scholarly journals Secondary Hyperthyroidism due to an Ectopic Thyrotropin-Secreting Neuroendocrine Pituitary Tumor: A Case Report

2020 ◽  
Vol 9 (2) ◽  
pp. 106-112
Author(s):  
Christian Trummer ◽  
Hannes Reiher ◽  
Verena Theiler-Schwetz ◽  
Marlene Pandis ◽  
Christian Gstettner ◽  
...  
Keyword(s):  
Pituitary Tumors ◽  
Somatostatin Analogues ◽  
Tracer Uptake ◽  
Diagnostic Process ◽  
Care Hospital ◽  
Biochemical Tests ◽  
Free Triiodothyronine ◽  
Case Presentation ◽  
Pet Ct ◽  
Negative Imaging

Introduction: The main differential diagnoses of secondary hyperthyroidism include thyrotropin-secreting neuroendocrine pituitary tumors (TSH-PitNETs) and resistance to thyroid hormone. As a rare cause of secondary hyperthyroidism, ectopic thyrotropin-producing neuroendocrine pituitary tumors must also be considered. Case Presentation: A 48-year-old female patient with overt hyperthyroidism and elevated thyrotropin was admitted to the endocrine outpatient clinic of a secondary care hospital in March 2018. The patient had an inconspicuous pituitary MRI and F18-F-DOPA PET-CT, but showed a tumor mass located at the pharyngeal roof. Most biochemical tests and an increased tracer uptake of the pharyngeal mass in a Ga68-DOTANOC PET-CT argued for the presence of an ectopic TSH-PitNET. After treatment with octreotide over 5 days and a consecutive normalization of free thyroxine and free triiodothyronine, the tumor was endoscopically resected. Histologically, the mass consisted of small partially spindle, partially polygonal monomorphic to mildly pleomorphic cells with immunoreactivity for thyrotropin and luteinizing hormone. Postoperatively, the patient required intermittent levothyroxine therapy. Discussion and Conclusions: Ectopic TSH-PitNETs represent an extremely rare cause for secondary hyperthyroidism. While the diagnostic process may be complicated by negative imaging studies of the pituitary gland, family history, biochemical tests, and functional imaging using gallium-labelled somatostatin analogues may be helpful in establishing the diagnosis.

Accuracy of 18F-FDG PET/CT in patients with the suspicion of cardiac implantable electronic device infections: good for pocket, not so good for endocarditis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Jeronimo Baza ◽  
C Olmos ◽  
I Vilacosta ◽  
A Ortega-Candil ◽  
C Rodriguez-Rey ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Tertiary Care ◽  
Negative Likelihood Ratio ◽  
Blood Cultures ◽  
Diagnostic Process ◽  
Care Hospital ◽  
Pet Ct ◽  
18F Fdg ◽  
Good For ◽  
Fdg Pet Ct

Abstract Introduction The usefulness of 18F-FDG PET/CT in the diagnosis of infective endocarditis (IE) associated with cardiac implantable electronic devices (CIED) is not well established. Purpose To assess the diagnostic yield of 18F-FDG PET/CT in patients with suspected CIED infections, placing special emphasis on differentiating between pocket infection (PI) and CIED-IE. Methods From 2013 to 2018, all patients (n=63) admitted to a tertiary care hospital with suspected CIED infection were prospectively recruited, undergoing a thorough diagnostic work-up that included blood cultures extraction, transthoracic (TTE) and transoesophageal echocardiography (TEE) and a PET/CT. When device explantation was required, material from the pocket, generator and leads were also cultured. The gold standard for the diagnosis of CIED-IE was a positive lead culture in the absence of PI when percutaneous extraction was performed or a positive culture from a surgically removed lead. In spite of negative lead cultures, the presence of typical TEE images of vegetations in a clinical context of positive blood cultures was also considered as CIED-IE. Results After the whole diagnostic process, 14 (22.2%) cases corresponded to isolated PI and 13 (20.6%) were categorized as CIED-IE. Considering radionuclide uptake in the intracardiac portion of the lead, values of sensitivity, specificity and global diagnostic accuracy of PET/CT for CIED-IE were 38.5%, 98.0% and 85.7%, respectively. Positive and negative likelihood ratio values, 19.2 and 0.6 respectively, suggest that a positive PET/CT is much more probable to correspond to a patient with CIED-IE, whereas it is not possible to exclude this diagnosis in case of a negative result. In the case of PI, fair sensitivity (72.2%) and good specificity values (95.6%) were obtained. Extracardiac lead SUVmax and SUVratio in PI were good, with an area under the ROC curve (AUC) of 0.870 and 0.879, respectively. However, semiquantitative analysis was not useful for the diagnosis of CIED-IE. Conclusions In patients with suspected CIED infection, the yield of 18F-FDG PET/CT differs depending on the site of infection, showing a very high specificity but poor sensitivity in CIED-IE; so negative studies must be interpreted with caution if the suspicion of CIED-IE is high. ROC curves SUVmax and SUV ratio for PI Funding Acknowledgement Type of funding source: None

scholarly journals Dosimetry and optimal scan time of [18F]SiTATE-PET/CT in patients with neuroendocrine tumours

2021 ◽  
Author(s):  
Leonie Beyer ◽  
Astrid Gosewisch ◽  
Simon Lindner ◽  
Friederike Völter ◽  
Lena M. Mittlmeier ◽  
...  
Keyword(s):  
Image Quality ◽  
Effective Dose ◽  
Neuroendocrine Tumours ◽  
Clinical Performance ◽  
Somatostatin Receptors ◽  
Somatostatin Analogues ◽  
Tracer Uptake ◽  
Visual Evaluation ◽  
Scan Time ◽  
Pet Ct

Abstract Purpose Radiolabelled somatostatin analogues targeting somatostatin receptors (SSR) are well established for combined positron emission tomography/computer tomography (PET/CT) imaging of neuroendocrine tumours (NET). [18F]SiTATE has recently been introduced showing high image quality, promising clinical performance and improved logistics compared to the clinical reference standard 68Ga-DOTA-TOC. Here we present the first dosimetry and optimal scan time analysis. Methods Eight NET patients received a [18F]SiTATE-PET/CT (250 ± 66 MBq) with repeated emission scans (10, 30, 60, 120, 180 min after injection). Biodistribution in normal organs and SSR-positive tumour uptake were assessed. Dosimetry estimates for risk organs were determined using a combined linear-monoexponential model, and by applying 18F S-values and reference target masses for the ICRP89 adult male or female (OLINDA 2.0). Tumour-to-background ratios were compared quantitatively and visually between different scan times. Results After 1 h, normal organs showed similar tracer uptake with only negligible changes until 3 h post-injection. In contrast, tracer uptake by tumours increased progressively for almost all types of metastases, thus increasing tumour-to-background ratios over time. Dosimetry resulted in a total effective dose of 0.015 ± 0.004 mSv/MBq. Visual evaluation revealed no clinically relevant discrepancies between later scan times, but image quality was rated highest in 60 and 120 min images. Conclusion [18F]SiTATE-PET/CT in NET shows overall high tumour-to-background ratios from 60 to 180 min after injection and an effective dose comparable to 68Ga-labelled alternatives. For clinical use of [18F]SiTATE, the best compromise between image quality and tumour-to-background contrast is reached at 120 min, followed by 60 min after injection.

Comparison of Fluorine(18)-fluorodeoxyglucose and Gallium(68)-citrate PET/CT in patients with tuberculosis

2019 ◽  
Vol 58 (05) ◽  
pp. 371-378
Author(s):  
Alfred O. Ankrah ◽  
Ismaheel O. Lawal ◽  
Tebatso M.G. Boshomane ◽  
Hans C. Klein ◽  
Thomas Ebenhan ◽  
...  
Keyword(s):  
Tracer Uptake ◽  
Pet Ct ◽  
The Mean ◽  
18F Fdg ◽  
Definition Of ◽  
Gallium 68 ◽  
Attending Physician ◽  
Pet Scans ◽  
The Brain

Abstract 18F-FDG and 68Ga-citrate PET/CT have both been shown to be useful in the management of tuberculosis (TB). We compared the abnormal PET findings of 18F-FDG- and 68Ga-citrate-PET/CT in patients with TB. Methods Patients with TB on anti-TB therapy were included. Patients had a set of PET scans consisting of both 18F-FDG and 68Ga-citrate. Abnormal lesions were identified, and the two sets of scans were compared. The scan findings were correlated to the clinical data as provided by the attending physician. Results 46 PET/CT scans were performed in 18 patients, 11 (61 %) were female, and the mean age was 35.7 ± 13.5 years. Five patients also had both studies for follow-up reasons during the use of anti-TB therapy. Thirteen patients were co-infected with HIV. 18F-FDG detected more lesions than 68Ga-citrate (261 vs. 166, p < 0.0001). 68Ga-citrate showed a better definition of intracerebral lesions due to the absence of tracer uptake in the brain. The mean SUVmax was higher for 18F-FDG compared to 68Ga-citrate (5.73 vs. 3.01, p < 0.0001). We found a significant correlation between the SUVmax of lesions that were determined by both tracers (r = 0.4968, p < 0.0001). Conclusion Preliminary data shows 18F-FDG-PET detects more abnormal lesions in TB compared to 68Ga-citrate. However, 68Ga-citrate has better lesion definition in the brain and is therefore especially useful when intracranial TB is suspected.

Computerized Tomography (CT) Updates and Challenges in Diagnosis of Bone Metastases During Prostate Cancer

2020 ◽  
Vol 16 (5) ◽  
pp. 565-571
Author(s):  
Jinguo Zhang ◽  
Guanzhong Zhai ◽  
Bin Yang ◽  
Zhenhe Liu
Keyword(s):  
Prostate Cancer ◽  
Computed Tomography ◽  
Bone Metastases ◽  
Computerized Tomography ◽  
Single Photon ◽  
Photon Emission ◽  
Major Complication ◽  
Tracer Uptake ◽  
Emission Computed Tomography ◽  
Pet Ct

Prostate cancer is one of the most common cancers in men. This cancer is often associated with indolent tumors with little or no lethal potential. Some of the patients with aggressive prostate cancer have increased morbidity and early deaths. A major complication in advanced prostate cancer is bone metastasis that mainly results in pain, pathological fractures, and compression of spinal nerves. These complications in turn cause severe pain radiating to the extremities and possibly sensory as well as motor disturbances. Further, in patients with a high risk of metastases, treatment is limited to palliative therapies. Therefore, accurate methods for the detection of bone metastases are essential. Technical advances such as single-photon emission computed tomography/ computed tomography (SPECT/CT) have emerged after the introduction of bone scans. These advanced methods allow tomographic image acquisition and help in attenuation correction with anatomical co-localization. The use of positron emission tomography/CT (PET/CT) scanners is also on the rise. These PET scanners are mainly utilized with 18F-sodium-fluoride (NaF), in order to visualize the skeleton and possible changes. Moreover, NaF PET/CT is associated with higher tracer uptake, increased target-to-background ratio and has a higher spatial resolution. However, these newer technologies have not been adopted in clinical guidelines due to lack of definite evidence in support of their use in bone metastases cases. The present review article is focused on current perspectives and challenges of computerized tomography (CT) applications in cases of bone metastases during prostate cancer.

scholarly journals Head-to-head intra-individual comparison of biodistribution and tumor uptake of 68Ga-FAPI and 18F-FDG PET/CT in cancer patients

2021 ◽  
Author(s):  
Frederik L. Giesel ◽  
Clemens Kratochwil ◽  
Joel Schlittenhardt ◽  
Katharina Dendl ◽  
Matthias Eiber ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Standard Of Care ◽  
Blood Pool ◽  
Tracer Uptake ◽  
Time Interval ◽  
Tumor Uptake ◽  
Primary Tumors ◽  
Individual Comparison ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract Purpose FAPI ligands (fibroblast activation protein inhibitor), a novel class of radiotracers for PET/CT imaging, demonstrated in previous studies rapid and high tumor uptake. The purpose of this study is the head-to-head intra-individual comparison of 68Ga-FAPI versus standard-of-care 18F-FDG in PET/CT in organ biodistribution and tumor uptake in patients with various cancers. Material and Methods This international retrospective multicenter analysis included PET/CT data from 71 patients from 6 centers who underwent both 68Ga-FAPI and 18F-FDG PET/CT within a median time interval of 10 days (range 1–89 days). Volumes of interest (VOIs) were manually drawn in normal organs and tumor lesions to quantify tracer uptake by SUVmax and SUVmean. Furthermore, tumor-to-background ratios (TBR) were generated (SUVmax tumor/ SUVmax organ). Results A total of 71 patients were studied of, which 28 were female and 43 male (median age 60). In 41 of 71 patients, the primary tumor was present. Forty-three of 71 patients exhibited 162 metastatic lesions. 68Ga-FAPI uptake in primary tumors and metastases was comparable to 18F-FDG in most cases. The SUVmax was significantly lower for 68Ga-FAPI than 18F-FDG in background tissues such as the brain, oral mucosa, myocardium, blood pool, liver, pancreas, and colon. Thus, 68Ga-FAPI TBRs were significantly higher than 18F-FDG TBRs in some sites, including liver and bone metastases. Conclusion Quantitative tumor uptake is comparable between 68Ga-FAPI and 18F-FDG, but lower background uptake in most normal organs results in equal or higher TBRs for 68Ga-FAPI. Thus, 68Ga-FAPI PET/CT may yield improved diagnostic information in various cancers and especially in tumor locations with high physiological 18F-FDG uptake.

scholarly journals The Dependence of Renal 68Ga[Ga]-DOTATOC Uptake on Kidney Function and Its Relevance for Peptide Receptor Radionuclide Therapy with 177Lu[Lu]-DOTATOC

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1216
Author(s):  
Falk Gühne ◽  
Alexander Heinzig ◽  
Philipp Seifert ◽  
Robert Drescher ◽  
Martin Freesmeyer
Keyword(s):  
Kidney Function ◽  
Specific Binding ◽  
Correlation Coefficients ◽  
Inverse Correlation ◽  
Peptide Receptor Radionuclide Therapy ◽  
Tracer Uptake ◽  
Significant Inverse Correlation ◽  
Peptide Receptor ◽  
Pet Ct ◽  
Induced Changes

Background: In addition to its SSTR-specific binding in tumors and healthy tissues, DOTATOC analogues accumulate in kidney parenchyma. Renal tracer uptake might be a surrogate of kidney function or dysfunction. This study aimed to evaluate if kidney function can be estimated from 68Ga[Ga]-DOTATOC uptake in PET/CT and its impact on the nephrotoxicity of 177Lu[Lu]-DOTATOC PRRT. Methods: Two cohorts of patients (A: 128 diagnostic patients; B: 32 PRRT patients) were evaluated retrospectively. SUV values of the kidneys, physiologically SSTR-expressing organs and in background compartments were assessed. Kidney function was calculated as eGFR by CKD-EPI creatinine equation. Pearson’s correlation coefficients and treatment-induced changes of uptake and kidney function were assessed and compared. Results: Kidney function and renal DOTATOC uptake showed a significant inverse correlation (R2 = 0.037; p = 0.029). Evaluated models of PET/CT measurements were not able to predict kidney function sufficiently. The uptake of other organs did not depend on eGFR. While the renal uptake increased after PRRT (p < 0.001), the kidney function did not change significantly (p = 0.382). Neither low pre-therapeutic eGFR nor high pre-therapeutic kidney uptake were risk factors of PRRT-induced deterioration in kidney function. Conclusion: The relevance of kidney function for renal 68Ga[Ga]-DOTATOC uptake is limited. The nephrotoxicity of 177Lu[Lu]-DOTATOC PRRT might be low and cannot be reliably predicted by pre-therapeutic measurements.

Complementary imaging of ultrasound and PET/CT: A new opportunity?

2021 ◽  
pp. 1-16
Author(s):  
Janine Rennert ◽  
Jirka Grosse ◽  
Ingo Einspieler ◽  
Wolf Bäumler ◽  
Christian Stroszczynski ◽  
...  
Keyword(s):  
High Resolution ◽  
Soft Tissue ◽  
Therapeutic Approach ◽  
Tissue Characterization ◽  
Tumor Detection ◽  
Tracer Uptake ◽  
Liver Lesions ◽  
Definite Diagnosis ◽  
Renal Lesions ◽  
Pet Ct

AIM: To evaluate the effectiveness of complementary imaging of high-resolution ultrasound including CEUS with PET/CT for tissue characterization and tumor detection. MATERIAL AND METHODS: 100 patients were examined with PET/CT and US/CEUS between January 2018 until February 2020. All patients underwent PET/CT followed by selective US/CEUS within 4 weeks. Comparison regarding concordant or diverging findings in PET/CT and US. Analysis of the differences concerning the lesions number of found by PET/CT and US/CEUS or the possibility of a secured diagnosis following ultrasound causing therapeutic changes. RESULTS: Diverging findings regarding the number of liver lesions in PET/CT and CEUS were found in 35 out of 64 patients (54%). Regarding renal lesions, a more definite diagnosis following ultrasound, causing a change of therapeutic approach, was achieved in 89%. Concordant results in PET/CT and US were found in 83%of patients with splenic and nodal findings. In 78%of patients with increased musculoskeletal or soft tissue tracer uptake, US was able to make a secured diagnosis with therapeutic changes. CONCLUSION: The present results indicate a strong benefit of complementary imaging of PET/CT and selective, high-resolution ultrasound especially in patients with liver, renal and musculoskeletal or soft tissue findings.

scholarly journals Antibiotic Susceptibility Pattern of Nosocomial Isolates of Staphylococcus aureus in a Tertiary Care Hospital, Nepal

2009 ◽  
Vol 48 (175) ◽  
Author(s):  
Bidya Shrestha ◽  
B M Pokhrel ◽  
T M Mohapatra
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Tertiary Care ◽  
Test Method ◽  
University Teaching ◽  
Clinical Samples ◽  
Resistance Pattern ◽  
Care Hospital ◽  
Biochemical Tests ◽  
Methicillin Resistant

Introduction: Methicillin resistant Staphylococcus aureus (MRSA), the most common cause ofnosocomial infection has been a major cause of morbidity and mortality around the world. They arenormally resistant to most of the antibiotics used in clinical practice. This study has been carried outto fi nd out the resistance pattern among S. aureus.Methods: During November 2007 to June 2008, clinical samples from patients with nosocomialinfection were processed for culture and sensitivity following standard methodology in microbiologylaboratory, Tribhuvan University teaching hospital, Kathmandu, Nepal.Results: Among 149 Staphylococcus aureus isolates, highest resistance was observed against Penicillin(91.94%) followed by Fluoroquinolone (61.74%), Erythromycin (52.94%), Gentamicin (46.98%),Cotrimoxazole (42.95%), Tetracycline (40.94%) and others, whereas susceptibility was observedmaximum against Chloramphenicol (94.85%) followed by Rifampicin (92.61%), Tetracycline(59.06%), Cotrimoxazole (57.04%), and others. None of the isolates were resistant to Vancomycinand Teicoplanin. Of these isolates 44.96 % of the isolates were Methicillin resistant S. aureus (MRSA).Resistance to Penicillin, Fluoroquinolone, Erythromycin, Gentamicin, Co-trimoxazole and Tetracyclinewere associated signifi cantly with MRSA isolates (X2= 8.779, p<0.05, X2= 74.233, p<0.05, X2= 84.2842,p<0.05, X2= 108.2032, p<0.05, X2= 88.1512, p<0.05 and X2= 79.1876, p<0.05 respectively). Althoughmost of the Methicillin sensitive S. aureus (MSSA) isolates were susceptible to both Rifampicinand Chloramphenicol, only Rifampicin susceptibility was signifi cantly associated with them (X2=10.1299, p<0.05). Among three Biochemical tests for the detection of β lactamase detection namelychromogenic, iodometric and acidimetric test, chromogenic test method had highest sensitivity andspecifi city.Conclusions: Since MRSA comprised a greater part of S. aureus isolates and were multi-resistant,patients infected by such strains should be identifi ed and kept in isolation for hospital infectioncontrol and treated with second line of drug like vancomycin.Key Words: β lactamase, methicillin resistant Staphylococcus aureus,methicillin sensitive Staphylococcus aureus, resistance pattern

scholarly journals Pituitary Macroadenoma Manifesting As Acromegaly: A Case Report

2021 ◽  
Vol 3 (1) ◽  
pp. 07-11
Author(s):  
Dian Primadia Putri ◽  
Brama Ihsan Sazli
Keyword(s):  
Brain Mri ◽  
Pituitary Tumors ◽  
Serum Levels ◽  
High Serum ◽  
Pituitary Macroadenoma ◽  
Case Presentation ◽  
Clinical Disorder ◽  
Comprehensive Management ◽  
Management Plans ◽  
Chief Complaints

Background: Acromegaly is an uncommon clinical disorder driven by high serum levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1). Over 99% of patients with acromegaly harbor a GH emitting pituitary adenoma. Pituitary tumors represent about 15% of essential intracranial neoplasms. Case presentation: A 38 years old woman, was referred to the H. Adam Malik central public hospital on December 15th, 2020, with chief complaints of enlarged fingers and toes. The patient complained that the patient's fingers and toes were getting bigger in the past 2 years. The brain MRI was performed showed intrasella spherical intensity lesions measuring ± 2.3x1.5x2 cm with the impression of macroadenoma. The patient later diagnosed with acromegaly due to pituitary macroadenoma. Therefore the patient was treated with administration of sandostatin injection, novorapid 6-6-6 IU SC, then 0-0-12 IU SC, 3x1 salt capsules. The patient is also consulted to the neurosurgery department for surgical management plans and a consulted to the Ophthalmology Department. Conclusion: We report an instance of acromegaly suspected because of pituitary macroadenoma in a patient with unmistakable clinical highlights, with comprehensive management.

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