Ongoing assertion of two-dimensional measurements on differentiation type of left ventricular hypertrophy: Focus on inferior vena cava.

BACKGROUND: Left ventricular hypertrophy (LVH), including hypertensive LVH, hypertrophic cardiomyopathy (HCM) and cardiac amyloidosis (CA), is a commonly encountered condition in cardiology practice, presenting challenges in differential diagnosis. In this study, we aimed to investigate the importance of echocardiographic evaluation of the inferior vena cava (IVC) in distinguishing LVH subtypes including hypertensive LVH, HCM, and CA. METHODS: In this retrospective study, patients with common causes of LVH including hypertensive LVH, HCM, and CA were included. The role of echocardiographic evaluation of IVC diameter and collapsibility in distinguishing these causes of LVH was assessed in conjunction with other echocardiographic, clinical, and imaging methods. RESULTS: A total of 211 patients (45% HCM, 43% hypertensive heart disease, and 12% CA) were included in our study. Their mean age was 56.6 years and 62% of them were male. While mean IVC diameter was significantly dilated in CA patients (13.4 mm in hypertensive LVH, 16.0 mm in HCM, and 21.1 mm in CA, p < .001), its collapsibility was reduced (IVC collapsible in 95% of hypertensive patients, 72% of HCM patients, and 12% of CA patients, p < .001). In the analysis of diagnostic probabilities, the presence of both hypovoltage and IVC dilation is significant for CA patients. Although it is not statistically significant, the presence of IVC dilation along with atrial fibrillation supports the diagnosis of HCM. CONCLUSION: In conclusion, although advances in imaging techniques facilitate the diagnosis of LVH, simple echocardiographic methods should never be overlooked. Our study supports the notion that IVC assessment could play an important role in the differential diagnosis of LVH.

The Role of FDG- PET/CT in Detecting Bone Marrow Involvement in Childhood Solid Tumors.

PURPOSE: To compare the results of 18F-Fluorodeoxy positron emission tomography/computed tomography (18 F-FDG-PET/CT) and bone marrow biopsy (BMB) procedures in the initial evaluation of bone marrow involvement (BMI) in pediatric solid tumors. METHODS: We conducted a retrospective analysis of newly diagnosed pediatric cases with lymphoma, neuroblastoma, Ewing sarcoma, rhabdomyosarcoma. Each case underwent both PET-CT imaging and BMB. Presence of tumor infiltration in BMB specimens and/or positive FDG-PET/CT findings indicate as BMI were regarded as true positive results. RESULTS: Sixty-four patients were included in the study. BMI was detected in 23/64 (36%) patients, FDG-PET/CT imaging and BMB results were concordant in 54/64 patients. In 9/64 patients the finding was FDG-PET/CT (+), BMB (-) indicating a false negative BMB result. In only 1/64 patients FDG- PET/CT (-), BMB (+), indicating a false negative FDG-PET/CT result. In the whole patient group, the sensitivity, specificity, positive predictive value and negative predictive value of PET/CT and BMB in detecting bone marrow involvement were 95.6%, 100%, 100% and 97.6% and 60.8 %, 100%, 100% and 82%, respectively. CONCLUSION: PET/CT has a high sensitivity and specificity for the assessing marrow involvement in pediatric solid tumors. We believe that PET/CT imaging should be performed as the first step in diagnostic staging, and BMB may not be necessary in every patient, only in patients with suspicious PET/CT results for bone marrow involvement. Additionally, for a more precise determination of bone marrow involvement, it is reasonable to perform BMB from FDG-retaining areas, using PET/CT as a guide tool.

The relation between staging fluorine-18 fluorodeoxyglucose positron emission tomog- raphy/computed tomography metabolic parameters and tumor necrosis rate in pediatric osteosarcoma patients

Background/aim: The aim of this study was to investigate the contribution of fluorine-18 (F-18) fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging in staging of pediatric osteosarcoma patients and also to evaluate the ability of metabolic parameters from the primary tumor to predict tumor necrosis rate (TNR). Material and methods: F-18 FDG-PET/CT imaging was performed in staging 37 pediatric osteosarcoma patients. The metabolic pa- rameters SUVmax (maximum standardised uptake value), MTV (metabolic tumour volume), and TLG (total lesion glycolysis) were measured from the primary tumor. TNR level of the primary tumor was histopathologically measured after standard neoadjuvant chemotherapy treatment. The contribution of F-18 FDG-PET/CT to staging of pediatric osteosarcoma patients and the accuracy of metabolic parameters of the primary tumor to predict TNR were analized by regression analysis. Results: MTV and TLG of the primary tumor were found to efficiently predict histopathologic TNR, whereas SUVmax was not (P = 0.012, P = 0.027, P = 0.25, respectively). Also 5 of 12 patients (41.6%) who were initially defined as localised osteosarcoma were upstaged in consequence of staging F-18 FDG-PET/CT findings. Conclusion: F-18 FDG-PET/CT staging in pediatric osteosarcoma patients can effectively distinguish metastatic-localised disease. MTV and TLG values are important parameters, which can efficiently be used to predict TNR.

A rare case describing catastrophic destruction of the whole skeleton caused by severe hyperparathyroidism.

Osteitis fibrosa cystica is a skeletal disorder seen in advanced stages of persistent hyperparathyroidism. Although the measurement of serum Ca and intact-parathormone levels provides early diagnosis and decreases the incidence of radiographic bone involvement, progressive major bone lesions may still be seen in developing countries even in the modern era. We aimed to share, by writing up this report, our astonishment after observing how the skeletal system can be ruined by persistent hyperparathyroidism.

Prognostic factors affecting disease-specific survival in patients with recurrent and/or metastatic differentiated thyroid carcinoma detected by positron emission tomography/computed tomography.

AIM: We aimed to analyze the prognostic factors affecting disease-specific survival in patients with recurrent and/or metastatic differentiated thyroid carcinoma. METHODS: Seventy-seven patients with recurrent/metastatic differentiated thyroid carcinoma who were previously treated with total thyroidectomy followed by radioactive iodine therapy were enrolled. Recurrent/metastatic disease was detected by positron emission tomography/computed tomography. At the time of last follow-up (mean 4.8±1.3 years), patients were grouped as having (i) clinical remission (n=17), (ii) stable disease (n=22), or (iii) progressive disease (n=38). We retrospectively examined the prognostic impact of clinical factors (age, sex, TNM stage), histopathological factors of the primary tumor (tumor size, histology, the presence of vascular invasion, extrathyroidal spread, and lymph node metastasis), serum thyroglobulin levels, and metabolic parameters of recurrent/metastatic disease such as radioactive iodine avidity, F18-fluorodeoxyglucose uptake (SUVmax) in metastatic deposits, number and location of F18-fluorodeoxyglucose-avid lesions (locoregional vs. distant), and the impact of surgery on disease-specific survival. RESULTS: Lack of vascular invasion (p=0.04), presence of surgically amenable recurrence/metastasis (p=0.0001), and suppressible on-therapy serum thyroglobulin levels at the time of recurrent/metastatic disease (p=0.01) were strong predictors of clinical remission and good prognosis on multivariate analysis. Lesional SUVmax, number or location of F18-fluorodeoxyglucose-avid lesions, and TNM stage did not correlate with clinical outcome. Clinical remission could only be achieved by curative surgery. Patients without curative surgery for recurrence/metastasis had a 43 times higher risk to develop progressive disease than patients with disease amenable to surgery. CONCLUSIONS: Curative surgery is an essential therapeutic modality to achieve clinical remission in metastatic/recurrent differentiated thyroid carcinoma. Positron emission tomography/computed tomography is a powerful method to detect surgically resectable disease for the selection of patients who may benefit from curative surgery.

Do clinical characteristics and metabolic markers detected on positron emission tomography/computerized tomography associate with persistent disease in patients with in-operable cervical cancer?

UNLABELLED: The objective of this retrospective study was to evaluate the prognostic significance of volume-based metabolic markers of PET/CT along with clinical characteristics in patients with in-operable cervical carcinoma. METHODS: Fifty-eight patients with cervical carcinoma (stage IIB-IVB) underwent FDG PET/CT for pretreatment evaluation and included in this study. Patients were staged according to International Federation of Gynecology and Obstetrics [FIGO] system. After chemoradiation therapy, patients were evaluated for persistent disease (PD) by clinical examinations, smear tests, pelvic MRI and PET/CT. Based upon follow-up results, clinical characteristics (patient age, tumor histology, FIGO stage) and PET/CT findings such as presence of PET-positive pelvic/para-aortic lymph nodes (LN), metabolic tumor volume (MTV), total lesion glycolysis (TLG), maximum standardized uptake values (SUVmax) of tumor and lymph nodes were analyzed for disease persistence. Survival analysis for disease-free survival and overall survival was performed with Kaplan-Meier method using PET findings and clinical characteristics. RESULTS: At the time of last follow-up (mean: 22 ± 12.6 months, range 6-48), 38 patients (65 %) had PD, 20 patients (35 %) had no evidence of disease (NED). Patient age, tumor histology, MTV, TLG and tumor SUVmax did not differ between groups. The frequency of PET-positive pelvic/para-aortic lymph nodes (84 vs. 60 %, p = 0.03), LN SUVmax (10.2 vs. 6.5, p = 0.02), and FIGO stage differed significantly between PD and NED groups. Cox proportional hazards model demonstrated advanced FIGO stage and the presence of PET-positive para-aortic LN were independent predictors for PD. Both disease-free survival and overall survival curves showed progressive worsening as the disease advanced, p = 0.015. PET LN status was the most important prognostic indicator for disease-free survival and overall survival. The worst outcome curves were detected for patients with PET-positive para-aortic lymph nodes among all patients, p = 0.03. CONCLUSION: Advanced FIGO stage and the presence of FDG-avid para-aortic lymph nodes on pretreatment PET/CT are significant prognostic biomarkers for PD and decreased overall survival in patients with in-operable cervical carcinoma independent from MTV, TLG, tumor and lymph node SUVmax.

Clinical factors related with helicobacter pylori infection--is there an association with gastric cancer history in first-degree family members?

BACKGROUND: The aim of this study was to assess clinical factors associated with Helicobacter pylori positivity and to evaluate the incidence of gastric carcinoma in first-degree family members of infected patients. A total of 580 patients (mean age:38±17) with gastrointestinal complaints underwent C-14 urea breath test (UBT). Patients were grouped as: Group-1, untreated patients (n:384); and Group-2, patients who previously treated with eradication triple therapy (n:196). C-14 UBT was performed 1-2 months after the completion of eradication therapy. Associations of H pylori positivity with age, gender, ABO and Rhesus groups, smoking, dietary habits, and history of gastric cancer in first-degree family members were evaluated. The frequency of H pylori positivity was significantly higher in group-1 (58%) compared to group-2 (20%), p=0.001. There were no correlations between H pylori positivity and age, gender, ABO groups, Rhesus subgroups, smoking and dietary habits in both patient groups. The frequency of gastric cancer in family members was significantly higher in patients with H pylori infection among group-1, compared to infected patients among group-2 (56% vs. 28.6% respectively, p=0.03). We observed a significant association between H pylori positivity and the presence of gastric cancer in first-degree relatives of group-1 patients. Our results provide some confirmation of the presence of a link between gastric cancer development and H pylori. C-14 UBT is a sensitive, reliable and a widely recommended test for the detection of H pylori infection and recurrence. We suggest that detection and eradication of H pylori may contribute to a reduced risk of gastric cancer in the family members of infected patients.

Fat necrosis may mimic local recurrence of breast cancer in FDG PET/CT / La necrosis grasa puede asemejarse a una recurrencia local del cáncer de mama en la PET/TC con FDG

Fat necrosis of the breast is a benign condition that most commonly occurs as the result of trauma. The radiographic and clinical significance of fat necrosis of the breast is that it may mimic malignancy. We present a case of false positive FDG PET/CT scan caused by fat necrosis and mimics local recurrence of breast carcinoma 3 years after radical mastectomy. Physicians must be aware of fat necrosis as a potential pitfall for PET/CT. Fat necrosis must be considered in the differential diagnosis of hypermetabolic breast masses in patients who previously had mastectomy or mammoplasty (AU)

La necrosis grasa de mama constituye una situación benigna que se produce de forma común como resultado de un trauma. El significado radiográfico y clínico de la necrosis grasa puede asemejarse a una neoplasia. Presentamos el caso de un resultado falso positivo de la PET/TC con FDG debido a una necrosis grasa, y su semejanza con una recurrencia local de carcinoma de mama a los 3 años de una mastectomía radical. Los facultativos deben ser conscientes de que la necrosis grasa puede constituir una limitación para el estudio PET/TC. La necrosis grasa debe considerarse en el diagnóstico diferencial de las masas hipermetabólicas de mama en pacientes sometidas previamente a mastectomía o mamoplastia (AU)

Fat necrosis may mimic local recurrence of breast cancer in FDG PET/CT.

Fat necrosis of the breast is a benign condition that most commonly occurs as the result of trauma. The radiographic and clinical significance of fat necrosis of the breast is that it may mimic malignancy. We present a case of false positive FDG PET/CT scan caused by fat necrosis and mimics local recurrence of breast carcinoma 3 years after radical mastectomy. Physicians must be aware of fat necrosis as a potential pitfall for PET/CT. Fat necrosis must be considered in the differential diagnosis of hypermetabolic breast masses in patients who previously had mastectomy or mammoplasty.

The incidence of secondary central nervous system involvement in patients with non-Hodgkin's lymphoma as detected by 18F-FDG PET/CT.

AIM: Secondary central nervous system (CNS) involvement is a devastating and usually fatal complication of non-Hodgkin's lymphoma (NHL). We aimed to evaluate the incidence of secondary CNS involvement and the value of (18)F-FDG PET/computed tomography (CT) imaging in the detection of secondary CNS involvement in patients with NHL. METHODS: A total of 123 immunocompetent patients (58 men, 65 women; mean age: 56.5±19.2) with biopsy-proven NHL who underwent (18)F-FDG PET/CT for primary staging (n=68) and restaging (n=55) of recurrent disease were reviewed retrospectively. Those with secondary CNS involvement as diagnosed on PET/CT were identified. CNS involvement was confirmed by MRI and cerebrospinal fluid cytology. RESULTS: The clinical Ann Arbor stages of the patient population were as follows: stage I - 10 patients; stage II - 44 patients; stage III - 32 patients, and stage IV - 37 patients. PET/CT detected CNS involvement in six patients. The ages of patients with CNS disease ranged from 23 to 68 (mean: 47.2) years. Three patients presented with CNS involvement associated with systemic disease manifestation at initial diagnosis; one patient had isolated CNS relapse and two had relapsed systemic NHL with progression to CNS involvement. Relapse interval was 8-12 months following initial diagnosis. The types of CNS involvement in patients were as follows: parenchymal (n=2), leptomeningeal (n=2), both parenchymal and leptomeningeal (n=1), and pituitary gland involvement (n=1), which is an uncommon manifestation. Median duration of survival was 2.5 months after the diagnosis of CNS involvement. CONCLUSION: The incidence of secondary CNS involvement was 4.4% at initial diagnosis and 5.4% among patients with relapse of lymphoma in our study. PET/CT is a sensitive, objective, and valuable method for the diagnosis of secondary CNS involvement in patients with NHL. In addition, pituitary gland involvement, as a very rare manifestation of secondary CNS lymphoma, has been shown.

Clinical impact of ¹8F-FDG PET/CT in the pretreatment evaluation of patients with locally advanced cervical carcinoma.

AIM: The aim of this study was to evaluate the impact of F-fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) on the pretreatment evaluation of patients with locally advanced cervical carcinoma. METHOD: Forty-seven patients with stage 2b-4a cervical carcinoma underwent F-FDG PET/CT for initial staging and pretreatment evaluation. Concomitant pelvic/abdominal MRI was performed in 38 patients. The contribution of PET/CT to treatment planning was evaluated, and the prognostic performance of PET/CT was compared with that of MRI. Lymph node (LN) status on PET/CT was correlated with patient follow-up data. RESULTS: PET/CT detected hypermetabolic LNs in 39/47 patients. In 24/39 patients (62%), PET/CT was found to be superior to MRI. In 13/24 patients (54%), PET/CT detected para-aortic ± pelvic LNs, which were not found on MRI. PET/CT successfully detected distant metastases in 10 patients and peritonitis carcinomatosa in one patient; these patients were upstaged clinically. Overall, PET/CT has led to modifications in the extent of the radiotherapy field in 34% of patients and to major alterations in treatment plans in 23% of patients with widespread disease. The frequency of PET-positive LNs was significantly lower in patients who were alive without disease at the time of last follow-up (60%) compared with patients with persistent disease and nonsurvivors (100%, P=0.012). CONCLUSION: The presence of PET-positive LNs has prognostic significance in patients with cervical carcinoma. PET/CT has the potential to show both lymphatic and distant metastases, which results in modifications to the chemoradiotherapeutic regimen. The use of PET/CT must be included in the initial workup of patients with locally advanced cervical carcinoma.

Prognostic significance of FDG PET/CT on the follow-up of patients of differentiated thyroid carcinoma with negative 131I whole-body scan and elevated thyroglobulin levels: correlation with clinical and histopathologic characteristics and long-term follow-up data.

AIMS: This study aimed (a) to determine the clinical and histopathologic factors that are related to FDG avidity in the recurrence/metastases of patients with differentiated thyroid carcinoma (DTC) who present with elevated thyroglobulin (Tg) levels and negative 131I whole-body scans (WBSs), (b) to clarify Tg cutoff levels in this setting, and (c) to evaluate the impact of PET/CT on patient management strategies and hence to critically look into the importance of PET/CT in combination with Tg in clinical decision making. METHODS: A total of 105 patients with DTC with negative 131I WBS and neck ultrasound but elevated Tg, who underwent FDG PET/CT for the suspicion of recurrent/metastatic disease, were included in this analysis. All patients had previously undergone total thyroidectomy and radioiodine ablation/therapy. PET/CT results were correlated with Tg levels and clinical and histopathologic characteristics of the primary tumor compared with the follow-up data. RESULTS: PET/CT was true-positive in 69 patients (of which 23 had surgically amenable disease), true-negative in 20, false-positive in 6 patients and false-negative in 10 patients. Extrathyroidal spread was an independent risk factor related to FDG-avid recurrence. Tumor size was significantly higher in PET-positive patients than others, 2.25 (1.8) versus 1.5 (1.1) cm, P = 0.02. Significant correlation was observed between PET positivity and high Tg levels (P = 0.0001). Receiver operating characteristic curve analysis demonstrated a Tg cutoff of 1.9 ng/mL under thyroid-stimulating hormone suppression, 38.2 ng/mL with thyroid-stimulating hormone stimulation. Among PET-negative patients, no recurrence was detected in patients with undetectable/suppressible Tg in on-therapy state. CONCLUSIONS: PET positivity correlated with extrathyroidal spread, and elevated Tg in recurrent/metastatic DTC. FDG PET/CT in combination with Tg levels was crucial in defining management strategies in patients with DTC with negative 131I WBS. A negative FDG PET/CT scan predicts a favorable prognosis and lack of recurrence on follow-up in patients with "suppressible Tg" levels in the on-therapy state despite significant elevation of Tg in the off-therapy state.

Demonstration of Adaptive Functional Differences Seen in Kidneys Accompanying a Nonfunctioning/Hypofunctioning Partner, using Camera Based Tc 99m MAG3 Clearance Measurement Technique.

OBJECTIVE: The aim of this study was to demonstrate the functional compensation that occurs in kidneys which accompany a partner with total or partial loss of renal functioning mass, using camera-based Tc 99m MAG3 clearance technique. MATERIAL AND METHODS: Eighty five patients (43M, 42F, age: 44.8±12.6, range: 18-77 years) with normal serum creatinine levels and normal (

The use of technetium-99m hexamethylpropylene amine oxime lung scintigraphy in the detection of subclinical lung injury in patients with noninsulin-dependent diabetes mellitus.

PURPOSE: The aims of this study were to evaluate subclinical pulmonary injury in patients with noninsulin-dependent diabetes mellitus (NIDDM) who showed normal chest radiograph and pulmonary function test results by using technetium-99 hexamethylpropylene amine oxime (Tc-99m-HMPAO) scintigraphy and to investigate the relationship between Tc-99m-HMPAO lung uptake and duration of diabetes, glycemic control, and the presence of diabetes-related microvascular complications. MATERIALS AND METHODS: A total of 40 patients with NIDDM (19 men, 21 women; age 56.5 ± 6.8 years; duration of diabetes: 13.1 ± 6.7 years) were included in this study. The pulmonary vascular damage was represented as lung/liver uptake ratios (L/L ratios) calculated by Tc-99m-HMPAO lung scintigraphy. Results were compared with those of age-matched controls. RESULTS: The L/L ratio was 0.36 ± 0.07 in normal controls and 0.51 ± 0.16 in patients with NIDDM. The L/L ratio was significantly higher in NIDDM patients than in the control group (P=0.002). No correlation was observed between L/L ratio and the presence of diabetic complications, glycemic control, and diabetes duration. CONCLUSION: Tc-99m-HMPAO lung scintigraphy is a sensitive and an objective method for the detection of subclinical lung injury in NIDDM patients. Tc-99m-HMPAO lung uptake serves as an indicator of pulmonary injury due to diabetes, regardless of diabetes age, glycemic control, and the presence of other diabetes-related microvascular complications.

FDG-PET/CT in the evaluation of epithelioid hemangioendothelioma of the liver: the role of dual-time-point imaging. A case presentation and review of the literature.

A 46-year-old man with liver lesions referred to us as having "metastases of a malignant mesenchymal tumor" underwent PET/computerized tomography (CT) imaging for the localization of the primary tumor and determination of the extent of disease. No pathological FDG uptake was observed in PET/CT images obtained after 60 min, following FDG injection but delayed PET/CT images demonstrated intense FDG uptake at the liver masses. Since the PET/CT findings were discordant with the initial diagnosis, the pathology specimen was reevaluated and with certain immunohistochemical examinations, the final histopathological decision was changed to epithelioid hemangioendothelioma (EHE). In this report, we discuss the FDG uptake pattern in a patient with hepatic EHE and emphasize the importance of dual-time-point hepatic FDG-PET/CT imaging.

[Differences in cerebral blood flow following risperidone treatment in children with autistic disorder]. / Otistik bozuklugu olan cocuklarda risperidon tedavisinin beyin kan akimi ile degerlendirilmesi]

OBJECTIVE: Functional changes in the brains of autistic children due to risperidone treatment and theirs relationship to the symptom clusters are yet unknown. In this autistic disorder case series we aimed to comparatively evaluate the clinical findings before and after risperidone treatment, and regional cerebral blood flow (rCBF) findings with 99mTc-hexamethylpropyleneamine oxime (HMPAO) brain SPECT. METHOD: Eleven autistic patients (age range: 6-7 years; 4 girls, 7 boys) received risperidone therapy (1.5-2.5 mg d(-1)) and were followed-up for 3 months. All the patients underwent neurologic examinations, psychometric examinations, and SPECT imaging, both at the start of risperidone treatment and 3 months after the treatment started. Clinical observations, and the observations of parents and teachers were recorded. These results were compared with cerebral perfusion indices obtained from SPECT data. RESULTS: After 3 months of treatment changes in rCBF were observed in various regions and to varying degrees. We observed relationships between clinical symptoms and pre-therapy rCBF findings, and between clinical improvement and rCBF changes. CONCLUSION: Findings in the present case series are the first to demonstrate a relationship between clinical improvement and regional perfusion patterns after risperidone treatment. We think that these findings may contribute to the understanding of the neurofunctional mechanisms and hypothetical models of autism.

Parathyroid adenomas seen in the clinical follow-up of patients with differentiated thyroid carcinoma: a diagnostic dilemma.

The coexistence of nonmedullary thyroid carcinoma and parathyroid adenoma is an uncommon clinical entity. In most of the previously published studies, thyroid carcinomas are diagnosed incidentally during or after the treatment of parathyroid disease, mostly in the pathology specimens. Here, we report 2 cases of parathyroid adenoma who presented years after the treatment of differentiated thyroid carcinoma. Neither of the patients had symptoms of hypercalcemia and hyperparathyroidism, and parathyroid adenomas were diagnosed on routine physical examination of the neck and on routine monitoring of serum calcium levels.