Publications (12)19.28 Total impact
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Article: Unusual F-18 FDG Uptake at the Ears of a Patient with Discoid Lupus Erythematosus Diskoid Lupus Eritamatozus.
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ABSTRACT: A 55-year-old patient, who had undergone excisional biopsy of upper lip two years ago and diagnosed to have squamous cell carcinoma, was referred to us for evaluation with Fluorine-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography (PET)/CT (F-18 FDG-PET/CT) scan. F-18 FDG-PET/CT scan was performed and the maximum intensity projection images (MIP) showed unusual FDG uptake at both ears. Histopathological examination of the biopsy specimen obtained from the ears revealed discoid lupus erythematosus (DLE). Conflict of interest:None declared.Molecular imaging and radionuclide therapy. 04/2012; 21(1):29-31. -
Article: Use of benzodiazepines before (18)F-FDG-PET/CT dual-phase imaging does not decrease the efficacy of the study.
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ABSTRACT: We aimed to investigate whether administration of benzodiazepines decreases the efficacy of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography PET/CT) ((18)F-FDG-PET/CT) dual-phase imaging. Eighteen patients with malignant tumors who were administered 0.5 mg alprazolam before undergoing (18)F-FDG-PET/CT scan (group A) and 21 patients with malignant tumors who were not administered alprazolam before (18)F-FDG-PET/CT scan (group B) were included in this study. Forty lesions from the 18 patients in group A and 66 lesions from the 21 patients in group B were evaluated. Initial "early" whole-body imaging commenced 60 ± 5 minutes after injection of (18)F-FDG and delayed scan was obtained 120 ± 10 minutes after the injection. Maximum standardized uptake values (SUVs) were obtained by drawing three-dimensional regions of interest (ROIs) around each lesion on the early study and the corresponding lesion on the delayed study. The average SUVmax in lesions in group A (mean ± S.D.) was 10.2 ± 6.4 on early examination (SUVmax E) and 12.6 ± 7.6 on delayed examination (SUVmax D). There was a significant difference between these two time points (P < 0.05). Similarly, for the lesions in group B, the average uptake values were 9.3 ± 5.2 (SUVmax E) and 11.2 ± 6.5 (SUVmax D). The increase in these values was significant as it was in group A (P < 0.05). Differences between groups A and B for the variables SUVmax E, SUVmax D were not significant statistically (P > 0.05). Benzodiazepines do not adversely affect the efficacy of the dual-phase FDG-PET imaging technique.Indian journal of nuclear medicine : IJNM : the official journal of the Society of Nuclear Medicine, India. 01/2012; 27(1):24-29. -
Article: Evaluation of Response to Therapy in a Patient with Lung Cancer: Correlation of Sclerotic Bone Lesions with F 18 FDG PET/CT and Bone Scintigraphy.
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ABSTRACT: A 64-year-old male patient with small cell lung cancer underwent Fluorine-18 fluorodeoxyglucose (F 18 FDG) positron emission tomography (PET)/CT scan which revealed multiple F 18 FDG uptake in the spine, both humeri, ribs, pelvis and proximal long bones. There was no obvious lytic or sclerotic bone destruction accompanying these lesions on CT component of the study. After the patient received six courses of chemotherapy a repeat F 18 FDG-PET/CT was performed for evaluation of therapy response. The PET/CT showed the presence of multiple sclerotic lesions on CT without FDG uptake, corresponding to the bone lesions on the previous PET/CT scan. A concomitant Tc 99m Methylene diphosphonate (Tc 99m MDP) bone scintigraphy (BS) revealed no pathologically increased Tc 99m MDP uptake in the skeletal system. The FDG avid lesions in the skeletal system, which were not sclerotic initially, were transformed into FDG non-avid sclerotic lesions after chemotherapy. This was attributed to the direct effect of previous successful therapy for bone metastases, leading to the transformation of metabolically active disease, into blastic metabolically inactive metastases. In conclusion, a F 18 FDG negative bone lesion, which is sclerotic on CT, may represent post-treatment osteoblastic change rather than active tumor and BS might play a role in the discrimination of these two situations. Conflict of interest:None declared.Molecular imaging and radionuclide therapy. 04/2011; 20(1):29-33. -
Article: A prospective diagnostic accuracy study of F-18 fluorodeoxyglucose-positron emission tomography/computed tomography in the evaluation of indeterminate renal masses.
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ABSTRACT: We evaluated the efficacy of fluorine-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography (PET)/computerized tomography (CT; F-18 FDG-PET/CT) in the detection of renal cell carcinoma (RCC) in patients with indeterminate renal masses. Between December 2008 and June 2010, 18 patients with suspicious primary renal masses detected by conventional imaging underwent FDG PET/CT imaging. All patients underwent nephrectomy or surgical resection of the renal mass and the final diagnoses were based on histopathology. Fifteen patients had RCC (14 clear-cell RCC, one papillary RCC). Three renal tumors were benign, corresponding to two renal cortical cysts and one oncocytoma. FDG PET/CT accurately detected seven malignant lesions and yielded false-negative results in eight patients. FDG PET/CT was true negative in two patients with a renal cortical cyst and false positive in a patient with oncocytoma. PET showed a sensitivity of 46.6%, specificity of 66.6%, and accuracy of 50% for primary RCC tumors. The median size of visualized tumors was greater than the median size of nonvisualized tumors, and the average Fuhrman grade of the patients with FDG-positive malignant lesions were higher than that of the patients with FDG-negative lesions. In malignant tumors, the change between early and delayed imaging for average standardized uptake values and maximum SUVs were not statistically significant. FDG PET/CT is not a reliable modality in the diagnosis of RCC with its low sensitivity, but it is effective in the detection of distant metastases and can be used as a complementary tool when conventional imaging studies yield equivocal results.Nuclear Medicine Communications 02/2011; 32(4):265-72. · 1.40 Impact Factor -
Article: Liver abscess due to Yersinia bacteremia in a well-controlled type I diabetic patient.
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ABSTRACT: Yersiniae enterocolitica, a gram negative rod-like organism, causes terminal ileitis and mesenteric adenitis in adolescents and adults. Some forms present with liver and spleen abscesses and have worse prognosis. We report a type 1 diabetic patient with a liver abscess mimicking metastatic liver disease who was successfully treated with percutaneous drainage and antibiotic administration; culture from blood was positive for Yersinia enterocolitica, but drainage material from the liver abscess did not yield a positive result for Yersinia enterocolitica. Although the prognosis is not good in such cases, with high mortality rates, our patient recovered from the disease with appropriate treatment.Endokrynologia Polska 01/2011; 62(4):357-60. · 1.24 Impact Factor -
Article: Clearance of the high intestinal (18)F-FDG uptake associated with metformin after stopping the drug.
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ABSTRACT: This study was done to determine whether interruption of metformin before (18)F-FDG PET/CT imaging could prevent the increased (18)F-FDG uptake in the intestine caused by this drug. Included in the study were 41 patients with known type 2 diabetes mellitus who were referred to our department for evaluation of various neoplastic diseases. Patients underwent two (18)F-FDG PET/CT scans, the first while they were on metformin and the second after they had stopped metformin. They stopped metformin and did not take any other oral antidiabetic medication starting 3 days before the second study and their blood glucose level was regulated with insulin when necessary to keep it within the range 5.55-8.33 mmol/l. FDG uptake was graded visually according to a four-point scale and semiquantitatively by recording the maximum standardized uptake value (SUVmax) in different bowel segments. A paired-samples t-test method was used to determine whether there was a significant difference between SUVmax measurements and visual analysis scores of the metabolic activity of the bowel in the PET/CT scans before and after stopping metformin. Diffuse and intense (18)F-FDG uptake was observed in bowel segments of patients, and the activity in the colon was significantly decreased both visually and semiquantitatively in PET/CT scans performed after patients stopped metformin (p<0.05). There was a statistically significant decrease in activity in the small intestine on visual analysis (p<0.05), but semiquantitative measurements did not show a significant decrease in the SUVmax values in the duodenum or jejunum (p>0.05). Metformin causes an increase in (18)F-FDG uptake in the bowel and stopping metformin before PET/CT study significantly decreased this unwanted uptake, especially in the colon, facilitating the interpretation of images obtained from the abdomen and preventing the obliteration of lesions.European Journal of Nuclear Medicine 05/2010; 37(5):1011-7. · 4.53 Impact Factor -
Article: Comparison of (18)F-FDG-PET/CT with (99m)Tc-MDP bone scintigraphy for the detection of bone metastases in cancer patients.
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ABSTRACT: We tried to assess the efficacy of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) ((18)F-FDG-PET/CT) scan in detecting bone metastases in cancer patients and to compare the results with bone scan (BS) findings. Seventy patients with a variety of neoplastic diseases, who had undergone both (18)F-FDG-PET/CT and BS and were eventually diagnosed as having metastatic bone disease, were enrolled in this study. The confirmation of the final diagnosis of bone metastasis was made by histopathological findings or clinical follow-up for 11 months, on average, including magnetic resonance imaging, (18)F-FDG-PET/CT or BS findings, showing progression of the lesions or their disappearance after therapy. (18)F-FDG-PET/CT imaging detected bone involvement in 68 out of 70 patients with a sensitivity of 97.1%. In contrast, BS showed the presence of metastases in 60 patients (85.7%). PET/CT detected 666 out of 721 metastatic lesions correctly (92.3%), whereas BS detected 506 lesions totally (70.1%). PET/CT revealed organ metastases in 24 patients and in seven patients with unknown primary; PET/CT also depicted primary tumor. (18)F-FDG-PET/CT is more sensitive than BS in detecting bone metastasis in patients with neoplastic diseases. (18)F-FDG-PET/CT has the advantage of detecting unknown primary cancers and visceral metastases besides bone metastases.Nuclear Medicine Communications 03/2010; 31(6):597-603. · 1.40 Impact Factor -
Article: A case of malignant melanoma with cardiac and gallbladder metastases detected by FDG PET-CT.
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ABSTRACT: An F-18-fluoro-2-deoxyglucose (F-18 FDG) whole-body positron emission tomography/computed tomography (PET/CT) study was requested with the purpose of staging for a 31-year-old man with a history of cutaneous malignant melanoma surgically removed from the skin of the left supraclavicular area 15 days ago. Mass lesions with increased FDG uptake in the right atrium, gallbladder, right adrenal gland, and subcutaneous tissue in the left side of the abdomen were detected on F-18 FDG PET/CT scan. The patient underwent cholecystectomy and the lesion in the right atrium was removed surgically. The histopathology of the both lesions revealed metastases from malignant melanoma.Clinical nuclear medicine 12/2009; 34(12):948-9. · 3.92 Impact Factor -
Article: Incidental detection of Sertoli-Leydig cell tumor by FDG PET/CT imaging in a patient with androgen insensitivity syndrome.
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ABSTRACT: A 29-year-old female patient who was being followed up for differentiated papillary thyroid carcinoma was referred to us for exploration of any possible metastasis since her serum thyroglobulin levels were high. The patient underwent an F-18 fluorodeoxyglucose positron emission tomography study, and a pathologically increased FDG uptake at the left lower abdomen was detected corresponding to a solid, cystic lesion on CT images. The patient had a history of primary amenorrhea and, together with the magnetic resonance imaging findings of absent uterus, short and blind end vagina, a diagnosis of androgen insensitivity syndrome was made. The patient underwent laparoscopic left pelvic mass resection, and the histopathology of the lesion revealed Sertoli-Leydig cell tumor.Annals of Nuclear Medicine 12/2009; 24(1):35-9. · 1.50 Impact Factor -
Article: Tc-99m MDP uptake by adrenal metastases from nonsmall cell carcinoma of the lung.
Clinical Nuclear Medicine 08/2005; 30(7):514-6. · 3.67 Impact Factor -
Article: The efficacy of (99m)Tc-MIBI scintimammography in the evaluation of breast lesions and axillary involvement: a comparison with X-rays mammography, ultrasonography and magnetic resonance imaging.
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ABSTRACT: This study was performed because the efficacy of technetium-99m methoxyisobutyl isonitrile scintimammography ((99m)Tc-MIBI-SM) in the evaluation of the breast lesions and axillary lymph node involvement in comparison with X-rays mammography (XRM), ultrasonography (US) and magnetic resonance imaging (MRI) has not been fully investigated. Forty six female patients were included in this study, with suspicious lesions detected in their breasts by palpation, by imaging modalities or clinically. All patients underwent (99m)Tc-MIBI-SM, US and MRI for the evaluation of breast lesions. All patients according to clinical situation and imaging studies underwent fine needle aspiration, mass extirpation, core biopsy, modified radical mastectomy or partial lumpectomy in order to confirm the nature of the lesions. Our results showed that (99m)Tc-MIBI-SM detected 15 of 16, US 11 of 16, XRM 13 of 16 and MRI 13 of 16 malignant lesions. Sensitivities were 93%, 68%, 81% and 81%, respectively. Among these cases there were 4 of 15 false positive (FP) results on SM whereas 4 of 11 on US, 11 of 13 on XRM and 8 of 13 on MRI. The specificities of the above modalities were 86%, 87%, 63% and 73%, respectively. The sensitivities of the above imaging modalities for the detection of axillary lymph node metastases were 55%, 55%, 11% and 77% for SM, US, XRM and MRI, respectively. The sensitivity and specificity of SM for the palpable lesions (n=31) were 100% and 84% and for the nonpalpable lesions (n=15) were 75% and 90%, respectively. In conclusion, although the number of patients studied was small it is the opinion of the authors that (99m)Tc-MIBI-SM has a much better sensitivity and less FP results in detecting malignant breast lesions than the other 3 modalities and also better sensitivity than XRM and MRI. Thus (99m)Tc-MIBI-SM can be included in the diagnostic algorithms for detecting malignancy in breast tumors.Hellenic journal of nuclear medicine 13(2):144-9. · 0.81 Impact Factor -
Article: Tumour thrombus from follicular thyroid cancer detected by 18F-FDG-PET/CT.
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ABSTRACT: To the Editor: Intravascular and intraatrial invasion of thyroid cancer is not a frequently encountered finding. To our knowledge there are 46 cases in the literature reporting tumour thrombus in the mediastinal great veins and/or right atrium due to thyroid cancer. When there is involvement of the superior vena cava and the right atrium, we usually have superior vena cava syndrome (SVCS). Fluoro-18 fluoro deoxyglucose positron emission tomography/computerized tomography ((18)F-FDG PET/CT) is useful in detecting tumor thrombus and discriminating it from clot of other aetiology. There are two papers reporting the usefulness of (18)F-FDG PET/CT in visualization of thrombus from thyroid cancer. It is important to detect the disease early, since thrombectomy can prevent sudden death due to tumor embolism or obstruction of the tricuspid valve. We report a case of tumor thrombus in the left brachiocephalic vein (LBCV), the superior vena cava (SVC) and the right atrium (RA), in a 45 years old male patient with metastatic follicular thyroid cancer. A 45 years old male patient underwent total thyroidectomy five months ago and histopathological examination showed follicular type thyroid carcinoma. Since the remnant thyroid tissue was large and the primary tumor was 4 cm in diameter showing vascular invasion together with multifocality, a second operation was carried out two months later and the patient was treated with 5625MBq of iodine-131 ((131)I) for thyroid remnant ablation. Post radioiodine ablation scan showed (131)I uptake only at the thyroid remnant tissue. He then suffered from hoarseness, dysphagia, swelling at the upper chest, face and in both upper extremities for a period of 2 months. His serum thyroglobulin levels were as high as 464ng/dl, while was on supression treatment with levothyroxine. A magnetic resonance imaging (MRI) of the neck and thorax, detected increased signal at the superior vena cava (SVC), suspicious for tumor thrombus. Radionuclide venography of the upper extremities with sequential images obtained every 3 sec after the administration of 740MBq (99m)Tc-DTPA from both antecubital veins, showed abnormal flow through collateral thoracic veins indicating an obstruction at the level of SVC. The patient was referred to our unit for an (18)F-FDG PET/CT scan for restaging. After ten hours of fasting and having serum glucose 105mg/dl, the patient was injected with 577.5MBq of (18)F-FDG intravenously (i.v.). After 55min of waiting in a semireclined relaxed chair, the patient was imaged using an integrated PET/CT scanner which consisted of a full-ring high resolution (HI-REZ) PET with lutetium oxy-orthosilicate (LSO) crystal and a 6-slice CT (Siemens Biograph 6, Chicago, USA). The CT portion of the study was done without an i.v. contrast medium, just for defining anatomical landmarks and making attenuation correction on PET images. Strongly increased (18)F-FDG accumulation was detected beginning from LBCV, extending through SVC and ending in the RA. Maximum standard uptake values (SUVmax) for the LBCV, SVC and RA were 7.0, 7.1 and 6.0 respectively. These findings were interpreted as intravascular involvement of primary thyroid cancer. There were also multiple pulmonary nodules showing moderately increased (18)F-FDG accumulation in the parenchyma of both lungs, suggestive of metastases. The patient received external beam radiation treatment (EBRT) to the mediastinum consisting of 33.5Gy given in 16 fractions over three weeks. He got symptomatic relief and is still being followed up after treated with EBRT. Out of 46 cases reported in the literature with vascular invation and intraarterial extension of thyroid cancer, 15 were follicular, 13 papillary and 5 cases were anaplastic thyroid carcinoma. The rest of the cases, were insular carcinoma, Hürthle cell carcinoma, adenocarcinoma, medullary carcinoma or sarcoma of the thyroid. The heart can be involved in two ways in thyroid cancer. It can either be filled with a tumor extending through the SVC, or involved by remote metastases usually together with widespread metastases. For exact diagnosis and the discrimination of the underlying mechanism of obstruction, CT scanning and MRI may differentiate external compression from intraluminal tumour. Colour Doppler ultrasound may exclude thrombus in the upper extremities. This test has the disadvantage of not being able to show SVC due to the interference of the osseous structures of the thorax or of lung parenchyma. Gallium-67 scintigraphy showed successfully tumour thrombus in a patient with anaplastic thyroid cancer. Radionuclide venography, CT venography and digital subtraction venography can also be used in the diagnosis of tumor thrombus. Patients may benefit from F-FDG PET/CT when tumor thrombus can not be diagnosed exactly by other conventional imaging modalities and may also be helpful in discriminating between benign and malignant thrombus. (18)F-FDG uptake in the tumor thrombus results from the increased glycolytic rate of the malignant cells in the thrombus. There are two other cases reported up to now in which (18)F-FDG PET/CT detected malignant tumor thrombi from thyroid cancer. Because of the relatively good prognosis of the majority of thyroid cancers and the high possibility of sudden death from tumor embolism or obstruction of the right atrium, it is generally thought that aggressive surgery would be curative or at least prolong survival in patients with tumor thrombosis of the great veins of the mediastinum. Without surgery the patient's quality of life will also decline significantly. In our case the patient rejected operation. Venous obstruction by thyroid cancer may respond dramatically to EBRT and our patient got some symptomatic relief from radiotherapy.Hellenic journal of nuclear medicine 12(1):66-7. · 0.81 Impact Factor
