RESUMEN
Background and Aim: The availability of new treatments for metastatic castrate-resistant prostate cancer (mCRPC) patients increases the need for reliable biomarkers to help clinicians to choose the better sequence strategy. The aim of the present retrospective and observational work is to investigate the prognostic value of 18F-fluorocholine (18F-FCH) positron emission tomography (PET) parameters in mCRPC. Materials and Methods: Between March 2013 and August 2016, 29 patients with mCRPC were included. They all received three-weekly docetaxel after androgen deprivation therapy, and they underwent 18F-FCH PET/computed tomography (CT) before and after the therapy. Semi-quantitative indices such as maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean) with partial volume effect (PVC-SUV) correction, metabolically active tumour volume (MATV), and total lesion activity (TLA) with partial volume effect (PVC-TLA) correction were measured both in pre-treatment and post-treatment 18F-FCH PET/CT scans for each lesion. Whole-body indices were calculated as sum of values measured for each lesion (SSUVmax, SPVC-SUV, SMATV, and STLA). Progression-free survival (PFS) and overall survival (OS) were considered as clinical endpoints. Univariate and multivariate hazard ratios for whole-body 18F-FCH PET indices were performed, and p < 0.05 was considered as significant. Results: Cox regression analysis showed a statistically significant correlation between PFS, SMATV, and STLA. No correlations between OS and 18F-FCH PET parameters were defined probably due to the small sample size. Conclusions: Semi-quantitative indices such as SMATV and STLA at baseline have a prognostic role in patients treated with docetaxel for mCRPC, suggesting a potential role of 18F-FCH PET/CT imaging in clinical decision-making.
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Colina/análogos & derivados , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Neoplasias de la Próstata Resistentes a la Castración/tratamiento farmacológico , Cintigrafía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Antagonistas de Andrógenos/administración & dosificación , Colina/administración & dosificación , Colina/química , Docetaxel/administración & dosificación , Docetaxel/química , Humanos , Masculino , Persona de Mediana Edad , Imagen Multimodal/métodos , Metástasis de la Neoplasia , Pronóstico , Supervivencia sin Progresión , Neoplasias de la Próstata Resistentes a la Castración/diagnóstico por imagen , Neoplasias de la Próstata Resistentes a la Castración/patología , Carga Tumoral/efectos de los fármacosRESUMEN
PURPOSE: Identification of pathologic parathyroid glands in primary hyperparathyroidism, traditionally based on neck ultrasound (US) and/or 99mTc-Sestamibi scintigraphy, can be challenging. PET/CT with 18F-Fluorocholine (18F-FCH) might improve the detection of pathologic parathyroid glands. We aimed at comparing the diagnostic performance of 18F-FCH-PET/CT with that of dual-phase dual-isotope parathyroid scintigraphy and neck US. METHODS: Thirty-four consecutive patients with primary hyperparathyroidism were prospectively enrolled, 7 had normocalcemic hyperparathyroidism, and 27 had classic hypercalcemic hyperparathyroidism. All patients underwent high-resolution neck US, dual-phase dual-isotope 99mTc-Pertechnetate/99mTc-Sestamibi scintigraphy, and 18F-FCH-PET/CT. RESULTS: In the whole patients' group, the detection rates of the abnormal parathyroid gland were 68% for neck US, 71% for 18F-FCH-PET/CT, and only 15% for 99mTc-Sestamibi scintigraphy. The corresponding figures in normocalcemic and hypercalcemic hyperparathyroidism were 57 and 70% for neck US, 70 and 71% for 18F-FCH-PET/CT, and 0 and 18% for 99mTc-Sestamibi scintigraphy, respectively. In the 17 patients in whom the abnormal parathyroid gland was identified, either at surgery or at fine needle aspiration cytology/biochemistry, the correct detection rate was 82% for neck US, 89% for 18F-FCH-PET/CT, and only 17% for 99mTc-Sestamibi scintigraphy. CONCLUSIONS: 18F-FCH-PET/CT can be considered a first-line imaging technique for the identification of pathologic parathyroid glands in patients with normocalcemic and hypercalcemic hyperparathyroidism, even when the parathyroid volume is small.
Asunto(s)
Colina/análogos & derivados , Hipercalcemia/patología , Hiperparatiroidismo/patología , Neoplasias de las Paratiroides/patología , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Cintigrafía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Hipercalcemia/diagnóstico por imagen , Hipercalcemia/cirugía , Hiperparatiroidismo/diagnóstico por imagen , Hiperparatiroidismo/cirugía , Masculino , Persona de Mediana Edad , Neoplasias de las Paratiroides/diagnóstico por imagen , Neoplasias de las Paratiroides/cirugía , Pronóstico , Radiofármacos , Ultrasonografía/métodosRESUMEN
Neuroendocrine tumours (NETs) are rare pathologies which origin from neuroectodermic and endodermic cells and that can produce peptides and amino acids. About 70% of NETs derive from gastroenterohepatic (GEP) system and the other 30% from the different sites through the body. They are distinguished into single and multiple localizations and also into sporadic, familial multiple endocrine-related forms and recurrent forms. Moreover, when they produce hormones they usually are symptomatic; yet, they are characterized by the synthesis and secretion in the blood stream of several tumor-specific markers or can express somatostatin receptors in their cellular surface. The diagnosis and follow-up of NETs rely on laboratory studies, histopathology and the combination of anatomical and functional imaging, with the latter being the main method for monitoring response to therapy. In recent years, nuclear medicine has contributed to the impressive development of the knowledge of NETs in terms of biology (receptor scintigraphy), pharmacology (development of new tracers) and therapy (radiometabolic therapy). Nuclear medicine procedures for diagnosis and treatment of NETs are based on the biological properties of these tumours: the expression of somatostatin receptors. Somatostatin receptor scintigraphy not only has a crucial role in diagnosis and staging of NETs, but also in assessing suitability for treatment with cold and radiolabelled somatostatin analogues, as well as in monitoring response to treatment and detecting recurrent disease. In conventional nuclear medicine, the two most important functional imaging modalities are ¹¹¹In-octrescan and ¹²³I-MIBG. Over the last 5 years, due to the development of new tracers, such as 68Ga labelled-DOTA-peptides PET and ¹8F-DOPA, PET has also been employed with significant benefits in the diagnosis and management of NETs.
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Neoplasias Gastrointestinales/diagnóstico por imagen , Tumores Neuroendocrinos/diagnóstico por imagen , Tomografía de Emisión de Positrones/métodos , Tomografía Computarizada de Emisión de Fotón Único/métodos , Neoplasias Gastrointestinales/metabolismo , Humanos , Tumores Neuroendocrinos/metabolismo , Receptores de Somatostatina/metabolismoRESUMEN
Endocrine tumors comprise a range of benign and malignant conditions that produce a spectrum of clinical symptoms and signs depending on the specific hormones they produce. The symptoms and presentations of these tumors are often independent of their size and location. Because of their expression of cell membrane receptors or production of specific types of hormones or peptides, endocrine tumors can be identified with functional radionuclide imaging much more readily compared to standard cross-sectional imaging. In recent years, 18F-fluoro-deoxy- D-glucose positron emission tomography (18F-FDG-PET) has emerged as a useful tool for diagnosing and assessing many tumors. In this review we describe how PET, using 18F-FDG and other radiopharmaceuticals can be useful in the diagnosis and management of a wide range of endocrine tumors.
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Neoplasias de las Glándulas Endocrinas/diagnóstico por imagen , Neoplasias de las Glándulas Suprarrenales/diagnóstico por imagen , Médula Suprarrenal/metabolismo , Carcinoma Neuroendocrino/diagnóstico por imagen , Catecolaminas , Síndrome de Cushing/etiología , Fluorodesoxiglucosa F18 , Humanos , Compuestos Organometálicos , Neoplasias de las Paratiroides/diagnóstico por imagen , Neoplasias Hipofisarias/diagnóstico por imagen , Tomografía de Emisión de Positrones/métodos , Radiofármacos , Receptores de Somatostatina/análisis , Neoplasias de la Tiroides/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodosRESUMEN
AIM: The aim of this study was to analyze the influence of scintigraphic uptake grade and tumour size on radio-guided surgery of neuroendocrine tumours (NETs) using 99mTc-EDDA/HYNIC-TOC (99mTc-octreotide). METHODS: We investigated 21 patients with NET (F=8, M=13) for localization of 27 known lesions using a gamma probe. Three to 6 hours before surgery, 550-650 MBq of 99mTc-octreotide was injected followed by immediate imaging prior to surgery. The uptake was graded on a scale from 0-4. Localization was confirmed by endoscopic ultrasound (EUS), computed tomography (CT) and/or magnetic resonance imaging (MRI). Morphological images were used to determine size of the lesion. Local measurements of radioactivity were performed during surgery using a gamma probe. RESULTS: Twenty lesions were successfully localized intraoperatively using a gamma probe (7=grade 4, 9=grade 3, 2=grade 2 and 2=grade 0). The size of successfully localized lesions ranged between 9 and 50 mm. Seven lesions were not localized successfully of which 6 were seen on scintigraphy (2=grade 4, 1=grade 3 and 3=grade 2). The 7th lesion was not seen on preoperative scintigraphy and not localized successfully. The size of unsuccessfully localized lesions ranged between 7 and 30 mm. CONCLUSIONS: High octreotide uptake (grade 3 and 4) influence radioguided surgery. Tumour size did not influence the success of localization of lesions by gamma probe.