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Öğe Diffusely Increased Splenic Fluorodeoxyglucose Uptake in Lung Cancer Patients(Bilimsel Tip Publishing House, 2017) Aktas, Gul Ege; Sarikaya, Ali; Demir, Selin SoyluogluOBJECTIVES: This study aimed to investigate the association of diffuse splenic F-18 fluorodeoxyglucose (FDG) uptake on positron emission tomography/computed tomography (PET/CT) with tumor maximum standardized uptake value (SUVmax), presence of distant metastases, and hematological and inflammatory parameters. MATERIAL AND METHODS: Initial FDG PET/CT of 15 lung cancer patients with diffuse splenic FDG uptake were retrospectively analyzed (Group 1). Twelve patients who recently underwent FDG PET/CT for histopathologically proven lung cancer were enrolled as the control group (Group 2). All 27 patients had hematological data, including C-reactive protein (CRP) level, within 5 days before or after PET/CT. To determine SUVmax, the region of interests included the tumor, liver, spleen, and iliac crest. The possible associations between the spleen/liver (S/L) and bone marrow/liver (BM/L) ratios and tumor SUVmax, presence of metastasis, and hematological parameters were evaluated. RESULTS: The S/L ratio and hemoglobin (Hb) levels were different between the two groups (p=0.000 and 0.05, respectively). The number of patients with anemia were significantly higher in Group 1 than in Group 2 (p=0.02). Although mean Hb levels were different between the two groups, there was no correlation between Hb levels and S/L ratios. There was no significant difference between the two groups with respect to the numbers of patients who had an accompanying infection site. Only CRP levels were correlated with S/L ratios in Group 1 among various other parameters (r=0.559, p=0.05). CONCLUSION: Our results suggested that inflammation degree correlated with increased splenic FDG uptake in lung cancer patients and was enhanced by anemia. Systemic inflammation and anemia could be important causes of diffusely increased splenic FDG accumulation on PET/CT examinations of lung cancer patients.Öğe Ectopic Pelvic Kidney Mimicking Sacral Metastasis on Post-Therapy Iodine-131 Scan of a Thyroid Cancer Patient(Galenos Yayincilik, 2017) Demir, Selin Soyluoglu; Aktas, Gul Ege; Polat, Ahmet; Sarikaya, AliA 25-year-old woman had total thyroidectomy and iodine-131 ablation therapy for papillary thyroid carcinoma. Whole body imaging on the 7th day of therapeutic activity demonstrated radioiodine uptake in the remnant tissue and intense heterogeneous uptake at the sacral region prominently in the posterior image. Initial interpretation was suspicious for sacral metastasis. Technetium-99m-methylene diphosphonate 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 suggestive of pelvic kidney were noticed. Magnetic resonance imaging scan confirmed the ectopic pelvic kidney overlying the sacrum.Öğe F-18 FDG PET/BT'de malign hastalığı taklit eden sarkoidoza bağlı FDG tutulumları: 7 hastanın değerlendirilmesi(2016) Altıay, Gündeniz; Aktaş, Gül Ege; Demir, Selin Soyluoglu; Sarıkaya, AliGiriş: Bu çalışmada akciğerde şüpheli lezyon ve mediastinal lenfadenopati nedeniyle kliniğimiz Pozitron Emisyon Tomografisi / Bilgisayarlı Tomografi (PET/BT) ünitesine refere edilen ve biyopsi sonucunda sarkoidoz tanısı alan hastaların genel ve ortak özellikleri değerlendirilerek, PET/BT'nin sarkoidoz tanısına katkısının belirlenmesi ve bulguların literatürle karşılaştırılması amaçlandı. Gereç ve Yöntemler: Ocak 2010 ile Haziran 2014 tarihleri arasında akciğerde kitle araştırması nedeniyle kliniğimize refere edilmiş ve PET/BT'si çekilmiş daha sonra son tanıları sarkoidoz olarak belirlenmiş yedi hastanın özellikleri retrospektif olarak incelendi. Bulgular: İncelenen yedi hastanın tümünde bilateral mediastinal lenf nodu pozitifliği, altı hastada multipl pulmoner parankim lezyonu saptandı. Üç hastada ekstratorasik lenf nodu tutulumu izlendi. Karaciğer tutulumu görülen iki hastadan birinde fokal nodüler, diğerinde diffüz tutulum saptandı. Dalak tutulumu izlenen üç hastanın birinde multipl nodüler görünüm, diğer ikisinde diffüz tutulum paterni mevcuttu. İki hastada kemik tutulumu saptandı. İncelenen yedi hastanın torasik veya ekstratorasik tüm vücuttaki lezyonlarına bakıldığında SUVmaks aralığı 3,2-20,7 (median: 6,9) idi. Sonuç: Akciğerle beraber ekstratorasik lenfadenopati bulguları, karaciğer ve dalak tutulumu, öncelikle akciğer malignitesi şüphesi ile gönderilmiş olan olgularda granülomatöz hastalık ayırıcı tanısı akla gelmesi açısından FDG PET/BT'nin tanı aşamasındaki yararıdır. PET/BT kolay ulaşılabilir biyopsi yeri belirlenmesi açısından özellikle yaygın hastalık olgularında oldukça yararlıdır. Hastalığın tanı anındaki metabolik aktifliği ve yaygınlığı tüm vücut değerlendirme ile yüksek doğrulukla belirlenebilmektedir. PET/BT'nin sarkoidozda tedavi takibi, kronik hastalıkta aktifleşen odakların belirlenmesi ve biyopsi yeri tayini gibi pek çok avantajının kabul edilmesine rağmen rutin uygulamada henüz yeri kesinleşmemiştir. Algoritmalarda yerini alabilmesi için iyi düzenlenmiş, prospektif klinik çalışmalara ihtiyaç vardır.Öğe F-18 FDG PET/CT in primary and metastatic pleural involvement(2017) Aktaş, Gül Ege; Demir, Selin Soyluoglu; Sarıkaya, AliAim: The aim was to determine the contribution of FDG PET/CT to differential diagnosis of pleural involvements.Material and Methods: Images of the patients who were refereed for PET/CT evaluation with suspicion of mesothelioma were respectively analysed. They were classified according to final histopathologic diagnosis. Involvement patterns, SUVmax of the lesions, mediastinal and extrathoracic lymph node, peritoneum involvement, distant metastasis were evaluated.Results: Findings of 25 patients were analysed. According to final diagnosis; eight patients were mesothelioma, 9 patients were lung cancer, a patient was colon cancer, other 2 patients were diagnosed as renal cell cancer and metastasis of lymphoma. In 5patients; involvements were inflammatory. SUV max values of inflammatory cases (5.6±2.4) and cases with malign involvement (9.1±2.3) and pleural involvement patterns of benign and malignant cases were significantly different (p=0.001, p=0,01). SUV max of mesotheliomas, metastatic lesions were not statistically different (p=0.367). There were no significant differences between the pleural involvement patterns of pleural mesothelioma and metastatic pleural involvements (p=0,14). Mediastinal LAP’s were detected in 8 metastatic and in 6 mesothelioma cases. There was not any mediastinal LAP in benign cases. Peritoneal involvement was determined in 8 patients with pleural metastases, in 4 patients with mesothelioma. Bone marrow involvement, chest wall invasion was determined in one each mesothelioma cases. Contralateral lung lesion was determined in 1 metastatic patient. Invasion of chest wall was seen in 2, bone marrow involvement in 1, bone metastasis was detected in 4 patients. Two patients with metastatic involvement had hepatic metastasis, 4 had surrenal metastasis.Conclusion: SUV max values of benign lesions were significantly lower than malign involvements. Involvement patterns could be useful for differentiating benign from malign pleural involvements, when evaluated together with the SUVmax. There was not any difference between mesothelioma and metastatic involvements according to patterns, SUVmax values. PET/CT could determine the thoracic/extra-thoracic primary tumor. This would reduce the burden, cost of diagnostic process. Whole-body evaluation contributes a more accurate staging of malignant cases.Öğe Incidental Detection of Subcutaneous Myopericytoma of Trunk on FDG PET/CT and Bone Scintigraphy for Imaging of Colon Cancer(Lippincott Williams & Wilkins, 2016) Demir, Selin Soyluoglu; Sarikaya, Ali; Aktas, Gul Ege; Puyan, Fulya Oz[Abstract Not Available]Öğe Microcalcified Hepatic Metastases Incidentally Detected on F-18 NaF PET/CT in a Patient with Prostate Cancer(Springer Heidelberg, 2017) Aktas, Gul Ege; Sarikaya, Ali; Can, Nuray; Demir, Selin SoyluogluF-18 NaF PET/CT evaluation has gained importance in recent years. Achievements from F-18 NaF PET/CT are: higher sensitivity of positron imaging, higher target background ratio with higher tracer accumulation in bone hydroxyapatite and higher specificity through CT correlation. These properties have also given directions to new research fields based on imaging microcalcifications, very recently. A limited number of cases have reported the F-18 NaF uptake in macrocalcified soft tissue metastases. Although the presence of microcalcification was not proved; accumulation of F-18 NaF in the metastatic brain lesion with no visible calcification on the CT, in a patient with ductal breast carcinoma has also been reported. Herein we present a patient with microcalcified hepatic metastasis of prostate cancer incidentally detected on F-18 NaF PET/CT which was confirmed with histochemical staining.Öğe Pre-therapy Iodine-131 Uptake Value as a Prediction Method for Metastatic Lymph Node Status in Patients with Differentiated Thyroid Carcinoma(Bentham Science Publ Ltd, 2017) Aktas, Gul Ege; Demir, Selin Soyluoglu; Ustun, Funda; Sarikaya, Ali; Altun, Gulay DurmusBackground: We hypothesized that postoperative lymph node status would affect I-131 uptake (RIU) due to pathophysiological behavior of benign and malign thyroidal tissue. This retrospective study was designed to assess whether RIU would predict the presence of lymph node metastasis (LNM). Methods: Data for differentiated thyroid cancer patients who received postoperative I-131 therapy at our institution between 2013 and 2016 were reviewed. Age, histopathology, TSH, Tg, anti-Tg, 2 and 24 hour RIU (2-24RIU), ultrasonography, I-131 dose, scans were reviewed. Patients were divided into groups according to lymph node status. The Delta RIU was calculated (Delta RIU=24RIU-2RIU) to define different metabolic behavior of I-131. Patients were grouped according to Delta RIU to assess the sensitivity, specificity, negative/positive predictive values, accuracy of Delta RIU predicting LNM. Results: 198 patients (38 males/160 females, age: 47 +/- 14 years) who received mean: 118 +/- 27 mCi I-131 were enrolled in the study. There was no difference between ages, TSH level, 2RIU values and the I-131 therapy dose of patients with and without LNM. Tg, anti-Tg, 24RIU, Delta RIU values were higher in patients with LNM. Patients with Delta RIU >= 1% had higher Tg values (mean +/- std: 16.63 +/- 46.53 vs. 6.70 +/- 31.18, p: 0.04). When Delta RIU >= 1% was used for predicting LNM, sensitivity, specificity, positive, negative predictive values, diagnostic accuracy were, 66%, 72%, 64%, 74 %, and 70% respectively. Conclusion: RIU was evaluated to predict neck LN status in this study. The sensitivity and specificity were comparable with modalities which are commonly used for determination of LNM. In light of the results of this study, when a pre-therapy RIU increase in time is observed, carrying out further investigation protocols for LNM, would contribute to pre-therapy staging.Öğe Primary Pulmonary Lymphoepithelioma-like Carcinoma on FDG PET/CT(Springer Heidelberg, 2017) Aktas, Gul Ege; Can, Nuray; Demir, Selin Soyluoglu; Sarikaya, AliA 69-year-old male smoker was referred to F-18-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) with the indication of a suspicious solitary pulmonary nodule. FDG PET/CT determined a 2.5 x 2-cm soft-tissue lesion (SUVmax, 16.2) with spiculated margins in the hilum of the right lung. A 1-cm diameter lymphadenopathy on the right hilum with an SUVmax of 3.2 was also determined. Transbronchial biopsy of the right hilar lymphadenopathy did not reveal any malignant features in histopathologic examination, and it was determined to be reactive. The patient underwent a right upper lobe segmentectomy, and the histopathologic evaluation revealed that the tumor was a primary lymphoepithelioma-like carcinoma (LELC) of the lung with negative Epstein-Barr virus (EBV) on in situ hybridization studies. In this case report, we mainly focus on the FDG avidity of this very rare kind of tumor comparatively with previous reports and possible explanations of discordancy in FDG avidity in relation to histopathologic characteristics.Öğe Splenic infarction as a pitfall on labeled red blood cell imaging(Medknow Publications & Media Pvt Ltd, 2016) Aktas, Gul Ege; Demir, Selin Soyluoglu; Genchellac, Hakan; Sarikaya, AliPatient with a history of overt gastrointestinal bleeding, diabetes mellitus, hypertension, polycythemia vera, and choledocojejunostomy was hospitalized because of hematemesis and melena. An area of Technetium-99m labeled red blood cells accumulation at the splenic flexure similar to an overt bleeding area, was observed on gastrointestinal bleeding scintigraphy (GIBS). In case of underlying malignancy, abdominal computed tomography was performed and demonstrated the infarction area placed laterally in spleen, appearing as a cold region on sctintigraphic image, separating the inferomedial and upper part of splenic uptake. Splenic variants and pathologies can complicate interpretation of GIBS.
