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1.
Medicine (Baltimore) ; 99(5): e19017, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000446

RESUMEN

O-(2-[F]fluoroethyl)-L-tyrosine positron-emission tomography/computed tomography (F-FET PET/CT) is well known in brain tumor management. Our study aimed to identify the prognostic value of F-FET PET/CT in high-grade gliomas (HGG) according the current 2016 World Health Organization (WHO) classification.Patients with histologically proven WHO 2016 HGG were prospectively included. A dynamic F-FET PET/CT was performed allowing to obtain 2 static PET frames (static frame 1: 20-40 minutes and static frame 2: 2-22 minutes). We analyzed static parameters (standard uptake value [SUV]max, SUVmean, SUVpeak, TBRmax, TBRmean, tumoral lesion glycolysis, and metabolic tumoral volume) for various isocontours (from 10% to 90%). PET parameters, clinical features, and molecular biomarkers were compared with progression-free survival (PFS) and overall survival (OS) in univariate and multivariate analysis.Twenty-nine patients were included (grade III n = 3, grade IV n = 26). Mean PFS and OS were, respectively, 8.8 and 13.9 months. According to univariate analysis, SUVmean, SUVpeak, TBRmax, and TBRmean were significantly correlated with OS. In static 1 analysis, TBRmax seemed to be the best OS prognostic parameter (P = .004). In static 2 analysis, TBRmean was the best parameter (P = .01). In static 1 analysis, only SUVpeak was significant (P = .05) for PFS. Good performance status (PS < 2; P < .0001) and extent of resection (P = .019) identified the subgroup of patients with the best OS. Only TBRmax (P = .026) and extent of resection (P = .025) remained significant parameters in multivariate analysis.Our data suggested that high TBRmax seemed to be the most significant OS independent prognostic factor in patients with newly diagnosed HGG.


Asunto(s)
Glioma/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Medios de Contraste , Femenino , Glioma/patología , Glioma/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Pronóstico , Estudios Prospectivos , Radiofármacos , Tasa de Supervivencia , Tirosina/análogos & derivados
2.
Clin Nucl Med ; 45(2): 127-128, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31876811

RESUMEN

Paclitaxel-ramucirumab chemotherapy is indicated in second line of metastatic gastroesophageal junction cancer (mGEJC) after progression under platinum-5-FU chemotherapy. Nevertheless, the reported common response after treatment is only partial within series. To date, only 1 case report of negative posttreatment FDG PET/CT was published without baseline examination from RAINBOW trial. We illustrated the interest of FDG PET/CT to evaluate treatment especially paclitaxel-ramucirumab with 2 examples of complete metabolic responses in 2 patients having different HER2 biomarker profiles of mGEJC. As illustrated, FDG PET/CT emerges as a useful approach for therapeutic assessment of targeted drugs in mGEJC.


Asunto(s)
Anticuerpos Monoclonales Humanizados/farmacología , Neoplasias Esofágicas/tratamiento farmacológico , Neoplasias Esofágicas/metabolismo , Unión Esofagogástrica/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Paclitaxel/farmacología , Tomografía Computarizada por Tomografía de Emisión de Positrones , Anticuerpos Monoclonales Humanizados/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/farmacología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Esofágicas/diagnóstico por imagen , Neoplasias Esofágicas/patología , Femenino , Humanos , Persona de Mediana Edad , Paclitaxel/uso terapéutico
3.
Medicine (Baltimore) ; 98(29): e16417, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31335691

RESUMEN

We aimed to assess serial F-FDG PET/CT imaging according to morphological (RECIST1.1, iRECIST) and functional (PERCIST, PECRIT) criteria to predict clinical response to therapy in patients with advanced melanoma receiving immune checkpoint blocking agents.Retrospective data collection and analysis was done for 37 patients with unresectable metastatic cutaneous melanoma eligible for immunotherapy (cycles: 4 for ipilimumab and pembrolizumab/ 6 for nivolumab).F-FDG PET/CT imaging was performed prior to (F-FDG PET/CT 0) and 14 weeks after ICI onset (F-FDG PET/CT 1). Some cases during the follow-up required imaging (F-FDG PET/CT 2). Assessment of patient response to treatment was done according to RECIST1.1, iRECIST, PERCIST and PECRIT criteria.Among 37 assessed patients, 27 had 1 line of ICI, 8 had 2 lines of ICI and 2 patients had 3 lines of ICI: total of 49 PET/CTs. Mean time between initiation of ICI and F-FDG PET/CT (1 or 2) were respectively 13.82 ±â€Š4.32 and 24.73 ±â€Š9.53 weeks. Time between F-FDG PET/CT 1 and F-FDG PET/CT 2 was at mean +/- SD: 11.19w ±â€Š5.59. Median PFS was 29.62 months (range 22.52-36.71) (P = .001: RECIST 1.1), (P < .0001: iRECIST), (P = .000: PERCIST), (P = .072: PECRIT). Median OS was 36.62 months (30.46-42.78) (P = .005: RECIST 1.1), (P < .0001: iRECIST), (P = .001: PERCIST), (P = .082 PECRIT).F-FDG PET/CT could detect eventual ICI-response in patients with metastatic melanoma undergoing ICI using iRECIST and PERCIST criteria.


Asunto(s)
Anticuerpos Monoclonales Humanizados , Ipilimumab , Melanoma , Nivolumab , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Neoplasias Cutáneas , Tomografía Computarizada por Rayos X/métodos , Anciano , Anticuerpos Monoclonales Humanizados/administración & dosificación , Anticuerpos Monoclonales Humanizados/efectos adversos , Antineoplásicos Inmunológicos/administración & dosificación , Antineoplásicos Inmunológicos/efectos adversos , Protocolos Antineoplásicos , Femenino , Fluorodesoxiglucosa F18/farmacología , Humanos , Ipilimumab/administración & dosificación , Ipilimumab/efectos adversos , Masculino , Melanoma/diagnóstico , Melanoma/tratamiento farmacológico , Melanoma/patología , Estadificación de Neoplasias , Nivolumab/administración & dosificación , Nivolumab/efectos adversos , Valor Predictivo de las Pruebas , Pronóstico , Radiofármacos/farmacología , Reproducibilidad de los Resultados , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/patología
4.
Clin Nucl Med ; 44(1): e22-e23, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30540599

RESUMEN

F-fluoroethyltyrosine (FET) is a well-established PET tracer for the imaging of cerebral gliomas. Recent studies reported interest in meningiomas. A study published by Cornelius et al concludes that FET PET may provide additional information for noninvasive grading of meningiomas. Indeed, the combination of tumor background ratio with a cutoff value of 2.3 associated with time activity curve pattern slightly improved the differentiation of high-grade from low-grade meningiomas (accuracy, 92%; P = 0.001). We present the case of a 75-year-old man that underlined the need to confirm the performance of these tools (curve pattern, tumor background ratios) to characterize meningiomas.


Asunto(s)
Neoplasias Meníngeas/metabolismo , Meningioma/metabolismo , Tirosina/análogos & derivados , Anciano , Transporte Biológico , Glioma/patología , Humanos , Cinética , Masculino , Neoplasias Meníngeas/diagnóstico por imagen , Meningioma/diagnóstico por imagen , Tomografía de Emisión de Positrones , Trazadores Radiactivos , Tirosina/metabolismo
5.
Ann Nucl Med ; 33(1): 47-54, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30219990

RESUMEN

AIM: 18F-Choline (FCH) uptake parameters are strong indicators of aggressive disease in prostate cancer. Functional parameters derived by magnetic resonance imaging (MRI) are also correlated to aggressive disease. The aim of this work was to evaluate the relationship between metabolic parameters derived by FCH PET/CT and functional parameters derived by MRI. MATERIALS AND METHODS: Fourteen patients with proven prostate cancer who underwent FCH PET/CT and multiparametric MRI were enrolled. FCH PET/CT consisted in a dual phase: early pelvic list-mode acquisition and late whole-body acquisition. FCH PET/CT and multiparametric MRI examinations were registered and tumoral volume-of-interest were drawn on the largest lesion visualized on the apparent diffusion coefficient (ADC) map and projected onto the different multiparametric MR images and FCH PET/CT images. Concerning the FCH uptake, kinetic parameters were extracted with the best model selected using the Akaike information criterion between the one- and two-tissue compartment models with an imaging-derived plasma input function. Other FCH uptake parameters (early SUVmean and late SUVmean) were extracted. Concerning functional parameters derived by MRI scan, cell density (ADC from diffusion weighting imaging) and vessel permeability (Ktrans and Ve using the Tofts pharmakinetic model from dynamic contrast-enhanced imaging) parameters were extracted. Spearman's correlation coefficients were calculated to compare parameters. RESULTS: The one-tissue compartment model for kinetic analysis of PET images was selected. Concerning correlation analysis between PET parameters, K1 was highly correlated with early SUVmean (r = 0.83, p < 0.001) and moderately correlated with late SUVmean (r = 0.66, p = 0.010) and early SUVmean was highly correlated with late SUVmean (r = 0.90, p < 0.001). No significant correlation was found between functional MRI parameters. Concerning correlation analysis between PET and functional MRI parameters, K1 (from FCH PET/CT imaging) was moderately correlated with Ktrans (from perfusion MR imaging) (r = 0.55, p = 0.041). CONCLUSIONS: No significant correlation was found between FCH PET/CT and multiparametric MRI metrics except FCH influx which is moderately linked to the vessel permeability in prostate cancer.


Asunto(s)
Colina , Radioisótopos de Flúor , Imagen por Resonancia Magnética , Tomografía Computarizada por Tomografía de Emisión de Positrones , Neoplasias de la Próstata/diagnóstico por imagen , Anciano , Humanos , Procesamiento de Imagen Asistida por Computador , Cinética , Masculino , Persona de Mediana Edad
6.
Medicine (Baltimore) ; 97(35): e11943, 2018 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30170388

RESUMEN

The aim of the study was to evaluate the interest of quantitative bone SPECT-CT in the preoperative assessment of knee osteoarthritis (OA) before unicompartmental knee arthroplasty (UKA).Patients eligible for UKA were prospectively included in 2 centers and underwent a preoperative SPECT-CT. Images were reconstructed with an OSEM, an OSCGM (allowing SUV quantification) and an enhanced OSCGM (containing uptakes to bones) algorithms. Visual analysis and quantification (SUVmax) were performed for each compartment (medial compartment [MC], lateral compartment [LC], and patellofemoral compartment [PFC]). Clinical data were preoperatively assessed. The gold standard was the per-operative OA staging (International Cartilage Repair Society [ICRS] scale). Spearman's correlation coefficient was used for correlations. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and accuracy of SPECT-CT were assessed.One hundred three patients (50 women, 53 men, mean age = 64.5 ±â€Š10.3 y/o, 120 preoperative knees) were analyzed. There was no correlation between SUVmax and clinical data. There was a correlation between ICRS staging and SUVmax with both OSCGM (MC [rs = 0.25], LC [rs = 0.51], and PFC [rs = 0.27]), and enhanced OSCGM, except in the PFC (MC [rs = 0.22], LC [rs = 0.62], and PFC [rs = 0.03]). The Se, Sp, PPV, NPV, and accuracy of SPECT-CT were, respectively, 0.99, 0.67, 0.98, 0.80, 0.97 for the MC; 0.50, 0.85, 0.42, 0.89, 0.79 for the LC; and 0.23, 0.86, 0.50, 0.64, 0.62 for the PFC.Bone SPECT-CT SUVmax is correlated with per-operative OA staging. Despite the low sensitivity of SPECT-CT in the LC, its high specificity in the LC should prompt the surgeon to be vigilant before UKA surgery.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Osteoartritis de la Rodilla/diagnóstico por imagen , Cuidados Preoperatorios/métodos , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único/estadística & datos numéricos , Anciano , Cartílago Articular/diagnóstico por imagen , Femenino , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/cirugía , Valor Predictivo de las Pruebas , Periodo Preoperatorio , Sensibilidad y Especificidad , Estadísticas no Paramétricas
7.
EJNMMI Res ; 8(1): 49, 2018 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-29904817

RESUMEN

BACKGROUND: Suboptimal temporal sampling of time-activity curves (TAC) from dynamic 18F-fluoromethylcholine (FCH) PET images may introduce bias in quantification of FCH uptake in prostate cancer assessment. We sought to define an optimal temporal sampling protocol for dynamic FCH PET imaging. Seven different time samplings were tested: 5 × 60″, 10 × 30″, 15 × 15″-1 × 75″, 6 × 10″-8 × 30″, 12 × 5″-8 × 30″; 10 × 5″-4 × 10″-3 × 20″-5 × 30″, and 8 × 3″-8 × 12″-6 × 30″. First, the irreversible and reversible one-tissue compartment model with blood volume parameter (VB) (respectively, 1T1K+VB and 1T2k+VB, with K1 = transfer coefficient from the arterial blood to the tissue compartment and k2 = transfer coefficient from the tissue compartment to the arterial blood) were compared for 37 lesions from 32 patients who underwent FCH PET imaging for initial or recurrence assessment of prostate cancer, and the model was selected using the Akaike information criterion. To determine the optimal time sampling, K1 values extracted from 1000 noisy-simulated TAC using Monte Carlo method from the seven different time samplings were compared to a target K1 value which is the average of the K1 values extracted from the 37 lesions using an imaging-derived input function for each patient. K1 values extracted with the optimal time sampling for each tumoral lesion were compared to K1 values extracted from each of the other time samplings for the 37 lesions. RESULTS: The 1T2k + VB model was selected. The target K1 value as the objective was 0.506 mL/ccm/min (range 0.216-1.246). Results showed a significant difference between K1 values from the simulated TAC with the seven different time samplings analyzed. The closest K1 value from the simulated TAC to the target K1 value was obtained by the 12 × 5″-8 × 30″ time sampling. Concerning the clinical validation, K1 values extracted from the optimal time sampling (12 × 5″-8 × 30″) were significantly different with K1 values extracted from the other time samplings, except for the comparison with K1 values extracted from the 10 × 5″-4 × 10″-3 × 20″-5 × 30″ time sampling. CONCLUSIONS: A two-phase framing of dynamic PET reconstruction with frame durations of 5 s (blood phase) and 30 s (tissue phase) could be used to sample the TAC for uptake quantification in prostate cancer assessment.

8.
Front Med (Lausanne) ; 5: 36, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29516001

RESUMEN

Objective: Respiratory motion in 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) induces blurred images, leading to errors in location and quantification for lung and abdominal lesions. Various methods have been developed to correct for these artifacts, and most of current PET/CT scanners are equipped with a respiratory gating system. However, they are not routinely performed because their use is time-consuming. The aim of this study is to assess the feasibility and quantitative impact of a systematic respiratory-gated acquisition in unselected patients referred for FDG PET/CT, without increasing acquisition time. Methods: Patients referred for a FDG PET/CT examination to the nuclear medicine department of Brest University Hospital were consecutively enrolled, during a 3-month period. Cases presenting lung or liver uptakes were analyzed. Two sets of images were reconstructed from data recorded during a unique acquisition with a continuous table speed of 1 mm/s of the used Biograph mCT Flow PET/CT scanner: standard free-breathing images, and respiratory-gated images. Lesion location and quantitative parameters were recorded and compared. Results: From October 1 2015 to December 31 2015, 847 patients were referred for FDG PET/CT, 741 underwent a respiratory-gated acquisition. Out of them, 213 (29%) had one or more lung or liver uptake but 82 (38%) had no usable respiratory-gated signal. Accordingly, 131 (62%) patients with 183 lung or liver uptakes were analyzed. Considering the 183 lesions, 140 and 43 were located in the lungs and the liver, respectively. The median (IQR) difference between respiratory-gated images and non-gated images was 18% (4-32) for SUVmax, increasing to 30% (14-57) in lower lobes for lung lesions, and -18% (-40 to -4) for MTV (p < 0.05). Technologists' active personal dosimetry and mean total examinations duration were not statistically different between periods with and without respiratory gating. Conclusion: This study showed that a systematic respiratory-gated acquisition without increasing acquisition time is feasible in a daily routine and results in a significant impact on PET quantification. However, clinical impact on patient management remains to be determined.

9.
Ann Nucl Med ; 32(4): 281-287, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-29492810

RESUMEN

AIM: The aim of the study was to compare the kinetic analysis of 18F-labeled choline (FCH) uptake with static analysis and clinicopathological parameters in patients with newly diagnosed prostate cancer (PC). MATERIALS AND METHODS: Sixty-one patients were included. PSA was performed few days before FCH PET/CT. Gleason scoring (GS) was collected from systematic sextant biopsies. FCH PET/CT consisted in a dual phase: early pelvic list-mode acquisition (from 0 to10 min post-injection) and late whole-body acquisition (60 min post-injection). PC volume of interest was drawn using an adaptative thresholding (40% of the maximal uptake) on the late acquisition and projected onto an early static frame of 10 min and each of the 20 reconstructed frames of 30 s. Kinetic analysis was performed using an imaging-derived plasma input function. Early kinetic parameter (K1 as influx) and static parameters (early SUVmean, late SUVmean, and retention index) were extracted and compared to clinicopathological parameters. RESULTS: K1 was significantly, but moderately correlated with early SUVmean (r = 0.57, p < 0.001) and late SUVmean (r = 0.43, p < 0.001). K1, early SUVmean, and late SUVmean were moderately correlated with PSA level (respectively, r = 0.36, p = 0.004; r = 0.67, p < 0.001; r = 0.51, p < 0.001). Concerning GS, K1 was higher for patients with GS ≥ 4 + 3 than for patients with GS < 4 + 3 (median value 0.409 vs 0.272 min- 1, p < 0.001). No significant difference was observed for static parameters. CONCLUSIONS: FCH influx index K1 seems to be related to GS and could be a non-invasive tool to gain further information concerning tumor aggressiveness.


Asunto(s)
Colina/análogos & derivados , Tomografía Computarizada por Tomografía de Emisión de Positrones , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/metabolismo , Anciano , Anciano de 80 o más Años , Transporte Biológico , Colina/metabolismo , Humanos , Cinética , Masculino , Persona de Mediana Edad
10.
EJNMMI Res ; 8(1): 14, 2018 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-29435671

RESUMEN

BACKGROUND: xSPECT Bone® (xB) is a new reconstruction algorithm developed by Siemens® in bone hybrid imaging (SPECT/CT). A CT-based tissue segmentation is incorporated into SPECT reconstruction to provide SPECT images with bone anatomy appearance. The objectives of this study were to assess xB/CT reconstruction diagnostic reliability and accuracy in comparison with Flash 3D® (F3D)/CT in clinical routine. Two hundred thirteen consecutive patients referred to the Brest Nuclear Medicine Department for non-oncological bone diseases were evaluated retrospectively. Two hundred seven SPECT/CT were included. All SPECT/CT were independently interpreted by two nuclear medicine physicians (a junior and a senior expert) with xB/CT then with F3D/CT three months later. Inter-observer agreement (IOA) and diagnostic confidence were determined using McNemar test, and unweighted Kappa coefficient. The study objectives were then re-assessed for validation through > 18 months of clinical and paraclinical follow-up. RESULTS: No statistically significant differences between IOA xB and IOA F3D were found (p = 0.532). Agreement for xB after categorical classification of the diagnoses was high (κ xB = 0.89 [95% CI 0.84 -0.93]) but without statistically significant difference F3D (κ F3D = 0.90 [95% CI 0.86 - 0.94]). Thirty-one (14.9%) inter-reconstruction diagnostic discrepancies were observed of which 21 (10.1%) were classified as major. The follow-up confirmed the diagnosis of F3D in 10 cases, xB in 6 cases and was non-contributory in 5 cases. CONCLUSIONS: xB reconstruction algorithm was found reliable, providing high interobserver agreement and similar diagnostic confidence to F3D reconstruction in clinical routine.

11.
Cancer Imaging ; 17(1): 16, 2017 Jun 07.
Artículo en Inglés | MEDLINE | ID: mdl-28592305

RESUMEN

BACKGROUND: SPECT/CT has been shown to increase the diagnostic performance of bone scintigraphy for staging of malignancies. A systematic double-bed SPECT/CT of the trunk may allow further improvement. However, this would be balanced by higher dosimetry and longer acquisition time. The objective was to assess the incremental diagnostic utility of a systematic double-bed SPECT/CT acquisition for bone scintigraphy in initial staging of cancer patients, especially compared with the usual approach consisting in a whole body planar scan (WBS) plus one single-bed targeted SPECT/CT. METHODS: One hundred two consecutive patients referred for bone scintigraphy for initial staging of malignancy were analyzed. All patients underwent a double-bed SPECT/CT acquisition of the trunk. Images were interpreted by two nuclear medicine physicians in a 3-step procedure. Firstly, only WBS planar images were used; secondly, one additional single-bed SPECT/CT chosen based on planar images was used; finally, WBS planar and double-bed SPECT/CT images were interpreted. Lesions were classified as benign, equivocal or suspicious for metastasis. A per-lesion, per-anatomical region and per-patient analysis was performed. RESULTS: In a per-lesion analysis, the number of equivocal and suspicious lesions was 91 and 241 using WBS planar images, 17 and 259 using a single-bed SPECT/CT acquisition and 11 and 269 using double-bed SPECT/CT images, respectively. In a per-patient analysis, the diagnostic conclusion was negative, equivocal or suspicious for malignancy in 35, 53 and 14 patients using WB planar images, 77, 6 and 19 patients using an additional single-bed SPECT/CT and 76, 7 and 19 using double-bed SPECT/CT images, respectively. Seventeen lesions unseen on WBS images were interpreted as suspicious (n = 12) or equivocal (n = 5) on double-bed SPECT/CT images. Six lesions unseen on "WBS + targeted single-bed SPECT/CT" were interpreted as suspicious on double-bed SPECT/CT, with no shift in the metastatic status of patients. CONCLUSION: A systematic double-bed SPECT/CT acquisition has a limited incremental diagnostic value over an oriented single-bed SPECT/CT in terms of specificity and conclusiveness of bone scintigraphy in the initial staging of cancer patients. However, it slightly improved the sensitivity of the test by detecting unseen lesions on WBS, which may be of value for initial staging of cancer.


Asunto(s)
Neoplasias Óseas/diagnóstico por imagen , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único/métodos , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Óseas/patología , Neoplasias Óseas/secundario , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Valor Predictivo de las Pruebas , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único/efectos adversos , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único/normas
12.
Ann Rheum Dis ; 75(8): 1506-10, 2016 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-26929219

RESUMEN

BACKGROUND: Glucocorticoids are the cornerstone treatment of polymyalgia rheumatica (PMR) but induce adverse events. OBJECTIVES: To evaluate the efficacy and safety of first-line tocilizumab in PMR. METHODS: In a prospective open-label study (ClinicalTrials.gov: NCT01713842), 20 glucocorticoid-free patients fulfilling Chuang's PMR criteria, with symptom onset within the last 12 months and a PMR activity score (PMR-AS) >10, each received three tocilizumab infusions at 4-week intervals, without glucocorticoids, followed by oral prednisone from weeks 12 to 24 (0.15 mg/kg if PMR-AS ≤10 and 0.30 mg/kg otherwise). The primary end point was the proportion of patients with PMR-AS≤10 at week 12. RESULTS: Baseline median PMR-AS was 36.6 (IQR 30.4-43.8). At week 12, all patients had PMR-AS≤10 and received the low prednisone dosage. Median PMR-AS at weeks 12 and 24 was 4.5 (3.2-6.8) and 0.95 (IQR 0.4-2), respectively (p<0.001 vs baseline for both time points). No patient required rescue treatment. Positron emission tomography-CT showed significant improvements. The most common adverse events were transient neutropenia (n=3) and leucopenia (n=5); in one patient, the second tocilizumab infusion was omitted due to leucopenia. CONCLUSIONS: Tocilizumab monotherapy is effective in recent-onset PMR. Randomised controlled trials are warranted. TRIAL REGISTRATION NUMBER: NCT01713842.


Asunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Antirreumáticos/uso terapéutico , Polimialgia Reumática/tratamiento farmacológico , Anciano , Anticuerpos Monoclonales Humanizados/administración & dosificación , Anticuerpos Monoclonales Humanizados/efectos adversos , Antirreumáticos/administración & dosificación , Antirreumáticos/efectos adversos , Esquema de Medicación , Quimioterapia Combinada , Femenino , Glucocorticoides/efectos adversos , Glucocorticoides/uso terapéutico , Humanos , Infusiones Intravenosas , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Polimialgia Reumática/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Prednisona/efectos adversos , Prednisona/uso terapéutico , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
13.
Eur J Nucl Med Mol Imaging ; 41(10): 1957-64, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-24719158

RESUMEN

PURPOSE: The aim of this management outcome study was to assess the safety of ventilation/perfusion single photon emission computed tomography (V/Q SPECT) for the diagnosis of pulmonary embolism (PE) using for interpretation the criteria proposed in the European Association of Nuclear Medicine (EANM) guidelines for V/Q scintigraphy. METHODS: A total of 393 patients with clinically suspected PE referred to the Nuclear Medicine Department of Brest University Hospital from April 2011 to March 2013, with either a high clinical probability or a low or intermediate clinical probability but positive D-dimer, were retrospectively analysed. V/Q SPECT were interpreted by the attending nuclear medicine physician using a diagnostic cut-off of one segmental or two subsegmental mismatches. The final diagnostic conclusion was established by the physician responsible for patient care, based on clinical symptoms, laboratory test, V/Q SPECT and other imaging procedures performed. Patients in whom PE was deemed absent were not treated with anticoagulants and were followed up for 3 months. RESULTS: Of the 393 patients, the prevalence of PE was 28 %. V/Q SPECT was positive for PE in 110 patients (28 %) and negative in 283 patients (72 %). Of the 110 patients with a positive V/Q SPECT, 78 (71 %) had at least one additional imaging test (computed tomography pulmonary angiography or ultrasound) and the diagnosis of PE was eventually excluded in one patient. Of the 283 patients with a negative V/Q SPECT, 74 (26 %) patients had another test. The diagnosis of PE was finally retained in one patient and excluded in 282 patients. The 3-month thromboembolic risk in the patients not treated with anticoagulants was 1/262: 0.38 % (95 % confidence interval 0.07-2.13). CONCLUSION: A diagnostic management including V/Q SPECT interpreted with a diagnostic cut-off of "one segmental or two subsegmental mismatches" appears safe to exclude PE.


Asunto(s)
Imagen de Perfusión/efectos adversos , Embolia Pulmonar/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Angiografía por Radionúclidos/efectos adversos , Ultrasonografía , Relación Ventilacion-Perfusión
14.
Clin Nucl Med ; 39(1): 8-13, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-23531735

RESUMEN

BACKGROUND: The diagnosis of wrist fractures, especially scaphoid fractures, remains a challenge because of nonunion risk. Currently, new hybrid technologies are emerging such as SPECT/CT systems, which combine functional and anatomical data sets. So, we wanted to evaluate the utility of SPECT/CT in the management of occult carpal fractures. METHODS: In this study, all patients addressed at the orthopedic department at Brest University Hospital for wrist pain after trauma with initial normal plain radiographs were prospectively included. Patients with normal radiographs but with signs strongly suggestive of clinical fracture underwent a bone SPECT/CT and an MRI of the wrist. Therapeutic management took into account the results of all modalities, and all patients were followed up for at least 6 months and reviewed by the same surgeon. SPECT/CT findings were compared with those of the other modalities and follow-up. RESULTS: From December 2009 to May 2011, 57 patients were enrolled. Fifty-seven SPECT/CT and 52 MRI scans were obtained. Twenty-eight patients had normal imaging results, whereas 29 patients presented bone bruise and/or fractures. Ten patients were concordant according to SPECT/CT and MRI; 2 patients presented fractures on SPECT/CT without MRI performed; 17 patients had partially discordant results. Only 1 patient presented a nonunion at the follow-up, whereas both investigations were positive. CONCLUSIONS: This study highlights the good performances of SPECT/CT, which allows the detection of most occult carpal fractures. When a carpal occult fracture is strongly suspected clinically, SPECT/CT might be proposed at first intention after normal radiographs.


Asunto(s)
Huesos del Carpo/lesiones , Fracturas Óseas/diagnóstico , Fracturas Óseas/terapia , Imagen por Resonancia Magnética , Imagen Multimodal , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Huesos del Carpo/diagnóstico por imagen , Femenino , Fracturas Óseas/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Adulto Joven
15.
Nucl Med Commun ; 34(6): 551-6, 2013 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23587836

RESUMEN

OBJECTIVE: The objective of this study was to investigate the independent prognostic value of dual-time-point (18)F-fluorodeoxyglucose ((18)F-FDG) PET-CT imaging in patients with head and neck squamous cell carcinoma (HNSCC). METHODS: Patients referred to our department to undergo (18)F-FDG PET-CT for staging of HNSCC were prospectively included. Each patient was scanned using a Philips Gemini PET-CT system 1 h (early acquisition) and 2 h (delayed acquisition) after injection. An intratumoral retention index (RI) of (18)F-FDG was measured for each examination by the dual-time-point method. Event-free survival (EFS) and overall survival (OS) were determined by the Kaplan-Meier method and compared with the conventional maximum standardized uptake value (SUV(max)) at 60 min, SUV(max) at 120 min, and RI in univariate and multivariate analyses including the usual prognostic factors such as age, sex, primary site, SCC histologic grade, and American Joint Committee on Cancer stage (I, II, III, and IV). RESULTS: Sixty-six consecutive patients (60 men and six women; mean age=61 ± 9 years) were included in the study. In univariate analysis, besides age and stage, RI was predictive of EFS (P=0.01) but not of OS (P=0.1), whereas SUV(max) at 60 min was not predictive of EFS (P=0.18) or OS (P=0.08) and SUV(max) at 120 min was predictive of OS (P=0.02) but not of EFS (P=0.05). In multivariate analysis, RI persisted as an independent predictive factor for EFS (P=0.02) but not SUV(max) at 120 min for OS (P=0.12). CONCLUSION: Our results suggest an additional prognostic interest of RI measured by dual-time-point (18)F-FDG PET-CT, independent of usual prognostic factors, in patients with HNSCC.


Asunto(s)
Carcinoma de Células Escamosas/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Imagen Multimodal , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Factores de Edad , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/patología , Femenino , Estudios de Seguimiento , Neoplasias de Cabeza y Cuello/patología , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Clasificación del Tumor , Estadificación de Neoplasias , Pronóstico , Factores Sexuales , Factores de Tiempo
16.
Eur J Nucl Med Mol Imaging ; 39(12): 1839-47, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-22895863

RESUMEN

PURPOSE: Locally advanced head and neck squamous cell carcinoma (HNSCC) has a high rate of recurrence. Induction chemotherapy with DCF (docetaxel, cisplatin, 5-fluorouracil) before chemoradiotherapy could lead to the best disease control of inoperable stage III/IV HNSCC but with an increased risk of acute toxicity. Early assessment of therapeutic efficacy is a key issue in considering the benefit of escalation in a poor prognosis population. METHODS: Patients with stage III/IV HNSCC, in whom DCF induction chemotherapy followed by concurrent chemoradiotherapy had been validated by a multidisciplinary team, were prospectively included in the study. FDG PET/CT scans were performed in all patients before and after two of the three cycles of DCF. EORTC99 criteria were used to evaluate PET responses as follows: group 1 (metabolic responders) showing a complete response (CR) or partial response (PR), and subgroup 0 (metabolic nonresponders) showing stable disease (SD) or progressive disease (PD). The primary endpoint for monitoring patients was event-free survival (EFS). EFS probabilities between the two groups were estimated by the Kaplan-Meier method and statistically compared using the log-rank test. RESULTS: Fifteen consecutive patients (14 men, 1 woman; age 57.5 ± 6.2 years, mean ± SD) were analysed. Therapeutic assessment by PET/CT demonstrated CR in four patients, PR in six, SD in four and PD in one. Among the ten patients with a metabolic response (group 1), none had relapsed at the time of this report, while four of five patients with no metabolic response (group 0) showed recurrence within an average of 9.0 ± 1.6 months. Median EFS was, respectively, 18.9 months (3.8-25.3 months) and 10.2 months (7.5-12.7 months) in group 1 and group 0. The corresponding 1-year EFS rates were 100 % and 20 %, respectively. The difference in EFS between the two groups was statistically significant (p = 0.0014). CONCLUSION: Early therapeutic response demonstrated on FDG PET/CT after two cycles of induction chemotherapy with DCF in patients with inoperable stage III/IV HNSCC seems to be a predictive factor for EFS.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Escamosas/diagnóstico por imagen , Fluorouracilo/uso terapéutico , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Quimioterapia de Inducción , Imagen Multimodal , Recurrencia Local de Neoplasia/diagnóstico por imagen , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Anciano , Carcinoma de Células Escamosas/tratamiento farmacológico , Cisplatino/administración & dosificación , Cisplatino/uso terapéutico , Supervivencia sin Enfermedad , Docetaxel , Femenino , Fluorodesoxiglucosa F18 , Fluorouracilo/administración & dosificación , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/tratamiento farmacológico , Radiofármacos , Carcinoma de Células Escamosas de Cabeza y Cuello , Taxoides/administración & dosificación , Taxoides/uso terapéutico , Resultado del Tratamiento
17.
Nucl Med Commun ; 33(7): 695-700, 2012 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-22441133

RESUMEN

OBJECTIVES: The use of summed planar images generated from single-photon emission computed tomography (SPECT) ventilation/perfusion (V/Q) scintigraphy has been proposed as a substitute for planar V/Q scans in order to use the revised PIOPED interpretation criteria when only SPECT acquisition is performed in patients with suspected pulmonary embolism. The aim was to evaluate the accuracy of angular summed planar scans in comparison with true planar images. METHODS: Patients included in the 'SPECT study' assessing the diagnostic performance of V/Q SPECT were analysed. Angular summed planar images were generated from SPECT acquisition data and compared with true planar scans. RESULTS: Angular summed planar images were successfully generated for 246 patients. Regarding interobserver variability, the interpretation result was different for 15 (6%) summed planar scans with an excellent degree of agreement (κ=0.92; 95% confidence interval 0.88-0.96). With regard to intermodality interpretation variability between conventional planar and angular summed images, the result was different for 63 (26%) of 246 patients with an intermodality degree of agreement of κ=0.66 (95% confidence interval 0.58-0.73). CONCLUSION: Planar images generated from SPECT V/Q scintigraphy are not a reliable substitute for true planar V/Q images.


Asunto(s)
Interpretación de Imagen Asistida por Computador/métodos , Embolia Pulmonar/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único/métodos , Relación Ventilacion-Perfusión/fisiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Reproducibilidad de los Resultados , Adulto Joven
18.
Head Neck ; 34(4): 462-8, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-21604320

RESUMEN

BACKGROUND: High tumor uptake of fluorodeoxyglucose (FDG) is associated with an unfavorable outcome in patients with cancer. We evaluated FDG uptake as a prognostic factor in patients with head and neck squamous cell carcinoma. METHODS: Maximum standardized uptake values (SUVmax) of tumor, liver, and pulmonary artery were recorded. Ratios of SUVmax from tumor to liver (T/L) and from tumor to pulmonary artery (T/PA) were calculated for each patient. Clinical data, tumor, and SUVmax ratios were compared with disease-free survival (DFS) and overall survival (OS). RESULTS: Eighty-nine patients were included: 48 presented a local recurrent disease or distant metastases and 42 died. For both DFS and OS, tumor SUVmax value of 7 was the best cutoff value and 4 and 5 for T/L and T/PA ratios. Multivariate analysis confirmed the independent prognostic value of these 3 thresholds for DFS and OS. CONCLUSIONS: FDG uptake has a significant and independent relationship with recurrence and survival.


Asunto(s)
Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/mortalidad , Fluorodesoxiglucosa F18/farmacocinética , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/mortalidad , Anciano , Análisis de Varianza , Biopsia con Aguja , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Estudios de Cohortes , Progresión de la Enfermedad , Supervivencia sin Enfermedad , Femenino , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/terapia , Humanos , Inmunohistoquímica , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Imagen Multimodal/métodos , Análisis Multivariante , Invasividad Neoplásica , Recurrencia Local de Neoplasia/diagnóstico por imagen , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Tomografía de Emisión de Positrones , Pronóstico , Modelos de Riesgos Proporcionales , Radiofármacos/farmacocinética , Estudios Retrospectivos , Sensibilidad y Especificidad , Estadísticas no Paramétricas , Análisis de Supervivencia , Tomografía Computarizada por Rayos X
19.
Ann Hematol ; 91(5): 715-721, 2012 May.
Artículo en Inglés | MEDLINE | ID: mdl-22083514

RESUMEN

The potential predictive value of tumor bulk, genetic, and immunological variants in patients with low-grade non-Hodgkin's lymphoma to respond to treatment with rituximab (RTX) monotherapy was evaluated. Thus, the value of assessing the effect of 18-fluoro-desoxy-D-glucose (FDG) uptake on PET scan, polymorphisms in Fc gamma receptor (FcγR) IIIa-158, FcγRIIa-131, and C1qA-276 genes in predicting the response to treatment were evaluated in 50 low-grade non-Hodgkin's lymphoma patients. The influence of RTX pharmacokinetics, plasma levels of the B cell-activating factor (BAFF), and human antichimeric antibodies was also investigated. The therapeutic response was evaluated 10 weeks after treatment using revised Cheson's criteria. Lower maximal standardized uptake values (SUV(max)) at baseline were predictive of complete response. FcγRIIIa-158 polymorphism was also associated with complete response to RTX confirming previous findings, whereas polymorphisms in the FcγRIIa-131 and C1qA-276 genes were not. Lower blood levels of RTX were observed in males, but the effectiveness of RTX in males and females was the same. BAFF was not detectable in plasma before or after treatment, and no patients developed human antichimeric antibodies. Low-grade non-Hodgkin's lymphoma patients with a low SUV(max) at baseline and an FcγRIIIa-158 V/V genotype generally had a complete response to RTX.


Asunto(s)
Anticuerpos Monoclonales de Origen Murino/uso terapéutico , Antineoplásicos/uso terapéutico , Linfoma de Células B/diagnóstico , Linfoma de Células B/tratamiento farmacológico , Adulto , Anciano , Anticuerpos Monoclonales de Origen Murino/farmacocinética , Antineoplásicos/farmacocinética , Factor Activador de Células B/sangre , Complemento C1q/genética , Femenino , Humanos , Masculino , Persona de Mediana Edad , Imagen Multimodal , Clasificación del Tumor , Norleucina/análogos & derivados , Norleucina/sangre , Polimorfismo Genético , Tomografía de Emisión de Positrones , Pronóstico , Receptores de IgG/genética , Rituximab , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Carga Tumoral
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