RESUMO
BACKGROUND: According to the National Comprehensive Cancer Network Guidelines, 18F-fluciclovine PET/CT is considered appropriate after negative standard of care (SOC) imaging. OBJECTIVE: To prospectively compare 18F-fluciclovine to SOC imaging, investigate whether it should be done when SOC imaging is (+), and evaluate its detection rate in patients receiving androgen deprivation therapy. METHODS: We recruited 57 prostate cancer patients with biochemical recurrence with 18F-fluciclovine PET/CT and SOC imaging within 30 days. Prostate-specific antigen (PSA) level, Gleason score (GS), history of radical prostatectomy (RP), radiation therapy (RT) or hormone therapy (HT) were reviewed. RESULTS: The 57 patients had a median PSA of 2.6 and average GS of 7.4; 27 (47.4%) had RP, 28 (49.1%) had RT, 1 (1.75%) had HT and 1 (1.75%) observation only. 18F-fluciclovine identified disease recurrence in 45/57 patients (78.9%), including oligometastasis in 18/45 (40%). SOC imaging identified recurrent disease in 12/57 patients (21.1%) while 18F-fluciclvoine identified additional sites of disease in 11/12 (91.7%). The (+) 18F-fluciclovine studies had a median PSA 2.6 ng/ml compared to 6.0 ng/ml in the (+) SOC studies. CONCLUSION: 18F-fluciclovine was superior to SOC imaging for lesion detection, identification of oligometastasis and identification of additional sites of disease.
Assuntos
Antagonistas de Androgênios , Ácidos Carboxílicos , Ciclobutanos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias da Próstata , Humanos , Ácidos Carboxílicos/uso terapêutico , Ciclobutanos/uso terapêutico , Masculino , Estudos Prospectivos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/terapia , Neoplasias da Próstata/patologia , Idoso , Pessoa de Meia-Idade , Antagonistas de Androgênios/uso terapêutico , Padrão de Cuidado , United States Department of Veterans Affairs , Estados Unidos , Guias de Prática Clínica como Assunto , Idoso de 80 Anos ou mais , RecidivaRESUMO
Myocardial perfusion SPECT plays a crucial role in the diagnosis of coronary artery disease, providing a noninvasive tool to monitor ischemia and infarction. The findings can have a profound impact on diagnosis and management in these patients. However, incidental noncardiac findings on myocardial perfusion SPECT images can also affect management. These noncardiac subtleties are most often detected on the rotating raw SPECT images, which are often overlooked. The intent of this pictorial essay is to illustrate several subtle noncardiac abnormalities within nuclear cardiac imaging that can have an impact on patient management and follow-up.