Association between pan-immune inflammatory value and ulcerative colitis.

OBJECTIVE: Ulcerative colitis is a chronic idiopathic disease that causes inflammation of the colon and rectum, progressing with relapses and remissions. Systemic inflammatory index (SII) and pan-immune inflammatory value (PIV) are newly developed biomarkers. There are many studies in the literature showing the relationship between SII and PIV with malignancies and inflammatory diseases. In this study we aimed to determine the relationship between SII and PIV with the activity of ulcerative colitis. MATERIALS AND METHODS: 146 Ulcerative colitis patients were retrospectively investigated by the time of diagnosis based on clinical, endoscopic and histolopathological findings. Patients and healthy individuals SII and PIV levels were calculated and compared with each other; and Mayo, DUBLIN, UCIES endoscopic subscores of patients were also obtained. Roc curve analysis were used to determine the cut-off value for PIV. RESULTS: SII (468.6 ± 203.5 vs. 823.1 ± 555.1; p < .001), PIV (288.2 ± 159.9 vs. 912.2 ± 924.1; p < .001), were statistically different between groups. PIV (OR: 1.157; (1.041-1.432), p = .036), was also observed to be the independent predictor of ulcerative colitis. The best cut off value of PIV in the prediction of ulcerative colitis was ≥ 506 with 89.6% sensitivity and 63.7% specificity (AUC = 0.812; 95% CI 0.763-0.854, p < .001). CONCLUSION: Based on the results of our study, we found that SII and PIV levels were significantly increased in ulcerative colitis patients at the time of diagnosis and were associated with disease severity in the endoscopic scores RACHMILEWITZ, UCEIS and DUBLIN scores, but not for MES score.

Unusual Breast Metastasis from Atypical Lung Carcinoid on 68Ga-DOTATATE PET/CT.

BACKGROUND: Atypical carcinoid (AC) is one of the rarest lung neuroendocrine tumors (NETs) that rarely metastasize to the breast, and only a few cases have been reported in the literature. Positron emission tomography/computed tomography (PET/CT) with somatostatin analogs (SSAs) labeled with Gallium-68 (68Ga) now represents the gold standard for diagnosis and management of NETs. A case of an unusual metastasis to the breast from an AC detected by 68Ga-DOTATATE PET/CT was reported. CASE PRESENTATION: A 73-year-old woman was presented with a right breast lesion found on mammography screening, which revealed a metastatic neuroendocrine tumor by histopathological analysis with a tru-cut biopsy. Subsequently, 68Ga-DOTATATE PET/CT imaging performed for the initial evaluation showed increased radiotracer uptake in the lesion in the right breast as well as the nodular lesion in the middle lobe of the right lung, which was histologically confirmed to be AC. CONCLUSION: Metastasis of uncommon AC of the lung to the breast is extremely rare. However, it is essential to properly differentiate metastatic tumors from primary disease due to differences in clinical management and prognosis, and 68Ga-DOTATATE PET/CT is a unique diagnostic tool with the advantage of whole-body imaging.

Comparison of body iodine pool assessment methods before radioiodine therapy.

INTRODUCTION AND OBJECTIVES: Radioactive iodine therapy (RAIT) is recommended to reduce the risk of recurrence and metastasis in patients with intermediate-high risk differentiated thyroid cancer (DTC). In preparation for RAIT, stimulation of thyroid-stimulating hormone and reduction of body iodine pool are important for treatment success. For this purpose, patients are asked to reduce their iodine intake before RAIT, and the body iodine pool can be evaluated by measuring iodine excretion in urine before treatment. The aim of our study is to compare the methods used to measure the body iodine pool in the evaluation of the restricted iodine diet (RID) effectiveness applied in the RAIT preparation. PATIENTS AND METHODS: Eighty DTC patients discontinued levothyroxine three weeks before RAIT and followed up with a RID two weeks before treatment. After two weeks of RID, all patients collected their 24-h urine the day before the RAIT date. Patients completed 24-h urine samples on the morning of the RAIT date and also provided a spot urine sample. The estimated 24-h creatinine excretion of the patients was calculated. Estimated 24-h urinary iodine excretion (UIE) was calculated using the spot urine iodine/creatinine (I/C) ratio of the patients. 24-h UIE, iodine concentration in spot urine, I/C ratios in spot urine and estimated 24-h UIE of the patients were analyzed by comparing with each other. RESULTS: In 99% of the patients, RID efficiency was sufficient according to 24-h UIE before RAIT. The mean 24-h UIE was 48.81 micrograms/day (mcg/day) in 24-h urine samples taken from the patients to evaluate the body iodine pool. The patients' iodine concentrations in spot urine, I/C ratios in spot urine, and estimated 24-h UIE were all statistically significantly lower than actual 24-h UIE, which was the reference method (p: 0.026 vs <0.001 vs 0.041). Moderate positive correlation between 24-h UIE and iodine concentration in spot urine (r: 0.440), I/C ratio in spot urine (r: 0.493), and estimated 24-h UIE (r: 0.560) found. The strongest correlation was obtained with the estimated 24-h UIE. CONCLUSION: The estimated 24-h UIE obtained by using the I/C ratio in spot urine can be used practically and safely as an alternative to UIE in 24-h urine, which is the gold standard method for evaluating body iodine pool.

PET/CT Imaging of Inflammatory Myofibroblastic Tumor of the Thigh.

A 13-year-old male patient presented with right leg pain and walking difficulty. Contrast-enhanced magnetic resonance imaging showed a softtissue lesion between muscle groups in the anterior half of the right thigh. The excisional biopsy result ended in an inflammatory myofibroblastic tumor (IMT). The 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) scan showed hypermetabolism in the multifocal soft tissue lesion and also confirmed that no other distant foci were present. A three-phase Tc-99m-methylene diphosphonate study of the region showed heterogeneously increased vascularity within the region. We described an unusual case of IMT in a pediatric patient and the importance of PET/CT scanning to delineate the lesion.

Is a strict restricted-iodine diet necessary for preparation of radioactive iodine therapy?

OBJECTIVE: A restricted-iodine diet (RID) increases the effectiveness of radioiodine therapy (RAIT) by decreasing the body's iodine pool, especially in iodine-rich regions. However, there is no consensus on the RID that should be applied in iodine-deficient areas. This study aims to assess the effect of strict and flexible RID before RAIT. METHODS: For the study, 144 patients were randomized into the strict or flexible RID group. All patients stopped levothyroxine before RAIT and followed a RID. After 2 weeks of RID, 24-h urine samples were taken. The urinary iodine excretion was compared. In 52 of 144 patients, the spot urine samples were taken before and after RID. The reduction in urinary iodine excretion was compared according to the iodine/creatinine ratio. RESULTS: Our study included 47 males and 97 females with a mean age of 45 years. After RID in the 24-h urine samples, the mean iodine level was 47.9 µg/day, and both protocols were sufficient to reduce the body iodine pool. There was no significant difference between the strict and the flexible group, 43.06 and 52.89 µg/day (P:0.147). The reduction in urinary iodine excretion was not statistically different in both groups according to spot urine samples (68.20 vs. 60.53%; P:0.377). CONCLUSION: The flexible RID protocol that less disrupts the patient's quality of life can be preferred for RAIT preparation in iodine-deficient countries.

The Radiation Dose Absorbed by Healthy Parenchyma Is a Predictor for the Rate of Contralateral Hypertrophy After Unilobar Radioembolization of the Right Liver.

Purpose: To investigate the predictors of contralateral hypertrophy in patients treated with unilobar transarterial radioembolization (TARE) with yttrium-90-loaded resin microspheres due to unresectable right-liver tumors. Methods: Patients who underwent right unilobar TARE with resin microspheres between May 2019 and September 2021 were screened retrospectively. Contralateral hypertrophy was evaluated by calculating the kinetic growth rate (KGR) in 8-10 weeks after TARE. The predictors of increased KGR were determined with linear regression analysis. Results: A total of 24 patients (16 with primary and 8 with metastatic liver tumors) were included in the study. After right unilobar TARE, mean volume of the left lobe increased from 368.26 to 436.16 mL, while the mean volume of the right lobe decreased from 1576.22 to 1477.89 mL. The median KGR of the left lobe was 0.28% per week. The radiation dose absorbed by the healthy parenchyma of the right lobe was significantly higher in patients with increased KGR (31.62 vs. 18.78 Gy, p = 0.037). Linear regression analysis showed that the dose absorbed by healthy parenchyma was significantly associated with increased KGR (b = 0.014, p = 0.043). Conclusion: Patients who received right unilobar TARE for liver malignancies could develop a substantial contralateral hypertrophy, and the radiation dose absorbed by the healthy parenchyma of the right lobe was significantly associated with increased KGR in the left lobe. TARE could have a role for inducing contralateral hypertrophy as it offers the advantage of concurrent local tumor control along with its hypertrophic effect.

Assessment of volumetric parameters derived from 68Ga-PSMA PET/CT in prostate cancer patients with biochemical recurrence: an institutional experience.

OBJECTIVE: The aim of this study was to evaluate the relationship between volumetric parameters calculated using semiautomatic quantification of lesions detected in 68Ga-labeled prostate-specific membrane antigen PET-computed tomography (68Ga-PSMA PET/CT) and clinical characteristics in prostate cancer (PCa) patients with biochemical recurrence. METHODS: A total of 85 consecutive PCa patients with biochemical recurrence who underwent 68Ga-PSMA PET/CT at our institution from January 2019 to March 2020 were retrospectively assessed. 68Ga-PSMA PET/CT-derived volumetric parameters, including whole-body PSMA tumor volume (wbPSMA-TV) and whole-body total lesion PSMA (wbTL-PSMA), as well as the established maximum and mean standardized uptake value (SUVmax and SUVmean), were calculated for each patient. All PET-derived parameters were analyzed for correlation with prostate-specific antigen (PSA) levels and for association with Gleason scores. RESULTS: Eighty-five patients with a mean age of 68.9 ± 7.8 years (range, 47-83 years) and a mean PSA level of 40.9 ± 92.1 ng/ml (range, 0.2-533.2 ng/ml) were analyzed. Volumetric parameters, that is, wbPSMA-TV and wbTL-PSMA, demonstrated a statistically significant correlation with PSA levels (r = 0.403 and r = 0.556, respectively, all at P < 0.001) and only the means of wbTL-PSMA were significantly different between the Gleason score groups (P < 0.05). CONCLUSIONS: The results of our study indicate that 68Ga-PSMA PET/CT might be a valuable tool for the detection and follow-up of recurrence in PCa patients. 68Ga-PSMA PET/CT-derived quantitative volumetric parameters demonstrated a highly significant correlation with changes in PSA levels. Larger prospective studies are needed to help reveal the full potential of parameters such as PSMA-TV and TL-PSMA derived from PET imaging with 68Ga-PSMA.

The relationship between glycemic control and BNP levels in diabetic patients.

BACKGROUND: Glycemic control affects cardiovascular risk factors positively. The purpose of this study was to assess B-type natriuretic peptide (BNP) levels in patients with poorly controlled diabetes before and after glycemic regulation was achieved. METHODS: The study was performed in a prospective design. The study population consisted of 79 consecutive diabetic patients with poor glycemic control. All subjects underwent transthoracic echocardiography. Levels of fasting plasma glucose, glycosylated hemoglobin (HbA1c), lipid parameters, and BNP were measured before the onset of the treatment and after glycemic regulation was achieved. RESULTS: A significant decrease in BNP (95.0 [4.0-1807] ng/L vs. 52.0 [2.1-987.0] ng/L, p < 0.001) levels were observed, after improving glycemic control. The decrease in BNP levels was positively correlated with the decrease in HbA1c (r = 0.345, p = 0.003) and fasting plasma glucose (r = 0.366, p = 0.002). There was no correlation between the decrease in BNP levels and lipid parameters (p = NS). CONCLUSIONS: We conclude that poor glycemic control may cause high levels of BNP which may lead to overdiagnosis of congestive heart failure. We suggest that HbA1c and fasting plasma glucose should be checked in patients with high levels of BNP.

Assessment of hepatic steatosis on contrast enhanced computed tomography in patients with colorectal cancer.

AIMS: Non-alcoholic fatty liver disease is often seen in patients with colorectal cancer. Insulin resistance and metabolic syndrome are related to increased risk of colorectal cancer. The aim of this study was to quantitatively determine the relationship between non-alcoholic fatty liver disease and colorectal cancer with the examination of routine abdominopelvic computed tomography images taken for staging. METHODS: A retrospective evaluation was made of the colonoscopy and histopathology reports of 1630 patients who presented for a scanning or diagnostic colonoscopy examination. Colorectal cancer was determined histopathologically in 129 cases. Colorectal cancer patients with distant metastasis or additional malignancies were excluded from the study. A total of 105 patients met the criteria and were included in the study. A control group was formed of 94 patients with no history of cancer. The liver density on abdominopelvic computed tomography and serum transaminase values were recorded for the patients and compared with those of the control group. RESULTS: The groups were similar in respect of age, gender and aspartate aminotransferase levels. Although not statistically significant, the alanine aminotransferase levels of the patient group were high compared to the control group. The liver density on computed tomography was statistically significantly lower in the patient group than in the control group. CONCLUSION: The liver density measurement on contrast abdominopelvic computed tomography of colorectal cancer patients was low, which is consistent with non-alcoholic fatty liver disease.