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    Assessing oral glucose and intravenous insulin loading protocol in18F-fluorodeoxyglucose positron emission tomography cardiac viability studies
    (Wolters Kluwer Medknow Publications, 2020) Sarikaya, Ismet; Sharma, Prem N.; Sarikaya, Ali; Elgazzar, Abdelhamid H.
    Oral glucose and intravenous insulin (G/I) loading protocols are commonly used in18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) cardiac viability studies. Although the amount of insulin to be given per blood glucose range has been well described in guidelines, the amount of glucose to be given is not detailed well. In this retrospective study, we aimed to assess if certain parameters, particularly the amount of glucose and insulin given, may affect18F-FDG uptake in the hibernating myocardium and also determine the problems with this protocol.18F-FDG PET cardiac viability study with G/I loading protocols was performed in 49 patients. Fasting blood glucose (FBG), amount of glucose given, blood glucose level after glucose load, amount of insulin given, and blood glucose level at the time of18F-FDG injection were recorded. Statistical analysis was performed to determine if there is any difference in the above values in PET viable and PET nonviable groups and also in subgroups assessing18F-FDG uptake also in normal myocardium. For G/I loading, we used our local protocol in 43 patients, and other protocols in six.18F-FDG PET showed viability in 31 patients, and it was negative for viability in 18. In 22 patients, mainly in PET viable group, there was varying degree of reduced18F-FDG uptake in normal myocardium. There was no significant difference in FBG, amount of glucose given, blood glucose level after glucose load, amount of insulin given, and blood glucose level at the time of18F-FDG injection in PET viable and PET nonviable groups and also in subgroups. The problems with G/I loading protocol included deciding on the amounts of glucose and insulin given, maximum amount of insulin to be given, handling diabetics, optimal time to measure blood glucose after insulin administration, and interpretation of findings in cases with diffusely reduced18F-FDG uptake. Further improvements in current guidelines are necessary to obtain images in optimal conditions for accurate results.
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    Can 68Ga-DOTA Peptides Be Potential Radiotracers for PET Imaging of the Spleen?
    (Soc Nuclear Medicine Inc, 2018) Sarikaya, Ismet; Elgazzar, Abdelhamid H.; Sarikaya, Ali; Alnafisi, Naheel; Alenezi, Saud
    On radionuclide somatostatin receptor imaging studies, the spleen shows high physiologic uptake. Reducing the intensity of the image settings helps to better assess the distribution of radiotracer in the spleen. In our routine studies, we incidentally recognized that Ga-68-DOTANOC PET provides higher-resolution splenic images than In-111-octreotide SPECT. Autoradiography and immunohistochemistry studies have shown that somatostatin receptors are located mainly in the red pulp of the spleen. The distribution of Ga-68-DOTANOC in the spleen appears to correlate with the distribution of red pulp. In this article, we present Ga-68-DOTANOC PET/CT spleen images of our patients.
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    Current status of F-18-FDG PET brain imaging in patients with dementia
    (Soc Nuclear Medicine Inc, 2018) Sarikaya, Ismet; Sarikaya, Ali; Elgazzar, Abdelhamid H.
    F-18-FDG PET brain imaging is commonly used in the early detection and differential diagnosis of various subtypes of dementias.F- 18-FDG PET images are mainly evaluated visually, and semiquantitative analysis programs are also commonly used in many centers. However, visual and semiquantitative analysis carry certain limitations. Visual assessment is subjective and dependent on expertise. Commercially available semiquantitative analysis programs have certain limitations such as suboptimal selection of brain areas or erroneous uptake normalization procedures that may provide inaccurate results, and physicians reporting semiquantitative results should be aware of these. In this pictorial review article, we will discuss the current status of F-18-FDG PET brain imaging in patients with dementia and present figures and semiquantitative analysis results of various sub-types of dementias as well as certain artifacts seen on F-18-FDG PET brain imaging studies.
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    Normal bone and soft tissue distribution of fluorine-18-sodium fluoride and artifacts on 18F-NaF PET/CT bone scan: a pictorial review
    (Lippincott Williams & Wilkins, 2017) Sarikaya, Ismet; Elgazzar, Abdelhamid H.; Sarikaya, Ali; Alfeeli, Mahmoud
    Fluorine-18-sodium fluoride (F-18-NaF) PET/CT is a relatively new and high-resolution bone imaging modality. Since the use of F-18-NaF PET/CT has been increasing, it is important to accurately assess the images and be aware of normal distribution and major artifacts. In this pictorial review article, we will describe the normal uptake patterns of F-18-NaF in the bone tissues, particularly in complex structures, as well as its physiologic soft tissue distribution and certain artifacts seen on F-18-NaF PET/CT images. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.