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1.
J Nucl Cardiol ; 29(2): 594-608, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-32748277

RESUMO

BACKGROUND: Utility of 18F-FDG PET/CT in diagnosing infective endocarditis (IE) associated with cardiac implantable electronic devices (CIEDs) is not well established. Current ESC guidelines recommend the use of FDG-PET imaging in patients with CIEDs and positive blood cultures, but the number of studies evaluating the diagnostic performance of FDG-PET imaging in these patients remain limited. Our objective was to assess the diagnostic yield of 18F-FDG PET/CT in patients with suspected CIED infections, differentiating between pocket infection (PI) and lead infection (CIED-IE). METHODS AND RESULTS: From 2013 to 2018, all patients (n = 63) admitted to a hospital with suspected CIED infection were prospectively recruited, undergoing a diagnostic work-up including a PET/CT. Explanted devices and material from the pocket were cultured. 14 cases corresponded to isolated PI and 13 were categorized as CIED-IE. Considering radionuclide uptake in the intracardiac portion of the lead, sensitivity and specificity of PET/CT for CIED-IE were 38.5% and 98.0%, respectively. Positive (19.2) and negative (0.6) likelihood ratio values, suggest that a positive PET/CT is much more probable to correspond to a patient with CIED-IE, whereas it is not possible to exclude this diagnosis when negative. For PI, sensitivity and specificity were 72.2% and 95.6%, respectively. CONCLUSIONS: The yield of 18F-FDG PET/CT for suspected CIED infections differs depending on the site of infection. Due to very high specificity but poor sensitivity, negative studies must be interpreted with caution if the suspicion of CIED-IE is high.


Assuntos
Desfibriladores Implantáveis , Endocardite Bacteriana , Endocardite , Marca-Passo Artificial , Infecções Relacionadas à Prótese , Desfibriladores Implantáveis/efeitos adversos , Eletrônica , Endocardite/diagnóstico por imagem , Fluordesoxiglucose F18 , Humanos , Marca-Passo Artificial/efeitos adversos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Tomografia por Emissão de Pósitrons , Infecções Relacionadas à Prótese/diagnóstico por imagem , Compostos Radiofarmacêuticos
2.
Eur J Nucl Med Mol Imaging ; 48(3): 768-776, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32901353

RESUMO

BACKGROUND: Lung involvement in patients with coronavirus disease 2019 (COVID-19) undergoing PET-CT has been previously reported. However, FDG uptake outside lung parenchyma was poorly characterized in detail. We evaluated the extra-parenchymal lung involvement in asymptomatic cancer patients with COVID-19 pneumonia through 18F-FDG PET-CT. METHODS: A total of 1079 oncologic 18F-FDG PET-CT were performed between February 2 and May 18, 2020. Confirmed COVID-19 pneumonia was defined as characteristic ground-glass bilateral CT infiltrates and positive genetic/serologic tests. Nonmetastatic extra-parenchymal lung PET-CT findings were evaluated through qualitative (visual), quantitative (measurements on CT), and semiquantitative (maximum standardized uptake value: SUVmax on PET) interpretation. Clinical data, blood tests, and PET-CT results were compared between patients with and without COVID-19 pneumonia. RESULTS: A total of 23 18F-FDG PET-CT scans with pulmonary infiltrates suggestive of COVID-19 and available laboratory data were included: 14 positive (cases) and 9 negative (controls) for COVID-19 infection, representing a low prevalence of COVID-19 pneumonia (1.3%). Serum lactate dehydrogenase and D-dimers tended to be increased in COVID-19 cases. Extra-parenchymal lung findings were found in 42.9% of patients with COVID-19, most frequently as mediastinal and hilar nodes with 18F-FDG uptake (35.7%), followed by incidental pulmonary embolism in two patients (14.3%). In the control group, extra-pulmonary findings were observed in a single patient (11.1%) with 18F-FDG uptake located to mediastinal, hilar, and cervical nodes. Nasopharyngeal and hepatic SUVmax were similar in both groups. CONCLUSION: In cancer patients with asymptomatic COVID-19 pneumonia, 18F-FDG PET-CT findings are more frequently limited to thoracic structures, suggesting that an early and silent distant involvement is very rare. Pulmonary embolism is a frequent and potentially severe finding raising special concern. PET-CT can provide new pathogenic insights about this novel disease.


Assuntos
COVID-19/diagnóstico por imagem , Fluordesoxiglucose F18/administração & dosagem , Pulmão/diagnóstico por imagem , Neoplasias/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Compostos Radiofarmacêuticos/administração & dosagem , COVID-19/complicações , COVID-19/epidemiologia , Teste para COVID-19 , Neoplasias do Ducto Colédoco , Feminino , Humanos , Masculino , Pneumonia/complicações , Pneumonia/diagnóstico por imagem , SARS-CoV-2
3.
Eur J Nucl Med Mol Imaging ; 42(6): 916-27, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25647075

RESUMO

PURPOSE: Diagnosing progressive primary aphasia (PPA) and its variants is of great clinical importance, and fluorodeoxyglucose (FDG) positron emission tomography (PET) may be a useful diagnostic technique. The purpose of this study was to evaluate interobserver variability in the interpretation of FDG PET images in PPA as well as the diagnostic sensitivity and specificity of the technique. We also aimed to compare visual and statistical analyses of these images. METHODS: There were 10 raters who analysed 44 FDG PET scans from 33 PPA patients and 11 controls. Five raters analysed the images visually, while the other five used maps created using Statistical Parametric Mapping software. Two spatial normalization procedures were performed: global mean normalization and cerebellar normalization. Clinical diagnosis was considered the gold standard. RESULTS: Inter-rater concordance was moderate for visual analysis (Fleiss' kappa 0.568) and substantial for statistical analysis (kappa 0.756-0.881). Agreement was good for all three variants of PPA except for the nonfluent/agrammatic variant studied with visual analysis. The sensitivity and specificity of each rater's diagnosis of PPA was high, averaging 87.8 and 89.9% for visual analysis and 96.9 and 90.9% for statistical analysis using global mean normalization, respectively. In cerebellar normalization, sensitivity was 88.9% and specificity 100%. CONCLUSION: FDG PET demonstrated high diagnostic accuracy for the diagnosis of PPA and its variants. Inter-rater concordance was higher for statistical analysis, especially for the nonfluent/agrammatic variant. These data support the use of FDG PET to evaluate patients with PPA and show that statistical analysis methods are particularly useful for identifying the nonfluent/agrammatic variant of PPA.


Assuntos
Afasia Primária Progressiva/diagnóstico por imagem , Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons/normas , Compostos Radiofarmacêuticos , Idoso , Idoso de 80 Anos ou mais , Afasia Primária Progressiva/patologia , Interpretação Estatística de Dados , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Sensibilidade e Especificidade
5.
Cancers (Basel) ; 15(18)2023 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-37760421

RESUMO

The three approved cyclin-dependent kinase 4/6 (CDK4/6) inhibitors, including abemaciclib, have shown differences in their preclinical, pharmacological, and clinical data. Abemaciclib stands out for its broader target range and more rapid and intense activity. It has demonstrated efficacy as a monotherapy or in combination with tamoxifen in endocrine-refractory metastatic breast cancer (MBC) patients with prior chemotherapy. However, the clinical data on abemaciclib after exposure to previous CDK4/6 inhibitors are limited. In this single-center retrospective case series, we identified all patients who received abemaciclib until February 2022 after experiencing documented progression on palbociclib or ribociclib. The safety profile and clinical outcomes of abemaciclib treatment in this specific patient cohort were evaluated. Eleven patients were included in this retrospective case series, nine receiving abemaciclib with tamoxifen. Eight patients had visceral involvement, and the median age was 69 (ranging from 42 to 84). The median time from the end of prior CDK4/6 inhibitor treatment to abemaciclib initiation was 17.5 months (ranging from 3 to 41 months). Patients had undergone a median of three prior therapies (ranging from 1 to 7), including chemotherapy in 54.5% of cases. The median follow-up time was six months (ranging from 1 to 22 months). The median progression-free survival (PFS) was 8 months (95% CI 3.9-12). Five patients continued abemaciclib treatment, and one patient with liver metastases achieved a complete hepatic response. The most common adverse events were diarrhea (72.7%, no grade ≥ 3) and asthenia (27.3%, no grade ≥ 3). Our preliminary findings suggest that abemaciclib could be an effective and safe treatment option for MBC patients who have previously received palbociclib or ribociclib.

6.
Nucl Med Commun ; 42(6): 678-684, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33560715

RESUMO

AIM: We aimed to determine the frequency and clinical significance of breast incidental uptake (BIU) detected through fluorine-18 fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) in a single, high-load center. PATIENTS AND METHODS: In this retrospective study, we analyzed a total of 13 763 PET/CT studies performed from January 2017 to January 2020. After excluding 3148 scans, the maximum standardized uptake value (SUVmax) and maximum diameter (cm) of each BIU were measured. Clinical management, ultrasound/mammography and pathology reports were analyzed. RESULTS: We found BIU in 27 scans of 26 patients (0.3% of the studies). Mean age was 62.2 years and 88.5% were women; 84.6% underwent PET/CT for oncological indications. Ultrasound/mammography was consequently performed in 23 patients (88.5%), and histological correlations were available for Breast Imaging Reporting and Data System categories 4 and 5. Finally, lesions were benign in 14 patients (60.9%; two of them with low/intermediate risk of malignancy) and malignant in nine patients (39.1%). The remaining three patients had no ultrasound/mammography reports. Mean SUVmax of benign and malignant lesions were 2.6 ± 1.4 and 5.8 ± 3.5, respectively (P = 0.002). Considering a SUVmax cut-off value of 4.0, the sensitivity and specificity for differentiating benign vs. malignant lesions were 67 and 93%, respectively. Benign lesions were smaller than malignant in CT (maximum diameter:1.3 ± 0.5 cm vs. 2.0 ± 1.0 cm, P = 0.02). CONCLUSION: Although BIU detected by 18F-FDG PET/CT is infrequently found, the risk of malignancy remains very high (39.1%). Both SUVmax and maximum diameter were greater in malignant than in benign lesions. An exhaustive study with ultrasound/mammography and selective histopathological correlation is mandatory after BIU findings, even in small lesions.


Assuntos
Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
Int J Cardiol ; 330: 148-157, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33592240

RESUMO

BACKGROUND: Infective endocarditis (IE) in patients with a valve-tube ascending aortic graft (AAG) is a rare entity with a challenging diagnosis and treatment. This study describes the clinical features, diagnosis and outcome of these patients. METHODS: Between 1996 and 2019, 1654 episodes of IE were recruited in 3 centres, of which 37 patients (2.2%) had prosthetic aortic valve and AAG-IE (21 composite valve graft, 16 supracoronary graft) and conformed our study group. RESULTS: Patients with aortic grafts were predominantly male (91.9%) and the mean age was 67.7 years. Staphylococci were the most frequently isolated microorganisms (32%). Viridans group streptococci were only isolated in patients with composite valve graft. TEE was positive in 89.2%. PET/CT was positive in all 15 patients in whom it was performed. Surgical treatment was performed in 62.2% of patients. In-hospital mortality was 16.2%. Heart failure and the type of infected graft (supracoronary aortic graft) were associated with mortality. Mortality among operated patients was 21.7%. Interestingly, 14 patients received antibiotic therapy alone, and only one died. Mortality was lower among patients with a composite valve graft compared to those with a supracoronary graft (4.8% vs 31.3%; p = 0.03). CONCLUSIONS: In patients with AAG and prosthetic aortic valve IE, mortality is not higher than in other patients with prosthetic IE. Multimodality imaging plays an important role in the diagnosis and management of these patients. Heart failure and the type of surgery were risk factors associated with in-hospital mortality. Although surgical treatment is usually recommended, a conservative management might be a valid alternative treatment in selected patients.


Assuntos
Endocardite Bacteriana , Endocardite , Próteses Valvulares Cardíacas , Infecções Relacionadas à Prótese , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Endocardite/diagnóstico por imagem , Endocardite/cirurgia , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/epidemiologia , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Masculino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/cirurgia , Estudos Retrospectivos
8.
JACC Case Rep ; 2(5): 764-768, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-34317344

RESUMO

We report a case of a 75-year-old man with a medical history of coronary artery bypass graft surgery and a recent graft angioplasty, who presented to our emergency department with fever. An 18F-fluorodeoxyglucose positron emission tomography demonstrated a saphenous graft infected aneurysm, which was successfully treated conservatively with antibiotic therapy. (Level of Difficulty: Beginner.).

9.
Heart ; 105(20): 1583-1589, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31113807

RESUMO

OBJECTIVE: The incidence of aortitis in patients with thoracic aortic diseases is not well established. The aim of this study was to analyse the frequency and clinical course of patients with aortitis in a surgical series. METHODS: 320 consecutive patients with ascending aorta/aortic arch aneurysm or acute aortic syndrome who underwent surgery from 2012 to 2017 in a single tertiary referral hospital were retrospectively reviewed. Epidemiological data, clinical course and variables related to diagnosis, treatment and follow-up were collected from patients with histologically proven aortitis. RESULTS: From 320 examined aortic samples, 279 (87.2%) thoracic aneurysms and 41 acute aortic syndromes (12.8%), 9 (2.8%) were aortitis: 3 cases of Takayasu's arteritis, 3 of IgG4-related aortitis, 2 of giant cell, and 1 classified as idiopathic. Median age at surgery was 53.4 (51-69.2) years and six cases were female. Seven patients presented with non-specific symptoms and the diagnosis was made at pathology. Surgery was elective in eight patients and emergent in one case of IgG4-related aortitis. 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) was performed for disease extension study and as a monitoring technique during the follow-up of five patients, with just one case performed presurgically. All the patients with IgG4-related disease showed extrathoracic aortic involvement. There were no deaths, neither in-hospital nor during the 1.7 years of median follow-up. CONCLUSIONS: In surgically treated thoracic aorta pathology, the frequency of aortitis is low; IgG4-related disease is among the most common aetiologies with a frequency similar to other types of aortitis, such as Takayasu's and giant cell arteritis, and clinical manifestations are non-specific making presurgical diagnosis difficult. 18F-FDG PET/CT allows a better assessment of disease extension and therapeutic response. Surgery can be successfully performed and corticosteroid therapy ensures a good mid-term follow-up.


Assuntos
Aorta Torácica , Aneurisma da Aorta Torácica , Aortite , Doença Relacionada a Imunoglobulina G4 , Procedimentos Cirúrgicos Vasculares , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/patologia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/epidemiologia , Aneurisma da Aorta Torácica/etiologia , Aneurisma da Aorta Torácica/cirurgia , Aortite/complicações , Aortite/diagnóstico , Aortite/epidemiologia , Aortite/imunologia , Diagnóstico Diferencial , Feminino , Arterite de Células Gigantes/diagnóstico , Humanos , Doença Relacionada a Imunoglobulina G4/diagnóstico , Doença Relacionada a Imunoglobulina G4/epidemiologia , Doença Relacionada a Imunoglobulina G4/fisiopatologia , Incidência , Masculino , Pessoa de Meia-Idade , Plasmócitos/imunologia , Tomografia por Emissão de Pósitrons/métodos , Espanha/epidemiologia , Arterite de Takayasu/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos
10.
Heart ; 104(17): 1447-1454, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29472288

RESUMO

OBJECTIVE: Infection of valved aortic grafts is a rare entity whose diagnosis remains challenging. Positron emission tomography (PET)/CT has become a criterion for the diagnosis of infective endocarditis (IE) in prosthetic valves, but its role on ascending aortic graft infections remains unclear. This study aims to assess the diagnostic value of PET/CT in patients with valved aortic graft infection. METHODS: 12 episodes with a valved aortic graft who had undergone a PET/CT due to suspicion of IE were prospectively included (group I) and compared with five controls free of infection who underwent PET/CT for other reasons (group II). Pathological uptake of 18F-fluorodeoxyglucose (FDG) and its pattern at the prosthetic valve and aortic graft were studied. RESULTS: Diagnosis of IE was confirmed in 9 out of 12 episodes of group I. 18F-FDG uptake was detectable in eight out of nine cases with a final diagnosis of IE. The most repeated pattern of uptake was homogeneous around the valve and heterogeneous around the tube. There was one false-negative study. Of the three patients in which IE was ruled out, there were two false positives and one true negative. In group II, there were three patients with a positive PET/CT study, two of them had active aortitis and the third was considered false positive. CONCLUSIONS: 18F-FDG PET/CT shows high sensitivity in the detection of infected aortic grafts. Thus, this technique should be considered in the diagnostic work-up of patients with suspicion of aortic graft infection. However, further validation of this approach is needed.


Assuntos
Valva Aórtica , Endocardite , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Infecções Relacionadas à Prótese/diagnóstico , Enxerto Vascular/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/patologia , Valva Aórtica/cirurgia , Prótese Vascular/efeitos adversos , Endocardite/diagnóstico , Endocardite/etiologia , Feminino , Fluordesoxiglucose F18/uso terapêutico , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Compostos Radiofarmacêuticos/uso terapêutico , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Espanha , Enxerto Vascular/instrumentação , Enxerto Vascular/métodos
11.
Rev Esp Med Nucl Imagen Mol ; 33(1): 14-21, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-23809513

RESUMO

PURPOSE: To prospectively study the value of PET-CT with fluorine-18 fluorodeoxyglucose (FDG) to predict neoadjuvant chemotherapy (NAC) response of locoregional disease of stages II and III breast cancer patients. MATERIAL AND METHODS: A written informed consent and approval were obtained from the Ethics Committee. PET-CT accuracy in the prediction of pathologic complete response (pCR) after NAC was studied in primary tumors and lymph node metastasis in 43 women (mean age: 50 years: range: 27-71 years) with histologically proven breast cancer between December 2009 and January 2011. PET-CT was performed at baseline and after NAC. SUV(max) percentage changes (ΔSUV(max)) were compared with pathology findings at surgery. Receiver-operator characteristic (ROC) analysis was used to discriminate between locoregional pCR and non-pCR. In patients not achieving pCR, it was investigated if ΔSUV(max) could accurately identify the residual cancer burden (RCB) classes: RCB-I (minimal residual disease (MRD)), RCB-II (moderate RD), and RCB-III (extensive RD). RESULTS: pCR was obtained in 11 patients (25.6%). Residual disease was found in 32 patients (74.4%): 16 (37.2%) RCB-I, 15 (35.6%) RCB-II and 2 (4.7%) RCB-III. Sensitivity, specificity, and accuracy to predict pCR were 90.9%, 90.6%, and 90.7%, respectively. Specificity was 94.1% in the identification of a subset of patients who had either pCR or MRD. CONCLUSION: Accuracy of ΔSUV(max) in the locoregional disease of stages II and III breast cancer patients after NAC is high for the identification of pCR cases. Its specificity is potentially sufficient to identify a subgroup of patients who could be managed with conservative surgery.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodos , Taxoides/administração & dosagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Anticorpos Monoclonais Humanizados/administração & dosagem , Neoplasias da Mama/terapia , Carcinoma Ductal de Mama/secundário , Carcinoma Ductal de Mama/terapia , Carcinoma Lobular/diagnóstico por imagem , Carcinoma Lobular/secundário , Carcinoma Lobular/terapia , Terapia Combinada , Docetaxel , Feminino , Fluordesoxiglucose F18 , Humanos , Metástase Linfática/diagnóstico por imagem , Mastectomia , Pessoa de Meia-Idade , Imagem Multimodal , Estadiamento de Neoplasias , Neoplasia Residual , Estudos Prospectivos , Curva ROC , Compostos Radiofarmacêuticos , Sensibilidade e Especificidade , Trastuzumab , Carga Tumoral
12.
JACC Cardiovasc Imaging ; 11(12): 1920-1922, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30121263
13.
ISRN Dermatol ; 2012: 308279, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23259071

RESUMO

Nuclear medicine plays an essential role in the correct staging of patients suffering from melanoma. Both sentinel lymph node biopsy (SLNB) and positron emission tomography (PET) represent its main diagnostic tools. SLNB is the choice procedure for lymphatic regional staging of these patients, including the result of this technique in the 2002 American Joint Cancer Committee melanoma staging. SLNB sensitivity is superior than PET/CT for the detection of lymphatic micrometastases in early stages of the disease. PET/CT is mainly used in confirming clinical metastases suspected, detection of recurrences, and recurrence restaging. PET/CT has also shown superiority against conventional diagnostic methods in the detection of distant metastases, being able to detect illness even six months earlier than those methods.

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