18F-Fluorodeoksiglukoz (FDG) Pozitron Emisyon Tomografisi/Bilgisayarlı Tomografi (PET/BT) pek çok kanserde ve özellikle iyot tutmayan varyant olmak üzere diferansiye tiroid karsinomlarında evreleme, yeniden evreleme ve tedaviye yanıtın değerlendirilmesinde kullanılır. Medüller, anaplastik tiroid kanserleri, tiroid lenfoması ve metastatik tümörler gibi tiroidin daha nadir tümörlerindeki potansiyeli henüz tam olarak belirlenmemiştir. Bu derlemenin amacı, 18F-FDG PET/BT’nin bu tümörlerdeki son uygulamaları ve endikasyonları hakkında genel bir bakış sunmak ve klinik çerçevedeki tartışmalar üzerine yoğunlaşmaktır.

Positron emission tomography/computed tomography (PET/CT) with 18F-fluorodeoxyglucose (FDG) is used in staging, restaging, evaluation of therapy response in many cancers as well as differentiated thyroid carcinomas especially in non-iodine avid variants. Its potential in less frequent tumors of thyroid like medullary, anaplastic thyroid cancers, thyroid lymphoma and metastatic tumors of the thyroid however, is not well established yet. The aim of this review is to give an overview on the recent 18F-FDG PET/CT applications and indications in these tumors and to focus on the controversies in the clinical setting

GİRİŞ ve AMAÇ: Hodgkin lenfoma (HL) tanısı konmuş çocuk hastalarda klinik prognostik faktörler ile tedavi öncesi 18F-florodeoksiglukoz (FDG) pozitron emisyon tomografisi /bilgisayarlı tomografi (PET/BT) görüntülemeden elde edilen SUV değerlerini karşılaştırmak.
YÖNTEM ve GEREÇLER: Bu retrospektif çalışmada HL tanılı 28 çocuk hastanın FDG PET/BT bulguları değerlendirildi. Metabolik tümor volümü (MTV), kiloya (SUVkilo), yağsız vücut kitlesine (SUVlbm), vücut yüzey alanına (SUVbsa) and plazma glukoz seviyesine göre (SUVglukoz) normalize edilmiş SUVmax değerleri tedavi öncesi FDG PET/CT görüntüleri kullanılarak hesaplandı. Bu metabolik parametrelerin klinik faktörler (yaş, cinsiyet, lenf nodu grup sayısı, dalak tutulumu, büyük mediastinal hastalık, Ann Arbor evreleme, serum lökosit sayımı, eritrosit sedimentasyon hızı (ESH), serum albumin ve hemoglobin seviyesi) ile ilişkisi araştırıldı.
BULGULAR: SUVbsa, SUVlbm, SUVweight, SUVglukoz and MTV evre III-IV hastalığı, büyük tümörü ve ≥3 lenf nodu grubu olan hastalarda daha yüksekti (P<0.05). SUVbsa and SUVglukoz dalak tutulumu olan hastalarda daha fazlaydı (P<0.05). Bu metabolik parametreler ile cinsiyet, ESR, albümin and WBC seviyeleri arasında önemli bir ilişki yoktu (P>0.05). SUVbsa ve SUVlbm anemisi olan hastalarda daha yüksekti (P<0.05). Ek olarak yaş arttıkça SUVkilo, MTV ve SUVglukozda önemli artış olduğu saptandı (sırasıyla; P=0.005, P=0.027, and P=0.009). SUVbsa ve SUVlbm ile yaş arasında önemli korelasyon yoktu (P˃0.05).
TARTIŞMA ve SONUÇ: HL tanılı hastalarda tedavi öncesi FDG PET/BT’den elde edilen metabolik parametreler yüksek riskli hastalığı tahmin etmede önemli bir rol oynayabilir. Ayrıca, pediatric hastalarda FDG PET/BT’nin kantitatif değerlendirilmesinde SUVbsa ve SUVlbm, SUVkilo’dan daha iyi marker olabilir.

INTRODUCTION: To compare SUV values derived from pretreatment 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging and clinical prognostic factors in pediatric patients with Hodgkin lymphoma (HL).
METHODS: Pretreatment FDG PET/CT findings of 28 children with HL were evaluated in this retrospective study. Metabolic tumor volume (MTV), SUVmax normalized by weight (SUVweight), lean body mass (SUVlbm), body surface area (SUVbsa) and plasma glucose levels of tumors (SUVglucose) were calculated using the pretreatment FDG PET/CT scan images. These metabolic parameters were correlated with the clinical factors (age, sex, number of lymph node groups, presence of splenic involvement, bulky mediastinal disease, Ann Arbor stage, serum white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), serum albumin and hemoglobin levels).
RESULTS: SUVbsa, SUVlbm, SUVweight, SUVglucose and MTV were higher in patients with stage III-IV disease, bulky tumor and ≥3 lymhp node groups (P<0.05). SUVbsa and SUVglucose were higher in patients with splenic involvement (P<0.05). There was no significant correlation between these metabolic parameters and sex, ESR, levels of albumin and WBC (P>0.05). SUVbsa and SUVlbm were higher in patients with anemia. (P<0.05). Additionally, significant increases were detected in SUVweight, MTV, and SUVglucose with increasing age (P=0.005, P=0.027, and P=0.009, respectively). SUVbsa and SUVlbm had no significant correlation with age (P˃0.05).
DISCUSSION AND CONCLUSION: Metabolic parameters derived from pretreatment FDG PET/CT may have an important role in predicting high-risk disease in patients with HL. Also, SUVbsa and SUVlbm may be better markers than SUVweight in the quantitative evaluation of FDG PET/CT scans in pediatric patients.

INTRODUCTION: Gastroparesis or delayed gastric emptying is a common medical condition in diabetes patients. Scintigraphy technique is commonly used as a standard diagnostic procedure for quantitative assessment of gastroparesis. The aims of this study were determination of an optimized imaging time for diagnosis of gastroparesis and assessment prevalence of gastroparesis. Relation between results of endoscopy and scintigraphy as well as relation between gastric emptying with patient’s sex, blood glucose concentration and functional dyspepsia were also studied.
METHODS: Gastric emptying was assessed in 50 diabetic patients with the mean age of 50.16 years. For evaluation of gastric emptying, a test meal containing 2 pieces of toast, 120 cc non-labeled water and fried egg labeled with 1 mCi of 99mTc was given to each patient then scintigraphy scan was performed immediately after ingestion and was repeated 1, 1.5, 2 and 4 hours after ingestion. In some patients 90-minute dynamic scan was also acquired.
RESULTS: Results of this study revealed that a 4-hours scan after ingestion is more suitable than a 90-minute dynamic scan for evaluation of gastric emptying. There was no statistically significant difference between 1-hour and 2-hour scans, 1-hour and 90-minute scans, 2-hours and 90-minute scans, 2-hour and 4-hour scans. Also there was no difference in FBS with all of scans and patient’s sex and results of gastric emptying scan.
DISCUSSION AND CONCLUSION: According to our findings, it can be suggested that prevalence of gastroparesis is more than that of mentioned in some previous studies. Also, the study may demonstrate that for diabetic patients who are suffering from dyspepsia without other evident reasons, a gastric emptying scintigraphy at 2 and 4 hours after meal ingestion may provide desired clinical information.

GİRİŞ ve AMAÇ: Endometrial kanserde (EK), primer tümöre ait maksimum standardize tutulum değeri (SUVmax) ve minimum görünen difüzyon katsayısı (ADCmin) değerlerinin klinikopatolojik özellikler ile olan ilişkisini araştırmak ve bunların öngörü gücünü belirlemek.
YÖNTEM ve GEREÇLER: : 18F–florodeoksiglukoz pozitron emisyon tomografi/bilgisayarlı tomografi (18F–FDG PET/BT) ve difüzyon ağırlıklı manyetik rezonans (DA–MRG) görüntüleme ile preoperatif değerlendirmeyi takiben evreleme cerrahisi uygulanan toplamda 45 hasta, planlı veri toplanarak prospektif bir vaka serisine dahil edildiler. Çalışma verileri arasındaki ilişkiler çoklu doğrusal regresyon analizi ile araştırıldı.
BULGULAR: Ortalama ADCmin ve SUVmax değerleri sırasıyla 0.72±0.22 ve 16.54±8.73 bulundu. Tek değişkenli analizde; yaş, miyometriyal invazyon (Mİ) ve lenfovasküler boşluk tutulumu (LVBT) ADCmin ile ilişkili potansiyel faktörler olarak bulunurken; yaş, evre, tümor boyutu, LVBT ve metastatik lenf düğümlerinin sayısı SUVmax ile ilişkili potansiyel değişkenler olarak tespit edildiler. Diğer taraftan çok değişkenli analizde Mİ, ADCmin (P=0.007) ve SUVmax (P=0.024) ile ilişkili tek anlamlı değişkendi. Mİ derinliği ≤0.77’lik bir ADCmin cut-off değeri [%93.7 duyarlılık, %48.2 özgüllük ve %93.0 negatif prediktif değer (NPD)] ve 20.5’in üzerinde bir SUVmax cut-off değeri ile (%62.5 duyarlılık, %86.2 özgüllük ve %81.0 NPD) öngörülebiliyordu. Ne var ki, her iki tanısal test birbirlerinden anlamlı şekilde farklı değildi (P=0.266).
TARTIŞMA ve SONUÇ: Klinikopatolojik özelliklerden yalnızca Mİ bağımsız ve anlamlı şekilde SUVmax ve ADCmin ile ilişkiliydi. Ne var ki, her iki parametrenin ideal olmayan öngörü performansları nedeniyle 18F–FDG PET/BT veya DA–MRG’nin rutin kullanımı şu noktada önerilemez.

INTRODUCTION: The aim of the study is to explore the relationship between the primary tumor’s maximum standardized uptake (SUVmax) and minimum apparent diffusion coefficient (ADCmin) value and clinicopathological features and to determine their predictive ability in endometrial cancer (EC).
METHODS: A total of 45 patients performed staging surgery after a preoperative evaluation with 18F–fluorodeoxyglucose positron emission tomography/computerized tomography (18F–FDG PET/CT) and diffusion–weighted magnetic resonance imaging (DW–MRI) were included in a prospective case–series study with planned data collection. Multiple linear regression analysis was used to determine the relationships between the study variables.
RESULTS: The mean ADCmin and SUVmax values were found 0.72±0.22 and 16.54±8.73, respectively. A univariate analysis identified age, myometrial invasion (MI) and lymphovascular space involvement (LVSI) as the potential factors associated with ADCmin while it identified age, stage, tumor size, MI, LVSI and number of metastatic lymph nodes as the potential variables correlated to SUVmax. In multivariate analysis, on the other hand, MI was the only significant variable correlated to ADCmin (P=0.007) and SUVmax (P=0.024). Deep MI was best predicted by an ADCmin cutoff value of ≤0.77 [93.7% sensitivity, 48.2% specificity, and 93.0% negative predictive value (NPV)] and SUVmax cutoff value of >20.5 (62.5% sensitivity, 86.2% specificity, and 81.0% NPV); however, the two diagnostic tests were not significantly different (P=0.266).
DISCUSSION AND CONCLUSION: Among clinicopathological features, only MI was independently correlated to SUVmax and ADCmin. However, the routine use of 18F–FDG PET/CT or DW–MRI cannot be recommended at the moment due to non-ideal predictive performances of both parameters.

INTRODUCTION: Camptodactyly-arthropathy-coxa-vara-pericarditis (CACP) syndrome is an autosomal recessive disorder caused by mutations in PRG4 gene that encodes for proteoglycan 4, the main lubricant for joints and tendon surfaces. It is non-inflammatory arthropathy, characterized by joint effusions and synovial hypertrophy. So far, there is no effective treatment for this disorder. To evaluate the effectiveness of yttrium-90 radiosynovectomy in arthropathy of patients with CACP syndrome
METHODS: Consecutive patients with CACP syndrome prospectively evaluated at the enrollment and 3 months after the right knee injection with yttrium-90. The outcome variables were patient/ parent and physician’s global assessment measured by a 3-point scale, right knee swelling and range of motion on a 3-point scale, in addition to Magnetic Resonance Imaging (MRI) assessment of the right knee for bone, cartilage, fluid, synovial hypertrophy and soft tissue changes.
RESULTS: Six (3 boys, 3 girls) patients with mean age of 12 years and mean follow-up duration of 8.5 years completed a single right knee intra-articular yttrium-90 injection with 5 mCi. The procedure was well tolerated without adverse events apart from mild and transient joint pain in 2 patients. There was a minimal radioisotope leakage to soft tissue in 2 patients. During the 3-month follow-up interval, there was no improvement in the outcome variables. Patients and parents did not notice favorable therapeutic effects and global physician assessment was unsatisfactory. No difference in knee joint swelling or range of motion. Furthermore, MRI findings were unchanged. However, there was a minimal increase in synovial fluid post injection.
DISCUSSION AND CONCLUSION: Yttrium-90 radiosynovectomy seems to be safe and well tolerated procedure, but with the given dosage and interval time it didn’t show a beneficial therapeutic effect in arthropathy of CACP syndrome. However, a large number of patients and probably repeated injections are needed to derive satisfactory results about the effectiveness of yttrium-90 in CACP syndrome patients.

Von Hippel-Lindau Sendromu (VHLS) malign ve benign tümörler ile karakterize otozomal dominant herediter ailesel bir hastalıktır. VHLS’lu hastalarda adrenal ve pankreatik kitlelerin ayırıcı tanısı zordur. Bu hastalarda I-123 metaiyodobenzilguanidin (I-123 MIBG) ve İndiyum-111 somatostatin reseptör sintigrafileri (İn-111 SRS) adrenal ve pankreatik kitlelerin ayırıcı tanısında önemli rol oynar. Bu olgu sunumunda VHLS’lu ailenin üç üyesinin I-123 MIBG SPECT/BT ve İn-111 SRS SPECT/BT bulgularını sunuyoruz. Hasta 1’de, İn-111 SRS SPECT/BT görüntülerinde pankreas başında rezidü nöroendokrin tümör (NET) saptandı. Hasta 2 ve 3’de, I-123 MIBG SPECT/BT cerrahi öncesi adrenal bezdeki kitleleri feokromositoma ve adrenal dışı kitleyi NET olarak onayladı. İn-111 SRS ve I-123 MIBG sintigrafilerinin VHLS’lu hastaların tanı ve tedavisi için rutin çalışmada yararlı olabileceğini düşündük. Hibrid SPECT/BT morfolojik ve fonksiyonel bilgileri birlikte değerlendirdiği için, planar görüntülerin tanısal doğruluğunu artırır.

Von Hippel-Lindau Syndrome (VHLS) is an autosomal dominant hereditary familial disorder characterized by development malignant and benign neoplasms. Differential diagnoseof the adrenal and pancreatic massesaredifficult in patients with VHLS.I-123 metaiodobenzylguanidine (I-123 MIBG) and Indium-111 somatostatin receptor scintigrapies (In-111 SRS) play important roles in the differential diagnosis of adrenal and pancreatic masses in those patients. In this case report, we present the findings of I-123 MIBG SPECT/CT and In-111 SRS SPECT/CT in three members of a family with VHLS. In patient 1, a residual neuroendocrine tumor (NET) was detected in the head of pancreas on In-111 SRS SPECT/CT images. In patient 2 and 3, I-123 MIBG SPECT/CT confirmed the adrenal masses as pheochromocytoma, and the extra-adrenal mass as NET, before surgery. We thought that In-111 SRS and I-123 MIBG scan might be helpful in routine work up of VHLS patients for diagnostic and therapeutic purposes. Hybrid SPECT/CT system may improve diagnostic accuracy of planar images since it assesses morphologic and functional information together.

Papiller tiroit karsinomu tanısı alan 25 yaşında kadın hastaya total tiroidektomi ve sonrasında I-131 ablasyon tedavisi uygulandı. Terapötik aktivite sonrası 7.gün yapılan tüm vücut görüntülemede tiroid lojunda bakiye dokuya ait yoğun aktivite tutulumu ile sakral bölgede posterior imajlarda daha belirgin olmak üzere yoğun, heterojen bir aktivite tutulum alanı saptandı. Görünüm sakral metastaz şüphesi uyandırmaktaydı. Tc-99m MDP kemik sintigrafisinde kemiklerde normal dağılım izlenirken, sol böbreğin normal lokalizasyonunda bulunmadığı görüldü. Kemik sintigrafisi kan havuzu fazı incelendiğinde, sol böbrek aktivitesi yerinde izlenmezken, sakral bölgede pelvik böbreğe ait olabilecek ekstra bir aktivite tutulum alanı saptandı. Yapılan MR görüntüleme ile sakrum önünde lokalize ektopik pelvik böbrek doğrulandı.

A 25-year-old woman had total thyroidectomy and 131I ablation therapy for papillary thyroid carcinoma. Whole body imaging on 7th day of therapeutic activity demonstrated radioiodine uptake in the remnant tissue and intense heterogeneous uptake at sacral region prominently in posterior image. Initial interpretation was suspicious for sacral metastasis. 99mTc-MDP bone scan demonstrated normal bone uptake and the absence of left kidney. On blood-pool phase of bone scan, the absence of left renal activity and an extra area of uptake in the sacral region that suggestive of pelvic kidney were noticed. MRI scan confirmed the ectopic pelvic kidney overlying the sacrum.