RESUMEN
OBJECTIVES: This study was aimed at correlating a magnetic resonance index of activity (MaRIA) and a magnetic resonance enterography global score (MEGS) with activity indexes in a paediatric population with Crohn's disease (CD). METHODS: This retrospective study included 32 paediatric patients (median age 14.5 years, 18 male) with proven CD who underwent magnetic resonance enterography (MRE). A correlation analysis was performed on the MRE-based scores, the simplified endoscopic score for CD (SES-CD), the paediatric Crohn's disease activity index (PCDAI), and C-reactive protein (CRP) levels. Based on PCDAI, comparison of both global MaRIA and MEGS was made between patients with mild and moderate/severe disease activity. RESULTS: Global MaRIA correlated with SES-CD (r = 0.70, p = 0.001) and PCDAI (r = 0.42, p = 0.016). MEGS correlated with PCDAI (r = 0.46, p = 0.007) and CRP levels (r = 0.35, p = 0.046). MEGS differed significantly (p = 0.027) between patients grouped by clinical disease severity. CONCLUSIONS: MRE-based global scores correlated with clinical indexes of CD activity. Therefore, they represent a potential useful tool to predict CD activity and severity, as well as a possible promising alternative to endoscopy, to monitor paediatric patients with CD during their follow-up. KEY POINTS: ⢠MRE is widely used to for accurate assessment of CD. ⢠Global MaRIA and MEGS have been suggested as indicators of CD activity. ⢠Paediatric studies comparing MRE-based global scores with clinical CD activity are lacking. ⢠Such scores can serve as predictors of CD activity/severity in paediatric patients. ⢠MRE offers an alternative to clinical score/endoscopy for paediatric CD monitoring.
Asunto(s)
Enfermedad de Crohn/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Adolescente , Adulto , Niño , Colon/diagnóstico por imagen , Colon/patología , Enfermedad de Crohn/patología , Femenino , Humanos , Íleon/diagnóstico por imagen , Íleon/patología , Masculino , Reproducibilidad de los Resultados , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
OBJECTIVES: To estimate an optimal follow-up (FU) interval for von Hippel-Lindau (VHL) patients with renal masses (RMs) by determining tumour growth rates from growth curves. METHODS: Thirty lesions (47.6%) were classified as solid tumours (STs) and 33 (52.4%) as complex cysts (CCs). Variations in lesion volume over time were analyzed. For 53 lesions, we calculated the growth rate during the period when the volume of the lesion changed most rapidly, and called this the fast growth rate (FGR). RESULTS: The STs initially grew fast, followed by a period of slower growth. The CCs varied in volume over time, associated with variable amounts of their fluid component. The FGR correlated better with the latest volume for STs (r = 0.905) than for CCs (r = 0.780). An optimal FU interval between 3 and 12 months was derived by combining the FGR calculated from the curve with the latest volume measured. CONCLUSIONS: Analyzing growth curves and related kinetic parameters for RMs in VHL patients could be useful with a view to optimizing the subsequent FU interval and improving the active surveillance program. KEY POINTS: ⢠Measuring volume changes over time enables tumour growth curves to be charted. ⢠Renal solid tumours increase in volume with a typical sigmoidal curve. ⢠Complex cysts may increase and decrease in volume spontaneously over time. ⢠The fast growth rate of solid tumours correlates with their latest volume. ⢠The fast growth rate can orient the scheduling of subsequent follow-ups.
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Enfermedades Renales Quísticas/patología , Neoplasias Renales/patología , Enfermedad de von Hippel-Lindau/patología , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Carga Tumoral , Espera Vigilante , Adulto JovenRESUMEN
Tracheobronchomalacia (TBM) is defined as an excessive collapse of the intrathoracic trachea. Bronchoscopy is the gold standard for diagnosing TBM; however it has major disadvantages, such as general anaesthesia. Cine computed tomography (CT) is a noninvasive alternative used to diagnose TBM, but its use in children is restricted by ionising radiation. Our aim was to evaluate the feasibility of spirometer-controlled cine magnetic resonance imaging (MRI) as an alternative to cine-CT in a retrospective study. 12 children with a mean age (range) of 12 years (7-17 years), suspected of having TBM, underwent cine-MRI. Static scans were acquired at end-inspiration and expiration covering the thorax using a three-dimensional spoiled gradient echo sequence. Three-dimensional dynamic scans were performed covering only the central airways. TBM was defined as a decrease of the trachea or bronchi diameter >50% at end-expiration in the static and dynamic scans. The success rate of the cine-MRI protocol was 92%. Cine-MRI was compared with bronchoscopy or chest CT in seven subjects. TBM was diagnosed by cine-MRI in seven (58%) out of 12 children and was confirmed by bronchoscopy or CT. In four patients, cine-MRI demonstrated tracheal narrowing that was not present in the static scans. Spirometer controlled cine-MRI is a promising technique to assess TBM in children and has the potential to replace bronchoscopy.
Asunto(s)
Imagen por Resonancia Cinemagnética/métodos , Traqueobroncomalacia/diagnóstico , Adolescente , Broncoscopía , Niño , Femenino , Humanos , Masculino , Respiración , Estudios Retrospectivos , Espirometría/métodos , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: (18)F-fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT) has proved effective in detecting recurrent or metastatic differentiated thyroid carcinoma (DTC) in the follow-up of operated DTC patients with high thyroglobulin (Tg) levels and negative findings on radioiodine whole-body scan. The aim of this retrospective study was to assess the impact of PET/CT on the planning of appropriate treatment for known recurrent disease in operated DTC patients. MATERIALS AND METHODS: The study concerned 44 consecutive DTC patients (36 papillary, 8 follicular), who underwent total thyroidectomy and thyroid remnant ablation with (131)I and PET/CT. All patients had proven or strongly suspected recurrent disease judging from neck ultrasound (US) and fine-needle aspiration cytology, and detectable basal Tg levels. RESULTS: PET/CT findings were positive in 25/44 patients (56.81 %) and negative in 19. A positive PET/CT result predicted resectable tumour recurrences in 19/25 patients, but also detected additional tumour sites that prompted changes to the treatment plan in 6/25 patients (24 %). A negative PET/CT result led to clinical monitoring for 11/19 patients (57.89 %). CONCLUSIONS: PET/CT can help select patients, who might benefit from a tailored therapy by improving the detection of local recurrences not apparent on neck US or metastases.
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Imagen Multimodal , Recurrencia Local de Neoplasia/diagnóstico por imagen , Neoplasias de la Tiroides/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja Fina , Femenino , Fluorodesoxiglucosa F18 , Humanos , Interpretación de Imagen Asistida por Computador , Radioisótopos de Yodo , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Planificación de Atención al Paciente , Tomografía de Emisión de Positrones , Valor Predictivo de las Pruebas , Radiofármacos , Estudios Retrospectivos , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To evaluate the clinical value of combining one-view mammography (cranio-caudal, CC) with the complementary view tomosynthesis (mediolateral-oblique, MLO) in comparison to standard two-view mammography (MX) in terms of both lesion detection and characterization. METHODS: A free-response receiver operating characteristic (FROC) experiment was conducted independently by six breast radiologists, obtaining data from 463 breasts of 250 patients. Differences in mean lesion detection fraction (LDF) and mean lesion characterization fraction (LCF) were analysed by analysis of variance (ANOVA) to compare clinical performance of the combination of techniques to standard two-view digital mammography. RESULTS: The 463 cases (breasts) reviewed included 258 with one to three lesions each, and 205 with no lesions. The 258 cases with lesions included 77 cancers in 68 breasts and 271 benign lesions to give a total of 348 proven lesions. The combination, DBT(MLO)+MX(CC), was superior to MX (CC+MLO) in both lesion detection (LDF) and lesion characterization (LCF) overall and for benign lesions. DBT(MLO)+MX(CC) was non-inferior to two-view MX for malignant lesions. CONCLUSIONS: This study shows that readers' capabilities in detecting and characterizing breast lesions are improved by combining single-view digital breast tomosynthesis and single-view mammography compared to two-view digital mammography. KEY POINTS: ⢠Digital breast tomosynthesis is becoming adopted as an adjunct to mammography (MX) ⢠DBT (MLO) +MX (CC) is superior to MX (CC+MLO) in lesion detection (overall and benign lesions) ⢠DBT (MLO) +MX (CC) is non-inferior to MX (CC+MLO) in cancer detection ⢠DBT (MLO) +MX (CC) is superior to MX (CC+MLO) in lesion characterization (overall and benign lesions) ⢠DBT (MLO) +MX (CC) is non-inferior to MX (CC+MLO) in characterization of malignant lesions.
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Neoplasias de la Mama/diagnóstico por imagen , Imagenología Tridimensional/métodos , Mamografía/métodos , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Adulto , Anciano , Anciano de 80 o más Años , Mama/patología , Reacciones Falso Positivas , Femenino , Humanos , Persona de Mediana Edad , Imagen Multimodal/métodos , Variaciones Dependientes del Observador , Curva ROC , Intensificación de Imagen Radiográfica/métodos , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVE: To determine the performance of combined single-view mediolateral oblique (MLO) digital breast tomosynthesis (DBT) plus single-view cranio-caudal (CC) mammography (MX) compared with that of standard two-view digital mammography. METHODS: A multi-reader multi-case (MRMC) receiver-operating characteristic (ROC) study was conducted, involving six breast radiologists. Two hundred fifty patients underwent bilateral MX and DBT imaging. MX and DBT images with the adjunct of the CC-MX view from 469 breasts were evaluated and rated independently by six readers. Differences in mean areas under the ROC curves (AUCs), mean sensitivity and mean specificity were analysed by analysis of variance (ANOVA) to assess clinical performance. RESULTS: The combined technique was found to be non-inferior to standard two-view mammography (MX((CC+MLO))) in mean AUC (difference: +0.021;95 % LCL = -0.011), but was not statistically significant for superiority (P = 0.197). The combined technique had equivalent sensitivity to standard mammography (76.2 % vs. 72.8 %, P = 0.269) and equivalent specificity (84.9 % vs. 83.0 %, P = 0.130). Specificity for benign lesions was significantly higher with the combination of techniques versus mammography (45.6 % vs. 36.8 %, P = 0.002). CONCLUSION: In this enriched study population, the combination of single-view MLO tomosynthesis plus single-view CC mammography was non-inferior to that of standard two-view digital mammography in terms of ROC curve area, sensitivity and specificity.
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Neoplasias de la Mama/diagnóstico por imagen , Imagenología Tridimensional/métodos , Mamografía/métodos , Posicionamiento del Paciente/métodos , Intensificación de Imagen Radiográfica/métodos , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
OBJECTIVES: Radiographically small pulmonary nodules (PNs) in patients with colorectal cancer are troublesome because their discovery raises concern about metastases. This study sought to establish the appropriate timing of radiological follow-up for PNs detected at initial staging evaluation of colorectal carcinoma patients. METHODS: The medical records of 376 consecutive colorectal cancer patients who underwent curative surgery and had baseline and follow-up chest X-rays (CXR) and computed tomography (CT) were reviewed. RESULTS: The study included 92 patients who had all CXR and chest CT available for review, at least one PN found on baseline imaging, and no synchronous neoplasms. On baseline chest CT, these 92 patients had 170 PNs altogether and 77 (45.2 %) of them were greater than 5 mm in size. Baseline CXR detected 13 PNs in 12 patients and all but 2 were larger than 5 mm. Nodule size greater than 5 mm and irregular margins were predictors of nodule growth. The mean doubling time of 24/170 (14.1 %) growing PNs was about 4 months. CONCLUSIONS: Our findings suggest that baseline and follow-up CXR are pointless, and short-interval CT follow-up is warranted when PNs larger than 5 mm with irregular margins are detected on preoperative chest CT. KEY POINTS: ⢠Pulmonary nodules in colorectal cancer patients raise concern about metastasis. ⢠Baseline and follow-up chest X-ray in colorectal cancer can be abandoned. ⢠CT is the best technique for assessing PNs in colorectal cancer. ⢠Short-interval CT follow-up advisable for PNs larger than 5 mm with irregular margins.
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Carcinoma/complicaciones , Carcinoma/diagnóstico por imagen , Neoplasias Colorrectales/complicaciones , Neoplasias Colorrectales/diagnóstico por imagen , Nódulo Pulmonar Solitario/complicaciones , Nódulo Pulmonar Solitario/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Oncología Médica/métodos , Persona de Mediana Edad , Análisis Multivariante , Metástasis de la Neoplasia , Radiografía Torácica/métodos , Factores de Tiempo , Tomografía Computarizada por Rayos X/métodosRESUMEN
BACKGROUND: Zenker's diverticulum (ZD) may be treated with a variety of endoscopic or open surgical techniques; the choice of treatment depends partly on the size of the diverticulum. The purpose of this study was to correlate ZD measurements obtained preoperatively and during surgery. METHODS: From March 2006 to November 2008, 20 consecutive patients (19 males; median age 64.5 (range 37-88) years) with dysphagia secondary to ZD were enrolled for this study. All patients had preoperative barium radiography of the pharynx and esophagus, and diagnostic endoscopy. Ten patients underwent transoral stapling diverticulostomy and ten had open surgery. The depth of the ZD was measured on radiographic views, at endoscopy and during surgery, focusing on the distance from the top of the septum to the bottom of the pouch. The ZD dimensions obtained radiologically and endoscopically were compared with those found during surgery. Correlations and agreements between measurements were assessed using Pearson's correlation coefficients and method-comparison analysis, respectively. RESULTS: The median depth of the ZD was 2.9 cm (mean 2.95 ± 1.12 cm; range 1.5-6 cm), 3.0 cm (mean 3.24 ± 1.27 cm; range 1.7-6.8 cm), and 3.0 cm (mean 2.99 ± 1.01 cm; range 1.5-6 cm) when measured during surgery, radiology, and endoscopy, respectively. The correlation and agreement between the radiographic and surgical ZD measurements were good, whereas those between the endoscopic and surgical measurements were poor. CONCLUSIONS: These findings confirm that preoperative barium radiography is mandatory in order to choose the most appropriate surgical treatment for ZD.
Asunto(s)
Esofagoscopía , Divertículo de Zenker/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Sulfato de Bario , Medios de Contraste , Trastornos de Deglución/etiología , Trastornos de Deglución/patología , Trastornos de Deglución/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios , Radiografía , Divertículo de Zenker/diagnóstico por imagen , Divertículo de Zenker/patologíaRESUMEN
Neuroradiological and metabolic imaging is a fundamental diagnostic procedure in the assessment of patients with primary and metastatic brain tumors. The correlation between objective parameters capable of quantifying the neoplastic angioarchitecture and imaging data may improve our understanding of the underlying physiopathology and make it possible to evaluate treatment efficacy in brain tumors. Only a few studies have so far correlated the quantitative parameters measuring the neovascularity of brain tumors with the metabolic profiles measured by means of amino acid uptake in positron emission tomography (PET) scans. Fractal geometry offers new mathematical tools for the description and quantification of complex anatomical systems, including microvascularity. In this study, we evaluated the microvascular network complexity of six cases of human glioblastoma multiforme quantifying the surface fractal dimension on CD34 immunostained specimens. The microvascular fractal dimension was estimated by applying the box-counting algorithm. As the fractal dimension depends on the density, size and shape of the vessels, and their distribution pattern, we defined it as an index of the whole complexity of microvascular architecture and compared it with the uptake of (11)C-methionine (MET) assessed by PET. The different fractal dimension values observed showed that the same histological category of brain tumor had different microvascular network architectures. Fractal dimension ranged between 1.19 and 1.77 (mean: 1.415+/-0.225), and the uptake of (11)C-methionine ranged between 1.30 and 5.30. A statistically significant direct correlation between the microvascular fractal dimension and the uptake of (11)C-methionine (p=0.02) was found. Our preliminary findings indicate that that vascularity (estimated on the histologic specimens by means of the fractal dimension) and (11)C-methionine uptake (assessed by PET) closely correlate in glioblastoma multiforme and that microvascular fractal dimension can be a useful parameter to objectively describe and quantify the geometrical complexity of the microangioarchitecture in glioblastoma multiforme.
Asunto(s)
Radioisótopos de Carbono/farmacocinética , Glioblastoma/patología , Metionina/farmacocinética , Microvasos/patología , Neovascularización Patológica/patología , Tomografía de Emisión de Positrones/métodos , Adulto , Anciano , Algoritmos , Transporte Biológico , Femenino , Fractales , Glioblastoma/irrigación sanguínea , Glioblastoma/diagnóstico por imagen , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Microvasos/diagnóstico por imagen , Persona de Mediana Edad , Neovascularización Patológica/diagnóstico por imagenRESUMEN
OBJECTIVE: To compare the clinical performance of digital breast tomosynthesis (DBT) with that of full-field digital mammography (FFDM) in a diagnostic population. METHODS: The study enrolled 200 consenting women who had at least one breast lesion discovered by mammography and/or ultrasound classified as doubtful or suspicious or probably malignant. They underwent tomosynthesis in one view [mediolateral oblique (MLO)] of both breasts at a dose comparable to that of standard screen-film mammography in two views [craniocaudal (CC) and MLO]. Images were rated by six breast radiologists using the BIRADS score. Ratings were compared with the truth established according to the standard of care and a multiple-reader multiple-case (MRMC) receiver-operating characteristic (ROC) analysis was performed. Clinical performance of DBT compared with that of FFDM was evaluated in terms of the difference between areas under ROC curves (AUCs) for BIRADS scores. RESULTS: Overall clinical performance with DBT and FFDM for malignant versus all other cases was not significantly different (AUCs 0.851 vs 0.836, p = 0.645). The lower limit of the 95% CI or the difference between DBT and FFDM AUCs was -4.9%. CONCLUSION: Clinical performance of tomosynthesis in one view at the same total dose as standard screen-film mammography is not inferior to digital mammography in two views.
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Neoplasias de la Mama/diagnóstico , Mama/patología , Mamografía/métodos , Intensificación de Imagen Radiográfica/métodos , Neoplasias de la Mama/diagnóstico por imagen , Femenino , Humanos , Variaciones Dependientes del Observador , Curva ROC , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: The purpose of this study was to investigate the clinical impact of radiological assessment on delivery of therapy in patients with laparoscopic adjustable gastric banding for morbid obesity who have developed gastroesophageal symptoms or have inadequate excess weight loss. METHODS: Institutional review board approval and informed consent were obtained from all patients. Suprabursal banding was performed in 373 patients who underwent 869 upper gastrointestinal series. The control group comprised 59 asymptomatic subjects from the study population with satisfactory weight loss at follow-up. RESULTS: There were no intra-operative deaths or gastric perforations. A small gastric pouch was found above the band in 13 (22.03%) of the 59 control subjects; the upper limit of the gastric pouch volume was 9.85 ml (mathematical formula for a sphere used). The main postoperative complications included: 21 of 373 (5.63%) gastric portions above the band with a mean volume of 137.98 ml and narrowed stoma of 0.99 mm; 15 of 373 (4.02%) gastric portions above the band with a mean volume of 33.27 ml and open stoma of 4.95 mm; and 16 of 373 (4.28%) tubing disconnection and displacement into the peritoneal cavity. Twenty-one of 21 narrowed-stoma and eight of 15 open-stoma gastric portions underwent repeat surgery, upward herniation of the stomach (from below the band) being found in all 29 cases. CONCLUSION: Our main findings following the use of the suprabursal approach for surgical band positioning suggest that repeat surgery may be worthwhile for all gastric upper portions >10 ml in patients with gastroesophageal symptoms or inadequate excess weight loss.
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Gastroplastia/efectos adversos , Laparoscopía/efectos adversos , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Adolescente , Adulto , Anciano , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Gastroplastia/métodos , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Radiografía , Estómago/diagnóstico por imagen , Estómago/cirugía , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: The optimal therapy for primary mediastinal large B-cell lymphoma (PMLBCL) remains undefined. The superiority of intensive chemotherapy regimens (Methotrexate, Doxorubicin, Cyclophosphamide, Vincristine, Prednisone, Bleomycin [MACOP-B]/Etoposide, Doxorubicin, Cyclophosphamide, Vincristine, Prednisone, Bleomycin [VACOP-B]) over Cyclophosphamide, Doxorubicin, Vincristine, Prednisone (CHOP)-like chemotherapy is upheld by some authors. The role of radiotherapy is still debated. In the absence of randomized trials, we report clinical findings and treatment response in 53 consecutive patients treated with intensive chemotherapy and mediastinal involved-field radiation therapy (IFRT). METHODS AND MATERIAL: Fifty-three consecutive patients with PMLBCL were retrospectively analyzed. Planned treatment consisted of induction chemotherapy (I-CT; Prednisone, Methotrexate, Doxorubicin, Cyclophosphamide, Etoposide-Mechloroethamine, Vincristine, Procarbazine, Prednisone [ProMACE-MOPP] in the first 2 patients, MACOP-B in the next 11, and VACOP-B in the last 40) followed by IFRT. Planned treatment was concluded in 43 of 53 patients; in 10 patients, I-CT was not immediately followed by IFRT. Among these 10 patients, 6 received high-dose chemotherapy (HD-CT) followed by IFRT, 2 received HD-CT, and 2 received no further treatment. RESULTS: After a median follow-up of 93.9 months (range, 6-195 months), 45 of 53 patients (84.9%) were alive without disease. Eight patients died: 7 of PMLBCL and 1 of toxicity during HD-CT. The 5-year disease-free survival (DFS) and overall survival rates were 93.42% and 86.6%, respectively. The response rates after I-CT were complete response (CR) in 20 (37.73%) and partial response (PR) in 30 (56.60%); 3 patients (5.66%) were considered nonresponders. Among patients in PR after chemotherapy, 92% obtained a CR after IFRT. CONCLUSIONS: Our report confirms the efficacy of intensive chemotherapy plus mediastinal IFRT. IFRT plays a pivotal role in inducing CR in patients in PR after chemotherapy.
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Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Linfoma de Células B/mortalidad , Linfoma de Células B/terapia , Recurrencia Local de Neoplasia/mortalidad , Radioterapia Adyuvante/mortalidad , Adolescente , Adulto , Anciano , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Incidencia , Italia/epidemiología , Masculino , Mediastino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/prevención & control , Pronóstico , Medición de Riesgo/métodos , Factores de Riesgo , Análisis de Supervivencia , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
It is now recognized that all human natural and diseased anatomic systems are characterized by irregular shapes and very complex behaviors. In geometrical terms, tumor vascularity (which is the result of a nonlinear dynamic process called angiogenesis) is an archetypal anatomic system that irregularly fills a 3-dimensional Euclidean space. This characteristic, together with the highly variable nature of vessel shapes and surfaces, leads to considerable spatial and temporal heterogeneity in the delivery of oxygen, nutrients, and drugs, and the removal of metabolites. Although these biologic features have been well established, the quantitative analysis of neovascularity in 2-dimensional histologic sections still fails to view its architecture as a non-Euclidean geometrical object, thus allowing errors in visual interpretation and discordant results concerning the same tumor from different laboratories. We discuss here the tumor-induced vascular system as a fractal object, and what changes this new way of observing may bring to the quantification of effective antiangiogenic therapies.
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Factor 2 de Crecimiento de Fibroblastos/uso terapéutico , Fractales , Neoplasias/irrigación sanguínea , Neovascularización Patológica/tratamiento farmacológico , Neovascularización Patológica/patología , Factor A de Crecimiento Endotelial Vascular/uso terapéutico , Humanos , Modelos BiológicosRESUMEN
We describe a case of hairy cell leukaemia (HCL) coexistent with non-Hodgkin's lymphoma (NHD). This combination is reported to be extremely rare with no clear demonstration of the clonal relationship between the two conditions. After a previous failure of purine analogue therapy, our patient was successfully treated with rituximab resulting in normalisation of blood cell count cessation of blood transfusion and negative iliac crest biopsy. Unfortunately, the patient developed intense and persistent bone pain during the 1(st) line treatment for HCL. Skeletal X-rays, neck-thorax-abdomen CT scan and repeated bone MRI were unremarkable and bone scintigraphy showed non-specific changes. Laboratory examinations were normal. To better evaluate bone scintigraphy results, we finally performed FDG-PET/CT, which showed multiple foci of intense abnormal radiotracer uptake involving the bone marrow. An FDG-PET/CT guided bone marrow biopsy showed primary bone marrow diffuse large B-cell lymphoma (LBCL). Despite 2(nd) and 3(rd) line treatment, the patient died shortly after for central nervous system involvement by NHD. The role of FDG-PET/CT in identifying bone and bone marrow localization of NHD is reviewed and an earlier use is suggested in poorly understood bone pain.
Asunto(s)
Radioisótopos de Flúor , Fluorodesoxiglucosa F18 , Leucemia de Células Pilosas/diagnóstico por imagen , Linfoma de Células B/diagnóstico por imagen , Linfoma de Células B Grandes Difuso/diagnóstico por imagen , Neoplasias Primarias Múltiples/diagnóstico por imagen , Radiofármacos , Adulto , Neoplasias de la Médula Ósea/diagnóstico por imagen , Femenino , Humanos , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Cancer remains one of the most complex diseases affecting humans and, despite the impressive advances that have been made in molecular and cell biology, how cancer cells progress through carcinogenesis and acquire their metastatic ability is still widely debated. CONCLUSION: There is no doubt that human carcinogenesis is a dynamic process that depends on a large number of variables and is regulated at multiple spatial and temporal scales. Viewing cancer as a system that is dynamically complex in time and space will, however, probably reveal more about its underlying behavioural characteristics. It is encouraging that mathematicians, biologists and clinicians continue to contribute together towards a common quantitative understanding of cancer complexity. This way of thinking may further help to clarify concepts, interpret new and old experimental data, indicate alternative experiments and categorize the acquired knowledge on the basis of the similarities and/or shared behaviours of very different tumours.
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Neoplasias/etiología , Algoritmos , Cocarcinogénesis , Progresión de la Enfermedad , Humanos , Modelos Biológicos , Metástasis de la Neoplasia , Neoplasias/patologíaRESUMEN
The gamma-irradiation of normal cells causes an increased synthesis of specific proteins. However, few studies have described the effects of high doses of irradiation on the expression of cell surface antigens in tumor cells. This study analyzed the effects of high doses of gamma-irradiation on the surface antigen expression of Major Histocompatability Complex (MHC) class I/II and intercellular adhesion molecule-1 (ICAM-I) in human multiple myeloma (MM) cell lines ARP-1, ARK-RS, and 10 MM primary tumors. The expression of surface antigens was evaluated by fluorescence-activated cell sorter analysis at different time points, following the exposure to high doses of gamma-irradiation. Doses of 10,000 and 15,000 cGy were not sufficient to totally block cell replication in both cell lines and primary tumors; cell replication was able to be inhibited completely only at 18,000 cGy. Lower doses (10,000 cGy) and lethal doses of irradiation (i.e., 15,000 and 18,000 cGy) increased the expression of all surface antigens present on the cells before irradiation. Essentially, such upregulation was shown to be dose dependent, with higher radiation doses resulting in higher antigen expression. Furthermore, when the kinetics of this upregulation were studied 3 and 6 d after irradiation, there was a constant increase in antigen expression in MM cells. These findings suggest that upregulation of costimulatory molecules, such as of MHC class I/II antigens and ICAM-I molecules in MM patients treated by gamma-radiation, can increase the immunogenicity of the tumor cells. In light of these findings, radiotherapy combined with immunotherapy might be considered in relapsing patients after receiving the standard treatment.
Asunto(s)
Rayos gamma , Regulación Neoplásica de la Expresión Génica/efectos de la radiación , Genes MHC Clase II , Genes MHC Clase I , Molécula 1 de Adhesión Intercelular/metabolismo , Mieloma Múltiple/inmunología , Mieloma Múltiple/radioterapia , Antígenos de Neoplasias/metabolismo , Antígenos de Superficie/metabolismo , Línea Celular Tumoral , Citometría de Flujo , Antígenos HLA , Humanos , Mieloma Múltiple/metabolismo , Mieloma Múltiple/patologíaRESUMEN
AIMS AND BACKGROUND: The aim of the present paper was to study the role of irradiation in the atherosclerotic process in patients affected by Hodgkin and non-Hodgkin lymphoma. METHODS: We studied 84 subjects, 42 with Hodgkin or non-Hodgkin disease and 42 controls. All 42 cases had been irradiated and were comparable in terms of risk factors for atherosclerosis. All 84 subjects underwent echo-color Doppler of the arterial axis (carotids, abdominal aorta, and femoral arteries), and the intima-media thickness was measured. RESULTS: The irradiated cases had a greater intima-media thickness in the carotid district, even after dividing them according to age and sex; males were affected more than females. The irradiated patients were at greater risk of developing cardiovascular events than the controls. CONCLUSIONS: An echo-color Doppler of the carotid district is advisable in all patients who have been submitted to radiotherapy, and the patients with a significantly greater than normal intima-media thickness need a strict follow-up, and antioxidant or antiaggregant therapy should be considered.
Asunto(s)
Aterosclerosis/diagnóstico por imagen , Aterosclerosis/etiología , Enfermedad de Hodgkin/radioterapia , Linfoma no Hodgkin/radioterapia , Traumatismos por Radiación/complicaciones , Ultrasonografía Doppler en Color , Adulto , Aorta Abdominal/efectos de la radiación , Arterias Carótidas/efectos de la radiación , Femenino , Arteria Femoral/efectos de la radiación , Humanos , Masculino , Persona de Mediana Edad , Traumatismos por Radiación/etiología , Radioterapia/efectos adversos , Túnica Íntima/efectos de la radiación , Túnica Media/efectos de la radiaciónRESUMEN
OBJECTIVE: In the last decade, surgery of primary hyperparathyroidism (HPT) due to a solitary adenoma has moved on from the traditional wide bilateral neck exploration (BNE) to more limited approaches such as unilateral neck exploration and minimally invasive parathyroidectomy. DESIGN: To define the role of intraoperative gamma probe and injection of a low (99m)Tc-MIBI dose in performing minimally invasive radio-guided surgery (MIRS) in HPT patients with a solitary parathyroid adenoma. METHODS: From September 1999 to July 2002, 214 patients with primary HPT entered the study. All patients were preoperatively investigated by a (99m)Tc-pertechnetate/MIBI subtraction scan and high-resolution neck ultrasound. The intraoperative technique we developed differs from other previously described techniques being based on the injection of a low (37 MBq) MIBI dose in the operating theatre a few minutes before the beginning of intervention. RESULTS: On the basis of scan/ultrasound findings 147 patients were selected for a MIRS and 144 of them (98%) were successfully treated by this approach: a solitary parathyroid adenoma was removed through a small 2-2.5 cm skin incision with a mean operative time of 35 min, and a mean hospital stay of 1.2 days. In the other 67 patients with scan/ultrasound evidence of concomitant nodular goiter (n=45) or multi-gland disease (n=13) or with a negative scan (n=9), the gamma probe was utilized during a traditional BNE. A low 37 MBq MIBI dose proved to be sufficient to perform a MIRS; moreover it delivered to the patient and surgeon a low, negligible, radiation exposure dose. CONCLUSIONS: The combination of a (99m)Tc-pertechnetate/MIBI subtraction scan and neck ultrasound appears to be an accurate imaging protocol in selecting primary HPT patients as candidates for a MIRS. A MIBI dose as low as 37 MBq injected in the operating theatre just before the start of surgery appears to be adequate to perform radio-guided surgery.
Asunto(s)
Hiperparatiroidismo/diagnóstico por imagen , Hiperparatiroidismo/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos , Paratiroidectomía/métodos , Adenoma/diagnóstico por imagen , Adenoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Cuidados Intraoperatorios , Masculino , Persona de Mediana Edad , Neoplasias de las Paratiroides/diagnóstico por imagen , Neoplasias de las Paratiroides/cirugía , Cuidados Preoperatorios , Cintigrafía , Pertecnetato de Sodio Tc 99m , Tecnecio Tc 99m SestamibiRESUMEN
BACKGROUND AND AIM: Surgery for primary hyperparathyroidism (PHPT) due to a solitary parathyroid adenoma (PA) is moving from traditional bilateral neck exploration (BNE) towards the use of limited neck exploration. The aim of the present study was to define the efficacy of minimally invasive radioguided surgery (MIRS) in PHPT patients with a high probability of a solitary PA with particular regard to benefits achievable in elderly patients. PATIENTS AND METHODS: The study population included a total of 266 consecutive PHPT patients who had undergone surgery at our centre between September 1999 and February 2003. Preoperative imaging consisted of [Tc]pertechnetate/Tc sestamibi (TcO4/sestamibi) scintigraphy and neck ultrasound obtained in the same session. One hundred and eighty-seven patients from the whole series (75 of whom were older than 65 years) with a high scan/ultrasound probability of a solitary PA, a high PA sestamibi uptake, and a normal thyroid gland were selected for MIRS. The other 79 patients were selected for traditional BNE. The intra-operative technique was based on the injection of a low dose (37 MBq) of sestamibi in the operating theatre a few minutes before the beginning of intervention and on the use of an 11 mm collimated gamma probe. RESULTS: MIRS was successfully performed in 97.8% of all PHPT patients selected for this type of surgery and, in particular, in 100% of the subgroup (n=75) of elderly patients. MIRS required a mean operating time of 35 min and a mean hospital stay of 1.2 days; that is, approximately half of that required for traditional BNE. Moreover, local anaesthesia was successfully performed in 27 patients, 19 of whom were >65 years with concomitant invalidating diseases contraindicating general anaesthesia. No major surgical complications were recorded. Transitory hypocalcaemia was observed in 9% of cases treated with MIRS compared with 27% of patients treated with BNE. CONCLUSION: MIRS can be accurately planned in elderly PHPT patients with a solitary PA on the basis of a TcO4/sestamibi scan and neck ultrasound. MIRS has been proven to be safe and effective in our experience, and allows a significant reduction of operating and recovery time, as well as the possibility of using local anaesthesia, especially in elderly patients with concomitant invalidating diseases.
Asunto(s)
Hiperparatiroidismo/diagnóstico por imagen , Hiperparatiroidismo/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Paratiroidectomía/métodos , Cirugía Asistida por Computador/métodos , Tecnecio Tc 99m Sestamibi , Adenoma/complicaciones , Adenoma/diagnóstico por imagen , Adenoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Hiperparatiroidismo/etiología , Masculino , Persona de Mediana Edad , Cintigrafía , Radiofármacos , Neoplasias de la Tiroides/complicaciones , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/cirugía , Resultado del Tratamiento , UltrasonografíaRESUMEN
The outcome of head and neck squamous cell cancer depends primarily on its prompt diagnosis and treatment. Unfortunately, in many cases ominous prognostic factors such as lymph node metastases or osteomandibular extension are present at the time of diagnosis. We review the relative efficacy of contrast-enhanced computed tomography (ceCT), MRI, and F-fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) in the early detection of head and neck squamous cell cancer, as well as its impact on treatment management and outcomes. Medline and Web of Knowledge databases, from 2000 to January 2013, were evaluated. Ninety-seven reports were selected, but only 11 studies comparing PET or PET/CT with CT and 11 comparing PET or PET/CT with MRI were found appropriate for analysis. ceCT and MRI continue to be the reference imaging modalities for the study of primary tumors, especially in the evaluation of the extension of disease and its relationship with nearby anatomical structures. There is increasing evidence that F-FDG PET/ceCT can provide accurate anatomical details similar to ceCT alone, as well as accurate information on osteomandibular tumor invasion similar to MRI. The major advantage of PET/CT over other imaging methods is its ability to detect relatively small lymph node metastases located in difficult-to-interpret positions. PET/CT is also highly sensitive for the detection of distant metastases and in assessing the response to chemotherapy or chemoradiation treatment and in predicting outcome. ceCT and MRI are the gold standards for evaluating primary and osteomandibular tumoral infiltration. F-FDG PET/CT plays a major role in the detection of lymph node and distant metastases, in assessing the response to neoadjuvant/adjuvant chemotherapy or chemoradiation therapy, and in predicting outcome.