OBJECTIVE: Using radioactive iodine (RAI) as first line therapy for Graves’ hyperthyroidism and as the treatment of choice for relapsed Graves’ disease is increasing in recent times. However, there has been little consensus on the most appropriate dose to use.
So this study is to determine the response of hyperthyroidism to fixed doses of 370 MBq and 555 MBq RAI therapies and determine the incidence of hypothyroidism at 6months post therapy.

METHODS: Hyperthyroid patients’ case records treated with radioiodine to determine response rate of hyperthyroidism to the two fixed dose regimens was retrospectively reviewed. Statistical analysis was with SPSS version 15.0. And the level of statistical significance was taken as P < 0.05.
Forty subjects, 6 males (15%) and 34 females (85%) received RAI therapy for Graves’ hyperthyroidism, mean age 49.4 years (range, 25-75years). The thyroid function status at 6months post therapy was available for all subjects. 24 patients (60%) received 370 MBq while 16 patients (40%) received 555 MBq.

RESULTS: The response for fixed doses of 370 MBq and 555 MBq were similar (100%). Also, the incidence of hypothyroidism in these subjects was 66.6% with fixed dose of 370 MBq and 62.5% with fixed dose of 555 MBq within 6months post RAI therapy were similar.
CONCLUSION: RAI is highly effective for the treatment of hyperthyroidism, with a cure rate of 100%. However, it has proved impossible to determine a fixed dose regimen for individual patients accurately to guarantee a euthyroid state. This is because hypothyroidism is a natural predictable sequel of RAI therapy.

OBJECTIVE: The aim of this study is to investigate the presence of pyramidal lobe in thyroid scintigraphy and to compare the presence of pyramidal lobe in different thyroid pathologies between genders.
METHODS: Images of 866 patients (663 female, 203 male) with ages ranging from 8 to 85 were evaluated retrospectively. Presence of pyramidal lobe and its location were established in images. Patients were divided into groups in terms of gender, nodular/diffuse goiter presence, and thyroid function test results, and their rates of the presence of pyramidal lobe and whether a significant difference existed between the groups were estimated.
RESULTS: Of the 866 patients, 156 (18%) had pyramidal lobe observed in scintigraphy image. Hundred and 26 (81%) of patients observed to have pyramidal lobe were female and 30 (19%) were male. Pyramidal lob stemmed from the left lobe in 76 (48%) patients, right lobe in 61 (40%) patients, and isthmus in 19 (12%) patients. Pyramidal lobe observation rate was 18% for euthyroidism and hyperthyroidism, it was established as 12% for hypothyroidism. The rate of pyramidal lobe observation was 13% in nodular goiter patients, 43% in diffuse goiter patients, and 20% in patients whose scintigraphy showed normal thyroid glands. In the statistical evaluation, rate of pyramidal lobe in diffuse goiter patients was found to be significantly higher compared to other patients (P<0.001).
CONCLUSION: Preoperative imaging of pyramidal lobe especially in patients needing total thyroidectomy would decrease relapses that may occur later and thus facilitate the treatment and monitoring of patients.

OBJECTIVE: End-stage chronic liver disease (CLD) adversely affects the function of multiple organ systems including the skeletal system. The aim of this study was to assess osseous and nonosseous bone scintigraphy (BS) findings in liver transplant (LT) candidates with end-stage CLD.
METHODS: We retrospectively evaluated BS findings in 50 consecutive patients with end-stage CLD who were undergoing preoperative assessment for LT from January 2006 to December 2011. All the patients were analyzed with respect to clinical and laboratory parameters, and BS findings. Scintigrams were visually assessed for the presence of osseous and nonosseous abnormalities. Osseous abnormalities were classified as those indicating bone metabolism changes or metastatic bone disease. Typical scintigraphic findings denoting to changes in bone metabolism were the presence of decreased osseous uptake, increased periarticular uptake, asymmetrical or unusual uptake patterns. Nonosseous findings were classified according to the degree of soft-tissue uptake as mild and severe.
RESULTS: The group consisted of 46 adult and 4 adolescent patients. All adolescent patients had normal skeletal accumulation with growth plate uptake and 1 had mildly increased renal cortical activity. A total of 46 adult patients had one or more of the following osseous findings: generalized decrease in osseous uptake (n=4, 8.7%); bilateral decrease in lower extremity uptake (n=26, 56.5%); symmetrically increased periarticular uptake (n=26, 56.5%); bilateral cortical/periosteal increased uptake in the lower extremity indicating hepatic hypertrophic osteoarthropathy (HOA) (n=8, 17.4%); bilateral increased sacroiliac activity (n=16, 34.8%); sacral activity (n=10, 21.7%), coccygeal activity (n=2, 4.3%), focally increased uptake suggestive of metastases (n=5, 10.9%). Three rib metastases appeared to be linear. Nonosseous findings observed in adult patients were mild diffuse liver uptake (n=4, 8.7%) and bilateral diffuse mild or severe degree of renal cortical uptake (n=20, 43.5%). There was a statistically significant difference in serum creatinine values between mild and severe renal uptake groups (p<0.05). There was also statistically significant difference in serum BUN and creatinine values between patients with severe degree of renal uptake and without renal uptake (p<0.05).
CONCLUSION: The results of the current study has shown that adolescent LT candidates with end-stage CLD had no osseous abnormality on BS. However, all of adult patients exhibit one or one more osseous abnormalities. Typical scintigraphic findings denoting to abnormalities in bone metabolism were generalized decreased osseous uptake, decreased lower extremity osseous uptake, increased periarticular uptake, and other unusual uptake patterns as increased cortical/periosteal uptake indicating hepatic HOA. Hepatocellular carcinoma metastases may present itself as rib metastases linear in pattern. Soft-tissue uptake in the form of diffuse bilateral mild or severe degree of renal uptake and less commonly mild diffuse liver uptake can be observed. Increased renal uptake may be an early marker of renal dysfuntion or a predictor of hepatorenal syndrome.

OBJECTIVE: To assess the efficacy of high-resolution magnetic resonance imaging (HRMRI) for preoperative local staging in patients with rectal cancer who did not receive preoperative radiochemotherapy.
METHODS: In this retrospective study, 30 patients with biopsy proved primary rectal cancer were evaluated by HRMRI. Two observers independently scored the tumour and lymph node stages, and circumferential resection margin (CRM) involvement. The sensitivity, specificity, the negative predictive value and the positive predictive value of HRMRI findings were calculated within the 95% confidence interval. The area under the curve was measured for each result. Agreement between two observers was assessed by means of the Kappa test.
RESULTS: : In T staging the accuracy rate of HRMRI was 47-67%, overstaging was 10-21%, and understaging was 13-43%. In the prediction of extramural invasion with HRMRI, the sensitivity was 79-89%, the specificity was 72-100%, the PPV was 85-100%, the NPV was 73-86%, and the area under the curve was 0.81-0.89. In the prediction of lymph node metastasis, the sensitivity was 58-58%, the specificity was 50-55%, the PPV was 43-46%, and the NPV was 64-66%. The area under the curve was 0.54-0.57. When the cut off value was selected as 1 mm, the sensitivity of HRMRI was 38-42%, the specificity was 73-82%, the PPV was 33-42%, and NPV was 79-81% in the prediction of the CRM involvement. The correlation between the two observers was moderate for tumour staging, substantial for lymph node staging and predicting of CRM involvement.
CONCLUSION: Preoperative HRMRI provides good predictive data for extramural invasion but poor prediction of lymph node status and CRM involvement.

OBJECTIVE: We aimed to evaluate the value of somatostatin receptor imaging (SRI) with In-111 octreotide and Ga-68 DOTATATE in localizing ectopic ACTH producing tumors.
METHODS: Nineteen patients who had In-111 octreotide somatostatin receptor scintigraphy (SRS) and/or Ga-68 DOTATATE PET-CT to localize ectopic ACTH producing tumors in between 2000 and 2012 years were included to our study retrospectively. The results of SRI were compared with clinical onset,radiological findings and surgical data of the patients.
RESULTS: Sixteen In-111 octreotide SRS and five Ga-68 DOTATATE PET-CT had been done in 19 patients. In eight out of 19 patients ectopic ACTH secretion site could be detected. In five patients, SRS showed pathologic uptake. In four of these patients, the operations revealed pulmonary carcinoid tumors and in one patient pancreatic neuroendocrine tumor. In one patient, Ga-68 DOTATATE PET-CT revealed pathologic uptake in lung nodule which came out to be pulmonary carcinoid tumor. In another patient who had resections of metastases of atypical carcinoid tumor prior to scans, new metastatic foci were detected both with SRS and Ga-68 DOTATATE PET-CT imaging. In one patient, although SRS was negative, CT which was taken three years later showed a lung nodule which was pulmonary carcinoid tumor. In 11 patients, ectopic ACTH secretion site could not be detected. In 10 of those patients, scintigraphic and radiological imagings could not show any lesions and in one patient, Ga-68 DOTATATE PET-CT was false positive.
CONCLUSION: SRI has a complementary role with radiological imagings in localizing ectopic ACTH secretion sites. PET-CT imaging with Ga-68 peptide conjugates is a promising new modality for this indication.