RESUMEN
INTRODUCCIÓN: Nuestro objetivo fue evaluar los cambios metabólicos corticales y el resultado clínico en los pacientes afectados por la hidrocefalia idiopática de presión normal (iNPH) después de la colocación de una derivación ventriculoperitoneal (VP). MATERIALES Y MÉTODOS: Diez pacientes afectados por la sospecha de iNPH se sometieron a una evaluación de la hidrodinámica del LCR basada en una prueba de infusión lumbar. El principal criterio de selección para la cirugía se basó en la elasticidad intracraneal (EI)>0,30. Todos los sujetos con una EI> 0,30 se sometieron a una exploración PET con 18 fluorodesoxiglucosa (18F-FDG) en la línea de base (PET1) y un mes después de la cirugía (PET2). Además, los mismos pacientes fueron sometidos a una evaluación clínica antes y un mes después de la cirugía mediante pruebas neuropsicológicas y análisis de la marcha. RESULTADOS: Se realizó un número total de 20 exploraciones de PET 18F-FDG en todos los pacientes reclutados. En comparación con la PET1, la PET2 mostró un aumento en el consumo de glucosa en el lóbulo frontal izquierdo y el lóbulo parietal izquierdo en la PET2 en comparación con la PET1 (p < 0,001). Todos los pacientes reclutados presentaron un aumento significativo en las puntuaciones neuropsicológicas (i.e. Batería de evaluación frontal y Evaluación cognitiva de Montreal) y han mejorado clínicamente en el análisis de la marcha. Se encontró una correlación significativa entre el aumento del consumo de glucosa cortical en el área parietal izquierda y la mejoría cognitiva detectable por la evaluación neuropsicológica. CONCLUSIONES: La mejora en 18F-FDG PET del metabolismo de la glucosa podría considerarse un marcador de imagen útil para la evaluación de la respuesta de la iNPH a la derivación ventriculoperitoneal
INTRODUCTION: Our objective was to evaluate the cortical metabolic changes and clinical outcome in patients affected by idiopathic normal pressure hydrocephalus (iNPH) after a placement of ventriculoperitoneal (VP) shunt. MATERIALS AND METHODS: 10 patients affected by suspected iNPH underwent a CSF hydrodynamics evaluation based on a lumbar infusion test (LIT). The main selection criterion for surgery was based on intracranial elasticity (IE)>0.30. All subjects with an IE>0.30 underwent a PET scan with 18 fluorodeoxiglucose (18F-FDG) at baseline (PET1) and 1 month after surgery (PET2). Furthermore, the same patients were submitted to clinical evaluation before and 1 month after surgery through neuropsychological tests and gait analysis. RESULTS: An overall number of 20 18F-FDG PET scans were performed in all the enrolled patients. As compared to PET1, PET2 showed an increase in glucose consumption in the left frontal and left parietal lobe in PET2 as compared to PET1 (P<.001). All the enrolled patients presented a significant increase in neuropsychological scores (i.e Frontal Assessment Battery and Montreal Cognitive Assessment) and have clinically improved at gait analysis. A significant correlation was found between the increase of cortical glucose consumption in the left parietal area and the cognitive improvement as detectable by neuropsychological assessment. CONCLUSIONS: Improvement in 18F FDG PET glucose metabolism could be considered a useful imaging marker for the assessment of iNPH response to VP shunting
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Hidrocéfalo Normotenso/cirugía , Derivación Ventriculoperitoneal/métodos , Análisis de la Marcha , Complejo Nuclear Corticomedial/diagnóstico por imagen , Complejo Nuclear Corticomedial/metabolismo , Tomografía de Emisión de Positrones , Resultado del Tratamiento , Pruebas Neuropsicológicas , Estudios RetrospectivosRESUMEN
An early identification of non-responders in oncology is of crucial importance to rapidly switch treatment regimens. Here we report a positron emission tomography, (PET)-guided switch from immunotherapy to targeted therapy in a patient affected by metastatic melanoma. We describe the case of a 78-years-old male patient diagnosed with nodular melanoma, submitted to baseline PET/CT with 18fluorodeoxyglucose (18F-FDG) that showed cutaneous and skeletal metastases (stage IV). The patients started immunotherapy with pembrolizumab. A PET/CT performed 3 months after the start of immunotherapy demonstrated progressive metabolic disease both at skeletal and cutaneous level, confirmed also by the biopsy. As patients resulted positive for BRAF V600k mutation, treatment regimen was rapidly switched to combined anti-BRAF/MEK targeted therapy. The PET/CT performed 3 months later, showed almost complete metabolic response. Ten months after the beginning of targeted therapy, the patient continues to present a durable metabolic response. PET/CT with 18F-FDG may help in monitoring the response to treatment in metastatic melanoma thus defining personalized therapeutic pathways.
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Anticuerpos Monoclonales Humanizados/uso terapéutico , Antineoplásicos Inmunológicos/uso terapéutico , Antineoplásicos/uso terapéutico , Inmunoterapia , Melanoma/terapia , Neoplasias Cutáneas/terapia , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica , Humanos , Imidazoles/uso terapéutico , Inmunoterapia/métodos , Masculino , Oximas/uso terapéutico , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Tomografía de Emisión de Positrones , Inhibidores de Proteínas Quinasas/uso terapéutico , Piridonas/uso terapéutico , Pirimidinonas/uso terapéutico , Resultado del Tratamiento , Melanoma Cutáneo MalignoRESUMEN
INTRODUCTION: Our objective was to evaluate the cortical metabolic changes and clinical outcome in patients affected by idiopathic normal pressure hydrocephalus (iNPH) after a placement of ventriculoperitoneal (VP) shunt. MATERIALS AND METHODS: 10 patients affected by suspected iNPH underwent a CSF hydrodynamics evaluation based on a lumbar infusion test (LIT). The main selection criterion for surgery was based on intracranial elasticity (IE)>0.30. All subjects with an IE>0.30 underwent a PET scan with 18 fluorodeoxiglucose (18F-FDG) at baseline (PET1) and 1 month after surgery (PET2). Furthermore, the same patients were submitted to clinical evaluation before and 1 month after surgery through neuropsychological tests and gait analysis. RESULTS: An overall number of 20 18F-FDG PET scans were performed in all the enrolled patients. As compared to PET1, PET2 showed an increase in glucose consumption in the left frontal and left parietal lobe in PET2 as compared to PET1 (P<.001). All the enrolled patients presented a significant increase in neuropsychological scores (i.e Frontal Assessment Battery and Montreal Cognitive Assessment) and have clinically improved at gait analysis. A significant correlation was found between the increase of cortical glucose consumption in the left parietal area and the cognitive improvement as detectable by neuropsychological assessment. CONCLUSIONS: Improvement in 18F FDG PET glucose metabolism could be considered a useful imaging marker for the assessment of iNPH response to VP shunting.
Asunto(s)
Corteza Cerebral/metabolismo , Hidrocéfalo Normotenso/cirugía , Tomografía Computarizada por Tomografía de Emisión de Positrones , Derivación Ventriculoperitoneal , Anciano , Corteza Cerebral/diagnóstico por imagen , Trastornos del Conocimiento/etiología , Femenino , Radioisótopos de Flúor , Fluorodesoxiglucosa F18 , Trastornos Neurológicos de la Marcha/etiología , Humanos , Hidrocéfalo Normotenso/complicaciones , Hidrocéfalo Normotenso/diagnóstico por imagen , Hidrocéfalo Normotenso/metabolismo , Masculino , Periodo Posoperatorio , Radiofármacos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
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Humanos , Masculino , Persona de Mediana Edad , Cicatriz/diagnóstico por imagen , Lesiones Cardíacas/diagnóstico por imagen , Arritmia Sinusal/diagnóstico por imagen , Ventriculografía con Radionúclidos/métodos , Miocitos Cardíacos , Electrocardiografía/métodos , Tomografía Computarizada de Emisión de Fotón Único/métodos , Espectroscopía de Resonancia Magnética/métodosAsunto(s)
3-Yodobencilguanidina , Arritmias Cardíacas/etiología , Cicatriz/complicaciones , Cicatriz/diagnóstico por imagen , Corazón/diagnóstico por imagen , Imagen por Resonancia Magnética , Imagen Multimodal , Miocardio/patología , Radiofármacos , Tomografía Computarizada de Emisión de Fotón Único , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Tomografía Computarizada de Emisión de Fotón Único/métodosRESUMEN
OBJECTIVES: Metastatic breast cancer is a heterogeneous disease, commonly affecting the liver. We report our experience with (90)Y radioembolisation (RE) and its effects on the survival of patients with treatment-refractory breast cancer liver metastases. METHODS: A total of 77 female patients affected by breast cancer were accepted into our department for RE. Inclusion criteria were inoperable and chemotherapy-refractory hepatic metastases, acceptable performance status, sufficient residual liver, no significant hepato-pulmonary shunts. Patients were divided in two groups: group 1 (29 patients) included those with Eastern Cooperative Oncology Group (ECOG) score 0, liver involvement (0-25 %) and no extrahepatic disease (EHD); group 2 (23 patient) included patients with ECOG score 1-2, liver involvement (26-50 %) and evidence of EHD. RESULTS: A total of 25 patients were considered ineligible. The median age of the remaining 52 patients was 57.5 years. The median overall survival was 11.5 months and better in those whose performance status and liver function were preserved (14.3 versus 8.2 months). According to Response Evaluation Criteria in Solid Tumor (RECIST), partial response (PR) was achieved in 29 patients (56 %), stable disease (SD) was achieved in a further 18 patients (35 %) and 5 patients showed progressive disease (PD) (10 %). DISCUSSION: (90)Y RE is effective in the treatment of liver metastases from breast cancer. We demonstrated a relevant survival and encouragingly high response rate in patients with treatment-refractory disease.
Asunto(s)
Neoplasias de la Mama/patología , Quimioembolización Terapéutica/métodos , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/secundario , Radioisótopos de Itrio/uso terapéutico , Progresión de la Enfermedad , Femenino , Humanos , Pruebas de Función Hepática , Microesferas , Persona de Mediana Edad , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND: A variety of human tumours, including non-small cell lung cancer, overexpress epithelial growth factor (EGF) receptors. In this study we evaluated the feasibility of immunoscintigraphy with a technetium-99m-labelled monoclonal antibody directed towards the EGF receptor (MINT5). MATERIALS AND METHODS: The labelling with technetium-99m was performed using the glucoheptonate-iminothiolane method. Eight patients with non-small cell lung cancer were i.v. injected 740 MBq of MINT5. Neither side-effects, nor toxicity, nor HAMA response were observed. Each patient was submitted to total body planar images in anterior and posterior projections at 1-2 hours and at 4-6 hours after the injection. RESULTS: Uptake of MINT5 was mainly visible in liver, spleen and bone marrow; it proved stable in vivo. The primary lung cancer was imaged in 7 out of 8 patients and metastases were detected in 3 out of 3 cases. CONCLUSION: MINT5 is a safe and promising radiopharmaceutical for in vivo localization and biological characterization of non-small cell lung cancer.