Molecular Imaging and Radionuclide Therapy最新文献

Objectives: Detection of a sentinel lymph node (SLN) in patients with endometrial cancer (EC) reduces the rate of unnecessary systemic lymph dissection. The aim of this study was to assess the SLN detection rate, accuracy of the method using Tc-99m-SENTI-SCINT and the rate of metastatic nodal involvement in patients with preoperative first stage EC.

Methods: A prospective study of SLN biopsy of 41 patients with stage I EC was conducted after cervical application of 4mCi Tc-99m-SENTI-SCINT. Planar lymphoscintigraphy and single-photon emission computed tomography/computed tomography (SPECT/CT) of the pelvis were performed, followed by site-specific lymphadenectomy in intermediate-risk patients if no SLN was detected per hemipelvis and pelvic lymphadenectomy in all high-risk patients.

Results: Pre-operative detection rate of planar lymphoscintigraphy was 80.49 [95% confidence interval (CI): 68.36-92.62] and of SPECT/CT 95.12 (95% CI: 88.52-101.7). The total intraoperative SLN detection rate was 95.12 (95% CI: 88.52-101.7) per patient and 26.83 (95% CI: 19.91-33.75) bilaterally. The average number of SLNs removed was 1.6±0.8. The most common anatomical location of SLN was the right external iliac region. The SLN metastatic rate was 17%. Both sensitivity and negative predictive value regarding metastatic involvement were 100%.

Conclusion: The SLN detection rate, sensitivity and negative predictive value using Tc-99m-SENTI-SCINT in patients with EC in our study were high. The application of ultra-staging in the histopathological analysis of SLN increases the detection of nodal metastases and improves the staging in these patients.

Ovarian cancer is one of the deadliest tumors among women. It mostly metastasizes to the liver, pleura, lungs, and bones. We present a sixty-six-year-old patient with skin lesions. The patient who underwent biopsy due to skin lesions was diagnosed with ovarian cancer. ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) performed for metastasis search shows widespread skin involvement, especially in the lower abdomen and legs. Skin involvement it ovarian cancer can be rarely seen, and in this article we would like to share ¹⁸F-FDG PET/MRI of skin involvement in ovarian cancer.

In differentiated thyroid cancer, radioiodine therapy and whole body scans (WBS) are integral part of disease management. We present the case of a 33-year-old woman with multifocal thyroid carcinoma who was treated with radioiodine. Post-treatment WBS scintigraphy showed focal increased I-131 uptake in the spleen, although stimulated thyroglobulin level was not suggestive of distant metastasis. Dynamic magnetic resonance imaging performed later revealed that the finding was an incidental splenic cyst. Radioiodine uptake is not specific to the thyroid tissue. Benign pathologies showing increased radioiodine uptake should be considered in cases with splenic radioiodine accumulation in WBSs.

Meningiomas constitute 37% of primary central nervous system tumors and are more common in women. Also may occur with other primary malignancies, which can cause confusion with the metastasis in whole body bone scan (WBBS) imaging. A 58-year-old woman diagnosed with breast cancer was referred to the WBBS for the investigation of possible bone metastases. In the planar images, radiotracer uptake at multiple sites was detected on the anterior side of the skull base and the posterior side of the vertex of the cranium. Single photon emission computed tomography/computed tomography was performed for anatomical localization of possible metastatic lesions, and it revealed that detected accumulations of radiotracer did not belong to the bone metastases; uptakes were located at the cerebral parenchyma and the lesions in the falx cerebri. Patient history explained that she had been diagnosed with meningioma five years ago, which mimicked bone metastases in this study.

Objectives: We aimed to investigate and compare the role of computed tomography (CT)-based attenuation-corrected images (AC) with non-attenuation-corrected images (NAC) obtained by single-photon emission computed tomography/computed tomography (SPECT/CT) myocardial perfusion imaging (MPI).

Methods: The data of 124 patients who were applied one-day stress-rest Tc-99m sestamibi SPECT/CT MPI and who had coronary angiography (CAG) results within ±3 months were retrospectively reviewed. AC and NAC images were visually evaluated by two nuclear medicine specialists in a consensus. CAG results were used as the reference standard.

Results: Specificity, sensitivity, and accuracy were calculated as 66%, 61%, 71%, 79% and 69%, 70% for AC and NAC imaging in the whole group, respectively. There was no statistically significant difference between AC and NAC images for specificity, sensitivity, and accuracy in the male and female subgroups. In the diagnosis of right coronary artery (RCA) disease, CT AC significantly increased the specificity from 87% to 96%. However, in the left anterior descending artery (LAD) region, the specificity was significantly reduced from 95% to 77%.

Conclusion: CT-based AC did not significantly contribute to diagnostic performance for increased specificity for the RCA and reduced specificity in the LAD region. Therefore, AC images should always be evaluated side by side with NAC images to benefit from the different advantages of both techniques.

Prostate cancer is one of the most prevalent cancers in the world. After radical prostatectomy, prostate-specific antigen (PSA) levels are usually used as a marker of recurrence for prostate cancer. In the case of increased PSA levels, ⁶⁸Ga-prostate-specific membrane antigen (PSMA) or ¹⁸F-PSMA, a new alternative, can be performed for the detection of recurrent disease. We report a case of a 49-year-old male patient with increasing PSA levels who was previously operated 8 years ago. Although no obvious pathological uptake was detected in ⁶⁸Ga-PSMA positron emission tomography/computed tomography (PET/CT), ¹⁸F-PSMA PET/CT revealed a lesion with pathological uptake on the urinary bladder wall.

A 69-year-old male was admitted to our hospital because of left facial trauma with bone fractures, including the maxillary sinus, zygomatic arch, and ethmoid and sphenoid bones. Brain computed tomography was unremarkable but regional cerebral blood flow with hexamethyl-propylene-amine oxime single-photon emission computed tomography (SPECT) showed hypoperfusion of the left hemisphere, which was reversible since a repeat SPECT 4 months later was substantially improved. Brain perfusion SPECT may provide information on cerebrovascular status in some cases of facial injury.

A 42-year-old female patient diagnosed with invasive ductal breast ca underwent ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/ computed tomography (PET/CT) scan for staging, 1.5 cm diameter hypermetabolic lesion was observed in the lower inner quadrant of the right breast that was compatible with primary tumor [maximum standardized uptake value (SUV_max): 10.5]. No pathological ¹⁸F-FDG uptake was observed in lymph nodes whose fatty hilum was seen in the right axilla. However, in the left axilla and left deep axilla, hypermetabolic lymph nodes with a maksimum diameter of 19 mm and fatty hilum were observed (SUV_max: 8.0). In a detailed CT evaluation, these lymph nodes have thicker walls than the ones in the right axilla. The patient was questioned again and coronavirus disease-2019 (COVID-19) vaccination history (with BNT162b2, COVID-19 mRNA vaccine) was determined that was administrated to the left arm 5 days ago. Tru-cut biopsy was performed from the left aksillary lymph nodes and proved to be reactive lymphoid tissue and there was no primary or metastatic tumor in these axillary lymph node tissues. The patient was given neoadjuvant chemotherapy 4.5 months after the first ¹⁸F-FDG PET/CT, and the second was performed for the treatment response evaluation. Significant regression was determined from the findings. The patient underwent right total mastechtomy. She was being followed up with adjuvant chemotherapy and radiotherapy. In conclusion, hypermetabolic lymph nodes in the axillas should be interrogated for vaccination in patients with breast cancer. Hypermetabolic lymph nodes observed on the same side of the vaccinated arm in the ¹⁸F-FDG PET/CT scan may be related to vaccine-induced reactive lymph node enlargement. Lymph node metastasis may be excluded, especially if there are hypermetabolic lymph nodes with preserved fatty hilum in the contralateral axilla on the same side as the vaccinated arm. Active lymph nodes reactive to the vaccine become inactive after a while.

Sixty two years old man referred to our clinic due to suspicion of thymic mass. The hypermetabolic nodular lesion in the right lung upper lobe was seen in ¹⁸F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) in addition to the mass in the anterior mediastinum which was found to without malignancy. The patient underwent wedge resection and final diagnosis was pulmonary giant cell carcinoma. In follow-up ¹⁸F-FDG PET/CT multiple lesions with pathological activity were observed in the cerebrum, right postauricular region, bilateral adrenal, stomach, pancreas, pelvic soft tissue, mesenteric, left femur and bilateral lung parenchyma 6 months after. The pathology results of the right frontal, pelvic mass and the postauricular region were metastasis.