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1.
Mol Imaging Biol ; 22(1): 47-65, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31049831

RESUMO

Here, we report on the outcome of the 2nd International Danube Symposium on advanced biomarker development that was held in Vienna, Austria, in early 2018. During the meeting, cross-speciality participants assessed critical aspects of non-invasive, quantitative biomarker development in view of the need to expand our understanding of disease mechanisms and the definition of appropriate strategies both for molecular diagnostics and personalised therapies. More specifically, panelists addressed the main topics, including the current status of disease characterisation by means of non-invasive imaging, histopathology and liquid biopsies as well as strategies of gaining new understanding of disease formation, modulation and plasticity to large-scale molecular imaging as well as integrative multi-platform approaches. Highlights of the 2018 meeting included dedicated sessions on non-invasive disease characterisation, development of disease and therapeutic tailored biomarkers, standardisation and quality measures in biospecimens, new therapeutic approaches and socio-economic challenges of biomarker developments. The scientific programme was accompanied by a roundtable discussion on identification and implementation of sustainable strategies to address the educational needs in the rapidly evolving field of molecular diagnostics. The central theme that emanated from the 2nd Donau Symposium was the importance of the conceptualisation and implementation of a convergent approach towards a disease characterisation beyond lesion-counting "lumpology" for a cost-effective and patient-centric diagnosis, therapy planning, guidance and monitoring. This involves a judicious choice of diagnostic means, the adoption of clinical decision support systems and, above all, a new way of communication involving all stakeholders across modalities and specialities. Moreover, complex diseases require a comprehensive diagnosis by converging parameters from different disciplines, which will finally yield to a precise therapeutic guidance and outcome prediction. While it is attractive to focus on technical advances alone, it is important to develop a patient-centric approach, thus asking "What can we do with our expertise to help patients?"


Assuntos
Biomarcadores/metabolismo , Congressos como Assunto/organização & administração , Imagem Molecular/métodos , Neoplasias/patologia , Relatório de Pesquisa , Áustria , Biomarcadores/análise , Humanos , Agências Internacionais , Imagem Molecular/instrumentação , Imagem Molecular/tendências , Neoplasias/diagnóstico por imagem , Neoplasias/metabolismo , Neoplasias/terapia
2.
EJNMMI Res ; 6(Suppl 1): 32, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27090254

RESUMO

TABLE OF CONTENTS: A1 68Ga-PSMA PET/CT in staging and restaging of Prostate Cancer Patients: comparative study with 18F-Choline PET/CTW Langsteger, A Rezaee, W Loidl, HS Geinitz, F Fitz, M Steinmair, G Broinger, L Pallwien-Prettner, M BeheshtiA2 F18 Choline PET - CT: an accurate diagnostic tool for the detection of parathyroid adenoma?L Imamovic, M Beheshti, G Rendl, D Hackl, O Tsybrovsky, M Steinmair, K Emmanuel, F Moinfar, C Pirich, W LangstegerA3 [18F]Fluoro-DOPA-PET/CT in the primary diagnosis of medullary thyroid carcinomaA Bytyqi, G Karanikas, M Mayerhöfer, O Koperek, B Niederle, M HartenbachA4 Variations of clinical PET/MR operations: An international survey on the clinical utilization of PET/MRIT Beyer, K Herrmann, J CzerninA5 Standard Dixon-based attenuation correction in combined PET/MRI: Reproducibility and the possibility of Lean body mass estimationI Rausch, P Rust, MD DiFranco, M Lassen, A Stadlbauer, ME Mayerhöfer, M Hartenbach, M Hacker, T BeyerA6 High resolution digital FDG PET/MRI imaging for assessment of ACL graft viabilityK Binzel, R Magnussen, W Wei, MU Knopp, DC Flanigan, C Kaeding, MV KnoppA7 Using pre-existing hematotoxicity as predictor for severe side effects and number of treatment cycles of Xofigo therapyA Leisser, M Nejabat, M Hartenbach, G Kramer, M Krainer, M Hacker, A HaugA8 QDOSE - comprehensive software solution for internal dose assessmentWencke Lehnert, Karl Schmidt, Sharok Kimiaei, Marcus Bronzel, Andreas KlugeA9 Clinical impact of Time-of-Flight on next-generation digital PET imaging of Yttrium-90 radioactivity following liver radioembolizationCL Wright, K Binzel, J Zhang, Evan Wuthrick, Piotr Maniawski, MV KnoppA10 Snakes in patients! Lessons learned from programming active contours for automated organ segmentationM Blaickner, E Rados, A Huber, M Dulovits, H Kulkarni, S Wiessalla, C Schuchardt, RP Baum, B Knäusl, D GeorgA11 Influence of a genetic polymorphism on brain uptake of the dual ABCB1/ABCG2 substrate [11C]tariquidarM Bauer, B Wulkersdorfer, W Wadsak, C Philippe, H Haslacher, M Zeitlinger, O LangerA12 Outcome prediction of temporal lobe epilepsy surgery from P-glycoprotein activity. Pooled analysis of (R)-[11C]-verapamil PET data from two European centresM Bauer, M Feldmann, R Karch, W Wadsak, M Zeitlinger, MJ Koepp, M-C Asselin, E Pataraia, O LangerA13 In-vitro and in-vivo characterization of [18F]FE@SNAP and derivatives for the visualization of the melanin concentrating hormone receptor 1M Zeilinger, C Philippe, M Dumanic, F Pichler, J Pilz, M Hacker, W Wadsak, M MitterhauserA14 Reducing time in quality control leads to higher specific radioactivity of short-lived radiotracersL Nics, B Steiner, M Hacker, M Mitterhauser, W WadsakA15 In vitro 11C-erlotinib binding experiments in cancer cell lines with epidermal growth factor receptor mutationsA Traxl, Thomas Wanek, Kushtrim Kryeziu, Severin Mairinger, Johann Stanek, Walter Berger, Claudia Kuntner, Oliver LangerA16 7-[11C]methyl-6-bromopurine, a PET tracer to measure brain Mrp1 function: radiosynthesis and first PET evaluation in miceS Mairinger, T Wanek, A Traxl, M Krohn, J Stanek, T Filip, M Sauberer, C Kuntner, J Pahnke, O LangerA17 18F labeled azidoglucose derivatives as "click" agents for pretargeted PET imagingD Svatunek, C Denk, M Wilkovitsch, T Wanek, T Filip, C Kuntner-Hannes, J Fröhlich, H MikulaA18 Bioorthogonal tools for PET imaging: development of radiolabeled 1,2,4,5-TetrazinesC Denk, D Svatunek, T Wanek, S Mairinger, J Stanek, T Filip, J Fröhlich, H Mikula, C Kuntner-HannesA19 Preclinical evaluation of [18F]FE@SUPPY- a new PET-tracer for oncologyT Balber, J Singer, J Fazekas, C Rami-Mark, N Berroterán-Infante, E Jensen-Jarolim, W Wadsak, M Hacker, H Viernstein, M MitterhauserA20 Investigation of Small [18F]-Fluoroalkylazides for Rapid Radiolabeling and In Vivo Click ChemistryC Denk, D Svatunek, B Sohr, H Mikula, J Fröhlich, T Wanek, C Kuntner-Hannes, T FilipA21 Microfluidic 68Ga-radiolabeling of PSMA-HBED-CC using a flow-through reactorS Pfaff, C Philippe, M Mitterhauser, M Hartenbach, M Hacker, W WadsakA22 Influence of 24-nor-ursodeoxycholic acid on hepatic disposition of [18F]ciprofloxacin measured with positron emission tomographyT Wanek, E Halilbasic, M Visentin, S Mairinger, B Stieger, C Kuntner, M Trauner, O LangerA23 Automated 18F-flumazenil production using chemically resistant disposable cassettesP Lam, M Aistleitner, R Eichinger, C ArtnerA24 Similarities and differences in the synthesis and quality control of 177Lu-DOTA-TATE, 177Lu -HA-DOTA-TATE and 177Lu-DOTA-PSMA (PSMA-617)H Eidherr, C Vraka, A Haug, M Mitterhauser, L Nics, M Hartenbach, M Hacker, W WadsakA25 68Ga- and 177Lu-labelling of PSMA-617H Kvaternik, R Müller, D Hausberger, C Zink, RM AignerA26 Radiolabelling of liposomes with 67Ga and biodistribution studies after administration by an aerosol inhalation systemU Cossío, M Asensio, A Montes, S Akhtar, Y te Welscher, R van Nostrum, V Gómez-Vallejo, J LlopA27 Fully automated quantification of DaTscan SPECT: Integration of age and gender differencesF VandeVyver, T Barclay, N Lippens, M TrochA28 Lesion-to-background ratio in co-registered 18F-FET PET/MR imaging - is it a valuable tool to differentiate between low grade and high grade brain tumor?L Hehenwarter, B Egger, J Holzmannhofer, M Rodrigues-Radischat, C PirichA29 [11C]-methionine PET in gliomas - a retrospective data analysis of 166 patientsN Pötsch, I Rausch, D Wilhelm, M Weber, J Furtner, G Karanikas, A Wöhrer, M Mitterhauser, M Hacker, T Traub-WeidingerA30 18F-Fluorocholine versus 18F-Fluorodeoxyglucose for PET/CT imaging in patients with relapsed or progressive multiple myeloma: a pilot studyT Cassou-Mounat, S Balogova, V Nataf, M Calzada, V Huchet, K Kerrou, J-Y Devaux, M Mohty, L Garderet, J-N TalbotA31 Prognostic benefit of additional SPECT/CT in sentinel lymph node mapping of breast cancer patientsS Stanzel, G Pregartner, T Schwarz, V Bjelic-Radisic, B Liegl-Atzwanger, R AignerA32 Evaluation of diagnostic value of TOF-18F-FDG PET/CT in patients with suspected pancreatic cancerS Stanzel, F Quehenberger, RM AignerA33 New quantification method for diagnosis of primary hyperpatahyroidism lesions and differential diagnosis vs thyropid nodular disease in dynamic scintigraphyA Koljevic Markovic, Milica Jankovic, V Miler Jerkovic, M Paskas, G Pupic, R Dzodic, D PopovicA34 A rare case of diffuse pancreatic involvement in patient with merkel cell carcinoma detected by 18F-FDGMC Fornito, D FamiliariA35 TSH-stimulated 18F-FDG PET/CT in the diagnosis of recurrent/metastatic radioiodine-negative differentiated thyroid carcinomas in patients with various thyroglobuline levelsP Koranda, H Polzerová, I Metelková, L Henzlová, R Formánek, E Buriánková, M KamínekA36 Breast Dose from lactation following I131 treatmentWH Thomson, C LewisA37 A new concept for performing SeHCAT studies with the gamma cameraWH Thomson, J O'Brien, G James, A NotghiA38 Whole body F-18-FDG-PET and tuberculosis: sensitivity compared to x-ray-CTH Huber, I Stelzmüller, R Wunn, M Mandl, F Fellner, B Lamprecht, M GabrielA39 Emerging role 18F-FDG PET-CT in the diagnosis and follow-up of the infection in heartware ventricular assist system (HVAD)MC Fornito, G LeonardiA40 Validation of Poisson resampling softwareWH Thomson, J O'Brien, G JamesA41 Protection of PET nuclear medicine personnel: problems in satisfying dose limit requirementsJ Hudzietzová, J Sabol, M Fülöp.

3.
Mol Imaging Biol ; 17(5): 595-608, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26286794

RESUMO

This paper summarises key themes and discussions from the 4th international workshop dedicated to the advancement of the technical, scientific and clinical applications of combined positron emission tomography (PET)/magnetic resonance imaging (MRI) systems that was held in Tübingen, Germany, from February 23 to 27, 2015. Specifically, we summarise the three days of invited presentations from active researchers in this and associated fields augmented by round table discussions and dialogue boards with specific topics. These include the use of PET/MRI in cardiovascular disease, paediatrics, oncology, neurology and multi-parametric imaging, the latter of which was suggested as a key promoting factor for the wider adoption of integrated PET/MRI. Discussions throughout the workshop and a poll taken on the final day demonstrated that attendees felt more strongly that PET/MRI has further advanced in both technical versatility and acceptance by clinical and research-driven users from the status quo of last year. Still, with only minimal evidence of progress made in exploiting the true complementary nature of the PET and MRI-based information, PET/MRI is still yet to achieve its potential. In that regard, the conclusion of last year's meeting "the real work has just started" still holds true.


Assuntos
Imageamento por Ressonância Magnética , Imagem Multimodal , Tomografia por Emissão de Pósitrons , Alemanha , Humanos
4.
Nuklearmedizin ; 53(2): 19-25, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24473996

RESUMO

AIM: To elucidate techniques most commonly used for interpreting oncologic PET/CT studies. This survey forms a basis to work on standardization of reporting and highlight the most important issues to be addressed. METHODS: A web-based survey of 329 PET/CT imaging specialists was designed with the intent to determine image interpretation patterns. The questionnaire consisted of 19 questions. Of the 329 participants, 230 were nuclear medicine specialists, 46 were radiologists, and 53 had dual-board certification. RESULTS: Report ofstandardized uptake values (SUV) is not consistent;only50.2% of respondents always report SUVs, while 45.2% report only if needed or requested. 80.9% of respondents indicated that reporting of SUV is only appropriate when its limitations are understood whereby a large majority prefer to report SUVmax. Maximum intensity projection (MIP) images are almost always reviewed by 91.1% of the respondents. An accurate and detailed clinical history is considered an essential element for reading PET/CT studies by 84.0%, but only 20.7% report that this is always available. The most common self-reported average time for reviewing and reporting of whole body PET/CT (with no prior comparison scan) was 15-20 min (27.5%). CONCLUSION: PET readers have considerable reservations regarding the use and reporting of SUVs. SUVmax is more frequently used than SUVmean. Evaluation of MIP images is considered an important element of PET/CT interpretation. Although availability of sufficient patient's history is considered essential, this is rarely available.


Assuntos
Registros Eletrônicos de Saúde/estatística & dados numéricos , Imagem Multimodal/estatística & dados numéricos , Neoplasias/diagnóstico , Tomografia por Emissão de Pósitrons/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Sistemas de Informação em Radiologia/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Registros Eletrônicos de Saúde/classificação , Pesquisas sobre Atenção à Saúde , Registros de Saúde Pessoal , Humanos , Internacionalidade
5.
Q J Nucl Med Mol Imaging ; 55(6): 620-32, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22231582

RESUMO

In the past, enormous public and private investments have been made to reduce cancer incidence and mortality. Despite some improvements over the last 10 years, the overall outcome of the "war on cancer" has been disappointing. Among the reasons for this limited success is our inability to determine, whether the therapeutic target is present, and whether the target is reached by the drug. A further important issue is our limited ability to correctly assess response to treatment early after start of therapy which would allow for more individualized treatment approaches. PET and PET/CT with the glucose analogue 2'-[(18)F]-fluoro-2'-deoxy-D-glucose (FDG) are increasingly used to assess response to therapy in patients, and a converging large body of evidence is emerging that suggests that changes in glucose utilization during therapy can be used to predict clinical outcome. In this article we provide an overview of the utility of (18)F-FDG PET/CT imaging for early monitoring of cancer therapy and address current and future challenges for its more widespread adoption. First, we discuss general requirements that any imaging modality must meet to provide valid and valuable treatment response assessment. We will then review the strengths and limitations of CT (RECIST) and PET based response criteria. Finally, we will examine the role of FDG-PET/(CT) imaging for response assessments in solid tumors.


Assuntos
Fluordesoxiglucose F18 , Imagem Molecular/tendências , Neoplasias/diagnóstico , Neoplasias/terapia , Avaliação de Resultados em Cuidados de Saúde/tendências , Tomografia por Emissão de Pósitrons/tendências , Tomografia Computadorizada por Raios X/tendências , Humanos , Compostos Radiofarmacêuticos , Técnica de Subtração/tendências , Resultado do Tratamento
6.
Nuklearmedizin ; 44 Suppl 1: S18-23, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16395974

RESUMO

PET/CT is now established as the most important imaging tool in oncology. PET/CT stages and restages cancer with a higher accuracy than PET or CT alone. The sometimes irrational approach to combine state of the art PET with the highest end CT devices should give way to a more reasonable equipment design tailored towards the specific clinical indications in well-defined patient populations. The continuing success of molecular PET/CT now depends more upon advances in molecular imaging with the introduction of targeted imaging probes for individualized therapy approaches in cancer patients and less upon technological advances of imaging equipment.


Assuntos
Neoplasias/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/normas , Tomografia Computadorizada por Raios X/normas , Feminino , Humanos , Estadiamento de Neoplasias , Neoplasias/patologia , Tomografia por Emissão de Pósitrons/tendências , Reprodutibilidade dos Testes , Software , Tomografia Computadorizada por Raios X/tendências
7.
Clin Nephrol ; 57(1): 56-62, 2002 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-11837802

RESUMO

PURPOSE: The use of whole-body PET for re-staging of renal cell carcinoma has not been investigated. The aim of the current study was to examine the diagnostic accuracy and clinical usefulness of whole-body PET imaging for re-staging of renal cell cancer. PATIENTS AND METHODS: Clinical PET was performed for re-staging in 36 patients with advanced renal cell cancer. Written reports of imaging studies (including CT, MRI, US, plain film and bone scan), patient history, and extensive chart notes were used to define the clinical stage before PET (pre-PET stage). The written PET report was used to define the clinical stage after PET (PET stage). Reports were used to determine the accuracy of PET for re-staging renal cell cancer and for defining biopsy proven lesions. Clinical parameters and biopsy proven lesions served as reference for the accuracy of PET for re-staging renal cell cancer. RESULTS: PET classified the clinical stage correctly in 32/36 patients (89%) and was incorrect in 4/36 (11%) (sensitivity and specificity: 87% and 100%). In 20 patients, 25 suspicious lesions were biopsied within 3.2 +/- 6.7 months of the PET study. Of these, 17 were malignant and 8 were benign. PET correctly classified 21/25 (84%) of the biopsied lesions (sensitivity and specificity: 88% and 75%). CONCLUSION: PET re-stages renal cell cancer with a diagnostic accuracy of 89%. Its diagnostic accuracy for classifying biopsy proven anatomic lesions as malignant or benign was 84%. These findings suggest that PET is useful in characterizing anatomic lesions of unknown significance in patients with renal cell cancer.


Assuntos
Carcinoma de Células Renais/diagnóstico por imagem , Fluordesoxiglucose F18 , Neoplasias Renais/diagnóstico por imagem , Estadiamento de Neoplasias/métodos , Compostos Radiofarmacêuticos , Tomografia Computadorizada de Emissão/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade
8.
Acta Med Austriaca ; 29(5): 162-70, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12506767

RESUMO

Positron emission tomography together with F-18-deoxyglucose (FDG) has emerged as a valuable clinical tool in the field of oncology. FDG-PET diagnoses, stages and restages most cancers with a high diagnostic accuracy. The effects of chemotherapy on tumour metabolism can be monitored with this whole-body technique. Recent studies have established a high prognostic accuracy of PET for predicting the clinical outcome of cancer patients. The current review addresses the role of FDG-PET for diagnosing, staging and restaging of lung cancer, colorectal cancer, lymphoma, melanoma and breast cancer staging and provides a brief outlook for future applications of clinical PET imaging.


Assuntos
Fluordesoxiglucose F18 , Neoplasias/diagnóstico por imagem , Tomografia Computadorizada de Emissão/métodos , Humanos , Metástase Neoplásica/diagnóstico por imagem , Estadiamento de Neoplasias , Neoplasias/patologia , Compostos Radiofarmacêuticos
9.
J Nucl Med ; 42(9): 1334-7, 2001 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-11535721

RESUMO

UNLABELLED: FDG PET has emerged as an important clinical imaging modality for diagnosing and staging cancer. However, the impact of FDG PET on staging and managing patients with breast cancer from the referring physician's point of view is unknown. METHODS: The referring physicians of 160 breast cancer patients received standardized questionnaires inquiring if and how PET findings altered their patient's stage and their clinical management decisions. Management changes were classified as intermodality if the change was from one modality to another (e.g., medical to surgical, surgical to radiation, medical to no treatment, and vice versa) or as intramodality if the change was within the same modality (e.g., altered medical or radiotherapy approach). RESULTS: Fifty of the 160 surveys were completed (31% response rate). PET changed the clinical stage in 36% of patients (28% upstaged, 8% downstaged) and resulted in intermodality changes in 28% of patients and intramodality changes in 30% of patients. CONCLUSION: The results of this prospective survey show that FDG PET has a major impact on the management of breast cancer patients, influencing both clinical stage and management in more than 30% of patients.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Fluordesoxiglucose F18 , Compostos Radiofarmacêuticos , Adulto , Idoso , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Feminino , Humanos , Medicina , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Encaminhamento e Consulta , Especialização , Inquéritos e Questionários , Tomografia Computadorizada de Emissão
10.
J Nucl Med ; 42(8): 1139-43, 2001 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-11483671

RESUMO

UNLABELLED: Correct staging is important in selecting the appropriate treatment for lymphoma patients. PET imaging with (18)F-FDG is useful for staging of lymphoma as well as for monitoring of therapy. However, to our knowledge, the clinical impact of PET on staging and management of lymphoma patients has not been reported. METHODS: Standardized questionnaires were mailed to referring physicians asking them whether and how the results of PET imaging had influenced clinical staging and management of the disease in their patients. Management changes, when present, were classified as intermodality (e.g., medical to surgical, surgical to radiation, medical to no treatment) or intramodality (e.g., altered medical, surgical, or radiotherapy approach). RESULTS: The referring physicians returned 52 of 108 questionnaires (48.1%). Physicians indicated that PET led to a change in the clinical stage in 44% of patients: 21% were upstaged and 23% were downstaged. Findings of the PET examination resulted in intermodality changes in management in 42% of patients, in intramodality changes in 10%, and in a combination of the management changes in 10%. Other, not further specified, treatment changes were reported in 6% of patients. PET did not result in any management changes in only 32% of patients. CONCLUSION: This survey-based study of referring physicians indicates that FDG PET has a major impact on the management of lymphoma patients, contributing to changes in clinical stage in 44% and changes in treatment in >60% of cases.


Assuntos
Fluordesoxiglucose F18 , Linfoma/diagnóstico por imagem , Estadiamento de Neoplasias/métodos , Compostos Radiofarmacêuticos , Adolescente , Adulto , Idoso , Feminino , Doença de Hodgkin/diagnóstico por imagem , Doença de Hodgkin/cirurgia , Doença de Hodgkin/terapia , Humanos , Interpretação de Imagem Assistida por Computador , Linfoma/cirurgia , Linfoma/terapia , Linfoma não Hodgkin/diagnóstico por imagem , Linfoma não Hodgkin/cirurgia , Linfoma não Hodgkin/terapia , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Tomografia Computadorizada de Emissão , Contagem Corporal Total
12.
J Nucl Med ; 42(4): 586-90, 2001 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-11337546

RESUMO

UNLABELLED: Whole-body PET imaging with 18F-FDG has been used successfully to stage colorectal cancer. However, the impact of FDG PET on patient management from the referring physician's point of view has not been determined. METHODS: A questionnaire was sent to referring physicians to determine whether and how PET altered the management of colorectal cancer patients. Management changes, when present, were classified as intermodality (e.g., medical to surgical, surgical to radiation, medical to no treatment) or intramodality (e.g., altered medical, surgical, or radiotherapy approach). RESULTS: Of 60 responses from referring physicians, changes in clinical stage were reported for 25 patients (42%). Among these, the disease was upstaged in 20 patients (80%) and downstaged in 5 patients (20%). The PET findings contributed to intermodality management changes in 22 of the 60 patients (37%), intramodality changes in 11 patients (18%), a combination of management changes in 4 patients (7%), and no change in 19 patients (32%). Two of the 60 patients (3%) had other changes, and no response to this question was received for the remaining 2 patients (3%). As a result of PET findings, physicians avoided major surgery in 41% of patients for whom surgery was the intended treatment. CONCLUSION: This survey-based study of referring physicians shows that FDG PET had a major impact on the management of colorectal cancer patients and contributed to changes in clinical stage and major management decisions in >40% of patients.


Assuntos
Neoplasias Colorretais/diagnóstico por imagem , Fluordesoxiglucose F18 , Compostos Radiofarmacêuticos , Tomografia Computadorizada de Emissão , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/patologia , Neoplasias Colorretais/terapia , Feminino , Humanos , Masculino , Medicina , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Encaminhamento e Consulta , Especialização , Inquéritos e Questionários
13.
Anticancer Res ; 21(1B): 701-6, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11299829

RESUMO

One hundred and seventy-nine images were collected from healthy subjects who underwent whole-body 18F-fluoro-2-d-deosyglucose positron emission tomography (FDG-PET) for health examination. Images showing visually increased FDG uptake based on a five-point visual scale in the hilar regions were included for analyses. We evaluated the sizes, standard uptake values (SUV), and lesion-to-background (L/B) ratios of the hilar lymph nodes (HLN). Fifty of 179 (28%) subjects had visually increased FDG uptake in the hilar regions with a total of 84 HLN. By a five-point visual scale, 67 out of 84 (79.8%) HLN were grade 2, 16 out of 87 (19%) were grade 3, and 1 out of 84 (1.2%) was grade 4. The average size of the HLN was 1.55 x 1.46 cm. SUV of the HLN ranged from 1.132-2.975 with an average of 1.8 +/- 0.44. L/B ratio of the HLN ranged from 1.05-2.63 with an average of 1.52 +/- 0.39. Twenty-eight % of healthy subjects who underwent whole-body FDG-PET demonstrated visually increased FDG uptake in the HLN. However, all of the 84 HLN had a size < 2 x 2 cm, SUV < 3.0 and L/B ratios < 3.


Assuntos
Fluordesoxiglucose F18 , Linfonodos/diagnóstico por imagem , Compostos Radiofarmacêuticos , Tomografia Computadorizada de Emissão , Adulto , Idoso , Feminino , Fluordesoxiglucose F18/farmacocinética , Humanos , Masculino , Mediastino , Pessoa de Meia-Idade , Compostos Radiofarmacêuticos/farmacocinética , Valores de Referência , Distribuição Tecidual
14.
Ann Surg ; 233(3): 310-9, 2001 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11224617

RESUMO

OBJECTIVE: To determine whether the use of [(18)F]2-fluoro-2-deoxyglucose positron emission tomography (FDG PET) in addition to computed axial tomography (CT) is helpful in managing recurrent colorectal cancer (CRC). SUMMARY BACKGROUND DATA: There is no consensus on a management algorithm for CRC. However, when recurrence is suspected, CT is generally used for further evaluation and staging of disease. METHODS: The authors used decision trees based on theoretical models to assess the cost-effectiveness of a CT + FDG PET strategy for the diagnosis and management of recurrent CRC compared with a CT-alone strategy. These theoretical models focus on patients with hepatic recurrence who are potentially curable through surgical hepatic resection. The population entering the decision trees consisted of patients with CRC who had undergone surgical resection of their primary CRC and who were suspected of having recurrence based on elevated levels of carcinoembryonic antigen. RESULTS: The CT + FDG PET strategy was found to be cost-effective for managing patients with elevated carcinoembryonic antigen levels who were candidates for hepatic resection. The CT + FDG PET strategy was higher in mean cost by $429 per patient but resulted in an increase in the mean life expectancy of 9.527 days per patient. CONCLUSIONS: These results show, through rigorous decision tree analysis, the potential cost-effectiveness of FDG PET in the management of recurrent CRC. The decision trees can be used to model various features of the management of recurrent CRC, including the cost-effectiveness of other newly emerging technologies.


Assuntos
Neoplasias Colorretais/economia , Neoplasias Colorretais/patologia , Árvores de Decisões , Custos Diretos de Serviços , Fluordesoxiglucose F18 , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/economia , Tomografia Computadorizada de Emissão/economia , Neoplasias Colorretais/mortalidade , Análise Custo-Benefício , Humanos , Expectativa de Vida , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/secundário , Modelos Teóricos , Estadiamento de Neoplasias/economia , Estadiamento de Neoplasias/métodos , Compostos Radiofarmacêuticos , Sensibilidade e Especificidade , Análise de Sobrevida , Tomografia Computadorizada de Emissão/métodos , Tomografia Computadorizada por Raios X/economia
15.
Q J Nucl Med ; 44(2): 153-67, 2000 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-10967625

RESUMO

BACKGROUND: A review and meta-analysis of the literature on the use of 2-[18F]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) in the detection of recurrent melanoma was conducted. The goals were to evaluate the quality of data reporting and to determine the overall values for the sensitivity and specificity of whole body FDG PET and management changes. METHODS: Guidelines to evaluate reporting within articles were formulated based on the United States medical payer source criteria for assessing studies reporting information on the utilization of new medical technology. A meta-analysis was conducted using methodology described in the peer reviewed literature. RESULTS: Our MEDLINE PLUS search resulted in a universe of 89 total articles. Within these 89, 19 were categorized in our targeted content area of which 13 were selected for analysis in our targeted subset, with the remaining 70 covering 24 different related content areas. Five of 13 (38%) articles in the target subset reported data which was adequate for incorporation into modeling objectives based on PET sensitivity and specificity values, with 1 of 13 (8%) in the same target subset reporting data adequate for modeling based on change-in-management data. Through a meta-analysis of the 13 target articles we determined, within a 95% confidence level, an overall sensitivity of 92% (95% confidence level 88.41%-95.82%) and an overall specificity of 90% (95% confidence level 83.26%-96.05%) as calculated by number of lesions, for FDG PET detecting recurrent melanoma throughout the whole body. Furthermore, limited data available for change-in-management suggests an overall FDG PET directed change-in-management value of 22%. CONCLUSIONS: Our review suggests that improvements can be made to more effectively report the results of these FDG PET studies. The overall values determined through the meta-analysis indicate the potential benefits of using FDG PET as a diagnostic/management tool. Furthermore, these values should prove useful to assessing the cost effectiveness of utilizing FDG PET in the management of recurrent melanoma.


Assuntos
Fluordesoxiglucose F18 , Melanoma/diagnóstico por imagem , Recidiva Local de Neoplasia/diagnóstico por imagem , Compostos Radiofarmacêuticos , Neoplasias Cutâneas/diagnóstico por imagem , Tomografia Computadorizada de Emissão , Irradiação Corporal Total , Intervalos de Confiança , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Reações Falso-Negativas , Reações Falso-Positivas , Humanos , Melanoma/terapia , Estadiamento de Neoplasias , Revisão da Pesquisa por Pares , Sensibilidade e Especificidade , Neoplasias Cutâneas/terapia , Avaliação da Tecnologia Biomédica
16.
J Nucl Med ; 41(7): 1177-89, 2000 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-10914907

RESUMO

UNLABELLED: A meta-analysis of the literature for the use of FDG PET in the detection of recurrent colorectal cancer (CRC) was conducted to evaluate the quality of the reported studies. Overall values for the sensitivity and specificity of whole-body FDG PET and an overall FDG PET-directed percentage change in management were also determined through this analysis. METHODS: Guidelines to evaluate the articles were formulated on the basis of the U.S. medical payer source criteria for assessing studies that report information on usage of new medical technology. A metaanalysis was conducted using methodology described in the peer-reviewed literature. RESULTS: On the basis of the guidelines established for our review, the availability of necessary information for assessing the reliability of the FDG PET data for diagnosing recurrent CRC was less than ideal. Through a meta-analysis of 11 articles, we determined, within a 95% confidence level, an overall sensitivity of 97% (95% confidence level, 95%-99%) and an overall specificity of 76% (95% confidence level, 64%-88%) for FDG PET detecting recurrent CRC throughout the whole body. Furthermore, through pooling of the change-in-management data, an overall FDG PET-directed change in management was calculated to be 29% (95% confidence level, 25%-34%). CONCLUSION: Our review suggests that improvements can be made to more effectively report the results of these FDG PET studies. The overall values determined through the meta-analysis indicate the potential benefits of using FDG PET as a diagnostic or management tool. Furthermore, these values should prove to be useful to assess the cost-effectiveness of using FDG PET in the management of patients with recurrent CRC.


Assuntos
Neoplasias Colorretais/diagnóstico por imagem , Fluordesoxiglucose F18 , Compostos Radiofarmacêuticos , Tomografia Computadorizada de Emissão , Neoplasias Colorretais/patologia , Humanos , Neoplasias Hepáticas/secundário , Recidiva Local de Neoplasia , Neoplasias Pélvicas/secundário , Sensibilidade e Especificidade
17.
Cardiology ; 94(2): 91-8, 2000.
Artigo em Inglês | MEDLINE | ID: mdl-11173779

RESUMO

Smoking is known to affect microcirculatory function in a middle-aged population. However, the effects of smoking on myocardial perfusion in young smokers have not been studied. Myocardial perfusion was measured in 15 smokers (24 +/- 2 years) and 15 nonsmokers (24 +/- 3 years) using positron emission tomography. Myocardial perfusion was measured at rest, during cold stress and during dipyridamole. Resting myocardial blood flow was similar in the two groups. The well-described correlation between rate-pressure product and myocardial blood flow was present only in the nonsmokers (r(2) = 0.61, p < 0.001). Myocardial blood flow corrected for the rate-pressure product declined during cold by 20% in the smokers [1.11 +/- 0.28 vs. 0.92 +/- 0.20 ml x g(-1) x min(-1) (p = 0.012)], but remained unchanged in nonsmokers [1.11 +/- 0.25 vs. 1.09 +/- 0.30 ml x g(-1) x min(-1) (p = NS)]. Dipyridamole-induced hyperemia was similar in the two groups [2.23 +/- 0.78 vs. 2.42 +/- 0.65 ml x g(-1) x min(-1) (p = NS)]. In conclusion, smoking induces abnormalities in myocardial microcirculatory regulation in young otherwise healthy smokers. The coronary flow reserve, however, is not significantly altered.


Assuntos
Coração/fisiopatologia , Fumar/fisiopatologia , Endotélio Vascular/fisiopatologia , Feminino , Hemodinâmica , Humanos , Masculino , Microcirculação , Fatores de Tempo
18.
Circulation ; 99(14): 1795-801, 1999 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-10199874

RESUMO

BACKGROUND: Impaired vasodilatation capacity in patients with angina pectoris and a normal coronary arteriogram (syndrome X [SX]) has been reported. Most studies report on the response in epicardial vessels. This does not necessarily reflect compromised myocardial microcirculation. Lack of the NO precursor L-arginine has been suggested as a possible cause. METHODS AND RESULTS: Myocardial blood flow (MBF) was measured, using PET, at rest (MBF-rest) and during intravenous dipyridamole (MBF-DIP) in 25 women (mean age 53+/-7 years) with SX. Thirty healthy volunteers served as controls. One group (A) consisted of 15 age-matched female volunteers (54+/-10 years). The other control group consisted of 15 young healthy women (B; 24+/-5 years). In 12 SX patients, MBF-rest and MBF during cold pressor testing were also measured after infusion of L-arginine (6.7 g/min for 45 minutes). The increase in MBF after cold pressor testing was similar in the SX group compared with controls. L-arginine did not affect MBF-rest (0.83+/-0.14 versus 0.89+/-0.13 mL. g-1. min-1) or MBF after cold pressor test (0.95+/-0.10 versus 1. 03+/-0.17 mL. g-1min-1). In contrast, the hyperemic response to DIP was blunted compared with the group A controls (1.68+/-0.49 versus 2. 34+/-0.45 mL. g-1. min-1, P<0.05); this resulted in a significant reduction of the coronary flow reserve in SX patients relative to controls (2.03+/-0.53 versus 2.96+/-0.63 mL. g-1. min-1, P<0.01). CONCLUSIONS: In patients with SX, the microcirculatory response to cold, reflecting the endothelium function, is normal and unaltered by intravenous L-arginine. This suggests preserved microcirculatory endothelial function. However, a markedly attenuated hyperemic flow and flow reserve after DIP suggest a dysfunction of the adenosine-mediated endothelium-independent vasodilatation at the microcirculatory level in these patients.


Assuntos
Arginina/uso terapêutico , Circulação Coronária/efeitos dos fármacos , Endotélio Vascular/fisiopatologia , Angina Microvascular/tratamento farmacológico , Angina Microvascular/fisiopatologia , Pressão Sanguínea/fisiologia , Temperatura Baixa , Dipiridamol , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Microcirculação/fisiopatologia , Angina Microvascular/diagnóstico , Angina Microvascular/diagnóstico por imagem , Pessoa de Meia-Idade , Valores de Referência , Tomografia Computadorizada de Emissão , Resistência Vascular/efeitos dos fármacos , Vasodilatadores
19.
Circulation ; 99(4): 491-7, 1999 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-9927394

RESUMO

BACKGROUND: Noninvasive measurements of myocardial blood flow (MBF) with PET revealed an abnormal coronary vasomotor response to cold pressor test in healthy long-term smokers. If coronary endothelial dysfunction accounted for this abnormality, we hypothesized that it could be reversed by L-arginine as the substrate for NO synthase. METHODS AND RESULTS: MBF was quantified with 13N-labeled ammonia and PET in 11 healthy smokers (age, 45+/-10 years; 27+/-10 years of smoking) and in 12 age-matched nonsmokers on 2 separate days. On day 1, MBF was measured at rest and, after intravenous L-arginine, during cold pressor test. On day 2, MBF was measured during cold pressor test and then at rest during L-arginine. Baseline rate-pressure product (RPP) (6559+/-1590 versus 7144+/-1157 bpmxmm Hg) and MBF (0.65+/-0.14 versus 0.73+/-0.13 mL x g-1 x min-1) were similar in nonsmokers and smokers. Cold pressor test increased RPP similarly in both groups (53+/-26% versus 46+/-26%), whereas MBF increased in nonsmokers (to 0.93+/-0.25 mL x g-1 x min-1; P<0.05) but not in smokers (0.80+/-0.16 mL x g-1 x min-1). The percent MBF increase differed between nonsmokers and smokers (44+/-25% versus 11+/-14%; P=0.0017). However, after L-arginine, the magnitude of MBF response to cold pressor test no longer differed between groups (48+/-36% versus 48+/-28%), whereas RPP again increased similarly in the 2 groups (59+/-30% versus 44+/-16%). L-Arginine had no effect on resting MBF in smokers or nonsmokers. CONCLUSIONS: Our findings implicate the coronary endothelium as the major site of the abnormal vasomotor response in long-term smokers. Cold pressor test combined with PET imaging may allow the noninvasive identification of coronary endothelial dysfunction in humans.


Assuntos
Arginina/farmacologia , Circulação Coronária/efeitos dos fármacos , Vasos Coronários/efeitos dos fármacos , Vasos Coronários/fisiopatologia , Endotélio Vascular/efeitos dos fármacos , Hemodinâmica/efeitos dos fármacos , Fumar/fisiopatologia , Adulto , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Estudos de Casos e Controles , Temperatura Baixa , Fatores de Confusão Epidemiológicos , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radioisótopos de Nitrogênio , Fatores de Tempo , Tomografia Computadorizada de Emissão/métodos , Resistência Vascular/efeitos dos fármacos , Vasoconstrição/efeitos dos fármacos , Vasodilatação/efeitos dos fármacos
20.
J Nucl Med ; 40(12): 2043-52, 1999 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-10616885

RESUMO

UNLABELLED: Receiver operating characteristic (ROC) and localization ROC (LROC) studies were performed to compare lesion detection at the borderline of detectability on images reconstructed with two-dimensional filtered backprojection (FBP) without attenuation correction (a common clinical protocol), three-dimensional FBP without attenuation correction, two-dimensional FBP with segmented attenuation correction and a two-dimensional iterative maximum a posteriori (MAP) algorithm using attenuation correction. Lung cancer was the model for the study because of the prominent role of 18F-fluorodeoxyglucose PET in the staging of lung cancer and the importance of lesion detection for staging. METHODS: Simulated lung cancer lesions were added to two-dimensional and three-dimensional PET data from healthy volunteers. Data were reconstructed using the four methods. Four nuclear medicine physicians evaluated the images. Detection performance with each method was compared using ROC and LROC analysis. Jackknife analysis provided estimates of statistical significance for differences across all readers for the ROC results. RESULTS: ROC and LROC results indicated statistically significant degradation in detection performance with three-dimensional acquisition (average area under ROC curves [Az] 0.51; average area under LROC curves [A(z,LROC)] 0.13) and segmented attenuation correction (average Az 0.59; average Az,LROC 0.29) compared with two-dimensional FBP without attenuation correction (average Az 0.79; average A(z,LROC) 0.54). ROC and LROC results indicated an improvement in detection performance with iterative MAP reconstruction (average Az 0.83; average A(z,LROC) 0.64) compared with two-dimensional FBP reconstruction; this improvement was not statistically significant. CONCLUSION: Use of segmented attenuation correction or three-dimensional acquisition with FBP reconstruction is not expected to improve detection of lung lesions on whole-body PET images compared with images with two-dimensional FBP without attenuation correction. The potential improvement in detection obtained with an iterative MAP reconstruction method is small compared with that obtained with two-dimensional FBP without attenuation correction.


Assuntos
Fluordesoxiglucose F18 , Processamento de Imagem Assistida por Computador , Compostos Radiofarmacêuticos , Tomografia Computadorizada de Emissão , Algoritmos , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Metástase Neoplásica/diagnóstico por imagem , Curva ROC
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