Somatostatin receptor (SSTR) PET has demonstrated a significant improvement over conventional imaging (CI) in patients with neuroendocrine tumors (NETs). SSTR PET should replace 111 In-pentetreotide scintigraphy (OctreoScan; Mallinckrodt) in all indications in which the latter is currently being used. These appropriate use criteria (AUC) are intended to aid referring medical practitioners in the appropriate use of SSTR PET for imaging of patients with NETs. The indications were evaluated in welldifferentiated NETs. Of the 12 clinical scenarios evaluated, 9 were graded as appropriate: initial staging after the histologic diagnosis of NET, evaluation of an unknown primary, evaluation of a mass suggestive of NET not amenable to endoscopic or percutaneous biopsy, staging of NET before planned surgery, monitoring of NET seen predominantly on SSTR PET, evaluation of patients with biochemical evidence and symptoms of a NET, evaluation of patients with biochemical evidence of a NET without evidence on CI or a prior histologic diagnosis, restaging at time of clinical or laboratory progression without progression on CI, and new indeterminate lesion on CI with unclear progression.

No abstract

The pathophysiological relation between periodic lateralized epileptiform discharges (PLEDs) and epileptic seizures is not known and the exact causative mechanism of PLEDs still remains unclear. In this report, the authors present a case in which the EEG displayed PLEDs after a complex partial seizure. This patient, with a long history of complex partial seizures, had previously undergone right standard anterior temporal lobectomy with hippocampectomy, with a diagnosis of mesial temporal sclerosis. She had one complex partial seizure 72 days after operation and was admitted to hospital. Her brain MRI revealed changes due to temporal lobectomy and small residual posterior hippocampic anomalies. PLEDs over the right temporal lobe were seen in postictal EEGs and persisted for 4 days despite the patient's normal mental status and normal neurologic examination. Brain perfusion scintigraphy with Tc-99m-HMPAO during PLEDs was performed on the second day after the seizure, and right temporal hyperperfusion was detected. EEGs and scintigraphic imaging were repeated after cessation of PLEDs. The repeated brain scan displayed right temporal hypoperfusion. PLEDs during the postictal period may actually be an ictal pattern, and if hyperperfusion in the brain SPECT studies during PLEDs is seen, further aggressive antiepileptic drug therapy may be necessary in some cases.

The purpose of this study was to assess the reliability and validity of the modified Conconi test on Concept II rowing ergometers. Twenty-eight oarsmen conducted 3 performance tests on separate days. Reliability was assessed using the break point in heart rate (HR) linearity called the Conconi test (CT) and Conconi retest (CRT) for the noninvasive measurement of anaerobic threshold (AT). Blood lactate measurement was considered the gold standard for the assessment of the AT, and the validity of the CT was assessed by blood samples taken during an incremental load test (ILT) on ergometers. According to the results, the mean power output (PO) scores for the CT, CRT, and ILT were 234.2 +/- 40.3 W, 232.5 +/- 39.7 W, and 229.7 +/- 39.6 W, respectively. The mean HR values at the AT for the CT, CRT, and ILT were 165.4 +/- 11.2 b.min, 160.4 +/- 10.8 b.min, and 158.3 +/- 8.8 b.min, respectively. Interclass correlation coefficient (ICC) analysis indicated a significant correlation between the 3 tests with one another. Also, Bland and Altman plots showed that there was an association between noninvasive tests and the ILT PO scores and HRs (95% confidence interval [CI]). In conclusion, this study showed that the modified CT is a reliable and valid method for determining the AT of elite men rowers.

No abstract

Exercise-induced left bundle branch block (Ex-LBBB) is a rare entity encountered during exercise testing. The authors present a 53-year-old woman who developed intermittent Ex-LBBB asymptomatically during Tl 201 myocardial perfusion scintigraphy. Scintigraphic findings revealed septal-anteroseptal ischemia while the coronary arteriogram appeared normal. False-positive septal-anteroseptal scintigraphic findings suggesting ischemia in patients with persistent left bundle branch block (LBBB) is well known, but since the LBBB in this case was induced by exercise testing and was spontaneously terminated at rest, scintigraphic findings may be attributed to microcirculatory ischemia, which cannot be detected angiographically, as the cause of Ex-LBBB.

No abstract

Nuclear theranostics functions as a bridge which connects targeted diagnosis to targeted therapy, just like Turkey functions as a geographical bridge which connects Asia to Europe. This unique geographical site of the country plays an important role with regard to introduction of novel scientific and technologic improvements, which originate from one continent to another, in the era of accelerated information. The first nuclear medicine practice in Turkey started in the beginning of 1950s with the first radioiodine treatment, which actually was a debut for nuclear theranostics in Turkey, years before many other countries in the world. For the time being, along with radioiodine treatment, many other theranostic applications such as I-131 MIBG treatment, Lu-177/Y-90 DOTA peptide treatment, Lu-177 PSMA treatment, Y-90 microsphere treatment, and bone palliative treatment are being performed in many centers countrywide. As science and technology improves, novel theranostic applications are eagerly awaited to be introduced in near future. This paper summarizes the story of nuclear theranostics in Turkey and aims to give an overview on the current status of theranostic applications in Turkey.