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Generalized Lymphadenopathy due to Chronic Lymphocytic Leukemia (CLL) : 18F-FDG PET Imaging Basuki Hidayat; Febby Hutomo; Ryan Yudistiro; Ivana D. Mulyanto; Hendra Budiawan; Johan S. Masjhur
Journal of Medicine and Health Vol. 1 No. 3 (2016)
Publisher : Universitas Kristen Maranatha

Lymphadenopaty is a common clinical finding with a broad differential diagnosis, withCarcinoma of Unknown Primary (CUP) as one of itâ€™s most common causes. Flourine-18 fluoro-2 deoxy glucose (18F- FDG) positron emission tomography (PET) is a Nuclear Medicinescintigraphy procedure commonly used to localize suspected a primary lesion by depicting ametabolic status. However, in the expertise of 18F FDG PET study, clinical finding andepidemiologic data must be considered to get a better conclusion. We describe 18F-FDG PETstudy in the presence of generalized lymphadenopathy due to chronic lymphocytic leukemia(CLL), a rare disease which is initially suspected of having CUP.Keywords: 18F-FDG PET, lymphadenopathy, lymphoma, leukemia

Generalized Lymphadenopathy due to Chronic Lymphocytic Leukemia (CLL) : 18F-FDG PET Imaging Basuki Hidayat; Febby Hutomo; Ryan Yudistiro; Ivana D. Mulyanto; Hendra Budiawan; Johan S. Masjhur
Journal of Medicine and Health Vol 1 No 3 (2016)
Publisher : Universitas Kristen Maranatha

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.28932/jmh.v1i3.520

Lymphadenopaty is a common clinical finding with a broad differential diagnosis, withCarcinoma of Unknown Primary (CUP) as one of itâ€™s most common causes. Flourine-18 fluoro-2 deoxy glucose (18F- FDG) positron emission tomography (PET) is a Nuclear Medicinescintigraphy procedure commonly used to localize suspected a primary lesion by depicting ametabolic status. However, in the expertise of 18F FDG PET study, clinical finding andepidemiologic data must be considered to get a better conclusion. We describe 18F-FDG PETstudy in the presence of generalized lymphadenopathy due to chronic lymphocytic leukemia(CLL), a rare disease which is initially suspected of having CUP.Keywords: 18F-FDG PET, lymphadenopathy, lymphoma, leukemia

Diagnostic Performance of Imaging Modalities in Persistent or Recurrent Hyperparathyroidism: A Network Meta-Analysis of 18F-Fluorocholine PET/CT, 4D-CT, and Scintigraphy Hendry Johan Renaldy Tandra; Endah Indriani; Hendra Budiawan; Basuki Hidayat
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 11 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i11.1424

Background: The surgical management of persistent or recurrent primary hyperparathyroidism (PHPT) is critically dependent on accurate preoperative localization of ectopic or residual hyperfunctioning glands within a scarred anatomical field. While 18F-Fluorocholine Positron Emission Tomography/Computed Tomography (18F-FCH PET/CT), four-dimensional computed tomography (4D-CT), and 99mTc-Sestamibi scintigraphy are employed, a definitive evidence-based hierarchy to guide their use is absent. This study aimed to establish this hierarchy by comparing their diagnostic performance through a network meta-analysis. Methods: A systematic search of PubMed, Embase, and Scopus was conducted for comparative studies published between January 2015 and August 2025 evaluating these modalities in persistent/recurrent PHPT. A Bayesian bivariate network meta-analysis was performed to calculate pooled sensitivities and specificities on both a per-patient and per-lesion basis. Modalities were ranked using Surface Under the Cumulative Ranking (SUCRA) scores. Methodological quality, inconsistency, and heterogeneity were formally assessed. Results: Seven studies involving 687 patients were included. On a per-patient analysis, 18F-FCH PET/CT demonstrated the highest sensitivity at 94.1% (95% Credible Interval [CrI]: 89.8%–97.5%), significantly outperforming 4D-CT (82.5%; 95% CrI: 75.1%–88.9%) and scintigraphy with SPECT/CT (60.3%; 95% CrI: 51.2%–69.1%). Specificities were uniformly high. Per-lesion analysis confirmed this hierarchy. SUCRA rankings identified 18F-FCH PET/CT as the superior modality for both per-patient (98.7%) and per-lesion (99.1%) detection. No significant network inconsistency was detected. Conclusion: 18F-FCH PET/CT exhibits superior diagnostic accuracy for localizing culprit parathyroid glands in persistent or recurrent PHPT. Its performance, grounded in robust metabolic targeting that overcomes the challenges of a reoperative field, supports its positioning as the primary imaging modality in this setting. These findings advocate for a revision of current diagnostic algorithms to enhance surgical planning and improve patient outcomes.

Detection of Small Lesion Insulinoma with 68Ga-DOTATATE PET/CT scan: A Case Report Irma Wahyuni; Tri Juli Edi Tarigan; Hendra Budiawan; Alvita Dewi; Rian Hidayatullah; Hasan Maulahela
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 2 No. 1 (2025): InaJEMD Vol. 2, No. 1
Publisher : PP PERKENI

Show Abstract | Download Original | Original Source | Check in Google Scholar

Endogenous hyperinsulinism is a rare condition characterized by inappropriate insulin secretion, with insulinoma accounting for approximately 55% of cases. A 36-year-old woman presented with recurrent hypoglycemic episodes for 4.5 years, particularly in the morning, relieved by glucose intake. Laboratory findings during a supervised fasting test revealed a blood glucose of 44 mg/dL, elevated insulin (15 μIU/mL), C-peptide (2.27 ng/mL), proinsulin (53.1 pmol/L), and suppressed beta-hydroxybutyrate (0.1 mmol/L), indicating endogenous hyperinsulinemia. Initial imaging modalities including CT, MRI, and EUS failed to localize the lesion. The patient discontinued investigation but resumed a year later with nuclear imaging studies. A 99mTc-HYNIC-TOC scan was inconclusive, but subsequent ^68Ga-DOTATATE PET/CT at Hasan Sadikin Hospital revealed a somatostatin receptor-expressing nodule at the pancreatic head, consistent with insulinoma. Given the lesion's location and imaging findings, treatment options were discussed, including Whipple’s procedure versus radiofrequency ablation. Insulinomas are typically small, with 80% under 2 cm and 40% under 1 cm, often making localization challenging. While CT and MRI have detection rates of 70% and 86% respectively, the combination of CT and EUS may reach 100% sensitivity. In cases where conventional imaging is inconclusive, ^68Ga-DOTATATE PET/CT provides a valuable alternative, capable of detecting neuroendocrine tumors as small as 6 mm. This case highlights the critical role of nuclear medicine in localizing elusive insulinomas and guiding definitive treatment.

Diagnostic Performance of Imaging Modalities in Persistent or Recurrent Hyperparathyroidism: A Network Meta-Analysis of 18F-Fluorocholine PET/CT, 4D-CT, and Scintigraphy Hendry Johan Renaldy Tandra; Endah Indriani; Hendra Budiawan; Basuki Hidayat
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 11 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i11.1424

Background: The surgical management of persistent or recurrent primary hyperparathyroidism (PHPT) is critically dependent on accurate preoperative localization of ectopic or residual hyperfunctioning glands within a scarred anatomical field. While 18F-Fluorocholine Positron Emission Tomography/Computed Tomography (18F-FCH PET/CT), four-dimensional computed tomography (4D-CT), and 99mTc-Sestamibi scintigraphy are employed, a definitive evidence-based hierarchy to guide their use is absent. This study aimed to establish this hierarchy by comparing their diagnostic performance through a network meta-analysis. Methods: A systematic search of PubMed, Embase, and Scopus was conducted for comparative studies published between January 2015 and August 2025 evaluating these modalities in persistent/recurrent PHPT. A Bayesian bivariate network meta-analysis was performed to calculate pooled sensitivities and specificities on both a per-patient and per-lesion basis. Modalities were ranked using Surface Under the Cumulative Ranking (SUCRA) scores. Methodological quality, inconsistency, and heterogeneity were formally assessed. Results: Seven studies involving 687 patients were included. On a per-patient analysis, 18F-FCH PET/CT demonstrated the highest sensitivity at 94.1% (95% Credible Interval [CrI]: 89.8%–97.5%), significantly outperforming 4D-CT (82.5%; 95% CrI: 75.1%–88.9%) and scintigraphy with SPECT/CT (60.3%; 95% CrI: 51.2%–69.1%). Specificities were uniformly high. Per-lesion analysis confirmed this hierarchy. SUCRA rankings identified 18F-FCH PET/CT as the superior modality for both per-patient (98.7%) and per-lesion (99.1%) detection. No significant network inconsistency was detected. Conclusion: 18F-FCH PET/CT exhibits superior diagnostic accuracy for localizing culprit parathyroid glands in persistent or recurrent PHPT. Its performance, grounded in robust metabolic targeting that overcomes the challenges of a reoperative field, supports its positioning as the primary imaging modality in this setting. These findings advocate for a revision of current diagnostic algorithms to enhance surgical planning and improve patient outcomes.

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