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1.
J Nucl Cardiol ; 29(4): 1671-1678, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-34036528

RESUMO

OBJECTIVES: Study designed to test association between stress-induced myocardial blood flow (sMBF), resting MBF (rMBF), and MBF reserve (MFR) and coronary artery disease (CAD) in a population of CAD and non-coronary patients. Secondary objectives were to confront visual analysis and dynamic analysis and to explore potential association between MBF and several cardiovascular risk factors METHODS: A total of 155 patients who underwent dynamic myocardial perfusion imaging on a CZT camera were included. sMBF, rMBF, and MFR were evaluated, and cardiovascular risk was assessed. RESULTS: Significantly lower total sMBF and MFR were observed in CAD patient vs non-CAD patient. In comparison with visual analysis, lower sMBF were found in pathologic territory, lower rMBF in necrotic territory and lower MFR in necrotic ones. A significant correlation between total sMBF, rMBF and diabetes was found. CONCLUSION: sMBF and MFR as assessed on CZT gamma-cameras can be used to determine the coronary state. Low total sMBF might be an independent risk factor of coronaropathy. An inverse correlation was suggested between total sMBF and rMBF with diabetes.


Assuntos
Doenças Cardiovasculares , Doença da Artéria Coronariana , Imagem de Perfusão do Miocárdio , Doenças Cardiovasculares/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Circulação Coronária , Fatores de Risco de Doenças Cardíacas , Humanos , Imagem de Perfusão do Miocárdio/métodos , Tomografia por Emissão de Pósitrons , Fatores de Risco
2.
BMC Cancer ; 20(1): 574, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32560632

RESUMO

BACKGROUND: In patients undergoing major liver resection, portal vein embolization (PVE) has been widely used to induce hypertrophy of the non-embolized liver in order to prevent post-hepatectomy liver failure. PVE is a safe and effective procedure, but does not always lead to sufficient hypertrophy of the future liver remnant (FLR). Hepatic vein(s) embolization has been proposed to improve FLR regeneration when insufficient after PVE. The sequential right hepatic vein embolization (HVE) after right PVE demonstrated an incremental effect on the FLR but it implies two different procedures with no time gain as compared to PVE alone. We have developed the so-called liver venous deprivation (LVD), a combination of PVE and HVE during the same intervention, to optimize the phase of liver preparation before surgery. The main objective of this randomized phase II trial is to compare the percentage of change in FLR volume at 3 weeks after LVD or PVE. METHODS: Patients eligible to this multicenter prospective randomized phase II study are subjects aged from 18 years old suffering from colo-rectal liver metastases considered as resectable and with non-cirrhotic liver parenchyma. The primary objective is the percentage of change in FLR volume at 3 weeks after LVD or PVE using MRI or CT-Scan. Secondary objectives are assessment of tolerance, post-operative morbidity and mortality, post-hepatectomy liver failure, rate of non-respectability due to insufficient FLR or tumor progression, per-operative difficulties, blood loss, R0 resection rate, post-operative liver volume and overall survival. Objectives of translational research studies are evaluation of pre- and post-operative liver function and determination of biomarkers predictive of liver hypertrophy. Sixty-four patients will be included (randomization ratio 1:1) to detect a difference of 12% at 21 days in FLR volumes between PVE and LVD. DISCUSSION: Adding HVE to PVE during the same procedure is an innovative and promising approach that may lead to a rapid and major increase in volume and function of the FLR, thereby increasing the rate of resectable patients and limiting the risk of patient's drop-out. TRIAL REGISTRATION: This study was registered on clinicaltrials.gov on 15th February 2019 (NCT03841305).


Assuntos
Neoplasias Colorretais/patologia , Embolização Terapêutica/métodos , Hepatectomia/efeitos adversos , Falência Hepática/prevenção & controle , Neoplasias Hepáticas/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Adulto , Ensaios Clínicos Fase II como Assunto , Neoplasias Colorretais/cirurgia , Embolização Terapêutica/efeitos adversos , Feminino , Seguimentos , Hepatomegalia/etiologia , Humanos , Fígado/irrigação sanguínea , Fígado/patologia , Fígado/fisiologia , Fígado/cirurgia , Falência Hepática/etiologia , Neoplasias Hepáticas/secundário , Regeneração Hepática , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Veia Porta , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
3.
Eur J Vasc Endovasc Surg ; 57(3): 424-432, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30301647

RESUMO

OBJECTIVES: The aim was to compare the antimicrobial efficacy of four different grafts: a standard graft (Intergard, IG), an IG graft soaked in rifampicin (IGrif), a silver impregnated graft (Intergard Silver, IGS), and a silver + triclosan impregnated graft (Intergard Synergy, IGSy). METHODS: This was a seven day in vitro study. The IG, IGrif, IGS, and IGSy grafts were each contaminated separately with the following microorganisms: Staphylococcus epidermidis, Methicillin resistant Staphylococcus aureus (MRSA), Escherichia coli, and Candida albicans from both clinical and American Type Culture Collection (ATCC) origins. The in vitro antimicrobial efficacy was evaluated by time to kill assays at T0, T24h, T48h, T72h, and T168h. Bactericidal activity was defined as >3 log10 reduction factor (logRF). Additionally, Rifampicin, triclosan and silver resistance development were screened. RESULTS: As anticipated for the non-antimicrobial IG, all microorganism strains proliferated. The IGSy and the IGS showed a seven day bactericidal efficacy (>3 logRF) for all tested microorganisms. This efficacy was confirmed at all time points for IGSy only, demonstrating faster bactericidal efficacy than IGS. The IGrif demonstrated a seven day bactericidal efficacy against the ATCC MRSA only, while showing no activity against C. albicans and ATCC E. coli. Regarding ATCC S. epidermidis, clinical MRSA and clinical E. coli, IGrif, although bactericidal at earlier time points, lost its antimicrobial efficacy at seven days leading to the emergence of rifampicin resistant mutants in four of six, two of six, and two of six assays, respectively. Mutant strains were also detected in ATCC MRSA in one of six assays. No triclosan or silver resistance has emerged at T7days. CONCLUSION: For all microorganisms tested, the Synergy graft combining silver with triclosan demonstrated a more sustainable and efficient seven day antimicrobial activity than the rifampicin soaked graft. The emergence of rifampicin resistant mutants suggests preference for a Synergy graft over a graft soaked in rifampicin, to prevent or treat an infection when a biological solution is not feasible.


Assuntos
Antibacterianos/farmacologia , Antifúngicos/farmacologia , Bactérias/efeitos dos fármacos , Prótese Vascular , Candida albicans/efeitos dos fármacos , Materiais Revestidos Biocompatíveis , Rifampina/farmacologia , Compostos de Prata/farmacologia , Triclosan/farmacologia , Bactérias/genética , Bactérias/crescimento & desenvolvimento , Candida albicans/crescimento & desenvolvimento , Farmacorresistência Bacteriana , Teste de Materiais , Testes de Sensibilidade Microbiana , Desenho de Prótese , Fatores de Tempo
4.
Eur J Vasc Endovasc Surg ; 57(6): 876-884, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31130421

RESUMO

OBJECTIVES: Prosthetic vascular graft infections (PVGIs) are associated with high mortality rates. To improve treatment outcome, an early and definite diagnosis is critical, and current diagnostic criteria are often insufficient. The accuracy of 2-deoxy-2-[fluorine-18]-fluoro-d-glucose positron emission tomography integrated with computed tomography (18F-FDG PET/CT) and white blood cell (WBC) scan for the diagnosis of PVGI were compared. METHODS: A retrospective single centre study was conducted on patients undergoing WBC scan and 18F-FDG PET/CT for a suspected PVGI between April 2013 and June 2016 at the Bordeaux University Hospital, France. The diagnostic value of both imaging tests was assessed for all grafts, using receiver operating characteristic (ROC) curve analysis. Images were independently interpreted by two nuclear medicine physicians blinded to the patients' clinical and other imaging data. RESULTS: Thirty-nine patients were included, of whom 15 had PVGI. Antibiotic treatment was started before nuclear imaging for 16 patients, including nine patients with a PVGI. The 96 grafts of these patients were analysed, and 19 were infected. The diagnostic value of the WBC scan was significantly higher than 18F-FDG PET/CT (ROC AUC = 0.902, 95% CI 0.824-0.980, and 0.759, CI 95% (0.659-0.858), respectively, p = .0071). Interobserver agreement was good for 18F-FDG PET/CT and excellent for WBC scan (kappa value of 0.76, 95% CI 0.62-0.9, and 0.97, 95% CI 0.92-1, respectively). Only one patient had a false negative 18F-FDG PET/CT result under antibiotic therapy. CONCLUSION: The WBC scan has a better diagnostic value than 18F-FDG PET/CT for PVGI diagnosis.


Assuntos
Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Fluordesoxiglucose F18/administração & dosagem , Contagem de Leucócitos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Infecções Relacionadas à Prótese/sangue , Infecções Relacionadas à Prótese/diagnóstico por imagem , Compostos Radiofarmacêuticos/administração & dosagem , Idoso , Implante de Prótese Vascular/instrumentação , Tomada de Decisão Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Prognóstico , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/terapia , Reprodutibilidade dos Testes , Estudos Retrospectivos
5.
Eur Radiol ; 28(7): 2801-2811, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29404766

RESUMO

AIM: To assess regular MRI findings and tumour texture features on pre-CRT imaging as potential predictive factors of event-free survival (disease progression or death) after chemoradiotherapy (CRT) for anal squamous cell carcinoma (ASCC) without metastasis. MATERIALS AND METHODS: We retrospectively included 28 patients treated by CRT for pathologically proven ASCC with a pre-CRT MRI. Texture analysis was carried out with axial T2W images by delineating a 3D region of interest around the entire tumour volume. First-order analysis by quantification of the histogram was carried out. Second-order statistical texture features were derived from the calculation of the grey-level co-occurrence matrix using a distance of 1 (d1), 2 (d2) and 5 (d5) pixels. Prognostic factors were assessed by Cox regression and performance of the model by the Harrell C-index. RESULTS: Eight tumour progressions led to six tumour-specific deaths. After adjusting for age, gender and tumour grade, skewness (HR = 0.131, 95% CI = 0-0.447, p = 0.005) and cluster shade_d1 (HR = 0.601, 95% CI = 0-0.861, p = 0.027) were associated with event occurrence. The corresponding Harrell C-indices were 0.846, 95% CI = 0.697-0.993, and 0.851, 95% CI = 0.708-0.994. CONCLUSION: ASCC MR texture analysis provides prognostic factors of event occurrence and requires additional studies to assess its potential in an "individual dose" strategy for ASCC chemoradiation therapy. KEY POINTS: • MR texture features help to identify tumours with high progression risk. • Texture feature maps help to identify intra-tumoral heterogeneity. • Texture features are a better prognostic factor than regular MR findings.


Assuntos
Neoplasias do Ânus/terapia , Carcinoma de Células Escamosas/terapia , Quimiorradioterapia/métodos , Idoso , Neoplasias do Ânus/mortalidade , Neoplasias do Ânus/patologia , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Quimiorradioterapia/mortalidade , Intervalo Livre de Doença , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Carga Tumoral
6.
Eur J Vasc Endovasc Surg ; 56(4): 562-571, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30076076

RESUMO

OBJECTIVES: Vascular graft infections (VGIs) are severe and require prolonged adequate antimicrobial therapy. However, up to 45% of conventional cultures are negative. Sonication and genus specific PCRs for microbiological diagnosis of VGI was evaluated. METHODS: Samples were prospectively obtained from explanted vascular grafts in Bordeaux University Hospital. Conventional bacterial cultures with and without prior sonication of samples were performed. A genus specific PCR assay panel, targeting the most frequent bacteria involved in VGI (Staphylococcus, Streptococcus, Enterococcus, and Enterobacteriaceae), was also applied to sonicate fluids. The performance of these three diagnostic strategies was compared. RESULTS: Forty-five patients (118 samples) were included between July 2014 and October 2015. Six patients had no infection and 39 had a VGI. Sensitivities of graft culture, sonicate fluid culture, and genus specific PCR were 85.7%, 89.7%, and 79.5%, respectively. Specificities were 100%, 100%, and 83.3%, respectively. Sonicate fluid culture was positive for five graft samples (from four patients) with negative culture without sonication. Four VGIs were detected by PCR only (3 patients had previously received antibiotics). For 15 patients with positive graft cultures, PCR identified at least one additional bacterium compared with culture, thus 30 additional bacteria for all included patients. By combining sonicate fluid culture and PCR, a microbiological diagnosis was obtained for all patients with VGI. CONCLUSIONS: There was no statistical difference between performances of culture with and without sonication and genus specific PCR. However, combining sonicate fluid cultures and PCR may be the best strategy for microbiological diagnostic of VGI.


Assuntos
Técnicas Bacteriológicas , Prótese Vascular/efeitos adversos , Reação em Cadeia da Polimerase , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase/métodos , Sensibilidade e Especificidade
7.
Prostate ; 75(3): 323-31, 2015 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-25393215

RESUMO

BACKGROUND: Accurate staging is important before surgical decision in patients with high-risk prostate cancer (PCa). The purpose of this study was to prospectively compare the diagnostic performance of (18) F-FCholine and MRI with diffusion weighted imaging (DWIMRI) for local and regional lymph node (LN) staging before radical prostatectomy (RP) with extended pelvic lymphadenectomy (PLND). METHODS: We identified 47 patients who underwent (18) F-FCholine and DWIMRI followed by surgical treatment (either prostatectomy or LN dissection or an association of prostatectomy and LN dissection) between May 2010 and December 2012 at Bordeaux University Hospital. These patients were part of a prospective study (EudraCT number 2009-014839-21) evaluating the interest of (18) F-FCholine in staging of high-risk PCa. Diagnostic performances were retrospectively determined for each of (18) F-FCholine and DWIMRI considering LN invasion, each of prostate sextants, capsular invasion and extension to seminal vesicles. (18) F-FCholine and MR findings were correlated with histological findings. RESULTS: In a region-based LN analysis, the sensitivity and positive predictive value specificity were respectively, 56% and 98% for (18) F-Choline, and 17% and 97% for DWIMRI. In a patient-based analysis the sensitivity and positive predictive value were respectively 78% and 94% for (18) F-Choline and 33% and 84% for DWIMRI (P = 0.015). For tumor staging, DWIMRI showed better performances with a better specificity (69%) for sextants analysis and sensitivity to detect seminal vesicle invasion (73% vs. 36%). CONCLUSIONS: (18) F-FCholine imaging appears to provide helpful additional information in the staging of high-risk PCa. It appears essential for predicting LN status due to its higher sensitivity and specificity for LN involvement. However, despite excellent performance, it cannot replace MRI that remains better for tumoral localization and local evaluation, especially for seminal vesicle invasion. PATIENT SUMMARY: This study highlights the interest of (18) F-Choline in the staging of high risk prostate cancer in addition with DWI MRI, especially so in the evaluation of lymph node involvement due to its high sensitivity and excellent specificity.


Assuntos
Estadiamento de Neoplasias/métodos , Pelve/patologia , Neoplasias da Próstata/diagnóstico , Idoso , Colina/análogos & derivados , Radioisótopos de Flúor , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Pelve/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodos , Valor Preditivo dos Testes , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Sensibilidade e Especificidade
8.
Ann Vasc Surg ; 29(2): 361.e13-5, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25462551

RESUMO

BACKGROUND: Diagnosis of prosthetic vascular graft infections is a clinical challenge, and surgical therapy is associated with comorbidity. Therefore, accurate diagnostic methods are required for their optimal management. METHODS: A 61-year-old-patient presented with erysipelas of the right lower limb 7 months after receiving a hybrid femoropopliteal bypass composed of a saphenous vein distally and external supported polytetrafluoroethylene proximally. He had been first treated for suspicious of septic arterial thrombosis or false aneurysm with antibiotics. A computed tomography (CT) angiogram was performed to detect any potential infection of the bypass and to explore erysipelas. It revealed a subcutaneous infiltration and an infiltration of the right groin but no anastomotic pseudoaneurysm or thrombosis of the bypass. The 2-[18F]-fluoro-2-desoxy-d-glucose positron emission tomography (18F-FDG PET) evidenced a significant uptake of cutaneous and subcutaneous tissue but no uptake on the vascular prosthetic graft. Therefore, the bypass was considered as noninfected and antibiotics were continued for 3 months. A physical examination on antibiotic cessation revealed a nonerythematous thigh with a C-reactive protein level significantly decreased to 36 mg/L and a normal white blood cell count. A PET scan confirmed this clinical improvement as attested by a dramatically decreased uptake of cutaneous and subcutaneous tissues and still no uptake of the graft. CONCLUSIONS: In conclusion, this case highlights the role that 18F-FDG PET-CT may play in excluding suspected prosthetic graft infection, thanks to its high sensitivity and in avoiding needless revision surgery with subsequent comorbidities.


Assuntos
Prótese Vascular/efeitos adversos , Tomografia por Emissão de Pósitrons , Infecções Relacionadas à Prótese/diagnóstico , Tomografia Computadorizada por Raios X , Materiais Biocompatíveis , Implante de Prótese Vascular/efeitos adversos , Polímeros de Fluorcarboneto , Fluordesoxiglucose F18 , Humanos , Masculino , Pessoa de Meia-Idade , Compostos Radiofarmacêuticos , Veia Safena/transplante
9.
Ann Vasc Surg ; 29(6): 1321.e1-4, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26080300

RESUMO

Diagnosis of prosthetic vascular graft infection (PVGI) is a clinical challenge requiring accurate diagnostic methods for their optimal management. A 65-year-old patient with suspected PVGI was explored by fluorodeoxyglucose positron emission tomography combined with computed tomography ((18)F-FDG PET-CT) for pretreatment staging. Standard imaging was unrevealing but PET images showed multiple foci with increased uptake suggesting prosthetic infection. While routine results from the diagnostic laboratory were negative, prosthesis sonication before standard culture revealed the same bacterium as a culture of preoperative lymphocele aspiration. (18)F-FDG PET-CT and preliminary sonication of the prosthetic graft could be very helpful in the diagnosis of PVGI especially for highlighting biofilm bacteria.


Assuntos
Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons , Infecções Relacionadas à Prótese/diagnóstico por imagem , Compostos Radiofarmacêuticos , Tomografia Computadorizada por Raios X , Idoso , Bactérias/crescimento & desenvolvimento , Bactérias/isolamento & purificação , Biofilmes , Implante de Prótese Vascular/instrumentação , Remoção de Dispositivo , Humanos , Contagem de Leucócitos , Masculino , Imagem Multimodal , Valor Preditivo dos Testes , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Veia Safena/transplante , Sonicação , Resultado do Tratamento
10.
Nucl Med Commun ; 44(5): 358-365, 2023 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-36862426

RESUMO

INTRODUCTION: The calculation of resin yttrium-90 ( 90 Y-) microspheres activity for selective internal radiotherapy (SIRT) needs to be investigated. METHODS AND MATERIALS: Analyses using Simplicit 90 Y (Boston Scientific, Natick, Massachusetts, USA) dosimetry software were performed to determine the concordance between the absorbed doses to the tumor (D T1 and D T2 ) and healthy liver (D N1 and D N2 ) during the pre-treatment and the post-treatment phases. An optimized calculation of the activity of 90 Y-microspheres performed using dosimetry software was applied retrospectively to assess the impact of this calculation method on the treatment. RESULTS: D T1 ranged from 38.8 to 372 Gy, with a mean value of 128.9 ± 73.6 Gy and median of 121.2 Gy [interquartile range (IQR): 81.7-158.8 Gy]. The median D N1 and D N2 was 10.5 Gy (IQR: 5.8-17.6). A significant correlation was between D T1 and D T2 ( r = 0.88, P < 0.001) and D N1 and D N2 ( r = 0.96, P < 0.001). The optimized activities were calculated; the target dose to the tumor compartment was 120 Gy. No activity reduction was applied in accordance with the tolerance of the healthy liver. Optimization of the microspheres dosages would have resulted in a significant increase in activity for nine treatments (0.21-2.54 GBq) and a reduction for seven others (0.25-0.76 GBq). CONCLUSIONS: The development of customized dosimetry software adapted to clinical practice makes it possible to use dosimetry to optimize the dosage for each patient.


Assuntos
Embolização Terapêutica , Neoplasias Hepáticas , Humanos , Estudos Retrospectivos , Neoplasias Hepáticas/radioterapia , Microesferas , Radioisótopos de Ítrio/uso terapêutico , Software
11.
Pharmaceuticals (Basel) ; 16(12)2023 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-38139803

RESUMO

Hepatocellular carcinoma (HCC) is one of the most common neoplasms worldwide and the third most common cause of cancer-related death. Several liver-targeted intra-arterial therapies are available for unresectable HCC, including selective internal radiation therapy (SIRT) and trans-arterial chemoembolization (TACE). Those two are the most used treatment modalities in localized non-operable HCC. TACE is the treatment option for patients with stage B, according to the BCLC staging system. In contrast, SIRT does not have an official role in the treatment algorithm, but recent studies showed promising outcomes in patients treated with SIRT. Although TACE is globally a safe procedure, it might provoke several vascular complications such as spasms, inflammatory constriction, and, in severe cases, occlusion, dissection, or collateralization. Hence, it is acclaimed that those complications could restrain the targeted response of the radio-embolization when we use it as second-line therapy post TACE. In this study, we will assess the efficacity of SIRT using Yttrium 90 Microspheres post incomplete or failure response to TACE. In our retrospective study, we had 23 patients who met the inclusion criteria. Furthermore, those patients have been followed radiologically and biologically. Then, we evaluated the therapeutic effect according to the mRECIST criteria, in addition to the personalized dose analysis. We found 8 patients were treated with TheraSphere®, with a median tumor absorbed dose of 445 Gy, while 15 received SIR-Spheres® treatment with a mean tumor dose of 268 Gy. After radiological analysis, 56.5% of the patients had a complete response, and 17.3% showed partial response, whereas 13% had stable disease and 13% had progressive disease. For patients treated with SIRT after an incomplete response or failure to TACE, we found an objective response rate of 73.8%. Despite the known vascular complications of TACE, SIRT can give a favorable response.

13.
Diagn Interv Imaging ; 103(7-8): 360-366, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35183483

RESUMO

PURPOSE: The purpose of this study was to evaluate the capabilities of radiomics using magnetic resonance imaging (MRI) data in the assessment of treatment response to 90yttrium transarterial radioembolization (TARE) in patients with locally advanced hepatocellular carcinoma (HCC) by comparison with predictions based on European Association for the Study of the Liver (EASL) criteria. PATIENTS AND METHODS: Twenty-two patients with HCC (19 men, 3 women; mean age: 66.7 ± 9.8 [SD]; age range: 37-82 years) who underwent contrast-enhanced MRI 4 ± 1 weeks before and 4 ± 4 weeks after TARE, were enrolled in this retrospective study. Regions of interest were placed manually along the contours of the treated tumor on each axial slice of arterial and portal phase images using the ITK-SNAP post-processing software. For each MRI, the Pyradiomics Python package was used to extract 107 radiomics features on both arterial and portal phases, and resulting delta-features were computed. The Mann-Whitney U test with Bonferroni correction was used to select statistically different features between responders and non-responders (i.e., those with progressive or stable disease) at 6-month follow-up, according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST). Finally, for each selected feature, univariable logistic regression with leave-one-out cross validation procedure was used to perform receiver operating characteristic (ROC) curve analysis and compare radiomics parameters with MRI variables. RESULTS: According to mRECIST, 14 patients (14/22; 64%) were non-responders and 8 (8/22; 36%) were responders. Four radiomics parameters (long run emphasis, minor axis length, surface area, and gray level non-uniformity on arterial phase images) were the only predictors of early response. ROC curve analysis showed that long run emphasis was the best parameter for predicting early response, with 100% sensitivity (95% CI: 68-100) and 100% specificity (95% CI: 78-100). EASL morphologic criteria yielded 75% sensitivity (95% CI: 41-96%) and 93% specificity (95% CI: 69-100%). CONCLUSION: Radiomics allows identify marked differences between responders and non-responders, and could aid in the prediction of early treatment response following TARE in patients with HCC.


Assuntos
Carcinoma Hepatocelular , Embolização Terapêutica , Neoplasias Hepáticas , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/terapia , Embolização Terapêutica/métodos , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/terapia , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
14.
Cardiovasc Intervent Radiol ; 45(1): 1-11, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34796373

RESUMO

PRIMARY OBJECTIVE: Recently, selective internal radiation therapy using yttrium-90 (Y90) glass microspheres (TheraSphere™) was approved for reimbursement by health authorities in France. The PROACTIF study aims to gather data on effectiveness, patient quality of life, and safety with use of Y90 glass microspheres in real-world clinical settings in France. INCLUSION CRITERIA: Patient with a diagnosis of hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (iCC), and/or metastatic colorectal cancer (mCRC) who was treated with a dose of Y90 glass microspheres that has been reimbursed in France and who do not oppose use of their personal medical data. EXCLUSION CRITERIA: If data collection is opposed, treatment is reimbursed but not administered, or treatment is administered but not reimbursed. OUTCOME MEASURES: Primary outcome measures include overall survival from time of Y90 glass microsphere treatment and quality of life, as assessed using the Functional Assessment of Cancer Therapy- Hepatobiliary questionnaire. ESTIMATED NUMBER OF PATIENTS TO BE INCLUDED: This is an open study and there is no set number of patients; 115 have already been enrolled. PLANNED SUBGROUP ANALYSES: Analyses will be stratified by disease state (HCC, iCC, or mCRC). Subgroups to be analyzed include age group, unilobar/bilobar disease at baseline, Eastern Cooperative Oncology Group (ECOG) status at baseline, liver tumor burden at baseline, target lesion size, and standard versus multi-compartment personalized dosimetry treatment. PLANNED RECRUITMENT AND OBSERVATION PERIOD: Recruitment includes patients who are prescribed and treated with a commercial vial of Y90 glass microspheres between 01 January 2019 and 31 December 2024. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04069468.


Assuntos
Neoplasias dos Ductos Biliares , Carcinoma Hepatocelular , Colangiocarcinoma , Neoplasias Colorretais , Embolização Terapêutica , Neoplasias Hepáticas , Ductos Biliares Intra-Hepáticos , Carcinoma Hepatocelular/radioterapia , Colangiocarcinoma/radioterapia , Ensaios Clínicos Fase IV como Assunto , Neoplasias Colorretais/radioterapia , Humanos , Neoplasias Hepáticas/radioterapia , Microesferas , Estudos Prospectivos , Qualidade de Vida , Sistema de Registros , Resultado do Tratamento , Radioisótopos de Ítrio/uso terapêutico
15.
Clin Nucl Med ; 46(12): 958-964, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34507332

RESUMO

PURPOSE: Selective internal radiotherapy with 90Y microspheres is widely used for the treatment of patients with liver cancer. A dosimetric analysis using the dosimetry software Simplicit90y (Boston Scientific, Natick, MA) was conducted to define doses to the tumor and healthy liver, and to determine a threshold tumor dose that could predict progression-free survival. METHODS: Patients experiencing hepatocellular carcinoma and treated with 90Y-labeled resin microspheres were included in a retrospective study. The time-to-progression of the target lesions (TTPLs) and overall survival (OS) were evaluated using Kaplan-Meier tests, and this comparison was based on a log-rank test. RESULTS: Twenty-four procedures for patients with portal vein thrombosis were realized. Median follow-up was 16 months. A threshold tumor dose of 125 Gy was determined with a sensitivity of 89% and a specificity of 100%. For patients with a tumor dose of less than 125 Gy, the median OS was 7.5 months (95% confidence interval [CI], 5-14 months) and the TTPL was 3 months (95% CI, 2-6 months) versus 33 months (95% CI, 22-39 months) and 23 months (95% CI, 7-38 months), respectively, for those with a tumor dose of 125 Gy or more (P = 0.002 and P = 0.0004). CONCLUSIONS: Personalized dosimetry based on 99mTc-MAA SPECT/CT is predictive of TTPL and OS in patients with hepatocellular carcinoma. Customized dosimetry software is essential to optimize treatment planning.


Assuntos
Carcinoma Hepatocelular , Embolização Terapêutica , Neoplasias Hepáticas , Carcinoma Hepatocelular/radioterapia , Humanos , Neoplasias Hepáticas/radioterapia , Microesferas , Estudos Retrospectivos , Radioisótopos de Ítrio/uso terapêutico
16.
Nucl Med Commun ; 42(10): 1135-1143, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34001823

RESUMO

OBJECTIVES: In multiple myeloma, the diagnosis of diffuse bone marrow infiltration on 18-FDG PET/CT can be challenging. We aimed to develop a PET/CT radiomics-based model that could improve the diagnosis of multiple myeloma diffuse disease on 18-FDG PET/CT. METHODS: We prospectively performed PET/CT and whole-body diffusion-weighted MRI in 30 newly diagnosed multiple myeloma. MRI was the reference standard for diffuse disease assessment. Twenty patients were randomly assigned to a training set and 10 to an independent test set. Visual analysis of PET/CT was performed by two nuclear medicine physicians. Spine volumes were automatically segmented, and a total of 174 Imaging Biomarker Standardisation Initiative-compliant radiomics features were extracted from PET and CT. Selection of best features was performed with random forest features importance and correlation analysis. Machine-learning algorithms were trained on the selected features with cross-validation and evaluated on the independent test set. RESULTS: Out of the 30 patients, 18 had established diffuse disease on MRI. The sensitivity, specificity and accuracy of visual analysis were 67, 75 and 70%, respectively, with a moderate kappa coefficient of agreement of 0.6. Five radiomics features were selected. On the training set, random forest classifier reached a sensitivity, specificity and accuracy of 93, 86 and 91%, respectively, with an area under the curve of 0.90 (95% confidence interval, 0.89-0.91). On the independent test set, the model achieved an accuracy of 80%. CONCLUSIONS: Radiomics analysis of 18-FDG PET/CT images with machine-learning overcame the limitations of visual analysis, providing a highly accurate and more reliable diagnosis of diffuse bone marrow infiltration in multiple myeloma patients.


Assuntos
Mieloma Múltiplo
17.
Nucl Med Commun ; 42(6): 633-638, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33660694

RESUMO

BACKGROUND: Transarterial radioembolization (TARE) is widely used for the treatment of hepatocellular carcinoma (HCC), but early treatment response can be very difficult to assess. The aim was to evaluate 18F-fluorocholine PET/computed tomography (CT) to assess the treatment response in patients with intermediate or locally advanced HCC. METHODS: Between March 2019 and July 2020, nine HCC patients treated with TARE, who underwent PET/CT at baseline and 1 month after treatment, were enrolled. The maximum, mean (SUVmean), and peak (SUVpeak) standardized uptake value (SUV), SUV normalized by lean body mass (SUL), and total lesion glycolysis (TLG) were measured. Statistical analysis used the Mann-Whitney test to evaluate the differences in parameters between responders (partial and complete response) and nonresponders (stable or progressive disease) at the 6-month follow-up, according to the modified Response Evaluation Criteria in Solid Tumors. RESULTS: Three patients were nonresponders (progressive disease and stable disease) and six were responders. Delta SUVmean, delta SUL, and delta TLG could predict an early response (P = 0.02, P = 0.04, and P = 0.02, respectively). None of the pre-therapeutic parameters were correlated with the response. Post-therapeutic SUL, SUVmean, TLG, and SUVpeak were also predictive of the response. CONCLUSIONS: Our preliminary results showed that changes in certain metabolic parameters (from baseline PET to 1-month PET) are predictive of the response to TARE in HCC (Delta SUVmean, delta TLG, and delta SUL). The absence of post-treatment inflammation could lead to a better prediction than MRI evaluation. This study suggests that 1-month 18F-choline PET/CT could modify the clinical management predicting responders.Video Abstract: http://links.lww.com/NMC/A193.


Assuntos
Carcinoma Hepatocelular , Colina/análogos & derivados , Neoplasias Hepáticas , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Adulto , Idoso , Embolização Terapêutica , Glicólise , Humanos , Masculino , Pessoa de Meia-Idade
18.
Infect Drug Resist ; 14: 2397-2401, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34211284

RESUMO

We describe the fourth cases of arterial aneurysm consecutive to Capnocytophaga canimorsus infection in a 77-year-old man. The infection occurred after a dog bite. He presented fever. The thoracic-abdominal computed tomography angiography revealed aneurysms on the abdominal aorta, left common femoral artery, and left popliteal artery. The diagnosis was performed by a blood culture positive for Capnocytophaga canimorsus. The outcome was favorable with surgery and antibiotic therapy.

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