Cumhuriyetimizin 100. kuruluş yıldönümüne yönelik olarak üniversitemizin yayınlamayı planladığı kitap serisi için yazmış olduğumuz bu eser, anabilim dalımızın yazmış olduğu 3. Nükleer Tıp Kitabı olma özelliğini taşımaktadır. Özet olarak yazılmasına rağmen önceki iki baskıya göre kitabın kalınlaşan hacmi Nükleer Tıp alanında yaşanan tanısal ve terapötik gelişmelerin bir yansımasını oluşturmaktadır. Gerçekten son 25 yıl içerisinde nükleer tıp alanında baş döndürücü gelişmeler yaşanmıştır ve halen de devam etmektedir. Konvansiyonel sintigrafide SPECT teknolojisinin devreye girmesi ile sağlanan tanısal duyarlılık artışı ve PET sintigrafisinin onkolojik görüntülemede paradigmayı değiştirmesinin yanı sıra PET/BT,SPECT/BT ve PET/MR gibi hibrit görüntüleme sistemlerinin ve daha etkin gama ışın tespit teknolojilerinin geliştirilmesi ile elde edilen yüksek tanısal doğruluk değerleri ve yeni geliştirilen tanısal nitelikli radyofarmasötiklerin kullanıma girmesi ile çeşitli hastalıkların patofizyolojisinin anlaşılmasında sintigrafinin etkinliğinin artması bir çırpıda söylenebilecek olanlardır. Bunların ötesinde 1946 yılından beri tiroit hastalıklarının hedefe yönelik tedavisinde büyük başarıyla uygulanan I-131 NaI tedavisi ve daha sonradan devreye giren nöral krest tümörlerinin tedavisindeki I-131 MIBG tedavisi ile yakılan mum ışıklarının, 2000’li yıllardan itibaren geliştirilen radyopeptit, radyoligand ve radyomikroküre bazlı yeni tedavi edici radyofarmasötikler eşliğinde, dozimetri hesaplamalarının katkısıyla kişiye özgün ölçülmüş-biçilmiş terapötik uygulamaların çeşitli kanserlerde sağladığı etkinlik sayesinde yeni radyonüklit tedavilerin, artık ilaç endüstrisinin de ilgisini çeken meşaleye dönüşmüş olduğunu söylemek mümkündür. Teranostik uygulamaların en başarılı örnekleri olan yeni radyonüklit tedavilerin özellikle karaciğer malignitelerine, nöroendokrin tümörlere ve prostat kanserine olan katkısı rutin klinik kılavuzların içerisinde çoktan yerini almıştır. Kitabımız 9 öğretim üyemizin değerli katkıları 33 bölümde özetlenmiş olup 270 sayfayı aşmaktadır. Bu eserin Tıp öğrencileri ve nükleer tıp uzmanlık öğrencileri başta olmak üzere tüm meslektaşlarımıza faydalı olacağını ümit ediyor, üniversitemize ve Türk Nükleer Tıp camiasına hayırlı olmasını temenni ediyoruz.

A 56-year-old male patient underwent total thyroidectomy, and pathology revealed multicentric papillary thyroid cancer. His post-operative stimulated thyroglobulin value was >500 ng/mL. 18F-fluorodeoxyglucose positron emission tomography (PET) computed tomography revealed hypermetabolic metastatic pulmonary nodules, cervical, and mediastinal lymph nodes. There was also a hypermetabolic lesion in the left gluteal muscle. Due to the patient's history of a pilonidal cyst in the same region, the possibility of an abscess was also considered, and due to the absence of radioactive iodine (RAI) uptake in the lesion, follow-up was deemed appropriate. During follow-up, as the patient progressed to RAI-refractory state, 68Ga-DOTATATE PET/magnetic resonance imaging, which was done for radionuclide therapy planning, revealed heterogeneously increased uptake in the gluteal lesion. A subsequent biopsy confirmed the diagnosis of PTC metastasis.

OBJECTIVE To introduce a novel technique, dynamic 99 mTc-MAG3 SPECT/CT (DyMAG3 SPECT/CT, SPECT; Single-photon emission computed tomography), which provides detailed anatomical structure, drainage patterns, presence of scarring, and split renal function in a single imaging session. This method seeks to improve the quality of conventional planar scintigraphy and offer comprehensive diagnostic convenience. MATERIALS AND METHODS DyMAG3 SPECT/CT was applied to nine index cases diagnosed with conditions such as ureteropelvic junction obstruction, ureterovesical junction obstruction, or hydronephrosis resembling ureteropelvic junction obstruction, with or without renal parenchymal thinning. Imaging was conducted just before planned pyeloplasty or ureteroneocystostomy. After a 0.1 mCi/kg 99 mTc-MAG3 bolus injection, planar perfusion imaging was performed at 2 seconds per frame for 1 minute. Subsequently, 2-minute-per-cycle SPECT acquisitions were undertaken over 20 minutes, followed by a CT acquisition. Time-activity curves (TACs) were generated from the isolated kidney volumes of interest. Split renal functions were calculated by integrating each kidney's time-activity curve between 2 and 4 minutes, emulating conventional 99 mTc-DMSA scintigraphy. RESULTS Preliminary findings from the first nine cases revealed that DyMAG3 SPECT/CT could provide both anatomical and functional data obtained equivalent to conventional techniques in a single imaging session. Moreover, DyMAG3 SPECT/CT improved the diagnostic abilities of 99 mTc-MAG3 scintigraphy by clearly distinguishing renal parenchyma from the collecting system. This allowed for voxelbased calculation of split renal function as an alternative to 99 mTc-DMSA scintigraphy. CONCLUSION This preliminary study suggests that DyMAG3 SPECT/CT could emerge as a state-of-the-art tool for the preoperative evaluation of obstructive uropathies. UROLOGY 199: 11-19, 2025. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

OBJECTIVES:Radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC) is associated with challenges in both imaging and treatment due to resistance to I-131. The aim of this study is to compare the lesion detection rates of [ 18 F] fluorodeoxyglucose (FDG) PET/computed tomography [CT] and [ 68 Ga]Ga-prostate specific membrane antigen (PSMA)-11 PET/CT, and to investigate the theranostic potential of PSMA in RAIR-DTC. METHODS:Thirty-eight RAIR-DTC patients followed between 2022 and 2024 underwent [ 18 F]FDG PET/CT and [ 68 Ga]Ga-PSMA-11 PET/CT. Lesions with uptake exceeding background activity were considered positive, while physiological uptake areas and benign-appearing foci were excluded. Lesion maximum standardized uptake value (SUVmax), tumor-to-background ratio (TBR), and detection rates were calculated and compared. RESULTS:[ 18 F]FDG PET/CT detected more lesions overall than [ 68 Ga]Ga-PSMA-11 PET/CT (96.8 vs. 60.1%), particularly in the thyroid bed, lymph nodes, and lungs. However, both modalities identified the same number of bone lesions. While [ 18 F]FDG PET/CT was superior in most patients, [ 68 Ga]Ga-PSMA-11 PET/CT detected more lesions in a subset of patients and performed better in the pure classic papillary thyroid carcinoma subtype compared to other subtypes (71.7 vs. 50.3%). SUVmax and TBR values were higher on [ 18 F]FDG PET/CT, yet in 14 patients (36.8%), [ 68 Ga]Ga-PSMA-11 PET/CT identified lesions with SUVmax exceeding liver SUVmax, indicating potential eligibility for PSMA-based radionuclide therapy. CONCLUSION:Although [ 18 F]FDG PET/CT demonstrated superior overall lesion detection, [ 68 Ga]Ga-PSMA-11 PET/CT identified more lesions in a subset of patients. [ 68 Ga]Ga-PSMA-11 PET/CT appears to be more beneficial in the pure classic subtype compared to other histological variants. Notably, [ 68 Ga]Ga-PSMA-11 PET/CT demonstrated high uptake in a considerable number of patients and may provide theranostic value in RAIR-DTC patients with limited treatment options.

Introduction and objectives: Incidentalomas of the thyroid gland are frequently observed in oncological patients undergoing FDG PET/CT imaging for staging or treatment response assessment. This study aims to investigate the utility of SUVmax and ADC values measured by PET/MRI in distinguishing between benign and malignant thyroid nodules. Materials and methods: We selected 108 patients (72 females, 36 males; mean age 54 +/- 12 years) who underwent routine oncological FDG PET/CT scans for staging or treatment response assessment, with nodule sizes greater than 1 cm. A one-bed neck PET/MRI scan followed the whole-body PET/CT. SUVmax values were measured, and ADC maps were created using DWI with b factors of 50 and 1000 s/mm(2). SUVmax and ADC values were correlated with FNAC results. Results: FNAC results revealed 76 (70.4%) benign and 32 (29.6%) malignant nodules among the 108 patients. The mean SUVmax of malignant nodules was significantly higher than that of benign nodules (10.6 +/- 8.3 vs. 5.94 +/- 5.2; P<.001). Similarly, the mean ADC value was lower in malignant nodules compared to benign ones (1.4 +/- 0.6 x 10(-3) mm(2)/s vs. 1.8 +/- 0.4 x 10(-3) mm(2)/s; P<.001). A significant but weak correlation was found between FNAC results and mean SUVmax (r = 0.335), as well as a significant weak negative correlation with mean ADC values (r = -0.355). Using a cut-off value of 6 for SUVmax and 1.56 x 10(-3) mm(2)/s for ADC, the sensitivity, specificity, and accuracy for SUVmax were 68.7, 73.6, and 72.1%, respectively, while for ADC, they were 71.8, 69.7, and 70.4%, respectively. The PET/MRI system demonstrated a relative sensitivity, specificity, accuracy, PPV, and NPV of 90.62, 51.32, 62.96, 43.94, and 92.86%. Conclusion: This study is one of the first in the literature to explore the use of FDG PET/MRI, a single-stop device, in distinguishing between benign and malignant thyroid nodules with high sensitivity and NPV.

INTRODUCTION AND OBJECTIVES:Incidentalomas of the thyroid gland are frequently observed in oncological patients undergoing FDG PET/CT imaging for staging or treatment response assessment. This study aims to investigate the utility of SUVmax and ADC values measured by PET/MRI in distinguishing between benign and malignant thyroid nodules. MATERIALS AND METHODS:We selected 108 patients (72 females, 36 males; mean age 54 ± 12 years) who underwent routine oncological FDG PET/CT scans for staging or treatment response assessment, with nodule sizes greater than 1 cm. A one-bed neck PET/MRI scan followed the whole-body PET/CT. SUVmax values were measured, and ADC maps were created using DWI with b factors of 50 and 1000 s/mm2. SUVmax and ADC values were correlated with FNAC results. RESULTS:FNAC results revealed 76 (70.4%) benign and 32 (29.6%) malignant nodules among the 108 patients. The mean SUVmax of malignant nodules was significantly higher than that of benign nodules (10.6 ± 8.3 vs. 5.94 ± 5.2, p < 0.001). Similarly, the mean ADC value was lower in malignant nodules compared to benign ones (1.4 ± 0.6 × 10-3 mm2/s vs. 1.8 ± 0.4 × 10-3 mm2/s; p < 0.001). A significant but weak correlation was found between FNAC results and mean SUVmax (r = 0.335), as well as a significant weak negative correlation with mean ADC values (r = -0.355). Using a cut-off value of 6 for SUVmax and 1.56 × 10-3 mm2/s for ADC, the sensitivity, specificity, and accuracy for SUVmax were 68.7%, 73.6%, and 72.1%, respectively, while for ADC, they were 71.8%, 69.7%, and 70.4%, respectively. The PET/MRI system demonstrated a relative sensitivity, specificity, accuracy, PPV, and NPV of 90.62%, 51.32%, 62.96%, 43.94%, and 92.86%. CONCLUSION:This study is one of the first in the literature to explore the use of FDG PET/MRI, a single-stop device, in distinguishing between benign and malignant thyroid nodules with high sensitivity and NPV.

Purpose: The main purpose is to evaluate the safety, and efficacy of 177 Lutetium labeled macroaggregated albumin (LUTMA) ablation of thyroid nodules. Material and methods: Patients with confirmed benign nodules who were not candidate or did not accept surgery were enrolled. Under ultrasonography (USG) guidance, LUTMA which was produced in our department, was administered into the nodules. Nodule volumes were assessed via USG before the injection and at 1-week, 1-month, and 3-months post-treatment. We calculated the volume reduction rates (VRRs) for these intervals. To detect extranodular activity leakage, patients underwent SPECT/CT imaging at one hour, 24 hours, and one week post-injection. Results: Fifteen patients (male: 12, female: 3) with benign thyroid nodules were eligible to join this study. These nodules were categorized as cystic (n = 9), solid (n = 3), or mixed (n = 3). Median nodules volume was 6.59 ml (range: 0.56-55 ml). Predicted absorbed dosee to the nodules varied between 10 to 1036 Gy. The VRRs at 3. months was 85% for all nodule types with gradual increases over time: 0-92%, 20-97%, and 28-98% at 1. week, 1. month, and 3-months, respectively. The median VRR of cystic nodules was 89% (range: 81%-98%) at 3-months. It is significantly higher than solid ones (p = 0.009). None of the patients experienced adverse reactions or discomfort during the injection or follow-up. Conclusion: LUTMA treatment significantly reduces the volume of benign thyroid nodules, offering relief from disease-associated symptoms and cosmetic concerns. It emerges as a promising alternative to surgical and other local treatments for benign thyroid nodule ablation. Clinical signification: LUTMA is a novel theranostic radiopharmaceutical which is promising in local ablative treatment of benign thyroid nodules. (c) 2024 Sociedad Espanola ola de Medicina Nuclear e Imagen Molecular. Published by Elsevier Espana, a, S.L.U. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Objetivo El objetivo principal del estudio fue evaluar la seguridad y eficacia en la ablación de nódulos tiroideos mediante macroagregados de albúmina radiomarcada con 177Lutecio (LUTMA). Material y métodos Se incluyeron pacientes con nódulos benignos confirmados que no eran candidatos o no aceptaron la cirugía. Bajo control ecográfico, se inyectó el LUTMA producido en nuestro departamento. Se evaluó mediante ecografía el volumen de los nódulos antes de la inyección, así como a la semana y al mes y 3 meses después del tratamiento. Para estos tiempos se calculó la tasa de reducción de volumen (TRV). Para detectar una extravasación extranodular de la actividad, los pacientes fueron sometidos a un estudio SPECT/TC una hora, 24h y una semana después de la inyección. Resultados Quince pacientes (12 hombres; 3 mujeres) con nódulos tiroideos benignos fueron candidatos para participar en este estudio. Estos nódulos se clasificaron como quísticos (n=9), sólidos (n=3) o mixtos (n=3). La mediana del volumen de los nódulos fue de 6,59ml (rango: 0,56-55ml). La dosis absorbida esperada en los nódulos osciló entre los 10 y 1036Gy. La TRV a los 3 meses fue del 85% para todos los tipos de nódulo, con su aumento progresivo a lo largo del tiempo: 0-92%, 20-97% y 28-98% a la semana, al mes y a los 3 meses, respectivamente. La mediana de la TRV de los nódulos quísticos fue del 89% (rango: 81-98%) a los 3 meses, siendo significativamente superior a la de los nódulos sólidos (p=0,009). Ninguno de los pacientes presentó reacciones adversas o molestias durante la inyección ni durante el seguimiento. Conclusión El tratamiento con LUTMA redujo significativamente el volumen de los nódulos tiroideos benignos, ofreciendo una mejoría de los síntomas asociados a la enfermedad y a la cuestión estética. Este tratamiento se perfila como una alternativa prometedora frente al tratamiento quirúrgico o frente a otros tratamientos locales para la ablación de los nódulos tiroideos benignos. Importancia clínica LUTMA es un nuevo radiofármaco teragnóstico prometedor para el tratamiento ablativo local de los nódulos tiroideos benignos.

BACKGROUND:Sarcoidosis is a granulomatous disease of unknown origin. Conventional laboratory and imaging modalities may lead to equivocal conclusions for sarcoidosis diagnosis. 68Ga-citrate PET/CT has been utilized in the diagnosis of inflammatory and infectious diseases due to its beter  performance.  Aims: This study was designed to determine the clinical trenchancy of 68Ga-citrate in sarcoidosis patients as an alternative tracer that binds to the somtastotin receptors of the inflammatory cells in sarcoid granulomas because current laboratory modalities may occasionally lack accuracy for sarcoidosis diagnosis. Conventional criteria including clinical, laboratory, radiologic modalities, and 18F-FDG PET/CT were compared with the 68Ga-citrate PET/CT to evaluate the diagnostic yield in sarcoidosis. METHODS:Forty-four sarcoidosis patients were include in the study. Conventional laboratory and imaging  modalities were done in 44 while  68Ga-citrate PET/CT and 18F-FDG-PET/CT  were    performed in 22 patients. The three modalities were compared with in regard to granulomatous activity evaluation, extrapulmonary organ involvement, and identification of coexistent malignant disease. RESULTS:68Ga-citrate PET/CT revealed a significantly higher diagnostic yield for sarcoidosis compared to conventional laboratory and 18F-FDG-PET/CT imaging modalties. 68Ga-citrate PET/CT revealed 72.7% sensitivity and 68.4% specificity for the detection of granulomatous inflammation in sarcoidosis. CONCLUSIONS:68Ga-citrate PET/CT was conclusive for activity assessment in sarcoidosis for diagnosis, activity assessment, and identification of extrapulmonary organ involvement. As an innovative novel tracer, 68Ga-citrate identified disease activity, extrapulmonary organ involvement, biopsy sites, and coexistent malignancy due to its chemical properties with a higher statistical diagnostic yield compared to conventional laboratory findings and the  PET/CT imaging manifestations in sarcoidosis.

Background: Sarcoidosis is a granulomatous disease of unknown origin. Conventional laboratory and imaging modalities may lead to equivocal conclusions for sarcoidosis diagnosis. 68 Ga-citrate PET/CT has been utilized in the diagnosis of inflammatory and infectious diseases due to its better diagnostic yield. Objectives: This study was designed to determine the clinical trenchancy of a novel tracer 68 Ga-citrate in sarcoidosis patients as an alternative radiopharmaceutical that binds to the somatostatin receptors of the inflammatory cells in sarcoid granulomas because current laboratory and imaging modalities may occasionally lack accuracy for sarcoidosis diagnosis. Conventional laboratory data including the clinic, serum biochemistry, and thorax CT findings were compared with the 18 F-FDG PET/CT and 68 Ga-citrate PET/CT imaging manifestations to evaluate the diagnostic yield of each modality in sarcoidosis. Methods: Forty-four sarcoidosis patients were included in the study. Conventional laboratory investigation and thorax CT were performed in 44 while 68 Ga-citrate PET/CT and 18 F-FDG PET/CT were done in 22 patients. Findings of each modality were analyzed in regard to the diagnostic yield for granulomatous activity assessment, extrapulmonary organ involvement identification, and detection of coexistent malignant disease in sarcoidosis patients. Results: 68 Ga-citrate PET/CT revealed a significantly higher diagnostic yield for sarcoidosis compared to conventional laboratory and 18 F-FDG-PET/CT imaging modalities. 68 Ga-citrate PET/CT revealed 72.7% sensitivity for the detection of granulomatous inflammation that was consistent with the final diagnosis of sarcoidosis. Diagnostic yield for biopsy site determination, discrimination between active inflammation and fibrosis was significantly higher by 68 Ga-citrate PET/CT. 18 F-FDG only displayed a slightly higher clinical expediency over 68 Ga-citrate for diagnosis of malignancy. Conclusions: 68 Ga-citrate PET/CT was conclusive for the diagnosis, activity assessment, and identification of extrapulmonary organ involvement in sarcoidosis patients. As an innovative novel tracer, 68 Ga-citrate identified disease activity, extrapulmonary organ involvement, and biopsy sites with a higher statistical diagnostic yield compared to the conventional laboratory findings in sarcoidosis due to its more advanced chemical properties. 18 F-FDG only provided a slightly higher clinical yield with a negligible significant statistical difference compared to 68 Ga-citrate for the detection of coexistent malignant disease among sarcoidosis patients.