RESUMO
OBJECTIVES: To assess variability of the average standard uptake value (SUV) computed by varying the number of hottest voxels within an (18)F-fluorodeoxyglucose ((18)F-FDG)-positive lesion. This SUV metric was compared with the maximal SUV (SUV(max): the hottest voxel) and peak SUV (SUV(peak): SUV(max) and its 26 neighbouring voxels). METHODS: Twelve lung cancer patients (20 lesions) were analysed using PET dynamic acquisition involving ten successive 2.5-min frames. In each frame and lesion, average SUV obtained from the N = 5, 10, 15, 20, 25 or 30 hottest voxels (SUV(max-N)), SUV(max) and SUV(peak) were assessed. The relative standard deviations (SDrs) from ten frames were calculated for each SUV metric and lesion, yielding the mean relative SD from 20 lesions for each SUV metric (SDr(N), SDr(max) and SDr(peak)), and hence relative measurement error and repeatability (MEr-R). RESULTS: For each N, SDr(N) was significantly lower than SDr(max) and SDr(peak). SDr(N) correlated strongly with N: 6.471 × N(-0.103) (r = 0.994; P < 0.01). MEr-R of SUV(max-30) was 8.94-12.63% (95% CL), versus 13.86-19.59% and 13.41-18.95% for SUV(max) and SUV(peak) respectively. CONCLUSIONS: Variability of SUV(max-N) is significantly lower than for SUV(max) and SUV(peak). Further prospective studies should be performed to determine the optimal total hottest volume, as voxel volume may depend on the PET system. KEY POINTS: ⢠PET imaging provides functional parameters of (18) F-FDG-positive lesions, such as SUVmax and SUVpeak. ⢠Averaging SUV from several hottest voxels (SUVmax-N) is a further SUV metric. ⢠Variability of SUVmax-N is significantly lower than SUVmax and SUVpeak variability. ⢠SUVmax-N should improve SUV accuracy for predicting outcome or assessing treatment response. ⢠An optimal total hottest volume should be determined through further prospective studies.
Assuntos
Fluordesoxiglucose F18/farmacocinética , Neoplasias Pulmonares/diagnóstico por imagem , Estadiamento de Neoplasias/métodos , Tomografia por Emissão de Pósitrons/métodos , Adulto , Idoso , Feminino , Fluordesoxiglucose F18/administração & dosagem , Humanos , Injeções Intravenosas , Neoplasias Pulmonares/metabolismo , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Compostos Radiofarmacêuticos/administração & dosagem , Compostos Radiofarmacêuticos/farmacocinética , Carga TumoralRESUMO
INTRODUCTION: Imaging currently performed in uro-oncology could provide useful information. The use of all this information could help to better understand tumor growth and response to treatment. Therefore, it seems interesting to review the knowledge, to describe the main techniques currently available in many centers or in process and to clarify their results. MATERIALS AND METHODS: A systematic literature review was conducted in the PubMed database to identify all imaging techniques performed for therapeutic evaluation in uro-oncology. The keywords used were: cancer, kidney, bladder, prostate, urology biomarkers, imaging, ultrasound, CT-scan, MRI, PET-CT, RECIST, BOLD, ASL, gold DWI Diffusion, contrast, F-miso. The first publications identified were analyzed to search unidentified studies by the selected keywords. RESULTS: From simple to more complex morphology data from functional imaging (PET, MRI), data obtained from imaging helps to better understand tumor growth and response to treatment. Although optimizations are coming, all the techniques reported are available in many centers or going to be. CONCLUSION: The imaging evaluation in onco-urology can bring a large amount of information. Integrating to research protocols is now essential to sustain this activity.
Assuntos
Diagnóstico por Imagem/métodos , Neoplasias Urogenitais/diagnóstico , Meios de Contraste , Humanos , Compostos RadiofarmacêuticosRESUMO
BACKGROUND/AIMS: Metastatic renal cell carcinoma (mRCC) can be rapidly progressive when tumors exhibit sarcomatoid or Fuhrman grade 4 features. Efficacy of gemcitabine (Gem) with doxorubicin (Dox) in sarcomatoid or rapidly progressive mRCC has been reported. We retrospectively evaluated Gem + Dox in a consecutive cohort of this particular patient population. PATIENTS AND METHODS: Patients had an Eastern Cooperative Oncology Group performance status of 2 or more and rapidly progressive mRCC or mRCC with sarcomatoid features. Gem (1,500 mg/m(2)) and Dox (50 mg/m(2)) were given every 2 weeks with granulocyte colony-stimulating factor. RESULTS: Twenty-nine patients were treated. Sarcomatoid features were predominant in 6 patients, while 14 tumors were Fuhrman grade 4. All patients had progressive mRCC within 4 months. No grade 4 toxicity or drug-related death was reported. One partial response (7 months), 1 mixed response, and 14 stable diseases (≥4 months for 9 patients) were observed and no response was seen in sarcomatoid tumors. The median disease-free survival was 3.7 months (≥6 months for 8 patients) and the median overall survival was 4.8 months (>12 months for 5 patients). CONCLUSION: This study showed a lower response rate than previously reported. Nevertheless, some patients had prolonged survival outcomes. This combination could be an option in sarcomatoid histology (NCCN guidelines) or rapidly progressive disease, but this population represents an unmet medical need.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células Renais/tratamento farmacológico , Carcinoma de Células Renais/patologia , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/patologia , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Desoxicitidina/administração & dosagem , Desoxicitidina/análogos & derivados , Doxorrubicina/administração & dosagem , Feminino , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Humanos , Neoplasias Pulmonares/secundário , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , GencitabinaRESUMO
We report a case of bladder located gastric heterotopy, which has never been described, to our mind in the scientific literature. We discuss the diagnosis and the physiopathological mechanisms that may have been involved in the genesis of such a lesion.
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Coristoma/patologia , Doenças da Bexiga Urinária/patologia , Dor Abdominal/etiologia , Adulto , Humanos , Masculino , EstômagoRESUMO
The objectives of this study were to evaluate the diagnostic value of 99mTc-HMPAO labelled white blood cell scintigraphy (WBCS) in patients with suspected osteomyelitis using late images and to study interobserver reproducibility. This study prospectively included 120 patients, and after a follow-up of one year, only 70 patients (n = 49 with implants, n = 21 without implants) were selected. The final diagnosis of infection was based either on microbiological data (n = 54) or follow-up (n = 16). We performed WBCS with 4 h and 24 h scans. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 77%, 72%, 83%, 64%, and 75% at 4 h, and 74%, 87%, 91%, 59%, and 79% at 24 h, respectively. The interobserver reproducibility shows a 63% prevalence of agreement between results (kappa = 0.5) at 4 h and 80% (kappa = 0.74) at 24 h, respectively. WBCS with 24-h images improves specificity and interobserver reproducibility in patients with suspected osteoarticular sepsis.
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Leucócitos/diagnóstico por imagem , Leucócitos/metabolismo , Osteoartrite/diagnóstico , Cintilografia/métodos , Tecnécio Tc 99m Exametazima/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Functioning endocrine pancreatic tumors in multiple endocrine neoplasia type 1 (MEN1) are rare. We present a case of a symptomatic neuroendocrine tumor in a 27-year old woman. The identification of the nature of the neuroendocrine tumors was difficult despite the use of a wide range of diagnostic procedures. This case is interesting in many ways: this is an exceptional illustration of MEN 1 with vipoma associated with calcitonin secretion and it is also a good example of the benefits and limitations of each diagnostic procedure in the heterogeneous group of neuroendocrine tumors.
Assuntos
Neoplasia Endócrina Múltipla Tipo 1/diagnóstico , Tumores Neuroendócrinos/diagnóstico , Vipoma/diagnóstico , Adulto , Biomarcadores , Calcitonina/metabolismo , Feminino , Humanos , Hipercalcemia/tratamento farmacológico , Hiperparatireoidismo/etiologia , Imageamento por Ressonância Magnética , Neoplasia Endócrina Múltipla Tipo 1/complicações , Neoplasia Endócrina Múltipla Tipo 1/diagnóstico por imagem , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/diagnóstico por imagem , Cintilografia , Tecnécio Tc 99m Sestamibi , Tomografia Computadorizada por Raios X , Vipoma/complicações , Vipoma/diagnóstico por imagemRESUMO
A 65-year-old patient with prostate adenocarcinoma was explored by 18F-fluorocholine (FCH) PET/CT for pretreatment staging because of a high risk of prostate cancer. Images showed multiple foci with increased uptake of 18F-FCH within some pelvic and retroperitoneal lymph nodes, osseous foci (iliac bones and sacrum), and much more unusual, increased uptake foci within some left supraclavicular and left axillary lymph nodes. Owing to the rarity of spread to supraclavicular lymph nodes, surgical removal was performed and revealed prostate cancer metastases.
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Adenocarcinoma/diagnóstico por imagem , Colina/análogos & derivados , Imagem Multimodal , Tomografia por Emissão de Pósitrons , Neoplasias da Próstata/diagnóstico por imagem , Compostos Radiofarmacêuticos , Tomografia Computadorizada por Raios X , Adenocarcinoma/patologia , Idoso , Humanos , Metástase Linfática/diagnóstico por imagem , Masculino , Neoplasias da Próstata/patologiaRESUMO
Polysplenia syndrome (PS) is usually discovered in symptomatic patients in association with congenital heart disease or biliary atresia. Asymptomatic patients can present associated anomalies of the digestive tract such as intestinal malrotation and gastric or splenic malfixation. We report a case of PS presenting as a left flank mass shown to be an accessory spleen by denatured red blood cell scintigraphy. Upper gastrointestinal tract studies showed intestinal malrotation. Laparoscopic exploration confirmed intestinal malrotation and showed the absence of fixation of the accessory spleen. We performed a laparoscopic Ladd's procedure followed by fixation of the accessory spleen and resection of Meckel's diverticulum through a short left-flank incision.
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Duodeno/anormalidades , Laparoscopia , Baço/anormalidades , Criança , Feminino , Humanos , Divertículo Ileal/cirurgia , Baço/diagnóstico por imagem , Síndrome , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
This work is a retrospective two years study of thyroid cancer, diagnosed in Reunion Island, using scintigraphic cold regions. Between April 1993 and April 1995, 1,364 thyroid scintigraphic studies were performed in the CHD F. Guyon at Saint Denis, Réunion). These studies resulted from all types of indication and of them 691 had cold regions, with 22 thyroid cancers among them, (i.e. a prevalence of 3.20% of cold areas). Analysis of these cancers allowed recognition of various characteristics. A large majority (82%) were in females, whose median age at the time of diagnosis was 49 years (as opposed to 48 years for the male patients). The associated cold zones were usually isolated cold nodules. Anatomical pathology investigation indicated six were papillary, five mixed, three vesicular nodule, four microcarcinoma, one each of anaplastic, one follicullar thyroid carcinoma, and two were metastases. Their geographical distribution was superposed on their medical demography. Treatment was surgical, but a variety of procedures was used. Generally the diagnostical, therapeutical and follow up procedures were not standardised. Needle cell biopsy was virtually excluded from the decision-making trees and a variety of protocols was used. In addition there are no local epidemiological data available concerning thyroid cancers. An improved method for dealing with these cancers appears to be essential for Reunion. It must be associated with a greater awareness from medical practitioners, agreement on procedures for diagnosis, treatment and follow up and the setting up of a register for thyroid cancer in the "Department". Some thought before detailed involvement should be given to the setting up of a team, trained in needle cell biopsy, and an associated metabolic radiotherapy facility, so allowing appropriate procedures and follow up for thyroid cancers in this "Department".
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Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/epidemiologia , Adenocarcinoma Folicular , Adulto , Carcinoma Papilar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cintilografia , Estudos Retrospectivos , Reunião/epidemiologia , Neoplasias da Glândula Tireoide/terapiaRESUMO
INTRODUCTION: It is known that for a fixed amount of injected tracer, the amount available for a tissue of interest will be less if other tissues show intense uptake. The aim of this study was to estimate the magnitude of 2-deoxy-2-[(18)F]fluoro-D-glucose (18FDG) uptake amount in physiological tissues that may show an intense uptake in current clinical practice. METHODS: A formula was established providing an estimate of the percentage of injected 18FDG molecules (P; in %) that are irreversibly trapped in an 18FDG-positive tissue during a PET examination. RESULTS: P â 0.17*exp(-λt(acq))*TLG/W, where λ is the (18)F physical decay constant, t(acq) is the injection-acquisition time delay, TLG is total lesion glycolysis (g) and W is the patient weight (kg). The magnitude of P was calculated in two patients showing an intense uptake in brown fat, myocardium and bowels: 0.5, 3.5, and 4.2% respectively. CONCLUSIONS: A formula is available to quickly estimate the amount of 18FDG uptake in tissues. We suggest that the accumulation of different physiological uptakes may actually affect SUV quantification in a tissue of interest.
Assuntos
Algoritmos , Peso Corporal , Fluordesoxiglucose F18/farmacocinética , Interpretação de Imagem Assistida por Computador/métodos , Modelos Biológicos , Tomografia por Emissão de Pósitrons/métodos , Adulto , Carga Corporal (Radioterapia) , Humanos , Masculino , Taxa de Depuração Metabólica , Pessoa de Meia-Idade , Especificidade de Órgãos , Compostos Radiofarmacêuticos/farmacocinética , Distribuição TecidualRESUMO
PET-CT imaging merges metabolic data obtained after injection of a tracer labelled with a positron emitter, with CT anatomical data. This whole-body technique provides (i) an improved spatial resolution and (ii) when the tracer is ¹8FDG, quantification of tissue glucose metabolism. In thoracic oncology, ¹8FDG PET-CT imaging allows diagnosis, staging, follow-up of treatment efficiency, and detection of recurrence. Furthermore, its potential usefulness in inflammatory and infectious diseases should be emphasized. Its main contra-indication is pregnancy, and a good knowledge of its technical procedure is mandatory. The most currently used quantification index is the standardized uptake value (SUV), whose interpretation requires caution.
Assuntos
Tomografia por Emissão de Pósitrons , Doenças Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Broncopatias/diagnóstico por imagem , Broncopatias/metabolismo , Contraindicações , Feminino , Radioisótopos de Flúor , Fluordesoxiglucose F18 , Humanos , Pneumopatias/diagnóstico por imagem , Pneumopatias/metabolismo , Doenças do Mediastino/diagnóstico por imagem , Doenças do Mediastino/metabolismo , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Doenças Pleurais/diagnóstico por imagem , Doenças Pleurais/metabolismo , Tomografia por Emissão de Pósitrons/métodos , Gravidez , Compostos Radiofarmacêuticos , Doenças Torácicas/metabolismo , Tomografia Computadorizada por Raios X/métodosRESUMO
OBJECTIVE: Therapeutic decision-making in metastatic renal cell carcinoma (MRCC) is based on conventional radiological evaluation. Fluorodeoxyglucose positron emission tomography (FDG-PET) scans may modify this strategy. METHODS: Patients with MRCC for whom a therapeutic decision had been made underwent an FDG-PET scan in order to complete the standard radiological evaluation. RESULTS: Twenty-four patients and 26 FDG-PET scans were eligible. In 18 patients, metastatic disease was evaluable on the computed tomography (CT) scan; the FDG-PET scan was positive in 16 patients and negative in 10. In 2 patients, the FDG-PET scan was positive while they were considered disease free on radiological evaluation. In 5 patients (20.8%), the previous therapeutic decision was changed. Thirteen patients had a pathological evaluation for 19 sites. One patient out of 13 had a false-positive FDG-PET scan, while 4 sites out of 6 were false-negative. The sensitivity was 75% (95% CI: 47.6-92.7) and the predictive positive value was 92.3% (95% CI: 64-99.8). With a median follow-up of 24 months, 3 patients developed new metastatic sites. CONCLUSION: Our data suggest that, when positive, an FDG-PET scan may modify the decision made; when negative, it should not modify decision-making especially for surgery, owing to its sensitivity.