Despite their very good prognosis, residual or recurrent nodal disease can be seen in approximately 30% of patients in differentiated thyroid cancers (DTC). Nodal disease is most common in the neck ...and it can be treated with surgery, radioactive iodine therapy and local treatment methods, usually with low morbidity. Nowadays, we see an increasing trend towards less aggressive treatment of low-volume nodal disease. The purpose of this review is to summarize the current approach to residual or recurrent cervical lymph node metastases in DTC and to provide information about auxiliary surgical techniques and local treatment methods.
The aim of the study was to retrospectively evaluate radiographic and metabolic changes in bone metastases in response to systemic therapy with (18)FDG-PET/CT and determine their roles on the ...evaluation of therapy response.
We retrospectively evaluated radiographic and metabolic characteristics of bone metastases in 30 patients who were referred for the evaluation of response to systemic therapy with (18)FDG-PET/CT. All patients underwent integrated (18)FDG-PET/CT before and after treatment.
The baseline radiographic patterns of the target lesions in responders group were lytic, sclerotic, mixed and CT negative; after treatment the radiographic patterns of all target lesions changed to a sclerotic pattern and attenuation increased (p = 0.012) and metabolic activity decreased (p = 0.012). A correlation was found between decreasing metabolic activity and increasing attenuation of the target lesions (r = -0.55) (p = 0.026). However, in nonresponders group, the baseline radiologic patterns of the target lesions were lytic, blastic, mixed and CT negative; after treatment all lytic target lesions remained the same and one CT negative lesion turned to lytic pattern and the attenuation of the target lesions decreased (p ± 0.12) and metabolic activity increased (p = 0.012). A correlation was found between increasing metabolic activity and decreasing attenuation (r = -0.65) (p = 0.032). An exception of this rule was seen in baseline blastic metastases which progressed with increasing in size, metabolic activity and attenuation.
This study shows that the metabolic activity of lesions is a more reliable parameter than the radiographic patterns for the evaluation of therapy response.
Objective: Non-Hodgkin's lymphomas arising from tissues other than primary lymphatic sites are classified as primary extranodal lymphomas (PEL). PELs of the gastrointestinal system (PGISL) originate ...from the lymphatic tissues within the gastrointestinal tract. The prognostic value of .sup.18F-FDG PET/CT in lymphomas is high in terms of both overall survival (OS) and disease-free survival (DFS). Our aim was to investigate the uptake patterns and properties of low-grade and high-grade PGISL on primary staging .sup.18F-FDG PET/CT, as well as the prognostic significance of metabolic tumor parameters in high grade PGISL. Methods: Thirty-nine patients with PGISL were enrolled in this retrospective cohort study between 2004-2015. Primary staging .sup.18F-FDG PET/CT have been performed and quantitative parameters of SUV.sub.max, SUV.sub.mean, metabolic tumor volume (MTV), total lesion glycolysis (TLG) have been calculated for all patients prior to treatment. Low-grade and high-grade PGISL were compared in terms of metabolic tumor parameters. Cox regression models were performed to determine factors that correlate with DFS in high-grade PGISL. Results: There were statistically significant differences between high-grade and low-grade PGISL in terms of SUV.sub.max, SUV.sub.mean, MTV, TLG, recurrence, mortality, DFS and OS. None of the potential risk factors (sex, age, site, SUV.sub.max, SUV.sub.mean, MTV, TLG) for recurrence and metastasis in high grade PGISL was identified as a risk factor on univariate and multivariate Cox regression analysis. Conclusion: Metabolic tumor parameters are not predictive markers in high-grade PGISL, especially in diffuse large B cell variant and primary gastric lymphoma. The first implications suggest they will not play a role in patient management. Keywords: .sup.18F-fluorodeoxyglucose positron emission tomography/computed tomography, metabolic tumor parameters, primary gastrointestinal lymphoma Amac: Primer lenfatik alanlar disindaki dokulardan kaynaklanan Non-Hodgkin lenfomalara primer ekstranodal lenfoma (PEL) denmektedir. Gastrointestinal sistemin PEL'i (PGISL) buradaki lenfatik dokulardan koken alir. .sup.18F-FDG PET/BT lenfomalarda genel ve hastaliksiz sagkalim acisindan yuksek prognostik degere sahiptir. Amacimiz dusuk grad ve yuksek grad PGISL'de primer evreleme .sup.18F-FDG PET/BT'de tutulum sekillerini, ozelliklerini, yuksek grad PGISL'de metabolik tumor parametrelerinin prognostik onemi ile birlikte arastirmaktir. Yontem: 2004-2015 yillari arasinda PGISL (evre 1-2) tanisi konmus 39 hasta bu retrospektif kohort calismaya dahil edildi. Hastalara tedaviden once primer evreleme .sup.18F-FDG PET/BT cekilmis ve maksimum standardize uptake degeri (SUV.sub.maks), ortalama standardize uptake degeri (SUV.sub.ortalama), metabolik tumor hacmi (MTV) ve total lezyon glikolizi (TLG) gibi metabolik tumor parametreleri hesaplanmisti. Dusuk grad ve yuksek grad PGISL metabolik tumor parametreleri acisindan karsilastirildi. Yuksek grad PGISL'de Cox regresyon modelleri uzerinden hastaliksiz sagkalim ile iliskili faktorler tespit edildi. Bulgular: Dusuk grad ve yuksek grad PGISL arasinda SUV.sub.maks, SUV.sub.ortalama, MTV, TLG, nuks, mortalite, genel ve hastaliksiz sagkalim acisindan istatistiksel olarak anlamli fark saptanmistir. Yuksek grad PGISL'de nuks ve metastaza etki eden tum potansiyel risk faktorlerinin (cinsiyet, yas, site, SUV.sub.maks, SUV.sub.ortalama, MTV, TLG) tek ve cok degiskenli Cox regresyon analizinden sonra metabolik tumor parametrelerinin bir risk faktoru olmadigi gorulmustur. Sonuc: Metabolik tumor parametreleri ozellikle diffuz buyuk B hucreli varyant ve primer gastrik lenfoma basta olmak uzere yuksek grade PGISL'nin prognoz tahmininde faydali degildir. ilk izlenimler hasta yonetiminde bir rolleri olamayacagi yonundedir. Anahtar kelimeler: .sup.18F-fluorodeoksiglukoz pozitron emisyon tomografi/bilgisayarli tomografi, metabolik tumor parametreleri, primer gastrointestinal lenfoma
Objectives: Gated myocardial perfusion imaging (gMPI) is an established tool for the diagnosis and risk stratification of patients with coronary artery disease (CAD) providing a variety of parameters ...regarding to perfusion and function of left ventricle (LV). Transient ischemic dilation (TID) is one of them. The presence of TID has been shown as a marker of severe and extensive CAD. The aim of this study was to correlate scintigraphic and angiographic findings of patients with positive TID on their gMPI scans. Methods: Stress-rest gMPI was performed for 27 patients with suspected CAD. TID was equal or higher than 1.03 (TID≥1.03) in all patients. All patients had invasive coronary angiography results during 3 months before or after their SPECT studies. Ejection fraction (EF), end-diastolic and end-systolic volumes (EDV, ESV), TID were calculated. We correlated angiographic results with scintigraphic findings of the patients with positive TID. Results: We couldn’t find statistical significant difference in functional parameters of the left ventricle between the groups of patients with normal or near normal coronary angiograms and with abnormal angiograms. Conclusions: TID should be considered a high risk marker in clinical management of patients with suspected or known CAD. But it can also be positive in normal coronary angiograms of conditions such as hypertensive heart disease and hypertrophic cardiomyopathy. Therefore, TID should be correlated with other perfusion and functional parameters of LV to reach the final diagnosis. If it is the only finding, it is reasonable to be cautious while interpreting gMPI.
Aims: Acute inflammatory processes are associated with perioperative complications. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) were reported to have prognostic importance ...in various diseases. We aimed to investigate the clinical importance of preoperative (preop) and postoperative (postop) NLR and PLR as predictors of morbidity and surgical or nonsurgical complications after major abdominal surgery. Methods: Patients who had a major abdominal surgery were retrospectively evaluated. Age, gender, American Society of Anesthesiologist (ASA) score, and the type of operation were recorded. Preop and postop days 1, 3 and 5 white blood cell (WBC), neutrophil, lymphocyte and platelet counts, duration of intensive care unit stay and hospitalization, Clavien Dindo classification, and surgical or non-surgical complications were determined. Results: The study included 462 subjects. Concerning increased need for red blood cell transfusions, NLR was significantly higher on postop day 3 but lower on day 5, and PLR was higher on postop day 1 compared to preop state. Regarding a worse Clavien-Dindo classification, NLR was higher on postop day 3 but lower on day 5, and PLR was higher on postop day 1 and 3 compared to baseline. In those with increased surgical complications, NLR was lower on postop day 5, and postop day 1 and 3 PLR were higher compared to baseline values. In subjects with higher non-surgical complications, NLR was higher on postop day 3 but lower on day 5 compared to preop measurements. PLR was similar across the days of follow up in terms of non-surgical complications. Conclusions: Higher NLR on postoperative day 5, and higher PLR on postoperative days 1 and 3 compared to preop values were the indicators of increased complications in this study.
Background/Aim. Isolated infradiaphragmatic lymph node involvement is not common and makes up 5?13% of stage I-II Hodgkin?s lymphoma. Important subjects about prognostic factors and optimal treatment ...of isolated infradiaphragmatic Hodgkin?s lymphoma (II HL) have not been clearly defined. We aimed to evaluate the prognostic value of metabolic tumor indices on initial 18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) through quantitative PET/CT parameters together with the classical predefined risk factors for patients with II HL. Methods. This retrospective cohort study conducted between 2004 and 2015 included 21 patients for whom FDG-PET/CT were requested for primary staging. Quantitative PET/CT parameters (maximum standardized uptake value ? SUV max) average standardized uptake value ? SUV mean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were used to estimate disease-free survival and overall survival. Results. Univariate Cox regression analysis was performed for all potential risk factors impacting metastasis/recurrence of the disease. Factors which had values of p < 0.2 after univariate analysis (sex, age, stage, bulky disease, SUV max, SUV mean, MTV, TLG) were processed with the multivariate model. Sex, TLG and bulky disease were found to be statistically significant risk factors for prognosis of outcome in patients with IIHL after multivariate analysis. Conclusion. The existence of bulky disease at the diagnosis and high TLG values on primary staging by FDG-PET/CT are potential risk factors for both disease-free survival and overall survival in Hodgkin?s lymphoma with isolated infradiaphragmatic lymph node involvement.
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Abstract
Background. The aim of the study was to retrospectively evaluate radiographic and metabolic changes in bone metastases in response to systemic therapy with
18
FDG-PET/CT and determine their ...roles on the evaluation of therapy response.
Patients and methods. We retrospectively evaluated radiographic and metabolic characteristics of bone metastases in 30 patients who were referred for the evaluation of response to systemic therapy with
18
FDG-PET/CT. All patients underwent integrated
18
FDG-PET/CT before and after treatment.
Results. The baseline radiographic patterns of the target lesions in responders group were lytic, sclerotic, mixed and CT negative; after treatment the radiographic patterns of all target lesions changed to a sclerotic pattern and attenuation increased (p = 0.012) and metabolic activity decreased (p = 0.012). A correlation was found between decreasing metabolic activity and increasing attenuation of the target lesions (r = -0.55) (p = 0.026). Ho wever, in nonresponders group, the baseline radiologic patterns of the target lesions were lytic, blastic, mixed and CT negative; after treatment all lytic target lesions remained the same and one CT negative lesion turned to lytic pattern and the attenuation of the target lesions decreased (p ± 0.12) and metabolic activity increased (p = 0.012). A correlation was found between increasing metabolic activity and decreasing attenuation (r = -0.65) (p = 0.032). An exception of this rule was seen in baseline blastic metastases which progressed with increasing in size, metabolic activity and attenuation.
Conclusions. This study shows that the metabolic activity of lesions is a more reliable parameter than the radiographic patterns for the evaluation of therapy response.
This study was aimed to evaluate whether there is any potential role of the measurement of the carotid intima-media thickness (cIMT) in patients with suspected coronary artery disease (CAD) during ...the echocardiography session on decision-making to refer patients for further diagnostic evaluation such as gated myocardial perfusion imaging (gMPI). cIMT of 199 consecutive patients was measured during the echocardiography session and all patients underwent gMPI. According to gMPI results, patients were divided into two groups as CAD and normal groups and according to cIMT measurements patients were divided into four subgroups. Although, there was a good correlation between the age and cIMT values of the patients (r=0.546, p<0.001), the correlation between the summed stress scores and the age of the patients was very weak (r=0.142, p=0.045) and the correlation between the summed stress scores and the cIMT values was very weak (r=0.107, p=0.131). The cIMT measurements of the CAD group (0.74±0.17 mm) were significantly higher than those of the normal group (0.67±0.16 mm) (p=0.012), but after the age correction, the significance between the cIMT measurements of the CAD and the normal groups was not found (p=0.131). Besides, the relationship between the categorical cIMT values of both the CAD and the normal groups was insignificant (p=0.059) and the correlation between the increasing cIMT values and the presence of detectable CAD was also very weak (r=0.187, p=0.08). cIMT can predict occurrence of cardiovascular events in subjects, but single cIMT measurement during echocardiographic examination does not seem to have potential role on decision making for further investigation in patients with suspected CAD.
The purpose of this study was to determine the clinical significance of (18)F-FDG PET/CT on initial staging and therapy planning in patients with invasive breast cancer. One hundred and forty-one ...consecutive, biopsy proven preoperative and 195 postoperative high-risk breast cancer patients who were referred for PET/CT for initial staging were included in this retrospective study. The clinical stage had been determined by conventional imaging modalities prior to the PET/CT scan. Of the 141 examined preoperative patients, 19 had clinical stage I (T1N0), 51 had stage IIA (12 T2N0 and 39 T1N1), 49 had stage IIB (2 T3N0 and 47 T2N1), 12 had stage IIIA (11 T3N1, 1 T2N2), 2 had stage IIIB (2 T4N1) and 8 had stage IV. PET/CT modified the staging for 26% of stage I patients, 29% of stage IIA patients, 46% of stage IIB patients, 58% of stage IIIA patients and 100% of stage IIIB patients. PET/CT scans detected extra-axillary regional lymph nodes in 14 (9.9%) patients and distant metastasis in 41 (29%) patients. PET/CT scans detected multifocal lesions in 30 (21%) patients, multicentric lesions in 21 (14%) patients and malign foci in the contralateral breast (bilateral breast cancer) confirmed by biopsy in 5 (3.5%) patients. Of the examined 195 postoperative patients PET/CT detected axillary lymph nodes in 22 (11%) patients, extra-axillary regional lymph nodes in 21 (10%) patients and distant metastasis in 24 (12%) patients. PET/CT findings altered plans for radiotherapy in 22 (11%) patients and chemotherapy was adapted to the meta-static diseases in 24 (12%) patients. PET/CT was revealed to be superior to conventional imaging modalities for the detection of extra-axillary regional metastatic lymph nodes and distant metastases. These features make PET/CT an essential imaging modality for the primary staging of invasive breast cancer, particularly in patients with clinical stages II and III.
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