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2.
Eur J Nucl Med Mol Imaging ; 50(8): 2432-2440, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-36988710

RESUMO

PURPOSE: The aim of this study was to compare [18F]FDG and [68Ga]Ga-PSMA-11 PET/CT image findings in patients with multiple myeloma (MM). METHODS: Twenty consecutive patients with symptomatic biopsy-proven MM were submitted to whole body [18F]FDG and [68Ga]Ga-PSMA-11 PET/CT with a time interval of 1-8 days between procedures. All lesions were counted and had their maximum SUV (SUVmax) measured. Intra-class correlation (ICC) was used to assess the agreement between [18F]FDG and [68Ga]Ga-PSMA-11 PET/CT findings. RESULTS: A total of 266 lesions were detected in 19/20 patients. [18F]FDG detected 223/266 (84%) lesions in 17 patients and [68Ga]Ga-PSMA-11 190/266 (71%) lesions in 19 patients. Both procedures did not identify any active lesion in 1 patient. Forty-three (16%) lesions were detected only by [68Ga]Ga-PSMA-11 and 76 (29%) only by [18F]FDG. Both tracers identified 147 (55%) lesions. Intralesional mismatch of FDG-PSMA uptake was identified in 25 of these 147 lesions, found in 8 different patients. Different lesions with uptake of only [18F]FDG or [68Ga]Ga-PSMA-11 in the same patient were found in 4 patients. The highest SUVmax of [18F]FDG and [68Ga]Ga-PSMA-11 had a median (min-max) SUVmax of 6.5 (2.0-37.8) and 5.5 (1.7-51.3), respectively. [18F]FDG and [68Ga]Ga-PSMA-11 respectively identified 18 and 19 soft tissue lesions. False-positive [18F]FDG findings had minimal or no uptake of [68Ga]Ga-PSMA-11. Good reliability (ICC ≥ 0.75) was found for number of lesions, number of soft tissue lesions and highest SUVmax in each patient. CONCLUSION: [18F]FDG or [68Ga]Ga-PSMA-11 alone can detect most MM lesions. Almost half of the lesions take up only one of the tracers, reflecting increased glycolysis or angiogenesis in specific lesions, and suggesting their possible complementary role in MM. The marked [68Ga]Ga-PSMA-11 uptake in some cases raises the possibility of a theranostic approach in selected patients.


Assuntos
Radioisótopos de Gálio , Mieloma Múltiplo , Humanos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Fluordesoxiglucose F18 , Mieloma Múltiplo/diagnóstico por imagem , Reprodutibilidade dos Testes
3.
Am J Nucl Med Mol Imaging ; 11(5): 352-362, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34754606

RESUMO

We reviewed the records of mCRPC patients treated with off-label use of Ra-223. Ra-223 efficiency in this non-study population was correlated to outcome measures overall survival (OS), progression-free survival (PFS), bone event-free survival, bone marrow failure (BMF), and disease-related biomarkers. There were no limits regarding the number of prior hormonal agents or chemotherapy received before or during Ra-223. Exclusion criteria consisted of baseline platelet counts below 50,000/mm3 and/or absolute neutrophil counts below 1,500/mm3. Twenty-eight patients received 130 cycles of Ra-223 between 2017 and 2018. The overall median OS was 15.6 months. However, in patients submitted to 4 or fewer cycles, the median OS was 9.1 months; in contrast, the median OS was 18.5 months in patients submitted to 5 or 6 cycles. There was a significant inverse correlation between the number of cycles and the occurrence of bone events (76.2% of the patients that completed 6 cycles did not present bone events, while 71.4% of the patients that had skeletal-related events were submitted to less than 6 cycles). 82.1% of the patients were submitted to concomitant therapies with no significant side effects. There was also a decrease in ALP and LDH levels throughout treatment. Radium-223 increased OS and decreased bone events, especially when patients were able to complete 5-6 cycles. The proper selection of patients is crucial to improve outcomes.

4.
Ann Nucl Med ; 35(2): 232-240, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33389651

RESUMO

INTRODUCTION: Radiosynovectomy (RS) with 90Y-hydroxyapatite (90Y-HyA) aims to control knee hemarthrosis in hemophiliac patients to prevent secondary arthropathy. However, knee RS using 153Sm-hydroxyapatite (153Sm-HyA) is considered less suitable due to the lower average soft tissue range and energy of 153Sm for large joints, such as the knees. PURPOSE: The objective of this investigation was to assess the efficacy and safety of knee RS with 153Sm-HyA, compared to 90Y-HyA. METHODS: Forty patients were prospectively assigned to undergo knee RS with 153Sm-HyA (n = 19) or with 90Y-HyA (n = 21). The frequency of hemarthrosis episodes before and after treatment were compared. RESULTS: After six months of knee RS, 153Sm-HyA and 90Y-HyA promoted a similar reduction of hemarthrosis episodes (50% and 66.7%, respectively). However, after 12 months of knee RS, the reduction of hemarthrosis episodes was significantly (p = 0.037) higher using 153Sm-HyA (87.5%) compared to 90Y-HyA (50.0%). This discrepancy was more pronounced (p = 0.002) for 153Sm-HyA compared to 90Y-HyA in adults/adolescents. CONCLUSION: Knee radiosynovectomy with 153Sm-HyA is safe, reduces hemarthrosis episodes after 12 months of treatments, especially in adults/adolescents and even with grades III/IV arthropathy, similar to 90Y-HyA. 90Y-HyA seems to promote better hemarthrosis control in small children.


Assuntos
Durapatita/química , Hemartrose/radioterapia , Articulação do Joelho/efeitos da radiação , Radioisótopos/química , Samário/química , Radioisótopos de Ítrio/química , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radioisótopos/efeitos adversos , Radioisótopos/uso terapêutico , Medição de Risco , Samário/efeitos adversos , Samário/uso terapêutico , Fatores de Tempo , Resultado do Tratamento , Radioisótopos de Ítrio/efeitos adversos , Radioisótopos de Ítrio/uso terapêutico
5.
Nucl Med Commun ; 41(10): 1081-1088, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32732603

RESUMO

PURPOSE: F-fluorodeoxiglucose (F-FDG)-PET/CT has been widely used to evaluate multiple myeloma. Tc-sestamibi (MIBI) scintigraphy has also been proposed for assessing multiple myeloma, but its use with state-of-the-art single-photon emission computed tomography/computed tomography (SPECT/CT) technology has not been fully evaluated.This study aimed to compare these two imaging modalities in multiple myeloma staging. MATERIALS AND METHODS: Sixty-two patients with recently diagnosed multiple myeloma were submitted to whole-body F-FDG-PET/CT and whole-body MIBI scans plus SPECT/CT of the chest and abdomen/pelvis. Number of focal lesions, contiguous soft tissue involvement (CSTI), extramedullary lesions (EMLs) and diffuse bone marrow (BM) involvement were recorded. RESULTS: PET/CT was positive in 59 patients (95%) and MIBI SPECT/CT in 58 (93%) (P = 0.69). MIBI detected more diffuse bone marrow involvement than PET/CT (respectively 78 vs. 58% of the patients), while PET/CT demonstrated more focal lesions than MIBI SPECT/CT (81 vs. 54% of the patients) (P = 0.002). PET/CT detected EMLs in four subjects and MIBI in one subject. CSTI was found in 28 (45%) and 23 (37%) patients on PET/CT and MIBI images, respectively (P = 0.36). Three patients with lytic lesions and no FDG uptake were MIBI positive, and two subjects with lytic lesions without MIBI uptake were FDG positive. CONCLUSION: MIBI SPECT/CT performs similarly to F-FDG-PET/CT in identifying sites of active disease in multiple myeloma staging. MIBI is more efficient than FDG for detecting the diffuse involvement of bone marrow but less efficient for detecting focal lesions. Some patients presented a 'mismatch' pattern of FDG/MIBI uptake.


Assuntos
Fluordesoxiglucose F18 , Mieloma Múltiplo/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tecnécio Tc 99m Sestamibi , Adulto , Idoso , Transporte Biológico , Difusão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/metabolismo
6.
Sci Rep ; 9(1): 16429, 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31712729

RESUMO

Many efforts have been made to standardize the interpretation of 18F-FDG PET/CT in multiple myeloma (MM) with qualitative visual analysis or with quantitative metabolic parameters using various methods for lesion segmentation of PET images. The aim of this study was to propose a quantitative method for bone and bone marrow evaluation of 18F-FDG PET/CT considering the extent and intensity of bone 18F-FDG uptake: Intensity of Bone Involvement (IBI). Whole body 18F-FDG PET/CT of 59 consecutive MM patients were evaluated. Compact bone tissue was segmented in PET images using a global threshold for HU of the registered CT image. A whole skeleton mask was created and the percentage of its volume with 18F-FDG uptake above hepatic uptake was calculated (Percentage of Bone Involvement - PBI). IBI was defined by multiplying PBI by mean SUV above hepatic uptake. IBI was compared with visual analysis performed by two experienced nuclear medicine physicians. IBI calculation was feasible in all images (range:0.00-1.35). Visual analysis categorized PET exams into three groups (negative/mild, moderate and marked bone involvement), that had different ranges of IBI (multi comparison analysis, p < 0.0001). There was an inverse correlation between the patients' hemoglobin values and IBI (r = -0.248;p = 0.02). IBI score is an objective measure of bone and bone marrow involvement in MM, allowing the categorization of patients in different degrees of aggressiveness of the bone disease. The next step is to validate IBI in a larger group of patients, before and after treatment and in a multicentre setting.


Assuntos
Osso e Ossos/diagnóstico por imagem , Osso e Ossos/patologia , Fluordesoxiglucose F18 , Mieloma Múltiplo/diagnóstico por imagem , Mieloma Múltiplo/patologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Osso e Ossos/metabolismo , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Mieloma Múltiplo/metabolismo , Osteólise , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos
7.
J Mov Disord ; 12(1): 43-46, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30732432

RESUMO

OBJECTIVE: Machado-Joseph disease (MJD) is a spinocerebellar ataxia, and osteoporosis is a multifactor disease that may affect patients with neurologic conditions. The frequency of osteoporosis among MJD patients, however, has not been studied. The purpose of this study is to evaluate bone mineral density (BMD) and identify correlations between clinical factors and frequency of vertebral fractures in patients with MJD. METHODS: Clinical data, lumbar X-rays and BMD data were obtained in 30 patients with MJD. RESULTS: Ten patients (33.3%) showed low BMD in at least one of the sites studied based on Z-scores. The Z-score correlated directly with body mass index, and the femoral neck Z-score was inversely correlated with cytosine-adenine-guanine (CAG) expansion. There was no correlation between BMD and other clinical factors. Forty-three percent of the patients reported previous pathologic fractures. Five patients (16.7%) had at least one fracture detected by lumbar X-ray. CONCLUSION: Low BMD and fractures are frequent among MJD patients, and careful management of BMD may be beneficial for these patients.

8.
Nucl Med Commun ; 39(5): 441-450, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29543624

RESUMO

BACKGROUND: Radioiodine-refractory thyroid carcinomas (RAIRs) are characterized by reduced expression of sodium-iodine symporter, rising serum thyroglobulin levels, and negative whole-body radioiodine scans. Interestingly, RAIRs continue to express somatostatin receptors and can be identified with Ga-DOTATATE PET/CT imaging. OBJECTIVE: The objective of this study was to compare lesion detectability in Ga-DOTATATE PET/CT performed with elevated thyroid-stimulating hormone (eTSH) levels with suppressed thyroid-stimulating hormone (sTSH) levels. PATIENTS AND METHODS: Fifteen patients with RAIR were prospectively enrolled in this pilot study. All patients underwent two Ga-DOTATATE PET/CT studies: with sTSH and with eTSH (after 30 days of levothyroxine withdrawal). All studies were blindly evaluated for differences pertaining to maximum standardized uptake values, detection of local recurrence, cervical lymph node (LN) metastases, cervical levels involved, distant LN metastases, lung metastases, and bone metastases. Reference standard consisted of fluorine-18-fluorodeoxyglucose PET/CT imaging, neck ultrasound, biopsy, and follow-up. RESULTS: Ga-DOTATATE PET/CT performed with both sTSH or eTSH was highly sensitive (91-100%) for detecting RAIR metastases. Ga-DOTATATE PET/CT with eTSH detected a higher total number of lesions (P=0.002), higher rate of cervical and distant LN metastases (P=0.002 and 0.0313, respectively), and significantly higher maximum standardized uptake values for cervical and distant LN metastases (P=0.0010 and 0.0078, respectively) when compared with sTSH. CONCLUSION: Ga-DOTATATE PET/CT presents a high sensitivity in detecting metastatic lesions in patients with RAIR. Detectability increases with iodine-resistance, both with and without higher thyroid-stimulating hormone levels. These findings might improve staging and subsequent treatment planning, especially with radiolabeled somatostatin analogs.


Assuntos
Radioisótopos do Iodo/uso terapêutico , Compostos Organometálicos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/metabolismo , Tireotropina/metabolismo , Adulto , Idoso , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Recidiva , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/radioterapia , Falha de Tratamento
9.
JAMA Otolaryngol Head Neck Surg ; 142(9): 834-41, 2016 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-27366869

RESUMO

IMPORTANCE: Single-photon emission computed tomography/computed tomography (SPECT/CT) and radioguided sentinel lymph node biopsy (rSLNB) are techniques that could potentially benefit surgeons and pathologists in the identification of sentinel lymph node (SLN) metastases in patients with papillary thyroid carcinoma (PTC). Evidence suggests that these novel techniques lead to substantial changes in PTC management by reducing understaging and of occult lymph node (LN) metastases and optimizing neck surgery by increasing the necessity of lateral lymphadenectomy and decreasing central lymphadenectomy. OBJECTIVES: To correlate the presence of LN metastases in PTC with clinical and pathological features using SPECT/CT and rSLNB. DESIGN, SETTING, AND PARTICIPANTS: For this prospective cohort study from June 2010 to November 2013, 42 patients with thyroid nodules suspicious for papillary carcinoma or classified as malignant on cytology examination without suspicion of lymph node metastases by clinical and ultrasound examinations were recruited from a single public medical institution. INTERVENTIONS: All 42 patients underwent preoperative lymphoscintigraphy after an ultrasound-guided peritumoral injection of Technetium Tc 99m nanocolloid. Cervical images were acquired with a SPECT/CT scanner 15 minutes after radiotracer injection. Approximately 2 hours after lymphoscintigraphy, the patients were submitted to intraoperative rSLNB using a handheld gamma probe. All SLNs identified were removed alongside with non-SLNs from the same compartment. Papillary thyroid carcinoma, SLNs and non-SLNs were submitted for histopathology and immunohistochemical analyses. RESULTS: Of the 42 patients initially enrolled, 37 were included in analysis, including 6 men and 31 women with a mean (range) age of 47 (22-83) years. Overall, T stage was as follows: T1, 23 patients (62.2%); T2, 8 patients (21.6%); and T3, 6 patients (16.2%). Sentinel lymph nodes were identified in 92% of the patients, and among these metastases were present in 17 patients (46%). The SLNs were false-negative in 3 patients. Metastases in the lateral compartment ocurred in 7 patients (18%). There was a significant association between LN metastases and tumor size (odds ratio, 1.06; 95% CI, 1.00-1.13; P = .02), with a Cohen d effect of 0.683 (medium to large effect). Overall, 17 patients (46%) with LN metastases had management changed because they were submitted to higher radioiodine ablation doses and closer clinical surveillance. CONCLUSIONS AND RELEVANCE: Radioguided SLNB is able to detect occult cervical lymph node metastases in patients with papillary thyroid carcinoma, and in 7 patients (18%) rSLNB detected lymph node metastases in the lateral compartments. The rSLNB technique lead to management change in 14 patients (37.8%).


Assuntos
Carcinoma/patologia , Metástase Linfática/diagnóstico , Biópsia de Linfonodo Sentinela/métodos , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Neoplasias da Glândula Tireoide/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Papilar , Estudos de Coortes , Feminino , Humanos , Linfocintigrafia , Masculino , Pessoa de Meia-Idade , Compostos Radiofarmacêuticos , Agregado de Albumina Marcado com Tecnécio Tc 99m , Câncer Papilífero da Tireoide , Adulto Jovem
10.
Arq Bras Endocrinol Metabol ; 58(3): 292-300, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24863093

RESUMO

OBJECTIVE: Current guidelines have advised against the performance of (131)I-iodide diagnostic whole body scintigraphy (dxWBS) to minimize the occurrence of stunning, and to guarantee the efficiency of radioiodine therapy (RIT). The aim of the study was to evaluate the impact of stunning on the efficacy of RIT and disease outcome. SUBJECTS AND METHODS: This retrospective analysis included 208 patients with differentiated thyroid cancer managed according to a same protocol and followed up for 12-159 months (mean 30 ± 69 months). Patients received RIT in doses ranging from 3,700 to 11,100 MBq (100 mCi to 300 mCi). Post-RIT-whole body scintigraphy images were performed 10 days after RIT in all patients. In addition, images were also performed 24-48 hours after therapy in 22 patients. Outcome was classified as no evidence of disease (NED), stable disease (SD) and progressive disease (PD). RESULTS: Thyroid stunning occurred in 40 patients (19.2%), including 26 patients with NED and 14 patients with SD. A multivariate analysis showed no association between disease outcome and the occurrence of stunning (p = 0.3476). CONCLUSION: The efficacy of RIT and disease outcome do not seem to be related to thyroid stunning.


Assuntos
Adenocarcinoma Folicular/radioterapia , Carcinoma Papilar/radioterapia , Radioisótopos do Iodo/uso terapêutico , Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/radioterapia , Adulto , Progressão da Doença , Feminino , Humanos , Radioisótopos do Iodo/administração & dosagem , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Cintilografia , Estudos Retrospectivos , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/classificação , Tireoidectomia , Resultado do Tratamento , Imagem Corporal Total
11.
Ultrasound Med Biol ; 40(7): 1414-9, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24726797

RESUMO

The purpose of this study was to verify the performance of quantitative ultrasound (QUS) parameters of proximal phalanges in the evaluation of reduced bone mineral density (BMD) in patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency (21 OHD). Seventy patients with 21 OHD (41 females and 29 males), aged between 6-27 y were assessed. The QUS measurements, amplitude-dependent speed of sound (AD-SoS), bone transmission time (BTT), and ultrasound bone profile index (UBPI) were obtained using the BMD Sonic device (IGEA, Carpi, Italy) on the last four proximal phalanges in the non-dominant hand. BMD was determined by dual energy X-ray (DXA) across the total body and lumbar spine (LS). Total body and LS BMD were positively correlated to UBPI, BTT and AD-SoS (correlation coefficients ranged from 0.59-0.72, p < 0.001). In contrast, when comparing patients with normal and low (Z-score < -2) BMD, no differences were found in the QUS parameters. Furthermore, UBPI, BTT and AD-SoS measurements were not effective for diagnosing patients with reduced BMD by receiver operator characteristic curve parameters. Although the AD-SoS, BTT and UBPI showed significant correlations with the data obtained by DXA, they were not effective for diagnosing reduced bone mass in patients with 21 OHD.


Assuntos
Absorciometria de Fóton/métodos , Hiperplasia Suprarrenal Congênita/complicações , Densidade Óssea , Técnicas de Imagem por Elasticidade/métodos , Falanges dos Dedos da Mão/diagnóstico por imagem , Osteoporose/diagnóstico , Osteoporose/fisiopatologia , Adolescente , Hiperplasia Suprarrenal Congênita/diagnóstico , Hiperplasia Suprarrenal Congênita/fisiopatologia , Adulto , Criança , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Osteoporose/etiologia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto Jovem
12.
Arq. bras. endocrinol. metab ; Arq. bras. endocrinol. metab;58(3): 292-300, abr. 2014. tab, graf
Artigo em Inglês | LILACS | ID: lil-709355

RESUMO

Objective : Current guidelines have advised against the performance of 131I-iodide diagnostic whole body scintigraphy (dxWBS) to minimize the occurrence of stunning, and to guarantee the efficiency of radioiodine therapy (RIT). The aim of the study was to evaluate the impact of stunning on the efficacy of RIT and disease outcome.Subjects and methods : This retrospective analysis included 208 patients with differentiated thyroid cancer managed according to a same protocol and followed up for 12-159 months (mean 30 ± 69 months). Patients received RIT in doses ranging from 3,700 to 11,100 MBq (100 mCi to 300 mCi). Post-RIT-whole body scintigraphy images were performed 10 days after RIT in all patients. In addition, images were also performed 24-48 hours after therapy in 22 patients. Outcome was classified as no evidence of disease (NED), stable disease (SD) and progressive disease (PD).Results : Thyroid stunning occurred in 40 patients (19.2%), including 26 patients with NED and 14 patients with SD. A multivariate analysis showed no association between disease outcome and the occurrence of stunning (p = 0.3476).Conclusion : The efficacy of RIT and disease outcome do not seem to be related to thyroid stunning. Arq Bras Endocrinol Metab. 2014;58(3):292-300.


Objetivo : As diretrizes atuais alertam contra a execução da cintigrafia de corpo inteiro com iodo-131 (dxWBS) para minimizar a ocorrência de atordoamento e garantir a eficiência do tratamento com radioiodo (RIT). O objetivo deste estudo foi avaliar o impacto do atordoamento sobre a eficácia do RIT e desfechos da doença.Sujeitos e métodos : Esta análise retrospectiva incluiu 208 pacientes com câncer diferenciado de tireoide submetidos ao mesmo protocolo e acompanhados por 12-159 semanas (média de 30 ± 69 meses). Os pacientes receberam RIT com doses variando de 3.700 a 11.100 MBq (100 mCi a 300 mCi). As imagens da cintigrafia após a RIT foram feitas 10 dias depois da RIT em todos os pacientes. Além disso, as imagens foram também obtidas após 24-48h em 22 pacientes. O desfecho foi classificado como nenhuma evidência de doença (NED), doença estável (SD) e doença progressiva (PD).Resultados : O atordoamento da tireoide ocorreu em 40 pacientes (19,2%), incluindo 26 pacientes com NED e 14 pacientes com SD. A análise multivariada não mostrou associação entre o desfecho da doença e a ocorrência de atordoamento (p = 0,3476).Conclusão : A eficácia da RIT e o desfecho da doença não parecem estar relacionados com o atordoamento da tireoide. Arq Bras Endocrinol Metab. 2014;58(3):292-300.


Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adenocarcinoma Folicular/radioterapia , Carcinoma Papilar/radioterapia , Radioisótopos do Iodo/uso terapêutico , Glândula Tireoide , Neoplasias da Glândula Tireoide/radioterapia , Progressão da Doença , Radioisótopos do Iodo/administração & dosagem , Análise Multivariada , Estudos Retrospectivos , Tireoidectomia , Resultado do Tratamento , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/classificação , Imagem Corporal Total
13.
Nucl Med Commun ; 35(3): 252-9, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24300379

RESUMO

PURPOSE OF THE REPORT: Although MRI is utilized for planning the resection of soft-tissue tumors, it is not always capable of differentiating benign from malignant lesions. The risk of local recurrence of soft-tissue sarcomas is increased when biopsies are performed before resection and by inadequate resections. PET associated with computed tomography using fluorodeoxyglucose labeled with fluorine-18 ((18)F-FDG PET/CT) may help differentiate between benign and malignant tumors, thus avoiding inadequate resections and making prior biopsies unnecessary. The purpose of this study was to evaluate the usefulness of (18)F-FDG PET/CT in differentiating benign from malignant solid soft-tissue lesions. MATERIALS AND METHODS: Patients with solid lesions of the limbs or abdominal wall detected by MRI were submitted to (18)F-FDG PET/CT. The maximum standardized uptake value (SUVmax) cutoff was determined to differentiate malignant from benign tumors. Regardless of the (18)F-FDG PET/CT results all patients underwent biopsy and surgery. RESULTS: MRI was performed in 54 patients, and 10 patients were excluded because of purely lipomatose or cystic lesions. (18)F-FDG PET/CT was performed in the remaining 44 patients. Histopathology revealed 26 (59%) benign and 18 (41%) malignant soft-tissue lesions. A significant difference in SUVmax was observed between benign and malignant soft-tissue lesions. The SUVmax cutoff of 3.0 differentiated malignant from benign lesions with 100% sensitivity, 83.3% specificity, 89.6% accuracy, 78.3% positive predictive value, and 100% negative predictive value. CONCLUSION: (18)F-FDG PET/CT seems to be able to differentiate benign from malignant soft-tissue lesions with good accuracy and very high negative predictive value. Incorporating (18)F-FDG PET/CT into the diagnostic algorithm of these patients may prevent inadequate resections and unnecessary biopsies.


Assuntos
Fluordesoxiglucose F18 , Imagem Multimodal , Tomografia por Emissão de Pósitrons , Neoplasias de Tecidos Moles/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
14.
Front Neurol ; 4: 207, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24391625

RESUMO

Cerebrovascular lesions are frequently observed in patients with sickle-cell disease (SCD) and these structural lesions are preceded by insidious perfusion deficits. Our aim was to investigate the presence of brain perfusion deficits in neurologically asymptomatic SCD patients, especially affecting microvessels. For this study, 42 SCD patients [33 sickle-cell anemia (HbSS), 6 sickle hemoglobin C disease (HbSC), and 3 sickle ß-thalassemia disease (HbSß)] with mean hematocrit of 25.1 (±4.85; 15.6-38.5) underwent brain perfusion single photon emission computerized tomography (SPECT) using the tracer (99m)Tc-ECD. Images from SCD patients were compared to images of a healthy control group (29 females and 20 males, mean age 31 ± 8; range 25-49 years). Images underwent voxel-wise comparison of regional tracer uptake using paired t-test to estimate the probability of each voxel to have an increased or decreased tracer uptake. When compared to controls, SCD patients exhibited significantly reduced tracer uptake in basal ganglia and thalami, the anterior frontal region and the watershed region of the temporo-parietal-occipital transition (p < 0.05). Our study showed that neurologically asymptomatic adult SCD patients exhibit a pattern of reduced (99m)Tc-ECD tracer uptake demonstrated by SPECT. Early diagnosis of this cerebral vasculopathy has prognostic implications and can be determinant in considering therapeutic alternatives to avoid increasing brain lesion load and progressive disability.

15.
Clin Nutr ; 32(1): 45-50, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22647418

RESUMO

BACKGROUND & AIM: Congenital adrenal hyperplasia due to 21-hydroxylase deficiency is associated with a high risk for obesity. Anthropometric measures are simple and inexpensive methods to assess body fat. However, the accuracy of alternative methods in these patients is unknown. This study aim to develop and evaluate the accuracy of predictive anthropometric equations in the estimation of percent body fat in individuals with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. METHODS: A total of 31 female and 22 male patients, aged 7-20 years, were evaluated. Dual-energy X-ray absorptiometry was used as the reference method for body fat, and anthropometric measurements were performed. RESULTS: Three new predictive equations showed similar results: Equation (1) (R² = 0.85; SEE = 2.89%), Equation (2) (R² = 0.86; SEE = 2.82%), and Equation (3) (R² = 0.86; SEE = 2.81%). Internal cross-validation procedures showed a high R² (range, 0.84-0.85) and low SEE (<3%). The limits of agreement ranged from -5.6% to 5.6% and no trend was observed. CONCLUSION: In children and adolescents with congenital adrenal hyperplasia due to 21-hydroxylase deficiency, three new predictive equations were validated for the estimation of percent body fat, with dual-energy X-ray absorptiometry as the reference method.


Assuntos
Adiposidade , Hiperplasia Suprarrenal Congênita/fisiopatologia , Modelos Biológicos , Obesidade/diagnóstico , Sobrepeso/diagnóstico , Absorciometria de Fóton , Adolescente , Desenvolvimento do Adolescente , Hiperplasia Suprarrenal Congênita/patologia , Adulto , Algoritmos , Antropometria/métodos , Índice de Massa Corporal , Pesos e Medidas Corporais , Criança , Desenvolvimento Infantil , Feminino , Humanos , Masculino , Obesidade/diagnóstico por imagem , Obesidade/etiologia , Obesidade/patologia , Sobrepeso/diagnóstico por imagem , Sobrepeso/etiologia , Sobrepeso/patologia , Caracteres Sexuais , Adulto Jovem
16.
Eur J Nucl Med Mol Imaging ; 39(11): 1730-6, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22949079

RESUMO

PURPOSE: Bone scintigraphy (BS) has been used extensively for many years for the diagnosis of bone metastases despite its low specificity and significant rate of equivocal lesions. (18)F-Fluoride PET/CT has been proven to have a high sensitivity and specificity in the detection of malignant bone lesions, but its effectiveness in patients with inconclusive lesions on BS is not well documented. This study evaluated the ability of (18)F-fluoride PET/CT to exclude bone metastases in patients with various malignant primary tumours and nonspecific findings on BS. METHODS: We prospectively studied 42 patients (34-88 years of age, 26 women) with different types of tumour. All patients had BS performed for staging or restaging purposes but with inconclusive findings. All patients underwent (18)F-fluoride PET/CT. All abnormalities identified on BS images were visually compared with their appearance on the PET/CT images. RESULTS: All the 96 inconclusive lesions found on BS images of the 42 patients were identified on PET/CT images. (18)F-Fluoride PET/CT correctly excluded bone metastases in 23 patients (68 lesions). Of 19 patients (28 lesions) classified by PET/CT as having metastases, 3 (5 lesions) were finally classified as free of bone metastases on follow-up. The sensitivity, specificity, and positive and negative predictive values of (18)F-fluoride PET/CT were, respectively, 100 %, 88 %, 84 % and 100 % for the identification of patients with metastases (patient analysis) and 100 %, 82 % and 100 % for the identification of metastatic lesions (lesion analysis). CONCLUSION: The factors that make BS inconclusive do not affect (18)F-fluoride PET/CT which shows a high sensitivity and negative predictive value for excluding bone metastases even in patients with inconclusive conventional BS.


Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Fluordesoxiglucose F18 , Imagem Multimodal , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
17.
Clin Nucl Med ; 37(6): 550-4, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22614185

RESUMO

PURPOSE: To investigate the factors influencing the success rate in a fixed, 15 mCi approach for treatment of Graves' hyperthyroidism. MATERIAL AND METHODS: The thyroid function outcome (hyperthyroidism or euthyroidism/hypothyroidism) was verified at least 1 year after radioiodine therapy (RIT) retrospectively and compared with presenting clinical characteristics and pre-RIT parameters in 87 patients treated with I-iodide for Graves' disease in a tertiary care center. RESULTS: After RIT, 16 patients (18.4%) became euthyroid, 54 patients (62.1%) became hypothyroid, and 17 (19.5%) remained hyperthyroid. We found no statistically significant association between thyroid function outcome and gender (P = 0.50), ophthalmopathy (P = 0.69), drug used (methimazole or propylthiouracil; P = 1.00), maintenance or withdrawal of thionamides pre-RIT (P = 0.98), or 99mTc sodium pertechnetate thyroid uptake prior to RIT (P = 0.75). The only variable associated with the success rate was thyroid mass <62 g (P < 0.001). CONCLUSIONS: Our study has shown that a fixed 15 mCi approach for treatment of Graves' disease was effective, but high failure rates were observed in patients presenting larger goiters, particularly those with estimated thyroid mass >62 g.


Assuntos
Doença de Graves/radioterapia , Adolescente , Adulto , Idoso , Feminino , Doença de Graves/patologia , Humanos , Radioisótopos do Iodo/uso terapêutico , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão/efeitos da radiação , Estudos Retrospectivos , Glândula Tireoide/patologia , Glândula Tireoide/efeitos da radiação , Falha de Tratamento , Adulto Jovem
18.
Arq. bras. endocrinol. metab ; Arq. bras. endocrinol. metab;54(9): 807-812, dez. 2010. ilus, tab
Artigo em Inglês | LILACS | ID: lil-578361

RESUMO

OBJECTIVE: Evaluate the efficacy of cumulative doses (CDs) of 131I-iodide therapy (RIT) in differentiated thyroid cancer (DTC). SUBJECTS AND METHODS: The probability of progressive disease according to CDs was evaluated in patients < 45 years old and > 45 years old and correlated to tumor-node-metastasis (TNM), thyroglobulin values, histological types and variants, age, and zduration of the disease. RESULTS: At the end of a follow-up period of 69 ± 56 months, 85 out of 150 DTC patients submitted to fixed doses RIT had no evidence of disease, 47 had stable disease and 18 had progressive disease. Higher CDs were used in the more aggressive variants (p < 0.0001), higher TNM stages (p < 0.0001), and follicular carcinomas (p = 0.0034). Probability of disease progression was higher with CDs > 600 mCi in patients > 45 years old and with CDs > 800 mCi in patients < 45 years. CONCLUSION: Although some patients may still respond to high CDs, the impact of further RIT should be carefully evaluated and other treatment strategies may be warranted.


OBJETIVO: Avaliar a eficácia de doses cumulativas (DCs) da terapia com iodeto-131I (RIT) no câncer diferenciado de tiroide (CDT). SUJEITOS E MÉTODOS: A probabilidade de doença em progressão conforme a DC foi calculada em pacientes com idade < 45 e > 45 anos e correlacionada com o TNM, valores de tiroglobulina sérica, tipos histológicos e variantes, idade e tempo de doença. RESULTADOS: Ao final de um seguimento de 69 ± 56 meses, 85 dos 150 pacientes CDT submetidos a doses fixas de RIT não tinham evidência de doença, 47 tinham doença estável e 18, doença progressiva. DCs mais elevadas foram usadas nas variantes agressivas (p < 0,0001), maior estágio TNM (p < 0,0001) e nos carcinomas foliculares (p = 0,0034). A probabilidade de doença em progressão foi maior com DCs > 600 mCi em pacientes > 45 anos e com DCs > 800 mCi em pacientes < 45 anos. CONCLUSÃO: Apesar de alguns pacientes ainda responderem a altas DCs, o impacto de RITs deve ser cuidadosamente avaliado e outras estratégias terapêuticas devem ser consideradas.


Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Papilar/radioterapia , Radioisótopos do Iodo/administração & dosagem , Neoplasias da Glândula Tireoide/radioterapia , Carcinoma Papilar/metabolismo , Carcinoma Papilar/secundário , Progressão da Doença , Relação Dose-Resposta à Radiação , Métodos Epidemiológicos , Radioisótopos do Iodo/efeitos adversos , Resultado do Tratamento
19.
Nucl Med Commun ; 31(11): 925-30, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20856153

RESUMO

PURPOSE: To assess the impact of [F-18] FDG-PET/CT on the restaging and changing management of patients with malignant melanoma. METHODS: Seventy-eight patients (32 female, 27-83 years) were reviewed. Treatment planning before and after [F-18] FDG-PET/CT scan was evaluated for changes in the management of the disease. Restaging was classified according to the disease extent as follows: local recurrence, locoregional recurrence or distant recurrence. Initial restaging of patients was as follows: local recurrence in 11 patients, locoregional recurrence in 23 patients and distant recurrence in 44 of 78 patients. All the patients were injected with 370 MBq of [F-18] FDG and imaged from the head to feet after 60 min. All the patients fasted for 4-6 h before imaging and blood glucose levels were below 140 mg/dl. Images were taken using a PET/CT scanner (Siemens Biograph). Two nuclear medicine physicians and a radiologist (all experienced in oncology) interpreted the images. RESULTS: In 27% of the patients the management was changed after the [F-18] FDG-PET/CT studies. Upstaging from locoregional recurrence to distant recurrence occurred in a striking 5 of 23 (22%) patients. The sensitivity, specificity and positive and negative predictive values for lesion detection were 95%, and accuracy was 94.9%. There were two false-positive and two false-negative studies. CONCLUSION: [F-18] FDG-PET/CT seems to be a valuable diagnostic tool in restaging and management of patients with malignant melanoma suspected of recurrence especially in patients with locoregional recurrence and distant recurrence.


Assuntos
Fluordesoxiglucose F18 , Melanoma/patologia , Melanoma/terapia , Estadiamento de Neoplasias/métodos , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Melanoma/diagnóstico por imagem , Pessoa de Meia-Idade , Estudos Retrospectivos
20.
Urology ; 76(2): 283-8, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20206974

RESUMO

OBJECTIVE: To evaluate the utility of diuretic dynamic renal scintigraphy (DDRS) with technetium-99m-L,L-ethylenedicysteine ((99m)Tc-EC) in patients with indeterminate or possible false-positive results for urinary obstruction by technetium-99m diethylenetriamine penta-acetic acid ((99m)Tc-DTPA) DDRS. METHODS: A total of 92 patients (63 male; mean age, 16.6 +/- 21.25 years) were studied, with a total of 103 kidneys presenting indeterminate (20/103) or possible false-positive results for obstruction attributable to reduced renal function or severe kidney dilation (83/103) by (99m)Tc-DTPA DDRS (<60% of radiopharmaceutical excreted in 20 minutes-half-time clearance [T(1/2)] >15 minutes). Patients were reimaged after intravenous injection of (99m)Tc-EC, with dynamic images before and after furosemide administration using the same acquisition parameters applied in the previous (99m)Tc-DTPA study. Time interval between (99m)Tc-DTPA and (99m)Tc-EC renograms was 2-64 days. The percentage of excreted material 20 minutes after furosemide was calculated using both radiopharmaceuticals, and were statistically compared using the paired samples t test. RESULTS: The excretion after furosemide injection was 25.3% +/- 18.2% for (99m)Tc-DTPA and 41.2% +/- 26.1% for (99m)Tc-EC, with a statistically significant difference between both radiopharmaceuticals (P <.0001). Using (99m)Tc-EC obstruction was excluded in 36 of 103 kidneys, which excreted >60%. A total of 10 of 83 kidneys (12.0%) with an obstructive pattern by (99m)Tc-DTPA study turned out to be indeterminate by (99m)Tc-EC DDRS. There was an agreement between (99m)Tc-EC and (99m)Tc-DTPA studies in 54 of 83 kidneys with obstructive (65.1%) and in 3 of 20 (15.0%) with indeterminate patterns. CONCLUSIONS: (99m)Tc-EC was more effective than (99m)Tc-DTPA for excluding obstruction, presenting less false-positive and indeterminate results. (99m)Tc-EC can substitute (99m)Tc-DTPA to evaluate patients with urinary tract dilation.


Assuntos
Cisteína/análogos & derivados , Pelve Renal , Compostos de Organotecnécio , Compostos Radiofarmacêuticos , Pentetato de Tecnécio Tc 99m , Obstrução Ureteral/diagnóstico por imagem , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Dilatação Patológica , Reações Falso-Positivas , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Cintilografia , Adulto Jovem
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