Congenital heart disease, such as Tetralogy of Fallot (TOF) are the most common human birth defects that may be a cause of pulmonary diseases.
Lung scintigraphy perfusion (LPS) has an important role in evaluation of lung burden in patient with these defects, to complete the work-up for a better management and in follow-up to assess the best therapeutic strategy.
We report the case of a 10-year-old female patient with TOF, submitted to cardiac surgery, who performed LPS. It showed hypo-perfusion of the left respect to the right lung and abnormal uptake of 99mTc-Macroaggregated Albumin in kidneys and spleen, revealing the presence of right-to-left shunt, and the necessity of further cardiac surgery.
This case is a demonstrative example of LPS usefulness in patients with TOF, allowing an accurate evaluation of the best therapeutic strategy with the benefits of low radiation exposure, side effects lack, repeatability, easy management and good compliance.

INTRODUCTION: Gastro-oesophageal reflux disease (GORD) is both common and troubling with a prevalence of 20-40%. We assessed the utility of a scintigraphic reflux study to evaluate the oesophageal and extra-oesophageal manifestation of disease compared to the standard tests such as pH monitoring and manometry.
METHODS: Patients were recruited into a prospective database of referrals to a tertiary referral centre for either resistance to maximal medical therapy or extra-oesophageal symptoms of GORD. Data included 2 channel 24 hour pH monitoring and manometry results, as well as scintigraphic reflux data with late images assessing pulmonary aspiration of refluxate.
RESULTS: Study population was 250 patients (155F, 95M) with an average age of 60 years. Patients were clinically classified as either GORD (n=72) or laryngopharyngeal reflux (LPR) (n=178). Lung aspiration was found significantly more commonly in LPR patients (58/178 compared with GORD 10/72). Strong correlations were found between the scintigraphic time-activity curves in the upper oesophagus and pharynx, and ineffective oesophageal motility (IOM) and pulmonary aspiration. pH studies were correlated with the scintigraphic studies but did not predict aspiration as well as the other modalities when evaluated by receiver operating characteristic analysis (ROC)
DISCUSSION AND CONCLUSION: Scintigraphic reflux studies offer a viable alternative test for GORD and extra-oesophageal manifestations of reflux disease. Strong correlations were found between measurable scintigraphic parameters and oesophageal motility and lung aspiration of refluxate. This may provide a more confident decision analysis in patients being considered for fundoplication for troubling extra-oesophageal symptoms.

A 23 year old african native male patient presented with fever, lumbalgia and dysuria after returning from a trip to Togo. Physical examination revealed pain in the pubic symphysis and tenderness during rectal exam. CRP was elevated, blood and urinary cultures were positive for MRSA. An MRI performed to rule out arthritis/osteomyelitis in the pubis revealed oedema of the symphysis. A F18-FDG PET-CT supported the diagnosis of prostatic infection and showed a focal uptake of the pubic symphysis, with diffuse hypermetabolism of the insertions of the rectus abdominis and longus adductor, corresponding to athletic pubalgia. Fever and CRP faded out quickly after antibiotherapy.

A 23 year old african native male patient presented with fever, lumbalgia and dysuria after returning from a trip to Togo. Physical examination revealed pain in the pubic symphysis and tenderness during rectal exam. CRP was elevated, blood and urinary cultures were positive for MRSA. An MRI performed to rule out arthritis/osteomyelitis in the pubis revealed oedema of the symphysis. A F18-FDG PET-CT supported the diagnosis of prostatic infection and showed a focal uptake of the pubic symphysis, with diffuse hypermetabolism of the insertions of the rectus abdominis and longus adductor, corresponding to athletic pubalgia. Fever and CRP faded out quickly after antibiotherapy.

GİRİŞ ve AMAÇ: Giriş: Radyoaktif iyot diferansiye tiroid karsinomu (DTK) görüntülemesinde kullanılan en yüksek özgüllüğe sahip radyonükliddir. Duyarlılık ve özgüllüğü yüksek olmakla birlikte I-131 tüm vücut tarama sintigrafisinde (TVTS) yanlış pozitif I-131 tutulumları görülebilmekte ve bu durum tanısal güçlüklere ve gereksiz tedavilerin uygulanmasına neden olabilmektedir. Bu çalışmada I-131 TVTS’de izlenen beklenmedik yanlış pozitif I-131 tutulumlarına ait TVTS ve SPECT/BT görüntüleme bulguları ile hastaların klinik sonuçlarının ve SPECT/BT görüntülemenin katkısının sunulması amaçlanmıştır.
YÖNTEM ve GEREÇLER: Kliniğimizde takipli 1507 DTK tanılı hastaya ait I-131 TVTS’leri retrospektif olarak incelendi ve alışılagelmiş yanlış pozitif I-131 tutulumları (timüs, meme gibi) çalışma dışında bırakılmıştır. Eş zamanlı single photon emission computed tomography/bilgisayarlı tomografi (SPECT/BT) görüntüleri olan ve beklenen alanlar dışında izlenen yanlış pozitif I-131 tutulumları çalışmaya dahil edildi.
BULGULAR: 21 hastada 23 adet eş zamanlı SPECT/BT ile lokalize edilen, beklenmedik yanlış pozitif I-131 tutulumu saptandı. Bulguların büyük çoğunluğu (%87) post-terapötik TVTS’de izlendi. Yanlış pozitif tutulumların çoğunun eş zamanlı SPECT/BT ve radyolojik bulgular ile tiroid dışı nedenlere (bronşektazi, akciğer enfeksiyonu, gluteal yağlı dokuya subkutan enjeksiyon, aort kalsifikasyonu, benign kemik kisti, vertebral hemangiom, yakın zamanlı tiroid dışı cerrahi girişim, rotator kılıf yaralanması, matür kistik teratom ve overde follikül kisti) bağlı olduğu anlaşıldı. 9 hastada ise yanlış pozitif iyot tutulumunu radyolojik görüntüleme bulguları ile açıklanamadı.
TARTIŞMA ve SONUÇ: Tiroid kanserli hastalarda yanlış pozitif I-131 tutulumlarının izlenebileceği ve altta yatan mekanizmaları (inflamasyon, kanlanma artışı, kistik lezyonda trapping vb.) akılda tutularak, beklenmeyen I-131 tutulumlarının serum tiroglobulin düzeyi, SPECT/BT ve radyolojik verilerle birlikte değerlendirilerek gereksiz tedavilerin önüne geçilmesi gerektiği sonucuna varılmıştır.

INTRODUCTION: Radioiodine is the most specific radionuclide for differentiated thyroid carcinoma (DTC) imaging. Despite its high specificity and sensitivity false positive I-131 uptakes could be seen on whole body scan (WBS) that may cause misdiagnosis and unnecessary radioiodine treatments. In this study, we aimed to present the I-131 WBS and concomitant SPECT/CT images of unexpected false positive radioiodine uptakes, the patients’ clinical outcomes and the contributions of SPECT/CT imaging.
METHODS: I-131 WBSs of 1507 patients with DTC were retrospectively reviewed and expected I-131 uptakes (like in breasts or thymus) were excluded from the study. The unexpected false positive I-131 uptakes with concomitant SPECT/CT imaging were recorded.
RESULTS: 21 patients had 23 unexpected I-131 uptakes on WBS and concomitant SPECT/CT imaging. The vast majority (87%) of these cases were seen on post-therapeutic I-131 WBS. Most of the false positive I-131 uptakes could be explained by SPECT/CT and radiological findings, and were secondary to non-thyroidal conditions (bronchiectasis, lung infection, subcutaneous injection into gluteal fatty tissue, aortic calcification, benign bone cyst, vertebral hemangioma, recent non-thyroidal surgical procedure site, rotator cuff injury, mature cystic teratoma and ovarian follicle cyst). However the possible reasons of 9 false positive I-131 uptakes could not be explained by radiological findings.
DISCUSSION AND CONCLUSION: We suggest that the false positive I-131 uptakes and underlying mechanisms (inflammation, trapping, increased perfusion, etc.) must be kept in mind in patients with thyroid cancer and unexpected findings must be considered together with serum thyroglobulin levels, SPECT/CT and radiological findings to avoid misdiagnosis and unnecessary radioiodine treatments.

INTRODUCTION: I-131 mIBG scan semi-quantitative analysis with Modified Curie and the International Society of Paediatric Oncology Europe Neuroblastoma (SIOPEN) scoring systems is helpful in the evaluation of extent of disease and has prognostic impact in stage 4 neuroblastoma.
METHODS: Retrospective, cross-sectional analysis of baseline I-131 mIBG scans in 21 patients with stage 4 or 4S neuroblastoma diagnosed between January 2007 and December 2015. All scans were assessed for Curie and SIOPEN scores. Distribution of scores was evaluated for risk factors i.e. age at diagnosis (>18 months) and early relapse (within 12 months). A curie score <2 and SIOPEN score <4 at diagnosis were correlated for event-free (EFS) and overall (OS) survival.
RESULTS: Data set was comprised of 12(57%) males and 9(43%) females. Patients with age > 18 months (n=9) at diagnosis or early relapse (n=9) had higher Curie (Mean 5+7.5SD, p=0.004) and SIOPEN (Mean 5.2+10.8SD, p=0.02) scores.
Patients with a Curie score <2 and a SIOPEN score of <4 had better EFS and OS than patients with higher scores. Curie: 5-year EFS = 79% versus 33% (p 0.03); 5-year OS= 56% versus 36% (p 0.01). SIOPEN: 5-year EFS = 70% versus 17% (p 0.002); 5-year OS= 58% versus 17% (p 0.04). No statistically significant difference was found between the survival predictive value of two scoring systems (Hazard ratio 2.38, 95% CI: 0.33-16.9, p = 0.38).

DISCUSSION AND CONCLUSION: I-131 mIBG Curie and SIOPEN scores have prognostication value in stage 4 neuroblastoma and should be routinely applied. Higher scores predict unfavorable prognosis.

INTRODUCTION: Radiation Pneumonitis /RP/ can be an adverse complication of radiotherapy /RT/ and can limit the application of the already planned radiation dose. It is often associated with radiotherapy of lung carcinoma and is occasionally caused by radiation therapy of breast carcinoma and lymphomas located in the mediastinum. PET-CT emerges lately as a prospective modality for early diagnostics of RP. Aim of this study was to summarize the initial data from the diagnostic application of PET-CT in patients suspicious of RP and to derive criteria, which can help differentiate RP from early recurrence of the disease and/or residual tumor.
METHODS: The current study included 23 patients, who had metabolic (PET) and anatomical (CT) changes consistent with RP. We additionally defined the metabolic activity (SUVmax) in the lung parenchyma of 20 patients without RT.
RESULTS: All patients had increased metabolic activity in the lung parenchyma involved in the irradiated area with a mean of SUVmax3,45 /ranging between 1 and 7,1/. The control group had a physiological background metabolic activity - SUVmax0.61 +/- 0.11.
DISCUSSION AND CONCLUSION: Metabolic changes in the patients suspicious of RP involved diffusely increased metabolic activity coinciding with the anatomical changes in the irradiated area. 3/23 patients had a proven recurrence of the primary neoplastic process in the irradiated area. The metabolic changes in those patients involved - increase in the metabolic activity at follow up or lack of tendency towards normalization after chemotherapy, which implied the existence of still viable tumor cells. Our initial experience in the diagnostic application of 18F-FDG PET/CT in patients suspicious of RP, allows us to summarize the following - PET/CT is a reliable imaging modality in the diagnostics of RP. Through its sequential use, we can differentiate inflammatory changes related to RP from early recurrence of the primary neoplastic process.

Altmış iki yaşındaki erkek hasta, uygulanan orşiektomi sonucunda testis ve spermatik kordda diffüz büyük B-hücreli lenfoma tanısı aldı. Hastaya başlangıç evrelemesi amacıyla 18F-fluoro-2-deoxy-d-glucose (FDG) positron emisyon tomografisi/bilgisayarlı tomografi (PET/BT) tetkiki yapıldı. Yapılan FDG PET/BT tetkikinde, hipermetabolik özellikte çok sayıda lenfadenopatiler, akciğer lezyonları, böbreklerde ve sürrenal bezlerde kitle lezyonları saptandı. Ek olarak, sağ testiste, prostat bezinde ve sol testiküler vende lenfoma tutulumu ile uyumlu diffüz özellikte artmış FDG tutuluşu izlendi. Lenfomada ürogenital sistem nadir ekstranodal tutulum yerlerinden biri olup bu olgu bildiğimiz kadarıyla tüm ürogenital sistem yapılarında artmış FDG tutulumu gösteren lezyonlar izlenen literatürdeki ilk vakadır.

A sixty-two year-old male patient underwent orchiectomy and diagnosed as diffuse large B-cell lymphoma in testicle and spermatic cord. 18F-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography/computed tomography (PET/CT) scanning was performed for initial staging. FDG PET/CT scan revealed multiple hypermetabolic lymphadenopathies, lung lesions and mass lesions in adrenal glands and kidneys. In addition, diffuse increased FDG uptake suggesting lymphomatous infiltration on right testicle, prostate and left testicular vein were also seen. The genitourinary system is extremely rare extranodal infiltration area in lymphomas and to the best of our knowledge this is the first case in literature having FDG accumulating lesions on all of the structures of genitourinary system.

GİRİŞ ve AMAÇ: Bu çalışmanın amacı, primeri bilinmeyen kanserlerde (PBK) 18F-florodeoksiglukoz (18F-FDG) pozitron emisyon tomografi/bilgisayarlı tomografi’nin (PET/BT) klinik rolünü araştırmaktır.
YÖNTEM ve GEREÇLER: Bu retrospektif çalışmaya PBK tanısıyla tüm vücut 18F-FDG PET/BT yapılan 121 hasta dahil edildi. Sonuç tanı histopatolojik olarak veya klinik izlemle doğrulandı.
BULGULAR: 18F-FDG PET/BT, 121 hastanın 59’unda (49%) primer tümörü saptadı. PET/BT ile en çok saptanan tümör akciğer kanseri idi (n=31). Bir hastada iki primer tümör saptandı (kolon ve prostat). Bu hastada kemik iliği biyopsisi prostat kanseri metastazını gösterdiği için kolon kanseri senkron ikinci primer olarak kabul edildi. 18F-FDG PET/BT bulguları 11 hastada yanlış pozitif idi. PET/BT ile herhangi bir lezyon saptanmayan 51 hastanın 11 tanesinde konvansiyonel tetkiklerle primer tümör saptandı ve bu hastalar yanlış negatif olarak değerlendirildi. Primer tümör saptanmasında 18F-FDG PET/BT ile duyarlılık, özgüllük ve doğruluk sırasıyla 84%, 78% ve 82% idi.
TARTIŞMA ve SONUÇ: PBK olan hastalarda primer tümörün saptanmasında tüm vücut 18F-FDG PET/BT etkin bir yöntemdir. Primer tümör saptanması yanında hastalığın yaygınlığını da belirleyerek hastaların izlenmine katkıda bulunur.

INTRODUCTION: The aim of this study is to investigate the clinical role of 18F -fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET/CT) in patients with carcinoma of unknown primary (CUP).
METHODS: One hundred twenty one patients with diagnosis of CUP who underwent whole body 18F-FDG PET/CT imaging included in this retrosepective study. The final diagnoses were confirmed histopathologically or by clinical follow-up.
RESULTS: The 18F-FDG-PET/CT successfully detected primary tumor in 59 out of 121 (49%) patients. The most common primary tumour detected by 18F-FDG PET/CT was in the lung (n=31). In a patient, two primary tumors (colon and prostat) detected on PET/CT imaging. Bone marrow biopsy revealed prostate cancer in this patient and colon cancer accepted as a synchronous second primary. 18F-FDG PET/CT findings were proved to be false positive in 11 patients. 18F-FDG PET/CT could not detected any primary lesion in 51 patients in which conventional work-up detected primary tumor in 11 of them and considered as false negative. The sensitivity, specificity and accuracy of 18F-FDG PET/CT in detection of primary tumor were 84%, 78% and 82% respectively.
DISCUSSION AND CONCLUSION: Whole body 18F-FDG PET/CT is an effective method for detecting the primary tumor in patients with CUP. In addition to detecting primary tumor, it can also help to determine the extent of disease and contributes to the management of this patients.

Primer malign melanom sıklıkla deride ortaya çıkmaktadır, daha az sıklıklada, gözün koroid tabakasında, leptomeninkslerde, oral kavitede, nazal mukozada, farinkste, özefagusta, bronşlarda, tırnak altında, vagende ve anorektal mukozada izlenmektedir. Gastrointestinal sistemin primer melanomu, özofagusta, mide, ince bağırsakta ve anorektumda görülen lezyonları çeşitli yayınlanmış raporlar ile teyit edilmiştir, çünkü bunlar melanositlerin normal olarak bulunduğu yerlerdir. Kolonda primer malign melanom oluşumu nadirdir, çünkü melanosit embriyolojik olarak kalın bağırsakta yoktur. Burada kolon malign melanoma tanısı alan ve 18F-FDG PET / BT taramasında dissemine metastatik lezyonları olan bir hastayı sunuyoruz. Her iki akciğerde artmış 18F-FDG uptake gösteren multiple nodüler lezyonlar vardı. Özofagus torakal segmentte, intraluminal alana taşan ılımlı düzeyde 18F-FDG uptake gösteren yumuşak doku lezyonu vardı. Asimetrik mide duvar kalınlaşmasında ve safra kesesi duvarında lümeni dolduran yumuşak doku lezyonlarında artmış metabolik aktivite görüldü. Karaciğerde multiple hipodens / hipermetabolik lezyonlar görüldü. Hemen tüm kolon segmentlerinde multiple hipermetabolik polipoid / yumuşak doku lezyonları görüldü. Tüm abdominal kadranda multiple hipermetabolik peritoneal implantlar saptandı. Sağ surrenal gland yumuşak doku lezyonunda artmış 18F-FDG tutulumu tespit edildi. Rektumun arka duvarında hipermetabolik yumuşak doku lezyonu vardı. Torakal ve lomber vertebralarda, sol skapulada, sol iliak kemikte, sakrumda ve sol femur boyunda hipermetabolik litik lezyonlar görüldü. Hem zayıflama düzeltilmiş hem de düzeltilmemiş görüntülerde, 18F-FDG ciddili cilt lezyonlarının kanıtı yoktu. Atenüasyon düzeltmesi yapılan ve yapılmayan imajlarda, 18F-FDG affiniteli deri lezyonu lehine bulgu yoktu.

Primary malignant melanoma occurs most often in the skin and much less frequently in the choroid layer of the eyes, in the leptomeninges, oral cavity, nasal mucosa, pharynx, esophagus, bronchus, under the nail and vaginal or anorectal mucosa. Primary melanoma of the gastro intestinal tract has been confirmed for lesions occurring in the esophagus, stomach, small bowel, and anorectum through several published reports, as these are the areas where melanocytes normally exist. The occurrence of primary malignant melanoma in the colon is relatively rare, because melanocytes is embryologicly absent in the large bowel. Here we report a patient whose colonic malignant melanoma was diagnosed and disseminated metastatic lesions were revealed with 18F-FDG PET/CT scan. There were multiple nodular lesions showing increased 18F-FDG uptake at the both lungs. There was a soft tissue lesion with slightly increased 18F-FDG uptake which extends to the intraluminal region of thoracal segment esophagus. Increased metabolic activity were seen in asymmetric stomach wall thickening and in a soft tissue lesion located on gall bladder wall which was filling the lumen. Multiple hypodens/hypermetabolic lesions were seen in liver. Multiple hypermetabolic polipoid/soft tissue lesions were seen on almost whole colonic segments. Multiple hypermetabolic peritoneal implants were noted in all abdominal quadrant. Increased 18F-FDG uptake was detected at right surrenal gland soft tissue lesion. There was a hypermetabolic soft tissue lesion on posterior wall of rectum. Hypermetabolic lytic lesions were seen at thoracal and lumbar vertebrae, left scapula, left iliac bone, sacrum and left femur neck. Both in attenuation corrected and non-corrected images, there was no evidence of 18F-FDG avid skin lesions.

Proper interpretation of SPECT myocardial perfusion imaging (MPI) is primarily based on strict adherence to standard procedural protocols from patient preparation to image processing and display. Inadvertent faulty injection of the radiopharmaceutical and, consequently, dose extravasation during SPECT MPI is an important issue than that in any other diagnostic scintigraphic procedure. As it can be considered as a major source of false negative result, clinician’s awareness of this problem during interpretation is of great importance. In some occasions, no local clinical signs or image findings may be available to the interpreter to be aware of dose extravasation to adopt a suitable approach. Herein, we present a case with dose extravasation during stress phase, which is repeated another day with the same protocol and the potential effects of dose extravasation on SPECT myocardial perfusion images from different aspects and useful image findings as hints are provided.

Radyolojik görüntülemede karaciğer sağ lob segment 5’de hepatoselüler karsinom (HCC) ile uyumlu bulunan kitle lezyonu ve alfa fetoprotein (AFP) yüksekliği (323 ng/ml) olan 43 yaşında erkek hasta sunuldu. FDG PET görüntüleri, kitle lezyonunda background seviyesinde FDG tutulumu gösterdi. Ek olarak, sol lobda segment 2’de artmış FDG tutulumu olan, yaklaşık 1,5 cm. çapında ikinci bir odak tespit edildi. Histopatolojik incelemede, daha düşük FDG tutan daha büyük kitle lezyonunda HCC, daha yüksek FDG tutan daha küçük kitle lezyonunda kolanjioselüler karsinom ortaya çıktı. Bildiğimiz kadarıyla; bu, karaciğerin farklı iki segmentinde, histopatolojik olarak farklı iki primer malign karaciğer tümörünün bildirildiği ilk vakadır.

A 43 year old male patient presented with mass lesion on right liver lobe, segment 5 in radiological imaging and elevated alpha-fetoprotein (AFP) levels (323 ng/ml) compatible with hepatocellular carcinoma (HCC). PET/CT images showed background level FDG uptake in the mass lesion. In addition, a secondary focus of increased FDG uptake on left liver lobe, segment 2, approximately 1,5 cm in diameter was detected. Histopathological examination revealed HCC in larger mass lesion with lower FDG uptake and cholangiocellular carcinoma (CCC) in smaller mass lesion with higher FDG uptake. To our knowledge, this is the first case reporting two histopathologically different primary malignant liver tumor in two distinct segments of liver, detected with PET/CT.