The importance of 68Ga-DOTATATE PET/CT in the evaluation of neuroendocrine tumors is well established. However, false-positive results can occur due to inflammatory pathologies. We report a 47-year-old man who was diagnosed with a neuroendocrine tumor of the stomach. Initial 68Ga-DOTATATE PET/CT showed intense 68Ga-DOTATATE uptake in the petrous apex. Histopathological confirmation could not be obtained, thus the asymptomatic patient was followed with periodic clinical/radiologic examinations for more than 2.5 years. Therefore, this lesion was diagnosed as a cholesterol granuloma of the temporal bone. These results suggested that an initial wait-and-scan approach is a feasible management strategy for similar presentations.
Objective Transarterial radioembolization (TARE) with Yttrium-90 ( 90 Y) labeled microspheres is an effective locoregional treatment option for patients with primary and metastatic liver cancer. However, TARE is also associated with radiationinduced lung injury due to hepatopulmonary shunting. If a large proportion of the injected radionuclide microspheres (more than 15%) is shunted, a rare but lethal complication may develop: radiation-induced pneumonitis (RP). Diffusion capacity of the lungs for carbon monoxide (DLCO) is a valuable test to assess lung function and a decrease in DLCO may indicate an impairment in gas exchange caused by the lung injury. Some previous researches have been reported the most consistent changes in pulmonary function tests after external beam radiotherapy are recorded with DLCO. This study aimed to examine the changes in DLCO after TARE with glass microspheres in newly treated and retreated patients with relatively higher lung shunt fractions. Methods We prospectively analyzed forty consecutive patients with liver malignancies who underwent lobar or superselective TARE with 90 Y glass microspheres. DLCO tests were performed at baseline and on days 15, 30, and 60 after the treatment. All patients were followed up clinically and radiologically for the development of RP. Results A statistically significant decrease was found in the DLCO after the first treatment (81.4 ± 13.66 vs. 75.25 ± 13.22, p = 0.003). The frequency of the patients with impaired DLCO at baseline was significantly increased after the first treatment (37.5 vs 57.5% p < 0.05). In the retreated group (n = 8), neither the DLCO (71.5 ± 10.82 vs. 67.50 ± 11.24, p = 0.115) nor the frequency of patients with impaired DLCO (25 vs 25%, p = 1) did not significantly change. Also, the change in DLCO values did not significantly correlate with lung shunt fraction, administered radiation dose, and absorbed lung dose after the first and second treatments (p > 0.05 for all). None of the patients developed RP. Conclusion Our study showed that a significant reduction in DLCO after TARE may occur in patients with relatively higher lung shunt fractions. Further studies with larger sample sizes are needed to better investigate the changes in DLCO in patients with high lung shunt fractions.
Background/aim: Hashimoto thyroiditis (HT) is an autoimmune disease that leads to tissue stiffening secondary to lymphocyte infiltration of the thyroid gland. Gray-scale ultrasound (US) is widely used in its diagnosis. Numerous studies have been conducted comparing elastography findings of HT with tissue stiffness and immunoreactivity levels. This study aims to reveal the relationship between shear-wave elastography (SWE) and Doppler parameters in patients with HT. Material and Methods: The study group consisted of 45 patients diagnosed with HT and 20 control patients without thyroid pathology. Thyroid-stimulating hormone (TSH) and anti-thyroid peroxidase (TPO) values were examined in patients with HT. Thyroid gland volume and echo patterns were evaluated in the gray-scale US. Doppler measurementspeak systolic velocity (Vmax), end-diastolic velocity (Vmin), pulsatility index (PI), resistivity index (RI)-from the superior thyroidal artery and SWE measurements were taken from both thyroid lobes. Results: The mean age of men and women in the HT group was 44.8 and 43.4 years. The mean TSH value (normal value: 0.3-4.2 uIU/ml) was 3.90 ± 6.6 uIU/ml, and the anti-TPO value (normal value: < 35 IU/ml) was 235.47 ± 271.12 IU/ml. The average thyroid gland volume was 10.12 ± 2.71 ml in the HT group and 6.62 ± 2.11 ml in the control group (p = 0.034). HT group mean Vmax, mean Vmin, mean PI and RI values were significantly lower compared to normal subjects (p = 0.022, p = 0.026, p = 0.042, p = 0.046, respectively). The average SWE value of the thyroid gland was 24.56 ± 18.04 kPa in the experimental group and 7.34 ± 3.54 (p < 0.05) in the control group. Conclusion: A positive correlation was found between PI and RI values and elastography values. An increase in SWE and decreases in Vmax and Vmin were found as high diagnostic value for HT.
Objective: Subacromial injection (SAI), due to its ease of application and increased patient tolerability, is one of the preferred invasive therapies. In this study, we aimed to evaluate effectiveness of ultrasound-guided SAI in patients with supraspinatus calcific tendinitis by assessment of roentgenograms and clinical appraisal. Patients and Methods: Thirty-five patients with supraspinatus tendon calcifications as revealed by the roentgenography underwent ultrasound-guided SAI. Pre-treatment the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) scores and Gartner's Classification of calcific tendinitis were obtained. Clinical follow-up was scheduled at 1st, 3rd and 6th months posttreatment along with a single roentgenogram planned at 6th month. Results: A total of 53 SAIs were performed on 36 shoulders, 21 female and 14 male patients. Mean size of calcifications were 12.3 and 7.1 mm, pre-treatment and at 6th month, respectively. Pre and post-injection calcification mean sizes in the group with clinical improvement were 13.6 and 5.7 mm; whereas, in group without diminished symptoms, they were 11.8 and 9.4 mm demonstrating a statistically significant intergroup difference (p<0.05). Pre-injection QuickDASH mean score was 52.2; this showed improvement at 1st, 3rd and 6th months post-treatment; 20.7, 22.2 and 19.5, respectively. Conclusion: Subacromial injection is a well-tolerated, easily applicable, safe and effective treatment for pain alleviation in supraspinatus calcific tendinitis.
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