[Peritoneal splenosis visualized by antigranulocyte antibody scintigraphy].
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Adult↗
Biomedical subjects
O Sabri
Publications and source records attributed to O Sabri.
Cerebral functional-morphological match or mismatch in cerebrovascular disease: a comparison of flow-volume SPET, CT findings and Doppler sonography.
Cerebral ischaemia (thromboembolic, haemodynamic) is usually classified according to morphological criteria, but intracerebral rheological aspects often remain underestimated, even though prognosis may depend on areas of reduced perfusion or perfusion reserve around a morphological defect. The aim of this study was to investigate regional haemodynamics in patients with cerebrovascular ischaemia by comparing the size of morphological defects (MD) and perfusion deficits (PD). Ninety patients with cerebrovascular disease were investigated and the size of morphological defects on computed tomography (CT) was compared to the size of perfusion deficits or the extent of exhausted cerebral perfusion reserve (CPR) on a combined flow-volume single photon emission tomographic (SPET) study. Carotid arteries were examined by Doppler ultrasonography. Defect/deficit size ratios of MD, PD and CPR were classified as: (1) CT/SPET mismatch: A (no MD or PD, reduced CPR), B (PD > MD); or (2) CT/SPET match: C (PD = MD). A CT/SPET mismatch was found in 79% of patients with a haemodynamic pattern and in 67% of transient ischaemic attack/reversible ischaemic neurological deficit patients who showed no MD. A mismatch was also found in 21% of patients with thromboembolic infarction. A match was found in 79% of the thromboembolic and in 16% of the haemodynamic infarctions. High grade (> 80%) stenosis of the internal carotid arteries was found in 81% of the mismatch cases, but in only 57% of the match cases. In conclusion, haemodynamic infarctions show a predominance of functional/morphological mismatch, a match being predominant in thromboembolic infarctions. Doppler failed to indicate disturbed intracerebral perfusion in nearly one-fifth of haemodynamically compromised patients. In addition to CT and Doppler, flow-volume SPET enables an assessment of intracerebral haemodynamics which might be relevant for prognosis and therapy.
Brain↗
Cerebral blood flow velocity in acute schizophrenic patients. A transcranial Doppler ultrasonography study.
BACKGROUND AND PURPOSE: The aim of this study was to determine whether acutely psychotic first-episode schizophrenics show an increased cerebral blood flow velocity and whether this condition is reversible on psychopathological improvement. METHODS: In the first of two examinations, transcranial Doppler ultrasonography and assessment with the Positive and Negative Syndrome Scale (PANSS) were performed on 28 acutely psychotic, neuroleptically naive, first-episode schizophrenics. In the second examination, the same patients were assessed psychometrically (PANSS) as well as with Doppler ultrasonography after psychopathological improvement. RESULTS: Acutely psychotic first-episode schizophrenics showed a significant increase of the mean velocity on both sides in the middle and anterior cerebral arteries and in the right posterior cerebral artery. Blood flow showed significant correlations with productive psychotic symptoms. After psychopathological improvement there was a bilateral normalization of the mean velocity in the middle, anterior, and posterior cerebral arteries. CONCLUSIONS: Acutely psychotic first-episode schizophrenics show a significantly increased bilateral cerebral blood flow velocity, which normalizes on psychopathological improvement. There were significant correlations of cerebral blood flow velocity with psychopathology.
Acute Disease↗
Correlation of neuropsychological, morphological and functional (regional cerebral blood flow and glucose utilization) findings in cerebral microangiopathy.
UNLABELLED: Cerebral microangiopathy, indicated in MRI by lacunar infarctions (LIs) and deep white matter lesions (DWMLs), is said to be accompanied by vascular dementia, which is reportedly caused by LI and DWML. METHODS: To confirm this assumption, 57 patients with cerebral microangiopathy were assessed for changes in regional cerebral blood flow (rCBF) and glucose utilization (rMRGlu) in both white matter and cortex, and these findings were correlated to the results of extensive neuropsychological testing (cognitive, mnestic and attentiveness tests), as well as to MRI findings. A special head holder ensured reproducibility of positioning during measurement of rCBF (99mTc-HMPAO SPECT) and rMRGlu (18F-FDG PET) and MRI. White matter and cortex were quantified with regions of interest defined on MRI and superimposed to corresponding PET/SPECT slices. The rMRGlu was calculated according to Sokoloff, and rCBF was determined from normalization to the cerebellum. LI and DWML were graded by number and extent. Brain atrophy was classified as no to slight inner and/or outer atrophy (Group A) or moderate-to-severe inner and outer atrophy (Group B). RESULTS: Even in severe DWMLs and in multiple LIs, rCBFs and rMRGlu values were not reduced. Analysis of variance identified atrophy and neuropsychological deficits as the main determinants for reduced rCBF and rMRGlu values (p < 0.05). However, 60% of patients (19 of 31) with neuropsychological deficits in attentiveness tests and 61% of patients (23 of 38) with mnestic deficits belonged to Group A and revealed decreased rCBF and rMRGlu values. Neuropsychological deficits correlated well with decreased rCBF and rMRGlu, whereas MRI patterns, such as LI and DWML, did not. CONCLUSION: We conclude that LI and DWML are epiphenomena that morphologically characterize cerebral microangiopathy. Dementia or neuropsychological deficits, however, are exclusively reflected by functional criteria (rCBF and rMRGlu), as long as cerebral atrophy does not occur.
Aged↗
FDG PET for detection and therapy control of metastatic germ cell tumor.
UNLABELLED: We investigated the use of PET and 2[18F]fluoro-2-deoxy-D-glucose (FDG) for detection and therapy control of metastatic germ cell cancer in comparison to CT. METHODS: Fifty-four PET studies were performed in addition to CT in 33 patients with histopathologically proven germ cell tumors (14 seminomas, 18 nonseminomas, 1 not classified). The scans were done either after initial diagnosis (Group 1; n = 12), within 2 wk after completion of chemotherapy (Group 2; n = 13) or 14-375 days after chemotherapy (Group 3; n = 29). PET and CT were validated either by histology (n = 19) or clinical follow-up for 182-1704 days (n = 35). Focal pathological uptake with PET was quantified using standardized uptake values (SUVs). RESULTS: PET was significantly more accurate than CT (0.86 versus 0.59; p < 0.025) for detection of residual viable tumor in Group 3. While sensitivities of PET and CT did not differ markedly, PET was significantly more specific than CT. No significant differences between PET and CT were found in Groups 1 and 2. PET scans after therapy resulted in false-negative findings in five of nine cases of Group 2 but only in two of nine cases of Group 3. False-positive PET findings occurred in three inflammatory processes. SUV of seminomas was significantly higher than in nonseminomas (p < 0.01). CONCLUSION: PET using FDG is superior to CT for assessment of residual tumor after chemotherapy of germ cell cancer and may thus have an increased effect on patient management in the future. PET must be performed at least 2 wk after completion of therapy. Further data are necessary to determine the role of FDG PET for initial staging of germ cell cancer.
Adult↗
[Determination of factors affecting the therapeutic outcome of radioiodine therapy in patients with Graves' disease].
AIM: Of this study was to determine whether success of radioiodine therapy (RIT) in Graves' disease depends on thyroid volume, function, thyroideal receptor antibodies (TRAK), thyreostasis, therapeutic dosage, 131I uptake, or effective half-life. METHOD: 78 patients received an average of 626 +/- 251 MBq of iodine-131 orally for thyroid ablation. 60 were assessed for successful therapy 3 months after RIT. RESULTS: In patients showing hyperthyreosis or a TRAK value > 11 U/l at the beginning of RIT, a significantly lower therapeutic dosage and effective iodine half-life were found than in non-hyperthyreotic patients or patients with TRAK < or = 11 U/l. Patients with a thyroid volume < or = 25 ml showed a significantly lower 131I uptake, but a significantly higher relative uptake (131I uptake/ volume) than patients with a thyroid volume > 25 ml. All failures were treated thyreostatically during RIT and showed a significantly lower therapeutic iodine dosage and relative uptake, as well as a significantly higher thyroid volume than patients with a successful therapy. RIT caused a thyroid volume reduction of 44%, with therapy failures showing a significantly lower volume reduction. Patients who received a therapeutic dosage of < or = 250 Gy showed significantly worse results than did those who had received > 250 Gy. Only one case of therapy failure received a dosage > 250 Gy, while 50% of failures received dosages > 200 Gy but < 250 Gy. Multivariate analyses (MANOVA, factor analyses) showed thyreostasis as the decisive negative factor for a successful course of therapy. CONCLUSIONS: Since most treatment failures occurred in patients under thyreostatic medication we recommend raising the target dosage to 250 Gy for these cases.
Administration, Oral↗
[Attenuation corrected myocardial PET after application of 18FDG: effect on the determination of regional myocardial uptake values].
AIM: Post injection transmission measurement (PIT) can be performed using rotating 68Ge/68Ga linesources. This study estimates attenuation coefficients, count densities and relative regional uptake values of PIT corrected cardiac PET (E-PIT) compared to routinely pre-injection transmission measurement (RT). METHODS: A thorax-phantom with homogeneously filled myocardium or with simulated defects and six patients with advanced coronary artery disease were studied using ECAT Exact tomograph (Siemens CTI) equipped with three rotating linesources. Transmission was performed twice (PIT, RT), attenuation coefficients and emission data were analysed, the latter without attenuation correction (E-UK), corrected with PIT (E-PIT) and with RT (E-RT) (count density, standard and relative uptake values). RESULTS: Both in phantom and patient studies attenuation coefficients differed significantly between PIT and RT. Comparing E-PIT and E-RT, regional uptake values were different only in phantom simulation with myocardial radioactivity concentrations higher than 10 kBq x ml-1. The image contrast between defects and remaining myocardium in the phantom studies or the standard and relative uptake values in patient studies did not vary significantly. CONCLUSION: Under clinical conditions a post injection transmission measurement does not influence the accuracy of regional myocardial uptake values relevantly.
Biological Transport↗
[Investigations on the effect of "ecstasy" on cerebral glucose metabolism: an 18-FDG PET study].
PURPOSE: The aim of the present study was to determine the acute effects of the "Ecstasy" analogue MDE (3, 4-methylendioxyethamphetamine) on the cerebral glucose metabolism (rMRGlu) of healthy volunteers. METHOD: In a randomised double-blind trial, 16 healthy volunteers without a history of drug abuse were examined with 18-FDG PET 110-120 minutes after oral administration of 2 mg/kg MDE (n = 8) or placebo (n = 8). Beginning two minutes prior to radiotracer injection, a constant cognitive stimulation was maintained for 32 minutes using a word repetition paradigm in order to ensure constant and comparable mental conditions during cerebral 18-FDG uptake. Individual brain anatomy was represented using T1-weighted 3D flash MRI, followed by manual regionalisation into 108 regions-of-interest and PFT/MRI overlay. Absolute quantification of rMRGlu and comparison of glucose metabolism under MDE versus placebo were performed using Mann-Whitney U-test. RESULTS: Absolute global MRGlu was not significantly changed under MDE versus placebo (MDE: 41.8 +/- 11.1 mumol/min/100 g, placebo: 50.1 +/- 18.1 mumol/min/100 g, p = 0.298). The normalised regional metabolic data showed a significantly decreased rMRGlu in the bilateral frontal cortex: left frontal posterior (-7.1%, p < 0.05) and right prefrontal superior (-4.6%, p < 0.05). On the other hand, rMRGlu was significantly increased in the bilateral cerebellum (right: +10.1%, p < 0.05; left +7.6%, p < 0.05) and in the right putamen (+6.2%, p < 0.05). CONCLUSIONS: The present study revealed acute neurometabolic changes under the "Ecstasy" analogon MDE indicating a fronto-striato-cerebellar dysbalance with parallels to other psychotropic substances and various endogenous psychoses respectively.
Administration, Oral↗
Correlation of positive symptoms exclusively to hyperperfusion or hypoperfusion of cerebral cortex in never-treated schizophrenics.
BACKGROUND: Studies of schizophrenia by single photon emission computed tomography (SPECT) and positron emission tomography (PET) have shown both regional cerebral hyperperfusion and hypoperfusion. The aim of this study was to examine the inter-relations between regional cerebral blood flow (rCBF), psychopathology, and effects of neuroleptic therapy. METHODS: 24 never-treated patients with acute schizophrenia were examined with hexamethylpropyleneamine-oxime brain SPECT and assessed psychopathologically according to the positive and negative syndrome scale; they were studied again after neuroleptic treatment and psychopathological remission. rCBF values that deviated from those of 20 controls by more than 2 SD were regarded as abnormal. FINDINGS: Both hyperperfused and hypoperfused patterns were found among schizophrenia patients during acute illness. The seven positive symptoms on the symptom scale showed different correlations with rCBF: formal thought disorders and grandiosity correlated positively (and strongly) with bifrontal and bitemporal rCBF; delusions, hallucinations, and distrust correlated negatively (and strongly) with cingulate, left thalamic, left frontal, and left temporal rCBF. Stereotyped ideas as a negative symptom correlated negatively (and strongly) with left frontal, cingulate, left temporal, and left parietal rCBF. After neuroleptic treatment (and reduction of positive symptoms), only negative symptoms correlated exclusively with bifrontal, bitemporal, cingulate, basal ganglia, and thalamic hypoperfusion. INTERPRETATION: Different positive symptoms are accompanied by different rCBF values--some related to hyperperfusion, others to hypoperfusion. This finding may help to explain observed inconsistencies of perfusion patterns in drug-naïve schizophrenics.
Adult↗
Fluorine-18 fluorodeoxyglucose positron emission tomography in the differential diagnosis of pancreatic carcinoma: a report of 106 cases.
The aim of this study was to evaluate fluorine-18 fluorodeoxyglucose positron emission tomography ([18F]FDG PET) as a tool for the differential diagnosis of pancreatic carcinoma while taking into account serum glucose level. A group of 106 patients with unclear pancreatic masses were recruited for the study. PET was performed following intravenous administration of an average of 190 MBq [18F]FDG. Focally increased glucose utilisation was used as the criterion of malignancy. In addition, the "standardised uptake value" (SUV) was determined 45 min after injection. Carcinoma of the pancreas was demonstrated histologically in 74 cases, and chronic pancreatitis in 32 cases. Employing visual evaluation, 63 of the 74 (85%) pancreatic carcinomas were identified by PET. In 27 of the 32 cases (84%) of chronic pancreatitis it was possible to exclude malignancy. False-negative results (n=11) were obtained mostly in patients with raised serum glucose levels (10 out of 11), and false-positives (n=5) in patients with inflammatory processes of the pancreas. Thus PET showed an overall sensitivity of 85%, a specificity of 84%, a negative predictive value of 71%, and a positive predictive value of 93%. In a subgroup of patients with normal serum glucose levels (n=72), the results were 98%, 84%, 96% and 93%, respectively. Quantitative assessment yielded a mean SUV of 6.4+/-3.6 for pancreatic carcinoma as against a value of 3.6+/-1.7 for chronic pancreatitis (P<0.001), without increasing the diagnostic accuracy. This shows PET to be of value in assessing unclear pancreatic masses. The diagnostic accuracy of PET examinations is very dependent on serum glucose levels.
Adenocarcinoma↗
Comparison of PET, SPET, neuropsychological and morphological findings in vascular dementia.
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Brain↗
Psychopathological and SPECT findings in never-treated schizophrenia.
A total of 24 never-treated (i.e. drug-naive) actively psychotic schizophrenic patients, operationalized according to DSM-III-R, were examined in a pre-post-treatment design using the Positive and Negative Syndrome Scale for Schizophrenia (PANSS) and 99mTc-HMPAO-single photon emission computed tomography (SPECT) to assess regional cerebral blood flow (rCBF). The control subjects were 20 patients free of neurological and psychiatric symptoms. Before treatment there was only a slight hypofrontality, and hypoperfusion was observed in the left temporal superior region. After treatment, hypofrontality was reduced to one region and temporal hypoperfusion disappeared. Formal thought disorders were accompanied by increased rCBF in the bilateral frontal interior and left temporal superior regions. Delusions were associated with hypoperfusion in the anterior cingulate cortex. Negative symptoms showed no linkage to hypofrontality, either before or after treatment. Factor analysis showed delusions and hallucinations loading on different dimensions. The disorganized dimension correlated positively with all regions of interest, whereas these were negatively correlated with reality distortion.
Adult↗
Fasting improves discrimination of grade 1 and atypical or malignant meningioma in FDG-PET.
UNLABELLED: We investigated the use of PET with 2[18F]fluoro-2-deoxy-D-glucose (FDG) to discriminate between atypical or malignant and grade 1 meningiomas. The influence of fasting state and high-dose corticosteroid medication was analyzed retrospectively. METHODS: Preoperative PET scans of 75 patients with suspected diagnosis of intracranial meningioma were evaluated using standardized uptake values (SUV) and tumor-to-contralateral gray matter ratios (TGR) of FDG uptake. Fifty-one of 75 patients fasted before the PET scan, and 27 of 75 patients were studied under high-dose corticosteroid medication. Eighteen tumors had recurred. PET results were compared to histopathological grading. RESULTS: PET correctly identified 8/9 atypical or malignant meningiomas and 58/66 grade 1 meningiomas using TGR and a threshold of 1.05 in primary meningioma and 0.85 in tumor recurrence. This corresponds to a specificity of 0.88 for the detection of higher tumor grading. Specificity was significantly higher in fasting compared to nonfasting subjects (0.96 versus 0.73; p < 0.025). SUV quantification lead to a reduced specificity of 0.77 at the same level of sensitivity. The only false-negative PET finding occurred in a recurrent meningioma, which had been operated on four times before. CONCLUSION: Overnight fasting before injection is needed to improve the diagnostic accuracy of FDG-PET for noninvasive metabolic grading of meningioma. Hyperglycemia in nonfasting patients and in diabetic patients may lead to overestimation of meningioma grading.
Adolescent↗
Regional cerebral blood flow and negative/positive symptoms in 24 drug-naive schizophrenics.
UNLABELLED: SPECT/PET studies in schizophrenia revealed inconsistent changes of regional cerebral blood flow (rCBF). Frontal hyperperfusion as well as hypoperfusion are described. This study was undertaken to investigate the relations between rCBF, psychopathology according to PANSS and effects of neuroleptic therapy. METHODS: Twenty-four drug-naive acute patients with a first manifestation of schizophrenia were examined with 99mTc-HMPAO brain SPECT and assessed according to PANSS. Of these, 22 were controlled again after neuroleptic treatment. Following attenuation correction, region-to-cerebellar count ratios were obtained from 98 irregular regions of interest drawn in all slices (6.25 mm). The ratios were compared to 20 control subjects, and changes lying outside of 2 s.d. were considered abnormal. RESULTS: In different drug-naive patients, hyperperfusion as well as hypoperfused patterns were found. In drug-naive patients, the seven subscores of positive symptoms (pos 1-7) in PANSS showed different correlations to rCBF: Formal thought disorders (pos 2) and grandiosity (pos 5) were positively correlated to bifrontal and bitemporal rCBF (r = +0.59 to +0.70). Delusional ideas (pos 1), hallucinatory behavior (pos 3) and suspiciousness (pos 6) demonstrated a negative correlation to bifrontal, cingulate, left temporal and left thalamic rCBF (r = -0.59 to -0.66). Stereotyped ideas (neg 7) as a negative symptom showed a negative correlation to left frontal, left temporal and left parietal rCBF (r = -0.59 to -0.65). No correlations were found between residual positive symptoms and rCBF after neuroleptic treatment and clinical improvement, but all negative symptoms (neg 1-7) had a negative correlation to bifrontal, bitemporal, cingulate, basal ganglia and thalamic rCBF (r = -0.59 to -0.74). CONCLUSION: Our results illustrate that different positive symptoms are accompanied by different rCBF values: some induce hyperperfusion, others hypoperfusion. After therapy (and reduction of positive symptoms), only negative symptoms correlate exclusively to hypoperfusion. This may be the crucial factor in explaining inconsistencies of past results in perfusion pattern in drug-naive schizophrenic patients.
Adult↗
Altered relationships between rCBF in different brain regions of never-treated schizophrenics.
AIM: of this study was to investigate the relations between regional cerebral blood flow (rCBF) of different brain regions in acute schizophrenia and following neuroleptic treatment. METHODS: Twenty-two never-treated, acute schizophrenic patients were examined with HMPAO brain SPECT and assessed psychopathologically, and reexamined following neuroleptic treatment (over 96.8 days) and psychopathological remission, rCBF was determined by region/cerebellar count quotients obtained from 98 irregular regions of interest (ROIs), summed up to 11 ROIs on each hemisphere. In acute schizophrenics, interregional rCBF correlations of each ROI to every other ROI were compared to the interregional correlations following neuroleptic treatment and to those of controls. RESULTS: All significant correlations of rCBF ratios of different brain regions were exclusively positive in controls and patients. In controls, all ROIs of one hemisphere except the mesial temporal ROI correlated significantly to its contralateral ROI. Each hemisphere showed significant frontal-temporal correlations, as well as cortical-subcortical and some cortico-limbic. In contrast, in acute schizophrenics nearly every ROI correlated significantly with every other ROI, without a grouping or relation of the rCBF of certain ROIs as in controls. After neuroleptic treatment and clinical improvement, this diffuse pattern of correlations remained. CONCLUSIONS: These results indicate differences in the neuronal interplay between regions in schizophrenic and healthy subjects. In never-treated schizophrenics, diffuse interregional rCBF correlations can be seen as a sign of change and dysfunction of the systems regulating specificity and diversity of the neuronal functions. Neuroleptic therapy and psychopathologic remission showed no normalizing effect on interregional correlations.
Adult↗
Imaging of beta-oxidation by static PET with 14(R,S)-[18F]-fluoro-6-thiaheptadecanoic acid (FTHA) in patients with advanced coronary heart disease: a comparison with 18FDG-PET and 99Tcm-MIBI SPET.
14(R,S)-[18F]-fluoro-6-thiaheptadecanoic acid (FTHA) has been proposed as a PET tracer of the beta-oxidation pathway. The aim of this study was to investigate the diagnostic value of FTHA using static PET imaging in patients with ischaemically reduced left ventricular function. Twenty-one patients with angiographically proven advanced coronary heart disease were examined. All patients underwent SPET with 400 MBq [99Tcm]-2-methoxy-isobutyl-isonitrile (MIBI) for perfusion assessment and PET with 250 MBq FTHA under fasting conditions and with 150 MBq 2-[18F]-fluoro-2-deoxyglucose (FDG) following an oral glucose load. The uptake of FTHA and FDG was analysed quantitatively in 33 regions. Regional uptake was normalized to the region with highest MIBI uptake and expressed as a percentage. FTHA uptake paralleled MIBI uptake (r = 0.80) but not FDG uptake (r = 0.57). Mean FTHA uptake (38.1 +/- 16.3%) in 190 regions with severely reduced perfusion (MIBI uptake < 50%, mean uptake 36.8 +/- 9.4%) was significantly lower compared to FDG uptake (54.6 +/- 25.0%). FTHA uptake was preserved (> or = 70%) in 8 of 52 (13%) regions only with severely reduced perfusion but preserved glucose metabolism (FDG uptake > or = 70%). The similarity between FTHA and MIBI uptake suggests that static PET imaging with FTHA is of limited value when distinguishing between ischaemic or hibernating myocardium and scar. The underestimation of viability may be caused both by the dependence of uptake on flow and the suppression of beta-oxidation in regional chronic ischaemia under fasting conditions.
Aged↗
[Successful electroconvulsive therapy of Cotard syndrome with bitemporal hypoperfusion].
A case study is presented to illustrate a rare condition described by Cotard as "délire de négation". The central symptom is a nihilistic delusion with denial of one's own existence of oneself and that of the external world. In the present case, the syndrome became manifest as an escalation of a recurrent depressive disorder late in life. After initial resistance to therapy, the syndrome was successfully treated with electroconvulsive therapy. For the first time, we report the regional cerebral blood flow measured by 99mTc-HMPAO-SPECT before and after therapy. Before treatment, significant bitemporal hypoperfusion relative to the cerebellum was found, which was no longer demonstrable on remission.
Aged↗
[MRI and oncoscintigraphy with 99m-Tc-MIBI in the follow up of thyroid cancer].
Magnetic resonance imaging (MRI) and 99mTc-MIBI oncoscintigraphy are new procedures for the detection of recurrent differentiated thyroid cancer. We evaluated the utility of both techniques compared to ultrasonography, radioiodine scanning, and measurement of serum thyroglobulin in patients with (n = 21) or without suspicion (n = 34) of tumor relapse. Although MRI was most effective in detecting local recurrencies (sensitivity: 100%), additional diagnostic information was only obtained in patients with mediastinal lesions. On the other hand, oncoscintigraphy was less sensitive (67%) but highly specific in differentiating reactive lymph node enlargement from metastatic disease (specificity: 93.5%). Oncoscintigraphy may be used instead of radioiodine scanning in patients with doubtful lymph node findings and spare them withdrawal of TSH-suppressive hormone medication. Routine estimation of serum thyroglobulin proved to be highly efficient in screening for tumor relapse using a cut-off level of 3 ng/ml (accuracy: 100%).
Adult↗