[Egg components involved in cognitive function]. / Componentes del huevo implicados en la función cognitiva.

Introduction: Interest in the relationship between diet and cognitive function has increased in recent years. In this sense, eggs contain many essential nutrients that are also beneficial for cognitive function. Several studies have shown that moderate egg consumption not only does not increase cardiovascular risk but is positively associated with better cognitive performance and a lower risk of dementia. Egg protein is particularly rich in tryptophan, which is a precursor to serotonin, the neurotransmitter involved in mood, and melatonin, the hormone that regulates the sleep-wake cycle. Consumption of tryptophan-rich egg hydrolysates has been associated with improved attention and reduced feelings of sadness or depression. Egg choline is needed for the synthesis of acetylcholine, the neurotransmitter involved in memory and learning, and also for the synthesis of phosphatidylcholine, the intake of which has been linked to better mental function and a lower risk of dementia in adults. Choline intake during pregnancy reduces the risk of neural tube defects and is associated with better offspring development. And lutein and zeaxanthin, which are particularly concentrated in the nervous system, are associated with better visual function and cognitive development in the offspring and also in the elderly. All this evidence confirms the importance of including eggs in a balanced diet to prevent cognitive decline and improve cognitive health throughout life.

Introducción: El interés por la relación entre la dieta y la función cognitiva ha aumentado en los últimos años. En este sentido, el huevo tiene numerosos nutrientes esenciales que son, además, beneficiosos para la función cognitiva. Diferentes estudios han demostrado que el consumo moderado de huevo no solo no aumenta el riesgo cardiovascular, sino que se asocia positivamente con un mejor desempeño cognitivo y un menor riesgo de demencia. La proteína del huevo es especialmente rica en triptófano, que es precursor de la serotonina, el neurotransmisor implicado en el estado de ánimo, y de la melatonina, la hormona que regula los ciclos de sueño-vigilia. La ingesta de hidrolizados de huevo ricos en triptófano se ha asociado con una mejor atención y una menor sensación de tristeza o depresión. La colina del huevo es necesaria para la síntesis de la acetilcolina, el neurotransmisor implicado en la memoria y el aprendizaje, y también para la síntesis de la fosfatidilcolina, cuya ingesta se ha relacionado con una mejor función mental y un menor riesgo de demencia en adultos. La ingesta de colina durante el embarazo disminuye el riesgo de defectos del tubo neural y se asocia a un mejor desarrollo del descendiente. Y la luteína y la zeaxantina, que se concentran especialmente en el tejido nervioso, se relacionan con una mejor función visual y desarrollo cognitivo del recién nacido y también del adulto mayor. Todas estas evidencias confirman la importancia de consumir huevo como parte de una dieta equilibrada para prevenir el deterioro y mejorar la salud cognitiva a lo largo de la vida.

Update in imaging tests used for the localization of parathyroid pathology.

Preoperative localization of parathyroid pathology, generally a parathyroid adenoma, can be difficult in some cases due to the anatomical variants that these glands present. The objective of this review is to analyse the different imaging techniques used for preoperative localization of parathyroid pathology (scintigraphy, ultrasound, CT, MRI and PET). There is great variability between the different tests for the preoperative localization of parathyroid pathology. The importance of knowing the different diagnostic options lies in the need to choose the most suitable test at each moment and for each patient for an adequate management of primary hyperparathyroidism (PHP) with surgical criteria.

[Importance of choline during pregnancy and lactation: A systematic review]. / Importancia de la colina durante el embarazo y lactancia. Una revisión sistemática.

Pregnancy is one of the most important and difficult moments that a woman goes through throughout her life. It is a period of great need for macro and micronutrients to meet the demands of the developing fetus and avoid deficiencies, in order to obtain the best possible result. Nowadays, most women who are pregnant or planning to become pregnant know the importance of getting the required amount of certain types of nutrients (proteins, fats, folate, etc.), as well as avoiding certain compounds (alcohol, tobacco, drugs, etc.) to avoid possible complications during pregnancy. In recent years, with the greatest scientific evidence available, it has been shown how some of these nutrients could have a more relevant role than previously believed in the optimal outcome of pregnancy. One of these nutrients being choline. Choline supplementation during pregnancy has been shown to be a non-pharmacological treatment capable of improving both physical (growth) and mental (memory) qualities of the new individual. Choline has been known as an essential nutrient since 1998 and several studies have shown its effectiveness in rodent models. The existence of recent publications that deal with its application in humans makes it necessary to carry out a systematic review. In this systematic review of the scientific evidence available from 2012 to the present that deals with the application of a higher intake of choline through supplementation as a treatment to improve pregnancy outcomes, its main objetive is to determine the effects that a nutritional intervention through choline supplementation in pregnant mothers can have on children's cognition. For this, 9studies have been analyzed where the treatment given to pregnant women is revealed, this being choline supplementation in different modalities (choline chloride, choline bitartrate, and phosphatidylcholine) and the different effects produced in the children of these mothers who have resulted from these treatment modalities. We conclude by stating that choline supplementation during pregnancy appears to be effective in improving or increasing cognition in children.

Cost analysis of next-generation imaging in high-risk prostate cancer staging.

INTRODUCTION AND OBJECTIVE: Next-generation imaging (NGI) tests, such as choline PET/CT and PSMA PET, have shown to increase sensitivity in the detection of nodal and metastatic disease in prostate cancer. However, their use implies an increase in diagnostic costs compared to conventional imaging (CI) tests such as CT and bone scan. The aim of our study was to determine which diagnostic pathway is more cost-effective in high-risk prostate cancer. MATERIAL AND METHOD: Cost-effectiveness analysis of the available imaging tests (CI, Choline/PSMA PET) for the staging of high-risk prostate cancer. Sensitivity and specificity were estimated based on published evidence, and costs were collected from the Management Department. In order to carry out a cost-effectiveness analysis, five diagnostic pathways were proposed estimating the accurate diagnoses. RESULTS: PSMA PET was the most accurate diagnostic option. The CI diagnostic workup was the most economical and CI+PSMA the most expensive. Analyzing the diagnostic cost-effectiveness ratio, CI+PSMA proved to be the most expensive (€5627.30 per correct diagnosis) followed by PET PSMA (€4987.11), choline (€4599.84) and CI (€4444.22). CONCLUSIONS: PSMA PET is the most accurate strategy in staging distant disease in patients with high-risk prostate cancer. Radiotracer uptake tests such as CI have been shown to be the most cost-effective option, followed by choline and PSMA.

Effectiveness of 11C-choline PET/CT in prostate cancer surveillance.

AIM: Our aim was to analyse the performance of [11C]choline PET/CT in prostate cancer (PCa) surveillance, especially in patients with prostate specific antigen (PSA) < 1 ng/mL. MATERIAL AND METHODS: Three hundred and twenty-nine [11C]choline PET/CT examinations from 191 patients (68.2 ±â€¯7.2 years) submitted for PCa surveillance or biochemical recurrence were retrospectively evaluated. PSA at study was 13.0 ±â€¯84.2 ng/mL. Main initial treatment was radical prostatectomy (RP) in 81 patients, and other treatments (radiotherapy, chemotherapy, hormonotherapy) in 110. PET/CT was acquired 20' after injection of 555-740 MBq of [11C]choline. Minimum follow-up was 12 months. RESULTS: Two hundred and nineteen (66.6%) out of the 329 PET/CT examinations were positive. The percentage of positive examinations was significantly higher in patients with other initial treatment than RP compared to patients with RP (85.6% vs. 43.6%, respectively). One hundred and thirty PET/CT (59.4%) showed local recurrence, 48 (21.9%) distant recurrence, and 41 (18.7%) local plus distant recurrence. Initial therapeutic approach was changed in 139 cases (63.5%). In the subgroup of 81 [11C]choline PET/CT scans performed with PSA < 1 ng/mL, 23 (28.4%) showed a positive result. Initial therapeutic approach was changed in 9 (11.1%). Three (4.8%) out of 63 patients died as per PCa. CONCLUSION: [11C]choline PET/CT demonstrated its effectiveness in PCa surveillance and restaging, even in patients with serum PSA < 1 ng/mL. The diagnostic performance was different depending on the initial treatment, been higher in patients with non-surgical treatment.

Casa Colina Fall Risk Assessment Scale-Revised: Predicting Falls in Inpatient Rehabilitation Facilities.

Objective: To revise the Casa Colina Fall risk assessment scale (CCFRAS) using the new Medicare standards required functional ability quality measures and to assess the sensitivity and specificity of this revised fall risk assessment tool. Design: The Casa Colina Fall risk assessment scale-revised (CCFRAS-R) was assessed both retrospectively and prospectively on consecutive patients at 3 inpatient rehabilitation facilities (IRFs) to determine the sensitivity and specificity of this tool in predicting fall risk. Setting: Three IRFs. Participants: A total of 6253 adult patients (N=6253) admitted to 1 of 3 IRF settings including those with stroke, brain injury, spinal cord injury, and other conditions requiring medical rehabilitation, with mean age of 66 years; 50% were female and 50% were male. Interventions: Not applicable. Main Outcomes: Each IRF quantified the number of falls detected for the patient population under evaluation and determined the site-specific sensitivity and specificity of the CCFRAS-R. Results: Quality measures were analyzed for predicting fall risk using logistic regression analyses and found that impaired toileting hygiene, impaired toilet transfer, impaired chair/bed transfer, and difficulty walking 3 meters were the most significant predictors for falls. The area under the curve was used to determine the cut-off score and new scoring for the revised falls scale. A second data set was used to validate the tool showing a sensitivity and specificity of 0.6 and 0.62, respectively (P=.001). The degree of "agreeability" between the original scale and the revised scale was 0.72. Conclusion: This multi-site data set predicted quality measures for the risk of falling resulting in a revised fall risk assessment scale for IRFs. Evaluation of this revised assessment tool indicates that the CCFRAS-R is effective and broadly generalizable for predicting patients at high risk for falling although the sensitivity and specificity of the tool may vary slightly based on environmental differences and patient acuity.

Morphological investigation of protective effects of CDP-choline on liver and small intestine in an experimental sepsis model in rats / Investigación morfológica de los efectos protectores de la CDP-colina en el hígado y el intestino delgado en un modelo experimental de sepsis en ratas

SUMMARY: Fifty male Wistar albino rats were divided into 5 groups; Group 1 as a sham group. Group 2 as a control group, Group 3 as 100 mg/kg CDP-choline administered group, Group as 200 mg/kg CDP-choline administered group, and Group 5 as sepsis group. The sepsis model was performed by ligating and perforating the caecum of rats. Liver and small intestine tissues were assessed either histologically or quantitatively and qualitatively. There was a significant difference between the sepsis and CDP-choline groups for liver and intestinal damage evaluated in tissue samples. (p <0.001). CDP-choline treatment partially improved dose-dependent the clinical parameters of sepsis and septic shock, reversed micro-anatomical damage caused by sepsis.

Cincuenta ratas albinas Wistar macho se dividieron en 5 grupos; Grupo 1 como grupo control simulador, el grupo 2 como grupo de control, el grupo 3 como grupo al que se administró 100 mg/kg de CDP-colina, el grupo 4 como grupo al que se administró 200 mg/kg de CDP-colina y el grupo 5 como grupo con sepsis. El modelo de sepsis se realizó ligando y perforando el intestino ciego de las ratas. Los tejidos del hígado y del intestino delgado se evaluaron histológicamente o cuantitativa y cualitativamente. Hubo una diferencia significativa entre los grupos de sepsis y CDP-colina para el daño hepático e intestinal evaluado en muestras de tejido (p<0,001). El tratamiento con CDP-colina mejoró parcialmente, según la dosis, los parámetros clínicos de sepsis y shock séptico y revirtió el daño micro anatómico causado por la sepsis.

[Quantification, dietary intake adequacy, and food sources of nutrients involved in the methionine-methylation cycle (choline, betaine, folate, vitamin B6 and vitamin B12) in pregnant women in Spain]. / Cuantificación, adecuación de la ingesta y fuentes alimentarias de nutrientes relacionados con el ciclo metionina-metilación (colina, betaína, folatos, vitamina B6 y vitamina B12) en mujeres embarazadas en España.

INTRODUCTION: Objective: a quantification of dietary intakes of the micronutrients involved in the methylation-methionine cycle (choline, betaine, folate, vitamins B6 and B12) in a representative sample of pregnant women in Spain; assessment of intake adequacy to available official recommendations; and analysis of their main food sources. Material and methods: the median intake of each micronutrient was established using food consumption data reported in the National Dietary Survey of adults, the elderly, and pregnant women (ENALIA-2) (n = 133). For folate, vitamin B6 and vitamin B12 intake, nutritional composition data from the Spanish Food Composition Tables were used, whereas for choline and betaine, which are not included in European food composition databases, the National Nutrient Database for Standard Reference of the United States Department of Agriculture (USDA) was considered. Intake adequacy was estimated in accordance with the recommendations of the main Spanish, European, and US guidelines. Results: mean daily intakes observed were 271.1 mg/day of choline; 142.5 mg/day of betaine; 182.8 µg/day of folate; 1.4 mg/day of vitamin B6; and 4.5 µg/day of vitamin B12. Intake adequacy levels were insufficient for choline (< 60.2 %) and folate (< 30.5 %); close to adequacy for vitamin B6 (> 71.6 %); and fully adequate only in the case of vitamin B12 (> 101.1 %). It is not possible to draw any conclusions regarding betaine intake in the absence of established recommendations. Main food sources included foods of animal origin for choline and vitamin B12 (71.8 % and 97.4 %, respectively); cereals and derivatives for betaine (85.3 %); vegetables (27.5 %) together with cereals and derivatives (18.6 %) for folate; and meats and derivatives (26.6 %) followed by vegetables (17.9 %) for vitamin B6. Conclusions: these findings are clearly indicative of the need to improve the intake and nutritional status of these components, which are of great nutritional interest for the health of pregnant women and, consequently, of their offspring. Consequent to the degree of adequacy observed, it seems necessary and urgent to employ not only dietary improvement strategies and the use of fortified foods, but also nutritional supplements with an individualized approach.

INTRODUCCIÓN: Objetivo: cuantificar las ingestas dietéticas de los micronutrientes implicados en el ciclo metilación-metionina (colina, betaína, folatos, vitaminas B6 y B12) en una muestra representativa de mujeres gestantes residentes en España; determinar la adecuación a las recomendaciones, y analizar sus principales fuentes alimentarias. Material y métodos: la determinación de la ingesta media se realizó a partir de los datos de consumo de los alimentos recogidos en la "Encuesta Nacional de Alimentación en población adulta, mayores y embarazadas" (ENALIA-2) (n = 133). Para el cálculo del aporte de folatos y de vitaminas B6 y B12 se emplearon los datos de composición nutricional recogidos en las "Tablas de Composición de Alimentos en España", mientras que para la colina y la betaína, nutrientes no incluidos en las bases de datos de composición de alimentos en Europa, se empleó la "Base de Datos Nacional de Nutrientes para Referencia Estándar del Departamento de Agricultura de los Estados Unidos" (USDA). La adecuación de la ingesta se estimó de acuerdo con las recomendaciones de las principales guías españolas, europeas y estadounidenses. Resultados: las ingestas medias diarias observadas fueron de 271,1 mg/día de colina; 142,5 mg/día de betaína; 182,8 µg/día de folatos; 1,4 mg/día de vitamina B6; y 4,5 µg/día de vitamina B12. Los niveles de adecuación a las recomendaciones resultaron insuficientes para la colina (< 60,2 %) y los folatos (< 30,5 %); cercanos a la adecuación para la vitamina B6 (> 71,6 %); y plenamente adecuados únicamente en el caso de la vitamina B12 (> 101,1 %). No resulta posible extraer ninguna conclusión con respecto al aporte de betaína al no existir recomendaciones establecidas. Las principales fuentes alimentarias fueron: alimentos de origen animal para la colina y la vitamina B12 (71,8 % y 97,4 %, respectivamente); cereales y derivados para la betaína (85,3 %); verduras y hortalizas (27,5 %) junto a cereales y derivados (18,6 %) para los folatos; y carnes y derivados (26,6 %), seguidos de verduras y hortalizas (17,9 %) para la vitamina B6. Conclusiones: los resultados obtenidos son indicativos de la necesidad de mejorar la ingesta y el estado nutricional de estos componentes de gran interés para la salud de la mujer embarazada. Como consecuencia del grado de adecuación observado, parece necesario y urgente el empleo no solo de estrategias para mejorar la dieta y el uso de alimentos fortificados, sino también de suplementos nutricionales de manera personalizada.

18F-choline PET/MRI on initial staging of prostate cancer. Impact on therapy approach. / La PET/RM con 18F-colina en el diagnóstico inicial del cáncer de próstata. Impacto en la estrategia terapéutica.

AIM: Evaluate the therapy impact of initial staging in patients diagnosed with prostate cancer by 18 F-choline PET/MRI hybrid technique. MATERIAL: A prospective study which included 31 patients diagnosed with prostate cancer; Gleason > 7; mean PSA 13.6 ng/mL (range 6.3-20.6). PET/MRI studies were acquired simultaneously with hybrid equipment (SIGNA.3T, GE) following intravenous injection of 185 ± 18.5MBq of 18F-choline: - Early/prostate imaging: PET emission + multiparametric MR: DIXON-T1-T2-diffusion-gadolinium. - Late/whole-body imaging: PET emission + MR: DIXON-T1-T2-diffusion-STIR sequences. Images were visually evaluated. SUV & ADC & textures were also calculated. Treatment selection was based upon Oncology Committee consensus decision. RESULTS: Procedure was well tolerated in all patients, and no artifacts were reported. MRI was superior in T staging in eight patients (25.8%) (Likert: 2-3), whereas PET increased MRI sensitivity in three patients (9.7%) (PIRADS: 3). PROSTATE LESION LOCATION: Peripheral 91.4%, transitional 8.6%. SUVmax threshold: 2.95: sensitivity 92.9%, specificity 66.7%. No correlation SUV vs. ADC. Better distinction between stage T2 vs. T3 using the DiscrLin model with NG = 16 (AUC 0.7767 ± 0.3386). PET was superior to T2 in textures analysis (0.588 vs. 0.412). Seventeen patients (54.8%) were staged ≥ T3, with surgical treatment being contraindicated. Fifteen patients (48.4%) presented with extra-prostatic disease: 8/31 oligometastatic and 7/31 multiple metastasis. Therapy approach following PET/MRI was: radical treatment in 24/31 patients (77.4%), 14 radical prostatectomy and 10 MRI-guided radiotherapy; systemic treatment in 7/31 patients (22.6%). CONCLUSION: 18F-choline PET/MRI had a complementary role for the T staging, with a high detection rate for NM infiltration. PET/MRI findings allowed patients to be directed either to prostatectomy or MRI-guided radiotherapy, and thus avoiding radicaltreatment in 22.6% of patients.

[Importance of choline in cognitive function]. / Importancia de la colina en la función cognitiva.

INTRODUCTION: Choline is a critical nutrient for cognitive development, metabolism and liver function, and regulation of homocysteine metabolism. It is necessary for the synthesis of the neurotransmitter acetylcholine, the synthesis of betaine and that of phosphatidylcholine. In the perinatal stage, the contribution of choline is essential to guarantee optimal cognitive development and prevent neural tube defects. In adults and the elderly, choline intake has been associated with better performance in some cognitive functions and a lower incidence of dementia. Despite their important role in health, most groups of the population do not reach their adequate intake of choline, and even some groups, such as pregnant women or childbearing women, have a higher risk of having suboptimal intakes. The main dietary sources of choline are eggs, dairy and meats, so reducing or limiting the consumption of these foods negatively impacts on the intake of this nutrient. Given the need to improve the intake of this vitamin, it is necessary to increase the knowledge that the population has about this nutrient, raising awareness about the importance of choline for health, and its main food sources.

INTRODUCCIÓN: La colina es un nutriente crítico para el desarrollo cognitivo, el metabolismo y la función hepática y la regulación del metabolismo de la homocisteína. Es necesaria para la síntesis del neurotransmisor acetilcolina, la síntesis de betaína y la de fosfatidilcolina. En la etapa perinatal el aporte de colina es fundamental para garantizar el desarrollo cognitivo y prevenir defectos del tubo neural. En adultos mayores y ancianos la ingesta de colina se ha asociado a mejor rendimiento en algunas funciones cognitivas y menor incidencia de demencia. A pesar de su importante papel en la salud, la mayoría de los colectivos no alcanza sus ingestas adecuadas (IA) de colina, aunque algunos colectivos, como gestantes o mujeres en edad fértil, tienen un mayor riesgo de tener ingestas subóptimas. Las principales fuentes dietéticas de esta vitamina son los huevos, lácteos y carnes, y disminuir o limitar el consumo de estos alimentos impacta negativamente en la ingesta de este nutriente. Dada la necesidad de mejorar la ingesta de esta vitamina, es necesario mejorar el conocimiento que tiene la población sobre este nutriente, concienciándola sobre la importancia de la colina para la salud y sus principales fuentes alimentarias.

Insufficient choline intake during pregnancy: cohort study / Ingestão insuficiente de colina durante a gestação: estudo de coorte

ABSTRACT Objective To investigate the intake of choline during pregnancy and associated factors. Methods Cohort study with 353 pregnant women recruited from the primary health care network in an inland city of the State of São Paulo. In-house interviews were conducted in each of the gestational trimesters. In each of these points in time, a 24-hour dietary recall was collected. Subsequently, a new dietary recall collection was performed by telephone in the same trimester on a non-consecutive day, differentiating weekday versus weekend/holiday. Dietary intake data were included in the Nutrition Data System for Research software, and the habitual food intake throughout pregnancy was determined, with intra-individual variation correction in the MSM software. The influence of socioeconomic, obstetric and lifestyle factors, and of the actual diet, on choline intake during pregnancy was assessed using linear regression models, that were developed with the Stata software version 14.2, at a significance level of 95%. Results Choline intake (281.1±68.6 milligrams) was below the recommended adequate intake, and only energy was positively associated with this micronutrient intake. Conclusion Choline intake in the population studied fell far short of current recommendations, and only higher energy intake was found as a factor associated with a higher intake.

RESUMO Objetivo Investigar a ingestão de colina durante a gestação e fatores associados. Métodos Estudo de coorte com 353 gestantes recrutadas na rede de assistência primária à saúde de cidade paulista. Foram realizadas entrevistas presenciais, no domicílio, em cada um dos trimestres gestacionais. Em cada momento foi coletado um recordatório alimentar de 24 horas, seguido por nova coleta via telefone no mesmo trimestre, em dia não consecutivo, diferenciando dia de semana versus final de semana/feriado. Os dados de consumo alimentar foram incluídos no software Nutrition Data System for Research, sendo obtida a ingestão habitual, durante toda a gestação, com correção da variação intraindividual, no software MSM. A influência de fatores socioeconômicos, obstétricos, de estilo de vida e da própria dieta sobre a ingestão de colina na gestação foi avaliada por modelos de regressão linear, realizados no software Stata versão 14.2, ao nível de significância de 95%. Resultados A ingestão diária de colina (281,1±68,6 miligramas) mostrou-se abaixo do recomendado, sendo que apenas a energia mostrou-se como positivamente associada à ingestão desse micronutriente. Conclusão A ingestão de colina na população estudada ficou muito aquém das recomendações atuais, sendo que apenas a maior ingestão energética foi encontrada como fator associado à maior ingestão de colina.

Relación de las cinéticas del PSA en la detección de la recurrencia del cáncer de próstata post prostatectomía radical con la 18f-colina tomografía por emisión de positrones/tomografía computada [PET/TC colina (PETC)] / Kinetic Relation Between PSA and 18F-choline PET/ CT in the Detection of Recurrent Prostatic Cancer After Radical Prostatectomy

Resumen Objetivo: El objetivo de este estudio es evaluar la relación de las cinéticas del antígeno prostático específico (PSA por su sigla en inglés) con la positividad de la tomografía por emisión de positrones/tomografía computada [PET/TC colina (PETC)]en pacientes con una recaída de cáncer de próstata (RCP). Materiales y métodos: Se realizó un trabajo retrospectivo de 48 pacientes con RCP post prostatectomía radical (PR) evaluados con PETC. Resultados: La PETC negativa tuvo una mediana de 16,3 meses y la PETC positiva de 5,5 meses (p = < 0,001) para el tiempo de doblaje de PSA (PSADT por su sigla en inglés); la PETC fue positiva en el 96% de los pacientes con un PSADT< 12 meses. La PETC negativa tuvo una mediana de 0,03 ng/ml/año y la PETC positiva de 4,1 ng/ml/año (p = < 0,001) para la velocidad del PSA (PSAVpor su sigla en inglés); la PETC fue positiva en el 92% de los pacientes con un PSAV > 0,75 ng/ml/año. Las áreas bajo la curva ROC para PSAV fue de 0,984 con un punto de corte de mayor discriminación de 0.785 ng/ml/año, mostrando razones de verosimilitud (LR por su sigla en inglés) LR + = 25 y LR- = 0,1. Para PSADT el ROC fue de 0,992 con un punto de corte de mayor discriminación de 11 meses, mostrando LR + = 11 y LR- = 0. Discusión: El PSA es un indicador inespecífico de PETC positiva. Un estudio inicial demostró que los pacientes con una RCP con una PETC positiva tenían un menor PSADT y una mayor PSAV que los pacientes con una PETC negativa. Conclusión: La positividad de la PETC se vio influenciada por las cinéticas del PSA, observándose que a menor PSADT y que a mayor PSAV mayor fue la probabilidad de la positividad de la PETC.

Abstract Purpose: The aim of this study is to evaluate the relationship between Prostate-Specific Antigen (PSA) kinetics and the detection of Prostate Cancer Relapse (PCR) with Positron-Emission Tomography (PETC). Material and methods: A retrospective study of 48 patients with a PCR after a radical prostatectomy evaluated with PETC was performed. Results: PSA Doubling Time (PSADT), with negative PETC, had a median of 16.3 months and the positive PETC a median of 5.5 months (p = < 0.001); 96% of patients with a PSADT <12 months had positive PETC. PSA Velocity (PSAV), negative PETC, had a median of 0.03 ng/ml/year and positive PETC a median of 4.1 ng/ml/year (p = < 0.001); 92% of patients who had a PSAV > 0.75 ng/ml/year had positive PETC. The ROC for PSAV was 0.984 with a cut-off value of 0.785 ng/ml/year, Showing Likelihood Ratios (LR) LR + = 25 and LR- = 0.1. The ROC for PSADT was 0.992 with a cut off value of 11 months, showing LR + = 11 and LR- = 0. Discussion: PSA is a nonspecific indicator of positive PETC. An initial study demon-strated that patients with a PCR and positive PETC had lower PSADT and higher PSAV than patients with a negative PETC. Conclusion: The rate of detection of PCR with PETC was influenced by the kinetics of PSA, and it was observed that the lower the PSADT and the higher the PSAV, the greater the probability of the positivity of the PETC.

Usefulness of 18F-Choline Positron Emission Tomography - Computed Tomography in the therapeutic management of patients with biochemical recurrence of prostate adenocarcinoma treated with brachytherapy. / Utilidad de la tomografía de emisión de positrones / tomografía computarizada con 18F-colina en el manejo terapéutico de pacientes con recidiva bioquímica de adenocarcinoma de próstata tratados con braquiterapia.

OBJECTIVE: The objective of the study was to evaluate the usefulness of 18F-choline PET/CT in biochemically recurrent prostate cancer patients treated with brachytherapy, as well as to assess the changes in therapeutic management derived from its outcome. MATERIAL AND METHODS: Retrospective study of 20 patients between 51 and 78 years old, with a history of prostate adenocarcinoma that had been treated with brachytherapy and presented biochemical recurrence (PSA 3.1-12 ng/ml) and staging tests (CT and bone scan) without alterations, were included. The findings visualized in the PET/CT scan with 18F-choline were correlated with the histopathology and/or the evolution of the PSA after therapy. RESULTS: 18F-choline PET/CT scan only detected local recurrence in 15 patients. Local and regional recurrences were seen in 4 patients, and 1 patient presented local and bone recurrence. Local recurrence detected in PET was confirmed by anatomopathological studies in 85% of the cases. In one patient, these findings (PET scan) turned out to be prostatitis, and it could not be confirmed in another patient. Of the cases with local and regional recurrence, local recurrence was histologically confirmed in 3 out of 4 patients. 18F-choline PET/CT changed the therapeutic management in 25% of the patients, discarding the initially planned salvage surgery in 3 cases, 1 radiotherapy and 1 brachytherapy. CONCLUSION: 18F-choline PET/CT could be a useful technique in the group of patients with biochemical recurrence after brachytherapy, providing locoregional and distant involvement findings which had not been detected with conventional imaging tests, thus determining a more adequate therapeutic management.

18F-choline PET/4D CT in hyperparathyroidism: correlation between biochemical data and study parameters. / PET/TC 4D 18F-colina en el hiperparatiroidismo: correlación entre datos bioquímicos y parámetros del estudio.

BACKGROUND: Hyperparathyroidism (HPT) is characterised by increased levels of parathyroid hormone (HPT), surgical excision being the only definitive curative option. After establishing the need for surgery, it is essential to identify the parathyroid glands in the preoperative period to use a minimally invasive approach. Negativity and / or discrepancy in first-line studies (ultrasound and Tc-99m MIBI parathyroid scintigraphy) require more accurate images to reduce the likelihood of bilateral cervical exploration or reintervention. OBJECTIVES: a) To demonstrate the sensitivity of 18F-fluorocholine (18F-choline) positron emission tomography (PET)/4D computed tomography (4D CT) in HPT. b) To check whether there is a correlation between calcaemia and preoperative PTH versus size and early and late SUVmax (Standardized Uptake Value) of the gland, determined by 18F-choline PET/4D CT and c) to study the behaviour of parathyroid lesions with intravenous contrast (IV). MATERIAL AND METHODS: A total of 28 patients were included between 2016 and 2019 in a single institution. Prospective observational cohort study. Correlations were analysed using Pearson's coefficient for variables with normal distribution and Spearman (rho) for those with non-normal distribution. Anatomopathological analysis was the benchmark standard to determine sensitivity was. A p<.05 was interpreted as significant. STATA 13 software was used. RESULTS: Of the 28 patients who underwent 18F-choline PET/4D CT, 18 were operated. Of the 26 lesions diagnosed by 18F-choline PET/4D CT as suggestive of parathyroid lesions, 23 corresponded to glandular disease (adenoma or hyperplasia) establishing a sensitivity of 88.5%. There was a correlation between the patient's preoperative PTH and the maximum size of the gland on 18F-choline PET/4D CT. (Spearman=.66; p=.0014). The parathyroid lesions showed, in addition to IV contrast enhancement, distinctive behavioural characteristics identified as highly suggestive. CONCLUSIONS: 18F-choline PET/CT 4D is an anatomical and functional study with high sensitivity in patients with HPT with negative or discrepant first-line studies. Preoperative PTH showed a correlation with maximum gland size on 18F-choline PET/CT 4D. Parathyroid lesions behave in a highly suggestive way and are enhanced by IV contrast.

Diagnostic utility and therapeutic impact of PET/CT [18F]F-Fluoromethylcholine -Choline in the biochemical recurrence of prostate cancer. / Utilidad diagnóstica e impacto terapéutico de la PET/TC con [18F]F-Fluormetilcolina en la recidiva bioquímica del cáncer de próstata.

OBJECTIVE: To assess the diagnostic capability of PET/CT with [18F]F-Fluoromethylcholine in prostate cancer (PC) with biochemical recurrence and its therapeutic impact. MATERIAL AND METHODS: We included 108 patients, diagnosed with PC with biochemical criteria for recurrence. A PET/CT Choline scan was performed by dynamic pelvic and whole body study at 60min post-tracer injection. The relationship between the positive studies and the PSA value was analysed by classifying patients into three groups (<1.2/1.2-2/>2ng/ml), and the diagnostic capacity was assessed with respect to pelvic MRI and the impact on the therapeutic decision. RESULTS: The location of recurrence was identified in 85 of 108 patients (78.7%): 34 local, 47 pelvic lymph nodes and 58 distant lesions, including retroperitoneal, mediastinal lymph nodes and distant organ lesions (bone and lung). Second tumors were diagnosed in 4 patients. No significant differences were found in the percentage of positive studies depending on primary treatment. Patients with PSA>2ng/ml showed a higher percentage of disease detection than patients with a lower PSA level, with significant differences (p<0.0001). PET/CT [18F]F-Choline was able to detect local disease, not previously known from MRI, in 29.41% of patients. PET/CT Choline had an impact on therapeutic management in 67 of 108 patients (62%). CONCLUSIONS: PET/CT with [18F]F-Fluoromethylcholine is a useful tool in the detection of locoregional and disseminated disease of PC treated with suspicion of recurrence, providing a change in therapeutic management in 62% of patients.

Identification of Occult Adenomas in Primary Hyperparathyroidism With 18F-fluorocholine PET/CT. / Identificación de adenomas ocultos en hiperparatiroidismo primario con PET-TC 18F-fluorocolina.

INTRODUCTION: Single parathyroid adenomas are the most common cause of primary hyperparathyroidism (PHP) in our population. Parathyroidectomy is still the only potentially curative treatment and requires preoperative localization imaging studies to perform selective surgery. In patients with negative results on conventional tests, PET/CT has demonstrated higher sensitivity rates. METHODS: A prospective cohort study was designed, including 34 patients diagnosed with PHP between 2017 and 2019, candidates for surgery with negative preoperative localization tests with scintigraphy and MIBI SPECT/CT. All patients underwent PET/CT with 18F-Fluorocholine. The clinical, biochemical and postoperative outcome results were compared with a control group of 30 patients with positive standard tests. RESULTS: Hyperfunctional parathyroid tissue was detected in 85% of the patients that had undergone choline PET/CT. The selective resection of the adenoma identified in these patients achieved curative criteria in 87% of the cases without undergoing bilateral cervical surgical exploration. The preoperative levels of PTH, calcemia and gland weight were significantly lower in this group compared to the control group. No differences were identified in cure criteria or approach between the 2groups. CONCLUSION: In our study, choline PET/CT showed higher detection rates compared to the gold standard. The increase provides the opportunity to perform unilateral selected adenoma resection, especially in patients with smaller adenomas associated with lower calcemia and PTH levels and patients with previous cervical surgery.

Value of 18F-Choline PET/MRI hybrid technique on the therapeutic approach for patients with prostate cancer treated with prostatectomy and rising prostate specific antigen levels below 1 ng/ml. / Impacto de la tecnología híbrida PET/RM con 18F-colina en la estrategia terapéutica de los pacientes con cáncer de próstata tratados con prostatectomía que presentan elevación del antígeno prostático específico inferior a 1 ng/ml.

OBJECTIVE: To assess the detection rate of 18F-Choline PET/MRI and subsequent changes in therapy approach for patients with prostate cancer treated by prostatectomy and with rising levels of PSA <1 ng/ml. METHODS: Prospective study with our first 36 patients with prostatectomy for prostate cancer and rising levels of PSA, who were referred for an 18F-Choline PET/MRI study. A dual-phase study was acquired after intravenous administration of 185±10% MBq of 18F-Choline: 1) early imaging (immediately after tracer administration) of prostate area (emission PET/Multiparametric MRI). 2) whole-body imaging 1 h after tracer injection (emission PET/MRI: T1, T2, STIR, diffusion). The therapy approach for patients was decided upon the Oncology Committee consensus based on 18F-Choline PET/MRI findings. RESULTS: Twenty out of 36 patients (55.6%) were positive for the 18F-Choline PET/MRI study: 8 (22.2%) within the prostatectomy bed, 7 (19.4%) with infradiaphragmatic lymph nodes, 4 (11.1%) with local recurrence and infradiaphragmatic lymph nodes, and 1 (2.8%) with bone metastasis. Sixteen out of the 36 patients (44.4%) were negative for the 18F-Choline PET/MRI study. 18F-Choline PET/MRI findings had an impact on the therapy approach to follow: 15 patients (41.6%) showed oligometastatic disease which was treated by imaging-guided radiotherapy, 5 (13.9%) with multiple metastatic disease were treated by androgen deprivation therapy, 16 (44.4%) negative were under active surveillance. CONCLUSION: Hybrid 18F-Choline PET/MRI procedure showed a high detection rate for recurrence in prostate cancer patients treated with prostatectomy and rising PSA levels <1 ng/ml, and 18F-Choline PET/MRI findings resulted in a better tailored therapy approach delivered to our patients.

Standardization of acquisition protocols using PET/CT with 18F-Choline in prostate cancer. / Estandarización de los protocolos de adquisición mediante PET/TC con 18F-Colina en el cáncer de próstata.

AIM: To standardize acquisition protocols for 18F-Choline PET/CT to prevent from urine interference, to determine the best time point for the whole-body study, and to assess whether "dual point" acquisition allows for differentiating malignant vs. benign lesions. METHODS: One hundred consecutive patients with prostate cancer were prospectively studied. Immediately after 18F-Choline injection, a pelvis study was acquired, and a whole-body was subsequently obtained 1 and 2 hours p.i. Mean SUVmax was obtained in regions and for every sequential imaging. Mean analysis (χ2) and SUV percentage change (2/1 hours; 1 hours/0 min) were obtained. Metabolic pattern dynamics were assessed: accumulative vs. clearance. Patient follow-up after therapy and directed classification whenever ethically possible were performed. RESULTS: Fifty-three prostate foci, without disturbing urinary activity was ever found on early images. Accumulative pattern in 42, with percentage increase was: 0 min/1 hour: +16.7% (χ20.94); 1/2 hours: +10,0% (χ2 0.83). Clearance pattern in 11, with percentage decrease: 0 min/1 hour: -21.4% (χ20.91): -7.7% (χ20.85), corresponding in 7 to initial staging and in 4 post-radiotherapy biochemical recurrence. Every infradiaphragmatic uptake (n: 24) showed accumulative pattern, with percentage increase of +9.1% (χ20.97), all of them depicted on early imaging. As for 12 supradiaphragmantic uptake, 8 of them showed clearance pattern with percentage decrease: -13.0% (χ20.95). Accumulative pattern showed in 4 of them with percentage increase +13.0% (χ2 0.96), thus being assessed as invasive/malignant. Every bone uptake (n: 18) showed accumulative pattern, with percentage increase: +17.1% (χ20.95), all of them depicted on 1 hour imaging. CONCLUSIONS: As for prostate assessment is concerned, dual point at 0 min/1 hour proved to be the best procedure. As for supradiaphragmatic lymph-nodes detection, dual point with 1/2 hours performed best. As for infradiaphragmatic and bone involvement, as well as for inconclusive findings, the 2 hour imaging increased our diagnostic confidence.

Utilidad de la 18f-colina pet/tc en hiperparatiroidismo primario persistente o recurrente: experiencia inicial / Usefulness of 18f-choline pet / tc in persistent or recurrent primary hyperparathyroidism: initial experience

El hiperparatiroidismo persistente/recurrente representa un desafío en la localización del tejido paratiroideo hiperfuncionante. En esta subpoblación, los métodos convencionales ofrecen un menor rédito diagnóstico. La 18F-colina PET/TC podría ser una buena alternativa dada su mejor resolución espacial, capacidad de detectar glándulas ectópicas y la conjunción de la imagen molecular y anatómica. Sin embargo, la evidencia en este subgrupo de pacientes es escasa. Objetivo: evaluar la utilidad de la 18F-colina PET/TC como método de localización en el hiperparatiroidismo persistente o recurrente. Materiales y métodos: se analizaron los pacientes con 18F-colina PET/TC para hiperparatiroidismo entre diciembre de 2015 y enero de 2018 en un centro terciario de alto volumen. Se analizaron el número de lesiones, su localización, tamaño y el Standard Uptake Value máximo (SUV max) en las imágenes tempranas y tardías. Se compararon los resultados con los métodos convencionales. Resultados: 7 de 15 pacientes habían sido operados previamente (persistentes/recurrentes). La 18F-colina PET/TC detectó 6/7 casos (83,33%), la ecografía cervical 1/4 (25%) y el SPECT de paratiroides y la resonancia nuclear magnética 2/5 (40%). El SUV max obtenido fue variable, en la mitad de los casos a los 10 minutos y en los restantes a la hora; el tamaño promedio de las lesiones fue 8,61 mm (6-12 mm). Conclusiones: la 18F-colina PET/TC muestra una alta tasa de detección en los pacientes con hiperparatiroidismo persistente/recurrente. La combinación del comportamiento biológico del PET con los hallazgos morfológicos aportados por la TC con contraste endovenoso le ofrecería ventajas sobre otros estudios que podrían posicionarlo como método de primera línea en esta subpoblación. (AU)

Persistent or recurrent hyperparathyroidism represents a challenge regarding the localization of the hyper-functioning parathyroid tissue. In this subpopulation of hyperpharathyroid patients, conventional methods have a low diagnostic yield. The 18F-choline PET /CT could be a good alternative given its better spatial resolution, ability to detect ectopic glands, and the conjunction of the molecular and anatomical image. However, the evidence in this subgroup of patients is limited. Objective: to evaluate the utility of 18F-choline PET/ CT as a localization method in persistent or recurrent hyperparathyroidism. Materials and methods: patients with 18F-choline PET / CT for hyperparathyroidism between December 2015 and January 2018 in a high-volume tertiary center were included. The number of lesions, and their location, size, and maximum Standard Uptake Value (SUV) in the early and late images were analyzed. The results were compared to conventional methods. Results: 7 of 15 patients had been previously operated (persistent/recurrent). 18F-choline PET / CT detected 6/7 cases (83,33%), cervical ultrasound 1/4 (25%) and parathyroid SPECT and magnetic resonance 2/5 (40%). The maximum SUV was variable, one half at 10 minutes and the other half at 60 minutes; the average size of the lesions was 8.61 mm (6-12 mm). Conclusions: 18F-Choline PET / CT shows a high detection rate in patients with persistent / recurrent hyperparathyroidism. The combination of the biological behavior of PET with the morphological findings provided by CT with intravenous contrast would offer advantages over other studies that could position it as a first line method in this subpopulation. (AU)

Intraindividual comparison of 68Ga-DOTATATE PET / CT vs 11C-Choline PET / CT in patients with prostate cancer in biochemical relapse: in vivo evaluation of the expression of somatostatin receptors. / Comparación intraindividual de la PET/TC con 68Ga-DOTATATE vs. PET/TC con 11C-colina en pacientes con cáncer de próstata en recaída bioquímica: evaluación in vivo de la expresión de receptores de la somatostatina.

BACKGROUND AND OBJECTIVES: To prospectively compare the detection rate of 68Ga-DOTATATE versus 11C-choline PET/CT in patients with prostate cancer in biochemical relapse, and to evaluate somatostatin receptor expression in vivo to plan targeted therapies (177Lu-DOTATATE). MATERIAL AND METHODS: We prospectively analysed 64 patients with biochemical relapse (median PSA: 4.25 ng/mL). A PET/CT was performed with 11C-choline, and another with 68Ga-DOTATATE. The SUVmax was measured in all lesions. The correlative images, histopathology and/or clinical and biochemical follow-up were taken as the reference standard. RESULTS: The overall detection rate per patient was 48.43% for 68Ga-DOTATATE and 46.87% for 11C-choline. The results were concordant in 53 cases (82.81%). The maximum SUV of 11C-choline was significantly higher than that of 68Ga-DOTATATE for all the concordant lesions (n=130): 6.17 (1.7-15.5) versus 4.38 (1.37-26.7), median (range) for each radiotracer, respectively (p < .0001). The sensitivity and specificity values per patient were the same for both techniques: 0.82 (0.65-0.93) and 0.9 (0.73-0.98), respectively. Although the difference was not significant, the sensitivity was lower in patients with lower PSA levels: 0.63 vs. 0.89; p=.13. A significant correlation was found between the SUVmax of both tracers (r = 0.41, n = 130, p <.0001). CONCLUSIONS: 68Ga-DOTATATE PET/CT and 11C-choline PET/CT seem to have a high capacity to detect pathological lesions in the assessment of patients with prostate cancer with biochemical relapse. Further studies are required to test the potential complementary value of these PET/CT techniques, and to evaluate the potential role of 8Ga-DOTATATE for planning somostatin receptor-mediated therapies (177Lu-DOTATATE).