RESUMEN
A 53-year-old man with T4aN2cM0 tongue base squamous cell carcinoma received definitive chemoradiation. FDG PET/CT at 6 weeks showed partial metabolic response with soft tissue air indicating radiation necrosis at primary site and complete response in the neck. At 9 weeks, contrasted CT showed worsening but nonenhancing ulceration, area biopsied demonstrating a minute carcinoma focus with treatment effect. At 12 weeks, PET/CT showed increased primary site uptake interpreted as disease progression; however, no viable tumor was found at salvage surgery. Because nonenhancing ulceration predicts pure radiation necrosis with no viable tumor, contrasted CT may guide treatment selection in challenging cases.
Asunto(s)
Traumatismos por Radiación/diagnóstico , Traumatismos por Radiación/patología , Neoplasias de la Lengua/terapia , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Quimioradioterapia , Progresión de la Enfermedad , Femenino , Fluorodesoxiglucosa F18 , Humanos , Persona de Mediana Edad , Necrosis/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Traumatismos por Radiación/etiología , Terapia Recuperativa , Neoplasias de la Lengua/patologíaRESUMEN
OBJECTIVES: To investigate the utility of positron-emission tomography-computed tomography (PET-CT) in identifying distant metastatic disease in patients with previously untreated head and neck squamous cell cancer (HNSCC) prior to definitive treatment. MATERIALS AND METHODS: Retrospective analysis of 27 consecutive patients with previously untreated HNSCC who underwent PET-CT imaging in addition to chest radiography (CXR) as part of their metastatic workup. RESULTS: The majority of patients (89%) had TNM stage III or IV disease. PET-CT was suspicious for pulmonary malignancy in four (15%) patients and indeterminate in one (4%) patient. CXR was suspicious for pulmonary malignancy in two (7%) patients. Pulmonary metastases or a new lung primary was present in 3 (11%) patients: 3 of 4 (75%) patients with positive PET-CT scans and 0 of 23 (0%) patients with negative or indeterminate PET-CT scans compared with 2 of 2 (100%) patients with positive CXR and 1 of 25 (4%) patients with negative CXR. The sensitivity and specificity of PET-CT in predicting pulmonary malignancy was 100% and 96%, respectively, with a positive predictive value of 75% and a negative predictive value of 100%. The sensitivity and specificity of CXR in predicting pulmonary malignancy was 67% and 100%, respectively, with a positive predictive value of 100% and a negative predictive value of 96%. Including nonpulmonary sites, the overall incidence of distant metastatic disease was 19% (5/27) with 11% (3/27) unsuspected prior to PET-CT. CONCLUSIONS: PET-CT improves detection of metastatic disease in the high-risk patient and should be performed as part of the routine pretreatment evaluation of patients with advanced stage HNSCC.
Asunto(s)
Carcinoma de Células Escamosas/secundario , Neoplasias de Cabeza y Cuello/patología , Neoplasias Pulmonares/secundario , Tomografía de Emisión de Positrones/métodos , Tomografía Computarizada Espiral/métodos , Carcinoma de Células Escamosas/diagnóstico , Medios de Contraste , Femenino , Fluorodesoxiglucosa F18 , Estudios de Seguimiento , Humanos , Neoplasias Laríngeas/patología , Neoplasias Pulmonares/diagnóstico , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/patología , Estadificación de Neoplasias , Neoplasias Orofaríngeas/patología , Valor Predictivo de las Pruebas , Radiografía Torácica , Radiofármacos , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
Kaolin pneumoconiosis may produce radiologic findings similar to those of malignancy. Current management includes serial radiologic examination and lung sampling of suspicious parenchymal opacities and nodules to exclude associated malignancy. This may result in unnecessary pulmonary resections in patients with already compromised lung function. In a patient with known kaolin pneumoconiosis and multiple nodules, we used positron emission tomography to identify suspicious areas for malignancy that were confirmed by open lung biopsy, leading to successful lung cancer treatment.
Asunto(s)
Fluorodesoxiglucosa F18 , Caolín/toxicidad , Neumoconiosis/diagnóstico por imagen , Tomografía de Emisión de Positrones , Radiofármacos , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Neumoconiosis/cirugía , NeumonectomíaRESUMEN
Extracardiac uptake on SPECT MPI, seen with physiologic radiotracer distribution, benign or malignant neoplasm, infection, inflammation, or granulomatous disease, may confound the accuracy of MPI or lead to unsuspected pathology. A 38-year-old woman with end-stage renal disease on hemodialysis had SPECT MPI for renal transplant preoperative risk stratification, showing left anterior descending artery ischemia and an intense extracardiac soft tissue focus adjacent to the diaphragmatic right ventricle concerning for focal infection related to prior coronary or gastric surgeries or tumor. CT revealed focal herniation of liver containing a flash-fill hemangioma into the left hemithorax accounting for this focal uptake.
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Hemangioma/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Imagen de Perfusión Miocárdica , Tomografía Computarizada de Emisión de Fotón Único , Adulto , Femenino , Humanos , Hallazgos IncidentalesRESUMEN
This article highlights the importance of functional imaging methods in the diagnosis and preoperative planning in temporal lobe epilepsy TLE). It starts with a discussion of the role of ictal and interictal single-photon emission computed tomography (SPECT) and interictal positron emission tomography (PET) in lateralizing TLE. The next section discusses the role of blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) and perfusion MRI, particularly for lateralization of language and memory in TLE patients. The final section explores the relatively new role that the emerging technique of diffusion tensor imaging (DTI) is playing in the evaluation of TLE.
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Mapeo Encefálico/métodos , Epilepsia del Lóbulo Temporal/diagnóstico , Epilepsia del Lóbulo Temporal/fisiopatología , Interpretación de Imagen Asistida por Computador/métodos , Imagen por Resonancia Magnética/métodos , Lóbulo Temporal/fisiopatología , Tomografía Computarizada de Emisión de Fotón Único/métodos , HumanosRESUMEN
Nuclear protein in testis (NUT) midline carcinoma (NMC) is a rare, aggressive, lethal, epithelioid, poorly differentiated cancer first described in Japan in 1991, unique in that is defined genetically rather than by histological tissue of origin. It usually arises in the body midline and presents as a mass with metastasis. An infant presenting with pneumonia was found to have a pericardial mass, NMC resected, and subsequent staging positron emission tomography (PET) showing residual mediastinal tumor and midline abdominal metastases. Fewer than 100 cases of NMC have been reported in the literature, and PET appears to be the imaging modality of choice in complete staging and evaluation of treatment response.
RESUMEN
This American College of Radiology and American College of Nuclear Medicine joint clinical practice parameter is for performance of dopamine transporter single photon emission computed tomography (SPECT) imaging, for patients with movement disorders. Parkinsonian syndrome (PS) consists of a group of neurodegenerative diseases including Parkinson disease (PD), progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal degeneration (CBD), and dementia with Lewy bodies (DLB). Accurate diagnosis of PS is critical for clinical management. An important diagnostic dilemma is the differentiation of PS and non-neurodegenerative disorders, such as essential tremor (ET) or drug-induced tremor, due to the overlap of clinical symptoms. The management approach to these conditions is distinctly different. An abnormal iodine-123 ioflupane SPECT scan suggests a decreased amount of dopamine transporter in the striatum, that is, a diagnosis of nigrostriatal neurodegenerative PS, whereas a normal scan suggests ET or other nondegenerative parkinsonism (drug-induced, vascular, or psychogenic).
Asunto(s)
Proteínas de Transporte de Dopamina a través de la Membrana Plasmática/metabolismo , Trastornos del Movimiento/diagnóstico por imagen , Trastornos del Movimiento/metabolismo , Guías de Práctica Clínica como Asunto , Sociedades Médicas , Tomografía Computarizada de Emisión de Fotón Único/métodos , Cuerpo Estriado/diagnóstico por imagen , Cuerpo Estriado/metabolismo , Humanos , Trastornos Parkinsonianos/diagnósticoRESUMEN
Three months after deceased donor kidney transplant, a patient who presented with proteinuric renal dysfunction and fever of undetermined origin was found to have BK viruria by quantitative polymerase chain reaction analysis. An ¹¹¹In leukocyte scan showed increased renal transplant uptake consistent with nephritis and linear uptake in the knee. Venous duplex ultrasound revealed acute occlusive thrombosis in the superficial right lesser saphenous vein in the area of increased radiolabeled leukocyte uptake. This ¹¹¹In leukocyte scan performed for fever of undetermined origin demonstrated findings of BK nephritis in a renal transplant patient and associated acute venous thrombosis related to leukocyte colonization.
Asunto(s)
Radioisótopos de Indio , Trasplante de Riñón , Riñón/diagnóstico por imagen , Nefritis/diagnóstico por imagen , Infecciones por Polyomavirus/diagnóstico por imagen , Vena Safena/diagnóstico por imagen , Infecciones Tumorales por Virus/diagnóstico por imagen , Trombosis de la Vena/diagnóstico por imagen , Anciano , Virus BK , Diagnóstico por Imagen , Femenino , Humanos , Leucocitos , Nefritis/complicaciones , Infecciones por Polyomavirus/complicaciones , Cintigrafía , Infecciones Tumorales por Virus/complicaciones , Ultrasonografía , Trombosis de la Vena/complicacionesRESUMEN
Cutaneous metastases of primary internal malignancies are rare, with an incidence of 0.7% to 10.4%. Cutaneous manifestations due to breast cancer are the most common metastases dermatologists observe, with a prevalence of 2.4% and an incidence of 23.9%. Presence of cutaneous metastases is usually a late event in disease progression, indicating grave prognosis. Recognition of cutaneous breast cancer metastases significantly alters therapeutic plans, especially when the disease was thought to be successfully cured. F-FDG PET CT imaging can detect cutaneous metastasis and sites of distant metastases and monitor response to therapy. We report 3 patients with cutaneous-predominant breast carcinoma seen by FDG PET/CT.
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Neoplasias de la Mama/diagnóstico por imagen , Carcinoma/diagnóstico por imagen , Tomografía de Emisión de Positrones , Neoplasias Cutáneas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Anciano , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/patología , Carcinoma/patología , Femenino , Fluorodesoxiglucosa F18 , Humanos , Persona de Mediana Edad , Imagen Multimodal , Radiofármacos , Neoplasias Cutáneas/secundarioAsunto(s)
Criptococosis/diagnóstico , Fluorodesoxiglucosa F18/uso terapéutico , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico , Neumonía/diagnóstico , Tomografía de Emisión de Positrones/métodos , Radiofármacos , Rabdomiosarcoma/diagnóstico por imagen , Rabdomiosarcoma/diagnóstico , Tomografía Computarizada por Rayos X/métodos , Niño , Diagnóstico Diferencial , Humanos , Masculino , Metástasis de la Neoplasia , Neumonía/microbiologíaRESUMEN
We retrospectively compared the seizure focus-localizing capability of interictal PET/CT to that of interictal magnetic resonance diffusion-weighted imaging and ictal SPECT in 21 patient candidate for neurosurgery with temporal lobe epilepsy (TLE) by assessing overall lateralizing ability of these modalities and concordance of findings on these studies with results of electroencephalography (EEG). PET/CT demonstrated the greatest lateralizing ability of any of the imaging modalities and had the highest concordance rate for lateralization with EEG, highlighting its increasing diagnostic utility in the preoperative imaging workup of patients with medically intractable TLE.
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Diagnóstico por Imagen , Epilepsia del Lóbulo Temporal/diagnóstico , Epilepsia del Lóbulo Temporal/patología , Periodo Preoperatorio , Convulsiones/diagnóstico , Convulsiones/patología , Epilepsia del Lóbulo Temporal/cirugía , Femenino , Humanos , Convulsiones/cirugía , Adulto JovenRESUMEN
Radiological techniques are important in evaluating patients with gastrointestinal bleeding. Scintigraphic, computed tomographic angiographic, and enterographic techniques are sensitive tools in identifying the source of bleeding and may be useful in identifying patients likely to have a benign course and in selecting patients for therapeutic intervention. Angiography plays a key role in bleeding localization, and modern embolization techniques make this a viable therapeutic option. With the refining developments in body imaging and related reconstructive techniques, it is likely that radiological interventions will play an expanding and critical role in evaluating patients with gastrointestinal hemorrhage in the future.
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Hemorragia Gastrointestinal/diagnóstico , Angiografía , Animales , Embolización Terapéutica , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Humanos , Intestinos/diagnóstico por imagen , Imagen por Resonancia Magnética , Arterias Mesentéricas/diagnóstico por imagen , Cintigrafía , Radiofármacos , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos XAsunto(s)
Fibroma/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Hemangiopericitoma/diagnóstico por imagen , Tomografía de Emisión de Positrones/métodos , Enfermedades Raras/diagnóstico por imagen , Sarcoma/diagnóstico por imagen , Femenino , Fibroma/diagnóstico , Hemangiopericitoma/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Radiofármacos , Sarcoma/diagnósticoRESUMEN
OBJECTIVES/HYPOTHESIS: Planned neck dissection following chemoradiation (CR) has been advocated in patients with head and neck squamous cell cancer (HNSCC) with advanced nodal disease and a clinical complete response to CR because of the potential for residual occult nodal disease. The utility of positron-emission tomography/computed tomography (PET-CT) in identifying occult nodal disease in this scenario is controversial. METHODS: The medical records of all patients treated with CR for advanced HNSCC with N2 or N3 disease from December 2003 to June 2007 were reviewed. Patients with a complete clinical response were included if PET-CT performed 8 to 11 weeks after CR showed no distant disease and they underwent planned neck dissection. RESULTS: Thirty-two patients met study criteria. PET-CT was positive for residual nodal disease in 20 patients (63%). Pathology revealed carcinoma in 10 patients (31%): six of 20 patients with positive PET-CT scans (30%) and four of 12 patients with negative PET-CT scans (33%). The sensitivity and specificity of PET-CT was 60% and 36%. Regional recurrence developed in two patients (6%) who were not successfully salvaged. CONCLUSIONS: PET-CT performed 8 to 11 weeks after CR does not reliably predict the need for planned post-treatment neck dissection in patients with a complete clinical response following CR. Regional recurrence rates are comparable to those reported for patients observed with PET-CT, suggesting no advantage for planned neck dissection, and salvage rates were poor. These data suggest that delaying the timing of PET-CT, with surgery reserved for positive findings, is a reasonable alternative to planned neck dissection to avoid unnecessary surgery.
Asunto(s)
Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/terapia , Disección del Cuello , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Adulto , Anciano , Carcinoma de Células Escamosas/tratamiento farmacológico , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirugía , Femenino , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Neoplasias de Cabeza y Cuello/radioterapia , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Estadificación de NeoplasiasRESUMEN
OBJECTIVES: To investigate the utility of positron-emission tomography/computed tomography (PET-CT) in identifying distant metastatic disease in patients with suspected recurrent head and neck squamous cell cancer (HNSCC). STUDY DESIGN: Retrospective analysis. METHODS: Retrospective analysis of 64 consecutive patients with suspected recurrent HNSCC following definitive treatment who underwent PET-CT imaging were eligible for inclusion. Patients with previous known distant metastatic disease were excluded. RESULTS: The majority of patients (81%) had TNM stage III or IV disease. PET-CT was suspicious for pulmonary malignancy in 14 patients (22%) and indeterminate in 6 patients (9%). Pulmonary metastases or a new lung primary were present in 10 patients (16%): 7 of 14 patients with positive PET-CT scans (50%) and 3 of 50 patients with negative or indeterminate PET-CT scans (6%). Including nonpulmonary sites, the overall incidence of distant disease was 23% (15/64) with 20% (13/64) unsuspected prior to PET-CT. The sensitivity and specificity of PET-CT in predicting distant malignancy was 86% and 84%, respectively, with a positive predictive value of 60% and a negative predictive value of 95%. There was a significant correlation between standardized uptake value (SUV) on PET-CT and positive histology, with a mean SUV of 8.5 (range, 4.7-16.2) in patients with distant metastases compared with a mean SUV of 2.9 (range, 1.9-4.2) in patients with benign pathology (r = 0.87, P < .0001). CONCLUSIONS: A significant number of patients with recurrent HNSCC have distant metastases at the time of recurrence. These data suggest that PET-CT improves detection of metastatic disease in the high-risk patient and should be performed as part of the routine evaluation of patients with suspected recurrence prior to salvage surgery.
Asunto(s)
Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/secundario , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/secundario , Adulto , Anciano , Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/cirugía , Quimioterapia Adyuvante , Femenino , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Incidencia , Neoplasias Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico por imagen , Tomografía de Emisión de Positrones , Cuidados Preoperatorios , Radioterapia Adyuvante , Estudios Retrospectivos , Terapia Recuperativa , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: On occasion, patients followed with positron emission tomographic (PET)/computed tomographic (CT) imaging for nonbreast malignancies will have incidental breast findings concerning for second primary breast cancers. The aim of this study was to determine the predictive value of PET/CT imaging to identify breast cancers in these patients. METHODS: Patients with primary nonbreast malignancies and findings concerning for second primary breast cancers were identified from a prospectively acquired nuclear medicine database from January 2005 to July 2008. Chart reviews were then performed. RESULTS: Nine hundred two women underwent PET/CT imaging to evaluate nonbreast malignancies. Nine women (1%) had concerning breast findings, and 5 (56%) had subsequent breast cancer diagnoses. The positive predictive value of PET/CT imaging in these patients was 63%. Evidence of compliance with current screening guidelines was present in only 22% of these patients. CONCLUSIONS: The data suggest that findings concerning for an additional primary breast cancer should be evaluated and that age-appropriate screening tools should not be abandoned.