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    68Ga-PSMA-I&T-PET/CT interobserver and intraobserver agreement for prostate cancer: a lesion based and subregional comparison study among observers with different levels of experience
    (Lippincott Williams & Wilkins, 2021) Soyluoglu, Selin; Korkmaz, Ulku; Ozdemir, Busra; Ustun, Funda; Durmus-Altun, Gulay
    Objective Ga-68-PSMA-PET/CT is a relatively new technique, that is rapidly becoming widespread. We aimed to contribute interobserver-intraobserver agreement of Ga-68-PSMA-PET/CT, among low/high-experienced interpreters. Methods Ga-68-PSMA-PET/CT of 56 patients with prostate cancer were evaluated blindly by four observers. Visual interpretation of malignant disease and SUVmax for lymph node (LN) regions, local tumor, bones and visceral organs were recorded. Cohen's Kappa and Fleiss' Kappa analyses were used to measure agreement between low/high/all-experienced observers. Variations were compared for regions, and the effect of prostate-specific antigen or Gleason score on the results was investigated. Results Interobserver agreement was almost perfect for all LN regions (LN1 low-experienced kappa: 0.84/0.84, high-experienced 0.89/0.96; LN2 low-experienced kappa: 0.88/0.79, high-experienced 0.95/0.95; LN3 low-experienced kappa: 0.84/0.89, high-experienced 0.87/0.94, first/second readings, respectively) and bone lesions (low-experienced kappa: 0.88/0.88, high-experienced 0.92/0.92, first/second readings, respectively). For local tumor, interobserver agreement was substantially-almost perfect among a high-experienced group (kappa: 0.74/0.89, first/second readings, respectively), and was moderate-substantial among a low-experienced group (kappa: 0.62/0.56, first/second readings, respectively). Intraobserver agreement was almost perfect for three observers for all regions and substantial for the observer with the lowest experience in LN3, local and visceral lesions (kappa: 0.74/0.79/0.62, respectively). Conclusion Interpretation of prostate-specific membrane antigen (PSMA) for prostate cancer is acceptably consistent among observers, but some details are noteworthy. The evaluation should be done more algorithmically for local tumors, since all observers showed relatively lower agreement. The agreement increased as prostate-specific antigen and Gleason score increased. The observer with PSMA experience <30 readings showed lower reliability, distinct from the others. This indicates that although a reader may be familiar with other PET agents, a more consistent interpretation of Ga-68-PSMA-PET/CT requires training with a small number of identified cases.
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    The Diagnostic Contribution of SPECT/CT Imaging in the Assessment of Gastrointestinal Bleeding: Especially for Previously Operated Patients
    (Galenos Yayincilik, 2021) Soyluoglu, Selin; Korkmaz, Ulku; Ozdemir, Busra; Altun, Gulay Durmus
    Objectives: Gastrointestinal bleeding (GIB) is a life-threatening problem that requires a multidisciplinary approach for successful treatment. This study aims to emphasize the clinical contribution of single photon emission computed tomography/computed tomography (SPECT/CT) for the diagnosis of acute bleeding. Methods: All 14 patients referred to the nuclear medicine department in 3 years with suspicion of acute GIB were evaluated retrospectively. Clinical records were analyzed to assess the scintigraphic findings, emphasizing the correlative contribution of the CT portion on SPECT/CT studies. Results: Five patients were negative on dynamic and static planar images. SPECT/CT was performed in 9 patients who had positive findings on planar imaging. SPECT/CT could identify the same bleeding site originating from the anastomosis in four patients with a history of abdominal surgery. SPECT/CT confirmed bleeding from the cecum in a patient with cervical cancer. SPECT/CT showed the bleeding focus in the bladder neck of a patient with bladder cancer and the bleeding from peritoneal metastases of a patient with gastric cancer. In 1 patient, the right upper quadrant activity accumulation, which may cause false positives, was found to be the gallbladder on SPECT/CT. Delayed images showed the true bleeding focus in the cecum. In 1 patient, suspicious activity accumulation in the midline of the abdomen was found to be due to a previously unknown aortic aneurysm on SPECT/CT. Conclusion: SPECT/CT imaging is a feasible technique to facilitate image interpretation in patients with GIB. SPECT/CT imaging can guide the surgeon through more accurate localization. Therefore, for proper patient management, SPECT/CT should be applied to detect the bleeding focus, if present, especially in patients who had undergone a previous operation.
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    PET/CT for Early Detection of COVID-19 Pneumonia: Diffuse Fluorodeoxyglucose Uptake in the Lungs without any Additional Changes in a Patient with Breast Cancer
    (Galenos Yayincilik, 2021) Ozdemir, Busra; Gunay, Burak; Karabulut, Derya; Altun, Gulay Durmus
    Coronavirus disease-2019 (COVID-19), which causes infections in the upper and lower respiratory tract, became a pandemic shortly after it was first diagnosed in Wuhan city, China. Many people are affected with high mortality rates and severe respiratory distress syndrome. During this pandemic, all physicians paid attention to the findings of COVID-19. Suggestive findings in (18)fluorine-fluorodeoxyglucose (F-18-FDG) positron emission tomography/computed tomography (PET/CT) were characterized as increased F-18-FDG uptake in bilateral peripheral consolidative areas and ground glass opacities. We aimed to show diffuse FDG uptake in PET images with indefinable lesions in CT as a suspicious finding for early COVID-19.