Mehrshad Abbasi

Background: Pulmonary metastases from breast carcinoma typically present as multiple solid nodules or diffuse lung involvement. Cavitary pulmonary metastases are uncommon, especially when appearing as a solitary lesion, and may closely resemble infectious or primary cavitary lung diseases. These atypical radiologic presentations pose significant diagnostic challenges and can delay appropriate treatment.Case Presentation: We report the case of a 49-year-old woman with a history of right breast invasive ductal carcinoma diagnosed approximately nine years earlier. Her tumor was estrogen receptor-positive, progesterone receptor-positive, and HER2-negative. Initial treatment included lumpectomy, chemoradiotherapy, and endocrine therapy with tamoxifen. She presented with a persistent cough, and chest CT revealed a solitary thick-walled cavitary lesion in the right lower lung lobe. Bronchoscopy showed no endobronchial abnormalities, and bronchoalveolar lavage was negative for both malignancy and infection. Due to ongoing suspicion, a CT-guided transthoracic biopsy was performed, confirming metastatic carcinoma consistent with breast primary. This case highlights a rare instance of solitary cavitary pulmonary metastasis occurring several years after the initial treatment.Conclusion: Solitary cavitary pulmonary metastasis from hormone receptor-positive breast carcinoma is an exceptionally rare phenomenon that can mimic infectious or primary lung malignancies. Persistent cavitary lung lesions in patients with a prior history of breast cancer warrant thorough evaluation and tissue diagnosis, even after extended disease-free periods.

Purpose: To evaluate the effects of radioactive iodine (RAI) ablation after radiofrequency ablation (RFA) in patients with recurrent papillary thyroid carcinoma (PTC). Material and methods: We conducted a retrospective cohort study involving 60 patients with documented cervical lymph node (LN) recurrent PTC. All RFA procedures were performed using the “pulling-back, moving-shot” approach under local anaesthesia. LN volume reduction ratio (VRR), thyroglobulin, and complications were analysed 6 and 12 months after RFA. This study comprised two distinct groups of patients: one group that received a combination of RFA and RAI ablation, and another group that underwent RFA alone (30 cases in each group). Results: The mean age of patients was 39.8 ± 10.5 years, 68% of whom were women. VRR of LNs was significant at 6 months and 12 months after RFA (87.4% and 91.9%, respectively, p < 0.001). Serum thyroglobulin level decreased after 12 months (2.7 ± 5.9 to 0.6 ± 1.8, p = 0.021). Post-RFA complication was noted in one patient with transient hoarseness. Ten new recurrent LNs were reported in 9 patients (15%) during follow-up. No benefit was detected for the RAI treatment at the end of 12 months of follow-up in terms of structural or biochemical recurrence. Based on the non-randomised retrospective study design, this comparison is descriptive in nature and cannot be used to make any causal inference regarding the effectiveness of adjuvant RAI. Conclusions: RFA has been shown to be effective in achieving volume reduction with a high success rate of 97% and with minimal complications. There was no additional benefit of adjuvant RAI. However, this result cannot be used to make any inference regarding the effectiveness of RAI due to confounding by indication. A prospective randomised trial is needed.

Background: The main goal of this pilot trial was to investigate the efficacy of botulinum toxin (Dysport) injection before radiotherapy in preserving salivary gland secretion in patients with head and neck cancer. Methods: Sixteen patients with head and neck cancer were enrolled, 9 received 50 IU Dysport, and 7 recieved NaCl (0.9%) into the submandibular glands before chemo‐radiotherapy. To investigate the salivary gland function, technetium pertechnetate salivary gland scintigraphy, as well as saliva accumulation and the University of Washington Quality of Life (UW‐QoL) Questionnaire were utilized “before” and “6 months after the end” of radiotherapy. Results: Sixteen patients were randomized (9 botulinum toxin, 7 placebo). Baseline characteristics were comparable between groups. At 6 months post‐radiotherapy, basal saliva volume was higher in the botulinum toxin group (median 5.0 cc vs. 2.0 cc; p < 0.001) as was stimulated saliva volume (6.0 cc vs. 2.0 cc; p < 0.001). UW‐QoL scores were significantly lower, indicating better quality of life, in the botulinum toxin group (37.0 vs. 67.0; p < 0.001). Covariate‐adjusted analyses confirmed botulinum toxin as the only significant predictor of saliva preservation and improved QoL. Conclusion: A single injection of botulinum toxin before radiotherapy preserves salivary gland function and improves quality of life. Based on these findings, we advocate for a multicenter Phase II trial to define the optimal dose–response relationship and determine the ideal timing for injection relative to the start of radiotherapy.

Lung resection surgeries, including lobectomy and pneumonectomy, are cornerstone treatments for lung cancer and other severe pulmonary conditions. Despite

In this study, the response to treatment in patients with extra-thyroid extension (ETE) of papillary thyroid cancer (PTC) was compared between different radioiodine treatment doses.In this retrospective cross-sectional study, patients with pathology-proven ETE who were hospitalized for radioiodine therapy from December 2015 to May 2018 at a referral university hospital were identified. Demographic data, radioiodine doses, and off-levothyroxine thyroglobulin and antithyroglobulin levels, before and after treatment, were collected. Alterations in thyroglobulin levels before and after treatment were compared between patients receiving different doses of radioiodine.Sixty patients were analyzed (mean age: 44.1 ± 14.4 years; 61.7% females). On average, the thyroglobulin levels were 59.1 ± 92.0 and 45.7 ± 81.5 ng/mL at baseline and after treatment, respectively. The thyroglobulin levels decreased from 6.2 ± 6.3 to 1.7 ± 0.2 ng/mL (p = 0.510), 55.8 ± 101.3 to 11.5 ± 17.2 ng/mL (p = 0.07), and 62.8 ± 91 to 60.9 ± 93.1 ng/mL (p = 0.83) in the 100- to 149-, 150- to 199-, and 200- to 250-mCi iodine therapy groups, respectively. Treatment with doses of less than 200 mCi were significantly more effective in reducing posttreatment thyroglobulin levels compared with higher doses (p = 0.05). In the subgroup analysis, nonmetastatic cases treated with less than 200 mCi iodine had significantly greater thyroglobulin reduction compared with metastatic patients treated with ≥200 mCi iodine (p = 0.05). Macroscopic (vs. microscopic) invasion into adjacent tissues had no impact on thyroglobulin decrease.The administration of higher radioiodine doses for the treatment of PTC patients with ETE does not yield additional therapeutic benefits in terms of posttreatment thyroglobulin reduction.

Objective. Modeling of the collimator-detector response (CDR) in single photon emission computed tomography (SPECT) reconstruction enables improved resolution and accuracy, and is thus important for quantitative imaging applications such as dosimetry. The implementation of CDR modeling, however, can become a computational bottleneck when there are substantial components of septal penetration and scatter in the acquired data, since a direct convolution-based approach requires large 2D kernels. This work proposes a 1D convolution and rotation-based CDR model that reduces reconstruction times but maintains consistency with models that employ 2D convolutions. To enable open-source development and use of these models in image reconstruction, we release a SPECTPSFToolbox repository for the PyTomography project on GitHub. Approach. A 1D/rotation-based CDR model was formulated and subsequently fit to Monte Carlo (MC) point source data representative of ¹⁷⁷Lu, ¹³¹I, and ²²⁵Ac imaging. Computation times of (i) the proposed 1D/rotation-based model and (ii) a traditional model that uses 2D convolutions were compared for typical SPECT matrix sizes. Both CDR models were then used in the reconstruction of MC, physical phantom, and patient data; the models were compared by quantifying total counts in hot regions of interest (ROIs) and activity contrast between hot ROIs and background regions. Results. For typical matrix sizes in SPECT reconstruction, application of the 1D/rotation-based model provides a two-fold computational speed-up over the 2D model when running on GPU. Only small differences between the 1D/rotation-based and 2D models (order of 1%) were obtained for count and contrast quantification in select ROIs. Significance. A technique for CDR modeling in SPECT was proposed that (i) significantly speeds up reconstruction times, and (ii) yields nearly identical reconstructions to traditional 2D convolution based CDR techniques. The released toolbox will permit open-source development of similar models for different isotopes and collimators.

Purpose Evaluating the impact of radioiodine therapy (RIT) on olfactory function in thyroid cancer patients through quantitative and qualitative olfactory tests. Method In this cohort study, patients with thyroid cancer were included. Demographic, clinical, and laboratory data were collected. To subjectively evaluate the olfactory changes aftter RIT, the Visual Analog Scale (VAS), Self-Reported Mini-Olfactory Questionnaire (self-MOQ), and the University of Washington Quality of Life Questionnaire (UW-QOL) were assessed. Out of UW-QOL questions those related to saliva, taste, and overall health condition were analysed. For objective assessment, patients underwent both the Butanol Threshold Test (BTT) and the a version of Smell Identification Test (SIT). Patients were assessed before, one month, and six months after RIT. Results Ninety eight patients were included (Male = 17). A statistically significant decrement was observed in olfaction based on the VAS, between the baseline and one (pvalue = 0.015) and six months (pvalue = 0.031) of follow-up. Additionally, saliva (pvalue = 0.001), taste (pvalue = 0.000), and overall health condition (pvalue = 0.010) significantly decreased one-month after RIT. The measures were not different between the baseline and 6-month follow up and the improvement of index of taste was significant from 1-month to 6-months follow ups (pvalue = 0.000). However, none of the objective tests (the BTT and the SIT) indicated a significant decline in olfaction during the follow up. Conclusion A subjective RIT related decrease in smell function, taste, and saliva production was documented without any objective olfactory dysfunction.

Segmentation of organs and lesions could be employed for the express purpose of dosimetry in nuclear medicine, assisted image interpretations, and mass image processing studies. Deep leaning created liver and liver lesion segmentation on clinical 3D MRI data has not been fully addressed in previous experiments. To this end, the required data were collected from 128 patients, including their T1w and T2w MRI images, and ground truth labels of the liver and liver lesions were generated. The collection of 110 T1w-T2w MRI image sets was divided, with 94 designated for training and 16 for validation. Furthermore, 18 more datasets were separately allocated for use as hold-out test datasets. The T1w and T2w MRI images were preprocessed into a two-channel format so that they were used as inputs to the deep learning model based on the Isensee 2017 network. To calculate the final Dice coefficient of the network performance on test datasets, the binary average of T1w and T2w predicted images was used. The deep learning model could segment all 18 test cases, with an average Dice coefficient of 88% for the liver and 53% for the liver tumor. Liver segmentation was carried out with rather a high accuracy; this could be achieved for liver dosimetry during systemic or selective radiation therapies as well as for attenuation correction in PET/MRI scanners. Nevertheless, the delineation of liver lesions was not optimal; therefore, tumor detection was not practical by the proposed method on clinical data.