RESUMEN
Besides well-known physiologic uptake of Ga-DOTATATE in spleen, pituitary gland, pancreatic head, adrenals, kidney, and urinary bladder, sometimes unusual areas of uptake are found. We report a case of a 53-year-old woman who had vague pain in abdomen for which abdominal CT was done showing a contrast-enhancing lesion in the pancreatic tail. It was suspected to be of neuroendocrine origin and Ga-DOTATATE PET/CT showed a corresponding focal uptake. Spleen-preserving pancreatic tail resection was performed. Pathology revealed the diagnosis of an accessory intrapancreatic spleen (AIPS).
Asunto(s)
Tumores Neuroendocrinos/diagnóstico por imagen , Compuestos Organometálicos , Páncreas/diagnóstico por imagen , Tomografía de Emisión de Positrones , Bazo/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Femenino , Humanos , Persona de Mediana Edad , Imagen Multimodal , Páncreas/anomalías , Radiofármacos , Bazo/anomalíasRESUMEN
PURPOSE: This study aims to compare the use of 18F-FDG-PET/CT, CT, brain MRI, and tumormarker S-100B in chemotherapy response assessment of stage IV melanoma patients. METHODS: In 25 patients with stage IV melanoma, FDG-PET/CT and S-100B after 2-3 months (three cycles) of chemotherapy was compared with baseline PET/CT and baseline S-100B. Retrospectively, the response was correlated with the outcome. In patients with clinical suspicion for brain metastases, MRI or CCT was performed. RESULTS: There was agreement between FDG-PET/CT and CT regarding response to chemotherapy in all patients. There was a clear trend to a longer OS of PET/CT responders (n=10) compared with PET/CT non-responders (n=15; p=0.072) with remarkably better 1-year OS of 80% compared to 40% (p=0.048). There was a significant longer PFS of PET/CT responders compared with PET/CT non-responders (p=0.002). S-100B was normal at baseline in eight of 22 patients where it was available. Chemotherapy response assessment with S-100B failed to show correlation with OS or PFS. Eleven patients developed brain metastases during treatment, first detected by PET/CT in two and by MRI or CCT in nine of 11 patients. Appearance of brain metastases was associated with a poor survival. CONCLUSIONS: 18F-FDG-PET/CT and CT alone are equally suitable for chemotherapy response assessment in melanoma patients and clearly superior to S-100B. PET/CT responders have better early survival, but this is shortlived due to late therapy failure--often with brain recurrence. Additional brain MRI for therapy response assessment in such high-risk patients is mandatory to detect brain metastases missed by PET/CT.
Asunto(s)
Antineoplásicos/uso terapéutico , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Fluorodesoxiglucosa F18 , Imagen por Resonancia Magnética/métodos , Melanoma , Factores de Crecimiento Nervioso/sangre , Tomografía de Emisión de Positrones/métodos , Proteínas S100/sangre , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/sangre , Humanos , Melanoma/sangre , Melanoma/diagnóstico , Melanoma/tratamiento farmacológico , Melanoma/secundario , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud/métodos , Pronóstico , Radiofármacos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Subunidad beta de la Proteína de Unión al Calcio S100 , Sensibilidad y Especificidad , Técnica de Sustracción , Análisis de Supervivencia , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
UNLABELLED: (18)F-FDG PET/CT has gained wide acceptance for evaluation of recurrent colorectal carcinoma. However in clinical practice, contrast-enhanced CT (ceCT) is still the first-line restaging tool. The aim of this study was to investigate the value of contrast-enhanced PET/CT (cePET/CT) as a first-line restaging tool with a special focus on the importance of the use of intravenous contrast. METHODS: Fifty-four patients (17 women, 37 men; mean age, 60.3 y), referred for restaging of colorectal carcinoma, were examined with cePET/CT. Retrospective analysis was performed by 2 experienced readers by consensus: first, ceCT alone; second, non-cePET/CT; and third, cePET/CT. The number, localization, and diagnostic certainty of lesions were evaluated. Additionally, the therapeutic impact of the findings was determined. In 29 patients, histology, clinical imaging, and clinical follow-up served as the reference standard. In 25 patients, clinical follow-up and imaging served as the reference standard. RESULTS: Overall, non-cePET/CT delivered correct additional information to the ceCT findings in 27 of 54 patients (50%). This occurred in (a) 20 of 30 patients, where ceCT was found to be inconclusive, and in (b) 7 of 24 patients with conclusive ceCT findings, where non-cePET/CT found additional lesions, leading to a therapy modification in 5 patients. Compared with non-cePET/CT, cePET/CT revealed additional information in 39 of 54 patients (72%), with therapeutic relevance in 23 patients. This large number was primarily due to correct segmental localization of liver metastases, which is crucial for surgical therapy planning. CONCLUSION: On the basis of its higher accuracy and therapeutic impact compared with ceCT, our data suggest that cePET/CT might be considered as the first-line diagnostic tool for restaging in patients with colorectal cancer.