RESUMEN
The objective of the present paper was to review the clinical application of [18F]FDG PET/CT in follicular lymphoma (FL). Once it was clear that, despite it is characterized as indolent, this type of lymphoma usually shows a high [18F]FDG avidity, PET/CT became more important and it's now considered the standard technique in staging, re-staging and response evaluation. Many studies have shown its impact on the management of patients (as it can change the stage in a significant proportion of cases and lead to treatment modifications), its superiority over CT (mainly because it's able to distinguish fibrosis in residual masses from viable tumor) and its prognostic value. The latter was initially associated only to the degree of metabolic response, which has proved to be a strong and independent predictive factor in terms of disease-free survival (DFS) and overall survival (OS). Thus, a negative PET/CT scan could be considered a guarantee in high-tumor-burden follicular lymphoma patients. However, semiquantitative parameters such as metabolic tumor volume or total lesion glycolysis, may also provide useful information and help us to identify patients with poor prognosis, guiding a risk-adjusted management and follow-up.
Asunto(s)
Fluorodesoxiglucosa F18 , Linfoma Folicular , Humanos , Linfoma Folicular/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Tomografía de Emisión de Positrones , RadiofármacosRESUMEN
A diagnosis of cancer is frightening at any age, but especially when the patient is a child. Only what is suspected can be diagnosed, only what is known or at least known to exist is suspected, but musculoskeletal tumors are infrequent and therefore very difficult to diagnose or treat. Probably due to their infrequency, the complexity of the radiological images, histopathological appearance, as well as the serious consequences due to inadequate biopsies and treatments, musculoskeletal tumor pathology requires clinical management that must be carried out by a group of specialists with specific training, allowing an adequate diagnosis, introduction of adjuvant therapies, as well as surgical treatment, making multidisciplinary treatment essential today. Imaging studies provide essential information on the nature of each lesion, its size, its anatomical location, the effect on the surrounding bone or soft tissues and the involvement of adjacent joints and neurovascular structures. In this article the authors will discuss the advances in nuclear medicine techniques (scintigraphy, SPECT/CT and PET/CT) and their usefulness in the staging of pediatric malignant musculoskeletal tumors, as well as in the assessment of response, follow-up, and diagnosis of recurrence.
Asunto(s)
Neoplasias , Medicina Nuclear , Niño , Humanos , Tomografía Computarizada por Tomografía de Emisión de Positrones , Cintigrafía , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
Bone metastases are very common complications associated with certain types of cancers that frequently negatively impact the quality of life and functional status of patients; thus, early detection is necessary for the implementation of immediate therapeutic measures to reduce the risk of skeletal complications and improve survival and quality of life. There is no consensus or universal standard approach for the detection of bone metastases in cancer patients based on imaging. Endorsed by the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM) a group of experts met to discuss and provide an up-to-date review of our current understanding of the biological mechanisms through which tumors spread to the bone and describe the imaging methods available to diagnose bone metastasis and monitor their response to oncological treatment, focusing on patients with breast and prostate cancer. According to current available data, the use of next-generation imaging techniques, including whole-body diffusion-weighted MRI, PET/CT, and PET/MRI with novel radiopharmaceuticals, is recommended instead of the classical combination of CT and bone scan in detection, staging and response assessment of bone metastases from prostate and breast cancer.Clinical trial registration: Not applicable.
Asunto(s)
Neoplasias Óseas , Neoplasias de la Mama , Neoplasias de la Próstata , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/secundario , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Neoplasias de la Mama/terapia , Femenino , Humanos , Masculino , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Próstata/patología , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/terapia , Calidad de Vida , RadiofármacosRESUMEN
INTRODUCTION AND OBJECTIVE: Neuroendocrine tumors (NETs) debut in 75% of cases with liver metastases (LMNETs), whose therapeutic approach includes surgical resection and liver transplantation, while liver radioembolization with 90 Y-microspheres (TARE) is reserved for non-operable patients usually due to high tumor burden. We present the accumulated experience of 10 years in TARE treatment of LMNETs in order to describe the safety and the effectiveness of the oncological response in terms of survival, as well as to detect the prognostic factors involved. MATERIAL AND METHODS: Of 136 TARE procedures, performed between January 2006 and December 2016, 30 LMNETs (11.1%) were retrospectively analyzed. The study variables were: Tumor response, time to liver progression, survival at 3 and 5 years, overall mortality and mortality associated with TARE. The radiological response assessment was assessed using RECIST 1.1 and mRECIST criteria. RESULTS: An average activity of 2.4 ± 1.3 GBq of 90 Y was administered. No patient presented postembolization syndrome or carcinoid syndrome. There were also no vascular complications associated with the procedure. According to RECIST 1.1 criteria at 6 months, 78.6% presented partial response and 21.4% stable disease, there was no progression or complete response (1 by mRECIST). Survival at 3 and 5 years was 73% in both cases. CONCLUSION: TARE treatment with 90 Y-microspheres in LMNETs, applied within a multidisciplinary approach, is a safe procedure, with low morbidity, capable of achieving a high rate of radiological response and achieving lasting tumor responses.
RESUMEN
Soft tissue sarcomas (STS) are a rare and heterogeneous group of tumors. They account for 1% of solid malignant tumors in adults and 7% in children and are responsible for 2% of cancer mortality. They require a multidisciplinary approach in centers with experience. This collaboration aims to update the scientific evidence to strengthen, together with clinical experience, the bases for the use and limitations of 18F-FDG-PET/CT in STSs. The general recommendations for the use of PET/CT in STS at present are summarized as the initial evaluation of soft tissue tumours when conventional image does not establish benignity with certainty and this determines the approach; in biopsy guiding in selected cases; in the initial staging, as additional tool, for rhabdomyosarcoma and STS of extremities or superficial trunk and head and neck tumours; in the suspicion of local recurrence when the CT or MRI are inconclusive and in the presence of osteosynthesis or prosthetic material and in assessment of therapy response to local/systemic therapy in stages ii/iii. In addition, PET/CT has the added value of being a surrogate marker of the histopathological response and it provides prognostic information, both in the baseline study and after treatment.
Asunto(s)
Radioisótopos de Flúor , Fluorodesoxiglucosa F18 , Metástasis de la Neoplasia/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Radiofármacos , Sarcoma/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Diagnóstico Diferencial , Reacciones Falso Negativas , Reacciones Falso Positivas , Humanos , Biopsia Guiada por Imagen/métodos , Terapia Neoadyuvante , Recurrencia Local de Neoplasia/diagnóstico por imagen , Estadificación de Neoplasias/métodos , Guías de Práctica Clínica como Asunto , Pronóstico , Sarcoma/patología , Sarcoma/secundario , Sarcoma/terapia , Sensibilidad y Especificidad , Neoplasias de los Tejidos Blandos/patología , Neoplasias de los Tejidos Blandos/terapia , Resultado del TratamientoRESUMEN
Colorectal cancer (CRC) has the second-highest tumor incidence and is a leading cause of death by cancer. Nearly 20% of patients with CRC will have metastases at the time of diagnosis, and more than 50% of patients with CRC develop metastatic disease during the course of their disease. A group of experts from the Spanish Society of Medical Oncology, the Spanish Association of Surgeons, the Spanish Society of Radiation Oncology, the Spanish Society of Vascular and Interventional Radiology, and the Spanish Society of Nuclear Medicine and Molecular Imaging met to discuss and provide a multidisciplinary consensus on the management of liver metastases in patients with CRC. The group defined the different scenarios in which the disease can present: fit or unfit patients with resectable liver metastases, patients with potential resectable liver metastases, and patients with unresectable liver metastases. Within each scenario, the different strategies and therapeutic approaches are discussed.
Asunto(s)
Neoplasias Colorrectales/patología , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/terapia , Oncología Médica/métodos , Grupo de Atención al Paciente/normas , Algoritmos , Terapia Combinada , Consenso , Hepatectomía , Humanos , Oncología Médica/organización & administración , EspañaRESUMEN
Colorectal cancer is the third most frequent cancer worldwide. Although its incidence is increasing, mainly in those aged under50, mortality has decreased by 50% in the more developed countries, principally due to the adoption of new practices in prevention, diagnosis and treatment. In particular, the various diagnostic imaging modalities allow improved therapeutic decision-making, evaluation of the response and early detection of recurrence. The aim of this paper is to review the available scientific evidence on the value of positron emission tomography with 18F-FDG (18F-FDG PET/CT) in the colorectal cancer, with special emphasis on the indications of the guidelines and recommendations of the main international scientific associations regarding this imaging technique.
Asunto(s)
Neoplasias del Colon/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Tomografía Computarizada por Tomografía de Emisión de Positrones , Radiofármacos , Neoplasias del Recto/diagnóstico por imagen , Neoplasias del Colon/patología , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Recurrencia Local de Neoplasia/diagnóstico por imagen , Estadificación de Neoplasias/métodos , Guías de Práctica Clínica como Asunto , Neoplasias del Recto/patologíaRESUMEN
The detection of malignant liver tumours is recently increasing. These lesions have frequently arterial vascularization which differs from healthy parenchyma with main portal flow making them especially susceptible to transarterial therapies. Transarterial Radioembolization (TARE) is an emerging treatment for the management of different liver tumours. Significant improvements in the procedure have been made so it is considered a safe and effective treatment. A multidisciplinary approach is necessary because of the complexity of the procedure. An optimal selection of the patients and good planning arteriography are essential to obtain benefit and reduce complication rate. Although TARE has been used mostly in hepatocellular carcinoma and liver metastases, indications are currently in expansion as the only treatment or in combination.
Asunto(s)
Braquiterapia , Carcinoma Hepatocelular/terapia , Embolización Terapéutica/métodos , Neoplasias Hepáticas/terapia , Algoritmos , Arterias , Terapia Combinada , Humanos , MicroesferasRESUMEN
INTRODUCTION: HaNDL syndrome (transient headache and neurological deficits with cerebrospinal fluid lymphocytosis) is characterised by one or more episodes of headache and transient neurological deficits associated with cerebrospinal fluid lymphocytosis. To date, few cases of HaNDL manifesting with confusional symptoms have been described. Likewise, very few patients with HaNDL and confusional symptoms have been evaluated with transcranial Doppler ultrasound (TCD). TCD data from patients with focal involvement reveal changes consistent with vasomotor alterations. DEVELOPMENT: We present the case of a 42-year-old man who experienced headache and confusional symptoms and displayed pleocytosis, diffuse slow activity on EEG, increased blood flow velocity in both middle cerebral arteries on TCD, and single-photon emission computed tomography (SPECT) findings suggestive of diffuse involvement, especially in the left hemisphere. CONCLUSIONS: To our knowledge, this is the first description of a patient with HaNDL, confusional symptoms, diffuse slow activity on EEG, and increased blood flow velocity in TCD. Our findings suggest a relationship between cerebral vasomotor changes and the pathophysiology of HaNDL. TCD may be a useful tool for early diagnosis of HaNDL.
Asunto(s)
Confusión/complicaciones , Cefalea/complicaciones , Linfocitosis/complicaciones , Enfermedades del Sistema Nervioso/complicaciones , Vasoespasmo Intracraneal/complicaciones , Adulto , Confusión/fisiopatología , Electroencefalografía , Cefalea/líquido cefalorraquídeo , Humanos , Linfocitosis/líquido cefalorraquídeo , Masculino , Enfermedades del Sistema Nervioso/líquido cefalorraquídeo , Síndrome , Factores de Tiempo , Ultrasonografía Doppler Transcraneal , Vasoespasmo Intracraneal/diagnóstico por imagenRESUMEN
Cervical cancer is the second most common gynecological cancer worldwide. In locally advanced cervical cancer, 18F-FDG PET/CT has become important in the initial staging, particularly in the detection of nodal and distant metastasis, aspects with treatment implications and prognostic value. The aims of this study were to review the role of 18F-FDG PET/CT in uterine cervical cancer, according to the guidelines of the main scientific institutions (FIGO, NCCN, SEGO, SEOM, ESGO, and ESMO) and its diagnostic accuracy compared to conventional radiological techniques, as well as to review the acquisition protocol and its utility in radiotherapy planning, response assessment and detection of recurrence.
Asunto(s)
Fluorodesoxiglucosa F18 , Tomografía Computarizada por Tomografía de Emisión de Positrones , Radiofármacos , Neoplasias del Cuello Uterino/diagnóstico por imagen , Femenino , Humanos , Metástasis Linfática , Estadificación de Neoplasias , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Guías de Práctica Clínica como Asunto , Neoplasias del Cuello Uterino/patologíaRESUMEN
Positron emission tomography/computed tomography (PET/CT) with 68Ga-PSMA is a non-invasive diagnostic technique to image prostate cancer with increased prostate-specific membrane antigen (PSMA) expression. PSMA is a transmembrane protein present in all prostatic tissues. Increased PSMA expression is seen in several malignancies, although prostate cancer is the tumour where it presents higher concentrations. Almost all prostate adenocarcinomas show PSMA expression in most of lesions, primary and metastatic. Immunohistochemistry has demonstrated that the expression of PSMA increases in patients with de-differentiated, metastatic or hormone-refractory tumours. Moreover, the expression level of PSMA has a prognostic value for disease outcome. PET measures the three-dimensional distribution of 68Ga-PSMA, producing semi-quantitative images that allow for non-invasive assessment of PSMA expression.
Asunto(s)
Adenocarcinoma/diagnóstico por imagen , Ácido Edético/análogos & derivados , Radioisótopos de Galio/farmacocinética , Oligopéptidos/farmacocinética , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Neoplasias de la Próstata/diagnóstico por imagen , Radiofármacos/farmacocinética , Adenocarcinoma/química , Adenocarcinoma/patología , Adenocarcinoma/terapia , Anciano , Ácido Edético/síntesis química , Ácido Edético/farmacocinética , Estudios de Seguimiento , Isótopos de Galio , Regulación Neoplásica de la Expresión Génica , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Oligopéptidos/síntesis química , Pronóstico , Antígeno Prostático Específico/análisis , Antígeno Prostático Específico/biosíntesis , Antígeno Prostático Específico/genética , Neoplasias de la Próstata/química , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/terapia , Radiometría , Radiofármacos/síntesis química , Recurrencia , Sensibilidad y Especificidad , Distribución Tisular , Carga TumoralRESUMEN
Bone metastatic disease is the main cause of morbidity / mortality in patients with prostate cancer, presenting frequently as bone pain, pathological fractures or spinal cord compression, which requires early and timely therapy. Although, for the moment, the therapeutic window for its use has not been definitively established, radium-223 (223Ra), an alpha particle emitter, has proved to be an effective therapeutic tool, pre or post-chemotherapy, in patients with castration-resistant prostate cancer with symptomatic bone metastases and absence of visceral metastases, significantly modifying the prognosis of the disease. It is therefore imperative to define the ideal scenarios and the correct protocol for the use of this therapy and thus offer the greatest possible clinical benefit to the patient.
Asunto(s)
Neoplasias Óseas/radioterapia , Neoplasias de la Próstata Resistentes a la Castración/patología , Radio (Elemento)/uso terapéutico , Neoplasias Óseas/secundario , Humanos , Masculino , Dosificación RadioterapéuticaRESUMEN
Hepatic radioembolization with 90Y is an increasingly widely used locoregional therapy in the treatment of hepatocellular carcinoma. Its potential benefit has recently been described as a downstaging treatment, achieving a decreased tumour burden and allowing patients to be rescued for more radical treatments, such as liver transplantation. The case is presented of a patient diagnosed with multifocal bilobar hepatocellular carcinoma, Barcelona Clinic Liver Cancer (BCLC) intermediate stage, in whom treatment with 90Y achieved a satisfactory radiological response with a very significant reduction of tumour burden, allowing rescue with liver transplantation.
Asunto(s)
Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/terapia , Embolización Terapéutica/métodos , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/terapia , Radioisótopos de Itrio/uso terapéutico , Carcinoma Hepatocelular/cirugía , Humanos , Neoplasias Hepáticas/cirugía , Trasplante de Hígado , Masculino , Microesferas , Persona de Mediana Edad , Estadificación de NeoplasiasRESUMEN
Bone metastases are very common complications associated with certain types of cancers that frequently negatively impact the quality of life and functional status of patients; thus, early detection is necessary for the implementation of immediate therapeutic measures to reduce the risk of skeletal complications and improve survival and quality of life. There is no consensus or universal standard approach for the detection of bone metastases in cancer patients based on imaging. Endorsed by the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM) a group of experts met to discuss and provide an up-to-date review of our current understanding of the biological mechanisms through which tumors spread to the bone and describe the imaging methods available to diagnose bone metastasis and monitor their response to oncological treatment, focusing on patients with breast and prostate cancer. According to current available data, the use of next-generation imaging techniques, including whole-body diffusion-weighted MRI, PET/CT, and PET/MRI with novel radiopharmaceuticals, is recommended instead of the classical combination of CT and bone scan in detection, staging and response assessment of bone metastases from prostate and breast cancer.
Asunto(s)
Humanos , Masculino , Femenino , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/secundario , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Neoplasias de la Mama/terapia , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Próstata , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/terapia , Calidad de Vida , RadiofármacosRESUMEN
El cáncer de próstata (CP) es el tumor más frecuente en varones en Occidente y la quinta causa de muerte relacionada con el cáncer. El uso de radioligandos antígeno prostático específico de membrana (PSMA) ha supuesto un importante avance tanto en su diagnóstico, a través de la imagen molecular de tomografía por emisión de positrones (PET), como en su tratamiento en fases avanzadas de la enfermedad. En este artículo, se hace una revisión de la aportación de los estudios PET con radioligandos PSMA en la estadificación inicial, en la detección tumoral en la recidiva bioquímica (elevación del antígeno prostático específico [PSA]) tras un tratamiento con intención curativa, y en los estadios más avanzados de la enfermedad (CP resistente a la castración o CPRC). Se analiza, además, la aportación de la terapia con radioligandos PSMA (PSMA-TRL) en pacientes con CPRC que progresan a la terapia estándar (AU)
Prostate cancer (PC) is the most common tumor in men in the West and the fifth leading cause of cancer-related death. The use of prostate-specific membrane antigen (PSMA) radioligands has represented an important advance in both in the diagnosis by positron emission tomography (PET) molecular imaging and the treatment of advanced stages of the disease. This article reviews the contribution of PET studies with PSMA radioligands in the initial staging, tumor detection in biochemical recurrence (elevation of PSA) after treatment with curative intent, and in the more advanced stages of the disease (castration-resistant PC [CRPC]). The contribution of PSMA radioligand therapy in CRPC patients who progress to standard therapy is also analyzed (AU)
Asunto(s)
Humanos , Masculino , Neoplasias de la Próstata Resistentes a la Castración/diagnóstico por imagen , Neoplasias de la Próstata Resistentes a la Castración/terapia , Antígeno Prostático Específico , Ensayo de Unión Radioligante , Tomografía de Emisión de Positrones , Estadificación de Neoplasias , Recurrencia Local de NeoplasiaRESUMEN
El objetivo de este trabajo fue revisar el papel de la [18F]FDG PET/TC en el linfoma folicular (LF). Tras confirmarse que a pesar de su carácter indolente este tipo de linfoma habitualmente muestra avidez por el radiotrazador, la [18F]FDG PET/TC fue cobrando una importancia progresivamente mayor hasta ser considerada como la técnica de elección para su estadificación, re-estadificación y valoración de respuesta al tratamiento. Múltiples estudios han demostrado el impacto que supone en el manejo de estos pacientes (puede cambiar el estadio de la enfermedad en una proporción significativa de casos y condicionar modificaciones en el tratamiento), su superioridad respecto a la TC (principalmente por la capacidad para distinguir tejido tumoral viable de tejido fibrótico residual) y su valor pronóstico. Esto último se atribuyó inicialmente de forma exclusiva al grado de respuesta metabólica alcanzado tras el tratamiento, que ha probado ser un factor predictivo fuerte e independiente de supervivencia libre de progresión (SLP) y supervivencia global (SG), de modo que una [18F]FDG PET/TC negativa podría considerarse una garantía para los pacientes con LF con elevada carga tumoral. No obstante, la obtención de parámetros metabólicos semicuantitativos como el volumen metabólico tumoral o la glucólisis total de la lesión podría también aportar información a este respecto y ayudarnos potencialmente a identificar a los pacientes de mal pronóstico antes del inicio del tratamiento, de forma que se pueda adecuar el manejo y seguimiento al riesgo del paciente (AU)
The objective of the present paper was to review the clinical application of [18F]FDG PET/CT in follicular lymphoma (FL). Once it was clear that, despite it's characterized as indolent, this type of lymphoma usually shows a high [18F]FDG avidity, PET/CT became more important and it's now considered the standard technique in staging, re-staging and response evaluation. Many studies have shown its impact on the management of patients (as it can change the stage in a significant proportion of cases and lead to treatment modifications), its superiority over CT (mainly because it's able to distinguish fibrosis in residual masses from viable tumor) and its prognostic value. The latter was initially associated only to the degree of metabolic response, which has proved to be a strong and independent predictive factor in terms of disease-free survival (DFS) and overall survival (OS). Thus, a negative PET/CT scan could be considered a guarantee in high-tumor-burden follicular lymphoma patients. However, semiquantitative parameters such as metabolic tumor volume or total lesion glycolysis, may also provide useful information and help us to identify patients with poor prognosis, guiding a risk-adjusted management and follow-up (AU)
Asunto(s)
Humanos , Linfoma Folicular/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Radiofármacos , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodosAsunto(s)
Artefactos , Carcinoma Hepatocelular/diagnóstico por imagen , Quimioembolización Terapéutica , Aceite Yodado/química , Neoplasias Hepáticas/diagnóstico por imagen , Tomografía de Emisión de Positrones/métodos , Anciano , Carcinoma Hepatocelular/terapia , Doxorrubicina/administración & dosificación , Doxorrubicina/uso terapéutico , Reacciones Falso Positivas , Espuma de Fibrina/administración & dosificación , Espuma de Fibrina/uso terapéutico , Humanos , Aceite Yodado/administración & dosificación , Aceite Yodado/uso terapéutico , Neoplasias Hepáticas/terapia , Masculino , Tomografía Computarizada por Rayos XRESUMEN
AIM: To assess the metabolic behavior of mesenteric panniculitis (MP), possible manifestation patterns in ¹8F-FDG PET/CT imaging and to discover if it is a reliable diagnostic method to differentiate tumor disease from inflammatory condition in this context. MATERIAL AND METHODS: A total of 2,666 PET/CT scans were evaluated prospectively from April 2012 to August 2013. Thirty patients were included (37 scans) with radiological signs of MP. There were 8 women and 22 men, aged between 39 and 81 years, in the sample. According to the ¹8F-FDG uptake in the mesenteric lesions, expressed as SUVmax, patients were classified into two different groups: Group A consisted of 10 patients with increased uptake, SUVmax ≥ 2 or greater than the activity found in the surrounding healthy mesenteric tissue, and Group B (20 patients) SUVmax <2 or indistinguishable from healthy tissue. RESULTS: No signs of mesenteric tumour involvement were demonstrated during a mean follow up of 13 months (false positives) in 80% of the Group A patients (mean SUVmax 7.11). Signs of the presence of tumor were only demonstrated in two patients of Group A (SUVmax 7.57 and 9.46) with a positive predictive value of 49.79%. All Group B patients were confirmed to be free of mesenteric involvement. CONCLUSIONS: The presence of radiological signs of suggestive of MP, increase in glycidic metabolism, even intense and focal in these lesions, which may not exclude the possibility of an ongoing tumour process, would have a high likelihood of being indicative of intense inflammatory activity.
Asunto(s)
Radioisótopos de Flúor/farmacocinética , Fluorodesoxiglucosa F18/farmacocinética , Metástasis Linfática/diagnóstico por imagen , Mesenterio/diagnóstico por imagen , Paniculitis Peritoneal/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Radiofármacos/farmacocinética , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paniculitis Peritoneal/metabolismo , Estudios ProspectivosRESUMEN
Splenosis is a common finding after traumatic rupture of the spleen or therapeutic splenectomy, defined as a heterotopic autotransplantation of the spleen in peritoneal cavity and surface. In splenectomized patients due to hematologic disease, splenosis can lead to disease recurrence. We present a case of splenosis in a patient with idiopathic thrombocytopenic purpura who relapsed after splenectomy. For its localization, conventional imaging and scintigraphy with (99m)Tc-denatured red cells was performed, and at least five splenic foci were observed. Given the difficult intraoperative localization of these nodules, radioguided surgery was performed, with excellent localization and removal of all known nodules and multiple peritoneal implants of millimeter size that were not previously observed. We conclude that radioguided surgery is an excellent tool for locating foci of peritoneal splenosis, which have difficult access, thus avoiding early recurrence of the disease.