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Objective(s): To compare the diagnostic performance of [68Ga]-Ga-FAPI-46 and [18F]-FDG PET/CT imaging for the detection of lesions and disease staging in breast cancer.Methods: Twelve female patients with breast cancer (mean age= 49.2±13.29 years) and previous [18F]-FDG PET/CT were recruited in the study. [68Ga]Ga-FAPI-46 imaging performed in all patients within one month after [18F]-FDG PET/CT imaging. The acquired PET/CT data with both tracers were reconstructed. Tracer avid lesions with each PET tracer were identified and the semi-quantitative parameters i.e. SUVmax, lesion counts and target-to-background ratio (TBRmax) were analyzed.Results: Physiologic distribution of [68Ga]-Ga-FAPI-46 was observed in the liver, blood pool and kidneys, whereas no tracer uptake was noted in the brain and heart. The mean liver SUVmax for [68Ga] Ga-FAPI-46 was 1.5±0.1 which was lower than that noted for [18F]-FDG PET/CT (2.9±0.2). Likewise, the mean blood pool SUVmax value for [68Ga]-Ga-FAPI-46 was lower than [18F]-FDG PET/CT (1.7±0.1 versus 2.0±0.1). [68Ga]-Ga-FAPI-46 PET/CT demonstrated higher tracer uptake in the lesions detected in the brain, bone, internal mammary and lymph nodes in 4/12 patients. The overall lesions detections and the mean SUVmax values did not differ significantly between the two techniques. On the other hand, [68Ga]-Ga-FAPI-46 demonstrated higher mean TBRmax than [18F] FDG PET/CT particularly for lesions detected in kidneys, chest wall, mediastinum, and musculoskeletal lesions. However, both techniques offered identical TNM staging.Conclusion: The findings of this preliminary study demonstrated that [68Ga]-Ga-FAPI-46 and [18F]-FDG PET/CT offered identical disease staging in the breast cancer patients. [68Ga]-Ga-FAPI-46 showed lower liver and blood pool uptake and an enhanced tumor-to-background ratio, thereby suggesting its potential for improved lesions detection. This may open opportunity for emerging FAP based radioligand for therapeutic applications in advanced stage breast cancers. However, this needs validation in a larger number of patients.

Background: Thyroid cancer is the most common endocrine malignancy in the world; however, these patients usually experience a high survival rate if they receive appropriate and timely treatment. Meanwhile, patients classified as having differentiated thyroid cancer with high thyroglobulin and negative iodine scan [Differentiated thyroid cancer with thyroglobulin elevation and negative iodine scintigraphy (TENIS)] are always considered a diagnostic-therapeutic challenge. Materials and Methods: We conducted a comprehensive literature search of published papers in the PubMed/MEDLINE database regarding nuclear imaging in differentiated thyroid cancer with thyroglobulin elevation and negative iodine scintigraphy. We included all human studies in this field. Results: In this review, we examined four major groups of imaging studies aimed at identifying GLUT, SSTR, PSMA and FAP receptors in patients with TENIS. The diagnostic rate of 2-[18F]FDG PET/CT in these patients has been reported as 63-81% based on various studies. Also, [68Ga]Ga-DOTATATE PET/CT, [68Ga]Ga-PSMA PET/CT and [68Ga]Ga-FAPI PET/CT scans have shown good results in these patients. Conclusion: [68Ga]Ga-FAPI PET/CT imaging has the highest diagnostic rate among these patients. Given the theranostic capability of FAPI and the numerous complications and limited inclusion criteria for treatment with tyrosine kinase inhibitors, it has been the next step in the treatment of patients with TENIS. Therefore, more extensive studies in this field are warranted.

Objective(s): To compare the diagnostic performance of [68Ga]-Ga-FAPI-46 and [18F]-FDG PET/CT imaging for the detection of lesions and disease staging in breast cancer. Methods: Twelve female patients with breast cancer (mean age= 49.2±13.29 years) and previous [18F]-FDG PET/CT were recruited in the study. [68Ga]Ga-FAPI-46 imaging performed in all patients within one month after [18F]-FDG PET/CT imaging. The acquired PET/CT data with both tracers were reconstructed. Tracer avid lesions with each PET tracer were identified and the semi-quantitative parameters i.e. SUVmax, lesion counts and target-to-background ratio (TBRmax) were analyzed. Results: Physiologic distribution of [68Ga]-Ga-FAPI-46 was observed in the liver, blood pool and kidneys, whereas no tracer uptake was noted in the brain and heart. The mean liver SUVmax for [68Ga] Ga-FAPI-46 was 1.5±0.1 which was lower than that noted for [18F]-FDG PET/CT (2.9±0.2). Likewise, the mean blood pool SUVmax value for [68Ga]-Ga-FAPI-46 was lower than [18F]-FDG PET/CT (1.7±0.1 versus 2.0±0.1). [68Ga]-Ga-FAPI-46 PET/CT demonstrated higher tracer uptake in the lesions detected in the brain, bone, internal mammary and lymph nodes in 4/12 patients. The overall lesions detections and the mean SUVmax values did not differ significantly between the two techniques. On the other hand, [68Ga]-Ga-FAPI-46 demonstrated higher mean TBRmax than [18F] FDG PET/CT particularly for lesions detected in kidneys, chest wall, mediastinum, and musculoskeletal lesions. However, both techniques offered identical TNM staging. Conclusion: The findings of this preliminary study demonstrated that [68Ga]-Ga-FAPI-46 and [18F]-FDG PET/CT offered identical disease staging in the breast cancer patients. [68Ga]-Ga-FAPI-46 showed lower liver and blood pool uptake and an enhanced tumor-to-background ratio, thereby suggesting its potential for improved lesions detection. This may open opportunity for emerging FAP based radioligand for therapeutic applications in advanced stage breast cancers. However, this needs validation in a larger number of patients. [ABSTRACT FROM AUTHOR]

Introduction: [68Ga]Ga-PSMA PET/CT has gained acceptance for localizing local and distant metastases; However, urinary activity remains a confounding factor in interpreting local metastases. The aim of this study was to evaluate the diagnostic value of two-phase protocol (i.e., early and regular imaging, TPP) in comparison with delayed optimized protocol (i.e., combined regular and delayed post hydration and diuresis images, DOP) to detect locoregional prostatic metastases. Methods: Forty-one prostate cancer patients referred for staging (n = 12) or the evaluation of rise in PSA level in prostate cancer (n = 29) were prospectively assessed. In this study, each patient received an early 5-10 min image from pelvic region for two bed position, regular (RP) (60 min) and finally delayed static images. The scan findings were characterized as positive, negative or equivocal. The diagnostic significance of TPP was compared with DOP for prostatic, periprostatic, locoregional lymph nodes and pelvic bone involvement. Results: The diagnostic agreement between DOP and TPP for prostate/prostate bed lesions was comparable with the agreement of DOP and RP (Kappa: 0.78, p value <0.001) vs. (Kappa: 0.8, p value <0.001). TPP in comparison with RP, had superior sensitivity for prostate/prostate bed lesions (95% vs. 80%). The sensitivity for lymph node metastases, extraprostatic extension and osteometastases was identical between the two protocols. Conclusion: TPP has the potential to replace DOP for the evaluation of prostate/prostate bed lesions; however, there remains instances where delayed imaging is helpful in characterizing the anatomic abnormality especially in the lymph node region. [ABSTRACT FROM AUTHOR]

Objective(s): Non-cutaneous malignant melanomas (NCM) are rare malignancies. Due to their nonspecific symptoms, they present later in life. The value of FDG PET/CT in this group of patients is not clear. The aim of this study is to assess the role of FDG PET/CT in the management of NCM and its prognostic implication.Methods: We retrospectively selected twenty-three patients with a diagnosis of NCM evaluated with FDG PET/CT in Shariati hospital between 2019 and 2021. The PET/CT data were reviewed and compared with available conventional imaging findings. Five patients died within five months. The surviving patients were followed within a time interval of 7 to 27.5 months after their PET/CT study, regarding their disease status.Results: Among 23 patients (8 ocular, 5 sinonasal, 3 pharyngeal, 2 anorectal, 2 vulvovaginal, and 3 unknown primaries), PET/CT was able to detect residual primary disease, assess treatment response, and reveal or exclude metastases. Additional lesions compared to conventional imaging were found in five, while in one with brain metastases PET/CT was unable to detect lesions on MRI. Thirteen patients had negative PET/CT finding of which 11 (85%) did not have remarkable finding on follow-up. Metastatic disease was recognized in eight. Patients with extensive metastases on FDG PET/CT had a poorer outcome.Conclusion: Similar to cutaneous melanoma, PET/CT is valuable in the management of NCM patients and is superior to conventional imaging modalities, with the exception of brain metastases. Patients with negative PET/CT findings have a better outcome as opposed to patients with significant positive PET/CT findings.

Objective(s): Prostate-specific membrane antigen (PSMA) ligand positron emission tomography/computed tomography (PET/CT) is an emerging modality to detect metastatic disease in patients with prostate cancer (PCa). This prospective study aimed to evaluate the role of [68Ga]-PSMA PET/CT in the initial workup of intermediate and high-risk PCa .Methods: Twenty-five patients with newly transrectal ultrasound biopsy-proven, untreated intermediate- and high-risk PCa (mean age, 68.5±6.2 years; range 55–83 years) were enrolled in this prospective study between September 2018 and June 2020 and underwent a [68Ga]-PSMA PET/CT examination. All images were analyzed both visually and semiquantitatively by measuring the maximum standardized uptake value (SUVmax) of the primary prostatic tumor and metastatic lesions. The diagnostic sensitivity of [68Ga]-PSMA PET/CT for the diagnosis of PCa was established by histopathology as the reference standard. The associations between SUVmax of the primary tumors and prostate-specific antigen (PSA) levels, Gleason scores (GSs), and metastatic extent of the disease were studied.Results: All patients had a positive [68Ga]-PSMA PET/CT exam. Seventeen patients (58%) showed [68Ga]-PSMA avidity in both prostate lobes and 8 (32%) had unilateral uptake. SUVmax in the primary tumor significantly correlated with serum PSA values (r=0.57, P=0.003). PSMA PET/CT depicted regional lymph node metastases in 32% of patients, distant lymph node metastases in 20%, osseous metastases in 16% and pulmonary metastases in 8% of patients. Sixty percent of PSMA-positive bone metastases and 21.4% of intraprostatic tumoral lesions were missed on the contemporaneous bone scintigraphy and magnetic resonance imaging, respectively.Conclusion: [68Ga]-PSMA PET/CT shows promise as a valuable imaging modality with high diagnostic sensitivity in the setting of intermediate and high-risk PCa. Moreover, the SUVmax of the primary tumor has a positive correlation with PSA levels at the time of the scan.

Rosai Dorfman disease is a rare form of nonlangerhans cell histiocytosis, presenting with extensive lymphadenopathies. Treatment in most cases of nodal disease, involves close observation; however, extranodal involvement requires a more definitive treatment strategy. Herein, we report a case of extensive Rosai Dorfman disease in a 43-year-old woman presenting for evaluation of treatment response by 18F-FDG PET/CT after frequent relapses and disease progression. In addition to extensive lymphadenothapies in cervical, supraclavicular, superior mediastinum, axillary, abdominopelvic and inguinofemoral regions, the patient had metabolically active bone and subcutaneous lesions which were not previously recognized. Following this 18F-FDG PET/CT study, the patient management was changed to sirolimus and prednisolone. To choose the best treatment option for Rosai Dorfman patients, knowledge of the full extent of disease is important. Compared with conventional imaging, 18F-FDG PET/CT has the advantage of being a whole-body imaging modality and can recognize disease involvement prior to any anatomical changes.

Objective(s): 68Ga-DOTATATE positron emission tomography (PET)/computed tomography (CT) has shown promising results in imaging of neural crest tumors (NCT). Herein, we compared the performance of 68Ga-DOTATATE PET/CT and 131I-MIBG single photon emission computed tomography (SPECT)/CT in the initial diagnosis, staging and follow-up of patients with NCTs. Methods: Twenty-five patients (males:females=8:17; age range=2–71 years) with clinically proven or suspicious neuroblastoma, pheochromocytoma (PCC) or paraganglioma (PGL) were enrolled in this prospective study and underwent both 68Ga-DOTATATE PET/CT and 131I-MIBG SPECT/CT. A composite reference standard derived from histopathological information, together with anatomical and functional imaging findings, was used to validate the results. Imaging findings were assessed on a per-patient and on a per-lesion basis. Sensitivity and accuracy were assessed using McNemar’s test. Results: Referring to radiological imaging and histopathological findings as reference standard, 68Ga-DOTATATE and 131I-MIBG scans showed a sensitivity and accuracy of (100%, 96%) and (86.7%, 88%), respectively, on a per-patient basis. In PCC/PGL patients, on a per-patient basis, the sensitivity of 68Ga-DOTATATE was 100% and that of 131I-MIBG was 77.8%. In neuroblastoma patients, on a per-patient basis, the sensitivities of both 68Ga-DOTATATE and 131I-MIBG were 100%. Overall, in this patient cohort, 68Ga-DOTATATE PET/CT identified 52 lesions and 131I-MIBG SPECT/CT identified only 30 lesions. On a per-lesion analysis, 68Ga-DOTATATE was found to be superior to 131I-MIBG in detecting lesions in all anatomical locations, particularly osseous lesions. According to the McNemar test results, differences were not statistically significant. Conclusion: This relatively small patient cohort suggests 68Ga-DOTATATE PET/CT be superior to 131I-MIBG SPECT/CT in providing particularly valuable information for both primary staging and follow-up in patients with NCT.

Objective(s): In view of somatostatin receptor (SSR) expression on cell membranes of the majority of neuroendocrine tumors (NETs), functional imaging exploiting analogs of SSR alongside the anatomical imaging is the mainstay of this diagnostic modality. In this prospective study, we assessed and directly compared the diagnostic parameters of 68Ga-DOTATATE PET/CT and 99mTc-Octreotide SPECT/CT, as well as CT/MRI. Methods: Twenty-five NET patients, either histologically proven or highly suspicious for NET, who were referred for Octreotide Scan were enrolled in this prospective study. They all underwent 99mTc-Octreotide SPECT/CT and then 68Ga-DOTATATE PET/CT. A blind interpretation was conducted for each imaging as well as for the previously obtained conventional imaging (CT or MRI). The patient-based and lesion-based analysis were conducted and the results of the three modalities were compared. The histopathologic confirmation or follow-up data were considered as the gold standard. Also, the impact of 68Ga-DOTATATE PET/CT on the patient’s management was assessed. Results: Overall, 77 lesions in 14 patients, 135 in 19 and 86 in 16 were detected on 99mTc-Octreotide SPECT/CT, 68Ga-DOTATATE PET/CT and CT/MRI, respectively. On patient-based analysis, the sensitivity was 65%, 90% and 71% for 99mTc-Octreotide SPECT/CT, 68Ga-DOTATATE PET/CT and CT/MRI, respectively. Also, the specificity was 80%, 80% and 75% for 99mTc-Octreotide SPECT/CT, 68Ga-DOTATATE PET/CT and CT/MRI, respectively. The correlation between 68Ga-DOTATATE PET/CT and 99mTc-Octreotide SPECT/CT results was significant (P=0.02; kappa value=0.57), no correlation, however, was depicted with CI (P=0.07; kappa value=0.35). On lesion-based analysis, 68Ga-DOTATATE PET/CT found more organs (P=0.02) and lesions (P=0.001) in comparison with 99mTc-Octreotide SPECT/CT and also more lesions in comparison with CT/MRI (P=0.003). In addition, comparing with 99mTc-Octreotide SPECT/CT and CT/MRI, 68Ga-DOTATATE PET/CT revealed more data in 44% and 36% of the patients, resulting in management modification in 24% and 20%, respectively. Conclusion: Comparing with 99mTc-Octreotide SPECT/CT and CT/MRI, 68Ga- DOTATATE PET/CT provided more sensitivity and specificity in patients with NETs showing more involved organs as well as tumoral lesions. Also, 68Ga-DOTATATE PET/ CT led to change of management in up to one-fourth of the patients, especially in a sub-group re-evaluated for recurrence.

Objective(s): Radiation therapy for breast cancer can induce myocardial capillary injury and increase cardiovascular morbidity and mortality. A prospective cohort was conducted to study the prevalence of myocardial perfusion abnormalities following radiation therapy of left-sided breast cancer patients as compared to those with right–sided cancer. Methods: To minimize potential confounding factors, only those patients with low 10-year risk of coronary artery disease (based on Framingham risk scoring) were included. All patients were initially treated by modified radical mastectomy and then were managed by postoperative 3D Conformal Radiation Therapy (CRT) to the surgical bed with an additional 1-cm margin, delivered by 46-50 Gy (in 2 Gy daily fractions) over a 5-week course. The same dose-adjusted chemotherapy regimen (including anthracyclines, cyclophosphamide and taxol) was given to all patients. Six months after radiation therapy, all patients underwent cardiac SPECT for the evaluation of myocardial perfusion. Results: A total of 71 patients with a mean age of 45.3±7.2 years [35 patients with leftsided breast cancer (exposed) and 36 patients with right-sided cancer (controls)] were enrolled. Dose-volume histogram (DVH) [showing the percentage of the heart exposed to >50% of radiation] was significantly higher in patients with left-sided breast cancer. Visual interpretation detected perfusion abnormalities in 42.9% of cases and 16.7% of controls (P=0.02, Odds ratio=1.46). In semiquantitative segmental analysis, only apical (28.6% versus 8.3%, P=0.03) and anterolateral (17.1% versus 2.8%, P=0.049) walls showed significantly reduced myocardial perfusion in the exposed group. Summed Stress Score (SSS) of>3 was observed in twelve cases (34.3%), while in five of the controls (13.9%),(Odds ratio=1.3). There was no significant difference between the groups regarding left ventricular ejection fraction. Conclusion: The risk of radiation induced myocardial perfusion abnormality in patients treated with CRT on the left hemi thorax is not low. It is reasonable to minimize the volume of the heart being in the field of radiation employing didactic radiation planning techniques. Also it is advisable to screen these patients with MPI-SPECT, even if they are clinically asymptomatic, as early diagnosis and treatment of silent ischemia may change the outcome.

Introduction: Large Vessel Vasculitis (LVV) is a chronic inflammatory process that affects the aorta and its main branches. LVV include Takayasu's Arteritis (TA) and Giant Cell Arteritis (GCA). The diagnosis of TA is made according to clinical criteria and based on the criteria of the American College of Rheumatology (ACR). Monitoring of disease progression and response to treatment is also done using the National Institutes of Health (NIH) criteria. Despite these criteria, diagnosing and evaluating TA activity is a challenging issue and usually occurs in the advanced stages of the disease. The lack of a comprehensive and non-invasive diagnostic method for diagnosing and monitoring the course of TA is obvious. The aim of this study was to evaluate the diagnostic agreement between 2- [18F]FDG PET-CT scan and clinical criteria for assessing TA disease activity. Methods: Twenty-four known cases of TA, who met the inclusion criteria, were enrolled in this study. The disease-related constitutional signs and symptoms, as well as laboratory and imaging findings were recorded. Patients underwent 2-[18F]FDG PETCT imaging with standard protocol. Fused PET-CT images were reviewed and, if necessary, images without attenuation correction were visualized as well. Also, 24 control patients of the same age and sex, among the patients who were referred to the imaging center for oncological indications were examined to compare the uptake of different vascular territories. Results: Out of 15 active patients (according to the NIH criteria), 2-[18F]FDG PET-CT scan was able to correctly identify 14 patients. Also, out of 9 inactive patients, PET scan was negative in eight patients showing that 2-[18F]FDG PET-CT scan could well differentiate between active and inactive status of the disease (p-value < 0.0001). Sensitivity, specificity, positive predictive value and negative predictive value of scan in this study were 93.3%, 88.9%, 93.3% and 88.9%, respectively. The study also showed that the severity of vascular lesion uptake was not affected by immunosuppressive drugs, including corticosteroids and methotrexate. Scan findings were comparable with the results of anatomical imaging in terms of disease activity and the number of vascular lesions with p-value = 0.1 and 0.304, respectively. Conclusion: In this study we showed that 2-[18F]FDG PET-CT has comparable results with other imaging modalities and NIH criteria; therefore, it can play an important role in assessing the severity of TA, even when patients are on immunosuppressive drugs. [ABSTRACT FROM AUTHOR]

Introduction: 2-[18F]fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (2-[18F]FDG-PET/CT) is implemented in papillary thyroid cancer (PTC) patients with elevated Thyroglobulin (Tg) and negative Iodine-131 wholebody scan (131I-WBS). Here, we evaluated the impact of TSH stimulation after levothyroxine withdrawal on the detection rate of 2-[18F]FDG-PET/CT. Methods: A prospective study was performed on 60 PTC patients, presented with negative 131I-WBS and elevated or unjustifiably high Tg. 2-[18F]FDG-PET/CT was performed in 30 patients while they were on levothyroxine therapy (unstimulated-TSH [uns-TSH]) and after Levothyroxine withdrawal in the other 30 patients (stimulated-TSH [s-TSH]). Results of the two groups were compared using nonparametric tests. Receiver operating characteristic curve was used to find Tg cutoff values for predicting positive scan results. Results: Overall, 2-[18F]FDG-PET/CT was positive in 63.3% of the patients, 80% (24/30) in s-TSH and 46.7% (14/30) in uns-TSH group. The detection rate was higher in s-TSH group (p=0.007). It was still significant in multiple regression analysis (p=0.041). In uns-TSH group, 2-[18F]FDG-PET/CT was more often positive in patients with higher uns-Tg level (p=0.002). An uns-Tg level of =19.00 ng/mL predicted positive results with the sensitivity of 0.786 and specificity of 0.750 (area under curve=0.819). Although statistically insignificant (p=0.055), s-Tg was higher in patients with positive 2-[18F]FDG-PET/CT studies in the s-TSH group. No relation was demonstrated between TSH and anti-Tg-antibody levels and 2-[18F]FDG-PET/CT positivity. Conclusion: TSH-stimulation after levothyroxine withdrawal might enhance the detection rate of 2-[18F]FDG-PET/CT in PTC patients. Additionally, 2-[18F]FDG-PET/CT is more often positive in patients with higher Tg levels. [ABSTRACT FROM AUTHOR]

Here, we describe a patient with a history of colorectal cancer in whom 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography ([18F]FDG PET/CT) was performed for the evaluation of response to therapy. [18F]FDG PET/CT showed a small residual disease in the rectum. In addition, multiple metabolically inactive soft tissue densities were demonstrated in the left hemithorax and the left upper abdominal region, previously interpreted as metastases on computed tomography. Furthermore, bizarre-shaped soft tissues were visualized in the anatomical location of the spleen. Hence, splenosis was suspected. Subsequently, the patient underwent [99mTc]Tc-denatured red blood cell ([99mTc]Tc-DRBC) scintigraphy, which confirmed the diagnosis of extensive thoracoabdominal splenosis. [ABSTRACT FROM AUTHOR]

Adrenal lesions are commonly observed during 18F-FDG PET/CT studies. Although, most of these lesions are considered benign, an important consideration in oncologic patients is metastasis. Benign lesions, such as adenomas usually present with low 18F-FDG uptake, although overlap with malignant lesions exist and clear SUV cut-off for distinguishing adrenal adenomas has not been established. Different criteria have been proposed to further characterize adrenal lesions, as benign or metastatic. Conventional imaging modalities have additional value when the degree of uptake is equivocal. In this review, we go through some of the common adrenal lesions, as well as discerning features that favor either benign or malignant etiology. [ABSTRACT FROM AUTHOR]

Objective(s): Prostate-specific membrane antigen (PSMA) ligand positron emission tomography/computed tomography (PET/CT) is an emerging modality to detect metastatic disease in patients with prostate cancer (PCa). This prospective study aimed to evaluate the role of [68Ga]-PSMA PET/CT in the initial workup of intermediate and high-risk PCa . Methods: Twenty-five patients with newly transrectal ultrasound biopsy-proven, untreated intermediate- and high-risk PCa (mean age, 68.5±6.2 years; range 55–83 years) were enrolled in this prospective study between September 2018 and June 2020 and underwent a [68Ga]-PSMA PET/CT examination. All images were analyzed both visually and semiquantitatively by measuring the maximum standardized uptake value (SUVmax) of the primary prostatic tumor and metastatic lesions. The diagnostic sensitivity of [68Ga]-PSMA PET/CT for the diagnosis of PCa was established by histopathology as the reference standard. The associations between SUVmax of the primary tumors and prostate-specific antigen (PSA) levels, Gleason scores (GSs), and metastatic extent of the disease were studied. Results: All patients had a positive [68Ga]-PSMA PET/CT exam. Seventeen patients (58%) showed [68Ga]-PSMA avidity in both prostate lobes and 8 (32%) had unilateral uptake. SUVmax in the primary tumor significantly correlated with serum PSA values (r=0.57, P=0.003). PSMA PET/CT depicted regional lymph node metastases in 32% of patients, distant lymph node metastases in 20%, osseous metastases in 16% and pulmonary metastases in 8% of patients. Sixty percent of PSMA-positive bone metastases and 21.4% of intraprostatic tumoral lesions were missed on the contemporaneous bone scintigraphy and magnetic resonance imaging, respectively. Conclusion: [68Ga]-PSMA PET/CT shows promise as a valuable imaging modality with high diagnostic sensitivity in the setting of intermediate and high-risk PCa. Moreover, the SUVmax of the primary tumor has a positive correlation with PSA levels at the time of the scan. [ABSTRACT FROM AUTHOR]

Rosai Dorfman disease is a rare form of nonlangerhans cell histiocytosis, presenting with extensive lymphadenopathies. Treatment in most cases of nodal disease, involves close observation; however, extranodal involvement requires a more definitive treatment strategy. Herein, we report a case of extensive Rosai Dorfman disease in a 43-year-old woman presenting for evaluation of treatment response by 18F-FDG PET/CT after frequent relapses and disease progression. In addition to extensive lymphadenothapies in cervical, supraclavicular, superior mediastinum, axillary, abdominopelvic and inguinofemoral regions, the patient had metabolically active bone and subcutaneous lesions which were not previously recognized. Following this 18F-FDG PET/CT study, the patient management was changed to sirolimus and prednisolone. To choose the best treatment option for Rosai Dorfman patients, knowledge of the full extent of disease is important. Compared with conventional imaging, 18F-FDG PET/CT has the advantage of being a whole-body imaging modality and can recognize disease involvement prior to any anatomical changes. [ABSTRACT FROM AUTHOR]

The extent of radiation exposure in emergency settings is not well documented; here, the corresponding effective dose (ED) is provided. In 500 patients admitted in row to the emergency department, ED was compared in patients according to complaints and their visiting physicians. Out of all, 220 patients aged 43.5 ± 22.2 years (admission: 2.0 ± 1.6 days) had at least an imaging. The main reasons for admission were trauma (10.5%) and then orthopedic problems (8.6%). EDs from CT and radiography were 1.66 ± 3.59 and 0.71 ± 1.67 mSv, respectively (from all 2.29 ± 4.12). Patients with abdominal (5.8 ± 5.2 mSv; p  < 0.002) and pelvic (12.0 ± 6.3 mSv; p  < 0.007) complaints received higher ED from CT and radiography and, also, patients visited by surgeons (7.94 ± 6.9 mSv). CT scan was the main source for ED to patients. Irrespective of the final diagnosis, patients with abdominopelvic complaints and those visited by surgeons are at higher exposure risk. [ABSTRACT FROM AUTHOR]

Multiple myeloma (MM) is a clonal B-lymphocyte neoplasm of terminally differentiated plasma cells. Imaging modalities which allow the recognition of the effects of myeloma cells on the skeletal system have been utilized for a long time. Herein, we represent a patient with generalized osteoporosis and hypercalcemia, who was referred for parathyroid scan, in whom the widespread bone marrow technetium-99m-methoxy-2-isobutylisonitrile (99mTc-MIBI) uptake suggested the presence of a bone marrow involving pathology, which turned out to be multiple myeloma on bone marrow biopsy. The current case report highlights the importance of 99mTc-MIBI scintigraphy, with a relatively low cost and better accessibility compared with other high sensitivity modalities such as PET-CT, to be used to demonstrate multiple myeloma bone marrow involvement, which could incline physicians to consider 99mTc-MIBI scintigraphy as a complementary diagnostic tool for multiple myeloma. [ABSTRACT FROM AUTHOR]

Objective(s): 68Ga-DOTATATE positron emission tomography (PET)/computed tomography (CT) has shown promising results in imaging of neural crest tumors (NCT). Herein, we compared the performance of 68Ga-DOTATATE PET/CT and 131IMIBG single photon emission computed tomography (SPECT)/CT in the initial diagnosis, staging and follow-up of patients with NCTs. Methods: Twenty-five patients (males:females=8:17; age range=2-71 years) with clinically proven or suspicious neuroblastoma, pheochromocytoma (PCC) or paraganglioma (PGL) were enrolled in this prospective study and underwent both 68Ga-DOTATATE PET/CT and 131I-MIBG SPECT/CT. A composite reference standard derived from histopathological information, together with anatomical and functional imaging findings, was used to validate the results. Imaging findings were assessed on a per-patient and on a per-lesion basis. Sensitivity and accuracy were assessed using McNemar's test. Results: Referring to radiological imaging and histopathological findings as reference standard, 68Ga-DOTATATE and 131I-MIBG scans showed a sensitivity and accuracy of (100%, 96%) and (86.7%, 88%), respectively, on a per-patient basis. In PCC/PGL patients, on a per-patient basis, the sensitivity of 68Ga-DOTATATE was 100% and that of 131I-MIBG was 77.8%. In neuroblastoma patients, on a per-patient basis, the sensitivities of both 68Ga-DOTATATE and 131I-MIBG were 100%. Overall, in this patient cohort, 68Ga-DOTATATE PET/CT identified 52 lesions and 131I-MIBG SPECT/CT identified only 30 lesions. On a per-lesion analysis, 68Ga-DOTATATE was found to be superior to 131I-MIBG in detecting lesions in all anatomical locations, particularly osseous lesions. According to the McNemar test results, differences were not statistically significant. Conclusion: This relatively small patient cohort suggests 68Ga-DOTATATE PET/CT be superior to 131I-MIBG SPECT/CT in providing particularly valuable information for both primary staging and follow-up in patients with NCT. [ABSTRACT FROM AUTHOR]

Introduction: Differentiated thyroid carcinoma (DTC) constitute approximately 90% of all thyroid tumors with an overall excellent prognosis. However, there is a small group of patients with a more aggressive form of disease, usually associated with certain poor prognostic factors. Using our large database of patients with DTC, the current study aims at identifying some of these factors. Methods: This retrospective study was based on the registry of patients with non-medullary thyroid carcinoma. Data were collected on the clinical, laboratory, and outcome characteristics of 501 patients followed at our department. Results: On multivariate analysis, the following variables were predictive of persistent disease: less than total thyroidectomy, residual disease on the post treatment whole body radioiodine scan (WBIS), higher received radioiodine activities, and higher levels of baseline stimulated thyroglobulin (Tg) and thyroid stimulating hormone (TSH). The greatest predictive value for the persistent/recurrent disease was attributed to the presence of residual disease on the post-treatment WBIS (odds ratio (OR): 33.72, 95% confidence interval (95% CI): 18.17-62.57), followed by type of surgical procedure (OR: 8.92, 95% CI: 2.90- 27.39), radioiodine ablation dose (OR: 4.03, 95% CI: 1.56-10.39), stimulated baseline Tg level (OR: 2.79, 95% CI: 1.53-5.08) and finally, the stimulated baseline TSH level (OR: 2.21, 95% CI: 1.08-4.519). Conclusion: In patients with DTCs, surgical procedures other than total thyroidectomy, presence of residual disease on the post-treatment WBIS, higher received radioiodine activities, higher baseline stimulated Tg and TSH levels are associated with a higher probability of having persistent disease and can be used in conjunction with other disease characteristics to reach proper decisions with regard to treatment and follow-up. [ABSTRACT FROM AUTHOR]

Objective(s): In view of somatostatin receptor (SSR) expression on cell membranes of the majority of neuroendocrine tumors (NETs), functional imaging exploiting analogs of SSR alongside the anatomical imaging is the mainstay of this diagnostic modality. In this prospective study, we assessed and directly compared the diagnostic parameters of 68Ga-DOTATATE PET/CT and 99mTc-Octreotide SPECT/CT, as well as CT/MRI. Methods: Twenty-five NET patients, either histologically proven or highly suspicious for NET, who were referred for Octreotide Scan were enrolled in this prospective study. They all underwent 99mTc-Octreotide SPECT/CT and then 68Ga-DOTATATE PET/CT. A blind interpretation was conducted for each imaging as well as for the previously obtained conventional imaging (CT or MRI). The patient-based and lesion-based analysis were conducted and the results of the three modalities were compared. The histopathologic confirmation or follow-up data were considered as the gold standard. Also, the impact of 68Ga-DOTATATE PET/CT on the patient's management was assessed. Results: Overall, 77 lesions in 14 patients, 135 in 19 and 86 in 16 were detected on 99mTc-Octreotide SPECT/CT, 68Ga-DOTATATE PET/CT and CT/MRI, respectively. On patient-based analysis, the sensitivity was 65%, 90% and 71% for 99mTc-Octreotide SPECT/CT, 68Ga-DOTATATE PET/CT and CT/MRI, respectively. Also, the specificity was 80%, 80% and 75% for 99mTc-Octreotide SPECT/CT, 68Ga-DOTATATE PET/CT and CT/MRI, respectively. The correlation between 68Ga-DOTATATE PET/CT and 99mTc-Octreotide SPECT/CT results was significant (P=0.02; kappa value=0.57), no correlation, however, was depicted with CI (P=0.07; kappa value=0.35). On lesionbased analysis, 68Ga-DOTATATE PET/CT found more organs (P=0.02) and lesions (P=0.001) in comparison with 99mTc-Octreotide SPECT/CT and also more lesions in comparison with CT/MRI (P=0.003). In addition, comparing with 99mTc-Octreotide SPECT/CT and CT/MRI, 68Ga-DOTATATE PET/CT revealed more data in 44% and 36% of the patients, resulting in management modification in 24% and 20%, respectively. Conclusion: Comparing with 99mTc-Octreotide SPECT/CT and CT/MRI, 68Ga- DOTATATE PET/CT provided more sensitivity and specificity in patients with NETs showing more involved organs as well as tumoral lesions. Also, 68Ga-DOTATATE PET/CT led to change of management in up to one-fourth of the patients, especially in a sub-group re-evaluated for recurrence. [ABSTRACT FROM AUTHOR]

Post-treatment or diagnostic whole-body radioiodine scintigraphy is widely used to assess the residual, recurrence, or metastases of differentiated thyroid carcinoma because of the high sensitivity and accuracy that this assessment provides. While bearing in mind all the diagnostic potential of this test, we have to consider its' potential pitfalls, as well. Herein, we present 4 patients with differentiated thyroid carcinoma, who received 131I for ablation therapy after having undergone total thyroidectomy. On post-treatment radioiodine scintigraphy, foci of unusual 131I uptake were noted in facial, axillary, inguinal, and renal regions, which were finally either histologically or anatomically diagnosed as papillary oncocytic cystadenoma, ectopic axillary breast tissue, epidydimal cyst, and simple renal cyst, respectively. Such 131I uptake patterns underscore the value of recognizing where and why false-positive uptakes take place and should appreciate the potential causes of falsepositive results in whole-body 131I scintigraphy. [ABSTRACT FROM AUTHOR]

Localization of 99mTc- hexakis-2-methoxyisobutylisonitrile (99mTc-MIBI) by parathyroid adenomas is well known, and this warrants MIBI scan to evaluate suspected parathyroid adenoma in primary hyperparathyroidism. Typically, the radionuclide concentrates in both the thyroid gland and parathyroid adenoma in early images, and later on delayed images washes out slowly from the parathyroid adenomas located in the neck or mediastinum, in comparison with more rapid wash out from the thyroid gland. We report a 71-year old woman with history of hypothyroidism, who has been on levothyroxine therapy for 5 years, and primary hyperparathyroidism, for which a double phase 99mTc-MIBI parathyroid scintigraphy was performed. Although the planar views demonstrated no evidence of radiotracer uptake in thyroid gland, single photon emission computed tomography/computed tomography (SPECT-CT) images revealed the presence of thyroid gland with a multinodular pattern on CT component of the study. Also planar images showed no focal uptake, but in SPECT-CT evaluation a MIBI-avid nodule was depicted in the posteromedial aspect of lower portion of left thyroid lobe, representing a parathyroid adenoma, later confirmed by pathology after surgical resection. The possible explanation for non-visualization of thyroid gland could be thyroid suppression with levothyroxine. [ABSTRACT FROM AUTHOR]

Introduction: The present study was aimed to assess the diagnostic performance of the two imaging methods of 131Imetaiodobenzylguanidine (131I-MIBG) and 99mTc-hydrazinonicotinyl-Tyr³-Octreotide (99mTc-HYNIC-TOC) in diagnosis and localization of pheochromocytoma and neuroblastoma. Methods: This study was conducted on 40 consecutive patients with positive pathological results for pheochromocytoma or neuroblastoma. The patients underwent both I-131 131I-MIBG and octreotide scintigraphies. By using the findings of cytopathology, biomarkers, imaging studies, as well as the results of a six-month follow-up, a composite reference standard (CRS) was defined as the diagnostic gold standard. Results: Overall comparison of these two agents revealed higher sensitivity for 131I-MIBG than octreotide study both in patient-based analysis (100% vs. 80.9%, respectively), and lesion-based analysis (94.4% vs. 80.56%, respectively). In pheochromocytoma 131I-MIBG and octreotide are both highly sensitive (100%), while 131I-MIBG is more specific (100% vs. 87.5%). In neuroblastoma, 131I-MIBG is more sensitive than octreotide (100% vs. 81.25%). Conclusion: Our study shows superiority of 131I-MIBG over octreotide scanning in detection of both neuroblastoma and pheochromocytoma lesions. However, a combination of these two diagnostic tools provides more complete information on the nature and the site of lesions. The first suggested study is 131I-MIBG scanning, and if it is not available, or detecting precise location of all lesions is of concern, octreotide scanning can be helpful as a complementary study. Furthermore, in case of octreotide positive lesions, follow-up can be performed with octreotide scan with less radiation burden. [ABSTRACT FROM AUTHOR]

Introduction: Myocardial perfusion imaging (MPI) is an important imaging modality in managing patients with cardiovascular disease. MPI has a significant role in diagnosis and management of cardiovascular disease; however it is subjected to different artifacts. Combining pharmacologic stress with submaximal exercise reduces side effects, improves image quality, and enhances the detection of ischemia, compared with suboptimal exercise or vasodilator stress alone. Methods: 97 patients (62 males and 35 females) which were randomly allocated into two groups were studied using gated single-photon emission computed tomography (SPECT) imaging. The patients were randomly allocated into two different groups: dipyridamole or dipyridamole combined with submaximal exercise group. Subsequently, they were imaged at 15, 60, 120, and 180 minutes after radiotracer injection. Results: 97 patients with an average age of 57.1 were compared 15, 60, 120 and 180 minutes after radiotracer injection. Comparing dipyridamole and dipyridamole submaximal exercise group a significant difference in target areas (myocardium, inferior and lateral wall) count ratio to both liver and colon count ratio was observed (P < 0.05) up to 120 min; However 180 minutes after the injection the difference between average count ratios of the myocardium to that of the visceral activity was only significant for the colon (P < 0.05). Conclusion: A protocol that combines submaximal exercise with dipyridamole stress is highly effective in improving the average count ratio of myocardial walls compared to visceral activity. [ABSTRACT FROM AUTHOR]

Introduction: In an ideal parallel-hole collimator, thickness of septal material should be sufficient to stop more than 95% of incident photons. However, some photons pass the septa without interaction or experience scattering before they reach the detector. In this study, we determined different contribution of collimator responses consist of geometrical response, septal penetration (SP) and scattering (SC) for low, medium and high energy collimators. Methods: A point source of activity with common energies in diagnostic nuclear medicine and three different collimators were simulated using SIMIND Monte Carlo code. Results: For Low Energy High Resolution (LEHR) collimator, SP was increased from 7% in 140 keV to 30% in 167keV and more than 75% in energies higher than 296keV. SC also was increased from 4% in 98keV to more than 15% in energies higher than 167keV and reached to its maximum (26%) in 296keV. For Medium Energy All Purpose (MEAP) collimator, SP was suddenly increased from 6% in 186keV to 28% for 296keV and more than 50% for higher energies. SC was also increased from 4% in energies below 186keV to 15% in 296keV and about 30% for higher energies. For High Energy (HE) collimator, SP was about 20% for 364keV photons. SC was 15% for 364keV photons and only 65% of photons were geometrically collimated. Conclusion: Our results showed that even by using nominally suitable collimators, there are considerable SC and SP that influence the quantitative accuracy of planar and SPECT images. The magnitude of geometrical response, SC and SP depend on collimator geometric structure and photons energy. [ABSTRACT FROM AUTHOR]

Introduction: Myocardial 18F-FDG uptake is highly variable in oncologic whole body 18F-FDG PET/CT studies, ranging from quite intense to minimal distribution. Intense or heterogeneous myocardial 18F-FDG uptake is undesirable as it may interfere with the visual or quantitative evaluation of tumoral invasion and metastases in pericardium, myocardium or adjacent mediastinal structures. The diet, as well as many other factors, is assumed to influence the myocardial 18F-FDG uptake. Using a multivariate model, we tried to identify and predict the main factors influencing cardiac 18F-FDG uptake in patients referred for oncologic PET/CT evaluation. Methods: A total of 214 patients referred for oncologic 18F-FDG PET/CT scan were enrolled in our study. Patients were randomly allocated into two groups according to the diet they were instructed to follow during 24-hour period before imaging. One hundred and seven cases with a routine diet (RD) and the same number of patients with a low carbohydrate, high fat (LCHF) diet were included. All patients were fast 6 hours before imaging. Weight, height, blood glucose, heart rate, systolic and diastolic blood pressure were measured before radiotracer injection. Visual and quantitative analysis were done after imaging and the pattern of 18F-FDG uptake, as well as standardized quantitative value of cardiac uptake was determined for each case. Results: The frequency of undesirable cardiac 18F-FDG uptake in the LCHF group was significantly less than RD group (17% vs. 72%, p<0.001). The univariate analyses showed male gender, BMI>=30 as well as consumption of cardiotoxic chemotherapeutic agents, benzodiazepines and β blockers were significantly associated with higher intensity of myocardial 18F-FDG uptake, while this undesirable finding was less evident in cases with diabetes mellitus. A multivariate logistic regression model including all of the mentioned variables revealed the diet was the only significant independent factor that predicted undesirable myocardial 18FFDG uptake (p<0.001). Conclusion: LCHF diet 24 hours before PET/CT imaging is the only controllable independent factor influencing the intensity and pattern of myocardial 18F-FDG uptake and is recommended as an optimal preparation to suppress cardiac 18F-FDG uptake. [ABSTRACT FROM AUTHOR]

Introduction: We evaluated the performance of muscle perfusion scan (MPS) to assess muscle perfusion reserve (MPR) for prediction of incident diabetic foot ulcerations (DFU). Methods: We recruited 41 diabetic patients without any history of DFU. Five mCi 99mTc-MIBI was injected intravenously during repetitive dorsal and plantar right foot flexions. Then posterior calves were imaged and the counts of the region of interests (ROI) over the right and left calves were collected. MPR was calculated as the percentage of counts of right calf ROI-counts of left calf ROI / counts of left calf ROI. Six patients did not complete the study, 3 of them due to technical errors. Patients were followed for possible occurrence of DFU for at least 12 months. Results: During the 563±84 (range: 309-633) days follow up period, 2 patients developed DFU (5.7%). MPR was insignificantly lower in patients who developed foot ulceration in comparison to those without foot ulceration (11.3±0.6% vs. 63.4±40.8%; p=0.08). The cutoff at first decile of MPR values (i.e. 16%) discriminated the patients with and without future DFU with accuracy of 92% (OR= 3; p-Value=0.005). Conclusion: MPS is useful to detect patients with diabetes at risk for future DFU. [ABSTRACT FROM AUTHOR]

Introduction: The external beam radiation therapy for patients with left breast cancer at the mastectomy site may cause myocardial perfusion abnormalities. We intended to study the change of these abnormalities at short and long term post radiotherapy follow up. Methods: Twenty patients with left and 20 patients with right breast cancer comprised the exposed and control groups, respectively. The patients had low risk for coronary disease. They underwent myocardial perfusion scans (MPS) 3 years after the external beam radiation therapy at the bed of modified radical mastectomy. These subjects were recruited from two bigger cohorts with previously reported data of scans at 6 months. The scans were acquired after injections of about 20 mCi MIBI at peak pharmacologic stress and at rest. The change of the perfusion abnormalities by both visual assessment and quantifications (Autoquant) at the baseline and 3 years follow up time are compared between exposed and control patients. Results: The exposed patients had more visual perfusion abnormality scores compared to control subjects (1.1±1.3 vs. 0.3±1.0; p=0.03). The indices of perfusion abnormality normalized in control subjects from baseline to follow up scans (p= 0.05 for summed difference score and p=0.04 for summed stress score). The difference of the perfusion abnormalities between the exposed and unexposed subjects remained unchanged along the 3 years of follow up. Conclusion: The radiation induced myocardial perfusion abnormalities in patients with left breast cancer could cause permanent coronary disease over time. [ABSTRACT FROM AUTHOR]

Introduction: Differentiated thyroid carcinoma (DTC) follow-up after thyroidectomy and radioiodine-ablation is performed mainly by thyroglobulin (Tg), diagnostic iodine-131 whole body scan (DxWBS) and sonography. Some patients with undetectable Tg have thyroid-bed uptake after ablation in whom decision making regarding the need for retreatment is still controversial. Methods: In this study, we enrolled DTC patients with undetectable Tg but small thyroid residue in six-month-DxWBS following first radioiodine-ablation. Patients with detectable Tg, high TgAb, suspicious neck lymphadenopathy in sonography and metastasis were excluded. Ninety four patients were placed in two groups of cohort, i.e., radioiodine-retreatment group (n=36) versus observation (untreated) group (n=58). After six months, the clinical outcome was compared by evaluating DxWBS, Tg, TgAb and sonography. Results: DxWBS showed sustained thyroid remnant in 47.2% of retreated patients while 34.5% of untreated group revealed negative DxWBS over the next period of follow-up. Also, only 6 cases (16.7%) in retreatment group and 12 cases (20.7%) in observation group revealed an additional finding other than local faint RAI uptake, including detectable serum Tg, rising TgAb or suspicious ultrasound finding, favoring no significant difference of the outcome as well as relative risk of new finding incidence between treated and untreated patients (CI 95% for relative risk: 0.58-2.41; p=0.630). Conclusion: Regarding sonologic and laboratory follow-up evidences, RAI-retreatment shows no significant advantage over observation in DTC patients with Tg negative, remnant positive DxWBS. In addition, residual thyroid tissue was completely disappeared in about one third of patients without retreatment. [ABSTRACT FROM AUTHOR]

Introduction: Peripheral Vascular Disease (PVD) is a major cause of morbidity and is associated with Coronary Artery Disease (CAD). We aimed to perform Lower Limb Perfusion Scan (LLPS) in patients referred for Myocardial Perfusion Imaging (MPI) and estimate prevalence of PVD in subgroups with normal and abnormal MPI results. We also compared quantitative indices of LLPS in patients with and without abnormal MPI results with semi-quantitative QPS indices. Methods: 120 patients referred for MPI entered the study. Exercise or dipyridamole infusion was used as stress modality. After 99mTc-MIBI injection at peak stress, whole body posterior views and planar images from thighs and calves were obtained. Gated MPI was done subsequently. Rest phase was performed the following day. LLPS was analyzed visually and quantitatively. Results: In patients with abnormal and normal MPI results, LLPS revealed 22.58% and 1.92% prevalence of PVD in exercise subgroup (P-Value=0.004) and 50.00% and 10.52% in dipyridamole subgroup (P-Value= 0.013), respectively. Both of these different prevalence were statistically significant. In exercise subgroup, mean ranks of Stress Index (Is) for all lower limb regions were statistically significantly greater in patients with normal MPI result. Also, among patients who had ischemia in exercise-rest MPI, negative correlations were seen between Is and Rest Index (Ir) of all regions and QPS quantitative indices. Conclusion: LLPS with 99mTc-MIBI, combined with MPI is a feasible method to detect lower limbs ischemia, especially in patients with abnormal MPI results. Correlating quantitative indices of LLPS with MPI-QPS also reflect coexistence of CAD and PVD. [ABSTRACT FROM AUTHOR]

Introduction: Differentiated thyroid carcinoma (DTC) is associated with excellent prognosis and high survival rates. This study was conducted to evaluate the influence of baseline and treatment-related factors on the health related quality of life (QoL) in cured DTC. Methods: This study was an analytic cross-sectional study on radio-iodine (RAI) treated DTC patients during 2011-2012. The data on patients' QoL were recorded using a validated EORTC QLQ-C30 version 3.0. Also a checklist was used to record demographic data as well as information about the educational, marital and economic status. Duration of follow up, frequency of RAI therapies and number of surgeries were also recorded. General linear model multivariate analysis of variances (GLM-MANOVA) was used to analyze the data. Results: Totally 435 DTC patients, 41.11±11.25 years, 77% female were assessed. Most of them were married (79%) and unemployed (57%). Global health and Qol as well as functional domains were better in women, single and higher educated patients. The QoL score in female cases was better in four functional subdomains, i.e physical, emotional, role and cognitive, but not for social functioning. QoL was adversely affected by increased number of radio-iodine therapies, radio-iodine cumulative doses and number of surgeries. Conclusion: We found that quality-of-life scores are affected by the majority of socio-economic, treatment and follow-up variables. Attention to the quality of life and well-being of the patient as well as availability of professional support may be important aspects of the DTC patients' treatment and follow-up. [ABSTRACT FROM AUTHOR]