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Öğe The Appearances of Brain Metastases of Small Cell Lung Cancer on 18F-FDG PET/CT(Selçuk Üniversitesi, 2022) Önner, Hasan; Yilmaz, Farise; Özer, Halil; Batur, Abdüssamet; Gedik, Gonca KaraPurpose: We evaluate the appearances of the brain metastases (BMs) detected by brain magnetic resonance imaging (MRI) of small cell lung cancer (SCLC) on 18Fluor-Fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT). Patients and methods: SCLC patients who had an 18F-FDG PET/CT scan and a brain MRI within 30 days for initial staging were included. MRI was used to detect BMs. The imaging results of BMs on 18F-FDG PET/CT were assessed. On the 18F-FDG PET/CT study, the BMs were classified as undetectable, hypometabolic, hypermetabolic, or mixed patterns (lesions with both hypermetabolic and hypometabolic parts). Results: A total of 51 patients [48 (94.1%) of whom were male and 3 (5.9%) female, with an average age of 62.57 ± 9.64] were included in this study. Fifteen patients (29.4%) were in the limited stage, whereas 36 patients (69.6%) were in the extensive stage. In 11 individuals, MRI indicated 28 BMs. On 18F-FDG PET/CT, 13 of the 28 metastases were visible. The following were the BMs appearances on 18F-FDG PET/CT: hypometabolic (n: 4), hypermetabolic (n: 6), and mixed (n: 3). While the mean diameter of BMs detected in 18F-FDG PET/CT was 16mm; the mean diameter of undetected ones was 4.3 mm. Conclusion: On 18F-FDG PET/CT, BMs can have a variety of appearances, including hypometabolic, hypermetabolic, and mixed patterns. On the other hand, failure to detect millimetric size BMs in 18F-FDG PET/CT prevents proper staging.Öğe A CASE OF PAGET'S DISEASE OF THE BONE PRESENTED WITH HEARING LOSS AS THE FIRST SYMPTOM(GUNES KITABEVI LTD STI, 2014) Baldane, Suleyman; Ipekci, Suleyman H.; Bulut, Serap; Baldane, Emine Gul; Gedik, Gonca Kara; Kebapcilar, LeventA 67-year-old woman presented to the audiology clinic with a complaint of bilateral hearing loss over the past two years. Routine biochemical screening showed an alkaline phosphatase level of 381 U/L, and she was referred to our endocrinology unit. Her vitamin D and parathyroid hormone levels, as well as thyroid, liver and kidney function test results, were within normal ranges. Cranial x-ray radiography showed an increase in the diploe distance and a sclerotic pattern in the calvarium; while whole body bone scintigraphy demonstrated a diffuse increase in radioactive substance involvement of the calvarium. Serum osteocalcin and spot urinary deoxypyridinoline levels were increased. The patient was diagnosed with Paget's disease with hearing loss as the first symptom, and she was started taking zoledronic acid treatment. Three months later, her alkaline phosphatase level had returned to the normal range, and audiologic examination showed a mild improvement in hearing.Öğe A CASE OF PAGET'S DISEASE OF THE BONEPRESENTED WITH HEARING LOSS AS THEFIRST SYMPTOM(2014) Baldane, Süleyman; İpekçi, Süleyman H; Bulut, Serap; Baldane, Emine Gül; Gedik, Gonca Kara; Kebapcılar, LeventAltmış yedi yaşında kadın hasta, her iki kulakta işitme kaybı nedeniyle odyoloji polikliniğinebaşvurdu. İki yıldır şikayeti olan hastanın rutin serum biyokimya incelemesinde alkalen fosfataz değerinin 381 U/L olması üzerine endokrinoloji ünitemize yönlendirildi. Hastanın vitamin D,parathormon, tiroid fonksiyon testleri, karaciğer fonksiyon testleri, böbrek fonksiyon testleri normal sınırlar içindeydi. Hastanın kranial grafisinde; diploe mesafesinde artış, kalvaryumda sklerotikgörünüm ve tüm vücut kemik sintigrafisinde; kalvaryumda diffüz tarzda artmış radyoaktif maddetutulumu izlendi. Serum osteokalsin ve spot idrarda deoksipridinolin düzeyleri yüksek saptandı.İşitme kaybının ilk semptom olarak görüldüğü hastaya mevcut bulgular ile kemiğin paget hastalığıtanısı ile zolendronik asit tedavisi verildi. Tedaviden üç ay sonraki kontrolünde, alkalen fosfatazdeğerinde normal düzeye gerileme ve odyolojik incelemede hafif düzeyde bir düzelme izlendiÖğe Contribution of SPECT-CT to Planar Imaging in Post-Ablation Imaging in Different Thyroid Cancers, the Clinical Significance of the Differential Diagnosis of Neck and Thorax Uptakes(Selçuk Üniversitesi, 2022) Yılmaz, Farise; Önner, Hasan; Gedik, Gonca KaraBackground: This study aims to demonstrate the superiority of Single Photon Emission Computed Tomography-Computed Tomography (SPECT-CT) over planar imaging in distinguishing benign from malignant foci and patient management after 131I ablation therapy in patients with differentiated thyroid cancer (DTC). Material and Methods: Planar and SPECT-CT imaging findings were retrospectively analyzed in Eighty patients who received I-131 therapy for thyroid cancer. Possible foci in whole body scanning (WBS), neck, and thorax were compared with SPECT-CT. Anatomical localization of the foci and differential diagnosis of the benign and malignant lesion was made with SPECT-CT. Those without anatomical counterparts were recorded as equivocal foci. According to the 2015 American Thyroid Association (ATA) guidelines, patients were divided into three groups: High, intermediate, and low-risk groups. Interpretation changes between both scannings were recorded as downstage and upstage. Results: A total of 80 patients, 53 female, and 27 male, were included in the study. The patients’ age ranged from 21 to 88 years with a mean age of 47 ±14.2. In 80 patients, 139 foci were detected in planar images and SPECT-CT images (neck: 118, thorax: 21). SPECT-CT revealed that 50% of the lateral neck foci were compatible with pathologies of malignant nature and 50% with pathologies of benign nature. Foci in the middle part of the neck were not only thyroid remnant (56%) but also thyroglossal duct remnant (40%) foci at a significant rate. It was determined that 66% of the foci in the thorax region were lung metastases ,and 34% were bone metastases. It was proved that 33% of the foci in the mediastinal area were lymph nodes. Although only one of the remaining patients had a pathological diagnosis, it was thought that all of them might have thymus pathologies. SPECT-CT images changed the interpretation of 18 patients (22.5%), 5 of whom (6.25%) were upstage and 13 (16.25%) were downstage. Conclusions: SPECT-CT will be very effective in, facilitating patient management and avoiding unnecessary procedures, especially in moderate/high-risk patients with suspicious focal lesions. Knowing the benign iodine uptake foci (thyroglossal duct remnant, etc.) that show iodine uptake other than the thyroid residue in the neck may be influential in deciding whether to ablate in low-risk patients.Öğe Differential diagnosis between secondary and tertiary hyperparathyroidism in a case of a giant-cell and brown tumor containing mass. Findings by Tc-99m-MDP, F-18-FDG PET/CT and (99)mTc-MIBI scans(HELLENIC SOC NUCLEAR MEDICINE, 2014) Gedik, Gonca Kara; Ata, Ozlem; Karabagli, Pinar; Sari, OktayBrown tumor is one of the skeletal manifegtations of hyperparathyroidism. It is a benign but locally aggressive bone lesion and its differential diagnosis with giant cell containing skeletal tumors or metastases may be complicated. We present a male patient with chronic renal failure who was initially misdiagnosed as having a giant-cell rich neoplasm of bone in his right thumb. Diffusely increased fluorine-18 fluorodeoxyglucose (F-18-FDG) uptake in the axial and appendicular skeleton and multiple F-18-FDG avid lytic lesions suggesting multiple metastases were observed on the F-18-FDG positron emission tomography/computed tomography (PET/CT) scan. On the usual technetium-99m methylene diphosphonate (Tc-99m-MDP) bone scan we noticed diffusely increased uptake in the skeleton and two focuses with very much increased uptake, which suggested a metabolic bone disease rather than a multiple metastatic giant cell tumor or bone metastases. Additional investigation documentated increased levels of parathyroid hormone. Parathyroid hyperplasia was finally diagnosed with Tc-99m-methoxyisobutylisonitrile (MIBI) parathyroid scintigraphy. Fluorine-18-FDG avid lytic lesions were attributed to hyerparathyroidism associated brown tumors instead of multiple metastases. In conclusion, we present a patient with chronic renal insufficiency, who suffered from secondary and later from tertiary HPT with polyostotic brown tumors, which were best shown by the F-18-FDG PET/CT than by the Tc-99m-MDP or the Tc-99m-MIBI scans.Öğe Does Treatment with Somatostatin Analogs Affect the Radioactivite Uptake of Normal Target Organs and Malignant Lesions on 68GaDOTATATE PET/CT imaging?(Selçuk Üniversitesi, 2022) Şahin, Özlem; Erol, Çağlagül; Yılmaz, Farise; Önner, Hasan; Gedik, Gonca Kara; Çelik, Ahmet VolkanObjective: Somatostatin analogs (SSA) are used in treating low-grade neuroendocrine tumors (NET), mainly because of their antiproliferative effect. 68Ga tetraazacyclododecantetraacetic acid-DPhe1-Tyr3-octreotate (DOTATATE) PET/CT as somatostatin receptor imaging has been widely used in recent years. However, there are conflicting publications in the literature, although there are guidelines for discontinuing the use of SSA before imaging. This study aims to investigate the effect of SSAs on Somatostatin receptor imaging. Material and Method: We retrospectively analyzed 253 patients who underwent 68Ga-DOTATATE PET/CT imaging between 2018 and 2022. Among these patients, those with low grades (grade 1 and grade 2) using SSA were included in the study. SUVmax (maximum standard uptake volume) of normal target organs, primary tumors, and metastases with the highest SUVmax in each organ were compared before and after SSA treatment. Results: 28 patients (16 females; 12 males, age [mean±SD], 54.82±14.27, range 18-78) with low-grade NET and 68Ga-DOTATATE PET/CT imaging with SSA therapy were included in the study. Although SUVmax was decreased in the values measured after SSA application in the liver and spleen, it was not statistically significant (p>0.05). There was no significant difference between SUVmax values in primary tumors and metastatic lesions in the liver, bone, lung, or lymph nodes before and after SSA application (P> 0.05). Conclusion: In conclusion, these drugs do not need to be discontinued before 68Ga-DOTATATE PET/CT imaging for treatment follow-up in neuroendocrine tumor patients using SSAs. In addition, these drugs may help report interpretation by increasing the intensity of metastatic lesions in the liver and spleen.Öğe Fibrous dysplasia mimicking vertebral bone metastasis on 18F-FDG PET/computed tomography in a patient with tongue cancer(ELSEVIER SCIENCE INC, 2015) Guler, Ibrahim; Nayman, Alaaddin; Gedik, Gonca Kara; Koplay, Mustafa; Sari, Oktay[Abstract not Available]Öğe Fluorodeoxyglucose positron emission tomography/computed tomography findings in a patient with cerebellar mutism after operation in posterior fossa(ELSEVIER SINGAPORE PTE LTD, 2017) Gedik, Gonca Kara; Sarı, Oktay; Köktekir, Ender; Akdemir, GökhanCerebellar mutism is a transient period of speechlessness that evolves after posterior fossa surgery in children. Although direct cerebellar and brain stem injury and supratentorial dysfunction have been implicated in the mediation of mutism, the pathophysiological mechanisms involved in the evolution of this kind of mutism remain unclear. Magnetic resonance imaging revealed dentatothalamocortical tract injuries and single photon emission computed tomography showed cerebellar and cerebral hypoperfusion in patients with cerebellar mutism. However, findings with F-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in this group of patients have not been documented previously. In this clinical case, we report a patient who experienced cerebellar mutism after undergoing a posterior fossa surgery. Right cerebellar and left frontal lobe hypometabolism was shown using FDG PET/CT. The FDG metabolism of both the cerebellum and the frontal lobe returned to normal levels after the resolution of the mutism symptoms. (C) 2017 Asian Surgical Association and Taiwan Robotic Surgical Association. Publishing services by Elsevier B.V.Öğe Influence of single photon emission computed tomography (SPECT) reconstruction algorithm on diagnostic accuracy of parathyroid scintigraphy: Comparison of iterative reconstruction with filtered backprojection(MEDKNOW PUBLICATIONS & MEDIA PVT LTD, 2017) Gedik, Gonca Kara; Sari, OktayBackground & objectives: Preoperative localization of parathyroid lesions is essential for improving the results in patients with primary hyperparathyroidism. The purpose of this study was to evaluate retrospectively the value of technetium-99m (Tc-99m) methoxyisobutylisonitrile (MIBI) single photon emission computed tomography (SPECT) and to compare the diagnostic accuracy of iterative reconstruction (IR) and filtered backprojection (FBP) reconstruction algorithms about localization of parathyroid lesions. Methods: Forty four patients with primary hyperparathyroidism, in whom histopathological correlation could be performed, were included in the study. Dual-phase Tc-99m parathyroid scintigraphy was performed 20 and 120 min after injection of 740 MBq Tc-99m MIBI in all patients. Tomographic images were acquired 120 min after the administration of radiopharmaceutical. The SPECT data were evaluated using an IR as well as a FBP algorithm. In 23 of 44 patients, SPECT acquisitions were performed in 64x64 matrix; in the remaining 21 patients, tomographic data were collected in 128x128 matrix. The imaging results were compared with pathological findings and sensitivities of both reconstruction algorithms, and planar views were calculated. Results: Using planar MIBI scans, abnormal parathyroid glands were correctly localized in 75 per cent of the cases. Sensitivity increased to 77 per cent using SPECT with FBP and to 84 per cent with IR. When the sensitivities were calculated according to the acquisition matrix, these were 95 per cent (20/21) and 85 per cent (18/21) for IR and FBP, respectively in patients in whom 128x128 matrix was used. The sensitivities were lower in patients who were imaged with 64x64 matrix; these were calculated as 74 per cent (17/23) and 70 per cent (16/23) with IR and FBP, respectively. Interpretation & conclusions: Our findings showed that compared to planar scintigraphy, Tc-99m MIBI SPECT was more sensitive diagnostic modality in the detection of abnormal parathyroid tissues. Image quality and sensitivity may be improved further when larger matrices with IR are used instead of FBP algorithm.Öğe Kemoterapi Tedavisi Sonucu Eritema Nodozum Gelişen Meme Kanseri Tanılı Bir Olgu(2017) Şen, Erdem; İnci, Fatih; Keleş, Burcu; Uğurluoğlu, Ceyhan; Gedik, Gonca Kara; Ata, ÖzlemEritema nodozum (EN) en sık görülen septal pannikülit tipidir. Genellikle 15-40 yaş arası bayanlarda görülmektedir. Etyolojik faktörler arasında ilaçlar, enfeksiyonlar, tümörler ve inflamatuvar hastalıklar bulunur. Bununla beraber genellikle nedeni bilinmemektedir. EN patogenezi tam olarak anlaşılamamıştır. Lezyonlar en sık bacaklarda yerleşim gösterir. Bunun dışında uyluk ve ön kolda sıklıkla tutulur. Gövde, boyun ve yüz tutulumu nadirdir. Akut ataklarda ateş, yorgunluk, eklem ağrısı, baş ağrısı, öksürük, karın ağrısı, bulantı veya ishal görülebilir. Enfeksiyonların, bağ doku hastalıklarının veya inflamatuar hastalıkların erken bulgusu olarak karşımıza çıkabilir. Biz meme kanseri tanılı, adjuvan tedavisi için siklofosfamid- doksorubisin- fluorourasil (CAF) kemoterapi tedavisi uygulanan hastada tedaviye bağlı gelişen eritema nodozumun takip ve tedavi sürecini sunmayı amaçladık.Öğe Marine-Lenhart syndrome in a young girl(WALTER DE GRUYTER GMBH, 2014) Sen, Yasar; Cimbek, Emine Ayca; Yuca, Sevil Ari; Gedik, Gonca Kara; Sari, OktayGraves' disease is the most common reason of hyperthyroidism in children. Graves' disease with accompanying functioning nodules is defined as Marine-Lenhart syndrome. This syndrome has not been described in children before. Here, a 15-year-old girl with Graves' disease and a coexisting cold nodule is presented. A thyroid scan showed diffuse uptake of Tc-99m pertechnatate in both lobes and decreased uptake in accordance with the left lobe nodule. The nodule was histologically diagnosed as benign. The patient was diagnosed with type 1 diabetes mellitus and polyglandular autoimmune syndrome during clinical follow-up. The differential diagnoses of Graves' disease with coexisting nodules should include the Marine-Lenhart syndrome. Treatment options should be determined taking this rare condition into account.Öğe Meme dokusunda tek taraflı Tc-99m perteknetat tutulumu: Laktas- yon dönemindeki bir hastada nadir patern(2014) Gedik, Gonca Kara; Sarı, OktayMeme dokusunda tek taraflı Tc-99m perteknetat tutulumu en sık meme karsinomu ile fibroadenom gibi meme hastalıklarında izle- nir. Meme dokusundaki Tc-99m perteknetat tutulumu, transmembrenal yerleşimli bir protein olan sodyum/iyot taşıyıcı proteinine bağlıdır. Bu proteinin ekspresyonu laktasyonda artar. Bu vaka takdiminde, tiroid sintigrafisinde saptanan ve tek taraflı olarak meme dokusunda Tc-99m perteknetat tutulumu gösteren, laktasyon dönemindeki bir hasta sunulmuşturÖğe Response to the letter to the editor entitled 'Fluorodeoxyglucose positron emission tomography/computed tomography standardized uptake value in discriminating benign versus malignant adrenal lesions: an open and debated issue'(LIPPINCOTT WILLIAMS & WILKINS, 2011) Kara, Pelin Ozcan; Kara, Taylan; Gedik, Gonca Kara[Abstract not Available]Öğe The role of fluorodeoxyglucose-positron emission tomography/computed tomography in differentiating between benign and malignant adrenal lesions(LIPPINCOTT WILLIAMS & WILKINS, 2011) Kara, Pelin Ozcan; Kara, Taylan; Gedik, Gonca Kara; Kara, Fatih; Sahin, Ozlem; Gunay, Emel Ceylan; Sari, OktayObjectives This retrospective study was designed to investigate the clinical role of whole-body positron emission tomography/computed tomography (PET/CT) by using 2[(18)F]fluoro-2-deoxy-D-glucose (FDG), for the evaluation of adrenal lesions and to find the best index to distinguish benign from malignant lesions in various cancer patients. Materials and methods A total of 81 patients (55 male and 26 female, age range: 31-81 years, mean: 61.5) who had confirmed primary malignancies (lung cancer in 47 patients, gastrointestinal malignancies in 13 patients, malignant melanoma in one patient, renal cell cancer in three patients, mesothelioma in two patients, breast carcinoma in nine patients, cervical cancer in one patient, ovarian cancer in two patients, pheochromocytoma in one patient, unknown primary in two patients) underwent PET/CT examinations for cancer screening, staging, restaging, and detection of suspected recurrence. Of the 81 patients, 104 adrenal lesions (34 benign and 70 malignant adrenal lesions) were shown by CT. On visual analysis of PET/CT imaging, adrenal uptake was based on a three-scale grading system. For final assessment standards of references for adrenal malignant lesions was based on biopsy (n=2), interval growth, or reduction after chemotherapy. An adrenal lesion, which remained unchanged on clinical and imaging follow-up of at least 7 months (mean follow-up time 19.31 months +/- 6.46, range 7-30 months), was decided as a benign lesion. Results In adrenal malignant lesions maximum standardized uptake value (SUV(max)) (8.82 +/- 4.47) was higher than that of adrenal benign lesions (3.02 +/- 1.15, P<0.0001). In the differentiation of adrenal benign and malignant lesions, a CT threshold of 10 Hounsfield units corresponded to a sensitivity of 64.7%, specificity of 98.6%, and accuracy of 87.5%. An SUV(max) cut-off value of 2.5 corresponded to a sensitivity of 100%, specificity of 38.2%, and accuracy of 80%. An SUV(max) cut-off value of 4.2 corresponded to a sensitivity of 88.6%, specificity of 88.2%, and accuracy of 88.5%. The ratio of tumor SUV(max) to liver SUV(mean) was 3.61 +/- 1.77 for adrenal malignant lesions whereas it was 1.20 +/- 0.38 for adrenal benign lesions (P<0.0001). T/L SUV ratio cut-off value of 1.8 corresponded to a sensitivity of 87%, specificity of 91%, and accuracy of 88.5%. T/L SUV ratio cut-off value of 1.68 corresponded to a sensitivity of 90%, specificity of 91.1%, and accuracy of 90.4%. Conclusion 2-[(18)F]fluoro-2-deoxy-D-glucose-PET/CT improves the diagnostic accuracy in the differentiation of benign from malignant adrenal lesions in various cancer patients. Combined information obtained from PET/CT (SUV(max) T/L SUV ratio, visual analysis) and unenhanced CT (size, Hounsfield units measurement) is recommended for better differentiation. Nucl Med Commun 32:106-112 (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins. Nuclear Medicine Communications 2011, 32:106-112
