Publications by authors named "Nurhan Ergul"

28 Publications

  • Page 1 of 1

18F-FDG PET/CT and 68Ga-FAPI-4 PET/CT Findings of Bilateral Knee Osteoarthritis in a Patient With Uveal Malignant Melanoma.

Clin Nucl Med 2021 Jul 26. Epub 2021 Jul 26.

From the Clinic of Nuclear Medicine, Istanbul Training and Research Hospital, Istanbul, Turkey.

Abstract: We present the findings of 68Ga-FAPI-4 PET/CT and 18F-FDG PET/CT of a metastatic malignant melanoma patient with osteoarthritis. A 65-year-old woman with a history of metastatic uveal malignant melanoma was referred to 18F-FDG PET/CT for restaging after enucleation and chemotherapy. 18F-FDG PET/CT imaging showed high radiotracer uptake in liver metastases; additionally mild uptake due to osteoarthritis was observed in both knees. However, although 68Ga-FAPI-4 showed lower uptake in liver lesions, it showed a more prominent uptake in both knee joints compared with 18F-FDG.
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http://dx.doi.org/10.1097/RLU.0000000000003854DOI Listing
July 2021

68Ga-DOTA-FAPI-04 PET/CT in Neuroendocrine Carcinoma of the Liver With Elevated AFP Level: Comparison With 18F-FDG PET/CT.

Clin Nucl Med 2021 Jul 20. Epub 2021 Jul 20.

From the Clinic of Nuclear Medicine Clinic of Pathology, Istanbul Training and Research Hospital, Istanbul, Turkey.

Abstract: A 68-year-old woman with a mass lesion in right hepatic lobe had an elevated α-fetoprotein level (>54,000 ng/mL). The lesion showed higher 68Ga-DOTA-FAPI-04 uptake than 18F-FDG uptake in consecutive PET/CT images. The histopathological examination revealed neuroendocrine carcinoma with Ki-67 proliferation index of 80%.
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http://dx.doi.org/10.1097/RLU.0000000000003811DOI Listing
July 2021

Ga-PSMA PET/CT Versus F-FDG PET/CT for Imaging of Hepatocellular Carcinoma

Mol Imaging Radionucl Ther 2021 06;30(2):79-85

University of Health Sciences Turkey, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey

Objectives: This study aimed to compare the metabolic parameters obtained from fluorine-fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) and gallium-68 (Ga)-prostate-specific membrane antigen (PSMA) PET/CT and investigate the relationship between serum alpha-fetoprotein and PET scan parameters in patients with hepatocellular carcinoma.

Methods: Fourteen patients were recruited after dynamic magnetic resonance imaging (MRI) of the upper abdomen, and F-FDG and Ga-PSMA PET/CT imaging studies were conducted. Regions of interest (ROIs) were drawn from lesion-free liver tissue, abdominal aorta (A), and right medial gluteal muscle (G) for the background activity. Maximum standard uptake value (SUV) of these regions were compared with the SUV of primary tumor (T).

Results: On visual assessment, five patients (36%) experienced low F-FDG uptake in the primary lesion, three patients (21%) experienced moderate uptake, and six patients (43%) experienced high uptake. However, only one patient (7%) showed low Ga-PSMA uptake, two patients (14%) showed moderate uptake, and 11 patients (79%) showed high uptake. Four patients with a low F-FDG uptake showed high Ga-PSMA uptake, while one patient exhibited low uptake with both F-FDG and Ga-PSMA. The number of lesions on Ga-PSMA PET/CT and MRI was significantly higher than F-FDG PET/CT (p=0.042 and 0.026, respectively). T/A and T/G values were significantly higher in Ga-PSMA than F-FDG (p=0.002 and 0.002, respectively).

Conclusion: Ga-PSMA PET/CT is superior to F-FDG PET/CT in the staging of hepatocellular carcinoma. High Ga-PSMA uptake could be promising for PSMA-targeted radionuclide treatments.
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http://dx.doi.org/10.4274/mirt.galenos.2021.92053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8185475PMC
June 2021

Synchronous Bilateral Adrenal Gland Metastases of Bladder Carcinoma Revealed on 18F-FDG PET/CT.

Clin Nucl Med 2021 Apr 21. Epub 2021 Apr 21.

From the Clinic of Nuclear Medicine Clinic of Pathology, Istanbul Training and Research Hospital, Istanbul, Turkey.

Abstract: Bilateral adrenal metastases from bladder carcinoma have been reported rarely. We report an 86-year-old man with urothelial bladder carcinoma who had received chemotherapy and radiotherapy. Bilateral synchronous adrenal gland metastases were observed on 18F-FDG PET/CT.
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http://dx.doi.org/10.1097/RLU.0000000000003666DOI Listing
April 2021

Solitary Vulvar Involvement of Ovarian Non-Hodgkin Lymphoma Mimicking Bartholin's Abscess on 18F-FDG PET/CT.

Clin Nucl Med 2021 03;46(3):255-257

From the Clinic of Nuclear Medicine, Istanbul Training and Research Hospital.

Abstract: A 49-year-old woman was diagnosed with diffuse large B-cell lymphoma of the left ovary. Two months after the hysterectomy and bilateral salpingo-oophorectomy operation, the patient was referred to 18F-FDG PET/CT for staging. A mass lesion measuring 2.8 × 3 cm with intense 18F-FDG uptake was observed at right labium majus, which could be considered as a Bartholin's cyst or abscess. The lesion was excised, and non-Hodgkin lymphoma involvement of vulva was revealed by histopathology.
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http://dx.doi.org/10.1097/RLU.0000000000003494DOI Listing
March 2021

Recurrent Brain Metastasis of Triple Negative Breast Cancer With High Uptake in 68Ga-PSMA-11 PET/CT.

Clin Nucl Med 2021 Feb;46(2):e106-e108

From the Departments of Nuclear Medicine.

Abstract: Triple negative breast cancer (TNBC) is characterized by poor prognosis and limited response to standard treatments. Although 18F-FDG PET/CT is frequently used in staging and restaging, in some cases, it may be insufficient considering tumor heterogeneity. Prostate-specific membrane antigen (PSMA) has been reported to be overexpressed in many types of cancer due to tumor-associated neovascularization. 68Ga-PSMA-11 PET/CT can be used to demonstrate radionuclide therapy option as well as detection of primary tumor and recurrence in TNBC. We present a 47-year-old woman with TNBC having recurrent brain metastasis with avid PSMA receptor activity versus low FDG uptake.
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http://dx.doi.org/10.1097/RLU.0000000000003336DOI Listing
February 2021

The ability of pre-treatment F-18 FDG PET/CT metabolic parameters for predicting axillary lymph node and distant metastasis and overall survival.

Nucl Med Commun 2019 Nov;40(11):1112-1121

Nuclear Medicine Department, Istanbul Training and Research Hospital, University of Health Sciences.

Introduction: The current study aimed to investigate the diagnostic performance of metabolic parameters of pre-treatment F-18 fluorodeoxyglucose PET/computed tomography for predicting axillary lymph node metastases, distant metastases, and overall survival rates in breast cancer patients.

Materials And Methods: One hundred thirteen breast cancer patients who underwent pre-treatment F18 [FDG] PET-computed tomography with biopsy-proven axillary lymph node status were included in the current study. In pre-treatment F18 [FDG] PET-computed tomography for primary tumour area maximum standard uptake value, metabolic tumour volume, tumour lesion glycolysis, tumour diameter and for axillary lymph nodes maximum standard uptake value-LN were recorded. Also if distant metastatic sites were observed they were verified.

Results: The median follow-up period was 43.8 months. Five-year overall survival was 98% vs. 56% in patients with tumour diameter < vs. ≥22 mm, 93% vs. 50% in patients with maximum standard uptake value-T < vs. ≥6.7, 71% vs. 70% in patients with metabolic tumour volume < vs. ≥8.31cm, 94% vs. 49% in patients with maximum standard uptake value-LN < vs. ≥1.6, 98% vs. 48% in patients with tumour lesion glycolysis < vs. ≥19 084 g/ml × cm, 90% vs. 30% in patients with negative or positive distant metastases in initial PET/computed tomography, respectively. Maximum standard uptake value-LN with a cut-off level of <1.6 and <5.7 had high sensitivity and specificity for predicting axillary lymph node and systemic metastasis, respectively. Additionally, tumour lesion glycolysis was the strongest independent prognostic factor for overall survival.

Conclusion: Our data shows that the combination of pre-treatment tumour lesion glycolysis and maximum standard uptake value-LN could improve risk stratification among breast cancer patients.
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http://dx.doi.org/10.1097/MNM.0000000000001085DOI Listing
November 2019

Comparison of preoperative locoregional Ga-68 PSMA-11 PET-CT and mp-MRI results with postoperative histopathology of prostate cancer.

Prostate 2019 06 23;79(9):1007-1017. Epub 2019 Apr 23.

Clinic of Nuclear Medicine, Istanbul Research and Training Hospital, Health Sciences University, Istanbul, Turkey.

Background: Conventional imaging modalities are inadequate to evaluate locoregional extension of prostate cancer (PCa). The aim of the current retrospective study was to investigate the diagnostic efficacy of Gallium-68 prostate-specific membrane antigen-11 (Ga-68 PSMA-11) positron emission tomography/computed tomography (PET/CT) and multiparametric magnetic resonance imaging (mp-MRI) for staging preoperative PCa patients with correlating histopathology.

Materials And Methods: Twenty-four patients with histologically proven PCa underwent both Ga-68 PSMA-11 PET/CT and mp-MRI before robot-assisted laparoscopic radical prostatectomy. For each tumor area, correlations with histopathological results were defined for tumor localization, extraprostatic extension (EPE) of the tumor, invasion of seminal vesicle (SVI) and bladder neck invasion (BNI). In patients with regional lymph node (LN) dissection, histopathological results were also correlated with imaging modalities.

Results: Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for detection of EPE and SVI were higher for mp-MRI than Ga-68 PSMA-11 PET/CT. On the other hand Ga-68 PSMA-11 PET/CT had significant successful results for detection of LN metastases when compared with mp-MRI. But for BNI detection both modalities had same insufficient results. Ga-68 PSMA-11 PET/CT had strong results for appropriate tumor localization in the gland.

Conclusion: Ga-68 PSMA PET/CT has superior results for assessing local LN metastases and for intraprostatic tumor localization. Whereas, mp-MRI must be the preferred modality for determining SVI and EPE. But both imaging modalities failed for determining BNI accurately. Both modalities should be used in conjunction with each other for better treatment planning.
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http://dx.doi.org/10.1002/pros.23812DOI Listing
June 2019

Effect of External Cooling on Lu-PSMA Uptake by the Parotid Glands.

J Nucl Med 2019 10 8;60(10):1388-1393. Epub 2019 Mar 8.

Nuclear Medicine Department, Istanbul Research and Training Hospital, University of Health Sciences, Istanbul, Turkey.

Recent years have seen the start of treatment of metastatic castration-resistant prostate cancer with prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (PRLT), especially Lu-PSMA-617. However, PRLT has side effects on the salivary glands that limit the safety of the treatment. The current study aimed to show the effect of external cooling with ice packs on Lu-PSMA-617 uptake by the parotid glands (PGs). The study included 19 patients (mean age, 72.9 y) with metastatic castration-resistant prostate cancer who had been referred for the first time for Lu-PSMA-617 treatment and underwent pretreatment Ga-PSMA-11 PET/CT. Before the initiation of PRLT, the SUV and SUV of the right and left PGs were measured on Ga-PSMA PET/CT. Frozen ice packs were then affixed over the right PG of each patient for approximately 5 h; 1 h after they were affixed, PRLT was administered. At 4 h after PRLT, head-and-neck SPECT/CT was performed, and at both 4 and 24 h after PRLT, whole-body planar scintigraphy was performed. Regions and volumes of interest were applied for the right and left PGs, and the counts and volumes were determined. Before PRLT, Ga-PSMA-11 PET/CT showed no significant difference in SUV or SUV between the right and left PGs ( > 0.05). At 4 and 24 h after PRLT, planar imaging showed no significant difference in counts between the cooled and noncooled PGs ( > 0.05). Furthermore, at 4 h after PRLT, SPECT/CT showed no significant difference in counts or volumes between the cooled and noncooled PGs ( > 0.05). External cooling does not reduce uptake of Lu-PSMA-617 by the PGs.
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http://dx.doi.org/10.2967/jnumed.119.226449DOI Listing
October 2019

The efficacy of pretreatment and after treatment 18F-FDG PET/CT metabolic parameters in patients with locally advanced squamous cell cervical cancer.

Nucl Med Commun 2019 Mar;40(3):219-227

Department of Nuclear Medicine, Istanbul Training and Research Hospital.

Objectives: Cervical cancer is one of the main causes of cancer death worldwide. Fluorine-18-fluorodeoxyglucose (F-FDG) PET/computed tomography (PET/CT) has been playing an increasingly important role in staging and monitoring treatment response in the disease. In the current study, we investigated metabolic F-FDG PET/CT parameters among patients with locally advanced squamous cell cervical cancer treated with concurrent chemoradiotherapy for predicting disease-free survival (DFS).

Patients And Methods: Forty-four patients with biopsy-proven locally advanced squamous cell cervical cancer were included in the study. Pretreatment and after treatment F-FDG PET/CT metabolic parameters [metabolic tumor volume, tumor lesion glycolysis, maximum standard uptake value (SUVmax)] for the primary tumor area and/or pelvic/para-aortic lymph nodes and also accompanying distant metastases were analyzed. Treatment response was divided into four groups according to a post-treatment F-FDG PET/CT scan.

Results: For all patients, the 3-year DFS was 79%. Pretreatment primary tumor SUVmax and tumor lesion glycolysis, pelvic lymph node SUVmax, and pretreatment para-aortic lymph node SUVmax were significant prognostic factors for DFS with different cut-off values. In contrast, for metabolic tumor volume-T1, there was no statistical significance for DFS.

Conclusion: F-FDG PET/CT cut-off values may help clinicians with their treatment planning and follow-up in locally advanced squamous cell cervical cancer patients.
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http://dx.doi.org/10.1097/MNM.0000000000000969DOI Listing
March 2019

68Ga-PSMA-11 PET/CT in Newly Diagnosed Prostate Adenocarcinoma.

Clin Nucl Med 2018 Dec;43(12):e422-e427

From the Clinic of Nuclear Medicine, and.

Introduction: Prostate-specific membrane antigen (PSMA) ligand PET/CT is an emerging modality to detect the metastatic disease, especially in intermediate- and high-risk prostate cancer (PCa). In this study, we analyzed the contribution of Ga-PSMA-11 PET/CT in staging and therapy management of newly diagnosed PCa.

Materials And Methods: A total of 78 patients with biopsy-proven PCa who were referred for Ga-PSMA-11 PET/CT for primary staging were retrospectively analyzed. The patients were divided into risk groups according to the D'Amico risk stratification criteria. All of the patients had undergone pelvic MRI, and 65 patients had bone scintigraphy also. The findings of Ga-PSMA-11 PET/CT were compared with these conventional imaging (CI) methods for staging of the disease. The relations between SUVmax of the primary tumors and Gleason scores (GSs), prostate-specific antigen (PSA) levels, and metastatic extent of the disease were analyzed.

Results: Of 78 patients, 5 patients were in low-risk group, 18 patients were in intermediate-risk group, and 55 patients were in high-risk group. Metastatic disease was found in 40 (51.2%) of 78 patients in Ga-PSMA-11 PET/CT. Ten patients had regional lymph node metastases, and 30 patients had distant metastases. Ga-PSMA-11 PET/CT changed the staging in 44 (56.4%) of 78 patients compared with CI. There was significant difference between the SUVmax of the tumors with GSs of 6 and 7 compared with GSs of 8, 9, and 10 (P = 0.003). The SUVmax were significantly different between the patients with no metastasis (n = 38) and patients with regional lymph node metastases or distant metastases (n = 40; 16.1 ± 10.9, 28.7 ± 25.8, P = 0.003, respectively). There was significant difference between the SUVmax of patients with PSA level less than 10 ng/mL compared with patients with PSA level of 10 or greater and less than 20 ng/mL and PSA 20 ng/mL or greater (P = 0.009). A weak correlation between PSA and primary tumor SUVmax was also found (r = 0.21).

Conclusions: Ga-PSMA-11 PET/CT is an important imaging modality for primary evaluation of newly diagnosed PCa changing the disease stage substantially. Also the SUVmax of the primary tumor has a relation with GS, metastatic extent of disease, and PSA levels defining the prognosis.
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http://dx.doi.org/10.1097/RLU.0000000000002289DOI Listing
December 2018

Incidental Meningioma Mimicking Metastasis of Prostate Adenocarcinoma in 68Ga-Labeled PSMA Ligand PET/CT.

Clin Nucl Med 2016 Dec;41(12):956-958

From the *Clinic of Nuclear Medicine, Istanbul Training and Research Hospital, Istanbul; and †Department of Nuclear Medicine, Sakarya University Medical Faculty, Adapazari, Turkey.

A 67-year-old man with prostate adenocarcinoma underwent Ga-labeled prostate-specific membrane antigen (PSMA) ligand PET/CT for restaging due to a rising prostate-specific antigen level. Local recurrence in the prostatic region and a metastasis in the left iliac bone were detected showing high PSMA expression. A mass lesion was seen in the left orbitofrontal region with high Ga PSMA uptake. The successive MRI confirmed that the lesion was consistent with meningioma.
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http://dx.doi.org/10.1097/RLU.0000000000001406DOI Listing
December 2016

Can Positron Emission Tomography and Computed Tomography Be a Substitute for Bone Marrow Biopsy in Detection of Bone Marrow Involvement in Patients with Hodgkin's or Non-Hodgkin's Lymphoma?

Turk J Haematol 2015 09;32(3):213-9

Introduction: Positron emission tomography and computed tomography (PET/CT) has become an important part of staging and treatment evaluation algorithms of lymphoma. We aimed to compare the results of PET/CT with bone marrow biopsy (BMB) with respect to bone marrow involvement (BMI) in patients with Hodgkin's lymphoma (HL) and aggressive non-Hodgkin's lymphoma (aNHL).

Methods: The medical files of a total of 297 patients diagnosed with HL or aNHL and followed at the hematology clinics of 3 major hospitals in İstanbul between 2008 and 2012 were screened retrospectively and 161 patients with classical HL and aNHL were included in the study. The patients were referred for PET/CT and BMB at the initial staging. BMB was performed as the reference standard for the evaluation of BMI.

Results: There were 61 (38%) HL and 100 (62%) aNHL patients. Concordant results were revealed between PET/CT and BMB in 126 patients (78%) (52 HL, 74 aNHL), 20 with positive PET/CT and BMB results and 106 with negative PET/CT and BMB results. There were discordant results in 35 patients (9 HL, 26 aNHL), 16 of them with positive BMB and negative PET/ CT results and 19 of them with negative BMB and positive PET/CT results.

Discussion And Conclusion: We observed that PET/CT is effective to detect BMI, despite it alone not being sufficient to evaluate BMI in HL and aNHL. Bone marrow trephine biopsy and PET/CT should be considered as mutually complementary methods for detection of BMI in patients with lymphoma. In suspected focal involvement, combining biopsy and PET/CT might improve staging results.
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http://dx.doi.org/10.4274/tjh.2013.0336DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4563196PMC
September 2015

Metastatic follicular thyroid carcinoma masquerading as olfactory neuroblastoma: with skull-base, cranium, paranasal sinus, lung, and diffuse bone metastases.

J Craniofac Surg 2015 Jan;26(1):e3-6

From the Departments of *Pathology, †Ear & Nose & Throat, and ‡Nuclear Medicine, Bağcilar Training and Research Hospital, Istanbul, Turkey.

Skull-base metastasis is rarely reported in thyroid carcinoma. We are presenting an unusual interesting case mimicking metastatic renal cell carcinoma with intense clear cell morphology, the thyroid origin of which was detected via positron emission tomography/computerized tomography scan proposed by the oncology council, while we were monitoring the subject with the initial diagnosis of paranasal sinus tumor. A mass was detected in the left nasal cavity in the endoscopic examination of the 68-year-old female patient referred by the ophthalmology clinic with the preliminary diagnosis of retro-orbital tumor upon being admitted with proptosis. A soft tissue lesion at a size of 68 × 39 × 53 mm located intracranially was detected by the brain computerized tomography. The biopsy taken and the immunohistochemical results were not satisfactory. Intense fluorodeoxyglucose involvement was observed in both lobes of the thyroid gland at positron emission tomography/computerized tomography taken with the recommendation of the council. Moreover, hypermetabolic nodules were seen in both lung parenchyma areas, whereas intense hypermetabolic lytic lesions were observed in the skeletal system. Thyroglobulin and thyroid transcription factor 1 stains displayed a strong staining on paraffin block. On the basis of these characteristics, the case was regarded as compatible metastatic follicular thyroid carcinoma, with skull-base, cranial, retro-orbital, paranasal sinus, lung, and bone metastases. This case showed us that multidisciplinary work and assessment of the oncology council play a highly critical role in making the diagnosis and guiding the treatment.
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http://dx.doi.org/10.1097/SCS.0000000000001188DOI Listing
January 2015

Assessment of multifocality and axillary nodal involvement in early-stage breast cancer patients using 18F-FDG PET/CT compared to contrast-enhanced and diffusion-weighted magnetic resonance imaging and sentinel node biopsy.

Acta Radiol 2015 Aug 10;56(8):917-23. Epub 2014 Jul 10.

Department of Surgery, Bezmialem Vakif University School of Medicine, Istanbul, Turkey.

Background: Non-invasive evaluation of the extent of axillary nodal involvement in early-stage breast cancer (ESBC) patients and accurate assessment of multifocality are both challenging. Few reports have explored whether 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) might be more useful than other diagnostic methods in these contexts.

Purpose: To prospectively evaluate the diagnostic utility of FDG PET/CT, contrast-enhanced, and diffusion-weighted magnetic resonance imaging (DCE-MRI and DWI), and sentinel lymph node biopsy (SNB), in detection of axillary metastatic lymph nodes in ESBC patients; and to explore the utilities of FDG PET/CT and DCE-MRI for identification of multifocality.

Material And Methods: Twenty-four female patients (mean age, 47 ± 9.9 years; range, 24-68 years) with ESBC underwent whole-body FDG PET/CT and breast MRI prior to operation. SNB and axillary lymph node dissection (ALND) were performed on all patients, as was mastectomy or wide local tumor excision. Histopathological findings served as the gold standard when evaluating either multifocality or axillary nodal involvement.

Results: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy, of PET/CT and DCE-MRI, used to detect multifocality, were as follows: 67% versus 78%, 100% versus 53%, 100% versus 50%, 83% versus 80%, and 88% versus 63%. SNB afforded the highest sensitivity (93%) in terms of detection of axillary metastasis. The sensitivity, NPV, and accuracy of PET/CT were 67%, 62%, and 75% respectively, thus higher than the equivalent values of either DCE-MRI or DWI.

Conclusion: For assessment of multifocality in ESBC patients, highly specific results of PET/CT should be taken into account along with DCE-MRI findings. For evaluation of axillary nodal involvement, PET/CT has higher sensitivity, NPV, and accuracy values than DCE-MRI and DWI and may guide a surgical decision to proceed or not to SNB or ALND.
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http://dx.doi.org/10.1177/0284185114539786DOI Listing
August 2015

The management and the diagnosis of fever of unknown origin.

Expert Rev Anti Infect Ther 2013 Aug;11(8):805-15

Infectious Diseases Department, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.

Prolonged fever presents a challenge for the patient and the physician. Fever with a temperature higher than 38.3°C on several occasions that lasts for at least 3 weeks and lacks a clear diagnosis after 1 week of study in the hospital is called a fever of unknown origin (FUO). More than 200 diseases can cause FUO, and the information gathered from history taking, physical examination, laboratory and imaging studies should be evaluated with care. History taking and physical examination may provide some localizing signs and symptoms pointing toward a diagnosis. Infection, cancers, noninfectious inflammatory diseases and some miscellaneous diseases are the main etiologies, and some patients remain undiagnosed despite investigations. Tuberculosis, lymphoma and adult-onset Still's disease are the main diseases. Fluorodeoxyglucose PET is a promising imaging modality in FUO. Establishing a uniform algorithm for FUO management is difficult. Every patient should be carefully evaluated individually considering the previous FUO management experience.
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http://dx.doi.org/10.1586/14787210.2013.814436DOI Listing
August 2013

F-18 Fdg PET/CT Findings of a Patient with Takayasu Arteritis Before and After Therapy.

Mol Imaging Radionucl Ther 2012 Apr 1;21(1):32-4. Epub 2012 Apr 1.

Istanbul University Cerrahpaşa Medical Faculty, Department of Nuclear Medicine, Istanbul, Turkey.

Unlabelled: Vasculitis is defined as inflammation and necrosis with leukocytic infiltration of the blood vessel wall. Takayasu arteritis is a chronic inflammatory arteritis that primarily involves the aorta and its main branches. A 64-year-old female patient with a 2-month history of fever of unknown origin was presented to our clinic for F-18 FDG PET/CT imaging. Baseline PET/CT images demonstrated intense F-18 FDG uptake in the aorta, bilateral subclavian and brachiocephalic arteries consistent with Takayasu arteritis. After 2 months of immunosuppressive therapy, she was asymptomatic and follow-up FDG PET/CT scan showed almost complete disappearance of large vessels' F-18 FDG uptake. FDG PET/CT is a sensitive technique for assessing presence of large-vessel vasculitis such as Takayasu arteritis, extent of large-vessel inflammation and disease activity after therapy.

Conflict Of Interest: None declared.
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http://dx.doi.org/10.4274/Mirt.021896DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3590965PMC
April 2012

Routine use of positron-emission tomography/computed tomography for staging of primary colorectal cancer: does it affect clinical management?

World J Surg Oncol 2013 Feb 27;11:49. Epub 2013 Feb 27.

Faculty of Medicine, Department of General Surgery, Bezmialem Vakif University, Adnan Menderes Bulvari, Istanbul, Fatih 34090, Turkey.

Background: The use of positron emission tomography-computed tomography (PET/CT) for the preoperative staging of patients with colon and rectal cancer has increased steadily over the last decade. The aim of this study was to evaluate the effect of PET/CT on the preoperative staging and clinical management of patients with colorectal cancer.

Methods: Between December 2010 and February 2012, 64 consecutive patients with colorectal cancer were evaluated with both PET/CT scans and conventional preoperative imaging studies. We prospectively recorded the medical reports of these patients. The PET/CT findings were compared with conventional imaging studies and the rate of over-staging or down-staging and changes in clinical management were evaluated. The correlation of the PET/CT with the conventional imaging was compared by a kappa agreement coefficient. Differences in the accuracy for N and T staging were assessed by χ2 and related-samples marginal homogeneity tests.

Results: Thirty-nine (60.9%) patients had rectal cancer and 25 (39.1%) had colon cancer. Based on PET/CT, additional lesions were found in 6 (9.4%) of the patients: hilar and paratracheal lesions in 4 patients, hepatic in 1 and supraclavicular in 1 patient. In four of six patients, detailed imaging studies or biopsies revealed chronic inflammatory changes. Hepatic and supraclavicular involvement was confirmed in two patients. Therefore, the false positivity rate of PET/CT was 6.25%. Based on the additional PET/CT, 2 (3.2%) patients had a change in surgical management. A chemotherapy regimen was administered to the patient with a 1.5 cm hepatic metastasis near the right hepatic vein; for another patient with an identified supraclavicular lymph node metastasis, a simultaneous excision was performed.

Conclusions: Routine use of PET/CT for preoperative staging did not impact disease management for 96.8% of our patients. The results of our study conclude that PET/CT should not be routinely used for primary staging of colorectal cancer. More studies are required for identifying the subgroup of patients who might benefit from a PET/CT in their initial staging.
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http://dx.doi.org/10.1186/1477-7819-11-49DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3599376PMC
February 2013

Delayed imaging of the pelvis with diluted and filled bladder: a simple and efficient method in FDG PET/CT imaging of bladder carcinoma.

Clin Nucl Med 2012 Aug;37(8):778-80

Department of Nuclear Medicine, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey.

A 53-year-old man with recent diagnosis of urinary bladder carcinoma was referred to our PET/CT unit. There was no sign and symptom other than hematuria. Urinary ultrasound showed a mass lesion at the right wall of the urinary bladder. FDG PET/CT was performed for initial staging. One-hour whole-body PET/CT images were normal, whereas delayed pelvic images with "diluted and filled bladder" demonstrated that intense hypermetabolic lesion at the right lateral wall of the urinary bladder.
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http://dx.doi.org/10.1097/RLU.0b013e31825ae141DOI Listing
August 2012

Evaluation of coronary artery abnormalities in Williams syndrome patients using myocardial perfusion scintigraphy and CT angiography.

Cardiol J 2012 ;19(3):301-8

Department of Pediatric Cardiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.

Background: Sudden death risk in Williams syndrome (WS) patients has been shown to be 25-100 times higher than in the general population. This study aims to detect coronary artery anomalies and myocardial perfusion defects in WS patients using noninvasive diagnostic methods.

Methods: This study features 38 patients diagnosed with WS. In addition to physical examination, electrocardiography, and echocardiography, computed tomography (CT) angiography and rest/dipyridamole stress technetium-99m sestamibi ((99m)Tc-sestamibi) single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy (MPS) were performed.

Results: Twenty-one (55%) patients were male; 17 (45%) were female. The average patient age was 12 ± 5 years (2.5-26 years); the average follow-up period was 7.2 ± 4.2 years (6 months-18 years). Cardiovascular abnormalities were found in 89% of patients, the most common one being supravalvar aortic stenosis (SVAS). CT angiography revealed coronary anomalies in 10 (26%) patients, the most common ones being ectasia of the left main coronary artery and proximal right coronary artery as well as myocardial bridging. SVAS was present in 80% of patients with coronary artery anomalies. (99m)Tc-sestamibi SPECT MPS revealed findings possibly consistent with myocardial ischemia in 29% of patients, and ischemia in 7 out of 10 patients (70%) with coronary anomalies shown on CT angiography (p = 0.03).

Conclusions: Coronary artery abnormalities are relatively common in WS patients and are often accompanied by SVAS. CT angiography and dipyridamole (99m)Tc-sestamibi SPECT MPS seem to be less invasive methods of detecting coronary artery anomalies and myocardial perfusion defects in WS patients.
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http://dx.doi.org/10.5603/cj.2012.0053DOI Listing
October 2012

FDG-PET or PET/CT in Fever of Unknown Origin: The Diagnostic Role of Underlying Primary Disease.

Int J Mol Imaging 2011 3;2011:318051. Epub 2011 Mar 3.

Clinic of Nuclear Medicine, Istanbul Education and Research Hospital, Samatya, Kocamustafapaşa, Fatih, 34098 Istanbul, Turkey.

Fever of unknown origin (FUO) is generally defined as a fever greater than 38.3°C on several occasions during a period longer than 3 weeks for which the etiology behind cannot be diagnosed at the end of at least 1 week hospital stay. Conventional diagnostic methods are still not adequate to reveal underlying reason in approximately 50% of patients with FUO. In patients with certain diagnosis, three major categories are infections, malignancies, and noninfectious inflammatory diseases. Fluoro-18-fluoro-2-deoxy-D-glucose (FDG) is a structural analog of 2-deoxyglucose and accumulates in malignant tissues but also at sites of infection and inflammation. For this reason, FDG PET or PET/CT has great advantage in understanding of underlying pathology in assessment of FUO. However, till today, there are limited studies about the role of FDG PET or PET/CT in evaluation of FUO. In this paper, the impact of FDG PET or PET/CT in the diagnostic work-up of FUO is described by data obtained from literature review.
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http://dx.doi.org/10.1155/2011/318051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065735PMC
July 2011

The Diagnostic Role of FDG PET/CT in Patients with Fever of Unknown Origin.

Mol Imaging Radionucl Ther 2011 Apr 1;20(1):19-25. Epub 2011 Apr 1.

Istanbul University Cerrahpasa Faculty of Medicine, Department of Nuclear Medicine, İstanbul, Turkey.

Objective: Fever of unknown origin (FUO) is a challenge for the physician and needs use of clinical, laboratory, and imaging studies and also invasive and/or non-invasive interventions to detect the etiology. The aim of present study was to assess the role of FDG PET/CT in determining the etiology in patients with FUO.

Material And Methods: Twenty-four patients (median age 52, range 5-77 years, 6 female, 18 male) who were diagnosed with FUO were retrospectively analyzed in this study. Before the FDG PET/CT studies, none of them had a definitive reason for their diseases investigated by conventional radiological or scintigraphic methods, clinical and laboratory observations.

Results: The positive result was achieved in 19 (79.2%) of 24 patients as findings of the FDG PET/CT. However, FDG PET/CT was useful for definitive diagnosis in 12 (63.2%) of 19 positive patients. Malignant diseases were determined to be the underlying cause of FUO in 5 (41.6%) of 12 patients. Noninfectious inflammatory causes were detected in 2 (16.7%) patients, infections were exhibited in 3 (25%) patients, and miscellaneous diseases demonstrated in 2 (16.7%) patients. In 7 patients the detected pathological uptakes on FDG PET/CT were not helpful for the definitive diagnosis. In remaining 5 patients who showed no pathological uptake in the FDG PET/CT, diagnosis could not be established by other methods, as well. The sensitivity, specificity, and positive and negative predictive values for the determination of FUO etiology were 92.3%, 45.4%, 63.1%, and 100% for FDG PET/CT.

Conclusion: Our results demonstrate that FDG PET/CT seems to have considerable contribution to reveal the reason of undiagnosed patients with FUO investigated by conventional diagnostic methods, clinical and laboratory observations.

Conflict Of Interest: None declared.
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http://dx.doi.org/10.4274/MIRT.20.04DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3590939PMC
April 2011

Bilateral breast involvement of Hodgkin lymphoma revealed by FDG PET/CT.

Med Oncol 2012 Jun 4;29(2):1105-8. Epub 2011 Mar 4.

Clinic of Nuclear Medicine, Istanbul Education and Research Hospital, Org. Abdurrahman Nafiz Gürman Cad, Samatya, Fatih, Istanbul, Turkey.

The involvement of breast tissue with Hodgkin's lymphoma (HL) has been reported in very few cases up to date. We report a 33-year-old woman who had been treated and followed up with nodular sclerosing HL for 7 years, and admitted with recurrent disease. The fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) images revealed disseminated disease with the involvement of bilateral breast tissues showing FDG uptake. In this case, the breast involvement of HL was confirmed by histopathological results.
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http://dx.doi.org/10.1007/s12032-011-9877-0DOI Listing
June 2012

The value of FDG PET/CT in the initial staging and bone marrow involvement of patients with multiple myeloma.

Skeletal Radiol 2011 Jul 13;40(7):843-7. Epub 2011 Jan 13.

Clinic of Nuclear Medicine, Istanbul Education and Research Hospital, Org. Abdurrahman Nafiz Gürman Cad, Samatya, Fatih, Istanbul, Turkey.

Objective: The aim of this study was to describe the role of positron emission tomography/computed tomography (PET/CT) with fluorine-18 fluorodeoxyglucose (FDG) in the detection of skeletal and visceral involvement in patients with MM (multiple myeloma) at the initial diagnosis and to evaluate the relation between maximum standardized uptake values (SUVmax) of FDG with bone marrow cellularity and plasma cell ratios.

Materials And Methods: The study population consisted of 42 patients (15 F, 28 M; mean ± SD age; 47 ± 12 years). Thirty-two patients were referred for initial diagnosis and ten patients were referred for assessment of therapy response. PET/CT scan was obtained 60 min after the administration of 5.4 MBq/kg FDG. The SUVmax of FDG uptake was measured from the region of interest, which was placed at the site of most prominent lesion in bone marrow in PET/CT images.

Results: Thirty patients were positive (29 of 32 initially diagnosed, one of ten previously treated) and 12 patients were negative on PET/CT scan. Conventional radiological methods were negative in three of 30 FDG PET/CT-positive patients and these methods did not show any pathological finding in 12 FDG PET/CT-negative patients. The sensitivity of FDG PET in detecting bone marrow involvement at initial diagnosis was 90%. There was a significant correlation between SUVmax values and bone marrow biopsy cellularity and plasma cell ratios, (r = 0.54 and r = 0.74, p < 0.01).

Conclusions: The results of this study demonstrated that FDG-PET is a useful technique for the assessment of MM and the correlation between SUVmax and plasma cell ratios in bone marrow biopsy may avoid repeated bone marrow biopsies in the follow-up period.
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http://dx.doi.org/10.1007/s00256-010-1088-9DOI Listing
July 2011

Appearance of situs inversus totalis and polysplenia syndrome on FDG PET/CT.

Clin Nucl Med 2008 Feb;33(2):142-3

Department of Nuclear Medicine, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey.

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http://dx.doi.org/10.1097/RLU.0b013e31815ef836DOI Listing
February 2008

PET/CT findings in a multicentric form of Castleman's disease.

Hell J Nucl Med 2007 Sep-Dec;10(3):172-4

Department of Nuclear Medicine, Cerrahpaşa Medical Faculty, University of Istanbul Aksaray Istanbul/Turkey.

We report a case of a multicentric form of Castleman's disease (CD). A thoracic computerized tomography (CT) scan showed multiple mediastinal and bilateral axillary lymph nodes. Fluoro-18 fluoro deoxyglucose ((18)F-FDG) positron emission tomography-PET/CT scan demonstrated increased (18)F-FDG accumulation in multiple lymphatic regions and in bilateral pleural areas. The histopathological sampling of an excised left axillary lymph node revealed a multicentric form of CD, of an intermediate (mixed) cell type. The disease, its differential diagnosis and the diagnostic contribution of nuclear medicine imaging, are described.
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April 2008
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