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The European Society of Endocrinology recommends surgical approach for suspicious adrenal mass with a limited role for adrenal biopsy. We report here a case of a patient with a 70 mm adrenal mass in whom adrenal biopsy avoided unnecessary adrenalectomy. An 80-year-old man was explored for a 67 × 41 mm suspect left adrenal tumor. Hormonal explorations were normal. 18F-FDG-PET/CT showed an increase in uptake of the adrenal mass (SUVmax: 44.6). As the diagnostic was uncertain, biopsy was performed. Pathology found T lymphocytic inflammatory infiltrate with CD4 phenotype without malignancy criteria. Simple close monitoring was decided in multidisciplinary meeting and with the patient's consent. At 1 and 3 months, CT and 18F-FDG-PET/CT showed a significant decrease in size and uptake of adrenal mass (40 × 20 mm and 19 × 10 mm and SUVmax 5.9 and 0.0). This report shows the interest of adrenal biopsy for well-selected cases to avoid unnecessary adrenal surgery.
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INTRODUCTION: Although aneurysmal subarachnoid hemorrhage (SAH) is often complicated by myocardial injury, whether this neurogenic cardiomyopathy is associated with the modification of cardiac metabolism is unknown. This study sought to explore, by positron emission tomography/computed tomography, the presence of altered cardiac glucose metabolism after SAH. METHODS: During a 16-month period, 30 SAH acute phase patients underwent myocardial (18)F- fluorodesoxyglucose positron emission tomography ((18)F-FDGPET), (99m)Tc-tetrofosmin and (123)I-meta-iodobenzylguanidine ((123)I-mIBG) scintigraphy, respectively, assessing glucose metabolism, cardiac perfusion, and sympathetic innervation. Patients with initial abnormalities were followed monthly for two months for (18)F-FDG, and six months later for (123)I-mIBG. RESULTS: In this SAH population, acute cardiac metabolic disturbance was observed in 83% of patients (n = 25), and sympathetic innervation disturbance affected 90% (n = 27). Myocardial perfusion was normal for all patients. The topography and extent of metabolic defects and innervation abnormalities largely overlapped. Follow-up showed rapid improvement of glucose metabolism in one or two months. Normalization of sympathetic innervation was slower; only 27% of patients (n = 8) exhibited normal (123)I-mIBG scintigraphy after six months. Presence of initial altered cardiac metabolism was not associated with more unfavorable cardiac or neurological outcomes. CONCLUSIONS: These findings support the hypothesis of neurogenic myocardial stunning after SAH. In hemodynamically stable acute phase SAH patients, cardiomyopathy is characterized by diffuse and heterogeneous (18)F-FDG and (123)I-mIBG uptake defect. TRIAL REGISTRATION: Clinicaltrials.gov NCT01218191. Registered 6 October 2010.
Assuntos
Glucose/metabolismo , Coração/inervação , Aneurisma Intracraniano/metabolismo , Miocárdio/metabolismo , Hemorragia Subaracnóidea/metabolismo , Sistema Nervoso Simpático/fisiopatologia , 3-Iodobenzilguanidina , Fluordesoxiglucose F18 , Humanos , Aneurisma Intracraniano/complicações , Radioisótopos do Iodo , Miocárdio Atordoado/etiologia , Compostos Organofosforados , Compostos de Organotecnécio , Tomografia por Emissão de Pósitrons , Qualidade de Vida , Compostos Radiofarmacêuticos , Ruptura Espontânea , Hemorragia Subaracnóidea/complicações , Tomografia Computadorizada de Emissão de Fóton Único , Troponina T/sangueRESUMO
Takotsubo cardiomyopathy (TTC) is a distinct clinical entity characterized by the presence of transient left ventricular wall dysfunction without significant culprit obstructive coronary artery disease. Invasive coronary angiography and ventriculography are the 'gold standard' for definitive diagnosis, with an integrated multi-modality imaging approach offering advantages in various clinical scenarios. Echocardiography is a widely available, first-line, non-invasive imaging technique appropriate both in emergency setting to confirm diagnosis, assess for various potential acute complications, and in serial follow-up to track myocardial recovery. Cardiac magnetic resonance (CMR) may be helpful to discriminate TTC from other acute cardiac syndromes with troponin elevation and ventricular dysfunction. Echocardiography, CMR, and nuclear imaging may also provide new insights into possible underlying pathophysiological mechanisms, and myocardial (123)I-metaiodobenzyl-guanidine imaging may have a role for retrospective diagnosis in the subacute phase of late-presenting cases. The potential diagnostic role of coronary computed tomography angiography in the emergency room requires a further study.
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Ecocardiografia Tridimensional , Ecocardiografia , Eletrocardiografia , Cardiomiopatia de Takotsubo/diagnóstico , Algoritmos , Angiografia Coronária/métodos , Ecocardiografia/métodos , Ecocardiografia Tridimensional/métodos , Eletrocardiografia/métodos , Fluordesoxiglucose F18 , Humanos , Incidência , Imageamento por Ressonância Magnética , Infarto do Miocárdio/diagnóstico , Tomografia por Emissão de Pósitrons , Prognóstico , Compostos Radiofarmacêuticos , Fatores de Risco , Cardiomiopatia de Takotsubo/fisiopatologia , Tomografia Computadorizada de Emissão de Fóton Único , Disfunção Ventricular Esquerda/fisiopatologiaAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Encefálicas/diagnóstico , Rearranjo Gênico , Genes Codificadores da Cadeia gama de Receptores de Linfócitos T , Linfadenopatia Imunoblástica/diagnóstico , Linfoma de Células T/diagnóstico , Idoso , Biópsia/métodos , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/patologia , Confusão/etiologia , Citarabina/administração & dosagem , Diagnóstico Diferencial , Feminino , Humanos , Linfadenopatia Imunoblástica/complicações , Linfadenopatia Imunoblástica/diagnóstico por imagem , Linfadenopatia Imunoblástica/tratamento farmacológico , Linfadenopatia Imunoblástica/genética , Linfadenopatia Imunoblástica/patologia , Imuno-Histoquímica , Linfoma de Células T/complicações , Linfoma de Células T/diagnóstico por imagem , Linfoma de Células T/tratamento farmacológico , Linfoma de Células T/genética , Linfoma de Células T/patologia , Imageamento por Ressonância Magnética , Metotrexato/administração & dosagem , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons/métodos , Tomografia Computadorizada por Raios X , Transtornos da Visão/etiologiaRESUMO
PURPOSE: The therapeutic management of rhabdomyosarcoma (RMS) is strongly dependent on initial staging. This study aimed to evaluate F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) as an adjunct to conventional imaging (CI) in the staging and follow-up of pediatric RMS. MATERIALS AND METHODS: A total of 13 consecutive children and adolescents (12 males, 1 female; mean age, 9.6 years) with histologically proven RMS (10 alveolar, 3 embryonal), in whom FDG PET/CT was performed at staging and follow-up, were retrospectively included. In total, 35 FDG PET/CT were compared with CI (MRI, CT, and bone scintigraphy) performed with a less than a 15-day interval. Histologic data, follow-up (mean, 27 months), and the final judgment of a multidisciplinary tumor board were considered as the standard of reference for result interpretation. RESULTS: At staging, FDG PET/CT revealed 1 RMS of the prostate missed by CI, and found 19 true-positive lymph node territories in 4 patients and 11 bone metastases in 3 patients, versus 12 and 3, respectively, with CI. Conversely, FDG PET/CT was less sensitive for detecting infracentimetric lung nodules in 1 patient. On the whole analysis, FDG PET/CT modified lymph node staging in 4 of 13 patients, bone involvement in 2 patients, and led to treatment alteration in 2 children. CONCLUSIONS: FDG PET/CT can be useful in staging and restaging pediatric RMS, especially for assessing lymph nodes and bone involvement, and for detecting unknown primary sites of RMS, with potential therapeutic strategy alteration.
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Fluordesoxiglucose F18 , Estadiamento de Neoplasias/métodos , Tomografia por Emissão de Pósitrons , Rabdomiossarcoma/diagnóstico , Rabdomiossarcoma/patologia , Tomografia Computadorizada por Raios X , Adolescente , Neoplasias Ósseas/secundário , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Linfonodos/diagnóstico por imagem , Masculino , Estudos Retrospectivos , Rabdomiossarcoma/diagnóstico por imagem , Adulto JovemRESUMO
Central nervous system (CNS) is a rare site of involvement by non-Hodgkin lymphoma (NHL). Therapeutic approach for primary and secondary CNS NHL is different and remains challenging. Therefore imaging data are essential at staging to discriminate these 2 clinical entities and during follow-up to assess therapy response. The adjunct role of positron emission tomography using F-18 fluorodeoxyglucose to morphologic imaging is still undefined. We report 2 didactic cases of primary and secondary CNS NHL assessed by F-18 fluorodeoxyglucose positron emission tomography. Metabolic imaging seems to be complementary to conventional imaging techniques for the extent-of-disease evaluation and therapy monitoring of CNS lesions.
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Neoplasias do Sistema Nervoso Central/diagnóstico por imagem , Fluordesoxiglucose F18 , Linfoma não Hodgkin/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Neoplasias do Sistema Nervoso Central/patologia , Neoplasias do Sistema Nervoso Central/fisiopatologia , Humanos , Linfoma não Hodgkin/patologia , Linfoma não Hodgkin/fisiopatologia , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The aim of the study was to analyze in breast tumors the correlation between [(18)F]fluorodeoxyglucose (FDG) uptake assessed by positron emission tomography (PET) and histopathological and immunohistochemical prognostic factors. METHODS: FDG-PET combined with computed tomography (CT) was performed before surgery in 45 women with biopsy-proven primary breast cancer. The standardized uptake value (SUV) was compared with histopathological findings after surgery. RESULTS: A positive relationship was found between SUV and histological grade (p < 0.0001), histological type (p = 0.001), tumor size (p < 0.0435), estrogen receptor status (p < 0.0005), and progesterone receptor status (p = 0.002). FDG-PET/CT revealed unknown distant metastatic lesions in 2 of 12 patients with triple-negative breast cancer. The sensitivity of FDG-PET/CT for detecting axillary lymph node metastases was, respectively, 21% and 100% for pN1 and pN2 cases, whereas specificity was 100% for pN0. CONCLUSION: SUV, a preoperative and noninvasive metabolic parameter, correlates with other known prognostic factors in breast cancer. This study provides valuable insight into the usefulness of FDG-PET/CT for preoperative staging of patients with triple-negative and poorly differentiated breast tumors but not for evaluating axillary lymph nodes and lobular carcinomas.
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Neoplasias da Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Lobular/diagnóstico por imagem , Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/metabolismo , Carcinoma Ductal de Mama/patologia , Carcinoma Lobular/metabolismo , Carcinoma Lobular/patologia , Feminino , Seguimentos , Humanos , Técnicas Imunoenzimáticas , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Cuidados Pré-Operatórios , Estudos Prospectivos , Taxa de Sobrevida , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Fluordesoxiglucose F18 , Linfoma não Hodgkin/diagnóstico , Linfoma não Hodgkin/patologia , Tomografia por Emissão de Pósitrons , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologia , Tomografia Computadorizada por Raios X , Adulto , Humanos , Linfoma não Hodgkin/terapia , Masculino , Estadiamento de Neoplasias , Neoplasias da Próstata/terapia , Resultado do TratamentoRESUMO
BACKGROUND: Takotsubo cardiomyopathy (TTC) is a novel heart disease, mimicking acute myocardial infarction. The term "transient left ventricular dysfunction syndrome" (TLVDS) seems to be more appropriate since variant forms of TTC sparing apical segments (mid-ventricular ballooning syndrome (MVBS) and inverted TTC) have been described. Patho-physiological bases of TLVDS remain poorly understood and its optimal management is until now empirical. Our aim was to characterize patho-physiological mechanisms of TLVDS by means of nuclear medicine procedures and to discuss the clinical usefulness of isotopic imaging for a non-invasive diagnosis of TLVDS. METHODS AND RESULTS: During the sub acute phase, eighteen patients with TLVDS (13 TTC and 5 MVBS) underwent myocardial (99m)Tc-tetrofosmin or (201)Thallium Gated Single Photon Emission Computed Tomography (G-SPECT) (n=11), (123)I-mIBG SPECT (n=8) and (18)F-FDG Gated Positron Emission Tomography (G-PET) (n=15), assessing respectively LV perfusion, sympathetic innervation and glucose metabolism. Hypocontractile LV segments were characterized by normal perfusion but reduced uptake of (18)F-FDG and (123)I-mIBG. Topography and extent of metabolic defects and innervation abnormalities were largely overlapping. Follow-up (123)I-mIBG SPECT and (18)F-FDG G-PET were performed in selected patients showing rapid normalization of LV motion and progressive improvement of both glucose metabolism and sympathetic innervation. DISCUSSION: With the hypothesis of neurogenic stunned myocardium as the central causative mechanism of TLVDS, (123)I-mIBG SPECT seems to be the most specific diagnostic technique. Sympathetic function and glucose metabolism seem to be strictly correlated in the hypocontractile LV segments. Finally, our results underline the role of nuclear imaging in the setting of patho-physiological mechanisms of TLVDS.
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Disfunção Ventricular Esquerda/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medicina Nuclear , Cintilografia , Estudos Retrospectivos , Síndrome , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Fatores de TempoAssuntos
Coriocarcinoma/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Testiculares/diagnóstico por imagem , Adulto , Coriocarcinoma/secundário , Fluordesoxiglucose F18 , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares/secundário , Masculino , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Neoplasias Retroperitoneais/patologia , Neoplasias Testiculares/patologia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: To gain more insight into the involvement of inflammatory response and neurohumoral activation in Takotsubo cardiomyopathy (TTC), we investigated C-reactive protein (CRP), leukocytes, plasma catecholamines levels, iodine 123 meta-iodobenzylguanidine (123I-mIBG) myocardial uptake, myocardial perfusion (thallium 201 [201Tl] or technetium [Tc] 99m-tetrofosmin myocardial single photon emission computed tomography [SPECT]), and metabolism (fluorine 18-fluorodeoxyglucose positron emission tomography). METHODS AND RESULTS: Inflammatory status and brain natriuretic peptide (BNP) levels in 17 patients with TTC were compared with 14 age-matched patients. In TTC, elevated levels of CRP were evidenced on admission, reaching a peak in the following days (P < .01). CRP levels were correlated to baseline left ventricular ejection fraction (LVEF) and BNP levels (P < .05). Leukocytes were correlated to BNP and noradrenaline levels. Myocardial 123I-mIBG SPECT showed a reduced activity in the midventricle and apex corresponding to 35% +/- 23% of the total myocardial mass, partially reversible at follow-up. An identical pattern was retrieved when assessing myocardial glucose metabolism. At rest, no relevant abnormalities of myocardial perfusion could be evidenced at the subacute phase. CONCLUSION: Inflammatory status in TTC was related to LVEF impairment and to the extent of neurohormonal activation. The hypothesis of a catecholamine-induced myocardial "stunning" is emphasized by the evidence of a reduced 123I-mIBG myocardial activity, impairment of myocardial glucose metabolism, and wall motion kinetic after the same temporospatial distribution.
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Proteína C-Reativa/análise , Peptídeo Natriurético Encefálico/sangue , Cardiomiopatia de Takotsubo/sangue , Cardiomiopatia de Takotsubo/diagnóstico por imagem , 3-Iodobenzilguanidina , Idoso , Estudos de Casos e Controles , Catecolaminas/sangue , Circulação Coronária , Feminino , Fluordesoxiglucose F18 , Glucose/metabolismo , Humanos , Contagem de Leucócitos , Masculino , Miocárdio/metabolismo , Norepinefrina/sangue , Compostos Organofosforados , Compostos de Organotecnécio , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Radioisótopos de Tálio , Tomografia Computadorizada de Emissão de Fóton Único , Troponina I/sangueRESUMO
The desmoplastic small round cell tumor (DSRCT) is an uncommon and highly aggressive cancer. The role of (18)F-FDG PET in management of DSRCT is little reported. We report a case of metastasized abdominal DSRCT detected in a 43-year old patient whose diagnostic and therapeutic approaches were influenced by (18)F-FDG PET-CT. The patient is still alive ten years after diagnosis. (18)F-FDG PET-CT seems to be a useful method for assessing therapeutic efficiency and detecting early recurrences even in rare malignancies such as DSRCT.
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3-Iodobenzilguanidina , Ventrículos do Coração/diagnóstico por imagem , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Medicina Nuclear/métodos , Compostos RadiofarmacêuticosRESUMO
We report a case of diffuse large B-cell lymphoma occurring in a patient with the hyperimmunoglobulinemia E syndrome, a rare immune disorder defined by elevated immunoglobulin E levels and recurrent bacterial and fungal infections often manifesting as cold abscesses. This case further supports the notion that patients with hyperimmunoglobulinemia E have an increased risk of lymphoid malignancies and should be closely monitored. Despite a theoretic risk of severe infectious complications, chemotherapy was well tolerated and resulted in a sustained complete remission.
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Fluordesoxiglucose F18 , Linfoma não Hodgkin/diagnóstico por imagem , Linfoma não Hodgkin/tratamento farmacológico , Compostos Radiofarmacêuticos , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/tratamento farmacológico , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Murinos , Antineoplásicos/uso terapêutico , Ciclofosfamida/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Cintilografia , Rituximab , Resultado do Tratamento , Vincristina/uso terapêuticoAssuntos
Glândulas Vestibulares Maiores/patologia , Tomografia Computadorizada de Emissão , Tomografia Computadorizada por Raios X , Neoplasias Vulvares/diagnóstico por imagem , Idoso , Antineoplásicos/uso terapêutico , Braquiterapia , Terapia Combinada , Feminino , Humanos , Neoplasias Vulvares/tratamento farmacológico , Neoplasias Vulvares/radioterapia , Imagem Corporal TotalRESUMO
Diffuse, increased gastric wall F-18 FDG uptake is widely observed during PET/CT examinations, frequently unrelated to malignant findings, but simply caused by inflammatory disease, physiological emptying, or visceral thickening. Hence, elevated F-18 FDG gastric uptake can lead to equivocal misinterpretation, especially in patients with known gastric malignant disease, at posttherapy reevaluation. Gastric wall contraction can increase F-18 FDG uptake, especially for a remnant stomach, increasing the percentage of false-positive results with a direct impact on therapeutic management. One field PET/CT acquisition centered on the hypochondrial regions a few minutes after water ingestion should be performed routinely if standard images are doubtful (increased tracer uptake and visceral thickening) to differentiate benign from malignant uptake.