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BACKGROUND: Although 18F- FDG PET/CT is validated in baseline workup of esophageal cancer to detect distant metastases, it remains underused in assessing local staging and biology of the primary tumor. This study aimed to evaluate the association between 18F- FDG PET/CT-derived parameters of esophageal cancer, and its clinico-pathological features and prognosis. METHODS: All patients (n = 86) with esophageal adenocarcinoma or squamous cell cancer operated between 2005 and 2014 were analyzed. Linear regression was used to identify clinico-pathologic features of esophageal cancer associated with the tumor's maximal Standardized Uptake Value (SUVmax), Total Lesion Glycolysis (TLG) and Metabolic Tumor Volume (MTV). ROC curve analysis was performed to precise the optimal cutoff of each variable associated with a locally advanced (cT3/4) status, long-term survival and recurrence. Kaplan Meier curves and Cox regression were used for survival analyses. RESULTS: High baseline SUVmax was associated with cT3/4 status and middle-third tumor location, TLG with a cT3/4 and cN+ status, whereas MTV only with active smoking. A cT3/4 status was significantly predicted by a SUVmax > 8.25 g/mL (p < 0.001), TLG > 41.7 (p < 0.001) and MTV > 10.70 cm3 (p < 0.01) whereas a SUVmax > 12.7 g/mL was associated with an early tumor recurrence and a poor disease-free survival (median 13 versus 56 months, p = 0.030), particularly in squamous cell cancer. CONCLUSIONS: Baseline 18F- FDG PET/CT has a high predictive value of preoperative cT stage, as its parameters SUVmax, TLG and MTV can predict a locally advanced tumor with high accuracy. A SUVmax > 12.7 g/mL may herald early tumor recurrence and poor disease-free survival.
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Adenocarcinoma/patología , Carcinoma de Células Escamosas/patología , Neoplasias Esofágicas/patología , Fluorodesoxiglucosa F18/administración & dosificación , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Radiofármacos/administración & dosificación , Adenocarcinoma/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/diagnóstico por imagen , Neoplasias Esofágicas/diagnóstico por imagen , Femenino , Glucólisis , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Interpretación de Imagen Radiográfica Asistida por Computador , Estudios Retrospectivos , Sensibilidad y Especificidad , Análisis de SupervivenciaRESUMEN
PURPOSE: To evaluate the efficacy and safety of percutaneous endovascular biopsy (PEB) in intravascular filling-defect lesions (IVLs) of the great vessels. MATERIAL AND METHODS: We retrospectively reviewed 19 patients (age 65 ± 12 years), 11 men and eight women, who underwent PEB for IVLs, between March 2004 and November 2014. All PEBs were performed for early diagnosis and/or characterization of the IVL, or in case of reasonable doubt about the IVL nature. Pre-intervention imaging work-up included CT, MRI and/or PET-CT. PEBs were obtained with a 7F biopsy forceps device. Clinical profile, procedure technical success and safety, and clinical success were evaluated. RESULTS: PEB was technically successful in all patients (mean of two samples per IVL). No intra- or post-procedural complications were reported. Histopathological analysis provided a diagnosis in all PEBs with a clinical success of 100%. Of the 19 IVLs, 14 were malignant (74%). The most frequent malignant lesion observed was leiomyosarcoma (29%). Benign lesions (26%) included three thrombi (pulmonary artery) and two myxomas. CONCLUSION: PEB is a safe and efficient procedure providing the most effective technique to obtain a tissue sample of high diagnostic quality, which serves to establish early diagnosis in patients with suspected malignant lesions. KEY POINTS: ⢠Intravascular filling-defect lesions are related to both benign conditions and malignant tumours. ⢠Endovascular biopsy is indicated in case of doubt about intravascular lesion nature. ⢠Percutaneous endovascular biopsy is a safe technique. ⢠Endovascular biopsy provides tissue samples leading to correct histopathological analysis. ⢠Percutaneous endovascular biopsy provides early diagnosis of malignant intravascular lesions.
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Neoplasias Vasculares/patología , Anciano , Anciano de 80 o más Años , Biopsia/métodos , Diagnóstico por Imagen/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiología Intervencionista/métodos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Neoplasias Vasculares/diagnóstico por imagenRESUMEN
PURPOSE: To compare the value of pretreatment functional and morphological imaging parameters for predicting survival in patients undergoing transarterial radioembolization using yttrium-90 (90Y-TARE) for unresectable hepatocellular carcinoma (uHCC). METHODS: We analysed data from 48 patients in our prospective database undergoing 90Y-TARE treatment for uHCC (31 resin, 17 glass). All patients underwent 18F-FDG PET/CT and morphological imaging (CT and MRI scans) as part of a pretherapeutic work-up. Patients did not receive any treatment between these imaging procedures and 90Y-TARE. Kaplan-Meier estimates of progression-free survival (PFS) and overall survival (OS) were used to assess the prognostic value of 18F-FDG PET/CT metabolic parameters, including SUVmax, tumour-to-liver (T/L) uptake ratio and SUVmean of healthy liver, and morphological data, including number and size of lesions, portal-venous infiltration (PVI). Relevant prognostic factors for HCC including Child-Pugh class, Barcelona Clinic Liver Cancer (BCLC) stage, tumour size, PVI and serum AFP level were compared with metabolic parameters in univariate and multivariate analyses. RESULTS: The median follow-up in living patients was 16.2 months (range 11.4-50.1 months). Relapse occurred in 34 patients (70.8%) at a median of 7.4 months (range 1.4-27.9 months) after 90Y-TARE, and relapse occurred in 24 of 34 patients (70.8%) who died from their disease at a median of 8.1 months (range 2.2-35.2 months). Significant prognostic markers for PFS were the mean and median lesion SUVmax (both P = 0.01; median PFS 10.2 vs. 7.4 months), and significant prognostic markers for OS were the first quarter (Q1) cut-off values for lesion SUVmax and T/L uptake ratio (both P = 0.02; median OS 30.9 vs. 9 months). The multivariate analysis confirmed that lesion SUVmax and T/L uptake ratio were independent negative predictors of PFS (hazard ratio, HR, 2.7, 95% CI 1.2-6.1, P = 0.02, for mean SUVmax; HR 2.6, 95% CI 1.1-5.9, P = 0.02, for median SUVmax:) and OS (HR 3.2, 95% CI 1-10.9, P = 0.04 for Q1 SUVmax; HR 3.7, 95% CI 1.1-12.2, P = 0.03, for Q1 T/L uptake ratio), respectively, when testing with either the BCLC staging system or serum AFP level. CONCLUSION: Lesion SUVmax and T/L uptake ratio as assessed by 18F-FDG PET/CT, but not morphological imaging, were predictive markers of survival in patients undergoing 90Y-TARE for uHCC.
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Arterias , Carcinoma Hepatocelular/radioterapia , Embolización Terapéutica , Fluorodesoxiglucosa F18 , Neoplasias Hepáticas/radioterapia , Tomografía Computarizada por Tomografía de Emisión de Positrones , Radioisótopos de Itrio/uso terapéutico , Anciano , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/cirugía , Supervivencia sin Enfermedad , Femenino , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Análisis de SupervivenciaRESUMEN
Early diagnosis of cardiac sarcoidosis remains difficult in the absence of specific symptoms. The evolution and prognosis of the disease are strongly correlated to an early and appropriate treatment. The multi-modality assessment based on cardiac MRI and positron emission tomography associated with computed tomography (PET/CT) has significantly improved the detection of cardiac sarcoidosis over the last two decades. These approaches appear as useful and suitable imaging strategy for the early diagnosis, the assessment of the disease extent as well as the management and therapeutic follow-up. This article is a didactic review on cardiac sarcoidosis, with a special focus on recent diagnostic and therapeutic modalities, prognosis and interest of imaging techniques.
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Imagen por Resonancia Magnética/métodos , Tomografía de Emisión de Positrones/métodos , Sarcoidosis/diagnóstico , Errores Diagnósticos , Diagnóstico Precoz , Humanos , Pronóstico , Sarcoidosis/fisiopatología , Sarcoidosis/terapia , Tomografía Computarizada por Rayos X/métodosRESUMEN
UNLABELLED: BACKROUND-AIMS: To determine long term outcomes, regarding recurrence and survival, in patients with HCC that achieved complete response after initial treatment with drug eluting beads (DEB) using DC Bead loaded with doxorubicin (DEB-DOX). METHODOLOGY: Forty-five patients with HCC, not suitable for curative treatments that exhibited complete response (EASL criteria) to initial DEB-DOX treatment were retrospectively analyzed after a median follow up period of 63 months. Child-Pugh class was A/B (62.2/37.8%) and mean lesion diameter 5.36 ± 1.1 cm. Lesion morphology was one dominant ≤5cm (53.3%), one dominant >5cm (31.1%) and multifocal (15.6%). RESULTS: At 5 years, overall survival was 62.2% and recurrence-free survival 8.9%. All deaths that occurred were related to tumor progression (31.1%) or complications of underlying liver disease (28.9%). Median time of initial recurrence from baseline treatment was 18 months (range 8-52). When recurrence occurred, a mean time interval between additional DEB-DOX procedures less than 9 months was correlated to a poorer prognosis (p=0.025). Multivariate analysis identified Child-Pugh class at baseline (p=0.048), combined therapy of recurrences with local ablation (p=0.03) and number of DEB-DOX procedures (p=0.037) as significant prognostic factors of 5-year survival. Lesion morphology displayed significance for recurrence-free survival (p=0.014). Child-Pugh class at baseline, additional local ablation, pattern of initial recurrence and initial sum of recurrent tumor diameters all displayed statistical significance for post-recurrence survival (median 40 months), with the first two variables maintaining statistical significance in multivariate analysis (p=0.015 and p=0.014 respectively). CONCLUSION: Initial complete response to DEB-DOX ensures a favorable prognosis. However, management of recurrent tumors, which occur frequently mostly as new lesions, and preservation of underlying liver function appear to play a key role in prolonging survival.
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Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica/métodos , Doxorrubicina/administración & dosificación , Neoplasias Hepáticas/terapia , Recurrencia Local de Neoplasia/epidemiología , Anciano , Carcinoma Hepatocelular/mortalidad , Femenino , Humanos , Neoplasias Hepáticas/mortalidad , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
BACKGROUND: The primary aims of this study were to compare in patients with esophageal or esophagogastric junction cancers the potential of 68Ga-NODAGA-RGD PET/CT with that of 18F-FDG PET/CT regarding tumoral uptake and distribution, as well as histopathologic examination. METHODS: Ten 68Ga-NODAGA-RGD and ten 18F-FDG PET/CT were performed in nine prospectively included participants (1 woman; aged 58 ± 8.4 y, range 40-69 y). Maximum SUV (SUVmax) and metabolic tumor volumes (MTV) were calculated. The Mann-Whitney U test and Spearman correlation analysis (ρ) were used. RESULTS: 68Ga-NODAGA-RGD PET/CT detected positive uptake in 10 primary sites (8 for primary tumors and 2 for local relapse suspicion), 6 lymph nodes and 3 skeletal sites. 18F-FDG PET/CT detected positive uptake in the same sites but also in 16 additional lymph nodes and 1 adrenal gland. On a lesion-based analysis, SUVmax of 18F-FDG was significantly higher than those of 68Ga-NODAGA-RGD (4.9 [3.7-11.3] vs. 3.2 [2.6-4.2] g/mL, p = 0.014). Only one participant showed a higher SUVmax in an osseous metastasis with 68Ga-NODAGA-RGD as compared to 18F-FDG (6.6 vs. 3.9 g/mL). Correlation analysis showed positive correlation between 18F-FDG and 68Ga-NODAGA-RGD PET parameters (ρ = 0.56, p = 0.012 for SUVmax, ρ = 0.78, p < 0.001 for lesion-to-background ratios and ρ = 0.58, p = 0.024 for MTV). We observed that 18F-FDG uptake was homogenous inside all the confirmed primary sites (n = 9). In contrast, 68Ga-NODAGA-RGD PET showed more heterogenous uptake in 6 out of the 9 confirmed primary sites (67%), seen mostly in the periphery of the tumor in 5 out of the 9 confirmed primary sites (56%), and showed slight extensions into perilesional structures in 5 out of the 9 confirmed primary sites (56%). CONCLUSIONS: In conclusion, 68Ga-NODAGA-RGD has lower potential in the detection of esophageal or esophagogastric junction malignancies compared to 18F-FDG. However, the results suggest that PET imaging of integrin αvß3 expression may provide complementary information and could aid in tumor diversity and delineation. TRIAL REGISTRATION: Trial registration: NCT02666547. Registered January 28, 2016-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02666547 .
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OBJECTIVE: To evaluate the efficacy of computed tomography (CT)-guided radiofrequency (RF) ablation for the treatment of osteoid osteomas in common and in technically challenging locations. MATERIALS AND METHODS: Twenty-three patients with osteoid osteomas in common (nine cases) and technically challenging [14 cases: intra-articular (n = 7), spinal (n = 5), metaphyseal (n = 2)] positions were treated with CT-guided RF ablation. Therapy was performed under conscious sedation with a seven-array expandable RF electrode for 8-10 min at 80-110 degrees C and power of 90-110 W. The patients went home under instruction. A brief pain inventory (BPI) score was calculated before and after (1 day, 4 weeks, 6 months and 1 year) treatment. RESULTS: All procedures were technically successful. Primary clinical success was 91.3% (21 of total 23 patients), despite the lesions' locations. BPI score was dramatically reduced after the procedure, and the decrease in BPI score was significant (P < 0.001, paired t-test; n-1 = 22) for all periods during follow up. Two patients had persistent pain after 1 month and were treated successfully with a second procedure (secondary success rate 100%). No immediate or delayed complications were observed. CONCLUSION: CT-guided RF ablation is safe and highly effective for treatment of osteoid osteomas, even in technically difficult positions.
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Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/cirugía , Ablación por Catéter/métodos , Osteoma Osteoide/diagnóstico por imagen , Osteoma Osteoide/cirugía , Cirugía Asistida por Computador/métodos , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto , Femenino , Humanos , Masculino , Resultado del Tratamiento , Ultrasonografía , Adulto JovenRESUMEN
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired stem cell disorder, with its primary clinical manifestations being hemolytic anemia, marrow failure and thrombophilia. Chronic hemolysis, failures of the fibrinolytic system, increased leukocyte-derived tissue factor levels in plasma, procoagulant microparticles generated through complement-mediated damage of platelets and venous endothelium are related to the acquired hypercoagulable state. Visceral thrombosis (including hepatic veins and mesenteric veins), cerebrovascular events and pulmonary embolism predict a poor outcome. Thrombosis is also associated with significant morbidity during pregnancy. Depending on the sites of thrombosis, a score-based probability to predict outcome can be assigned. Abdominal vein thromboses account for the majority of morbidity and mortality related to thrombosis, and time-dependent trends suggest that mortality rates tend to decline, with the advent of evolution of therapeutic and diagnostic strategies. In contrast, mortality rates from cerebrovascular events display no significant decline. Prompt diagnosis requires both clinical suspicion and sophisticated imaging techniques, along with multidisciplinary therapeutic intervention. In the eculizumab era, a significant reduction of thrombotic events was observed during therapy, and long-term follow up is needed to establish any benefit in rates and pattern of this complication. However, up to now, only bone marrow transplantation permanently abolishes the coagulation defect.
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Hemoglobinuria Paroxística/complicaciones , Trombosis/etiología , Anticoagulantes/uso terapéutico , Arteriopatías Oclusivas/etiología , Trasplante de Médula Ósea , Femenino , Hemoglobinuria Paroxística/patología , Hemoglobinuria Paroxística/terapia , Humanos , Embarazo , Complicaciones Cardiovasculares del Embarazo/etiología , Embolia Pulmonar/etiología , Terapia Trombolítica , Trombosis/patología , Trombosis/terapia , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares , Trombosis de la Vena/etiologíaRESUMEN
PURPOSE: To evaluate the efficacy and safety of computed tomography (CT)-guided radiofrequency thermal ablation (RFA) of liver tumors (hepatocellular carcinoma and liver metastases) > 3 mm in diameter that were in contact with blood vessels. MATERIALS AND METHODS: During a 3-year period RFA was performed in 28 patients (age range, 36-83 years; male/female ratio, 17:11) with liver tumors (primary and metastatic) that were in contact with blood vessels > 3 mm in diameter. Tumor diameter ranged from 1.7 to 5.1 cm. To evaluate the immediate response, dual-phase dynamic CT images were obtained after intravenous contrast material administration. Imaging follow-up was at 1, 3, 6, and 12 months post-RFA, and every year thereafter. RESULTS: All of 28 patients were treated with a total of 36 sessions. In 22 (79%) of the patients, complete ablation of the tumor was achieved. The remaining 6 (21%) patients showed irregular peripheral enhancement and underwent a second session. At 1-year follow-up 2 of the tumors showed a recurrent lesion and a new ablation was performed. The local tumor progression rate at 1-year follow-up was 8.7% and disease-free survival was achieved in 82.1% of the patients. Complications occurred in 4 patients (14.3%); 2 patients presented with a small sub-capsular hematoma, and 2 patients had a partial liver infarction. CONCLUSION: RFA is a safe and effective method, even with high-risk tumors adjacent to large blood vessels, which can lead to good results with minimal complications and a low rate of tumor progression.
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Carcinoma Hepatocelular/cirugía , Ablación por Catéter/métodos , Neoplasias Hepáticas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/patología , Ablación por Catéter/efectos adversos , Venas Hepáticas/diagnóstico por imagen , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/patología , Persona de Mediana Edad , Metástasis de la Neoplasia , Vena Porta/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Turquía , Vena Cava Inferior/diagnóstico por imagenRESUMEN
Acute lower gastrointestinal bleeding, is often a dramatic situation, associated with mortality rate up to 28%. Currently transcatheter alternatives have found their place in the therapeutic spectrum of this situation. An interesting question is when should this procedure be performed and which are the difficulties when performing it. We present the case of a 75-year old woman with acute massive lower gastrointestinal bleeding on the tenth post-operative day of a colic and partial ileal resection. Superselective angiography of the superior mesenteric artery was obtained that disclosed marked contrast extravasation of distal branches of the left colic artery as well as from a small branch feeding the distal enteric anastomoses. Clinical success was achieved after superselective embolization which was accomplished by using polyvinyl alcohol particles. The patient was discharged 5 days later and there were no procedure-related complications during 6-month follow-up period. So, especially in post-operative patients who are considered to be poor candidates for surgical treatment, arterial embolotherapy should be established not only as treatment option, but also as first line therapy for LGI bleeding.
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Embolización Terapéutica/métodos , Hemorragia Gastrointestinal/terapia , Alcohol Polivinílico/administración & dosificación , Enfermedad Aguda , Anciano , Anastomosis Quirúrgica/efectos adversos , Angiografía , Cateterismo , Embolización Terapéutica/instrumentación , Extravasación de Materiales Terapéuticos y Diagnósticos/terapia , Femenino , Estudios de Seguimiento , Hemorragia Gastrointestinal/diagnóstico por imagen , Hemorragia Gastrointestinal/etiología , Humanos , Arteria Mesentérica Superior/diagnóstico por imagen , Hemorragia Posoperatoria/terapia , Factores de TiempoRESUMEN
The aim of this study was to compare survival of patients treated for unresectable hepatocellular carcinoma (uHCC) with 90Y transarterial radioembolization (TARE) using pretreatment partition model dosimetry (PMD). Methods: We performed a retrospective analysis of prospectively collected data on 77 patients consecutively treated (mean age ± SD, 66.4 ± 12.2 y) for uHCC (36 uninodular, 5 multinodular, 36 diffuse) with 90Y TARE (41 resin, 36 glass) using pretreatment PMD. Study endpoints were progression-free survival (PFS) and overall survival (OS) assessed by Kaplan-Meier estimates. Several variables including Barcelona Clinic Liver Cancer (BCLC) staging system, tumor size, and serum α-fetoprotein (AFP) level were investigated using Cox proportional hazards regression. Results: The characteristics of 2 groups were comparable with regard to demographic data, comorbidities, Child-Pugh score, BCLC, serum AFP level, and 90Y global administered activity. The median follow-up time was 7.7 mo (range, 0.4-50.1 mo). Relapse occurred in 44 patients (57%) at a median of 6 mo (range, 0.4-27.9 mo) after 90Y TARE, and 41 patients (53%) died from tumor progression. Comparison between resin and glass microspheres revealed higher but not statistically significantly PFS and OS rates in the 90Y resin group than the 90Y glass group (resin PFS 6.1 mo [95% confidence interval CI, 4.7-7.4] and glass PFS 5 mo [95% CI, 0.9-9.2], P = 0.53; resin OS 7.7 mo [95% CI, 7.2-8.2] and glass OS 7 mo [95% CI 1.6-12.4], P = 0.77). No significant survival difference between both types of 90Y microspheres was observed in any subgroups of patients with early/intermediate or advanced BCLC stages. Among the variables investigated, Cox analyses showed that only in the glass group, the BCLC staging system and the serum AFP level were associated with PFS (P = 0.04) and OS (P = 0.04). Tumor size was a prognostic factor without significant influence on PFS and OS after 90Y TARE. Conclusion: Comparison between resin and glass microspheres revealed no significant survival difference in patients treated for uHCC with 90Y TARE using pretreatment PMD. Further, larger prospective studies are warranted to confirm these findings.
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Resinas Acrílicas/química , Carcinoma Hepatocelular/radioterapia , Embolización Terapéutica/métodos , Vidrio/química , Neoplasias Hepáticas/radioterapia , Microesferas , Radioisótopos de Itrio/uso terapéutico , Arterias , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/cirugía , Supervivencia sin Enfermedad , Femenino , Humanos , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Radiometría , Estudios RetrospectivosRESUMEN
BACKGROUND: For the past decade (18)F-fluoro-ethyl-l-tyrosine (FET) and (18)F-fluoro-deoxy-glucose (FDG) positron emission tomography (PET) have been used for the assessment of patients with brain tumor. However, direct comparison studies reported only limited numbers of patients. Our purpose was to compare the diagnostic performance of FET and FDG-PET. METHODS: We examined studies published between January 1995 and January 2015 in the PubMed database. To be included the study should: (i) use FET and FDG-PET for the assessment of patients with isolated brain lesion and (ii) use histology as the gold standard. Analysis was performed on a per patient basis. Study quality was assessed with STARD and QUADAS criteria. RESULTS: Five studies (119 patients) were included. For the diagnosis of brain tumor, FET-PET demonstrated a pooled sensitivity of 0.94 (95% CI: 0.79-0.98) and pooled specificity of 0.88 (95% CI: 0.37-0.99), with an area under the curve of 0.96 (95% CI: 0.94-0.97), a positive likelihood ratio (LR+) of 8.1 (95% CI: 0.8-80.6), and a negative likelihood ratio (LR-) of 0.07 (95% CI: 0.02-0.30), while FDG-PET demonstrated a sensitivity of 0.38 (95% CI: 0.27-0.50) and specificity of 0.86 (95% CI: 0.31-0.99), with an area under the curve of 0.40 (95% CI: 0.36-0.44), an LR+ of 2.7 (95% CI: 0.3-27.8), and an LR- of 0.72 (95% CI: 0.47-1.11). Target-to-background ratios of either FDG or FET, however, allow distinction between low- and high-grade gliomas (P > .11). CONCLUSIONS: For brain tumor diagnosis, FET-PET performed much better than FDG and should be preferred when assessing a new isolated brain tumor. For glioma grading, however, both tracers showed similar performances.
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Neoplasias Encefálicas/diagnóstico por imagen , Tomografía de Emisión de Positrones , Neoplasias Encefálicas/clasificación , Neoplasias Encefálicas/patología , Fluorodesoxiglucosa F18 , Glioma/diagnóstico por imagen , Glioma/patología , Humanos , Clasificación del Tumor , Tomografía de Emisión de Positrones/métodos , RadiofármacosRESUMEN
Ga-NODAGA-RGDyK(cyclic) and FDG PET/CT were performed in a 39-year-old man for the work-up of a moderately differentiated carcinoma of the gastro-esophageal junction within a clinical study protocol. Although FDG PET images showed intense, diffuse hypermetabolic lesion activity, NODAGA-RGDyK illustrated the neo-angiogenesis process with tracer uptake clearly localized in non-FDG-avid perilesional structures. Neo-angiogenesis is characterized by ανß3 integrin expression at the lesion surface of newly formed vessels. This case supports evidence that angiogenesis imaging might therefore be a crucial step in early disease identification and localization, metastatization potential, and in monitoring the efficacy of antiangiogenic therapies.
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Carcinoma/diagnóstico por imagen , Neoplasias Esofágicas/diagnóstico por imagen , Unión Esofagogástrica/diagnóstico por imagen , Neovascularización Patológica/diagnóstico por imagen , Adulto , Carcinoma/irrigación sanguínea , Complejos de Coordinación , Neoplasias Esofágicas/irrigación sanguínea , Unión Esofagogástrica/irrigación sanguínea , Fluorodesoxiglucosa F18 , Humanos , Masculino , Péptidos Cíclicos , Tomografía Computarizada por Tomografía de Emisión de Positrones , RadiofármacosRESUMEN
UNLABELLED: Respiratory motion negatively affects PET/CT image quality and quantitation. A novel Pulsatile-Flow Ventilation (PFV) system reducing respiratory motion was applied in spontaneously breathing patients to induce sustained apnea during PET/CT. METHODS: Four patients (aged 65 ± 14 y) underwent PET/CT for pulmonary nodule staging (mean, 11 ± 7 mm; range, 5-18 mm) at 63 ± 3 min after (18)F-FDG injection and then at 47 ± 7 min afterward, during PFV-induced apnea (with imaging lasting ≥8.5 min). Anterior-posterior thoracic amplitude, SUVmax, and SUVpeak (SUVmean in a 1-cm-diameter sphere) were compared. RESULTS: PFV PET/CT reduced thoracic amplitude (80%), increased mean lesion SUVmax (29%) and SUVpeak (11%), decreased lung background SUVpeak (25%), improved lesion detectability, and increased SUVpeak lesion-to-background ratio (54%). On linear regressions, SUVmax and SUVpeak significantly improved (by 35% and 23%, respectively; P ≤ 0.02). CONCLUSION: PFV-induced apnea reduces thoracic organ motion and increases lesion SUV, detectability, and delineation, thus potentially affecting patient management by improving diagnosis, prognostication, monitoring, and external-radiation therapy planning.
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Neoplasias Pulmonares/diagnóstico por imagen , Respiración Artificial , Mecánica Respiratoria , Anciano , Apnea/diagnóstico por imagen , Apnea/fisiopatología , Femenino , Fluorodesoxiglucosa F18 , Humanos , Procesamiento de Imagen Asistido por Computador , Pulmón/diagnóstico por imagen , Neoplasias Pulmonares/fisiopatología , Masculino , Persona de Mediana Edad , Movimiento (Física) , Tomografía de Emisión de Positrones , Valor Predictivo de las Pruebas , Radiofármacos , Nódulo Pulmonar Solitario/diagnóstico por imagenRESUMEN
This review discusses the current data on Hepasphere™ in the treatment of hepatocellular carcinoma. HepaSphere is a drug-loadable microsphere that can be bound with doxorubicin, epirubicin, cisplatin or oxaliplatin. In vitro and in vivo studies confirm lower systemic exposure to the drug and fewer systemic doxorubicin-related side effects. Studies suggest that this technique is better tolerated than conventional lipiodol-based chemoembolization (c-TACE). In intermediate and early stage hepatocellular carcinoma - nonresponsive to curative treatments - complete response and partial response rates range from 22.2 to 48% and 43.7 to 51%, respectively. Studies with survival as an end-point are needed and head-to-head comparisons with other drug-eluting beads are necessary.
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Carcinoma de Células de Merkel/diagnóstico por imagen , Neoplasias de la Parótida/diagnóstico por imagen , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carboplatino/administración & dosificación , Carcinoma de Células de Merkel/tratamiento farmacológico , Carcinoma de Células de Merkel/patología , Etopósido/administración & dosificación , Fluorodesoxiglucosa F18 , Humanos , Masculino , Estadificación de Neoplasias , Neoplasias de la Parótida/tratamiento farmacológico , Neoplasias de la Parótida/patología , Tomografía Computarizada por Tomografía de Emisión de Positrones , RadiofármacosRESUMEN
PURPOSE: To report the diffusion-weighted MRI findings in alveolar echinococcosis (AE) of the liver and evaluate the potential role of apparent diffusion coefficients (ADCs) in the characterisation of lesions. MATERIALS AND METHODS: We retrospectively included 22 patients with 63 AE liver lesions (≥1 cm), examined with 3-T liver MRI, including a free-breathing diffusion-weighted single-shot echo-planar imaging sequence (b-values=50, 300 and 600 s/mm(2)). Two radiologists jointly assessed the following lesion features: size, location, presence of cystic and/or solid components (according to Kodama's classification system), relative contrast enhancement, and calcifications (on CT). The ADC(total), ADC(min) and ADC(max) were measured in each lesion and the surrounding liver parenchyma. RESULTS: Three type 1, 19 type 2, 17 type 3, three type 4 and 21 type 5 lesions were identified. The mean (±SD) ADC(total), ADC(min) and ADC(max) for all lesions were 1.73 ± 0.50, 0.76 ± 0.38 and 2.63 ± 0.76 × 10(-3)mm(2)/s, respectively. The mean ADC(total) for type 1, type 2, type 3, type 4 and type 5 lesions were 1.97 ± 1.01, 1.76 ± 0.53, 1.73 ± 0.41, 1.15 ± 0.42 and 1.76 ± 0.44 × 10(-3)mm(2)/s, respectively. No significant differences were found between the five lesion types, except for type 4 (p=0.0363). There was a significant correlation between the presence of a solid component and low ADCmin (r=0.39, p=0.0016), whereas an inverse correlation was found between the relative contrast enhancement and ADCtotal (r=-0.34, p=0.0072). CONCLUSION: The ADCs of AE lesions are relatively low compared to other cystic liver lesions, which may help in the differential diagnosis. Although ADCs are of little use to distinguish between the five lesion types, their low value reflects the underlying solid component.
Asunto(s)
Imagen de Difusión por Resonancia Magnética/métodos , Equinococosis Hepática/patología , Interpretación de Imagen Asistida por Computador/métodos , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Adulto JovenRESUMEN
A 67-year-old woman was referred for staging of a mucosa-associated lymphoid tumor lymphoma involving the left conjunctiva. CT scan had shown paravertebral and pelvic masses, and a breast nodule. FDG PET/CT demonstrated moderately increased uptake in the left ocular conjunctiva and confirmed the paravertebral and pelvic masses and the breast nodule. Moreover, abnormal FDG uptake was shown in 2 breast nodules, the flank, the gluteus maximus, and the gastric cardia. The patient received 6 cycles of rituximab-bendamustine chemotherapy with a complete clinical and metabolic response at the 6-month follow-up PET/CT and remained relapse-free without visual acuity problem after a 36-month follow-up.
Asunto(s)
Neoplasias de la Conjuntiva/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Linfoma de Células B de la Zona Marginal/diagnóstico por imagen , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Anciano , Conjuntiva/diagnóstico por imagen , Conjuntiva/patología , Neoplasias de la Conjuntiva/patología , Femenino , Humanos , Linfoma de Células B de la Zona Marginal/patología , Imagen Multimodal , Estadificación de Neoplasias , Resultado del Tratamiento , Imagen de Cuerpo EnteroAsunto(s)
Hemoglobinuria Paroxística/complicaciones , Accidente Cerebrovascular/etiología , Trombosis/complicaciones , Adulto , Femenino , Hemoglobinuria Paroxística/diagnóstico por imagen , Hemoglobinuria Paroxística/mortalidad , Humanos , Imagen por Resonancia Magnética , Masculino , Pronóstico , Radiografía , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/mortalidad , Trombosis/diagnóstico por imagen , Trombosis/etiología , Trombosis/mortalidadRESUMEN
We present a case of a 70-year-old patient with hepatocellular carcinoma treated with RFA. The lesion was located in segment II under the ribs. During RFA pleural effusion is presented. After the procedure a dual phase CT revealed haemothorax and extravasation of the contrast medium from the intercostal vessels.