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.

FLT3-TKD (tyrosine kinase domain) mutations are identified in approximately 4

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.

Objective: Thyroid uptake test plays an important role in diagnosis, treatment planning and radioiodine dose determination in patients with hyperthyroidism. The aim of this study was to compare the % uptake values calculated with gamma camera and uptake probe after diagnostic I-131 application in hyperthyroid patients. Materials and Methods: In this study, % uptake values were measured using a thyroid uptake probe and gamma camera in 32 patients who underwent thyroid radioiodine uptake measurement in our Nuclear Medicine center. Thyroid uptake measurements were prepared in the neck phantom with 0.74-0.925 MBq activity of I-131 radionuclide. After counting the phantom with I-131 separately in the uptake probe and gamma camera, I-131 sample was orally administered to the patient. % uptake values were calculated by the uptake probe measurements and drawing regions of interest (ROI) from scintigraphic images at 2 and 24 h. Results: The 2-h mean % uptake values in the probe and gamma camera were calculated as 30.5 +/- 20.4 and 27.1 +/- 18.6, respectively. The 24-h mean % uptake values in the thyroid probe and gamma camera were calculated as 57.6 +/- 21.9 and 55.3 +/- 21.5, respectively. Linear regression analyses for the 2- and 24-h % uptake values calculated with the probe and gamma camera were found as R-2 = 0.8412 and R-2 = 0.7313, respectively. Conclusion: The 2- and 24-h % uptake values with the probe and gamma camera were found to be consistent with each other, indicating that they can be safely used interchangeably in patients with hyperthyroidism.

Introduction: The most important toxicity of transarterial radioembolization therapy applied in liver malignancies is radiation pneumonitis and fibrosis due to hepatopulmonary shunt of Yttrium-90 (90Y) microspheres. Currently, Technetium-99m macroaggregated albumin (99mTc-MAA) scintigraphic images are used to estimate lung shunt fraction (LSF) before treatment. The aim of this study was to create a phantom to calculate exact LFS rates according to 99mTc activities in the phantom and to compare these rates with LSF values calculated from scintigraphic images. Materials and Methods: A 3D-printed lung and liver phantom containing two liver tumors was developed from Polylactic Acid (PLA) material, which is similar to the normal-sized human body in terms of texture and density. Actual %LSFs were calculated by filling phantoms and tumors with 99mTc radionuclide. After the phantoms were placed in the water tank made of plexiglass material, planar, SPECT, and SPECT/CT images were obtained. The actual LSF ratio calculated from the activity amounts filled into the phantom was used for the verification of the quantification of scintigraphic images and the results obtained by the Simplicity90YTM method. Results: In our experimental model, LSFs calculated from 99mTc activities filled into the lungs, normal liver, small tumor, and large tumor were found to be 0%, 6.2%, 10.8%, and 16.9%. According to these actual LSF values, LSF values were calculated from planar, SPECT/CT (without attenuation correction), and SPECT/CT (with both attenuation and scatter correction) scintigraphic images of the phantom. In each scintigraphy, doses were calculated for lung, small tumor, large tumor, normal liver, and Simplicity90YTM. The doses calculated from planar and SPECT/CT (NoAC+NoSC) images were found to be higher than the actual doses. The doses calculated from SPECT/CT (with AC+with SC) images and Simplicity90YTM were found to be closer to the real dose values. Conclusion: LSF is critical in dosimetry calculations of 90Y microsphere therapy. The newly introduced hepatopulmonary shunt phantom in this study is suitable for LSF verification for all models/brands of SPECT and SPECT/CT devices.

Sarcoma is rarely seen in the thyroid gland and it is difficult to differentiate it from anaplastic thyroid carcinoma. Extraosseus osteosarcoma, a rare malignant nonepithelial neoplasia, can be seen in the thyroid gland, breast, soft tissue, and intraabdominal organs. A 31-year-old woman with a previous history of osteosarcoma of distal femur was presented with a constantly growing mass in her neck accompanied with progressive shortness of breath and worsening dysphagia. On physical examination, a 4 x 5 cm firm mass was palpated in the left lobe of her thyroid gland. Seven years ago, during her pregnancy, she was diagnosed with osteosarcoma of the distal femur and she received chemotherapy and radiotherapy after medical abortion. A year after her initial diagnosis, she underwent surgery for osteosarcoma. Two years later, pulmonary metastasis was detected incidentally in her control computed tomography. She was operated for pulmonary metastasis since there was no remission after chemotherapy. When she presented to the clinic with a neck mass, her thyroid function tests were within the normal range. On computed tomography scan, a 2.5 cm calcified lesion in left lobe of her thyroid gland was detected. Fine-needle aspiration of the thyroid mass displayed numerous discohesive pleomorphic tumors cells identical to osteosarcoma cells seen on her previous knee biopsy specimen. On positron emission tomography, a 3 x 3 x 4.5 cm hypermetabolic lesion with pathologic 18F-FDG uptake on the left side of her neck in thyroid cartilage level was detected. A bilateral total thyroidectomy was performed. The patient was discharged without any complications.

To assess frequency, clinical indications, and cumulative effective dose (CED) of patients undergoing multiple 18F-FDG PET/CT imaging. Retrospective analysis of 18F-FDG PET/CT scans performed at a university hospital for 11 years was done. The effective dose was estimated from activity administered and dose-length-product. A total of 55,424 18F-FDG PET/CT scans were performed in 32,658 patients. The average injected activity was 421 MBq and median 417 MBq. 24.2

Ovarian cancer is one of the deadliest tumors among women. It mostly metastasizes to the liver, pleura, lungs, and bones. We present a sixty-six-year-old patient with skin lesions. The patient who underwent biopsy due to skin lesions was diagnosed with ovarian cancer. 18F-fluorodeoxyglucose (FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) performed for metastasis search shows widespread skin involvement, especially in the lower abdomen and legs. Skin involvement it ovarian cancer can be rarely seen, and in this article we would like to share 18F-FDG PET/MRI of skin involvement in ovarian cancer.Over kanseri, kadınlar arasında en ölümcül tümörlerden biridir. Çoğunlukla karaciğer, plevra, akciğer ve kemiklere metastaz yapar. Altmış altı yaşında kadın hasta deri lezyonlarıyla başvuruyor. Deri lezyonları sebebiyle biyopsi yapılan hasta over kanseri tanısı alıyor. Metastaz arama amacıyla yapılan 18F-florodeoksiglukoz pozitron emisyon tomografi/manyetik rezonansta (PET/MR) özellikler alt batın ve bacaklarda yaygın deri tutulumları izleniyor. Over kanserinde deri tutulumları nadir olarak görülebilmektedir, bu yazıda over kanserinin deri tutulumunun 18F-FDG PET/MR görüntülerini paylaşmak istiyoruz.

Follicular variant of papillary thyroid carcinoma (FV-PTC) is the second most common subtype of PTC after the classic PTC. FV-PTC is characterized by nuclear features of classic PTC with a follicular architecture that lacks classic papillary morphology. Unlike follicular thyroid carcinoma (FTC), which is more often manifested by hematogenous metastases to lung and bone, PTC tends to metastasize to cervical lymph nodes. Distant metastases of PTC are very rare, whereas renal metastasis is extremely rare.[1] Renal fine-needle aspiration (FNA) is not commonly used due to concerns about safety and diagnostic accuracy. However, it can be used for diagnosis in poor surgical candidates or patients with unresectable tumors and for excluding metastasis, hematologic malignancy, and benign or reactive processes.[2] Here, we report the cytomorphological and clinical features of a 74-year-old female patient with renal mass diagnosed as FV-PTC metastasis with FNA. We report this case because of the rarity of renal metastasis of FV-PTC, which can be a diagnostic pitfall in the evaluation of renal FNA. A 74-year-old woman presented for evaluation of a right renal mass, and she did not have any urinary symptoms such as hematuria or pain. Computerized tomography (CT) of abdomen revealed a 29 × 28 mm homogeneous solid mass arising from the upper pole of the right kidney. The medical history of the patient indicated a total thyroidectomy performed at our hospital 7 years ago. The histologic type of tumor was identified as FV-PTC (with focal insular pattern and extrathyroidal extension). A recent fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan of the patient revealed multiple hypermetabolic pulmonary and bone metastasis as well as an additional new hypermetabolic lesion with an SUVmax value of 7.5 on right upper renal pole [Figure 1].Figure 1: FDG-PET/CT scan maximum intensity projection (MIP) image revealing intense FDG uptake on upper pole of right kidney, which was proven to be thyroid cancer metastasis on histopathology (black arrow). She also had multiple bone metastases and pulmonary metastases with increased FDG uptakeCT-guided FNA was performed on renal mass for diagnosis. Very few cells were found on slides by rapid on-site evaluation; however, a second FNA could not be performed because the patient was unable to tolerate the procedure. In cytological evaluation, the slides were hypocellular, but the hematoxylin and eosin slides of cell block were rich in tumoral cells. The small- to medium-sized tumor cells with a follicular architecture with slightly monomorphic atypia were seen [Figure 2]. An immunohistochemical study was carried out in cell block to support the diagnosis. Tumor cells were positive for CK7, thyroid transcription factor-1 (TTF-1), thyroglobulin, and focal positive for CD56. No staining was observed with PAX2 [Figure 3]. The case was assessed with previous slides of thyroid resection. The same histological features were seen. With these findings, the case was reported as renal metastasis of FV-PTC.Figure 2: Conventional slides were very hypocellular, and there were only a few tumor cells in the follicular pattern (a, May-Grünwald-Giemsa (MGG), x200; b, MGG, x400). In cell block sections, small- to medium-sized tumor cells with a follicular architecture that had slightly monomorphic atypia were seen (c, hematoxylin and eosin (H and E), x200; d, H and E × 400)Figure 3: The immunohistochemical stains (a, TTF-1, x200; b, CK7, x200; c, thyroglobulin, x200; d, CD56, x200; e, PAX2 × 200)Renal metastasis is very uncommon in cases of well-differentiated thyroid carcinomas.[1] Diagnosis of FV-PTC by FNA aspiration cytology is difficult because they do not have all cytologic features of classical PTC, such as papillary structures consisting of fibrovascular cores, or the nuclear features like nuclear enlargement and overlap, chromatin clearing, grooves, and intranuclear pseudo inclusions. FV-PTCs often show microfollicular patterns in cytologic specimens and are frequently classified under the “follicular neoplasm/suspicious for a follicular neoplasm” or “suspicious for PTC” category within the Bethesda System, according to the severity of atypia.[3] A diagnostically challenging lesion in the differential diagnosis of metastatic FV-PTC is FTC, showing a microfollicular pattern or a further cytologic feature such as a solid trabecular or cribriform pattern. Furthermore, both lesions have identical propensity to metastasize to lung and bone by hematogenous instead of lymphatic route as in conventional PTC.[3] In addition, FV-PTC also represents various genetic abnormalities with FTC, including RAS mutations and PAX8/PPARg rearrangements.[4] In differential diagnosis, thyroid-like follicular carcinoma (TLFC) of the kidney, which is an extremely rare type of renal tumor, was considered. Histologically, TLFC consists of follicles of various sizes filled with colloid-like material. These tumors are immunoreactive for PAX2, PAX8, and CK7 but lack reactivity for thyroglobulin and TTF-1.[5] In the present case, immunohistochemical analysis was performed for differential diagnosis. The tumor cells were immunoreactive for CK7, TTF-1, thyroglobulin, and focal positive for CD56 but PAX2-negative. These immunohistochemical results supported our diagnosis of renal metastasis of FV-PTC. In our case, there was a focal insular pattern with FV-PTC and extrathyroidal extension. It is known that insular thyroid carcinomas have a high incidence of metastasis, recurrence, mortality, and poor prognosis.[6] Focal insular pattern may explain the aggressive behavior and the large number of distant metastases of the initial carcinoma. In conclusion, metastatic tumors in the kidney can be difficult to diagnose on cytologic specimens. In our case, the patient’s clinical history of FV-PTC and immunohistochemical studies were helpful in distinguishing other tumors and supported the diagnosis. In differential diagnosis of renal masses, metastases of thyroid-origin carcinomas should be kept in mind. Future reports of similar cases may improve the awareness of this pathology and enrich the literature. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Purpose Bone metastasis is essential in patients with prostate cancer (PCa) as it determines prognosis and survival. Hybrid PET/MRI allows simultaneous acquisition of PET and MRI data, thus combining the strength of both technologies allows the detection of bone marrow metastases that are missed by PET/CT. In this retrospective study, we aimed to evaluate the diagnostic efficiency of hybrid PET/MRI with Ga-68 prostate-specific membrane antigen (PSMA) in detecting skeletal metastases in newly diagnosed PCa patients and compared the effectiveness of stand-alone PSMA PET reviewing versus stand-alone whole-body (WB) MRI evaluation. We also investigated the effect of the interpretation of all PET/MR data together on clinical management. Methods We studied 74 newly diagnosed PCa patients who underwent PSMA PET/MRI for staging purposes. At first, PET and MRI were evaluated separately for bone lesions on a patient-and-lesion basis and then a further joint PSMA PET/MRI interpretation was made. Results Patient-based sensitivity, specificity, positive predictive value, negative predictive value and accuracy analysis for bone metastasis was, respectively, 1.0, 0.83, 0.54, 1.0, 0.86 for PET; 0.75, 0.96, 0.81, 0.95, 0.93 for WB MRI and 0.91, 0.95, 0.78, 0,98, 0.94 for PET/MRI. The combined PET/MRI evaluation changed the clinical impact in 13.5% of patients (eight correct and two wrong decisions) compared to PET stand-alone interpretation. Conclusion PSMA PET imaging showed superior sensitivity to WB MRI in detecting bone metastases in newly diagnosed PCa patients, whereas WB MRI has superior specificity and PPV. Furthermore, the specificity and PPV of joint PET/MRI evaluation are better than PSMA PET alone. Despite the longer acquisition period, adding WB MRI sequences to PSMA PET imaging appears beneficial for PCa patient management.

Purpose To investigate the strength of quantitative imaging and metabolic parameters in differentiating invasive breast carcinomas with elevated Ki-67 levels. Materials and Methods A total of 123 patients with 129 breast lesions confirmed as invasive breast carcinoma underwent shear wave elastography (SWE), superb microvascular imaging (SMI) and positron emission tomography (PET)/CT or MRI. Adler's grade (classifying the microvascularity into four types) and Vascular Index (VI) was obtained by SMI as microvascular parameters. In addition, the stiffness value (E-mean) was evaluated in kilopascal by SWE. The average of consecutive measurements was recorded as mean VI and mean E-mean. PET scan parameters were obtained as SUVmax and SULpeak. Lesions were divided into two groups according to the Ki-67 expression, low as <=$$ \le $$14 and high as >14. Results Adler's grading was the most correlated imaging parameter with high Ki-67 expression (p < 0.05), while VI and E-mean had poor correlation (p > 0.05). SUVmax and SULpeak indicated a significant linear correlation with Ki-67 but a moderate correlation with the high levels of Ki-67 (p < 0,001). The sensitivity of VI, E-mean, SUVmax and SULpeak was 64.6%, 66.7%, 65.7%, and 66.7% when the cut-off point was set to 5.25, 102.5, 6.59, and 2.63, respectively. SUVmax had the highest AUC value of 0.740, according to the ROC curve analysis. Conclusions Our results suggest that the quantitative parameters obtained by advanced imaging methods may be useful in predicting the high proliferation in invasive breast carcinomas. But none of them is eligible to be used as an independent biomarker in distinguishing aggressive behavior. Nevertheless, as a noninvasive method, visual assessment of microvascular morphology using SMI increases the prognostic efficiency in invasive breast carcinomas.

Epileptic DisordersEarly View CASE VIGNETTE A medically refractory epilepsy case with discordant presurgical findings: The pitfall of burned-out hippocampus Merve Aktan Suzgun, Corresponding Author Merve Aktan Suzgun [email protected] orcid.org/0000-0002-0332-8453 Istanbul University-Cerrahpasa, Cerrrahpasa Medical Faculty, Department of Neurology, Istanbul, Turkey Correspondence Merve Aktan Suzgun, Istanbul University-Cerrahpasa, Cerrrahpasa Medical Faculty, Neurology Building, 34098, Fatih, Istanbul, Turkey. Email: [email protected]Search for more papers by this authorHuseyin Mert Cerci, Huseyin Mert Cerci Istanbul University-Cerrahpasa, Cerrrahpasa Medical Faculty, Department of Neurosurgery, Istanbul, TurkeySearch for more papers by this authorCihan Isler, Cihan Isler Istanbul University-Cerrahpasa, Cerrrahpasa Medical Faculty, Department of Neurosurgery, Istanbul, TurkeySearch for more papers by this authorLebriz Uslu-Besli, Lebriz Uslu-Besli Istanbul University-Cerrahpasa, Cerrrahpasa Medical Faculty, Department of Nuclear Medicine, Istanbul, TurkeySearch for more papers by this authorMustafa Uzan, Mustafa Uzan Istanbul University-Cerrahpasa, Cerrrahpasa Medical Faculty, Department of Neurosurgery, Istanbul, TurkeySearch for more papers by this authorCigdem Ozkara, Cigdem Ozkara Istanbul University-Cerrahpasa, Cerrrahpasa Medical Faculty, Department of Neurology, Istanbul, TurkeySearch for more papers by this author Merve Aktan Suzgun, Corresponding Author Merve Aktan Suzgun [email protected] orcid.org/0000-0002-0332-8453 Istanbul University-Cerrahpasa, Cerrrahpasa Medical Faculty, Department of Neurology, Istanbul, Turkey Correspondence Merve Aktan Suzgun, Istanbul University-Cerrahpasa, Cerrrahpasa Medical Faculty, Neurology Building, 34098, Fatih, Istanbul, Turkey. Email: [email protected]Search for more papers by this authorHuseyin Mert Cerci, Huseyin Mert Cerci Istanbul University-Cerrahpasa, Cerrrahpasa Medical Faculty, Department of Neurosurgery, Istanbul, TurkeySearch for more papers by this authorCihan Isler, Cihan Isler Istanbul University-Cerrahpasa, Cerrrahpasa Medical Faculty, Department of Neurosurgery, Istanbul, TurkeySearch for more papers by this authorLebriz Uslu-Besli, Lebriz Uslu-Besli Istanbul University-Cerrahpasa, Cerrrahpasa Medical Faculty, Department of Nuclear Medicine, Istanbul, TurkeySearch for more papers by this authorMustafa Uzan, Mustafa Uzan Istanbul University-Cerrahpasa, Cerrrahpasa Medical Faculty, Department of Neurosurgery, Istanbul, TurkeySearch for more papers by this authorCigdem Ozkara, Cigdem Ozkara Istanbul University-Cerrahpasa, Cerrrahpasa Medical Faculty, Department of Neurology, Istanbul, TurkeySearch for more papers by this author First published: 30 July 2023 https://doi.org/10.1002/epd2.20142 The work has not been presented at a meeting. Read the full textAboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat CONFLICT OF INTEREST STATEMENT The authors have no conflicts of interest to declare. Supporting Information Filename Description epd220142-sup-0001-Test_Yourself_Answers.docxWord 2007 document , 12.1 KB Data S1. epd220142-sup-0002-Educational_Slides.pptxPowerPoint 2007 presentation , 10.9 MB Data S2. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article. REFERENCES 1Vakharia VN, Duncan JS, Witt JA, Elger CE, Staba R, Engel J Jr. Getting the best outcomes from epilepsy surgery. Ann Neurol. 2018; 83(4): 676–690. 2Mintzer S, Cendes F, Soss J, Andermann F, Engel J Jr, Dubeau F, et al. Unilateral hippocampal sclerosis with contralateral temporal scalp ictal onset. Epilepsia. 2004; 45(7): 792–802. 3Nair PP, Menon RN, Radhakrishnan A, Cherian A, Abraham M, Vilanilam G, et al. Is 'burned-out hippocampus' syndrome a distinct electro-clinical variant of MTLE-HS syndrome? Epilepsy Behav. 2017; 69: 53–58. 4Gatzonis S, Siatouni A, Georgaculias N, Korfias S, Sakas DE. Ictal intracranial recording from a 'burned-out hippocampus'. Med Princ Pract. 2013; 22(1): 92–95. 5Gloor P, Salanova V, Olivier A, Quesney LF. The human dorsal hippocampal commissure. An anatomically identifiable and functional pathway. Brain. 1993; 116(Pt 5): 1249–1273. 6Freire Carlier ID, Andrade Rondón SA, Silva Sieger FA, Freire Figueroa IA, Barroso Da Silva EA. Burned-out hippocampus syndrome: myth or reality? A case report. Neurologia (Engl ed). 2021; 36(7): 558–561. 7Ferreira Caboclo LOS, Garzon E, Miyashira FS, Carrete H Jr, da Silva CR, Targas Yacubian EM, et al. Temporal lobe epilepsy with unilateral hippocampal sclerosis and contralateral temporal scalp seizure onset: report of four patients with "burned-out hippocampus". J Epilepsy Clin Neurophysiol. 2005; 11(2): 79–86. Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Purpose: To investigate the relationship between sonographic findings and the axillary status, especially the side of thickening in the presence of cortical asymmetry.Methods: Patients with biopsy-proven axillary lymph node (ALN) metastasis were included in this study. The lymph nodes were divided into three groups depending on the type of cortical thickening as diffuse, closer (eccentric cortical thickening on the side near the tumor and/or breast) and distant (thickening on the further side) asymmetry. Longitudinal to transverse axis (L/T) ratio, the largest cortical thickness, cortex to hilum ratio (C/H), hilar status (normal/displaced/absent), orientation (parallel/vertical), capsular integrity (sharp/indis-tinct), vascularisation pattern (hilar/peripheral/penetrant/anarchic/avascular) on superb microvascular imaging (SMI) and presence of conglomeration were recorded for each lymph node. Axillary nodal status on 18F-FDG PET-CT/MRI scans was recorded, if available. Features of the breast lesions like size, laterality, nuclear grade, hor-mone receptor status and the level of Ki-67 expression have been added.Results: A total of 219 metastatic ALNs [diffuse (n = 122), closer asymmetry (n = 71), distant asymmetry (n = 26)] were evaluated. By the univariate analysis, ALN metastasis was significantly associated with the presence of closer asymmetrical cortical thickening (p < 0,0001), C/H ratio (p = 0.001), cortical thickness (p = 0.001), hilar status (p < 0.005) and vascular pattern (p < 0.005). L/T ratio was only a statistically significant parameter for lymph nodes with diffuse cortical enlargement in predicting metastasis, and conglomeration was also observed only in this group (p < 0.05). By multivariate analysis, nodal metastasis was significantly associated with asymmetrical cortical thickening (p = 0.001), C/H ratio (p = 0.005) and vascular pattern (p < 0.0001).Conclusion: Asymmetrical cortical enlargement on the side closer to the breast, C/H ratio and abnormal micro -vascular pattern are the independent predictors of axillary nodal involvement. Closer asymmetry is an eligible, easy-to-detect grayscale US finding to decide sampling that highly predicts ALN metastasis.

Thyroid cancer is the most important endocrine cancer with increasingincidence. While thyroid cancers, especially papillary thyroid cancers, are known toexhibit generally a favorable outcome with excellent survival rates, some thyroidcancers are more aggressive with a poor prognosis. Several different biomarkers havebeen introduced for the diagnosis of disease, identification of tumor load, assessment oftherapy response, and the detection of recurrence during follow-up of the thyroidcancer patients. This chapter gives a brief overview of the circulating biomarkers usedin thyroid cancer patients.

OBJECTIVES:To describe 18 F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18 F-FDG PET/MRI) along with semiology and electroencephalography (EEG) in patients with gray matter heterotopia (GMH); to evaluate the concordance between 18 F-FDG PET/MRI and clinical epileptogenic zone (EZ).MATERIALS & METHODS:GMH (subcortical heterotopia [SCH] and periventricular nodular heterotopia [PNH]) patients with epilepsy who underwent 18 F-FDG PET/MRI were retrospectively enrolled. Two radiologists evaluated brain MRI, while two nuclear medicine specialists assessed the 18 F-FDG PET. The SUVmax values of visually hypometabolic cortical areas were compared to the contralateral cortex using a SUVmax threshold value of 10%; the SUVmax values of GMH lesions were compared with that of the right precentral gyrus. The cortex or GMH with hypometabolism on 18 F-FDG PET/MRI was considered representative of the EZ. The clinical EZ was identified using EEG and semiology.RESULTS:Thirty patients (19 PNH; 11 SCH) with a mean age of 28.46 ± 9.52 years were enrolled. The heterotopic nodules were ametabolic in 3 patients (10%), hypometabolic in 16 (33.33%), isometabolic in 13 (26.66%), and hypermetabolic in 4 (10%). 18 F-FDG PET/MRI demonstrated hypometabolism in the cortex and GMH in 22/30 (73.33%) and 16/30 (53.33%). We could identify a clinical EZ in 18 patients, and 15 out of 18 (83.33%) had concordant 18 F-FDG PET/MRI findings.CONCLUSION:Heterotopic nodules in GMH patients show different metabolic patterns on 18 F-FDG PET/MRI, with nearly three-quarters of the patients having cortical hypometabolism. 18 F-FDG PET/ MRI findings are mostly concordant with the clinical EZ.

Abstract Our aim in this study was to evaluate the prognostic significance of sialic acid (SA) and prolidase activity and to evaluate the association between airflow obstruction severity and these parameters in chronic obstructive pulmonary disease (COPD) patients. Ninety-four patients (84 M, 10 F) and 34 healthy subjects (19 M, 15 F) were included into the study. COPD staging was performed to COPD patients according to new global initiative for chronic obstructive lung disease criteria which includes pulmonary function tests, symptoms and hospitalization; COPD patients were divided into 4 subgroups as group A (n = 25), group B (n = 19), group C (n = 20), and group D (n = 28). SA and C-reactive protein levels were significantly higher than the control group in all COPD groups. SA levels were significantly higher in group B patients than the control and group A. Prolidase activity was significantly lower than control group in total COPD groups (P < .05). There was a weak negative correlation between SA and forced vital capacity (r = -0.217, P = .038) and forced expiratory volume in 1 second (FEV1) (r = -0.210, P = .045), whereas weak positive correlation was present between SA and Creactive protein (r = 0.247, P = .018) in all patient groups. There was weak positive correlation between prolidase and FEV1 (r = 0.222, P = .033) and FEV1/forced vital capacity (r = 0.230, P = .027). Our study shows that systemic inflammation, prolidase activity, and SA levels in stable COPD patients are associated with airflow obstruction severity. In addition to the prolidase activity; SA levels might be associated with inflammation.

AbstractPurposeTo investigate the strength of quantitative imaging and metabolic parameters in differentiating invasive breast carcinomas with elevated Ki‐67 levels.Materials and MethodsA total of 123 patients with 129 breast lesions confirmed as invasive breast carcinoma underwent shear wave elastography (SWE), superb microvascular imaging (SMI) and positron emission tomography (PET)/CT or MRI. Adler's grade (classifying the microvascularity into four types) and Vascular Index (VI) was obtained by SMI as microvascular parameters. In addition, the stiffness value (Emean) was evaluated in kilopascal by SWE. The average of consecutive measurements was recorded as mean VI and mean Emean. PET scan parameters were obtained as SUVmax and SULpeak. Lesions were divided into two groups according to the Ki‐67 expression, low as 14 and high as >14.ResultsAdler's grading was the most correlated imaging parameter with high Ki‐67 expression (p < 0.05), while VI and Emean had poor correlation (p > 0.05). SUVmax and SULpeak indicated a significant linear correlation with Ki‐67 but a moderate correlation with the high levels of Ki‐67 (p < 0,001). The sensitivity of VI, Emean, SUVmax and SULpeak was 64.6%, 66.7%, 65.7%, and 66.7% when the cut‐off point was set to 5.25, 102.5, 6.59, and 2.63, respectively. SUVmax had the highest AUC value of 0.740, according to the ROC curve analysis.ConclusionsOur results suggest that the quantitative parameters obtained by advanced imaging methods may be useful in predicting the high proliferation in invasive breast carcinomas. But none of them is eligible to be used as an independent biomarker in distinguishing aggressive behavior. Nevertheless, as a noninvasive method, visual assessment of microvascular morphology using SMI increases the prognostic efficiency in invasive breast carcinomas.