Effect of melatonin on low and high dose radiotherapy induced thyroid injury

We investigated the radioprotective effect of melatonin (MEL) against thyroid gland damage in rats caused by flattening filter (FF) and flattening filter free (FFF) single dose X-ray beams. We used 48 female rats divided into six groups of eight: group 1, untreated control group; group 2, MEL treated group; group 3, FF-low dose rate radiotherapy (FF-LDR) group; group 4, FF-LDR + MEL group; group 5, FFF-high dose rate radiotherapy (FFF-HDR) group; group 6, FFF-HDR + MEL group. Groups 2, 4 and 6 rats were injected intraperitoneally (i.p.) with 10 mg/kg MEL 15 min before exposure to radiation. The head and neck regions of each rat in groups 3 and 5 and groups 4 and 6 were irradiated with 16 Gy at 6 MV X-ray in FF and FFF beam modes. The histopathology of the thyroid gland and salient biochemical parameters were assessed in all rats 10 days after radiotherapy. We found increased inflammation, vacuolization, degradation, swelling and necrosis, and M30 apoptosis and M65 necrosis indicators in groups 3 and 5 compared to group 1; however, we found significant reductions in histopathological and biochemical parameters following application of MEL. MEL treatment before FF-LDR and FFF-HDR radiotherapy minimized thyroid gland injury due to irradiation.

Evaluation of diffuse lymphadenopathy via various quantitative PET/CT parameters

OBJECTIVE

Discovery of diffuse lymphadenopathy (DLAP) in fluorine-18-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) imaging alerts for the existence of many pathologic conditions with severity ranging from benign to malignancy. This study examines the role of various metabolic parameters reflecting ¹⁸F-FDG characteristics of organs/tissues to reach an accurate differential diagnosis for further clinical assessment.

MATERIALS AND METHODS

Positron emission tomography/CT images of 78 patients with DLAP were reviewed retrospectively. The diameter of the largest lymph node (DLlyn), maximum standardized uptake value (SUVmax) of the liver (L), the largest lymph node (Llyn), spleen (S), and bone marrow (BM) were measured. Ratios to liver SUVmax were calculated for all, resulting LLRmax, SLRmax, and BMLRmax respectively.

RESULTS

The diameter of the largest lymph node, Llyn.SUVmax, LLRmax, and SLRmax produced cut-off values as 25.5, 8.86, 2.80, and 0.82 with corresponding sensitivity:specificity values as 65%:83%, 74%:77%, 74%:71%, and 79%:63% respectively for risk stratification of malignant causes. To differentiate lymphoma from sarcoidosis, DLlyn, SLRmax, and BMLRmax were found valuable with cut-off values obtained as 28.5, 0.84, and 1.19 with corresponding sensitivity:specificity values as 79%:91%, 79%:82%, and 54%:91%, respectively.Interdependency between parameters was also evaluated.

CONCLUSION

High values of Llyn.Maximum SUV and LLRmax are the main characteristics of lymphoma, metastasis, and sarcoidosis. The diameter of the largest lymph node, SLRmax, and BMLRmax are determined as distinct parameters for distinguishing lymphoma from sarcoidosis. Besides, observed correlation structures amongst some PET/CT parameters were identified as nodal, extranodal, and diffuse patterns for three disease groups except sarcoidosis. These findings extend the knowledge about diagnostic factors based on ¹⁸F-FDG PET/CT patterns for DLAP.

Could serum ACE2 levels predict infarct size in acute phase of ST-segment elevation myocardial infarction: a comparative study with classical biomarkers

OBJECTIVE

Serum ACE2 level in the acute phase of ST-segment elevation myocardial infarction may be an indicator of heart failure, however, limited studies have reported conflicting results. Therefore, in our study, we aimed to evaluate the relationship between serum ACE2 level and infarct size in the acute phase of ST-segment elevation myocardial infarction and compare the predictive value of ACE2 level with classical biomarkers.

PATIENTS AND METHODS

Sixty-six patients after the primary percutaneous coronary intervention were included in the study. For the measurement of serum ACE2 levels, blood samples were taken twice from the patients: in the first 24 hours and on the 5th day of the infarction, and once from 30 healthy volunteers. hs-cTnT, BNP, and CRP levels were measured daily, and their peak values were taken. On the 7th day of ST-segment elevation myocardial infarction, gSPECT was used with the 99mTc-MIBI method for assessment of infarct size.

RESULTS

Baseline ACE2 values were found to be higher in patients compared to controls, and ACE2 values obtained on the 5th day were found to be higher than the baseline values in the patients. There was no significant correlation between serum ACE2 levels and the RSS (%), while peak levels of hs-cTnT, BNP, and CRP were assessed as predictive factors for the RSS (%).

CONCLUSIONS

Although serum ACE2 levels increased in the acute phase of ST-segment elevation myocardial infarction, this increase was not associated with infarct size. Serum ACE2 level did not provide additional benefit to classical biomarkers for infarct size-related prognosis prediction.

Diagnosing breast cancer tumors using stacked ensemble model

Breast cancer is the most common cancer that progresses from cells in the breast tissue among women. Early-stage detection could reduce death rates significantly, and the detection-stage determines the treatment process. Mammography is utilized to discover breast cancer at an early stage prior to any physical sign. However, mammography might return false-negative, in which case, if it is suspected that lesions might have cancer of chance greater than two percent, a biopsy is recommended. About 30 percent of biopsies result in malignancy that means the rate of unnecessary biopsies is high. So to reduce unnecessary biopsies, recently, due to its excellent capability in soft tissue imaging, Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) has been utilized to detect breast cancer. Nowadays, DCE-MRI is a highly recommended method not only to identify breast cancer but also to monitor its development, and to interpret tumorous regions. However, in addition to being a time-consuming process, the accuracy depends on radiologists’ experience. Radiomic data, on the other hand, are used in medical imaging and have the potential to extract disease characteristics that can not be seen by the naked eye. Radiomics are hard-coded features and provide crucial information about the disease where it is imaged. Conversely, deep learning methods like convolutional neural networks(CNNs) learn features automatically from the dataset. Especially in medical imaging, CNNs’ performance is better than compared to hard-coded features-based methods. However, combining the power of these two types of features increases accuracy significantly, which is especially critical in medicine. Herein, a stacked ensemble of gradient boosting and deep learning models were developed to classify breast tumors using DCE-MRI images. The model makes use of radiomics acquired from pixel information in breast DCE-MRI images. Prior to train the model, radiomics had been applied to the factor analysis to refine the feature set and eliminate unuseful features. The performance metrics, as well as the comparisons to some well-known machine learning methods, state the ensemble model outperforms its counterparts. The ensembled model’s accuracy is 94.87% and its AUC value is 0.9728. The recall and precision are 1.0 and 0.9130, respectively, whereas F1-score is 0.9545.

Tc-99m MDP Bone SPECT/CT Findings of a Patient Detected with a New Mutation in LEMD3 Gene: A Case of Osteopoikilosis

Osteopoikilosis is an inherited condition with autosomal dominant trait resulting in sclerotic foci throughout the skeleton. It has been suggested that loss-of-function mutations of LEMD3 gene located on 12q14.3 result in osetopoikilosis. A bp heterozygote deletion was detected in our patient at the cytosine nucleotide at position 1105 with molecular genetic analysis. Although this mutation has not been previously described, it was considered to be the most likely cause of the disease in our patient due to frame shift and premature stop codon formation. As in our case, three phase bone scintigraphy and whole body imaging did not reflect the true extent of lesion sites and lesion activity. SPECT/CT images could reflect lesion location and activity more accurately, and could be a good alternative for differential diagnosis of unexplained bone pain and sclerotic lesions in one examination.

[Can ischemia-modified albumin help in differentiating myocardial perfusion scintigraphy results?]

OBJECTIVE

Myocardial perfusion scintigraphy (MPS) is a diagnostic tool commonly used to detect significant coronary lesion. However equivocal, false negative or positive results can be yielded. Controversial findings regarding the role of ischemia-modified albumin (IMA) in MPS evaluation persist. The aim of the present study was to examine the role of serum IMA in the assessment of MPS results.

METHODS

MPS using technetium (99mTc) sestamibi and transthoracic echocardiography was performed on 62 consecutive subjects prospectively enrolled. Exercise treadmill test (ETT) with modified Bruce protocol was used to induce coronary ischemia. During MPS performance, blood samples for serum IMA were obtained at 3 times: at pre-exercise, at the peak of ETT, and 6 hours after ETT. Patients were classified into 3 groups according to MPS results (normal, equivocal, and ischemia).

RESULTS

Sixty-two patients (23 normal, 20 equivocal, 19 with ischemia) were included. Pre- and peak-exercise IMA values were similar among the groups (p=0.706 and 0.904). Post-exercise IMA values of the normal and equivocal groups were similar (p=0.733), while that of the ischemia group was significantly higher than the values of either the normal (p<0.001) or equivocal groups (p<0.001). ΔIMA (the difference between post-exercise and peak-exercise IMA) of the ischemia group was significantly higher than that of either the normal (p<0.001) or equivocal groups (p<0.001).

CONCLUSION

Serum IMA was found to be significantly increased in cases of ischemia on MPS. Subjects with normal and equivocal MPS had a similar pattern during the test. IMA may be used in differentiation of equivocal results from false positive results.

Serum copeptin level can be a helpful biomarker in evaluation of myocardial perfusion scintigraphy results

BACKGROUND

Myocardial perfusion scintigraphy (MPS) is a well-established diagnostic tool. The sensitivity and specificity of single photon emission computed tomography (SPECT) MPS to detect significant coronary lesion were 86% and 74%, respectively. The aim of this study was to examine the role of serum copeptin in evaluation of MPS.

METHODS

Sixty-two consecutive patients underwent both SPECT MPS using 99mTc-sestamibi and transthoracic echocardiography were enrolled prospectively. Age, gender, height, weight, presence of cardiovascular risk factors were recorded. Exercise treadmill test (ETT) with modified Bruce protocol was used to induce coronary ischemia during MPS. While performing MPS, blood samples for serum copeptin level were drawn three times at pre-exercise, at the peak of ETT, and 6 h after ETT, respectively. The patients were enrolled into three groups according to MPS results (normal, equivocal and ischemia).

RESULTS

The study included 62 patients (23 with normal, 20 with equivocal, 19 with ischemia on MPS). Pre-, peak-, and post-exercise B-type natriuretic peptide and troponin I values were similar across the groups (p > 0.05 for all comparisons). Serum copeptin values for pre- and peak-exercise were similar among all groups (p = 0.883 and p = 0.089). Post-exercise copeptin values of the normal and equivocal groups were similar (p = 0.661, z = -0.438) while that of the ischemia group was significantly higher than both the normal (p < 0.001) and equivocal group (p < 0.001).

CONCLUSIONS

Serum copeptin was found to be increasing significantly in case of ischemia on MPS. It may be used in differentiation of equivocal results from false positive results.

Clinical Significance of Lymphoscintigraphy Findings in the Evaluation of Lower Extremity Lymphedema

OBJECTIVE

The purpose of this study was to investigate the clinical significance of lymphoscintigraphy imaging in the evaluation of lower extremity lymphedema.

METHODS

Technetium-99m-labeled nanocolloid was injected subcutaneously in the first web spaces of both feet of 123 patients (M/F: 43/80, mean age 57.5±13.1 years, range 16-78 years) who had clinical evidence of lower extremity swelling with suspicion of lymphedema, and were referred for routine lymphoscintigraphy. Lymphoscintigraphy scan was started as dynamic viewing followed by static whole body imaging at 10 minute, 1 hour and 4 hours after injection.

RESULTS

Eighty-seven patients had lymphedema. Patients who had lymphedema were divided into two groups according to their scintigraphy findings: Group I included 58 patients without uptake in the popliteal nodes, and group II included 29 patients with positive popliteal nodes. The rate of popliteal node visualization was higher in patients with dermal backflow as compared to those without dermal backflow (p<0.001). The duration of lymphedema was also longer in patients with dermal backflow and popliteal nodes (p<0.004).

CONCLUSION

Lymphoscintigraphy is a reliable, easily applied and well-tolerated objective method to diagnose lower extremity lymphedema. Uptake by popliteal lymph nodes and the presence of dermal backflow on lymphoscintigraphy, which is performed for evaluation of the lower limb lymphedema, were important signs indicating longer disease duration and higher severity of lymphatic dysfunction.

Is there a relationship between symptoms of patients and tomographic characteristics of styloid process?

OBJECTIVES

To investigate the angulations and length of the styloid process (SP) on three-dimensional computed tomography (3D-CT) images between the patients having elongated SP complaints and those without any stylalgia symptoms.

PATIENTS AND METHODS

One hundred patients underwent 3D-CT evaluation of the bilateral temporomandibular joints to investigate for symptomatic elongated styloid process (ESP) at our institution. The differences between the mean angulations and lengths of the SP and comparisons between patient and control groups were analyzed by student t test.

RESULTS

In study group, mean length of styloid processes was 40.7 ± 10.8 mm on the right and 40.3 ± 10.9 mm on the left. Mean medial angles of SP were measured as 22.60 ± 4.0 on the right side and 22.60 ± 4.5 on the left side. In the same group, mean anterior angles of SP were 16.10 ± 6.9 on the right and 16.70 ± 7.1 on the left side. The "in-group" comparisons of lengths, medial and anterior angles did not produce statistically significant results. The comparison of medial angulations between the symptomatic and asymptomatic patients was the only statistically meaningful result in our study.

CONCLUSION

3D-CT has several advantages according to conventional tomography for visualization of head and neck anatomy. The increase of medial angulation of SP may be responsible for the development of complaints in ESP.

Does bone mineral density have an effect on hearing loss in postmenopausal patients?

OBJECTIVES

An age-related decline in the bone mineral density (BMD) of the temporal bone, specifically in the segments that house the middle and inner ear, has been suggested as an additional risk factor for sensorineural hearing loss. We evaluated the effect of BMD on hearing loss in postmenopausal patients.

METHODS

This study involved 120 postmenopausal women who were referred between May 1,2012, and September 1, 2012. The age range was 50 to 55 years (mean, 52.7 +/- 2.3 years). The subjects were divided into three groups according to the results of BMD measurements. Of these, 30 were control subjects with normal BMD values, 45 had osteopenia, and 45 had osteoporosis. Each subject was tested with low- and high-frequency audiometry by a single experienced investigator under standard audiometric testing conditions. For each set of tests, mean values of air and bone conduction at each frequency and tympanometric values were calculated for the osteopenia, osteoporosis, and control groups.

RESULTS

All three groups were designed to have similar mean ages and roughly equal durations of menopause and body mass indexes. At low frequencies (0.25, 0.5, 1, and 2 kHz), the differences in the mean air conduction threshold values among the three groups were not statistically significant (p > 0.05). At high frequencies (4, 6, and 8 kHz), the difference in the mean air conduction threshold values between the osteopenia and control groups was not statistically significant (p > 0.05), but that in the osteoporosis group was statistically significantly higher than those in the osteopenia and control groups (p < 0.05). At low frequencies (0.5, 1, and 2 kHz), the differences in the mean bone conduction threshold values among the three groups were not statistically significant (p > 0.05). At 4 kHz, the difference in the mean bone conduction threshold values between the osteopenia and control groups was not statistically significant (p > 0.05), but that in the osteoporosis group was statistically significantly higher than those in the osteopenia and control groups (p < 0.05). There was no statistically significant difference among the three groups in tympanometric values (p > 0.05).

CONCLUSIONS

We conclude that patients with low BMD values should routinely be counseled for an audiological assessment to detect any change in hearing thresholds.

The impact of unilateral concha bullosa on mucociliary activity: an assessment by rhinoscintigraphy

BACKGROUND

In this study, we aimed to compare the differences of nasal mucociliary clearance rate (NMCR) by rhinoscintigraphic examination between the nasal cavities of patients with unilateral concha bullosa (CB).

METHODS

The study group consisted of 43 patients (18 men and 25 women), with unilateral CB ranging in age from 20 to 58 years (mean age, 33.5 ± 9.51 years). The nasal mucociliary clearance was described as the velocity (mm/min) of nasal mucociliary transport of the technetium 99m-macroaggragated albumin droplet. Rhinoscintigraphy was performed on each nasal cavity with 2-day intervals in the patients. The mucociliary clearance rates obtained in the unaffected side were accepted as control values.

RESULTS

The average values for mucociliary clearance rate were 2.29 ± 0.42 mm/min in the CB side of the nasal cavity, and 3.19 ± 0.52 mm/min in the other side of the nasal cavity. Mucociliary transport took a longer time in the CB side of the nasal cavity than in the other side of the nasal cavity, which was found to be statistically significant (p < 0.001).

CONCLUSION

Our study showed that unilateral CB might impair NMCR in the ipsilateral side of the nasal cavity. Thus surgical intervention to reduce the middle concha volume may result in a better mucociliary clearance with possibly a less chance of development of chronic sinus diseases and nasal pathologies. Obviously, it is of utmost importance that new studies be planned with larger patient series to better understand nasal mucociliary transport mechanism and CB relationships.

A novel index in healthy infants and children - subarachnoid space: ventricle ratio

BACKGROUND

The subarachnoid space (SAS) and ventricular width (VW) in normal infants and children were studied with ultrasonography to provide the objective measurement and define a normal range for these measurements. The additional aim was to determine the stable ratio as a SAS/VW.

MATERIALS AND METHODS

A total of 100 healthy subjects, including 48 males and 52 females, were studied. The cases were divided into 3 age groups: 0-6 months(n = 65), 7-12 months (n = 24) and > 13 months (n = 11). Transfontanel ultrasonography was performed in all the cases. SAS, VW and the SAS/VW ratios were calculated. The study was approved by the ethical committee. All parents were informed about the sonographic examination and their approvals were taken.

RESULTS

SAS was calculated as 3.1 (0.5-6) mm and VW was calculated as 3.6(1.3-5) mm. SAS/VW ratio was 0.9 ± 0.3. There was no statistically significant difference among SAS, VW and SAS/VW ratios in 3-97 percentile group (p > 0.05).

CONCLUSIONS

Ultrasonography can be used as a practicable and reproducible modality in the measurement of SAS and VW in healthy children. It is a non-invasive method and allows for serial follow-up. SAS/VW ratio can be used as an index in healthy children.

The effect of nasal septal deviation on maxillary sinus volumes and development of maxillary sinusitis

OBJECTIVES

The purpose of this study was to determine the possible role of nasal septal deviation on volume of maxillary sinuses and its relationship with development of maxillary sinusitis.

MATERIALS AND METHODS

Between May 2010 and September 2012, paranasal sinus computed tomography (CT) findings of 825 patients (470 males, 355 females), who admitted to Ear Nose and Throat Department of Bozok University Medical Faculty were retrospectively analyzed. By excluding the other co-existent sino nasal pathologies, 109 consecutive patients (47 males, 62 females mean age 36 ± 13.4 years; range 18-71 years) with isolated nasal septal deviations were recruited for the study. The convex side of the septal curvature was accepted as the direction of deviation. The findings were grouped according to the radiologically measured angle of nasal septal deviations. The deviation angle of the nasal septum was described as; mild (<9°), moderate (the angle between 9° and 15°), or severe (15° and up). The volume of each maxillary sinus (ipsi- and contralateral to the deviation side) was also calculated using the computer program. Sinusitis was defined as any evident thickening of the maxillary sinus mucosa.

RESULTS

There were 62 females and 47 males with a mean age of 36 ± 13.4. Nasal septal deviation angles were found to range between 5° and 27.2° (mean 13° ± 3.4°). The right sided deviations included 19 mild (<9°, Group I), 16 moderate (9°-15°, Group II), and 16 severe (15° and up, Group III) cases. The left sided deviations included 19 mild (<9°, Group I), 19 moderate (9°-15°, Group II), and 20 severe (15° and up, Group III) subjects. Maxillary sinus volumes were compared between right and left sided deviation groups. We could not demonstrate a statistically significant difference between the right maxillary sinus volumes of Groups I and II in left sided deviation cases (p = 0.77). In the same side, comparison of Groups I-III and Groups II-III, the maxillary sinus volume differences were found to be significantly meaningful (p = 0.001 and p = 0.013, respectively). Identical results were yielded in the right sided septal deviation group related to the maxillary sinus volumes of Groups I and II and Groups I-III and Groups II-III compartments (p = 0.99, p = 0.004 and p = 0.003, respectively). In both right and left deviation groups, ipsi and contralateral maxillary sinus volume comparements produced statistically significant results (p = 0.002 and p = 0.04, respectively). The presence of maxillary sinusitis findings were significantly increased in both group (p = 0.00). Statistical significance was set at p < 0.05.

CONCLUSION

Our findings suggest that maxillary sinus volumes tend to be higher at the contralateral side of the severe septum deviations. In addition, the chance of finding maxillary sinusitis findings on ipsilateral to the severe septum deviation was significantly increased.

Comparison of two different adenoidectomy techniques with special emphasize on postoperative nasal mucociliary clearance rates: coblation technique vs. cold curettage

OBJECTIVE

To compare the cold curettage and coblation techniques for pediatric adenoidectomy by means of intraoperative blood loss, operation time, and pre- and postoperative nasal mucociliary clearance rates.

METHODS

The study included 60 consecutive patients undergoing adenoidectomy operation upon the diagnosis of adenoid hypertrophy ranging in age 4-8 years (mean age: 5.82±1.25 years). Two groups consist of 30 patients. The two different adenoidectomy techniques were compared by means of intraoperative blood loss, operation duration, preoperative and postoperative nasal mucociliary clearance rate (NMCR) values. The nasal mucociliary clearance was described as the velocity (mm/min) of nasal mucociliary transport of the 99mTc-MAA droplet. Rhinoscintigraphy was performed on right nasal cavity before and after the surgery in all the patients.

RESULTS

The average NMCR of the curettage adenoidectomy and coblation adenoidectomy groups before surgery was 1.33±0.20mm/min and 1.35±0.19mm/min, respectively. There was no statistically significant difference between the two groups before surgery (p=0.615). In the six weeks of the post-operative period, the average NMCR of the curettage adenoidectomy and coblation adenoidectomy groups were 1.80±0.21mm/min and 2.06±0.31mm/min, respectively. The NMCR differences of preoperative and postoperative periods in coblation adenoidectomy group were higher than curettage adenoidectomy group (p<0.001). Mean operative time was 20.5±5.5min for coblation adenoidectomy group (n: 30), and 13.5±5.2min for curettage adenoidectomy group (n: 30). Mean intraoperative blood loss was 5.25±3.5ml for coblation adenoidectomy group, and 21.55±8.2ml for curettage adenoidectomy group. The difference between mean intraoperative blood loss and operative time of two groups were statistically significant (p<0.05).

CONCLUSION

The coblation technique provides a less bleeding surgical bed but a longer operation time when compared to curettage technique. Also the better NMCR values that we have found with coblation adenoidectomy may be translated to a more rapid recovery of ciliary function of the surface mucosa.

The effects of lycopene on cisplatin-induced ototoxicity

To investigate the potential preventive effect of lycopene in cisplatin-related ototoxicity. Thirty-five healthy 3-3.5-month adult female Sprague-Dawley rats were randomly divided into three groups and treated as follows: Group 1 (n = 10), received no cisplatin or lycopene. Both group 2 (n = 10) and; Group 3 (n = 15) received a single dose of 12 mg/kg cisplatin intraperitoneally. Lycopene was administered via gavage feeding in group 2 for 15 days. Prior to any medication administration, the baseline distortion product emissions were obtained in three groups. The animals were tested again at 15th day. The resulting distortion product otoacoustic emissions (DPOAE) were evaluated at 1.5, 2, 3, 4, 5, 6, 7, 8, 10, and 12 kHz. On day 0, prior to any medications, the initial DPOAEs measurement results gave similar values in the three groups (p > 0.05). In group 2 and 3, statistically significant differences were recorded for all frequencies between day 0 and day 15 values (p < 0.05). Lycopene group demonstrated significantly higher DP-grams except for 1.5 kHz frequency when compared to cisplatin group (p < 0.05). There was a statistically significant difference in basal and mid turn external ciliated cells number (p < 0.05), but there was no statistically significant difference in apical turn between three groups (p > 0.05). Stria vascularis changes were statistically significant between the groups, and the median score for stria vascularis injury was significantly greater in group 3 than in group 2 (p < 0.05). The median scores for spiral ganglion cells changes were significantly greater in group 3 than in group 2 (p < 0.05). The analyses of the results revealed statistically significant differences between two groups (p < 0.05), suggesting lycopene's possible protective effect against cisplatin ototoxicity. The present study revealed that administration of lycopene may demonstrate a protective role against cisplatin-induced ototoxicity in rats.

Octreotide uptake in parathyroid adenoma

The patient with a history of bone pain and muscle weakness, was thought to have oncogenic osteomalacia as a result of biochemical investigations and directed to Nuclear Medicine Department for a whole-body bone scintigraphy and 111In-octreotide scintigraphy. There was no focal pathologic tracer uptake, but generalized marked increase in skeletal uptake on bone scintigraphy. Octreotide scintigraphy showed accumulation of octreotide in the region of the left lobe of the thyroid gland in the neck. Thereafter, parathyroid scintigraphy was performed with technetium-99m labeled metroxy-isobutyl-isonitryl (99mTc-MIB) and MIBI scan demonstrated radiotracer uptake at the same location with octreotide scintigraphy. The patient underwent left inferior parathyroidectomy and histopathology confirmed a parathyroid adenoma. Somatostatin receptor positive parathyroid adenoma may show octreotide uptake. Octreotide scintigraphy may be promising and indicate a possibility of using somatostatin analogues for the medical treatment of somatostatin receptor positive Conflict of interest:None declared.