Gonca Bural

Izmir Katip Celebi Universitesi, Temnos, İzmir, Turkey

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Publications (26)73.98 Total impact

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    ABSTRACT: Objectives: Our aim was to explore a novel quantitative method [based upon an MRI-based image segmentation that allows actual calculation of grey matter, white matter and cerebrospinal fluid (CSF) volumes] for overcoming the difficulties associated with conventional techniques for measuring actual metabolic activity of the grey matter. Methods: We included four patients with normal brain MRI and fluorine-18 fluorodeoxyglucose (F-FDG)-PET scans (two women and two men; mean age 46±14 years) in this analysis. The time interval between the two scans was 0-180 days. We calculated the volumes of grey matter, white matter and CSF by using a novel segmentation technique applied to the MRI images. We measured the mean standardized uptake value (SUV) representing the whole metabolic activity of the brain from the F-FDG-PET images. We also calculated the white matter SUV from the upper transaxial slices (centrum semiovale) of the F-FDG-PET images. The whole brain volume was calculated by summing up the volumes of the white matter, grey matter and CSF. The global cerebral metabolic activity was calculated by multiplying the mean SUV with total brain volume. The whole brain white matter metabolic activity was calculated by multiplying the mean SUV for the white matter by the white matter volume. The global cerebral metabolic activity only reflects those of the grey matter and the white matter, whereas that of the CSF is zero. We subtracted the global white matter metabolic activity from that of the whole brain, resulting in the global grey matter metabolism alone. We then divided the grey matter global metabolic activity by grey matter volume to accurately calculate the SUV for the grey matter alone. Results: The brain volumes ranged between 1546 and 1924 ml. The mean SUV for total brain was 4.8-7. Total metabolic burden of the brain ranged from 5565 to 9617. The mean SUV for white matter was 2.8-4.1. On the basis of these measurements we generated the grey matter SUV, which ranged from 8.1 to 11.3. Conclusion: The accurate metabolic activity of the grey matter can be calculated using the novel segmentation technique that we applied to MRI. By combining these quantitative data with those generated from F-FDG-PET images we were able to calculate the accurate metabolic activity of the grey matter. These types of measurements will be of great value in accurate analysis of the data from patients with neuropsychiatric disorders.
    Nuclear Medicine Communications 10/2015; DOI:10.1097/MNM.0000000000000394 · 1.67 Impact Factor
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    ABSTRACT: Recent literature demonstrates the potential of fluorine-18 fluorodeoxyglucose-positron emission tomography ((18)F-FDG-PET) to detect, localize, and quantify the degree of inflammatory changes in the arterial wall due to early atherosclerosis. Our aim was to assess the correlation between the age and (18)F-FDG uptake of aortic segments and determine its correlation with respect to in both age and genders. Fluorine-18-FDG uptake in aortic segments in 143 subjects (58 men, 85 women; ages 5-82 years) was evaluated in this study. Subjects were initially grouped according to the gender, and then by age (below or above 50) with at least 26 subjects per group. Mean standardized uptake value (SUV) of ascending aorta, arch, descending thoracic aorta, and abdominal aortic segments were calculated in each subject. Correlative analyses between age and mean SUV of aortic segments in all subjects were undertaken. Mean SUV between genders for all groups were also compared. There was a positive correlation between age and mean SUV of all aortic segments. The correlation values in all aortic segments were higher in subjects below 50 years old compared to those above 50 years in the entire group of patients as well as when they were subdivided and analyzed according to both genders (P<0.001). Descending thoracic and ascending aortic segments in men below 50 years of age had the highest correlation of (18)F-FDG uptake and age (0.85 and 0.80, respectively) whereas abdominal aortic segments in men the above 50 years age group had the lowest correlation value (0.20). Comparison between mean SUV in four visible arterial segments between the two genders did not reveal any statistically significant difference. In conclusion, (18)F-FDG uptake in aortic segments increases with age irrespective of genders. The increase with age is more significant in younger subjects compared to older subjects for both men and women. This finding may indicate a deceleration in the inflammatory component of atherosclerosis with aging in older subjects.
    Hellenic journal of nuclear medicine 10/2013; 16(3). DOI:10.1967/s002449910092 · 0.99 Impact Factor
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    ABSTRACT: The reticuloendothelial system (RES) cells are in the defense against certain pathogens, and in the removal of dying cells, cell debris, microorganisms, and malignant cells. Liver, spleen, and bone marrow represent the major organs with high RES activity. We hypothesized that in subjects with active lung cancer, the metabolic activity of these organs would be greater than that of the subjects with no active tumor. We have studied two groups of subjects who had undergone (18)F-FDG-PET imaging for clinical purposes. The first group consisted of 39 subjects (20 women, 19 men, mean age 64.8+/-10.2 years) with benign lung nodules as demonstrated by (18)F-FDG-PET imaging. The second group consisted of 30 subjects (18 women, 12 men; mean age 65.1+/-11 years) who were known to have active lung cancer with or without distant metastases as seen on (18)F-FDG-PET imaging. The subjects in the second group did not have any evidence of liver, spleen, bone marrow, or heart involvement on (18)F-FDG-PET images. We measured the mean SUV of the liver, spleen, bone marrow, heart, and of the contralateral unaffected lung, and compared the average SUV for these organs between the two groups. We found that the mean SUV of the liver, bone marrow, and spleen were significantly greater in subjects with evidence of active primary or metastatic lung cancer compared with those of subjects who had benign lung nodules and no evidence of active malignant disease. There was a statistically significant difference between mean SUV for organs noted above between the two groups (P<0.05). In contrast, mean SUV for the heart and contralateral normal lung did not show any significant difference between the two groups. In conclusion, the mean SUV for the major organs of RES, liver, spleen, and bone marrow were higher in subjects with active lung cancer with or without metastases than in those without active malignancy. We believe these differences in SUV may indicate a differential activation of the systemic immune response, related to the presence or absence of active lung cancer, which can be detected and quantified non-invasively through (18)F-FDG-PET imaging.
    Hellenic journal of nuclear medicine 01/2010; 13(1):23-5. · 0.99 Impact Factor
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    ABSTRACT: The aim of this study was to compare hepatic standardized uptake values (SUVs) and hepatic metabolic volumetric products (HMVP) between patients of diffuse hepatic steatosis and control subjects with normal livers. Twenty-seven subjects were included in the study (13 men and 14 women; age range, 34-72 years). All had 18F-2-fluoro-2-D-deoxyglucose-positron emission tomography (FDG-PET) and magnetic resonance imaging (MRI) scans with an interscan interval of 0-5 months. Twelve of 27 subjects had diffuse hepatic steatosis on MRI. The remaining 15 were selected as age-matched controls based on normal liver parenchyma on MRI. Mean and maximum hepatic SUVs were calculated for both patient groups on FDG-PET images. Hepatic volumes were measured from MRI. HMVP in each subject was subsequently calculated by multiplication of hepatic volume by mean hepatic SUV. HMVPs as well as mean and maximum hepatic SUVs were compared between the two study groups. HMVPs, mean hepatic SUVs, and maximum hepatic SUVs were greater (statistically significant, p < 0.05) in subjects with diffuse hepatic steatosis compared to those in the control group. The increase in HMVP is the result of increased hepatic metabolic activity likely related to the diffuse hepatic steatosis. The active inflammatory process related to the diffuse hepatic steatosis is the probable explanation for the increase in hepatic metabolic activity on FDG-PET study.
    Molecular imaging and biology: MIB: the official publication of the Academy of Molecular Imaging 10/2009; 12(3):233-9. DOI:10.1007/s11307-009-0258-4 · 2.77 Impact Factor
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    ABSTRACT: Fluorine-18 fluorodeoxyglycose -position emission tomography ((18)F-FDG-PET) as an efficient staging tool for lung carcinoma; allows description and characterization of the primary tumor and of local and distant metastases in a single examination. One of the important limiting factors in quantification of metabolic parameters with PET is the partial volume effect. Our aim for this study was to delineate tumor (size) both in the primary and metastatic lesions in patients with lung cancer by using partial volume correction techniques. Thirty two patients with proven lung cancer who had (18)F-FDG-PET and computerized tomography (CT) within the last 80 days were involved in this study. They were 18 women and 14 men, with age range 43-83 years. Maximum standardized uptake values (SUVmax) in primary and metastatic lesions for all patients were measured. The lesions were categorized into 4 different Groups according to their site. Partial volume corrections were applied using the CT sizes of lesions to obtain corrected SUVmax values. Average corrected SUVmax in each lesion site was calculated and compared between the 4 Groups. A total of 81 primary and metastatic lesions were included in this analysis. They were 28 mediastinal-hilar lymph node lesions, 26 lung lesions, 11 solid organ lesions, and 16 bone marrow lesions. The average uncorrected SUVmax for the primary lung lesions, mediastinal-hilar lymph node lesions, solid organ lesions, and the bone marrow lesions before application of partial volume correction formula were 7.2+/-3.2; 7.0+/-2.7; 6.3+/-3.4 and 7.0+/-3.4, respectively. The average corrected SUVmax for the lesions in the above mentioned regions were 11+/-6, 10+/-4, 13+/-7, and 18+/-13, respectively. A statistically significant difference was observed in the average SUVmax values between lung lesions and nodal lesions compared to the bone marrow lesions. In conclusion, our findings indicate that metabolic activities of lung cancer lesions vary depending on the sites of metastatic disease.
    Hellenic journal of nuclear medicine 09/2009; 12(3):218-22. · 0.99 Impact Factor
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    ABSTRACT: Correction of the "partial volume effect" has been an area of great interest in the recent times in quantitative PET imaging and has been mainly studied with count recovery models based upon phantoms that incorporate hot spheres in a cold background. The goal of this research study was to establish a similar model that is closer to a biological imaging environment, namely hot spheres/lesions in a warm background and to apply this model in a small cohort of patients. A NEMA phantom with six spheres (diameters 1-3.7 cm) was filled with (18)FDG to give sphere:background activity ratios of 8:1, 6:1, and 4:1 for three different acquisitions on a Philips Allegro scanner. The hot sphere SUVmax and the background average SUV were measured for calculation of recovery coefficients (RCs). Using the RCs, the lesion diameters, and the lesion:background ratio, the SUVmax of 64 lesions from 17 patients with biopsy proven lung cancer were corrected. The RCs versus sphere diameters produced characteristic logarithmic curves for each phantom (RCs ranged from 80% to 11%). From a cohort of 17 patients with biopsy proven lung cancer, 64 lesions combined had a mean SUVmax of 7.0 and size of 2.5 cm. After partial volume correction of the SUVmax of each lesion, the average SUVmax increased to 15.5. Hot spheres in a warm background more closely resemble the actual imaging situation in a living subject when compared to hot spheres in a cold background. This method could facilitate generation of equipment specific recovery coefficients for partial volume correction. The clinical implications for the increased accuracy in SUV determination are certainly of potential value in oncologic imaging.
    Annals of Nuclear Medicine 05/2009; 23(4):341-8. DOI:10.1007/s12149-009-0241-9 · 1.68 Impact Factor
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    ABSTRACT: Our aim was to quantify changes in the inflammatory and calcific components of atherosclerosis in the aortic wall using fluoro-18-2-fluoro-2-deoxy-D-glucose positron emission tomography (18)F-FDGPET and contrast enhanced computerized tomography (CECT) with increasing age. Twelve subjects, 8 men and 4 women aged from 21-80 years who had both (18)F-FDG-PET and CECT of the chest and abdomen were included in this study. Subjects were grouped into three according to age. (18)F-FDG uptake in four segments of the aorta was measured. Using CECT images, aortic segmental wall volumes were measured. Wall calcification volume in each aortic segment was also measured via adaptation of a coronary artery calcium-scoring program to the aorta. Calcification volumes were then subtracted from aortic wall volumes. Each net segmental aortic wall volume was then multiplied by the accompanying mean SUV of the segment to calculate global metabolic activity (GMA) for each aortic segment. Our results showed that in each aortic wall segment, mean SUV, wall volumes, wall calcification volumes, and GMA statistically significantly increased with age. In conclusion, (18)F-FDG uptake, wall volume, wall calcification volume, and GMA in the aorta increase with aging. The (18)F-FDG uptake represents the early inflammatory component of the atherosclerotic process, whereas calcification generally represents a later and irreversible stage of the disease. Measurement and combination of PET and CECT parameters to calculate GMA may allow for optimal morphologic and functional noninvasive quantitative assessment of global aortic atherosclerotic disease.
    Hellenic journal of nuclear medicine 05/2009; 12(2):123-8. · 0.99 Impact Factor
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    ABSTRACT: This study aimed at determining whether non attenuation corrected (NAC) positron emission tomography (PET) images, in addition to the attenuation corrected (AC) PET images, should be included in the interpretation of fluoro-18 fluorodeoxyglucose ((18)F-FDG-PET) images in patients with lymphoma. The study included 58 patients, 35 males 23 females, mean age 55+/-16 years. There were 64 superficial and 170 deep lymph node (LN) lesions. Lesion detection, uptake intensity using a three-point scale (1-mild, 2-moderate, 3- intense) and overall clarity of each lesion were compared on both PET images. Our results showed that the detection rate for superficial LN was 100% for NAC-PET and 98.4% for AC-PET images. The degree of (18)F-FDG uptake (intense, moderate and mild uptake) was 56.3%, 31.3% and 12.5% for NAC-PET images and 23.4%, 34.4% and 40.6% for AC-PET images, respectively. The overall image clarity was significantly in favor of NAC compared to AC-PET images (89% vs 20%, P<0.01). For deep LN, lesions, detection rate was for NAC and AC-PET images 95.3% and 99.4%, respectively. (18)F-FDG uptake intensity (intense, moderate and mild uptake) was 42.4%, 27.1% and 25.9% for NAC and 52.4%, 43% and 4.1% for AC-PET images, respectively. The overall image clarity for AC-PET images was superior to NAC-PET images (81.8% vs 53% P=0.01). In conclusion, NAC-PET images appeared to be superior to AC-PET images in detecting superficial LN lesions. AC-PET images are superior to NAC-PET images with regard to the deep-seated LN lesions. Therefore, AC and NAC-PET images are complimentary to each other and require to be reviewed together in the evaluation of patients with lymphoma.
    Hellenic journal of nuclear medicine 01/2009; 12(1):5-9. · 0.99 Impact Factor
  • S Basu · G Li · G Bural · A Alavi ·
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    ABSTRACT: A relative paucity of data exists in the literature with regard to the utility of fluorodeoxyglucose positron emission tomography (FDG-PET) imaging in the clinical management of patients with primary lymphoma of the thyroid gland (PTL). To explore the FDG-PET imaging characteristics and their potential role in PTL, and to compare the results with anatomical imaging modalities. Patients with thyroid lymphoma who had undergone whole-body FDG-PET or PET/computed tomography (CT) during their course of the disease were identified by examination of case records. PET scans were reevaluated, and maximum standardized uptake value (SUV(max)) was calculated and used as the semiquantitative measure of FDG uptake for this analysis. CT and/or magnetic resonance imaging (MRI) studies carried out within 1 week of FDG-PET scan and without any therapeutic intervention between the two studies were considered for the purpose of comparison. A total of six patients with 20 studies (14 FDG-PET and six PET/CT examinations) were identified following the criteria. All patients were female (age 16-83 years). Among these, five were proven to have PTL. Two patients had localized PTL (stage IE), two patients had associated regional nodal involvement (IIE), and one patient had associated nodal involvement on both sides of the diaphragm (IIIE) at presentation. Except for one patient with follicular B-cell lymphoma, all others were diffuse large-B-cell lymphoma (DLBCL) subtype. Avid FDG uptake was observed in both cases of untreated PTL, with SUV(max) of 23 and 7.6, respectively. One patient showed focal FDG uptake (SUV(max) 6.7) in the thyroid in the setting of a responding abdominal non-Hodgkin lymphoma (NHL) and was subsequently proven as adenomatous nodule with Hurthle cell changes. Following successful therapy, SUV(max) declined consistently with improvement in disease status. In one patient, complete response was noted earlier by FDG-PET compared to CT. Disease recurrence was detected earlier by FDG-PET compared to CT in two patients with increased FDG activity in both thyroid lobes without any corresponding CT abnormality. FDG-PET is a useful and sensitive modality for assessing disease activity in thyroid lymphoma. Its ability to detect disease recurrence was found to be superior compared to CT in two patients.
    Acta Radiologica 01/2009; 50(2):201-4. DOI:10.1080/02841850802620689 · 1.60 Impact Factor
  • Wengen Chen · Gonca G Bural · Drew A Torigian · Daniel J Rader · Abass Alavi ·
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    ABSTRACT: Atherosclerosis is a dynamic inflammatory disorder. The biological composition and inflammatory state of an atherosclerotic plaque, rather than the degree of stenosis or its size are the major determinants of acute clinical events. A noninvasive technique to detect vulnerable atherosclerotic plaque is critically needed. FDG-PET/CT, a combined functional and structural whole-body imaging modality, holds great potential for this purpose. FDG uptake in large arteries has been frequently observed and is associated with cardiovascular risk factors. FDG accumulates in plaque macrophages and uptake is correlated with macrophage density. It is known that vascular FDG uptake and calcification do not overlap significantly and changes of FDG uptake are common, suggesting that FDG uptake may represent a dynamic inflammatory process. It has been reported that vascular FDG uptake can be attenuated by simvastatin in patients, and by the antiinflammatory drug probucol in rabbits. Vascular FDG uptake has been linked to cardiovascular events in some preliminary studies. Data from basic sciences, and animal and clinical studies support the emerging role of FDG-PET/CT in assessing atherosclerosis in large arteries in humans.
    European Journal of Nuclear Medicine 12/2008; 36(1):144-51. DOI:10.1007/s00259-008-0947-2 · 5.38 Impact Factor
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    ABSTRACT: The main aim of this research was to determine the changes of FDG uptake in large arteries with aging as visualized by FDG-PET imaging. We examined the presence of arterial FDG uptake in 149 subjects (61 males, 88 females; age range 5-83 years) who underwent whole-body PET scans for the assessment of non-cardiovascular disorders. The subjects were divided into eight age decade groups, with at least 12 subjects in each group. The presence of FDG uptake was recorded in the ascending, arch, descending thoracic and abdominal segments of the aorta, as well as in iliac and femoral arteries. We then calculated the percentage of segments with visible FDG uptake for each age group. Mean SUVs were calculated for each of the arterial segments and compared among the age groups. Among 149 subjects, 145 were noted to have visible uptake in at least one segment of the large vessels. Percentage of segments with visible FDG uptake increased with age (p < 0.01). Mean SUVs of the ascending aorta, aortic arch, descending thoracic aorta, iliac arteries and femoral arteries increased with age (p < 0.01). Prevalence and intensity of FDG uptake in large arteries generally increases with aging. Increased FDG uptake likely represents the presence of active inflammatory process of atherosclerotic plaque. The magnitude of inflammation within the wall of the large arteries increases with aging.
    European journal of nuclear medicine and molecular imaging 03/2008; 35(3):562-9. DOI:10.1007/s00259-007-0528-9 · 5.38 Impact Factor
  • Khaled Alkhawaldeh · Gonca Bural · Rakesh Kumar · Abass Alavi ·
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    ABSTRACT: Our aim was to assess the diagnostic potential of (18)F-FDG PET using partial volume correction and dual-time-point imaging in the assessment of solitary pulmonary nodules. We included 265 patients in this retrospective study (171 men; 94 women; age range, 41-92 years). All had pulmonary nodules on CT, and diagnosis was confirmed by biopsy or follow-up CT. All underwent whole body FDG PET, 60 min after FDG injection. Of the 265 patients, 255 underwent second FDG PET for chest 100 min after injection. Maximum SUVs for nodules were calculated from both scans. Partial volume correction for first time SUVs was applied, using coefficient factor. Malignancy was defined using the following criteria: (1) Visual assessment; (2) First time SUV > or = 2.5; (3) Partial volume corrected first time SUV > or = 2.5; (4) second time SUV > or = 2.5; (5) Increase in SUV over time; (6) Increase or no change in SUV; (7) First time SUV > or = 2.5 and/or increase or no change in SUV. Biopsy and follow-up revealed 72 malignant lung nodules and 193 benign nodules. Sensitivity, specificity and accuracy for the five criteria were as follows: (1) 97, 58 and 68%; (2) 65, 92 and 85%; (3) 84, 91 and 89%; (4) 90, 80 and 83%; (5) 84, 95 and 92%; (6) 92, 92, and 92%; (7) 95, 90 and 91%, respectively. Dual-time-point (18)F-FDG PET has potential impact on improving the diagnostic accuracy for malignant lung nodules. Dual-time-point (18)F-FDG PET imaging should be included in the clinical work-up of patients with pulmonary nodule.
    European journal of nuclear medicine and molecular imaging 03/2008; 35(2):246-52. DOI:10.1007/s00259-007-0584-1 · 5.38 Impact Factor
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    ABSTRACT: The aim of this study was to introduce a new concept for accurate measurement of the global metabolic activity of the red marrow by combining segmented volumetric data from structural imaging techniques such as magnetic resonance imaging (MRI) and quantitative metabolic information provided by functional modalities such as positron emission tomography (PET). Imaging studies from five subjects who had undergone both MRI and 2-deoxy-2-[F-18]fluoro-D-glucose(FDG)-PET were selected for this analysis to test the feasibility of this approach. In none of the subjects, there were any marrow abnormalities as determined either by the MRI or by FDG-PET studies. The mean blood glucose level was 96+/-25 mg/dl. The first step was to calculate vertebral volume at L1, L3, and L5 from the available MRI studies. The red and yellow marrows were then segmented within the lumbar vertebrae using the 3DVIEWNIX software system from which the respective volumes were also calculated for each. This also allowed calculating the bone volume in each of the vertebral bodies examined. By employing the standard techniques, the mean of the maximum standardized uptake values (mean SUVmax) for the bone marrow were calculated in L1, L3 and L5 of the lumbar spine, and then global red marrow activity was calculated using the following approach: (1) Whole vertebral metabolic activity (WVMA)=vertebral volume x mean SUVmax of the entire marrow, (2) whole vertebral metabolic activity for yellow marrow (WVMAYM)=yellow marrow volume x mean SUVmax of fat (obtained from measurements of subcutaneous fat), (3) whole vertebral metabolic activity for red marrow (WVMARM)=WVMA-WVMAYM; and finally, (4) SUVmax for pure red marrow=whole vertebral metabolic activity for red marrow (WVMARM)/red marrow volume (obtained from the segmentation data). The mean volume of the lumbar vertebral body was 15.6+/-1.4 cm3, the bone marrow mean SUVmax was 1.5+/-0.3, and the MVP for the lumbar vertebral body was 23.4+/-5.9. The mean volume of the yellow marrow in the lumbar vertebral body was 7.7+/-1.1 cm3, the yellow marrow mean SUVmax was estimated to be 0.38+/-0.1 and the MVP for the yellow marrow in the lumbar vertebral body was 2.9+/-0.9. The mean volume of the red marrow in lumbar vertebral body was 7.9+/-1.1 cm3, the red marrow mean SUVmax was estimated to be 2.6+/-0.6, and the MVP for the red marrow in the lumbar vertebral body was 20.5+/-5.9. Estimation of the individual component of the bone marrow is plausible using medical image segmentation with combined structure-function approach. This can have potential research and clinical applications concerning the study of global metabolic activity of the individual component and diagnosis of benign and malignant bone marrow disorders.
    Molecular Imaging & Biology 10/2007; 9(6):361-5. DOI:10.1007/s11307-007-0112-5 · 2.77 Impact Factor
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    ABSTRACT: A 35-year old woman presented with vaginal bleeding. She had a normal gynecologic examination and Papanicolaou test. A CT scan of the pelvis showed a cervical mass, which on biopsy proved to be B-cell lymphoma. PET before preoperative staging demonstrated a large area of increased FDG uptake in the pelvis, corresponding to the mass seen on the CT scan. There were no other abnormal F-18 FDG avid sites. The patient received chemotherapy followed by total abdominal hysterectomy. Histopathology was consistent with large B-cell lymphoma of the uterine cervix. Posttherapy CT scan and PET scan showed no evidence of active and or residual disease.
    Clinical Nuclear Medicine 10/2007; 32(9):748-50. DOI:10.1097/RLU.0b013e318124fd89 · 3.93 Impact Factor
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    ABSTRACT: In this review, we describe the current approaches used for quantitative assessment of regional and global function with positron emission tomography (PET) imaging (combined with structural imaging modalities) with emphasis on both research and clinical applications of this powerful approach. We particularly refer to the impact of such measurements in assessing physiological processes such as aging and measuring response to treatment in serious disorders such as cancer. Although a multitude of methods has been described in literature, the optimal approaches that are both accurate and practical in clinical settings need to be defined and refined. Standardized uptake value (SUV) continues to be the most widely used index in the current practice. Calculating SUV at a single time point and assigning standard regions of interest are inadequate and suboptimal for the purposes adopted by the medical community. The concepts of partial volume correction for measured values in small lesions, dual-time point and delayed PET imaging, and global metabolic activity for assessment of various stages of disease may overcome deficiencies that are associated with the current quantitative (ie, SUV) techniques. Serious consideration of these concepts will enhance the role and reliability of these quantitative techniques, and therefore compliment the World Health Organization or the Response Evaluation Criteria in Solid Tumors (RECIST) criteria for managing patients with cancer and other disorders, including physiological states such as aging and serious diseases such as atherosclerosis and neurological diseases. We also introduce the concepts that allow for segmentation of various structural components of organs like the brain for accurate measurement of functional parameters. We also describe complicated kinetic modeling and methodologies that have been used frequently for assessing metabolic and pharmacological parameters in the brain and other organs. Simplified quantitative techniques based on these concepts are described, but should be validated against the kinetic models to test their role as practical tools.
    Seminars in Nuclear Medicine 06/2007; 37(3):223-39. DOI:10.1053/j.semnuclmed.2007.01.005 · 3.34 Impact Factor
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    ABSTRACT: In this article, we report quantitative preliminary data obtained from retrospective analysis of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) and combined PET-computed tomography (PET/CT) examinations in subjects ages 3 to 84 years pertaining to changes in the metabolism of skin, subcutaneous adipose tissue, visceral adipose tissue, and skeletal muscle with age, as well as age-related changes in skeletal muscle attenuation. We also propose a new method for identifying hypermetabolic brown fat on FDG-PET. Finally, we present a review of the literature regarding reported age-related structural and functional changes that occur in skin, fat, and skeletal muscle. Using FDG-PET, We evaluated 213 subjects for changes in the metabolism of skin, adipose tissue, and skeletal muscle with aging. Thirty-two separate subjects were chosen to measure maximum standardized uptake value (SUV) of hypermetabolic brown fat on dual-time point PET imaging. Finally, 15 subjects evaluated by PET/CT were selected to measure changes in metabolism and attenuation of skeletal muscle, and changes in metabolism of adipose tissue with aging. We found that skin, fat, and skeletal muscle all demonstrate significant (P < 0.05) increases in SUV with increasing age on PET imaging. Dual-time point PET imaging demonstrates increasing FDG uptake of hypermetabolic brown fat in various regions studied. Finally, our PET/CT studies revealed statistically insignificant (P > 0.05) decreases in SUV of adipose tissue with aging and the opposite trend in skeletal muscles (P > 0.05). Skeletal muscle attenuation in the various regions studied was found to significantly decrease with age (P < 0.05). Our study shows notable trends in metabolism and attenuation of skeletal muscle and metabolism of skin and adipose tissue that occur with normal aging. We hope that the methodologies and data we present here will serve as a useful starting point for those interested in conducting future prospective research on age-related changes in these structures.
    Seminars in Nuclear Medicine 05/2007; 37(3):195-205. DOI:10.1053/j.semnuclmed.2007.02.002 · 3.34 Impact Factor
  • Khaled Alkhawaldeh · Gonca Bural · Abass Alavi ·
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    ABSTRACT: Without Abstract
    European journal of nuclear medicine and molecular imaging 05/2007; 34(4):615. DOI:10.1007/s00259-006-0270-8 · 5.38 Impact Factor
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    ABSTRACT: Physicians have long told their patients that the doctor's job is to help patients "get as old as they can." As physicians, we have been aided in this objective by many other scientists in other disciplines. The entity of aging and its related changes blends imperceptibly with a variety of age-related diseases. However, these entities do appear to be separate though interrelated. Curing disease is important and a goal that we all work toward to add years to life expectancy. Here, we consider aging as it affects the heart and great vessels and as it serves to influence and support, if not cause, age-related cardiac diseases. This relationship is drawn as cardiac mechanics, hemodynamics, perfusion, metabolism and innervation, anatomy, and pathophysiology are each considered. The effects of aging are presented in 2 sections related to the early and recent "spikes" in aging related information. The latter is largely based in recent developments in chemistry, genetic engineering, molecular biology and the new imaging methods. The purpose of this manuscript is to present these new imaging methods, especially PET, and their impact on the second "spike." This is emphasized particularly in the second half of this review. As a method of demonstrating these imaging tools and their finest potential application, we decided to "showcase" atherosclerosis as the age-related disease for which these methods have made their greatest impact, for which yet more is promised, and for which the influence on longevity is most obvious. The application of positron emission tomography and other imaging methods to the characterization and image identification of atherosclerotic plaques and particularly the "vulnerable" plaque is emphasized. Yet, even with the eradication of coronary disease, the potential for very long life would not be likely. Only with the identification and eradication of the causative factors of aging can this possibility have a chance of becoming reality.
    Seminars in Nuclear Medicine 04/2007; 37(2):120-43. DOI:10.1053/j.semnuclmed.2006.10.005 · 3.34 Impact Factor
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    ABSTRACT: Our objective was to develop a technique for quantifying the extent of atherosclerosis in the aorta by combining standard uptake values (SUVs) in the aortic wall with volumetric data provided by computed tomography (CT). Eighteen patients who had both 18-fluorodeoxyglucose (FDG)-positron emission tomography (PET) and contrast-enhanced CT of the chest and abdomen were selected. All had homogeneous diffuse FDG wall uptake in four segments of the aorta. We divided the patients into three groups according to their age and measured FDG uptake in all four segments of the aorta by calculating the mean SUV for each segment. On each axial CT image, region-of-interest tracings along the inner and outer wall contours of the aorta were generated. The inner surface area was subtracted from the outer surface area. The net area values for each segment were subsequently multiplied by slice thickness to calculate arterial wall volume. By multiplying SUV with wall volume, we were able to calculate the atherosclerotic burden (AB) for each segment of the aorta. We compared the aortic wall volumes, SUVs and AB values in each arterial segment for each age group. In each aortic wall segment, AB values, SUVs and wall volumes increased with age (P<.05). AB can be used as an indicator of the extent of the atherosclerotic process in the aorta through the use of both metabolic and morphologic data provided by FDG-PET and CT, respectively. This may allow for the optimal screening, diagnosis and management of patients with this common and potentially lethal disorder.
    Nuclear Medicine and Biology 12/2006; 33(8):1037-43. DOI:10.1016/j.nucmedbio.2006.08.005 · 2.41 Impact Factor
  • Gonca Gul Bural · Rakesh Kumar · Ayse Mavi · Abass Alavi ·
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    ABSTRACT: A 69-year-old man with colon carcinoma underwent serial fluorine-18 fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) scans for restaging and monitoring the treatment response. He was having symptoms of possible persistent reflux esophagitis following chemotherapy. Serial FDG-PET scans obtained during and after completion of chemotherapy revealed abnormal diffuse FDG uptake in the esophagus in all 3 PET studies. These findings of FDG-PET scans were suggestive of possible postchemotherapy reflux esophagitis.
    Clinical Nuclear Medicine 04/2005; 30(3):182-3. DOI:10.1097/00003072-200503000-00008 · 3.93 Impact Factor

Publication Stats

580 Citations
73.98 Total Impact Points


  • 2013
    • Izmir Katip Celebi Universitesi
      Temnos, İzmir, Turkey
  • 2009
    • Brigham and Women's Hospital
      • Department of Radiology
      Boston, Massachusetts, United States
  • 2004-2009
    • Hospital of the University of Pennsylvania
      • Department of Radiology
      Philadelphia, Pennsylvania, United States