INTRODUCTION: The diagnosis of hepatopulmonary syndrome (HPS) which is a common complication in cirrhosis patients is still subject to debate. This study investigated the association of clinical findings with hepatopulmonary syndrome in cirrhotic patients using macro-aggregated albumin lung perfusion scan ( 99mTc-MAA lung scintigraphy). In addition, comparison between 99mTc-MAA lung scintigraphy and contrast echocardiography comparison (CEE) in detection of HPS was also performed.
METHODS: In this study, 27 patients with cirrhosis underwent 99mTc-MAA lung scintigraphy and contrast echocardiography comparison (CEE) and the frequency of HPS was assessed in them and also was compared across the other variables.
RESULTS: The 99mTc-MAA lung scintigraphy showed HPS in 13 patients (48.1%) while CEE demonstrated HPS in 5 patients with HPS (18.51%). HPS was mild in 84.61% (11/27) of the patients, and severe in only 2 patient. There was no any relationship between gender, disease duration, disease past history, pulmonary symptoms and child score variations and HPS (p>0.05). Comparison of hemodynamic indices, arterial blood gas (ABG) analysis and laboratory indices between patients with and without HPS were also nonsignificant (p value >0.05). Between coagulation factors assessed in cirrhotic patients, we found only significant (P<0.05) correlation between HPS and Prothrombin Time(PTT).
DISCUSSION AND CONCLUSION: Hepatopulmonary syndrome particularly mild form is noted in a great number of patients with cirrhosis using 99mTc-MAA lung scintigraphy. Because of its technical ease, and possibility to obtain objective quantitative information, 99mTc-MAA lung scintigraphy can be complementary to other diagnostic methods in the evaluation of hepatopulmonary syndrome assessment, although additional studies are needed.

INTRODUCTION: The role of gastroesophageal reflux disease (GERD) in the aetiology of laryngopharyngeal reflux (LPR) is poorly understood and remains a controversial issue. 24-hour impedance monitoring has shown promise in the evaluation of LPR but is problematic in pharyngeal recording. We have shown the utility of scintigraphic studies in the detection of LPR and lung aspiration of refluxate. Correlative studies were obtained in patients with a strong history of LPR and severe GERD.
METHODS: A highly selected sequential cohort of patients with a high pre-test probability of LPR/ severe GERD who had failed maximal medical therapy were studied by 24-hour impedance/ pH, manometry and scintigraphic reflux studies.
RESULTS: The study group comprised 34 patients (15M, 19F) with a mean age of 56 years (Range: 28-80 years). The majority had LPR symptoms (mainly cough) in 31 and severe GERD in 3. Impedance bolus clearance and pH studies were abnormal in all patients in the upright and supine position. A high rate of non-acid GERD was detected by impedance monitoring. Lower oesophageal sphincter tone and ineffective oesophageal clearance was found in the majority of patients. Scintigraphic studies showed strong correlations with impedance, pH and manometric abnormalities, with 10 patients showing pulmonary aspiration.
DISCUSSION AND CONCLUSION: Scintigraphic studies appear to be a good screening test for LPR and pulmonary aspiration as there is direct visualisation of tracer at these sites. Impedance studies highlight the importance of non-acidic reflux and bolus clearance in the causation of cough and may allow the development of a risk profile for pulmonary aspiration of refluxate.

GİRİŞ ve AMAÇ: Kolorektal kanserde KRAS mutasyonu ve tümörün lokalizasyonu ile ilişkili prognostik etki tartışmalı bir konudur. Bu nedenle 18F-FDG PET / BT görüntülemede FDG tutulum paterni ile kolon kanseri tanısı almış hastalarda KRAS mutasyonu ve tümör lokalizasyonu arasındaki ilişkiyi değerlendirdik. Bu üç faktörün prognoz ve sağkalım üzerindeki etkilerini değerlendirdi.
YÖNTEM ve GEREÇLER: Kolorektal kanser tanılı 83 hasta retrospektif olarak bu çalışmaya dahil edildi. Tedavi öncesi evreleme 18F-FDG PET / BT çalışması yapıldı. Primer tümöre ait ortalama SUVmax ve sağkalım verileri gruplar arasında karşılaştırıldı. KRAS mutasyonları, parafine gömülü tümör dokusu bloklarından ekstrakte edilen genomik DNA ile gerçek zamanlı PCR tekniği ile tespit edildi. Potansiyel KRAS mutasyonları olan tümöral lezyonlar mutant KRAS ve wild tip olarak sınıflandırıldı.

BULGULAR: Olguların 25’i kadın, 58’i erkekti. Hastaların yaş ortalaması 59.8 ± 11.3 idi. Ortalama takip süresi 35.5 ± 18.9 aydı. Primer tümör hastaların % 83.1'inde sol kolonda ve % 16.9'unda sağ kolonda lokalize idi. KRAS mutasyonu % 54.2 (n = 45) hastada tespit edildi.
Primer tümör ortalama SUVmax 21.1 ± 9.1 (Dağılım aralığı = 6.0-47.5) olarak hesaplandı. KRAS mutasyonu olan hastaların ortalama tümör SUV max'ı (24.0 ± 9.0), KRAS mutasyonu olmayanlara (17.7 ± 8.2) göre anlamlı derecede yüksek bulundu (p=0.001)
Ortalama sağkalım, lokorejyonel nodal metastazı olan hastalarda, lokorejyonel nodal metastazı olmayanlarda olduğu kadar uzak nodal metastazı olan hastalarda da, uzak nodal metastazı olmayanlarda ve organ metastazı olmayanlarda, evreleme amaçlı PET / BT'de organ metastazı olmayanlardan anlamlı olarak daha kısaydı.
Ayrıca, ortalama sağkalım sol kolonda lokalize tümörü bulunan hastalarda (34.2 ± 19.4) sağ kolondan (43.2 ± 14.6) istatistiksel olarak anlamlı derecede kısaydı (p = 0.059). Ancak KRAS mutasyonunun sağkalım üzerinde anlamlı bir etkisi olmadığı belirlendi.

TARTIŞMA ve SONUÇ: Çalışmamızda, kolon tümörü lokalizasyonunun prognoz üzerinde anlamlı bir etkisinin olmadığını bulduk. Öte yandan, FDG tutulumunun KRAS mutasyonu varlığında daha yüksek olduğu gözlendi ve KRAS mutasyonunun yüksek SUVmax ile birlikteliğinin negatif prognostik bir faktör olduğu sonucuna varıldı.

INTRODUCTION: KRAS mutation and tumor-side associated prognostic effect in colorectal cancer is highly controversial subject. We evaluated the association between FDG uptake pattern in 18F-FDG PET/CT imaging and KRAS mutation and tumor localization in patients with a diagnosis of colon cancer and assessed the effects of these three factors on prognosis and survival.
METHODS: Eighty-three patients with colorectal cancer were retrospectively included in this study. 18F-FDG PET/CT study was performed for pretreatment staging. The maximum standardized uptake value (SUVmax) of the primary tumor and survival data of patients were compared between groups. KRAS mutations were detected with the help of real-time Polymerase Chain Reaction (PCR) technique through genomic DNA extracted from paraffin-embedded tumor tissue blocks. Tumor lesions with potential KRAS mutations were classified as mutant KRAS and wild.
RESULTS: 25 patients were female, 58 were male. Mean age 59.8±11.3. Mean follow-up 35.5±18.9 months. Primary tumor localized in the left colon in 83.1% and in the right colon in 16.9%. KRAS mutation detected in 54.2% (n=45). Mean SUVmax of primary tumor 21.1±9.1 (Range = 6.0-47.5). Mean tumor SUVmax with KRAS mutation (24.0±9.0) was found significantly higher than those without KRAS mutation (17.7±8.2) (p=0.001). Mean survival was significantly shorter in patients with locoregional nodal metastasis than without.As well as with distant nodal metastasis than without distant nodal metastasis and in patients with organ metastasis in i without organ metastasis. Mean survival was nearly statistically-significantly shorter with tumors located to left colon (34.2±19.4) than in right colon (43.2±14.6) (p=0.059). However, we found no significant impact of KRAS mutation on survival.
DISCUSSION AND CONCLUSION: We found that tumor localization had no significant effect on prognosis with colon cancer. FDG uptake was observed to be higher in the presence of KRAS mutation and it was concluded that coexistence of KRAS mutation with higher SUVmax is a negative prognostic factor.

GİRİŞ ve AMAÇ: Bu çalışmanın amacı primer tümörlerde ve metastatik lezyonlarda 18F-FDG tutulum paternlerini değerlendirmek ve ayrıca mide kanserinin (MK) evrelemesinde PET / BT' nin tanısal katkısını değerlendirmektir.
YÖNTEM ve GEREÇLER: Çalışmaya toplam 341 MK hastası dahil edildi. Primer evreleme 18F-FDG PET / BT görüntüleme ile yapıldı.18F-FDG PET / BT görüntülemeden elde edilen primer tümöre ait SUVmax MK alt tipleri arasında karşılaştırıldı.
BULGULAR: 339 hastaya ait primer tümörün ortalama SUVmax değeri 12.9 ± 8.6 idi. En yüksek ortalama SUVmax, medüller alt tip MK' li hastalarda (17.8 ± 9.9), en düşük ortalama SUVmax (9.7 ± 7.6), Taşlı Yüzük Hücreli Mide Kanseri’ nde (TYHMK) görüldü.
Ortalama SUVmax, AK (adenokarsinom) grubunda TYHMK grubundan istatistiksel olarak daha yüksek bulundu (p <0.001).
Daha yüksek SUVmax değerleri, AK'li hastalarda ileri yaşla (yaş ≥60) ve artan tümör büyüklüğü (> 3 cm) ile istatistiksel olarak anlamlı derecede ilişkili bulundu (p = 0.03) Primer tümör SUVmax, bölgesel lenf nodu (RLN) pozitif olan hastalarda AK ve TYHMK gruplarındaki RLN negatiflerden anlamlı olarak yüksek bulundu (p <0.001, p = 0.012, sırasıyla). Ayrıca, TYHMK 'li hastalarda, uzak metastatik grupta SUVmax, metastazı olmayan gruba göre anlamlı derecede yüksekti (p = 0.025).

TARTIŞMA ve SONUÇ: Primer tümör SUVmax’ı yüksek AK'li hastalarda yaş ve RLN metastazı gibi bazı klinik parametrelerle ilişkilendirildi. Bununla birlikte, AK'de uzak metastatik durum ile primer tümör 18F-FDG tutulumu arasında ilişki bulunmadı. Bununla birlikte, TYHMK 'deki primer tümörün yüksek SUVmax'ı, bölgesel ve uzak metastaz ile ilişkiliydi ve primer tümörün 18F-FDG tutulumu, bu alt grup için prognostik bir değeri olabileceğini düşünmekteyiz.

INTRODUCTION: The aim of this study was to evaluate 18F-FDG uptake patterns in primary tumors and metastatic lesions, and also to assess the diagnostic contribution of PET/CT in the initial staging of gastric cancer (GC).


METHODS: The total number of 341 GC patients were included in this study. All 18F-FDG PET/CT imagings were performed for initial staging. The SUVmax of primary tumor, obtained from 18F-FDG PET/CT imaging were compared between subtypes of GC.
RESULTS: Mean SUVmax of 339 patients’ primary tumor was 12.9±8.6. The highest mean SUVmax was detected in patients with medullary subtype GC (17.8±9.9) while the lowest mean SUVmax (9.7±7.6) seen in Signet Ring Cell Carcinoma (SRCC). The primary mean SUVmax was found statistically higher in AC (adenocarcinoma) group than SRCC group (p<0.001). Higher SUVmax values were found statistiacally significantly correlated with advanced age (aged ≥60) and increased tumor size (>3 cm) in patients with AC (p=0.03). Primary tumor SUVmax was found statistically higher in patients with regional lymph node (RLN) positive patients than RLN negative’s in AC and SRCC groups (p<0.001, p=0.012, respectivelly). Also, in patients with SRCC, SUVmax was significantly higher in the distant metastatic group than the group without metastasis (p=0.025).
DISCUSSION AND CONCLUSION: Conclusions: Increased primary tumor SUVmax was associated with some of clinical parameters such as age and RLN metastasis in patients with AC. However, there was no relationship between distant metastatic state and primary tumor 18F-FDG uptake in AC. However, high SUVmax of primary tumor in SRRC was associated with regional and distant metastasis, and primary tumor 18F-FDG uptake may be a prognostic value for this subgroup.

Son dönem böbrek hastalığı nedeni ile 15 yıldır hemodiyalize giren, tersiyer hiperparatiroidi ve osteoporozu bulunan 55 yaşında bir kadın hastayı sunuyoruz. Hastanın boyun ultrasonografisinde multinodüer guatr ve paratiroid adenomu ile uyumlu olan hipoekoik bir lezyon saptandı. Dual faz Tc-99m MIBI SPECT, dört paratiroid bezi lokaliazsyonunda patolojik tutulum gösterdi. Total tiroidektomi ve subtotal paratiroidektomi sonucu tiroid bezinde nodüler hiperplazi ve 4 paratiroid bezinde atipik paratiroid adenomu ile uyumlu geldi. Atipik paratiroid adenomu nadir görülen bir klinik antitedir. Multipl atipik paratiroid adenomu daha da az sıklıkla görülür. Bu olguda, dört atipik paratiroid adenomunun dual faz Tc-99m MIBI SPECT ile saptandığı çok nadir bir durumu sunuyoruz.

We report a case of a 55 years old female patient with tertiary hyperparathyroidism and osteoporosis who had end stage renal disease and a history of hemodialysis for 15 years. Neck ultrasonography showed multinodular goiter together with a hypoechoic lesion compatible with a parathyroid adenoma. Dual phase Tc-99m MIBI SPECT showed pathological uptake on four parathyroid gland locations. Total thyroidectomy and subtotal parathyroidectomy revealed nodular hyperplasia of the thyroid and atypical adenoma of four parathyroid glands. Atypical parathyroid adenoma is a rare clinical entity. Multiple atypical adenomas are even less frequent. A very rare condition, detection of atypical adenomas in four of the parathyroid glands by dual phase Tc-99m MIBI SPECT, is presented in this case.

Yirmi üç yaşında erkek hasta böbrek yetmezliği ile diyaliz için hastanemize yönlendirilmiştir. Hastanın ultrasonografisinde tesadüfen saptanan intraabdominal kitle lezyonunun metabolik karaktezirasyonu için yapılan F-18 FDG PET/BT çalışmasında hipermetabolik kitle izlenmiş olup kitlenin biyopsisi amiloidosis ile uyumlu olarak bulunmuştur. Bilgilerimize göre, bu vaka ile, dev amiloid kitlesi ile başvuran bir hastanın F-18 FDG PET/BT görüntüleri literatürde ilk kez sunulmaktadır.

Twenty three years old male patient who presented with impaired kidney function tests attended the hospital for hemodialysis underwent F-18 FDG PET/CT examination for the metabolic characterization of the intraabdominal mass which was found in the ultrasonography. F-18 FDG PET/CT revealed a mass lesion adjacent to the liver which was hypermetabolic and the pathology of the lesion determined amyloidosis. To the best of our knowledge, the case with F-18 FDG PET/CT images of a huge amyloid mass is going to be the first in the literature.

Kanser tanısının artmasıyla birlikte tanı ve evreleme için görüntüleme yöntemlerinin kullanım sıklığı da artmaktadır. Kanserin ve tümör davranışının karmaşık yapısından dolayı değerlendirme yöntemleri güncellenmiştir ve metabolik görüntüleme ağırlık kazanmıştır. Bu tekniklerin en popüler olanı hibrid pozitron emisyon tomografi (PET / CT, PET / MR) sistemleridir. Prostat kanseri dünyada en sık görülen ikinci kanser ve erkeklerde kanserle ilgili ölüm nedenleri arasında beşinci en sık nedendir. Kemik metastazı, prostat kanserinde morbidite ve mortalite açısından prognostik bir faktördür. NaF PET / CT, iskelet sisteminin değerlendirilmesinde umut verici bir görüntüleme yöntemidir. Bu makale F18 NaF'in prostat kanserinde kemik dışı dokulardaki tutulumunu gözden geçirecek ve bu alanlarda F18 NaF görüntüleme ve F18 FDG görüntülemenin temel farklılıklarını ortaya koyacaktır

With the increase of the cancer diagnosis, the frequency of using imaging methods for diagnosis and for staging is also increased. Because of the complex structure of cancer and tumor behavior the assessment methods have been updated and metabolic imaging has gained weight. The most popular of these techniques are hybrid positron emission tomography (PET/CT, PET/MR) systems.
Prostate cancer is the second most common cancer in the world, is the fifth common type in cancer-related male deaths. Estimation of prognosis and treatment planning of the patients is based on the TNM classification. Bone metastasis is a prognostic factor in prostate cancer for morbidity and mortality. NaF PET/CT is a promising imaging modality on evaluate skeletal system. This article will review the involvement of F18 NaF in extra osseous tissues in the prostate cancer and reveal the fundamental differences of F18 NaF imaging and F18 FDG imaging in these areas

A 57-year-old male with history of thalassemia intermedia and hepatocellular carcinoma underwent a PET/CT scan with 18F-choline before radioembolization procedure with 90Y-microspheres. 18F-choline demonstrated highly increased tracer incorporation within a gross lesion in the hepatic dome coupled with diffuse activity in bone marrow, this latter aspect probably due to the compensatory hematopoiesis stimulation induced by chronic hemolysis. This pattern of skeletal 18F-choline uptake should be considered as a peculiar PET/CT finding in thalassemic patients.