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    Evaluation of FDG Uptake in Pulmonary Hila with FDG PET/CT and Contrast-Enhanced CT in Patients with Thoracic and Non-Thoracic Tumors
    (Springer, 2010) Kara Gedik, Gonca; Özcan Kara, Pelin; Kara, Taylan; Sarı, Oktay; Kara, Fatih
    Objective Fluorine-18 fluorodeoxyglucose (FDG) uptake is frequently observed in lung hilus. This finding causes difficulties during the interpretation. Our objective was to evaluate the features of FDG uptake in lung hilus associated with benign or malignant etiology in patients with thoracic and non-thoracic tumors. Methods We retrospectively evaluated the files of 1172 patients who had undergone FDG positron emission tomography (PET)/computed tomography (CT) examination between January 2008 and June 2009. Forty-eight patients (21 males, 27 females, age range 12-80 years, mean 60.9 +/- 15.82 years) with either unilateral or bilateral hilar FDG uptake and who had thorax contrast-enhanced computed tomography (CECT) performed within 1 month of the FDG PET/CT scan were enrolled in the study. Characteristics of FDG uptake were classified according to the pathology and CECT or PET/CT follow-up over 12 months. Results The characteristics of 71 hilar regions with FDG uptake could be classified. In 30 of 71 (42.3%) hilar regions, FDG uptake was considered to be physiological because no lymph node was observed on CECT. In 19 of 71 (26.8%), FDG uptake was secondary to benign lymph nodes and in 22 (30.9%) to malignant lymph nodes. Significant differences were observed between benign and malignant lymph nodes for SUVhilus and SUVhilus/SUVliver ratio. Using 4.49 as the cut-off value for SUVhilus, a sensitivity of 85.7% and a specificity of 86.4% were achieved (area under curve, AUC: 0.956). For SUVhilus/SUVliver ratio, sensitivity and specificity to detect malignant lymph nodes were 77.6 and 77.3% (AUC: 0.885), respectively, at a cut-off value of 1.75. Conclusion SUVhilus and SUVhilus/SUVliver ratio were found to be significant parameters for determining malignancy in lung hilus. Combined interpretation with CECT is warranted during the evaluation of lung hilus with FDG PET/CT.
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    FDG Uptake Pattern on PET/CT Imaging in Non-Infectious Graft of a Patient with Operated Abdominal Aortic Aneurysm
    (2012) Kara, Pelin Özcan; Kara, Gonca Gedik; Kara, Taylan; Koçak, Ismail; Varoğlu, Erhan; Sarı, Oktay
    Florodeoksiglukoz kullanılarak yapılan positron emisyon tomografisi, kanser hastalarının rutin değerlendirilmesinde iyi bilinen bir tanısal yöntemdir. Florodeoksiglukoz tutulumu, glukoz metabolizması göstergesi olarak malign durumlarda olduğu gibi infeksiyöz ve inflamatuar proseslerde de artar. Bu olgu sunumunda aort anevrizmasına bağlı greft operasyonu geçirmiş ve renal hücreli karsinom nedeni ile takipte olan bir hastada greft bölgesinde postoperatif değişiklikler ile uyumlu PET/BT bulguları takdim edilmiştir. PET/BTdeki tutulum paterninin infeksiyoz ve non-infeksiyoz durumların ayırıcı tanısındaki önemi işaret edilmiştir. (MIRT 2012;21:110-113)
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    FDG-PET/CT Imaging in a Patient With Lymphangiosarcoma
    (Lippincott Williams & Wilkins, 2010) Kara, Pelin Özcan; Kara Gedik, Gonca; Sarı, Oktay; Kara, Taylan; Yılmaz, Farise
    Lymphangiosarcoma is a well-recognized complication of chronic lymphedema. We present a rare case of lymphangiosarcoma in a 34-year-old woman who presented with a mass on her left lymphedematous leg. Her leg had become persistently swollen in the weeks during pregnancy and a clinical diagnosis of lymphedema was made, initially. During the third trimester, she developed an ulcerated mass lesion. MRI and FDG-PET/CT scans were performed after delivery. MRI demonstrated a 6 8 9.5 cm mass in the left thigh. Biopsy of the lesion was consistent with lymphangiosarcoma. FDG-PET/CT demonstrated the primary lesion and its distant metastases.
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    Findings on fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography in a patient with malignant pheochromocytoma
    (2011) Özcan, Pelin Kara; Kara, Taylan; Kara, Gonca Gedik; Sarı, Oktay; Şahin, Özlem
    Feokromasitomalar sempatoadrenal sistemin kromafin hücrelerinden köken alan nadir tümörlerdir ve %85’i adrenal medullada lokalize olur. Malign feokromasitomalar tüm feokromasitomaların %10’unu oluşturur. Klinik, biyokimyasal ve histopatolojik yöntemlerin hiçbiri malign tümörleri benign tümörlerden ayıramadığından, malignite uzak metastaz varlığında tanımlanır. Her ne kadar bazı vakalarda metastazlar takip sırasında gelişebilirse de, vakaların büyük çoğunluğunda ilk tanı anında metastatik hastalık mevcuttur. Bu olgu sunumunda, malign feokromasitomalı bir hastada takip sırasında rekürens ve uzak metastazlarının 18-florodeoksiglukoz pozitron emisyon tomografi/ bilgisayarlı tomografi (FDG PET/BT ) ile saptanması sunulmuştur. (MIRT 2011;20:67-69)
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    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, Oktay
    Objectives 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