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To investigate the predictors of contralateral hypertrophy in patients treated with unilobar transarterial radioembolization (TARE) with yttrium-90-loaded resin microspheres due to unresectable right-liver tumors.Patients who underwent right unilobar TARE with resin microspheres between May 2019 and September 2021 were screened retrospectively. Contralateral hypertrophy was evaluated by calculating the kinetic growth rate (KGR) in 8-10 weeks after TARE. The predictors of increased KGR were determined with linear regression analysis.A total of 24 patients (16 with primary and 8 with metastatic liver tumors) were included in the study. After right unilobar TARE, mean volume of the left lobe increased from 368.26 to 436.16 mL, while the mean volume of the right lobe decreased from 1576.22 to 1477.89 mL. The median KGR of the left lobe was 0.28% per week. The radiation dose absorbed by the healthy parenchyma of the right lobe was significantly higher in patients with increased KGR (31.62 vs. 18.78 Gy,Patients who received right unilobar TARE for liver malignancies could develop a substantial contralateral hypertrophy, and the radiation dose absorbed by the healthy parenchyma of the right lobe was significantly associated with increased KGR in the left lobe. TARE could have a role for inducing contralateral hypertrophy as it offers the advantage of concurrent local tumor control along with its hypertrophic effect.

Objectives This study investigates whether textural features (TFs) extracted from 18F-FDG positron emission tomography/computed tomography (PET/CT) are associated with immunohistochemical characteristics (IHCs) of invasive ductal breast carcinoma (IDBC). Materials and methods The relationship of TFs with IHCs [estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER-2), Ki-67 proliferation index, and histological grades] from solely excised primary tumors were evaluated for a more accurate assessment. Therefore patients with early-stage IDBC who underwent pre-operative 18F-FDG PET/CT scan for staging were included in this retrospective study. The clinical staging was performed according to the 8th edition of the American Joint Committee on Cancer. Maximum standardized uptake value (SUVmax) and 37 TFs of the primary tumor were extracted from 18F-FDG PET/CT. Spearman’s rank correlation test was used to evaluate the correlation between TFs and SUVmax. Receiver operating characteristic curves were generated to define the diagnostic performance of each parameter. Among these parameters, those with the highest diagnostic performance were included in the multivariate logistic regression model to identify the independent predictors of histopathological characteristics. Results A total of 124 patients were included. Histogram-uniformity, grey-level co-occurrence matrix (GLCM), GLCM-energy, and GLCM-homogeneity showed a strong negative correlation with SUVmax, while grey-level run-length matrix (GLRLM), GLRLM-SRHGE, grey-level zone length matrix (GLZLM), GLZLM-HGZE, GLRLM-HGRE, GLCM-entropy, GLCM-contrast, histogram-entropy, and GLCM-dissimilarity showed a strong positive correlation. Some of the TFs were independently associated with ER-negativity, PR-negativity, HER-2-positivity, and increased Ki-67 proliferation index (GLCM-contrast, GLZLM-GLNU, histogram-uniformity, and shape-sphericity respectively). While SUVmax had an independent association with high-grade and triple-negativity, GLZLM-SZLGE, a high-order TF that shows the distribution of the short homogeneous zones with low grey-levels, had an independent association with axillary lymph node metastasis. Conclusions ER-negative, PR-negative, HER-2-positive, triple-negative, high-grade, highly proliferative, and high-stage tumors were found to be more glycolytic and metabolically heterogeneous. These findings suggest that the use of TFs in addition to SUVmax may improve the prognostic value of 18F-FDG PET/CT in IDBC, as certain TFs were independently associated with many IHCs and predicted axillary lymph node involvement.

In patients with mechanical aortic and mitral valves and left ventricular (LV) tachycardia (VT), catheter ablation is technically challenging due to the limited access to the LV. Promising new alternatives to radiofrequency ablation include pulsed-field electroporation, percutaneous or surgical sympathetic neuromodulation, and noninvasive stereotactic radioablation therapy (SBRT). We herein describe the effect of SBRT as a bailout therapy on the management of a challenging VT case in the presence of double left-sided mechanical valves.

OBJECTIVE The aim of this study was to evaluate the relationship between volumetric parameters calculated using semiautomatic quantification of lesions detected in 68Ga-labeled prostate-specific membrane antigen PET-computed tomography (68Ga-PSMA PET/CT) and clinical characteristics in prostate cancer (PCa) patients with biochemical recurrence. METHODS A total of 85 consecutive PCa patients with biochemical recurrence who underwent 68Ga-PSMA PET/CT at our institution from January 2019 to March 2020 were retrospectively assessed. 68Ga-PSMA PET/CT-derived volumetric parameters, including whole-body PSMA tumor volume (wbPSMA-TV) and whole-body total lesion PSMA (wbTL-PSMA), as well as the established maximum and mean standardized uptake value (SUVmax and SUVmean), were calculated for each patient. All PET-derived parameters were analyzed for correlation with prostate-specific antigen (PSA) levels and for association with Gleason scores. RESULTS Eighty-five patients with a mean age of 68.9 ± 7.8 years (range, 47-83 years) and a mean PSA level of 40.9 ± 92.1 ng/ml (range, 0.2-533.2 ng/ml) were analyzed. Volumetric parameters, that is, wbPSMA-TV and wbTL-PSMA, demonstrated a statistically significant correlation with PSA levels (r = 0.403 and r = 0.556, respectively, all at P < 0.001) and only the means of wbTL-PSMA were significantly different between the Gleason score groups (P < 0.05). CONCLUSIONS The results of our study indicate that 68Ga-PSMA PET/CT might be a valuable tool for the detection and follow-up of recurrence in PCa patients. 68Ga-PSMA PET/CT-derived quantitative volumetric parameters demonstrated a highly significant correlation with changes in PSA levels. Larger prospective studies are needed to help reveal the full potential of parameters such as PSMA-TV and TL-PSMA derived from PET imaging with 68Ga-PSMA.

Background: Stereotactic body radioablation therapy (SBRT) has recently been introduced with the ability to provide ablative energy noninvasively to arrhythmogenic substrate while reducing damage to normal cardiac tissue nearby and minimizing patients' procedural risk. There is still debate regarding whether SBRT has a predominant effect in the early or late period after the procedure. We sought to assess the time course of SBRT's efficacy as well as the value of using a blanking period following a SBRT session.Methods: Eight patients (mean age 58 ±14 years) underwent eight SBRT sessions for refractory ventricular tachycardia (VT). SBRT was given using a linear accelerator device with a total dose of 25 Gy to the targeted area.Results: During a median follow-up of 8 months, all patients demonstrated VT recurrences, however, implantable cardioverter-defibrillator (ICD) therapies were significantly reduced with SBRT (8.46 to 0.83/per month, p=0.047; 18.50 to 3.29/per month, p=0.036, respectively). While analyzing the temporal SBRT outcomes, the two weeks to 3 months period demonstrated the most favorable outcomes. After 6 months, one patient was ICD therapy-free and the remaining patients demonstrated VT episodes. Conclusions: Our findings showed that the SBRT was associated with a marked reduction in the burden of VT and ICD interventions especially during first 3 months. Although SBRT doesn’t seem to succeed complete termination of VT in long-term period, our findings support the strategy that SBRT can be utilized for immediate antiarrhythmic palliation in critically ill patients with otherwise untreatable refractory VT and electrical storm.

To develop a nomogram based on commonly used clinical data for predicting the likelihood of metastasis in gallium-68 prostate-specific membrane antigen PET/computed tomography (Ga-68 PSMA PET/CT) scans of prostate cancer patients with confirmed biochemical recurrence (BCR).One-hundred thirty-five ( n = 135) patients who underwent Ga-68 PSMA PET/CT due to BCR were included in the study. Predictors of metastasis in Ga-68 PSMA PET/CT were determined with multivariable logistic regression analysis. Coefficients derived from the regression model were used to develop a prediction nomogram. The performance of the prediction model was evaluated with receiver operating characteristic analysis. Internal validation was performed with 50 bootstrap resamples, and the nomogram's clinical benefit was assessed with decision curve analysis.Multivariable logistic regression analysis revealed that ISUP group, prostate-specific antigen (PSA) before PET and PSA doubling time were independent predictors of metastasis in Ga-68 PSMA PET/CT. A prediction nomogram was developed according to this model [the area under curve: 0.866; 95% confidence interval (CI), 0.788-0.944]. The best cutoff value of the nomogram-derived likelihood for predicting metastasis was 60%, with a bootstrap-corrected accuracy of 78.8%. An online version of the nomogram was implemented on pro-gram.nzm.co ( https://pro-gram.nzm.co ).The proposed nomogram provides a practical approach for predicting the likelihood of imaging-based metastasis according to Ga-68 PSMA PET/CT in patients with BCR, with results ≥60% being the most accurate cutoff for referring patients to Ga-68 PSMA PET/CT. If validated in a larger cohort, this tool can serve as a guide for the appropriate use of Ga-68 PSMA PET/CT.

Aim Gastric carcinoma is one of the most frequent cancers and leading causes of cancer-related death worldwide. Treatment strategies are planned according to the Tumour-Node-Metastasis (TNM) stage of the disease. However, the prognosis varies substantially even within the same stage. Prognostic nomograms were designed to overcome this diversity. In this study, staging systems and prognostic tools are compared in the context of their ability to predict patients' prognosis. Methods Records of 391 patients operated for gastric cancer from January 2006 to September 2013 were analysed retrospectively. TNM staging system, Metastatic lymph node ratio (LNR), Kattan Prognostic Tool and Prognostic Tool of Italian Research Group on Gastric Cancer (GIRCG) were compared with the patients' survival times by their concordance indices and correlation coefficients. Results A total of 343 patients were included in the study. Concordance indices of the compared staging systems were 0.678 for TNM, 0.601 for GIRCG scale, 0.646 for LNR stage and 0.680 for Kattan scale. Pearson correlation coefficients were 0.404 for TNM staging, 0.314 for GIRCG scale, 0.304 for LNR stage and -0.406 for Kattan scale. Spearman correlation coefficients were 0.383, 0.311, 0.310 and -0.400 respectively. Conclusion Based on these results, Kattan prognostic scale was found to be the most accurate system for predicting mortality. This was followed by TNM staging system.

Background Several countries have increasingly focused on improving care for acute myocardial infarction (AMI), heart failure (HF), and pneumonia to reduce their readmissions and mortality rates. Frailty is becoming increasingly important to accurately predict healthcare utilization for the aging population. The preferred method for the measurement of frailty remains unclear, and current risk-adjustment models do not account for frailty. We sought to compare commonly used frailty indices in terms of the ability to predict clinical adverse outcomes in AMI, HF, and pneumonia patients. Methods A nationwide cohort study included AMI, HF, and pneumonia with 65 years and older patients in the Turkey between January 1 and December 31, 2018. The primary predictor of interest was frailty. We used two claims-based frailty indices (Johns Hopkins Claims-Based Frailty Index and Hospital Frailty Risk Score) to assess frailty. The main outcome was all-cause long-term mortality up to 3 years. Time to death was calculated as the time period between the date of first admission and the date of death. Patients were censored as of September 30, 2020, which marked the end of the follow-up period. Findings Of the 200,948 patients, 35,096 (17.5%) had AMI, 62,403 (31.1%) had HF, and 103,449 (51.5%) had pneumonia. Johns Hopkins Claims-Based Frailty Index (c-statistics for long-term mortality: 0.68 in AMI, 0.61 in HF, 0.64 in pneumonia) was better compared to Hospital Frailty Risk Score (c-statistics for long-term mortality: AMI=0.62, HF=0.58, pneumonia=0.62) (DeLong p Interpretation Readmission and mortality rates after AMI, HF, and pneumonia gradually increases with increasing frailty score. While the Hospital Frailty Risk Score had a better discrimination for predicting readmissions, Johns Hopkins Claims-Based Frailty Index had a better discrimination for predicting mortality. These findings should be taken into account for a better evaluation of hospital performance. Funding This study was supported by funding from The Scientific and Technological Research Council of Turkey (grant 120S422, HK).

Objective The aim of this study was to evaluate the accuracy of technetium- 99m-methoxyisobutylisonitrile (Tc-MIBI) single-photon emission computed tomography/computed tomography (SPECT/CT) and ultrasound in preoperative localization of single parathyroid adenomas (PTAs) in patients with primary hyperparathyroidism (pHPT) who would be suitable for minimally invasive parathyroidectomy (MIP). Methods A retrospective study of 143 consecutive patients with biochemical evidence of hyperparathyroidism who underwent preoperative localization of parathyroid lesions using Tc-MIBI SPECT/CT and ultrasound, and proceeded to parathyroid surgery at our institution from January 2013 to January 2018. Of these, 125 had single adenomas and are the subject of this study. The sensitivity, positive predictive value (PPV) and accuracy of the two imaging techniques for the accurately identification and lateralization of PTAs were determined using histopathology as the criterion standard. Results Of 125 PTAs, the correct identification and lateralization were significantly higher by SPECT/CT than ultrasound. SPECT/CT and ultrasound detected lesions with histopathologically proven PTAs in 116 and 95 patients, respectively. The sensitivity, PPV and accuracy were 92.17, 94.64 and 87.60%, respectively, for SPECT/CT and 75.89, 90.43 and 70.25%, respectively, for ultrasound in lateralization analysis. Conclusions The results of our study indicate that Tc-MIBI SPECT/CT is more accurate than ultrasound for the preoperative identification of single PTAs in patients with pHPT who are candidates for MIP.

Purpose We sought to investigate the performance of radiomics analysis on baseline 18F-FDG PET/CT for predicting response to first-line chemotherapy in diffuse large B-cell lymphoma (DLBCL). Material and methods Forty-five patients who received first-line rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) chemotherapy for DLBCL were included in the study. Radiomics features and standard uptake value (SUV)-based measurements were extracted from baseline PET images for a total of 147 lesions. The selection of the most relevant features was made using the recursive feature elimination algorithm. A machine-learning model was trained using the logistic regression classifier with cross-validation to predict treatment response. The independent predictors of incomplete response were evaluated with multivariable regression analysis. Results A total of 14 textural features were selected by the recursive elimination algorithm, achieving a feature-to-lesion ratio of 1:10. The accuracy and area under the receiver operating characteristic curve of the model for predicting incomplete response were 0.87 and 0.81, respectively. Multivariable analysis revealed that SUVmax and gray level co-occurrence matrix dissimilarity were independent predictors of lesions with incomplete response to first-line R-CHOP chemotherapy. Conclusion Increased textural heterogeneity in baseline PET images was found to be associated with incomplete response in DLBCL.

In this study, we aimed to investigate the effects of chronic sleep deprivation on mucociliary clearance, which is the primary defence mechanism of the upper airway tract and nasal mucosal histology. Forty-two Wistar Albino rats (250-300 g), 8 or 12 weeks old, were randomly assigned into three groups as follows. The first sleep-deprivation group consisted of 14 rats (A), another 14 of them were assigned to platform group (B), and the remaining 14 were included to the home cage control group (C). For the two deprivation groups (A and B), the modified multiple platform method (MMPM) was used to induce sleep deprivation for 21 days. Tc-99m MAA rhinoscintigraphy was performed to assess mucociliary clearance and the nasal histopathological changes of the sacrificed rats were also examined. Mucociliary clearance was significantly higher in sleep deprivation (A) and deprivation control (B) groups than the control group (C) (p = .037). The ratio of columnar ciliary was significantly higher in group A and B than in the control group (p = .003). The transitional epithelial ratio in groups A and B was also significantly increased compared with group C (p = .04). The control group's squamous epithelial ratio was increased compared to the sleep-deprived groups (p = .003). There was a significantly increased inflammatory response in the ciliated columnar epithelium in groups A and B compared to group C (p = .02). For the first time in the literature, we demonstrated that chronic sleep deprivation has caused a significant increase in mucociliary clearance speed and in the number of ciliary cells.

OBJECTıVES: This study investigates whether textural features (TFs) extracted fromThe relationship of TFs with IHCs [estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER-2), Ki-67 proliferation index, and histological grades] from solely excised primary tumors were evaluated for a more accurate assessment. Therefore patients with early-stage IDBC who underwent pre-operativeA total of 124 patients were included. Histogram-uniformity, grey-level co-occurrence matrix (GLCM), GLCM-energy, and GLCM-homogeneity showed a strong negative correlation with SUVmax, while grey-level run-length matrix (GLRLM), GLRLM-SRHGE, grey-level zone length matrix (GLZLM), GLZLM-HGZE, GLRLM-HGRE, GLCM-entropy, GLCM-contrast, histogram-entropy, and GLCM-dissimilarity showed a strong positive correlation. Some of the TFs were independently associated with ER-negativity, PR-negativity, HER-2-positivity, and increased Ki-67 proliferation index (GLCM-contrast, GLZLM-GLNU, histogram-uniformity, and shape-sphericity respectively). While SUVmax had an independent association with high-grade and triple-negativity, GLZLM-SZLGE, a high-order TF that shows the distribution of the short homogeneous zones with low grey-levels, had an independent association with axillary lymph node metastasis.ER-negative, PR-negative, HER-2-positive, triple-negative, high-grade, highly proliferative, and high-stage tumors were found to be more glycolytic and metabolically heterogeneous. These findings suggest that the use of TFs in addition to SUVmax may improve the prognostic value of

Hypertrophic pulmonary osteoarthropathy (HPOA) is a paraneoplastic manifestation of gastric and, more frequently, lung carcinomas. It is characterized by extremity pain, clubbing, arthritis and periostitis of the long bones. Periostitis is the hallmark of HPOA and can be revealed with bone scintigraphy. Whole-body bone scintigraphy (WBBS) is very sensitive during the active lesion period and WBBS findings usually precede that of plain radiography. WBBS can also show improvement in the first 6 months following treatment, thus making it an important technique in the management and follow-up of these patients. While HPOA findings are usually seen in the lower extremities, involvement of both upper and lower extremities is a rare condition. In this case report, it is aimed to present findings of a 67-year-old male patient with lung cancer and complaint of extremity pain. We report on this patient to draw attention to HPOA of both upper and lower extremities.Hipertrofik pulmoner osteoartopati (HPOA), mide ve özellikle akciğer kanserlerinde görülebilen bir paraneoplastik sendromdur. Çomak parmak, artrit, ekstremite ağrısı ve uzun kemiklerde periostit ile karakterizedir. Periostit HPOA’nın ayırıcı bulgularındandır ve sintigrafi ile gösterilebilir. Sintigrafik bulgular çoğunlukla radyolojik bulgulardan önce ortaya çıkar. Tüm vücut kemik sintigrafisi (TVKS) aktif lezyon döneminde oldukça duyarlıdır. TVKS ile tedavi sonrası ilk 6 ayda bulgularda gerileme gösterilebilir. Dolayısıyla TVKS, bu hastaların tanı ve takibinde önemli bir yer tutar. HPOA bulguları çoğunlukla alt ekstremitede görülür; hem üst hem alt ekstremite tutulumu nadir görülen bir durumdur. Bu olgu takdimi, ekstremite ağrısı ile başvuran akciğer kanseri hastalarında, hem alt hem üst ekstremitede nadiren görülen HPOA tablosuna dikkat çekmek amacıyla sunulmaktadır.

Stress fractures are injuries most commonly seen in the lower limbs and are usually caused by repetitive stress. While the distal and middle third of the tibia is the most frequent site for stress fractures (almost 50%), stress fractures of the proximal tibia is relatively rare and could be confused with other types of tibial fractures, thus altering management plans for the clinician. Early diagnosis of stress fractures is also important to avoid complications. Imaging plays an important role in the diagnosis of stress fractures, especially bone scan. Combined with single-photon emission computed tomography/computed tomography (SPECT/CT) it is an important imaging technique for stress fractures in both upper and lower extremities, and is widely preferred over other imaging techniques. In this case, we present the case of a 39-year-old male patient diagnosed with stress fracture of the proximal tibia and demonstrate the contribution of CT scan fused with SPECT imaging in the early diagnosis of stress fracture prior to other imaging modalities.Stres kırıkları çoğunlukla alt ekstremitede görülen ve genellikle tekrarlayan strese bağlı gelişen yaralanmalardır. Tibia orta kesimi ve distali stres kırıklarının en sık görüldüğü bölgeler iken (yaklaşık %50), proksimal tibianın stres kırıkları nispeten nadirdir, diğer kırık türleriyle karıştırılabilir ve bu durum klinisyenin tedavi planını etkileyebilir. Stres kırıklarının erken tanısı komplikasyonları önlemek açısından önemlidir. Görüntüleme yöntemleri, stres kırıklarının teşhisinde önemli bir rol oynamaktadır. Özellikle tek-foton emisyon bilgisayarlı tomografi/bilgisayarlı tomografi (SPECT/BT) ile birleştirilen kemik sintigrafisi hem üst hem de alt ekstremite stres kırıkları için önemli bir görüntüleme tekniğidir ve diğer görüntüleme tekniklerine göre çok daha fazla tercih edilmektedir. Bu yazıda proksimal tibiada stres kırığı tanısı alan 39 yaşındaki bir erkek hastanın hikayesini sunuyor ve stres kırığının erken tanısında SPECT/BT taramasının katkısını gösteriyoruz. Anahtar kelimeler: Stres kırığı, proksimal tibia, kemik sintigrafisi, tek-foton emisyonlu bilgisayarlı tomografi/bilgisayarlı tomografi.