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Sarikaya I. Radiation Treatments, Autoimmune Activation, and PET Imaging. J Nucl Med Technol 2023; 51:80. [PMID: 36351803 DOI: 10.2967/jnmt.122.265093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ismet Sarikaya
- Kirklareli University Faculty of Medicine Kirklareli, Turkey
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Sarikaya I. Biology of Cancer and PET Imaging: Pictorial Review. J Nucl Med Technol 2022; 50:jnmt.121.263534. [PMID: 35440477 DOI: 10.2967/jnmt.121.263534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
Development and spread of cancer is a multi-step and complex process which involves number of alterations, interactions and molecular networks. PET imaging is closely related with biology of cancer as it detects the cancer based on biological and pathological changes in tumor cells and tumor microenvironment. In this review article, biology of development and spread of cancer and role of PET imaging in Oncology was summarized and supported with various PET images demonstrating cancer spread patterns.
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Sarikaya I, Sarikaya A, Albatineh AN, Tastekin E, Sezer YA. Assessing the correlation between FDG PET findings of IDC breast carcinoma and histopathology of coexisting ductal carcinoma in-situ. Nucl Med Rev Cent East Eur 2022; 25:6-11. [PMID: 35137931 DOI: 10.5603/nmr.a2022.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/09/2021] [Accepted: 03/15/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Ductal carcinoma in-situ (DCIS) often coexists with invasive ductal carcinoma (IDC) of the breast. DCIS is considered as a non-obligate precursor of IDC when both coexist. 18F-fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT) imaging is commonly used in the staging and follow-up assessment of breast cancer. In this study, we aimed to assess if there is any correlation between primary tumor PET and histopathology findings and histopathological features of the coexisting DCIS. MATERIAL AND METHODS FDG PET/CT images and histopathology results of the patients with newly diagnosed breast cancer (IDC) with coexisting DCIS were analyzed in this retrospective study. The grade and size of the primary tumor and histopathological features of the coexisting DCIS (nuclear grade and architectural pattern) were obtained from the postoperative histopathology results. Maximum standardized uptake values (SUV: SUVmax and SULmax) of the primary tumor normalized by weight and lean body mass were measured. Statistical analysis was performed to assess the correlation between various parameters of IDC and DCIS. RESULTS This study included sixty-two (62) patients with IDC-DCIS. Primary tumor grade was significantly correlated and associated with the nuclear grade of the coexisting DCIS (polychoric correlation r = 0.736, and Fisher exact test, PV < 0.001, respectively). Primary tumor SUV was not correlated with the nuclear grade and architectural pattern of the coexisting DCIS (polyserial correlation r = 0.172, PV = 0.155, and Point Bi-Serial correlation r = -0.009, PV = 0.955, respectively). Median primary tumor size was marginally significantly different among DCIS nuclear grades but it was not significantly different in comedo and non-comedo cases (Kruskal-Wallis test PV = 0.053, and Mann-Whitney U test PV = 0.890, respectively). CONCLUSIONS Primary tumor grade is correlated with the nuclear grade of the coexisting DCIS. SUV of primary tumor does not seem to be correlated with the histopathological features of coexisting DCIS (nuclear grade and architectural pattern) but this may be further studied in a larger number of patients.
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Affiliation(s)
- Ismet Sarikaya
- Faculty of Medicine, Department of Nuclear Medicine, Kuwait University, Kuwait.
| | - Ali Sarikaya
- Faculty of Medicine, Department of Nuclear Medicine, Trakya University, Edirne, Turkey
| | - Ahmed N Albatineh
- Faculty of Medicine, Department of Community Medicine and Behavioral Sciences, Kuwait University, Kuwait
| | - Ebru Tastekin
- Faculty of Medicine, Department of Pathology, Trakya University, Edirne, Turkey
| | - Yavuz Atakan Sezer
- Faculty of Medicine, Department of Surgery, Trakya University, Edirne, Turkey
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Sarikaya I. Letter to the Editor: 68Ga-PSMA-11 for renal cortical PET imaging. Clin Transl Imaging 2022; 10:321-322. [PMID: 35096684 PMCID: PMC8786448 DOI: 10.1007/s40336-021-00475-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/23/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Ismet Sarikaya
- Department of Nuclear Medicine (Retired), Kuwait University Faculty of Medicine, Kuwait City, Kuwait
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Sarikaya I, Schierz JH, Sarikaya A. Liver: glucose metabolism and 18F-fluorodeoxyglucose PET findings in normal parenchyma and diseases. Am J Nucl Med Mol Imaging 2021; 11:233-249. [PMID: 34513277 PMCID: PMC8414405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
Liver has a complex and unique energy metabolism and plays a major role in glucose homeostasis. Liver is the main control center for glycogenesis, glycogenolysis, glycolysis and gluconeogenesis which are essential to provide energy for other tissues. Liver meets its own energy need from various sources which is mainly glucose in the fed state and fatty acids in the fasting state. In this review article, we will mainly describe the glucose metabolism of the liver, effect of various factors on 18F-fluorodeoxyglucose (FDG) activity/uptake in the normal liver and 18F- FDG positron emission tomography (PET) uptake patterns in various malignant and benign liver pathologies. Brief information on metabolomics profiling analyses in liver disorders will also be provided.
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Affiliation(s)
- Ismet Sarikaya
- Department of Nuclear Medicine, Kuwait University Faculty of MedicineSafat, Kuwait
| | | | - Ali Sarikaya
- Department of Nuclear Medicine, Trakya University Faculty of MedicineTurkey
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Schierz JH, Sarikaya I, Wollina U, Unger L, Sarikaya A. Immune checkpoint inhibitor related adverse effects and FDG PET/CT findings. J Nucl Med Technol 2021; 49:324-329. [PMID: 34330805 DOI: 10.2967/jnmt.121.262151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/20/2021] [Indexed: 11/16/2022] Open
Abstract
Immune check-point inhibitor (ICI) treatments activate the T-cells against tumor. Activated T-cells not only attack the tumor but also healthy cells, causing an autoimmune reaction in various tissues. These immune related adverse effects (IRAE) cause 18F-fluorodeoxyglucose (FDG) uptake in various tissues due to inflammation. It is important to recognize and report these findings on FDG Positron Emission Tomography/Computed Tomography (PET/CT) studies. FDG PET helps to determine the presence, location and severity of IRAEs. In severe cases, ICI treatments are interrupted or suspended and anti-inflammatory treatments are started. FDG uptake due IRAEs may mimic metastases or disease progression. Their presence may also help predicting response to treatment and have prognostic implications. In this review article, we will provide basic information about ICI treatments, IRAEs and FDG PET/CT findings.
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Affiliation(s)
| | - Ismet Sarikaya
- Kuwait University Faculty of Medicine, Department of Nuclear Medicine, Kuwait, Kuwait
| | - Uwe Wollina
- Municipal Hospital Dresden, Department of Dermatology, Dresden, Germany
| | - Leonore Unger
- Municipal Hospital Dresden, Department of Rheumatology, Dresden, Germany
| | - Ali Sarikaya
- Trakya university Faculty of Medicine, Department of Nuclear Medicine, Turkey
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Schierz JH, Sarikaya I, Albatineh AN, Sarikaya A. Assessing the correlation between 68Ga-PSMA-11 renal PET parameters and renal function tests. J Nucl Med Technol 2021; 50:43-48. [PMID: 34330809 DOI: 10.2967/jnmt.121.262462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/07/2021] [Indexed: 11/16/2022] Open
Abstract
Aim: 68Ga -PSMA ligands are used for prostate cancer but also show high renal cortical uptake. In this study, we aimed to assess if there is any correlation between renal PSMA PET parameters and renal function tests using the images of prostate cancer patients. Methods: 68Ga-PSMA-11 PET/CT images of the patients with prostate cancer were retrospectively evaluated. The following PET parameters were obtained: SUVmax, SUVmean, SULmax, SULmean, volume, TLGSUL and counts of both kidneys as well as SUVmean of liver, blood pool and spleen. Total TLGSUL, total volume, kidney to liver and kidney to blood pool ratios were calculated. Patient's creatinine values were obtained and GFR was calculated using the MDRD formula. Statistical analysis was performed to understand if there is a correlation between above parameters and renal function tests. Results: Twenty five patients were included in this study. GFR was significantly/positively correlated and creatinine was significantly/negatively correlated with renal SUV/liver SUV and renal SUV/blood pool SUV ratios. GFR was marginally positively correlated with renal SULmean and creatinine was marginally negatively correlated with total TLGSUL. Total renal parenchymal volume was significantly and directly (positively) associated with GFR and significantly and inversely (negatively) associated with creatinine. Conclusion: Renal 68Ga-PSMA uptake appears to be correlated with renal function tests. Our method of measuring approximate renal parenchymal volume on PET image appears to be reliable.
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Sarikaya I, Alqallaf A, Sarikaya A, Baqer A, Kazem N. Renal Cortical Scarring: 68Ga-PSMA-11 PET versus 99mTc-DMSA Scan in a Case with Pyelonephritis. J Nucl Med Technol 2021; 50:49-53. [PMID: 34330812 DOI: 10.2967/jnmt.121.262415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/20/2021] [Indexed: 11/16/2022] Open
Abstract
We previously reported 68Ga-prostate‑specific membrane antigen (PSMA)-11 and 99mTcdimercaptosuccinic acid (DMSA) images of the 1st case of our prospective research comparing renal PSMA PET to DMSA scan in adult patients with pyelonephritis. Here, we present renal cortical PSMA PET and DMSA images of our 2nd patient with chronic recurring pyelonephritis which demonstrated renal parenchymal defects secondary to scarring in the kidney.
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Sarikaya I, Kamel WA, Ateyah KK, Essa NB, AlTailji S, Sarikaya A. Visual versus semiquantitative analysis of 18F- fluorodeoxyglucose-positron emission tomography brain images in patients with dementia. World J Nucl Med 2021; 20:82-89. [PMID: 33850493 PMCID: PMC8034786 DOI: 10.4103/wjnm.wjnm_53_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 05/31/2018] [Accepted: 07/19/2018] [Indexed: 11/04/2022] Open
Abstract
Various studies have reported to the superiority of semiquantitative (SQ) analysis over visual analysis in detecting metabolic changes in the brain. In this study, we aimed to determine the limitations of SQ analysis programs and the current status of 18F- fluorodeoxyglucose (FDG)-positron emission tomography (PET) scan in dementia. 18F- FDG-PET/computed tomography (CT) brain images of 39 patients with a history of dementia were analyzed both visually and semiquantitatively. Using the visually markedly abnormal 18F- FDG-PET images as standard, we wanted to test the accuracy of two commercially available SQ analysis programs. SQ analysis results were classified as matching, partially matching and nonmatching with visually markedly abnormal studies. On visual analysis, 18F- FDG-PET showed marked regional hypometabolism in 19 patients, mild abnormalities in 8 and was normal in 12 patients. SQ analysis-1 results matched with visual analysis in 8 patients (42.1%) and partially matched in 11. SQ analysis-2 findings matched with visual analysis in 11 patients (57.8%) and partially matched in 7 and did not match in 1. Marked regional hypometabolism was either on the left side of the brain or was more significant on the left than the right in 63% of patients. Preservation of metabolism in sensorimotor cortex was seen in various dementia subtypes. Reviewing images in color scale and maximum intensity projection (MIP) image was helpful in demonstrating and displaying regional abnormalities, respectively. SQ analysis provides less accurate results as compared to visual analysis by experts. Due to suboptimal image registration and selection of brain areas, SQ analysis provides inaccurate results, particularly in small areas and areas in close proximity. Image registration and selection of areas with SQ programs should be checked carefully before reporting the results.
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Affiliation(s)
- Ismet Sarikaya
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Kuwait University, Kuwait
| | - Walaa A Kamel
- Department of Neurology, Faculty of Medicine, Beni-Suef University, Egypt.,Department of Nuclear Medicine, Ibn Sina Hospital, Kuwait
| | | | - Nooraessa Bin Essa
- Department of Nuclear Medicine, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait
| | | | - Ali Sarikaya
- Department of Nuclear Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey
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Abstract
Breast cancer is the most common malignancy in women and among the most common indications of oncologic positron emission tomography (PET) studies. In this review article, updated anatomical, pathological, and clinical information about breast cancer were provided for Nuclear Medicine physicians to better understand breast cancer and interpret PET images and a review of the literature on the use of PET imaging in breast cancer was summarized.
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Affiliation(s)
- Ismet Sarikaya
- Kuwait University Faculty of Medicine, Department of Nuclear Medicine, Kuwait City, Kuwait.
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Sarikaya I. Is There a Need for a Pediatric PET/CT Camera? J Nucl Med Technol 2020; 48:386-387. [DOI: 10.2967/jnmt.119.240713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Sarikaya I, Alqallaf A, Sarikaya A. Renal Cortical 68Ga-PSMA-11 PET and 99mTc-DMSA Images. J Nucl Med Technol 2020; 49:30-33. [PMID: 32887764 DOI: 10.2967/jnmt.120.248922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/30/2020] [Indexed: 11/16/2022] Open
Abstract
68Ga-prostate-specific membrane antigen (PSMA) ligands are novel PET radiotracers for prostate cancer. These radiotracers also localize in the normal renal cortex to a high degree and can demonstrate parenchymal defects. We recently started a prospective research study to compare 68Ga-PSMA-11 PET/CT with 99mTc-dimercaptosuccinic acid (DMSA) scan in adults with pyelonephritis. Here, we present a side-by-side comparison of renal cortical PSMA PET/CT and DMSA images of an adult patient with chronic recurring pyelonephritis. Methods: Our prospective study was approved by the Ethical Committees. DMSA images (multiple planar and SPECT) were obtained 3 h after intravenous injection of 111 MBq (3 mCi) of 99mTc-DMSA. On a separate day, we obtained PET/CT images of the kidneys 60 min after intravenous injection of 74 MBq (2 mCi) of 68Ga-PSMA-11 after the patient provided written informed consent. Results: The patient was a 46-y-old woman with history of chronic recurring pyelonephritis. Both DMSA scan and PSMA PET/CT demonstrated slight cortical thinning with mildly reduced uptake in the upper pole of the right kidney, with no significant cortical defects. There was an excellent distribution of activity in the renal cortex and better image resolution with PSMA PET than with DMSA scan. Non-attenuation-corrected PSMA PET images also showed the same findings, with reasonable image quality. Conclusion: In our first case, 68Ga-PSMA-11 PET imaging provided promising results in an adult patient with pyelonephritis. The results of our prospective study on a larger number of adult patients will provide a more accurate comparison of 68Ga-PSMA-11 PET to 99mTc-DMSA scanning in pyelonephritis.
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Affiliation(s)
- Ismet Sarikaya
- Department of Nuclear Medicine, Kuwait University Faculty of Medicine, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait
| | - Ahmed Alqallaf
- Department of Medicine, Division of Nephrology, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait; and
| | - Ali Sarikaya
- Department of Nuclear Medicine, Trakya University Faculty of Medicine, Edirne, Turkey
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Abstract
PURPOSE Tc-dimercaptosuccinic acid (DMSA) scan is the current gold standard in detecting parenchymal changes, particularly scarring, in pyelonephritis. Recently, magnetic resonance imaging (MRI) is gaining popularity in the diagnosis of pyelonephritis. The aim of this study is to perform a meta-analysis on studies directly comparing MRI to DMSA scan in patients with pyelonephritis. MATERIALS Systematic searches of PUBMED and EMBASE databases were performed to extract studies comparing MRI and DMSA scan in patients with pyelonephritis. The relevance of articles was assessed by two authors according to predefined inclusion and exclusion criteria. The pooled estimates of the sensitivities of MRI and DMSA scan were computed using random-effects meta-analysis model following DerSimonian and Laird's method. Subgroup analysis and publication bias were performed. RESULTS Seven studies were included (164 patients). Using random effect model, the pooled estimate of the sensitivities of MRI and DMSA scan were 0.62 (95%CI: 0.44 - 0.77) and 0.59 (95%CI: 0.48 - 0.70), respectively. The pooled estimates of sensitivities of MRI and DMSA scan for acute pyelonephritis were 0.73 (95%CI: 0.49- 0.89) and 0.66 (95%CI: 0.56 - 0.75), respectively, and for scar detection were 0.48 (95%CI: 0.31- 0.66), and 0.50 (95%CI: 0.30 - 0.71), respectively. CONCLUSION The overall sensitivities of MRI and DMSA scan were equivalent in detecting parenchymal changes in pyelonephritis. MRI and DMSA scan appeared to be equivalent to scar detection. In a small number of studies, MRI appeared to be better than the DMSA scan in acute pyelonephritis but this should be further studied in a larger number of patients.
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Affiliation(s)
| | - Ahmed N Albatineh
- Department of Community Medicine and Behavioral Sciences, Kuwait University Faculty of Medicine, Kuwait University, Kuwait
| | - Ali Sarikaya
- Department of Nuclear Medicine, Trakya University Faculty of Medicine, Edirne, Turkey
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Abstract
PET/CT images are usually obtained in the arms-up position in patients with no head and neck pathology and in the arms-down position to image the head and neck area. The arms usually cause artifacts regardless of up or down positioning. These artifacts include beam hardening, scatter, truncation, and cold areas (cold artifacts) in obese or large patients; motion artifacts; implanted-metal-object artifacts; and artifacts related to radiotracer extravasation at the injection site. In this review article, we will discuss the mechanisms of these artifacts and suggest solutions to reduce or eliminate them, such as reviewing the non-attenuation-corrected PET images, performing extended-field-of-view reconstruction, not applying scatter correction, and using software to correct beam-hardening, scatter, and truncation artifacts. We will present various PET/CT images before and after corrections for such artifacts.
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Affiliation(s)
- Ismet Sarikaya
- Department of Nuclear Medicine, Kuwait University Faculty of Medicine, Safat, Kuwait; and
| | - Ali Sarikaya
- Department of Nuclear Medicine, Trakya University Faculty of Medicine, Edirne, Turkey
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Sarikaya I, Sharma PN, Sarikaya A, Elgazzar AH. Assessing oral glucose and intravenous insulin loading protocol in 18F-fluorodeoxyglucose positron emission tomography cardiac viability studies. World J Nucl Med 2020; 19:1-7. [PMID: 32190015 PMCID: PMC7067136 DOI: 10.4103/wjnm.wjnm_58_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 07/13/2018] [Indexed: 11/04/2022] Open
Abstract
AbstractOral glucose and intravenous insulin (G/I) loading protocols are commonly used in 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) cardiac viability studies. Although the amount of insulin to be given per blood glucose range has been well described in guidelines, the amount of glucose to be given is not detailed well. In this retrospective study, we aimed to assess if certain parameters, particularly the amount of glucose and insulin given, may affect 18F-FDG uptake in the hibernating myocardium and also determine the problems with this protocol. 18F-FDG PET cardiac viability study with G/I loading protocols was performed in 49 patients. Fasting blood glucose (FBG), amount of glucose given, blood glucose level after glucose load, amount of insulin given, and blood glucose level at the time of 18F-FDG injection were recorded. Statistical analysis was performed to determine if there is any difference in the above values in PET viable and PET nonviable groups and also in subgroups assessing 18F-FDG uptake also in normal myocardium. For G/I loading, we used our local protocol in 43 patients, and other protocols in six. 18F-FDG PET showed viability in 31 patients, and it was negative for viability in 18. In 22 patients, mainly in PET viable group, there was varying degree of reduced 18F-FDG uptake in normal myocardium. There was no significant difference in FBG, amount of glucose given, blood glucose level after glucose load, amount of insulin given, and blood glucose level at the time of 18F-FDG injection in PET viable and PET nonviable groups and also in subgroups. The problems with G/I loading protocol included deciding on the amounts of glucose and insulin given, maximum amount of insulin to be given, handling diabetics, optimal time to measure blood glucose after insulin administration, and interpretation of findings in cases with diffusely reduced 18F-FDG uptake. Further improvements in current guidelines are necessary to obtain images in optimal conditions for accurate results.
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Affiliation(s)
- Ismet Sarikaya
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Prem N. Sharma
- Department of Statistics, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Ali Sarikaya
- Department of Nuclear Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Abdelhamid H. Elgazzar
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
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Abstract
PET imaging, particularly oncologic applications of 18F-FDG, has become a routine diagnostic study. To better describe malignancies, various PET parameters are used. In 18F-FDG PET studies, SUVmax is the most commonly used parameter to measure the metabolic activity of the tumor. In obese patients, SUV corrected by lean body mass (SUL), and in pediatric patients, SUV corrected by body surface area, are recommended. Metabolic tumor volume is an important parameter to determine the local and total tumor burden. Total lesion glycolysis (SUVmean × metabolic tumor volume) provides information about averages. Some treatment response assessment protocols recommend using the SUVpeak or SULpeak of the tumor. Tumor-to-liver ratio and tumor-to-blood-pool ratio are helpful when comparing studies for treatment response assessment. Dual-time-point PET imaging with retention index can help differentiate malignant from benign lesions and may help detect small lesions. Dynamic 18F-FDG PET imaging and quantitative analysis can measure the metabolic, phosphorylation, and dephosphorylation rates of lesions but are mainly used for research purposes. In this article, we will review the currently available PET parameters in 18F-FDG studies with their importance, uses, limitations, and reasons for erroneous results.
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Affiliation(s)
- Ismet Sarikaya
- Department of Nuclear Medicine, Kuwait University Faculty of Medicine, Kuwait City, Kuwait; and
| | - Ali Sarikaya
- Department of Nuclear Medicine, Trakya University Faculty of Medicine, Edirne, Turkey
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Sarikaya I. 68Ga-PSMA Ligand as Potential 99mTc-DMSA Alternative. J Nucl Med 2019; 60:12N. [PMID: 31676710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Affiliation(s)
- Ismet Sarikaya
- Kuwait University Faculty of Medicine Mubarak Al-Kabeer Hospital Kuwait City, Kuwait
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Sarikaya I, Albatineh AN, Sarikaya A. Revisiting Weight-Normalized SUV and Lean-Body-Mass-Normalized SUV in PET Studies. J Nucl Med Technol 2019; 48:163-167. [PMID: 31604893 DOI: 10.2967/jnmt.119.233353] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/06/2019] [Indexed: 12/31/2022] Open
Abstract
SUV normalized by total body weight is affected by the amount of body fat. The SUV of normal tissues and lesions is higher (overestimated) in obese patients than in patients with a normal body mass index (BMI). SUL (SUV normalized by lean body mass [LBM]) is recommended for more accurate SUV results. Given the importance of a quantitative PET parameter, particularly when comparing PET studies, we aimed to revisit the effect of obesity on SUV, measuring SUL in normal-BMI patients and obese patients and testing the effect of the amount of LBM. Methods: 18F-FDG whole-body images of adult patients were analyzed retrospectively. We measured both SUVmax and SUVmean in the blood pool and liver of patients with a normal BMI (18.5-24.9) and a high BMI (≥30) (obese). In all patients, we calculated LBM via an equation using patient height and weight and corrected all SUVs to SULs. Mean (±SD) SUVs and SULs were compared under various circumstances. Scatterplots were generated for weight and SUV-SUL differences. Results: SUVmean in the liver and blood pool was significantly higher in obese patients (30 patients) than in patients with a normal BMI (20 patients) (4.1 ± 0.7 and 3.0 ± 0.5, respectively, in liver, vs. 3.2 ± 0.6 and 2.4 ± 0.4, respectively, in blood pool; P < 0.001). SULmean was significantly lower in both liver and blood pool in all patients, being approximately 75% of SUVmean in patients with a normal BMI and 55% of SUVmean in obese patients (P < 0.001). SULmean in the liver and blood pool did not significantly differ between obese patients and normal-BMI patients (P > 0.05). The SUV-SUL difference was significantly higher in obese patients than in patients with a normal BMI (P < 0.001). These statistical results were the same when SUVmax and SULmax were compared. Conclusion: SUV overestimates metabolic activity in all patients, and this overestimation is more significant in obese patients than in patients with a normal BMI. SUL is not affected by body weight or the amount of LBM.
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Affiliation(s)
- Ismet Sarikaya
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, and Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Ahmed N Albatineh
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Safat, Kuwait; and
| | - Ali Sarikaya
- Department of Nuclear Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey
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Sarikaya I, Sarikaya A. Current Status of Radionuclide Renal Cortical Imaging in Pyelonephritis. J Nucl Med Technol 2019; 47:309-312. [DOI: 10.2967/jnmt.119.227942] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/23/2019] [Indexed: 11/16/2022] Open
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Sarikaya I, Sarikaya A, Sharma P. Assessing the Effect of Various Blood Glucose Levels on 18F-FDG Activity in the Brain, Liver, and Blood Pool. J Nucl Med Technol 2019; 47:313-318. [PMID: 31182660 DOI: 10.2967/jnmt.119.226969] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/16/2019] [Indexed: 12/17/2022] Open
Abstract
Studies have extensively analyzed the effect of hyperglycemia on 18F-FDG uptake in normal tissues and tumors. In this study, we measured SUV in the brain, liver, and blood pool in normoglycemia, hyperglycemia, and hypoglycemia to understand the effect of blood glucose on 18F-FDG uptake and to develop a formula to correct SUV. Methods: Whole-body 18F-FDG PET/CT images of adults were selected for analysis. Brain SUVmax, blood-pool SUVmean, and liver SUVmean were measured at blood glucose ranges of 61-70, 71-80, 81-90, 91-100, 101-110, 111-120, 121-130, 131-140, 141-150, 151-160, 161-170, 171-180, 181-190, 191-200, and 201 mg/dL and above. At each blood glucose range, 10 PET images were analyzed (total, 150). The mean (±SD) SUV of the brain, liver, and blood pool at each blood glucose range was calculated, and blood glucose and SUV curves were generated. Because brain and tumors show a high expression of glucose transporters 1 and 3, we generated an SUV correction formula based on percentage reduction in brain SUVmax with increasing blood glucose level. Results: Mean brain SUVmax gradually decreased with increasing blood glucose level, starting after a level of 110 mg/dL. The approximate percentage reduction in brain SUVmax was 20%, 35%, 50%, 60%, and 65% at blood glucose ranges of 111-120, 121-140, 141-160, 161-200, and 201 mg/dL and above, respectively. In the formula we generated, measured SUVmax is multiplied by a reduction factor of 1.25, 1.5, 2, 2.5, and 2.8 for the blood glucose ranges of 111-120, 121-140, 141-160, 161-200, and 201 mg/dL and above, respectively, to correct SUV. Brain SUVmax did not differ between hypoglycemic and normoglycemic patients (P > 0.05). SUVmean in the blood pool and liver was lower in hypoglycemic patients (P < 0.05) and did not differ between hyperglycemic (P > 0.05) and normoglycemic patients. Conclusion: Hyperglycemia gradually reduces brain 18F-FDG uptake, starting after a blood glucose level of 110 mg/dL. Hyperglycemia does not affect 18F-FDG activity in the liver or blood pool. Hypoglycemia does not seem to affect brain 18F-FDG uptake but appears to reduce liver and blood-pool activity. The simple formula we generated can be used to correct SUV in hyperglycemic adults in selected cases.
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Affiliation(s)
- Ismet Sarikaya
- Department of Nuclear Medicine, Kuwait University Faculty of Medicine, Safat, Kuwait
| | - Ali Sarikaya
- Department of Nuclear Medicine, Trakya University Faculty of Medicine, Edirne, Turkey; and
| | - Prem Sharma
- Dasman Diabetes Institute, Biostatistics Unit, Al Kuwayt, Kuwait
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Gurkan G, Sarikaya I, Sarikaya A. Semiquantitative assessment of osteoblastic, osteolytic, and mixed lytic-sclerotic bone lesions on fluorodeoxyglucose positron emission tomography/computed tomography and bone scintigraphy. World J Nucl Med 2019; 18:132-136. [PMID: 31040743 PMCID: PMC6476240 DOI: 10.4103/wjnm.wjnm_31_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Bone scintigraphy is widely used to detect bone metastases, particularly osteoblastic ones, and F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) scan is useful in detecting lytic bone metastases. In routine studies, images are assessed visually. In this retrospective study, we aimed to assess the osteoblastic, osteolytic, and mixed lytic-sclerotic bone lesions semiquantitatively by measuring maximum standardized uptake value (SUVmax) on FDG PET/computed tomography (CT), maximum lesion to normal bone count ratio (ROImax) on bone scintigraphy, and Hounsfield unit (HU) on CT. Bone scintigraphy and FDG PET/CT images of 33 patients with various solid tumors were evaluated. Osteoblastic, osteolytic, and mixed lesions were identified on CT and SUVmax, ROImax, and HU values of these lesions were measured. Statistical analysis was performed to determine if there is a difference in SUVmax, ROImax, and HU values of osteoblastic, osteolytic, and mixed lesions and any correlation between these values. Patients had various solid tumors, mainly lung, breast, and prostate cancers. There were 145 bone lesions (22.8% osteoblastic, 53.1% osteolytic, and 24.1% mixed) on CT. Osteoblastic lesions had a significantly higher value of CT HU as compared to osteolytic and mixed lesions (P < 0.01). There was no significant difference in mean ROImax and mean SUVmax values of osteolytic and osteoblastic bone lesions. There was no correlation between SUVmax and ROImax, SUVmax and HU, and ROImax and HU values in osteolytic, osteoblastic, and mixed lesions (P > 0.05). Not finding a significant difference in SUVmax and ROImax values of osteoblastic, osteolytic, and mixed lesions and also lack of correlation between SUVmax, ROImax, and HU values could be due to treatment status of the bone lesions, size of the lesion, nonmetastatic lesions, erroneous measurement of SUVmax and ROImax, or varying metabolism in bone metastases originating from various malignancies.
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Affiliation(s)
- Guray Gurkan
- Department of Nuclear Medicine, Sultan 1. Murat State Hospital, Kirklareli, Turkey
| | - Ismet Sarikaya
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Ali Sarikaya
- Department of Nuclear Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey
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Sarikaya I, Sarikaya A. Assessing 18F-FDG Uptake in the Sentinel Lymph Node in Breast Cancer. J Nucl Med Technol 2018; 47:149-153. [PMID: 30413593 DOI: 10.2967/jnmt.118.219758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/03/2018] [Indexed: 01/12/2023] Open
Abstract
18F-FDG PET/CT has limited value in early breast cancer. Sentinel lymph node (SLN) biopsy is the current procedure of choice to search for small metastatic deposits in the axillary lymph nodes in early breast cancer. In this retrospective study, we reevaluated 18F-FDG PET/CT images after locating the SLN on PET/CT with the help of SLN SPECT/CT images and assessed 18F-FDG uptake, particularly in the SLN. Our goal was to understand if combined evaluation of 18F-FDG PET/CT and SLN SPECT/CT could be useful for detecting early lymph node metastasis in the axilla. Methods: 18F-FDG PET/CT images of newly diagnosed breast cancer patients who also had SLN scintigraphy (SPECT/CT) and biopsy results were analyzed to assess 18F-FDG uptake in the SLN. The SLN seen on SPECT/CT images was located on PET/CT images, and its metabolic activity was assessed both visually and semiquantitatively using SUVmax 18F-FDG PET results were compared with the histopathology result for the SLN. Results: Twenty patients among 130 met the inclusion criteria. SLN SPECT/CT images were helpful for locating the SLN on 18F-FDG PET/CT images in all 20 patients. Histopathologic analysis of the SLNs demonstrated metastasis in 7 patients and no metastasis in 13. There was mild (visible) 18F-FDG uptake in the SLN (SUVmax, 1.2-4.1; metastatic deposit size, 6-8 mm) in 6 of 7 patients with SLN metastasis (85.7%). There was no or only faint 18F-FDG uptake in the SLN (SUVmax < 1) in 9 of 13 patients with no SLN metastasis (69.2%). Receiver-operating-characteristic curve analysis indicated that the SUVmax cutoff for differentiating SLN-positive from -negative cases was 0.85 (sensitivity, 85.7%; specificity, 61.5%; area under the curve, 0.747; P < 0.05). Conclusion: Combined evaluation of 18F-FDG PET/CT and SPECT/CT images to assess 18F-FDG uptake, particularly in the SLN, is a new image analysis technique to detect early metastatic disease in the axillary lymph nodes in breast cancer. Although this technique does not currently seem feasible for use in routine practice, mainly because of the limitations of current PET/CT technology in detecting small tumors, it is an interesting image analysis technique to be aware of for possible future use.
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Affiliation(s)
- Ismet Sarikaya
- Department of Nuclear Medicine, Kuwait University Faculty of Medicine, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait; and
| | - Ali Sarikaya
- Department of Nuclear Medicine, Trakya University Faculty of Medicine, Edirne, Turkey
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Sarikaya I, Sharma P, Sarikaya A. F-18 fluoride uptake in primary breast cancer. Ann Nucl Med 2018; 32:678-686. [DOI: 10.1007/s12149-018-1294-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 08/25/2018] [Indexed: 11/30/2022]
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Sarikaya I, Al-Banna Z, Baqer A. Recognizing Pinhole Parallax Error for Accurate Localization of Thyroid and Parathyroid Disease. J Nucl Med Technol 2018; 46:288-289. [PMID: 29724805 DOI: 10.2967/jnmt.118.207928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/05/2018] [Indexed: 11/16/2022] Open
Abstract
Parallax error is a pitfall of pinhole scintigraphy that causes mislocalization of the findings. It is important to notice this error on pinhole thyroid and parathyroid scintigraphy and obtain additional images with a parallel-hole collimator to accurately determine the upper and lower margins of large goiters and nodules and the location of ectopic thyroid tissue and parathyroid adenomas. In this teaching case report, we revisit pinhole parallax error, present pinhole and SPECT/CT images of a patient with a large, hyperactive thyroid nodule, and review the literature and potential solutions to this important problem.
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Affiliation(s)
- Ismet Sarikaya
- Department of Nuclear Medicine, Kuwait University Faculty of Medicine, Safat, Kuwait; and
| | - Zaina Al-Banna
- Department of Nuclear Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Ali Baqer
- Department of Nuclear Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
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25
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Sarikaya I, Sarikaya A, Elgazzar AH. Current Status of 18F-FDG PET Brain Imaging in Patients with Dementia. J Nucl Med Technol 2018; 46:362-367. [DOI: 10.2967/jnmt.118.210237] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/07/2018] [Indexed: 11/16/2022] Open
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26
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Sarikaya I, Elgazzar A, Sarikaya A, Alfeeli M. Fluorodeoxyglucose, sodium fluoride, and prostate-specific membrane antigen positron emission tomography studies for treatment response assessment in prostate cancer. World J Nucl Med 2018; 17:207-210. [PMID: 30034289 PMCID: PMC6034537 DOI: 10.4103/wjnm.wjnm_51_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Various positron emission tomography (PET) studies are available for prostate cancer which show various successes at demonstrating primary, recurrent, or metastatic tumor and assessing response to treatment. In this case report, we will present and compare pre- and post-therapy fluorodeoxyglucose, sodium fluoride, and gallium-68 prostate-specific membrane antigen PET images of a patient with prostate cancer.
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Affiliation(s)
- Ismet Sarikaya
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Kuwait
| | - Abdelhamid Elgazzar
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Kuwait
| | - Ali Sarikaya
- Department of Nuclear Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Mahmoud Alfeeli
- Department of Nuclear Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
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Sarikaya I, Elgazzar AH, Alfeeli MA, Sarikaya A. Gallbladder activity on sodium fluoride positron emission tomography/computed tomography bone scan. World J Nucl Med 2018; 17:201-203. [PMID: 30034287 PMCID: PMC6034551 DOI: 10.4103/wjnm.wjnm_45_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We incidentally identified gallbladder activity on 18F sodium fluoride (NaF) positron emission tomography/computed tomography (PET/CT) bone images in five patients. Variable degree of bowel activity is usually seen on NaF PET/CT images, and its mechanism is unknown. Gallbladder activity in our cases may indicate that hepatobiliary excretion of the 18F NaF is the reason for bowel activity on NaF PET/CT images. However, excretion of radiotracer through bowel may also contribute to the bowel activity.
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Affiliation(s)
- Ismet Sarikaya
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Abdelhamid H Elgazzar
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Mahmoud A Alfeeli
- Department of Nuclear Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Ali Sarikaya
- Department of Nuclear Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey
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Sarikaya I, Elgazzar AH, Alfeeli MA, Sarikaya A. Can Gallium-68 Prostate-specific Membrane Antigen Ligand be a Potential Radiotracer for Renal Cortical Positron Emission Tomography Imaging? World J Nucl Med 2018; 17:126-129. [PMID: 29719490 PMCID: PMC5905259 DOI: 10.4103/wjnm.wjnm_35_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Gallium-68 prostate-specific membrane antigen (Ga-68 PSMA) ligand (HBED-CC) is a new promising positron emission tomography (PET) tracer for prostate cancer. Intense renal parenchymal uptake is a physiologic finding on Ga-68 PSMA ligand PET images. Evaluation of kidneys in low intensity demonstrates excellent distribution of this radiotracer in renal parenchyma with excellent image quality and resolution. In this article, we present the Ga-68 PSMA ligand PET renal images of four patients with prostate cancer. In two patients, there is normal distribution of radiotracer, and in other two, there are renal cysts causing parenchymal defects.
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Affiliation(s)
- Ismet Sarikaya
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Safat 13110, Kuwait
| | - Abdelhamid H Elgazzar
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Safat 13110, Kuwait
| | - Mahmoud A Alfeeli
- Department of Nuclear Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Ali Sarikaya
- Department of Nuclear Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey
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Sarikaya I, Elgazzar AH, Sarikaya A, Alnafisi N, Alenezi S. Can 68Ga-DOTA Peptides Be Potential Radiotracers for PET Imaging of the Spleen? J Nucl Med Technol 2018; 46:133-135. [PMID: 29599400 DOI: 10.2967/jnmt.117.203448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/06/2018] [Indexed: 11/16/2022] Open
Abstract
On radionuclide somatostatin receptor imaging studies, the spleen shows high physiologic uptake. Reducing the intensity of the image settings helps to better assess the distribution of radiotracer in the spleen. In our routine studies, we incidentally recognized that 68Ga-DOTANOC PET provides higher-resolution splenic images than 111In-octreotide SPECT. Autoradiography and immunohistochemistry studies have shown that somatostatin receptors are located mainly in the red pulp of the spleen. The distribution of 68Ga-DOTANOC in the spleen appears to correlate with the distribution of red pulp. In this article, we present 68Ga-DOTANOC PET/CT spleen images of our patients.
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Affiliation(s)
- Ismet Sarikaya
- Department of Nuclear Medicine, Kuwait University Faculty of Medicine, Safat, Kuwait
| | - Abdelhamid H Elgazzar
- Department of Nuclear Medicine, Kuwait University Faculty of Medicine, Safat, Kuwait
| | - Ali Sarikaya
- Department of Nuclear Medicine, Trakya University Faculty of Medicine, Edirne, Turkey and
| | - Naheel Alnafisi
- Department of Nuclear Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Saud Alenezi
- Department of Nuclear Medicine, Kuwait University Faculty of Medicine, Safat, Kuwait
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Sarikaya I, Sarikaya A, Alnafisi N, Alenezi S. Significance of splenic uptake on somatostatin receptor imaging studies. Nucl Med Rev Cent East Eur 2018; 21:66-70. [PMID: 29319140 DOI: 10.5603/nmr.a2018.0012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/09/2018] [Indexed: 11/25/2022] Open
Abstract
Spleen shows a high physiological uptake on radionuclide somatostatin receptor (SSTR) imaging studies. Autoradiography and immunohistochemistry studies showed that SSTRs are mainly located in the red pulp of the spleen. In this review article we will summarize the significance of splenic uptake in SSTR imaging studies and will also present high resolution splenic images of Ga-68 DOTANOC PET in which splenic distribution of the radiotracer appears to be correlating with the distribution of red pulp.
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Sarikaya I, Sarikaya A, Elgazzar AH, Caloglu VY, Sharma P, Baqer A, Caloglu M, Alfeeli M. Prostate-specific antigen cutoff value for ordering sodium fluoride positron emission tomography/computed tomography bone scan in patients with prostate cancer. World J Nucl Med 2018; 17:281-285. [PMID: 30505227 PMCID: PMC6216736 DOI: 10.4103/wjnm.wjnm_87_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The use of F-18 sodium fluoride (NaF) positron emission tomography/computed tomography (PET/CT) bone scan is increasing because of its higher sensitivity and specificity over standard bone scintigraphy (BS). Studies previously reported a prostate-specific antigen (PSA) cutoff value for ordering standard BS. However, this has not been determined for NaF PET yet. In this study, our goal was to determine a PSA cutoff level for ordering NaF PET/CT bone scan. Newly diagnosed and previously treated prostate cancer patients who had NaF PET/CT scan and PSA measurements within 2 mos of PET study were selected for analysis. When available, other parameters, such as Gleason score (GS), clinical stage, alkaline phosphatase levels, skeletal symptoms, and correlative image findings, were recorded. Receiver operating characteristic (ROC) analysis was performed to determine PSA cutoff values. Sixty-two patients (32 newly diagnosed and 30 previously treated) met the inclusion criteria. Near half of previously treated patients were on hormone therapy. NaF PET/CT was positive in 9 newly diagnosed (PSA mean: 91.6 ng/ml, range: 6.2-226 ng/ml) and in 6 previously treated patients (PSA mean: 146.4 ng/ml, range: 6.6-675 ng/ml). ROC analysis indicated that PSA cutoff value for NaF PET/CT positivity was >20 ng/ml in newly diagnosed and >6 ng/ml in previously treated patients. PSA cutoff value for ordering NaF PET/CT in newly diagnosed patients does not seem significantly different than the previous results for BS (>20 ng/ml). However, we found a lower PSA cutoff value of >6 ng/ml in previously treated patients.
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Affiliation(s)
- Ismet Sarikaya
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Ali Sarikaya
- Department of Nuclear Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Abdelhamid H Elgazzar
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Vuslat Yurut Caloglu
- Department of Radiation Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Prem Sharma
- Department of Statistics, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Ali Baqer
- Department of Nuclear Medicine, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait
| | - Murat Caloglu
- Department of Radiation Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Mahmoud Alfeeli
- Department of Nuclear Medicine, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait
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Sarikaya I, Elgazzar AH, Alfeeli MA, Sharma PN, Sarikaya A. Status of F-18 fluorodeoxyglucose uptake in normal and hibernating myocardium after glucose and insulin loading. J Saudi Heart Assoc 2017; 30:75-85. [PMID: 29910577 PMCID: PMC6000987 DOI: 10.1016/j.jsha.2017.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/14/2017] [Accepted: 07/05/2017] [Indexed: 11/28/2022] Open
Abstract
Objective F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) has been increasingly used in myocardial viability imaging. In routine PET viability studies, oral glucose and intravenous insulin loading is commonly utilized. In an optimal study, glucose and insulin loading is expected to cause FDG uptake both in hibernating and normal myocardium. However, in routine studies it is not uncommon to see absent or reduced FDG uptake in normal myocardium. In this retrospective study we further analyzed our PET viability images to evaluate FDG uptake status in myocardium under the oral glucose and intravenous insulin loading protocol that we use in our hospital. Methods Patients who had both myocardial perfusion single photon emission computed tomography (SPECT) and FDG PET cardiac viability studies were selected for analysis. FDG uptake status in normal and abnormal myocardial segments on perfusion SPECT was evaluated. Based on SPECT and PET findings, patients were divided into two main groups and four subgroups. Group 1 included PET viable studies and Group 2 included PET-nonviable studies. Subgroups based on FDG uptake in normal myocardium were 1a and 2a (normal uptake) and 1b and 2b (absent or significantly reduced uptake). Results Seventy-one patients met the inclusion criteria. Forty-two patients were PET-viable and 29 were PET-nonviable. In 33 of 71 patients (46.4%) there was absent or significantly reduced FDG uptake in one or more normal myocardial segments, which was identified more in PET-viable than PET-nonviable patients (59.5% vs. 27.5%, p = 0.008). This finding was also more frequent in diabetic than nondiabetic patients (53% vs. 31.8%), but the difference was not significant (p = 0.160). Conclusions In nearly half of our patients, one or more normal myocardial segments showed absent or significantly reduced FDG uptake. This finding, particularly if it is diffuse, could be from suboptimal study, inadequacy of current glucose and insulin loading protocols, or various other patient-related causes affecting FDG uptake both in the normal and hibernating myocardium. In cases with significantly reduced FDG uptake in normal myocardium, PET images should be interpreted cautiously to prevent false-negative results for viability.
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Affiliation(s)
- Ismet Sarikaya
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Kuwait
| | - A H Elgazzar
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Kuwait
| | - M A Alfeeli
- Department of Nuclear Medicine, Mubarak Al-Kabeer Hospital, Ministry of Health, Kuwait
| | - P N Sharma
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Kuwait
| | - A Sarikaya
- Department of Nuclear Medicine, Faculty of Medicine, Trakya University, Turkey
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Elgazzar AH, Dannoon S, Sarikaya I, Farghali M, Junaid TA. Scintigraphic Patterns of Indium-111 Oxine-Labeled White Blood Cell Imaging of Gram-Negative versus Gram-Positive Vertebral Osteomyelitis. Med Princ Pract 2017; 26:415-420. [PMID: 28797001 PMCID: PMC5757572 DOI: 10.1159/000480083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 08/06/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The goal of the study was to investigate whether or not gram-negative organisms that secrete antichemotactic factors cause the nonaccumulation pattern of 111In-oxine-labeled white blood cell (111In-WBC) scans. MATERIALS AND METHODS Staphylococcus aureus (gram-positive) (group 1) was injected into 25 rabbits and Escherichia coli (gram-negative) (group 2) into another 25 to induce infection in the lumbar vertebrae or left thigh bone (femur). Sixteen successfully infected and surviving rabbits from each group were used for imaging and analysis. Of the 16 rabbits, each group included 8 with vertebral infection and 8 with femur infection. For imaging, each rabbit was injected intravenously with 11.1 MBq (300 μCi) 111In-WBC, and images were acquired 24 h later. Microscopic histopathology was performed after decalcification to confirm osteomyelitis. RESULTS The 111In-WBC accumulation was observed in 7 (87.5%) of the 8 rabbits infected with S. aureus in the vertebrae and thigh bone. Of the rabbits infected with the gram-negative vertebrae, 1 (12.5%) showed little accumulation of 111In-WBC. Of the 8 rabbits with gram-negative-infected femurs, 1 had high accumulation and another had low accumulation of 111In-WBC, while the rest did not show any uptake. Osteomyelitis was confirmed by histopathology in all the successfully infected rabbits used for imaging. CONCLUSION In the majority of the gram-positive-infected rabbit vertebrae there was high accumulation of 111In-WBC. However, no accumulation of 111In-WBC was observed in most of the vertebrae infected with gram-negative organisms, which release antichemotactic factors that prevent adequate accumulation of WBC at the infected area.
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Affiliation(s)
- Abdelhamid H. Elgazzar
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
- *Dr. Abdelhamid H. Elgazzar, Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, PO Box 24923, Safat, Kuwait 13110 (Kuwait), E-Mail
| | - Shorouk Dannoon
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
| | - Ismet Sarikaya
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
| | - Medhat Farghali
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
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Sarikaya I. PET studies in epilepsy. Am J Nucl Med Mol Imaging 2015; 5:416-430. [PMID: 26550535 PMCID: PMC4620171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 06/23/2015] [Indexed: 06/05/2023]
Abstract
Various PET studies, such as measurements of glucose, serotonin and oxygen metabolism, cerebral blood flow and receptor bindings are availabe for epilepsy. (18)Fluoro-2-deoxyglucose ((18)F-FDG) PET imaging of brain glucose metabolism is a well established and widely available technique. Studies have demonstrated that the sensitivity of interictal FDG-PET is higher than interictal SPECT and similar to ictal SPECT for the lateralization and localization of epileptogenic foci in presurgical patients refractory to medical treatments who have noncontributory EEG and MRI. In addition to localizing epileptogenic focus, FDG-PET provide additional important information on the functional status of the rest of the brain. The main limitation of interictal FDG-PET is that it cannot precisely define the surgical margin as the area of hypometabolism usually extends beyond the epileptogenic zone. Various neurotransmitters (GABA, glutamate, opiates, serotonin, dopamine, acethylcholine, and adenosine) and receptor subtypes are involved in epilepsy. PET receptor imaging studies performed in limited centers help to understand the role of neurotransmitters in epileptogenesis, identify epileptic foci and investigate new treatment approaches. PET receptor imaging studies have demonstrated reduced (11)C-flumazenil (GABAA-cBDZ) and (18)F-MPPF (5-HT1A serotonin) and increased (11)C-cerfentanil (mu opiate) and (11)C-MeNTI (delta opiate) bindings in the area of seizure. (11)C-flumazenil has been reported to be more sensitive than FDG-PET for identifying epileptic foci. The area of abnormality on GABAAcBDZ and opiate receptor images is usually smaller and more circumscribed than the area of hypometabolism on FDG images. Studies have demonstrated that (11)C-alpha-methyl-L-tryptophan PET (to study synthesis of serotonin) can detect the epileptic focus within malformations of cortical development and helps in differentiating epileptogenic from non-epileptogenic tubers in patients with tuberous sclerosis complex. (15)O-H2O PET was reported to have a similar sensitivity to FDG-PET in detecting epileptic foci.
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Affiliation(s)
- Ismet Sarikaya
- Nuclear Medicine Section, Baskent University Hospital Istanbul, Turkey
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Collins BT, Vahdat S, Erickson K, Collins SP, Suy S, Yu X, Zhang Y, Subramaniam D, Reichner CA, Sarikaya I, Esposito G, Yousefi S, Jamis-Dow C, Banovac F, Anderson ED. Radical cyberknife radiosurgery with tumor tracking: an effective treatment for inoperable small peripheral stage I non-small cell lung cancer. J Hematol Oncol 2009; 2:1. [PMID: 19149899 PMCID: PMC2647945 DOI: 10.1186/1756-8722-2-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 01/17/2009] [Indexed: 12/19/2022] Open
Abstract
Objective Curative surgery is not an option for many patients with clinical stage I non-small-cell lung carcinoma (NSCLC), but radical radiosurgery may be effective. Methods Inoperable patients with small peripheral clinical stage I NSCLC were enrolled in this study. Three-to-five fiducial markers were implanted in or near tumors under CT guidance. Gross tumor volumes (GTVs) were contoured using lung windows. The GTV margin was expanded by 5 mm to establish the planning treatment volume (PTV). A dose of 42–60 Gy was delivered to the PTV in 3 equal fractions in less than 2 weeks using the CyberKnife radiosurgery system. The 30-Gy isodose contour extended at least 1 cm from the GTV. Physical examination, CT imaging and pulmonary function testing were completed at 6 months intervals for three years following treatment. Results Twenty patients with an average maximum tumor diameter of 2.2 cm (range, 1.1 – 3.5 cm) and a mean FEV1 of 1.08 liters (range, 0.53 – 1.71 L) were treated. Pneumothorax requiring tube thoracostomy occurred following CT-guided fiducial placement in 25% of the patients. All patients completed treatment with few acute side effects and no procedure-related mortality. Transient chest wall discomfort developed in 8 of the 12 patients with lesions within 5 mm of the pleura. The mean percentage of the total lung volume receiving a minimum of 15 Gy was 7.3% (range, 2.4% to 11.3%). One patient who received concurrent gefitinib developed short-lived, grade III radiation pneumonitis. The mean percent predicted DLCO decreased by 9% and 11% at 6 and 12 months, respectively. There were no local failures, regional lymph node recurrences or distant metastases. With a median follow-up of 25 months for the surviving patients, Kaplan-Meier overall survival estimate at 2 years was 87%, with deaths due to COPD progression. Conclusion Radical CyberKnife radiosurgery is a well-tolerated treatment option for inoperable patients with small, peripheral stage I NSCLC. Effective doses and adequate margins are likely to have contributed to the optimal early local control seen in this study.
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Affiliation(s)
- Brian T Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA.
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Abstract
The purpose of this article is to summarize the role of gamma probes in intraoperative tumor detection in patients with colorectal cancer (CRC), as well as provide basic information about the physical and practical characteristics of the gamma probes, and the radiopharmaceuticals used in gamma probe tumor detection. In a significant portion of these studies, radiolabeled monoclonal antibodies (Mabs), particularly 125I labeled B72.3 Mab that binds to the TAG-72 antigen, have been used to target tumor. Studies have reported that intraoperative gamma probe radioimmunodetection helps surgeons to localize primary tumor, clearly delineate its resection margins and provide immediate intraoperative staging. Studies also have emphasized the value of intraoperative gamma probe radioimmunodetection in defining the extent of tumor recurrence and finding sub-clinical occult tumors which would assure the surgeons that they have completely removed the tumor burden. However, intraoperative gamma probe radioimmunodetection has not been widely adapted among surgeons because of some constraints associated with this technique. The main difficulty with this technique is the long period of waiting time between Mab injection and surgery. The technique is also laborious and costly. In recent years, Fluorine-18-2-fluoro-2-deoxy-D-glucose (18F-FDG) use in gamma probe tumor detection surgery has renewed interest among surgeons. Preliminary studies during surgery have demonstrated that use of FDG in gamma probe tumor detection during surgery is feasible and useful.
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Affiliation(s)
- Ismet Sarikaya
- Division of Nuclear Medicine, Georgetown University Hospital, Washington DC, 20007, USA.
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Povoski SP, Sarikaya I, White WC, Marsh SG, Hall NC, Hinkle GH, Martin EW, Knopp MV. Comprehensive evaluation of occupational radiation exposure to intraoperative and perioperative personnel from 18F-FDG radioguided surgical procedures. Eur J Nucl Med Mol Imaging 2008; 35:2026-34. [PMID: 18618106 DOI: 10.1007/s00259-008-0880-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2008] [Accepted: 06/21/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of the current study was to comprehensively evaluate occupational radiation exposure to all intraoperative and perioperative personnel involved in radioguided surgical procedures utilizing (18)F-fluorodeoxyglucose ((18)F-FDG). METHODS Radiation exposure to surgeon, anesthetist, scrub technologist, circulating nurse, preoperative nurse, and postoperative nurse, using aluminum oxide dosimeters read by optically stimulated luminescence technology, was evaluated during ten actual radioguided surgical procedures involving administration of (18)F-FDG. RESULTS Mean patient dosage of (18)F-FDG was 699 +/- 181 MBq (range 451-984). Mean time from (18)F-FDG injection to initial exposure of personnel to the patient was shortest for the preoperative nurse (75 +/- 63 min, range 0-182) followed by the circulating nurse, anesthetist, scrub technologist, surgeon, and postoperative nurse. Mean total time of exposure of the personnel to the patient was longest for the anesthetist (250 +/- 128 min, range 69-492) followed by the circulating nurse, scrub technologist, surgeon, postoperative nurse, and preoperative nurse. Largest deep dose equivalent per case was received by the surgeon (164 +/- 135 microSv, range 10-580) followed by the anesthetist, scrub technologist, postoperative nurse, circulating nurse, and preoperative nurse. Largest deep dose equivalent per hour of exposure was received by the preoperative nurse (83 +/- 134 microSv/h, range 0-400) followed by the surgeon, anesthetist, postoperative nurse, scrub technologist, and circulating nurse. CONCLUSION On a per case basis, occupational radiation exposure to intraoperative and perioperative personnel involved in (18)F-FDG radioguided surgical procedures is relatively small. Development of guidelines for monitoring occupational radiation exposure in (18)F-FDG cases will provide reassurance and afford a safe work environment for such personnel.
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Affiliation(s)
- Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA.
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Sarikaya I, Povoski SP, Al-Saif OH, Kocak E, Bloomston M, Marsh S, Cao Z, Murrey DA, Zhang J, Hall NC, Knopp MV, Martin EW. Combined use of preoperative 18F FDG-PET imaging and intraoperative gamma probe detection for accurate assessment of tumor recurrence in patients with colorectal cancer. World J Surg Oncol 2007; 5:80. [PMID: 17634125 PMCID: PMC1941735 DOI: 10.1186/1477-7819-5-80] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Accepted: 07/16/2007] [Indexed: 11/20/2022] Open
Abstract
Background The purpose of this study was to combine intraoperative gamma probe (GP) detection with preoperative fluorine 18-fluoro-2-deoxy-glucose positron emission tomography (18F FDG-PET) imaging in order to improve detection of tumor recurrence in colorectal cancer (CRC) patients. Methods Twenty-one patients (12 females, 9 males) with a mean age of 54 years (range 31–78) were enrolled. Patients were suspected to have recurrent CRC by elevated CEA (n = 11), suspicious CT findings (n = 1), and clinically suspicious findings (n = 9). Preoperative FDG-PET scan and intraoperative GP study were performed in all patients. Mean time interval between preoperative FDG-PET scan and surgery was 16 days (range 1–41 days) in 19 patients. For intraoperative GP studies, 19 patients were injected with a dose of 10–15 mCi 18F FDG at approximately 30 minutes before the planned surgery time. In two patients, the intraoperative GP study was performed immediately after preoperative FDG-PET scan. Results Preoperative FDG-PET and intraoperative GP detected 48 and 45 lesions, respectively. A total of 50 presumed site of recurrent disease from 20 patients were resected. Thirty-seven of 50 presumed sites of recurrent disease were histological-proven tumor positive and 13 of 50 presumed sites of recurrent disease were histological-proven tumor negative. When correlated with final histopathology, the number of true positive lesions and false positive lesions by preoperative FDG-PET and intraoperative GP were 31/9 and 35/8, respectively. Both preoperative FDG-PET and intraoperative GP were true positive in 29 lesions. Intraoperative GP detected additional small lesions in the omentum and pelvis which were not seen on preoperative FDG-PET scan. FDG-PET scan demonstrated additional liver metastases which were not detected by intraoperative GP. Preoperative FDG-PET detected distant metastasis in the lung in one patient. The estimated radiation dose received by a surgeon during a single 18F FDG GP surgery was below the occupational limit. Conclusion The combined use of preoperative FDG-PET and intraoperative GP is potentially helpful to the surgeon as a roadmap for accurately locating and determining the extent of tumor recurrence in patients with CRC. While intraoperative GP appears to be more sensitive in detecting the extent of abdominal and pelvic recurrence, preoperative FDG-PET appears to be more sensitive in detecting liver metastases. FDG-PET is also a valuable method in detecting distant metastases.
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Affiliation(s)
- Ismet Sarikaya
- Division of Nuclear Medicine, Section of PET, Department of Radiology, The Ohio State University, Columbus, OH 43210, USA
| | - Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
| | - Osama H Al-Saif
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
| | - Ergun Kocak
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
| | - Mark Bloomston
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
| | - Steven Marsh
- Division of Nuclear Medicine, Section of PET, Department of Radiology, The Ohio State University, Columbus, OH 43210, USA
| | - Zongjian Cao
- Department of Radiology, Medical College of Georgia, Augusta, GA 30912, USA
| | - Douglas A Murrey
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
| | - Jun Zhang
- Division of Nuclear Medicine, Section of PET, Department of Radiology, The Ohio State University, Columbus, OH 43210, USA
| | - Nathan C Hall
- Division of Nuclear Medicine, Section of PET, Department of Radiology, The Ohio State University, Columbus, OH 43210, USA
| | - Michael V Knopp
- Division of Nuclear Medicine, Section of PET, Department of Radiology, The Ohio State University, Columbus, OH 43210, USA
| | - Edward W Martin
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
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Sarikaya I, Bloomston M, Povoski SP, Zhang J, Hall NC, Knopp MV, Martin EW. FDG-PET scan in patients with clinically and/or radiologically suspicious colorectal cancer recurrence but normal CEA. World J Surg Oncol 2007; 5:64. [PMID: 17555577 PMCID: PMC1896164 DOI: 10.1186/1477-7819-5-64] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Accepted: 06/07/2007] [Indexed: 12/19/2022] Open
Abstract
Background Although frequently used for tumor surveillance, the sensitivity of carcinoembryonic antigen (CEA) to detect recurrent colorectal cancer (CRC) is not optimal. Fluorine 18-fluoro-2-deoxy-glucose-positron emission tomography (18F FDG-PET) scans promise to improve recurrent CRC detection. We aimed to review PET scans of patients with clinically and/or radiologically suspicious tumor recurrence but normal CEA. Methods A retrospective review of an electronic database of 308 patients with CRC who had PET scans was performed. Only PET studies of patients with normal CEAs and suspected tumor recurrence who had pathological verification were selected for further analysis. Thirty-nine patients met the inclusion criteria. Results PET was positive in 26 patients (67%) and normal in 13 (33%). Histopathologic evidence of tumor recurrence was seen in 27 of the 39 patients (69%). When correlated with histopathology, PET was true positive in 22 patients, false positive in 4, true negative in 8 and false negative in 5. Overall, the accuracy of PET was 76.9%, negative predictive value (NPV) was 61.5%, and positive predictive value (PPV) was 84.6%. PPV value of PET for liver metastases was 88.8% compared to 73.3% for local recurrence. In two patients with confirmed recurrence, CEA became positive 2 months after PET scan indicating earlier detection of disease with PET. The false positive PET findings were mainly in the bowel and were secondary to acute/chronic inflammation and granulation tissue. In 3 patients with false negative PET, histopathology was consistent with mucinous adenocarcinoma. Conclusion PET yields high PPV for recurrent CRC, particularly for liver metastases, in spite of normal CEA levels and should be considered early in the evaluation of patients with suspected tumor recurrence.
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Affiliation(s)
- Ismet Sarikaya
- Division of Nuclear Medicine, Section of PET, Department of Radiology, The Ohio State University, Columbus, OH, 43210, USA
| | - Mark Bloomston
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital The Ohio State University, Columbus, OH 43210, USA
- Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
| | - Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital The Ohio State University, Columbus, OH 43210, USA
- Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
| | - Jun Zhang
- Division of Nuclear Medicine, Section of PET, Department of Radiology, The Ohio State University, Columbus, OH, 43210, USA
| | - Nathan C Hall
- Division of Nuclear Medicine, Section of PET, Department of Radiology, The Ohio State University, Columbus, OH, 43210, USA
| | - Michael V Knopp
- Division of Nuclear Medicine, Section of PET, Department of Radiology, The Ohio State University, Columbus, OH, 43210, USA
| | - Edward W Martin
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital The Ohio State University, Columbus, OH 43210, USA
- Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
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Affiliation(s)
- I Sarikaya
- PET/CT Unit, DiagnaMed Imaging Center, Istanbul, Turkey.
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Tanriverdi F, Eryol NK, Atmaca H, Unluhizarci K, Ozdogru I, Sarikaya I, Bayram F, Kelestimur F. The effects of 12 months of growth hormone replacement therapy on cardiac autonomic tone in adults with growth hormone deficiency. Clin Endocrinol (Oxf) 2005; 62:706-12. [PMID: 15943833 DOI: 10.1111/j.1365-2265.2005.02283.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Growth hormone deficiency (GHD) in adults is associated with a cluster of cardiovascular risk factors. Some abnormalities of cardiac structure and function have been reported in adult patients with GHD, but there are few data related to cardiac autonomic tone. Non-invasive assessment of cardiac autonomic status can be achieved by heart rate variability (HRV), which can be measured by using time-domain or frequency-domain variables. To our knowledge, short-term (6 months) effects of GH replacement therapy (GHRT) on HRV in a limited number of patients have been evaluated prospectively in only two previous studies. The present study was therefore designed to investigate the effects of GHD and 12 months of GHRT on cardiac autonomic tone in a larger number of adult patients with severe GHD. PATIENTS AND METHODS HRV measurement, by using time-domain variables, was performed in 22 patients with GHD (eight men, 14 women; mean age 45.4 +/- 2.4 years) and 22 healthy controls (nine men, 13 women; mean age 40.8 +/- 1.8 years) at baseline. The time-domain variables (sympathetically influenced parameters SDNN and SDANN and parasympathetically influenced parameters RMSSD and PNN50) were derived from 24-h electrocardiogram (ECG) recordings. In the patient group, cardiac autonomic tone was re-evaluated after 6 and 12 months of GHRT. RESULTS Mean baseline values of SDNN and SDANN were significantly higher (higher values mean lower sympathetic activity) in GHD patients than in healthy controls (P < 0.05), but mean baseline values of RMSSD and PNN50 did not differ significantly in healthy controls and patients. After 6 and 12 months of GHRT, mean SDNN and SDANN were decreased significantly when compared with the baseline values before GHRT (P < 0.05). However, mean RMSSD and PNN50 did not differ significantly from baseline. When SDNN and SDANN measurements were evaluated individually for each patient, after 12 months of GHRT both of the sympathetically influenced parameters decreased in 90% of the patients. CONCLUSIONS These data indicate that sympathetic tone is decreased in adult patients with severe GHD. Additionally, an increment in sympathetic activity and normalization of sympathovagal balance have been demonstrated after 6 and 12 months of GHRT. This result suggests that, at least at the doses used in this study, GHRT improves sympathetic tone, without an obvious arrhythmogenic effect.
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Affiliation(s)
- F Tanriverdi
- Department of Endocrinology, Erciyes University Medical School, Kayseri, Turkey
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Abstract
The new combined positron emission (PET)/computed tomographic (CT) scanners have many advantages over PET scanners alone. However, physicians must be aware of the potential artefacts observed in PET/CT scanners. A body PET/CT was performed on an 81-year-old man with colorectal cancer. The CT-based, attenuation-corrected PET image showed a right lower lung lesion. However, there was no lung lesion on the transmission CT image. Nonattenuation-corrected PET, and rod source-based, attenuation-corrected PET images demonstrated focal uptake in the dome of the liver. Dedicated CT with intravenous contrast confirmed that the lesion was in the liver dome and not in the right lower lung. The liver lesion was misplaced to the right lower lung in the CT-based, attenuation-corrected PET image because of a respiratory artefact. To overcome this respiration artefact the authors suggest a routine review of the nonattenuation-corrected PET images, particularly when evaluating liver dome and lower lung lesions.
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Affiliation(s)
- Ismet Sarikaya
- Memorial Sloan-Kettering Cancer Center, Nuclear Medicine Section, New York, NY 10021, USA.
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Affiliation(s)
- Ismet Sarikaya
- Section of Nuclear Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Sarikaya A, Sarikaya I, Pekindil G, Firat MF, Pekindil Y. Technetium-99m sestamibi limb scintigraphy in post-traumatic reflex sympathetic dystrophy: preliminary results. European Journal of Nuclear Medicine and Molecular Imaging 2001; 28:1517-22. [PMID: 11685495 DOI: 10.1007/s002590100615] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2001] [Accepted: 06/01/2001] [Indexed: 11/27/2022]
Abstract
Reflex sympathetic dystrophy (RSD) has widely variable clinical manifestations. Its pathogenesis remains partially unexplained. RSD is commonly divided into three stages; these stages are not always clearly separable, but staging remains important for correct treatment. Since the disease involves soft tissue alterations as well as bone changes, we decided to investigate whether technetium-99m sestamibi limb imaging can be used to evaluate the soft tissue appearance. Fifteen patients (seven females and eight males; age range 12-68 years) with clinically significant post-fracture RSD were evaluated with both three-phase bone scan (TPBS) and 99mTc-sestamibi limb scintigraphy. Although, in general, patients with similar duration of disease, clinical stage and TPBS activity tended to have similar patterns of sestamibi uptake, discordant uptake patterns were observed in some patients with clinical stage 1. Thus, of 12 patients with stage I disease, eight had increased 99mTc-sestamibi activity in the distal part of the affected limb, while three had normal activity and one had decreased activity. All three patients with stage II disease showed normal 99mTc-sestamibi uptake. Although most of the patients with increased 99mTc-sestamibi uptake had increased activity on all three phases of the bone scan, there were discordant results between the scan patterns in other patients. On the basis of these findings, we suggest that 99mTc-sestamibi imaging may contribute to the differentiation between clinical stages and may permit evaluation of the disease course and selection of appropriate therapy. 99mTc-sestamibi imaging is not, however, a primary diagnostic procedure for RSD.
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Affiliation(s)
- A Sarikaya
- Department of Nuclear Medicine, Trakya University Hospital, Edirne, Turkey.
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Abstract
Single photon emission computed tomography (SPECT) of the bone is the second most frequently performed SPECT examination in routine nuclear medicine practice, with cardiac SPECT being the most frequent. Compared with planar scintigraphy, SPECT increases image contrast and improves lesion detection and localization. Studies have documented the unique diagnostic information provided by SPECT, particularly for avascular necrosis of the femoral head, in patients with back pain, for the differential diagnosis between malignant and benign spinal lesions, in the detection of metastatic cancer in the spine, for the diagnosis of temporomandibular joint internal derangement, and for the evaluation of acute and chronic knee pain. Although less rigorously documented, SPECT is being increasingly used in all types of situations that demand more precise anatomic localization of abnormal tracer uptake. The effectiveness of bone SPECT increases with the selection of the proper collimator, which allows one to acquire adequate counts and minimize the patient-to-detector distance. Low-energy, ultrahigh-resolution or high-resolution collimation is preferred over all-purpose collimators. Multihead gamma cameras can increase the counts obtained or shorten acquisition time, making SPECT acquisitions more practical in busy departments and also increasing image quality compared with single-head cameras. Iterative reconstruction, with the use of ordered subsets estimation maximization, provides better quality images than classical filtered back projection algorithms. Three-dimensional image analysis often aids lesion localization.
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Affiliation(s)
- I Sarikaya
- University of Maryland Medical System, Department of Radiology, Baltimore 21201, USA
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Affiliation(s)
- I Sarikaya
- University of Maryland Medical Center, Department of Radiology, Baltimore 21201, USA.
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Affiliation(s)
- I Sarikaya
- University of Maryland Medical Systems, Department of Radiology, Baltimore 21201, USA.
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Sarikaya I, Aygit AC, Candan L, Sarikaya A, Türkyilmaz M, Berkarda S. Assessment of tissue viability after frostbite injury by technetium-99m-sestamibi scintigraphy in an experimental rabbit model. Eur J Nucl Med 2000; 27:41-5. [PMID: 10654145 DOI: 10.1007/pl00006660] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Frostbite causes injury to the tissue by direct ice-crystal formation at the cellular level with cellular dehydration and microvascular occlusion. Muscle that initially appears viable on reperfusion may subsequently become necrotic because of microcirculatory collapse. Since muscle is a sensitive tissue in frostbite injury, we used technetium-99m-sestamibi limb scintigraphy to assess tissue viability in an experimental rabbit model. Twelve rabbits were used for this investigation. The right hind limb of the rabbits was immersed to the ankle joint in a container filled with 90% ethanol at -25 degrees C for 10 min. Frostbitten limbs were allowed to thaw in air at room temperature. Imaging and pathological examination of the affected limbs were performed 2 h, 24 h, 48 h and 72 h after freezing. In 2-h images, initial hypoperfusion was seen that corresponded to circulatory collapse. In 24-h images, there was hyperperfusion (so-called period of temporary reperfusion), corresponding to circulatory restoration. In 48-h images, a second hypoperfusion corresponded to viable but ischaemic tissue. In 72-h images, there was non-perfusion of the limb that correlated with the pathologically determined diagnosis of necrosis. All scintigraphic patterns correlated with pathological findings. We suggest that these scintigraphic patterns in soft tissue may be helpful in distinguishing between frank infarction and reversible ischemia and therefore may be useful in selecting early therapeutic or surgical interventions to salvage bone and soft tissue. Further studies are needed to show the usefulness of 99mTc sestamibi scintigraphy in clinical frostbite cases.
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Affiliation(s)
- I Sarikaya
- Department of Nuclear Medicine, Kocaeli University Medical Faculty, Turkey
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Affiliation(s)
- I Sarikaya
- Department of Nuclear Medicine, Ankara University Hospital, Turkey.
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Abstract
PURPOSE Various radionuclide methods have been studied for the evaluation of the disease activity and extent of ulcerative colitis and other protein-losing enteropathies. Recently, Tc-99m dextran and Tc-99m human immunoglobulin (HIG) have been used to detect inflammation and protein loss into the intestine, but only a few studies have been reported with these agents. MATERIALS AND METHODS In this study, Tc-99m dextran and Tc-99m HIG were used to evaluate disease activity and extent in patients with ulcerative colitis. These agents were used in 12 patients with active disease and in five patients in remission, and five healthy control participants also were included. RESULTS Large bowel activity was detected in 11 of the 12 patients with active ulcerative colitis using Tc-99m dextran and in 10 patients using Tc-99m HIG. Fifty-eight bowel segments were found to be active with endoscopy, 39 with Tc-99m dextran, and 31 with Tc-99m HIG. No intestinal activity was detected in the control participants. Grade 1 activity localization in the large bowel was detected in three patients with ulcerative colitis in remission using Tc-99m dextran and in one patient using Tc-99m HIG. CONCLUSION Tc-99m dextran is more sensitive for detecting disease activity and extent than is Tc-99m HIG.
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Affiliation(s)
- I Sarikaya
- Department of Nuclear Medicine, Ankara University Hospital, Turkey
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