Impact of baseline and interim quantitative PET parameters on outcomes of classical Hodgkin Lymphoma.

Currently, analysis of interim PET (iPET) according to the Deauville score (DS) is the most important predictive factor in Hodgkin lymphoma (HL); however, there is room for improvement in its prognostic power. This study aimed to evaluate the prognostic value of quantitative PET analysis (maximum standard uptake value [SUVmax], total metabolic tumor volume [TMTV] and total lesion glicolysis [TLG]) at baseline (PET0) and iPET in a retrospective cohort of newly diagnosed classical HL. For positive iPET (+ iPET), the reduction of quantitative parameters in relation to PET0 (ΔSUVmax, ΔTMTV and ΔTLG) was calculated. Between 2011 and 2017, 234 patients treated with ABVD were analyzed. Median age was 30 years-old, 59% had advanced stage disease, 57% a bulky mass and 25% a + iPET (DS 4-5). At baseline, high TLG was associated with an increased cumulative incidence of failure (CIF) (p = 0.032) while neither SUVmax, TMTV or TLG were associated with overall survival (OS) or progression-free survival (PFS). In multivariate analysis, only iPET was associated with CIF (p < 0.001). Among ΔSUVmax, ΔTMTV and ΔTLG, only a ΔSUVmax ≥ 68.8 was significant for PFS (HR: 0.31, CI95%: 0.11-0.86, p = 0.024). A subset of patients with improved PFS amongst + iPET was identified by the quantitative (ΔSUVmax ≥ 68.8%) analysis. In this real-world Brazilian cohort, with prevalent high-risk patients, quantitative analysis of PET0 did not demonstrate to be prognostic, while a dynamic approach incorporating the ΔSUVmax to + iPET succeeded in refining a subset with better prognosis. These findings warrant validation in larger series and indicate that not all patients with + iPET might need treatment intensification.

Segmental cardiac strain assessment by two-dimensional speckle-tracking echocardiography in surviving MIS-c patients: Correlations with myocardial flow reserve (MFR) by 13 N-ammonia PET-CT.

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-c) is associated with severe cardiovascular impairment and eventually death. Pathophysiological mechanisms involved in myocardial injury were scarcely investigated, and cardiovascular outcomes are uncertain. Autopsy studies suggested that microvascular dysfunction may be relevant to LV impairment. OBJECTIVE: We aimed to evaluate segmental LV longitudinal strain by 2DST echocardiography and myocardial flow reserve (MFR) by 13 N-ammonia PET-CT, in six surviving MIS-c patients. METHODS: Each patient generated 34 LV segments for combined 2DST and MRF analysis. MFR was considered abnormal when <2, borderline when between 2 and 2.5 and normal when >2.5. RESULTS: From July 2020 to February 2021, six patients were admitted with MIS-c: three males, aged 9.3 (6.6-15.7) years. Time from admission to the follow-up visit was 6.05 (2-10.3) months. Although all patients were asymptomatic and LV EF was ≥55%, 43/102 (42.1%) LV segments showed MFR <2.5. There was a modest positive correlation between segmental peak systolic longitudinal strain and MFR: r = .36, p = .03 for basal segments; r = .41, p = .022 for mid segments; r = .42, p = .021 for apical segments. Median peak systolic longitudinal strain was different among MRF categories: 18% (12%-24%) for abnormal, 18.5% (11%-35%) for borderline, and 21% (12%-32%) for normal MFR (p = .006). CONCLUSION: We provided preliminary evidence that surviving MIS-c patients may present subclinical impairment of myocardial microcirculation. Segmental cardiac strain assessment 2DST seems useful for MIS-c cardiovascular follow-up, given its good correlation with 13 N-ammonia PET-CT derived MFR.

Home-Based Exercise Training in the Recovery of Multisystem Inflammatory Syndrome in Children: A Case Series Study.

OBJECTIVE: To assess the potential therapeutic role of exercise on health-related quality of life, assessed by the Pediatric Outcomes Data Collection Instrument (PODCI), coronary flow reserve (CFR), cardiac function, cardiorespiratory fitness, and inflammatory and cardiac blood markers in multisystemic inflammatory syndrome in children (MIS-C) patients. METHODS: This is a case series study of a 12-wk, home-based exercise intervention in children and adolescents after MIS-C diagnosis. From 16 MIS-C patients followed at our clinic, 6 were included (age: 7-16 years; 3 females). Three of them withdrew before the intervention and served as controls. The primary outcome was health-related quality of life, assessed PODCI. Secondary outcomes were CFR assessed by 13N-ammonia PET-CT imaging, cardiac function by echocardiography, cardiorespiratory fitness, and inflammatory and cardiac blood markers. RESULTS: In general, patients showed poor health-related quality of life, which seemed to be improved with exercise. Additionally, exercised patients showed improvements in coronary flow reserve, cardiac function, and aerobic conditioning. Non-exercised patients exhibited a slower pattern of recovery, particularly in relation to health-related quality of life and aerobic conditioning. CONCLUSIONS: Our results suggest that exercise may play a therapeutic role in the treatment of post-discharge MIS-C patients. As our design does not allow inferring causality, randomized controlled trials are necessary to confirm these preliminary findings.

In-depth cardiovascular and pulmonary assessments in children with multisystem inflammatory syndrome after SARS-CoV-2 infection: A case series study.

We assessed PET-CT myocardial blood flow (MBF) using N-13 ammonia, brachial flow-mediated dilation, and cardiopulmonary exercise test in five post-discarged MIS-C survivors. None of the patients (median age: 9, range: 7-18 years; 3 females; 2 males) had preexisting pediatric chronic conditions. At the follow-up visit, two patients exhibited severe perfusion defect developed in the left ventricular cavity, suggesting extensive myocardial ischemia (MBF <2.0) and one patient showed persistent mild pericardial effusion. Others two patients demonstrated endothelial dysfunction. Nevertheless, all patients had lower predicted values in the VO2peak , VO2VAT , OUES, and O2 Pulse (range: 35.2%-64.5%; 15.6%-38.2%; 1.0-1.3 L/min; 4-7 ml/beat), respectively. Our d suggested that previously health MIS-C patients had impaired MBF, endothelial dysfunction and lower cardiopulmonary capacity at follow-up analysis. Multidisciplinary further investigations should be conducted to reinforce these findings.

Bone marrow uptake of 18F-fluorodeoxyglucose in Hodgkin lymphoma without bone involvement: comparison between patients with and without B symptoms.

OBJECTIVE: To compare the degree of benign bone marrow uptake of 18F-fluorodeoxyglucose (18F-FDG) between Hodgkin lymphoma patients with and without B symptoms. MATERIALS AND METHODS: We analyzed the medical charts of 74 Hodgkin lymphoma patients who underwent 18F-FDG positron emission tomography/computed tomography (PET/CT) prior to the initiation of therapy between October 2010 and September 2013. In all of the patients, the bone marrow biopsy was negative and the 18F-FDG PET/CT images did not suggest bone marrow involvement. Of the 74 patients evaluated, 54 presented inflammatory (B) symptoms and 20 did not. Regions of interest (ROIs) were drawn on the sternum, the proximal thirds of the humeri, the proximal thirds of the femora, and both iliac wings (totaling seven ROIs per patient). To compare the patients with and without B symptoms, in terms of standardized uptake values (SUVs) for the seven ROIs, we used the Mann-Whitney U test. RESULTS: For six of the ROIs, the SUVs were higher in the patients with B symptoms than in those without, and the difference was statistically significant (p < 0.05). There was also a tendency toward a statistically significant difference between the two groups in terms of the SUV for the right iliac wing ROI (p = 0.06). CONCLUSION: In our sample, the presence of B symptoms was associated with increased 18F-FDG uptake in bone marrow.

OBJETIVO: Comparar o grau de absorção benigna de 18F-fluordesoxiglicose (18F-FDG) na medula óssea de pacientes com linfoma de Hodgkin com e sem sintomas B. MATERIAIS E MÉTODOS: Analisamos os prontuários de 74 pacientes com linfoma de Hodgkin submetidos a tomografia por emissão de pósitrons/tomografia computadorizada (PET/CT) com 18F-FDG antes do início da terapia entre outubro de 2010 e setembro de 2013. Em todos os pacientes, a biópsia da medula óssea foi negativa e as imagens de 18F-FDG PET/CT não sugeriram envolvimento da medula óssea. Dos 74 pacientes avaliados, 54 apresentaram sintomas inflamatórios (B) e 20 não. As regiões de interesse (ROIs) foram desenhadas no esterno, nos terços proximais dos úmeros, nos terços proximais dos fêmures e nas duas asas ilíacas (totalizando sete ROIs por paciente). Para comparar os pacientes com e sem sintomas B, em termos dos standardized uptake values (SUVs) para as sete ROIs, utilizamos o teste U de Mann-Whitney. RESULTADOS: Para seis das ROIs, os SUVs foram maiores nos pacientes com sintomas B do que nos pacientes sem, e a diferença foi estatisticamente significante (p < 0,05). Houve também tendência para uma diferença estatisticamente significante entre os dois grupos em termos do SUV para a ROI da asa ilíaca direita (p = 0,06). CONCLUSÃO: Na nossa amostra, a presença de sintomas B foi associada ao aumento da captação de 18F-FDG na medula óssea.

Prevalence of exclusive lower extremity metastases at (18)F-NaF PET/CT.

OBJECTIVE: To evaluate the prevalence of exclusive lower extremity metastases, specifically in the femur and below the knee, observed at (18)F-NaF PET/CT. MATERIALS AND METHODS: One thousand consecutive PET/CT studies were retrospectively evaluated for the presence of exclusive uptake in lower extremities suggesting metastatic involvement. The presumptive diagnoses based on such uptakes were subsequently obtained by evaluation of other imaging studies. RESULTS: No exclusive uptake suggestive of metastasis below the femur was observed in the present series. Exclusive uptake was observed in the proximal femur with a presumptive diagnosis of metastasis in two patients. CONCLUSION: The prevalence of exclusive metastasis below the femur is low and scanning from head to knees is appropriate in most cases.

OBJETIVO: Avaliar a prevalência de metástases exclusivas em membros inferiores, subdivididas em lesões femorais e abaixo dos joelhos, em exames de PET/TC com 18F-NaF. MATERIAIS E MÉTODOS: Mil exames consecutivos foram retrospectivamente avaliados para a presença de captações exclusivas em membros inferiores sugestivas de comprometimento metastático. Os diagnósticos presuntivos dessas captações foram posteriormente obtidos pela avaliação de outros exames realizados. RESULTADOS: Não foram observadas captações exclusivas sugestivas de metástases abaixo dos fêmures na nossa casuística. Foi observada captação exclusiva no terço superior do fêmur com diagnóstico de metástase em dois pacientes. CONCLUSÃO: A prevalência de metástase exclusiva abaixo dos fêmures é baixa e a realização do exame da cabeça até os joelhos é adequada na maioria dos casos.

Bone marrow uptake of 18F-fluorodeoxyglucose in Hodgkin lymphoma without bone involvement: comparison between patients with and without B symptoms / Captação de 18F fluordesoxiglicose na medula óssea em pacientes com linfoma de Hodgkin sem comprometimento ósseo: comparação entre pacientes com e sem sintomas B

Abstract Objective: To compare the degree of benign bone marrow uptake of 18F-fluorodeoxyglucose (18F-FDG) between Hodgkin lymphoma patients with and without B symptoms. Materials and Methods: We analyzed the medical charts of 74 Hodgkin lymphoma patients who underwent 18F-FDG positron emission tomography/computed tomography (PET/CT) prior to the initiation of therapy between October 2010 and September 2013. In all of the patients, the bone marrow biopsy was negative and the 18F-FDG PET/CT images did not suggest bone marrow involvement. Of the 74 patients evaluated, 54 presented inflammatory (B) symptoms and 20 did not. Regions of interest (ROIs) were drawn on the sternum, the proximal thirds of the humeri, the proximal thirds of the femora, and both iliac wings (totaling seven ROIs per patient). To compare the patients with and without B symptoms, in terms of standardized uptake values (SUVs) for the seven ROIs, we used the Mann-Whitney U test. Results: For six of the ROIs, the SUVs were higher in the patients with B symptoms than in those without, and the difference was statistically significant (p < 0.05). There was also a tendency toward a statistically significant difference between the two groups in terms of the SUV for the right iliac wing ROI (p = 0.06). Conclusion: In our sample, the presence of B symptoms was associated with increased 18F-FDG uptake in bone marrow.

Resumo Objetivo: Comparar o grau de absorção benigna de 18F-fluordesoxiglicose (18F-FDG) na medula óssea de pacientes com linfoma de Hodgkin com e sem sintomas B. Materiais e Métodos: Analisamos os prontuários de 74 pacientes com linfoma de Hodgkin submetidos a tomografia por emissão de pósitrons/tomografia computadorizada (PET/CT) com 18F-FDG antes do início da terapia entre outubro de 2010 e setembro de 2013. Em todos os pacientes, a biópsia da medula óssea foi negativa e as imagens de 18F-FDG PET/CT não sugeriram envolvimento da medula óssea. Dos 74 pacientes avaliados, 54 apresentaram sintomas inflamatórios (B) e 20 não. As regiões de interesse (ROIs) foram desenhadas no esterno, nos terços proximais dos úmeros, nos terços proximais dos fêmures e nas duas asas ilíacas (totalizando sete ROIs por paciente). Para comparar os pacientes com e sem sintomas B, em termos dos standardized uptake values (SUVs) para as sete ROIs, utilizamos o teste U de Mann-Whitney. Resultados: Para seis das ROIs, os SUVs foram maiores nos pacientes com sintomas B do que nos pacientes sem, e a diferença foi estatisticamente significante (p < 0,05). Houve também tendência para uma diferença estatisticamente significante entre os dois grupos em termos do SUV para a ROI da asa ilíaca direita (p = 0,06). Conclusão: Na nossa amostra, a presença de sintomas B foi associada ao aumento da captação de 18F-FDG na medula óssea.

Prevalence of exclusive lower extremity metastases at 18F-NaF PET/CT / Prevalência de metástases exclusivas em membros inferiores em exames de PET/TC com 18F-NaF

Abstract Objective: To evaluate the prevalence of exclusive lower extremity metastases, specifically in the femur and below the knee, observed at 18F-NaF PET/CT. Materials and Methods: One thousand consecutive PET/CT studies were retrospectively evaluated for the presence of exclusive uptake in lower extremities suggesting metastatic involvement. The presumptive diagnoses based on such uptakes were subsequently obtained by evaluation of other imaging studies. Results: No exclusive uptake suggestive of metastasis below the femur was observed in the present series. Exclusive uptake was observed in the proximal femur with a presumptive diagnosis of metastasis in two patients. Conclusion: The prevalence of exclusive metastasis below the femur is low and scanning from head to knees is appropriate in most cases. .

Resumo Objetivo: Avaliar a prevalência de metástases exclusivas em membros inferiores, subdivididas em lesões femorais e abaixo dos joelhos, em exames de PET/TC com 18F-NaF. Materiais e Métodos: Mil exames consecutivos foram retrospectivamente avaliados para a presença de captações exclusivas em membros inferiores sugestivas de comprometimento metastático. Os diagnósticos presuntivos dessas captações foram posteriormente obtidos pela avaliação de outros exames realizados. Resultados: Não foram observadas captações exclusivas sugestivas de metástases abaixo dos fêmures na nossa casuística. Foi observada captação exclusiva no terço superior do fêmur com diagnóstico de metástase em dois pacientes. Conclusão: A prevalência de metástase exclusiva abaixo dos fêmures é baixa e a realização do exame da cabeça até os joelhos é adequada na maioria dos casos. .