ga-DOTATATE PET/CT showed intense 68Ga-DOTATATE uptake in the petrous apex. Histopathological confirmation could not be obtained, thus the asymptomatic patient was followed with periodic clinical/radiologic examinations for more than 2.5 years. Therefore, this lesion was diagnosed as a cholesterol granuloma of the temporal bone. These results suggested that an initial wait-and-scan approach is a feasible management strategy for similar presentations.

Erdheim-Chester disease is an uncommon non-Langerhans cell histiocytosis. The diagnosis depends on imaging and histological criteria. The most common presentation is the multiple bone lesions with involvement of at least 1 more organ. We present the FDG PET/CT findings of a 19-year-old man who presented with central nervous system symptoms such as progressive polyuria, polydipsia, gait disturbances, and eye pain and was later diagnosed with Erdheim-Chester disease.

Schwannomas are benign tumors that arise from Schwann cells of neural sheath. They can occur in any part of the body. However, the most common locations are the head, neck, spinal cord, and extremities. Schwannoma in the porta hepatis is extremely rare. Herein, we describe a case of porta hepatic schwannoma in a 36-year-old woman who presented with abdominal pain for a month.

Objectives We aimed to perform a comparison between V/Q single-photon emission computed tomography/computed tomography (SPECT/CT) and V/Q Quotient single-photon emission computerized tomography (SPECT) in the detection of chronic thromboembolic pulmonary hypertension (CTEPH) and in depicting the extent of the disease on per-segment basis in patients with CTEPH. Methods Between January 2015 and November 2019, a total of 412 patients with pulmonary hypertension secondary to CTEPH at the preoperative assessment underwent pulmonary endarterectomy (PEA), of whom 92 consecutive patients with their V/Q SPECT/CT scans have been performed in our institution prior to PEA were included in this study. Histopathological findings and post-PEA fully resected surgical specimens were used as the reference standard. Results On a per-patient basis analysis, V/Q SPECT/CT and V/Q Quotient SPECT both revealed CTEPH in the same 85 of the 92 patients (κ = 1) with a detection rate of 92.4%. In six of these patients, chronic thromboembolic disease could not be reported on both of these two methods due to extensive 'matched' V/Q defects. On a per-segment basis analysis, V/Q SPECT/CT and V/Q Quotient SPECT showed a sensitivity of 75.8 and 73.1%, respectively. Correlation analysis results showed a significant correlation (κ = 0.933) between these two methods on a per-segment basis analysis. Conclusion In the light of histopathological findings and post-PEA surgical specimen examinations, the results of the present study indicated that both V/Q SPECT/CT and V/Q Quotient SPECT showed relatively high efficacy for the detection of CTEPH on per-patient and per-segment bases with an excellent agreement.

Background In the last years, Selective Internal Radiation Therapy (SIRT), using biocompatible Yttrium-90 (90Y) labeled microspheres have emerged for the treatment of malignant hepatic tumors. Unfortunately, a significant part of 90Y-labeled microspheres may shunt to the lungs after intraarterial injection. It can be predictable by infusing technetium-99 m-labeled macro-aggregated albumin particles through a catheter placed in the proper hepatic artery depending on the lobe to be treated with performing a quantitative lung scintigraphy. Radiation pneumonitis (RP) can occur 1 to 6 months after the therapy, which is a rare but severe complication of SIRT. Prompt timing of steroid treatment is important due to its high mortality rate. On the other hand, pulmonary diffusion capacity measured by carbon monoxide (DLCO) is an excellent way to measure the diffusing capacity because carbon monoxide is present in minimal amount in venous blood and binds to hemoglobin in the same manner as oxygen. Some authors reported that the most consistent changes after radiation therapy (RT) are recorded with this quantitative reproducible test. The relationship between the proportional reductions in DLCO and the severity of RP developing after this therapy may prove to be clinically significant. Case presentation We herein present a patient who developed RP after SIRT that could be quantified using DLCO. To the best of our knowledge, this case is the first who developed unexpected RP after SIRT with significant decrease in DLCO with internal radiation exposure. Conclusions RP is a very rare complication and may lead to a fatal outcome. Decline in DLCO could be a valuable parameter for follow-up and to identify potential candidates for RP and could be also another trigger for administration of steroid therapy with prompt timing in this patient group.

Renal cell carcinoma (RCC) is the most common primary malignancy of the kidney. Approximately 35% of patients of RCC presents with distant metastasis at initial evaluation. CT and MRI are the mainstay imaging modalities. Distinguishing radiation necrosis from tumor progression after stereotactic radiosurgery is challenging. Herein, we present a case of a 43-year-old man with RCC who was treated with stereotactic radiosurgery for brain metastases. We want to emphasize the potential value of 68Ga-PSMA PET/CT imaging in the differential diagnosis and follow-up of tumor progression from radiation necrosis in RCC patients.

Classic type of high-grade osteosarcoma is the most common type of skeletal malignancy in children and adolescents. Metastasis of osteosarcoma frequently occurs in the lung. Adrenal metastasis of osteosarcoma is extremely rare, with only few reported case in the literature. Herein, we present the case of a 13-year-old boy with adrenal metastasis of high-grade osteosarcoma, which was seen as a solitary calcified hypermetabolic adrenal lesion on FDG PET/CT.

FDG PET/CT is used in the diagnosis and follow-up of various malignant tumors and changes patient management in routine clinical practice. However, inflammatory, infectious, physiological, and technical causes and benign pathological conditions may lead to false-positive FDG uptake. We report a case of a 59-year-old man who was considered having a false-positive FDG-PET pulmonary nodular lesion in favor of metastasis, which was formed by the use of hemostatic powder.

Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor originating from endothelial cells. Clinical aspect of the disease covers a wide spectrum from a low-grade tumor to a fatal cancer. Most common sites of EHE are reported as lung, liver and bone. Hepatic EHE (HEHE) is a clinical form with an incidence of less than 1 person in a million. Due to rarity of the disease, there is no standard therapy established. Surgery and liver transplantation still seem to be the best approach if possible. However, most of the patients present with unresectable or metastatic disease. Many conventional chemotherapeutic agents and antiangiogenic drugs have been reported previously in the literature with inconsistent outcomes. Here we report 4 cases of HEHE, who benefit distinctly from anti-VEGF treatments in different settings. While combination of paclitaxel and bevacizumab resulted in partial response in 3 patients, one of them also achieved long-term disease stabilization with bevacizumab maintenance with no adverse event. Two of the patients had clear benefit from pazopanib during the course of disease. One patient was treated with thalidomide for 18 months with stable disease, and is still being followed without any treatment. Although targeting VEGF-VEGFR pathway seems to be the best approach in HEHE, randomized studies are urgently needed to support these findings.

Corticomedullary mixed tumor (CMT) is a single adrenal tumor mass composed histologically by an admixture of adrenal cortical and medullary cells. It is a rare condition, with approximately 20 cases reported to date. To our knowledge, the positron emission tomography (PET) imaging findings of this mostly benign tumor have not been reported in the literature. We present a case of CMT who was evaluated with both F-18-fluorodeoxyglucose (F-18-FDG) and Ga-68-DOTATATE. The hypermetabolic tumor seen on F-18-FDG PET/computed tomography scan showed no abnormal uptake by Ga-68-DOTATATE.

Tertiary hyperparathyroidism (TH) is a rare condition that develops from secondary hyperparathyroidism in cases when the secretion becomes autonomous. Brown tumors (BTs) are rare skeletal lesions of hyperparathyroidism that may mimic cancer metastasis. We report a case of a patient who was diagnosed with TH with multiple BTs which mimics osteolytic/osteoblastic metastases that were evaluated with two fluorodeoxyglucose positron emission tomography scans with an interval of 23 months in the preoperative and postoperative period.

The standard treatment for patients with stage III non-small cell lung cancer (NSCLC), unsuitable for resection and with good performance, is definitive radiotherapy with cisplatin-based chemotherapy. Our aim is to evaluate the effect of the maximum value of standardized uptake values (SUVmax) of the primary tumor in positron emission tomography-computed tomography (PET/CT) before treatment on complete response (CR) and overall survival. The data of 73 stage III NSCLC patients treated with concurrent definitive chemoradiotherapy (CRT) between 2008 and 2017 and had PET/CT staging in the pretreatment period were evaluated. ROC curve analysis was performed to determine the ideal cut-off value of pretreatment SUVmax to predict CR. Median age was 58 years (range 27–83 years) and 66 patients were male (90.4%). Median follow-up time was 18 months (range 3–98 months); median survival was 23 months. 1-year overall survival (OS) rate and 5-year OS rate were 72 and 19%, respectively. Median progression-free survival (PFS) was 9 months; 1-year PFS rate and 5-year PFS rate were 38 and 19%, respectively. The ideal cut-off value of pretreatment SUVmax that predicted the complete response of CRT was 12 in the ROC analysis [AUC 0.699 (0.550–0.833)/P

Although tracheal involvement of lung cancer is frequently seen, endotracheal metastasis of colon cancer is a rare entity. Since endotracheal lesion gives no symptom until tracheal lumen nearly occluded, the diagnosis of endotracheal metastasis could be challenging. F-18 fluorodeoxyglucose positron emission tomography/computed tomography may be crucial to detect this unusal distant metastasis of colon cancer. Herein, we report FDG avid endotracheal lesion that was confirmed as metastasis from colon cancer in 56-year-old female patient.

T-cell/histiocyte-rich B-cell lymphoma accounts for approximately 1% to 3% of all cases of diffuse large B-cell lymphoma, and involvement of the kidneys comprises a mere 1% of the total primary extranodal lymphomas. We present a case of T-cell/histiocyte-rich B-cell lymphoma who had acute renal failure at initial presentation with bilateral lymphomatous infiltration depicted on FDG PET/CT scan. Four months after the treatment, a repeat FDG PET/CT scan revealed complete resolution of the renal lesions, indicative of the complete remission for kidneys.

Papillary carcinoma of thyroid (PTC) is the most common neoplasm of the thyroid gland that usually invades lymphatics rather than blood vessels. Hematogenous metastasis of PTC is rare, and distant metastasis to the liver is even rarer. Selective internal radiation therapy with Y microspheres is a well-recognized technique in the treatment of liver metastases. Herein, we present a case of PTC with radioactive iodine-negative hepatic metastasis detected by F-FDG PET/CT and treated with selective internal radiation therapy.

Many causes of incidental focal uptake on raw data images using myocardial perfusion imaging, including malignant diseases, metastatic processes, benign pathologies, and physiological conditions, have been reported in the literature. However, iatrogenic 99mTc sestamibi emboli have not yet been reported. Herein, we demonstrated iatrogenic 99mTc sestamibi embolization on consecutive rest and stressed myocardial perfusion images at different locations.

Tek foton emisyon tomografisi/bilgisayarli tomografi (SPECT/BT); SPECT ile alinan fonksiyonel bilgi ve BT ile elde edilen anatomik bilginin fuzyonunu saglayan etkin bir tanisal goruntuleme teknigidir. SPECT/BT klinikte diger bircok endikasyonun yani sira; medikal tedavi, cerrahi tedavi, radyasyon tedavisi (internal, eksternal) planlamada da kullanilmaktadir. Bu derlemede, SPECT/ BT’nin radyoterapi ve medikal/cerrahi tedavi planlamadaki rolu ozetlenmistir. Anahtar kelimeler: Tomografi, emisyon-bilgisayarli, tek foton cok kesitli bilgisayarli tomografi, nukleer tip, kisisellestirilmis tedavi, SPECT/BT, radyoterapi planlama, bilgisayar-yardimli Abstract

Splenosis is the autoimplantation of ectopic spleen tissue resulting heterotopic auto-transplantation and implantation of splenic tissue after splenic ruptur caused by trauma or splenectomy.

Purpose:Lung adenocarcinoma is histologically diverse but has distinct histologic growth patterns. There is no consensus on the clinical benefit of this histologic model. We aimed to evaluate the differences in the distribution of the preoperative primary tumor positron emission tomography (PET)/computed tomography (CT) standardized uptake values (SUVs) and survival in the lung adenocarcinoma subtypes.Methods:We retrospectively evaluated the data of 107 patients with resected lung adenocarcinoma who had preoperative PET/CT between 2005 and 2017 in a single center. Patients had lepidic, acinar, papillary, micropapillary, and solid histologic subtypes. We compared fluorodeoxyglucose SUVs and survival data of histologic subtypes.Results:The median age of the patients was 62 years (40–75), 76.4% were male, the median SUVmax was 9.4 (1–36.7), and the median follow-up time was 29 months (3–135 months). The median overall survival (OS) was 71 months and the median progression-free survival (PFS) was 33 months. SUVmax was significantly different in histologic subtypes: values for papillary, micropapillary, solid, acinar, and lepidic subtypes were 9.7, 8, 12, 9.1, and 3.9, respectively ( p = 0.000). Solid predominant adenocarcinoma had significantly higher SUVmax than the other subtypes ( p = 0.001). Lepidic predominant adenocarcinoma had significantly lower SUVmax than the other subtypes ( p = 0.000). There was no significant difference in OS between histologic subtypes ( p = 0.66), but PFS was significantly different between the groups ( p = 0.017), and the solid subtype had a shorter PFS than the other histologic subtypes.Conclusion:Lung adenocarcinoma consists of a diverse group of diseases. Different SUVmax values are seen in different histologic subtypes of nonmetastatic lung adenocarcinoma. Solid predominant types have high SUVmax values while lepidic predominant types have lower SUVmax values. The solid subtype had a shorter PFS than the other histologic subtypes.

Delayed 18F-2-fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography (PET) imaging has been associated with improved diagnostic yield in several malignancies; however, data on the use of delayed imaging in patients with hepatocellular carcinoma (HCC) is scarce. This study aimed to examine tumoral and background standardized uptake value (SUV) alterations in dual-phase 18F-FDG PET/computed tomography (CT) imaging. Fifty-two HCC cases underwent dual-time-point 18F-FDG PET/CT examination where early and delayed images were obtained. The maximum and mean SUVs (SUVmax and SUVmean) of the tumor were determined for both time points. Similarly, the average SUVmean were also determined for background (liver, soft tissue, and spleen). Changes in tumoral and background SUV between early and delayed images were examined. The mean age was 62.0 ± 12.9 years (range, 20–88 years) and the majority of the patients were men (86.5%). Tumor SUVs, both tumor SUVmean and tumor SUVmax, significantly increased at delayed images when compared to early images. In contrast, the average SUVmean for the liver, soft tissue, and spleen significantly decreased at delayed images. A significant increase in tumor SUV in delayed images in contrast to a significant decrease in background SUVs suggests that delayed images in HCC may contribute to diagnostic performance through a potential increase in the contrast between the tumor and background. However, further studies with larger sample sizes including patients with benign lesions and different grades of the disease are warranted to better elucidate the diagnostic contribution as well as the association of delayed imaging values with prognosis.

Background: Primary squamous cell carcinoma (SCC) of the breast is a metaplastic carcinoma subtype which includes fibromatosis-like and sarcomatoid features. This is a very aggressive tumor with poor prognosis. Other sites of primary SCC should be ruled out first to classify these tumors as primary SCC of the breast. Here we present a case of locally advanced primary SCC of the breast. Case Report: A 72 years old woman presented with a right axillary lump. Trucut biopsy was performed, it showed squamous cell carcinoma. Estrogen receptor had poor immunoreactivity, negative for both progesteron receptor and HER 2 in immunohistochemistry staining. PETCT imaging were conducted to showing only 6 × 6.5 cm mass in right breast adjacent to axilla, multiple lymphadenomegaly in right axillary. We planned neoadjuvant chemotherapy consisting of weekly paclitaxel followed by epirubicin and cyclophosphamide combination. Postoperative pathology revealed wide necrosis, no viable tumor cell. We started adjuvant anastrozole treatment of 1 mg/day. No evidence of disease was detected after 1 year follow up. Conclusion: Primary squamous cell carcinoma of the breast is a very rare disease with no standard treatment approach. Our case achieved pathologic complete response after neoadjuvant chemotherapy.

Background: Selective internal radiation therapy (SIRT) with embolization of branches of the hepatic artery is a valuable therapeutic tool for patients with hepatic malignancies; however, it is also associated with lung injury risk due to shunting. Diffusion capacity of the lungs for carbon monoxide (DLCO) is a clinically significant lung function test, and worsening in DLCO is suggested to reflect a limited gas exchange reserve caused by the potential toxicity of chemoradiotherapy or it may be a marker of related lung injury. This study aimed to examine the changes in DLCO during SIRT with resin microspheres in newly treated and retreated patients. Forty consecutive patients who received SIRT for a variety of malignant conditions were included. All subjects were treated with Yttrium-90 labelled resin microspheres. DLCO tests were performed after the procedures. In addition, patients were specifically followed for radiation pneumonitis. Results: The mean DLCO did not significantly change after the first (82.8 +/- 19.4 vs. 83.1 +/- 20.9, p = 0.921) and the second treatments (87.4 +/- 19.7 vs. 88.6 +/- 23.2, p = 0.256). Proportion of patients with impaired DLCO at baseline was not altered significantly after the first (37.5 vs. 45.0%, p = 0.581) and the second treatments (27.3 vs. 27.3%, p = 1.000). Also, percent change in DLCO values did not correlate with radiation dose, lung shunt fraction, or lung exposure dose (p > 0.05 for all comparisons). None of the patients developed radiation pneumonitis. Conclusions: Our results suggest that no significant change in DLCO in association with SIRT occurs, both after the first or the second treatment sessions. Further larger studies possibly with different protocols are warranted to better delineate DLCO changes after SIRT in a larger spectrum of patients.