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This study aimed to determine the most important perfusion score in patient selection for coronary angiography (CA) by quantitatively evaluating myocardial perfusion scintigraphy (MPS).Patients who underwent MPS single-photon emission computerized tomography/computed tomograph imaging in our clinic between December 2017 and January 2019, without coronary artery disease (CAD) history, followed by CA were included in the study. CA was considered positive when there is a stenosis of 70% or more in at least one coronary vessel. The summed stress score, rest score, and differential score; total perfusion deficit (TPD); and the defect's extent obtained from non-attenuation-corrected (NC) and attenuation-corrected (AC) images of 80 patients were evaluated using the Mann-Whitney U test. A p value of0.05 was considered significant. Receiver operating characteristic (ROC) analysis was performed.The scores obtained from NC and AC images showed a significant difference between the two groups for all scores except for the extent and TPD scores at rest from AC images. The applied ROC curves' highest diagnostic value was determined as the TPD score at stress (TPDS) obtained from NC images (area under the curve: 0.880, 95% confidence interval, 0.807-0.952, p0.001). The cut-off value obtained for the TPDS from the ROC curve was found to be 5.5.The scores obtained from NC images have more power to detect CAD than those obtained from AC images. Patients with no prior CAD history with TPDS score higher than 5 in MPS should be referred for CA with priority.Bu çalışmada miyokard perfüzyon sintigrafisinin (MPS) kantitatif değerlendirilmesiyle koroner anjiyografi (KAG) yapılacak hastalarının seçiminde en önemli perfüzyon skorunun belirlenmesi amaçlandı.Aralık 2017-Ocak 2019 tarihleri arasında kliniğimizde MPS tek foton emisyon tomografisi/bilgisayarlı tomografi (SPECT/BT) görüntüleme uygulanan ve daha önce koroner arter hastalığı (KAH) tanısı bulunmayan ve MPS sonrası KAG yapılan hastalar çalışmaya dahil edildi. KAG sonucunda en az bir koroner damarda %70 veya daha fazla darlık izlenen hastalar koroner arter darlığı (KAD) açısından pozitif kabul edildi. Seksen hastanın atenüasyon düzeltilmemiş (NC) ve SPECT/BT ile atenüasyon düzeltilmiş (AC) görüntülerden elde edilen toplam stres skoru, toplam rest skoru, toplam perfüzyon bozukluğu ve extent puanları Mann-Whitney U testi ile değerlendirildi. P0,05 değeri anlamlı kabul edildi. Alıcı işlem karakteristikleri (ROC) analizi yapıldı.NC ve AC görüntülerinden elde edilen skorlar, ExtentRac ve TPDRac dışındaki tüm skorlar için iki grup arasında anlamlı fark görüldü. ROC eğrilerindeki en yüksek tanı değeri NC görüntülerinden elde edilen TPDS değeri olarak belirlendi (eğrinin altında kalan alan: 0,880, %95 güven aralığı, 0,807-0,952, p0,001). TPDS için ROC eğrisinden elde edilen kesim değeri 5,5 olarak bulundu.NC görüntülerden elde edilen skorların AC görüntülerden elde edilen skorlara göre daha fazla KAD saptama gücü vardır. Daha önceden bilinen KAH olmayan ve MPS’de TPDS skoru 5’in üzerinde olan hastalar KAG’ye öncelikli olarak yönlendirilmelidir.

The aim of this study was to evaluate the metastatic potential of primary tumor and survival in esophageal cancer (EC) patients by using metabolic tumor volume (MTV) and total lesion glycolysis (TLG) from the stagingMedical records of EC patients were retrospectively evaluated. Sixty-two patients with stagingSignificant factors on survival were determined as lymph node or distant metastasis (p=0.024, 0.008, respectively) at the staging PET/CT. A significant relationship between volumetric parameters of the primary tumor and total tumor burden (MTVp, TLGp, MTVwb and TLGwb) between survivors and non-survivors for one-year and five-year was detected. In receiver operating characteristics analysis, the most significant volumetric parameter was MTVwb, with area under curve 0.771 in estimated five-year survival. The best cut-off value was detected as 36.1 mL with 78% sensitivity and 75% specificity for MTVwb in determining long-term survivors.Tumor burden inBu çalışmanın amacı evrelemeÖK tanılı hastaların tıbbi kayıtları geriye dönük olarak değerlendirildi. Evreleme anındaSağkalım üzerinde önemli faktörler evreleme PET/BT’de lenf nodu veya uzak metastaz bulunması (sırasıyla; p=0,024, 0,008) olarak belirlendi. Primer tümörün volümetrik parametreleri ile toplam tümör yükü (MTVp, TLGp, MTVwb ve TLGwb) arasında, bir yıl ve beş yılda sağ kalanlar ve ölenler arasında anlamlı bir ilişki tespit edildi. Alıcı işlem karakteristikleri analizinde, beş yıllık sağkalımı tahmin etmede en önemli hacimsel parametre eğrinin altındaki alan 0,771 ile MTVwb idi. Uzun süreli sağ kalanların belirlenmesinde MTVwb için en iyi kesim değeri %78 duyarlılık ve %75 özgüllük ile 36,1 mL olarak tespit edildi.ÖK’li hastaların evreleme anındaki

The aim of this study was to investigate the relationship between volumetric data obtained from staging 68Ga-prostate-specific membrane antigen (PSMA) PET computerized tomography (CT) images with prostate-specific antigen (PSA), risk groups, Gleason Grade (GG) groups and presence of metastasis.We performed a retrospective analysis of 68Ga-PSMA PET-CT images from 88 patients undergoing initial staging of prostate adenocarcinoma between January 2015 and September 2018. Images were evaluated in LIFEx software; PSMA involvement above the background activity in prostate gland, lymph node and other distant metastases was plotted with 40% SUVmax threshold, SUVmax, PSMA tumor volume (PSMA-TV) and total lesion PSMA (TL-PSMA) values were obtained.In all patients, there was a moderate correlation between PSA and PSMA-tumor volume whole-body (PSMA-TVwb) (P0.001, r = 0.580) and a high correlation between total lesion-PSMAwb (TL-PSMAwb) (P0.001, r = 0.636). Prostate PSMA-TV (PSMA-TVp) and TL-PSMA (PSMA-TVp) values were different in local and locally advanced/metastatic patients (P = 0.020 and 0.006, respectively). PSMA-TVp and TL-PSMAp values were significantly different in low-moderate and high-risk patients (P = 0.003 and0.001, respectively), and in patients with and without metastasis (P = 0.008 and0.001, respectively). PSMA-TVp, PSMA-TVwb, TL-PSMAp and TL-PSMAwb values were significantly different in patients with GG ≤3 and3 (P = 0.030, 0.002,0.001 and0.001, respectively).Pretreatment 68Ga-PSMA PET/CT volumetric parameters provides unique data to use in the clinical decision-making process of patients with adenocarcinoma of the prostate.

Objective The aim of this study was to assess the interreader agreement in evaluation 68Ga-prostate-specific membrane antigen (PSMA) PET/CT according to three current criteria European association of nuclear medicine, PROMISE with miTNM, and PSMA-RADS in newly diagnosed prostate cancer (PC) patients. Methods The images of 101 patients who had been diagnosed with PC and underwent Ga-68-PSMA PET/CT at the time of initial staging were evaluated according to the three interpretation criteria by two nuclear medicine specialists. Local tumor, pelvic lymph node metastasis and distant metastasis were evaluated separately. Abdominal lymph nodes, bone and visceral organ metastases were additionally evaluated as subregions of distant metastatic sites. Patients were evaluated in subgroups Gleason score >= 8 or prostate-specific antigen >= 20 ng/mL as the high-risk group (HR) and prostate-specific antigen

Objective This study evaluates the ability of several machine learning (ML) algorithms, developed using volumetric and texture data extracted from baseline F-18-FDG PET/CT studies performed initial staging of patient with esophageal cancer (EC), to predict survival and histopathology. Methods The initial staging F-18-FDG PET/CT images obtained on newly diagnosed EC patients between January 2008 and June 2019 were evaluated using LIFEx software. A region of interest (ROI) of the primary tumor was created and volumetric and textural features were obtained. A significant relationship between these features and pathological subtypes, 1-year, and 5-year survival was investigated. Due to the nonhomogeneity of the data, nonparametric test (The Mann-Whitney U test) was used for each feature, in pairwise comparisons of independent variables. A p value of < 0.05 was considered significant. Receiver operating curve (ROC) analysis was performed for features with p < 0.05. Correlation between the significant features was evaluated with Spearman correlation test; features with correlation coefficient < 0.8 were evaluated with several ML algorithms. Results In predicting survival in a 1-year follow-up J48 was obtained as the most successful algorithm (AUC: 0.581, PRC: 0.565, MCC: 0.258, acc: 64.29%). 5-year survival results were more promising than 1-year survival results with (AUC: 0.820, PRC: 0.860, MCC: 271, acc: 81.36%) by logistic regression. It is revealed that the most successful algorithm was naive bayes (AUC: 0.680 PRC: 0.776, MCC: 0.298, acc: 82.66%) in the histopathological discrimination. Conclusion Texture analysis with ML algorithms could be predictive of overall survival and discriminating histopathological subtypes of EC.

Endokrin sistem hastaliklarinin bir kismini olusturan ve Tibbi Onkoloji ve Endokrinoloji bolumlerinin ortak konulari olan Endokrin Sistem Tumorleri suphesiz multidisipliner yaklasim gerektiren malign hastaliklarin icerisinde yer almakta ve gunluk pratigimizde azimsanmayacak siklikta rastlanilmakta ve ozel tedavi yaklasimlari gerektirmektedir. Bu bilgiler dogrultusunda onkolojinin ozel konularindan olan ENDOKRIN SISTEM TUMORLERI konulu bu kitabimizi ulkemizin alaninda uzman ve akademik vizyonu olan hocalarimizin katkilariyla hazirladik. Emegi gecen hocalarimiza teker teker davetimi kirmayip verdikleri destek icin tesekkur ediyorum. Ayrica Onkoloji alaninda yayimladigimiz ve yayimlamayi planladigimiz kitaplarin hazirlanmasinda emegi gecen ve her an yanimizda olan basta Akademisyen Yayinevi sahibi Yasin DILMEN olmak uzere tum yayinevi calisanlarina da tesekkur ederim.

Purpose The aim of this study was to evaluate the ability of(18)F-FDG PET/CT texture analysis to predict the exact pathological outcome of thyroid incidentalomas. Methods F-18-FDG PET/CT images between March 2010 and September 2018 were retrospectively reviewed in patients with focal(18)F-FDG uptake in the thyroid gland and who underwent fine needle aspiration biopsy from this area. The focal uptake in the thyroid gland was drawn in 3D with 40% SUVmax threshold. Features were extracted from volume of interest (VOI) using the LIFEx package. The features obtained were compared in benign and malignant groups, and statistically significant variables were evaluated by receiver operating curve (ROC) analysis. The correlation between the variables with area under curve (AUC) value over 0.7 was examined; variables with correlation coefficient less than 0.6 were evaluated with machine learning algorithms. Results Sixty patients (70% train set, 30% test set) were included in the study. In univariate analysis, a statistically significant difference was observed in 6 conventional parameters, 5 first-, and 16 second-order features between benign and malignant groups in train set (p < 0.05). The feature with the highest benign-malignant discriminating power was GLRLM(RLNU)(AUC:0.827). AUC value of SUVmax was calculated as 0.758. GLRLM(RLNU)and SUVmax were evaluated to build a model to predict the exact pathology outcome. Random forest algorithm showed the best accuracy and AUC (78.6% and 0.849, respectively). Conclusion In the differentiation of benign-malignant thyroid incidentalomas, GLRLM(RLNU)and SUVmax combination may be more useful than SUVmax to predict the outcome.

Objective The aim of this study was to assess the value of baseline 18F-FDG PET/CT in predicting the response to neoadjuvant chemo-radiotherapy (NCRT) in patients with locally advanced rectal cancer (LARC) via the volumetric and texture data obtained from 18F-FDG PET/CT images. Methods In total, 110 patients who had undergone NCRT after initial PET/CT and followed by surgical resection were included in this study. Patients were divided into two groups randomly as a train set (n: 88) and test set (n: 22). Pathological response using three-point tumor regression grade (TRG) and metastatic lymph nodes in PET/CT images were determined. TRG1 were accepted as responders and TRG2-3 as non-responders. Region of interest for the primary tumors was drawn and volumetric features (metabolic tumor volume (MTV) and total lesion glycolysis (TLG)) and texture features were calculated. In train set, the relationship between these features and TRG was investigated with Mann-WhitneyUtest. Receiver operating curve analysis was performed for features withp < 0.05. Correlation between features were evaluated with Spearman correlation test, features with correlation coefficient < 0.8 were evaluated with the logistic regression analysis for creating a model. The model obtained was tested with a test set that has not been used in modeling before. Results In train set 32 (36.4%) patients were responders. The rate of visually detected metastatic lymph node at baseline PET/CT was higher in non-responders than responders (71.4% and 46.9%, respectively,p = 0.022). There was a statistically significant difference between TLG, MTV, SHAPE_compacity, NGLDMcoarseness, GLRLM_GLNU, GLRLM_RLNU, GLZLM_LZHGE and GLZLM_GLNU between responders and non-responders. MTV and NGLDMcoarseness demonstrated the most significance (p = 0.011). A multivariate logistic regression analysis that included MTV, coarseness, GLZLM_LZHGE and lymph node metastasis was performed. Multivariate analysis demonstrated MTV and lymph node metastasis were the most meaningful parameters. The model's AUC was calculated as 0.714 (p = 0.001,0.606-0.822, 95% CI). In test set, AUC was determined 0.838 (p = 0.008,0.671-1.000, 95% CI) in discriminating non-responders. Conclusions Although there were points where textural features were found to be significant, multivariate analysis revealed no diagnostic superiority over MTV in predicting treatment response. In this study, it was thought higher MTV value and metastatic lymph nodes in PET/CT images could be a predictor of low treatment response in patients with LARC.

PURPOSE: The aim of this study was to evaluate the ability of (18)F-FDG PET/CT texture analysis to predict the exact pathological outcome of thyroid incidentalomas. METHODS: (18)F-FDG PET/CT images between March 2010 and September 2018 were retrospectively reviewed in patients with focal (18)F-FDG uptake in the thyroid gland and who underwent fine needle aspiration biopsy from this area. The focal uptake in the thyroid gland was drawn in 3D with 40% SUVmax threshold. Features were extracted from volume of interest (VOI) using the LIFEx package. The features obtained were compared in benign and malignant groups, and statistically significant variables were evaluated by receiver operating curve (ROC) analysis. The correlation between the variables with area under curve (AUC) value over 0.7 was examined; variables with correlation coefficient less than 0.6 were evaluated with machine learning algorithms. RESULTS: Sixty patients (70% train set, 30% test set) were included in the study. In univariate analysis, a statistically significant difference was observed in 6 conventional parameters, 5 first-, and 16 second-order features between benign and malignant groups in train set (p

Objective: Myocardial perfusion scintigraphy (MPS) is a diagnostic test which is frequently used in the diagnosis of coronary heart disease (CHD). MPS is generally interpreted as ischemia present or absent; however, it has a power in predicting the disease, similar to other diagnostic tests. In this study, we aimed to assist in directing the high-risk patients to undergo coronary angiography (CA) primarily by evaluating patients without prior CHD history with pre-test and post-test probabilities. Methods: The study was designed as a retrospective study. Between January 2008 and July 2011, 139 patients with positive MPS results and followed by CA recently (