Análisis del manejo del linfoma de Hodgkin clásico durante 10 años en el Hospital Clínico Red Salud UC-Christus con énfasis en el uso del PET CT / Decade of Hodgkin lymphoma: PET CT vs biopsy in single Academic Chilean Center

INTRODUCCIÓN: El Linfoma de Hodgkin (LH) es una causa prevalente de morbilidad por Cáncer Hematológico en el mundo y también en nuestro entorno. OBJETIVOS: Mostrar la experiencia de diez años tratando el LH en un centro docente chileno. Adicionalmente, exponer el rendimiento de diagnóstico del PET CT y la Biopsia de Médula Ósea. MATERIAL Y MÉTODOS: Se realiza un estudio de Cohorte retrospectivo para recopilar datos y resultados de los pacientes tratados en nuestro centro. RESULTADOS: Se analizaron 82 pacientes (edad promedio 35 años. Razón entre hombres y mujeres de 1,9:1). La sobrevida libre de progresión de 88,6% y 66,4% para estadios localizados y avanzados respectivamente. El PET como estrategia de etapificación tuvo mejor sensibilidad al comparar con la Biopsia de Médula. CONCLUSIONES: El resultado clínico de los pacientes tratados en este centro docente chileno fueron comparables a la literatura internacional. Adicionalmente, el PET CT evidenció ser una herramienta superior en el diagnóstico y etapificación superior a la biopsia en nuestros pacientes.

INTRODUCTION: Hodgkin Lymphoma (HL) is a prevalent hematological cancer in the world and Chile. OBJECTIVES: Show the experience of 10 years treating HL in a Chilean academic center. Additionally, it exposes the diagnostic performance of PET CT and Bone Marrow Biopsy. MATERIAL AND METHODS: We conducted a retrospective cohort study to collect data and outcomes of patients treated in our center. RESULTS: 82 patients were analyzed (Average age, 35 years old; the ratio between men and women was 1.9:1). Progression-free survival was 88.6% and 66.4% for localized and advanced stages, respectively. PET as a staging strategy had better sensitivity than Marrow Biopsy. CONCLUSIONS: The clinical results of the patients treated in this Chilean teaching center were comparable to the international literature. Additionally, PET CT proved to be a superior tool in diagnosis and staging compared to biopsy in our patients.

Comparison of prognostic value of different metabolic response criteria determined by PET/CT in patients with metastatic breast cancer under CDK 4/6 inhibitor treatment.

PURPOSE: This study evaluates the prognostic role of different [18F]FDG PET/CT metabolic response criteria in metastatic breast cancer (MBC) patients treated with cyclin-dependent kinase 4/6 inhibitors (CDK 4/6). MATERIALS AND METHODS: We retrospectively evaluated the data of MBC patients treated with CDK 4/6 inhibitors who underwent an [18F]FDG PET/CT scan before starting and during treatment. [18F]FDG PET/CT response was assessed with the European Organization for Research and Treatment of Cancer (EORTC), PET Response Criteria in Solid Tumors (PERCIST), and whole-body total lesion glycolysis (WBTLG) criteria. Fleiss kappa was computed to assess the agreement between metabolic response criteria. The endpoint of the study was progression-free survival (PFS). PFS data were analyzed by the Kaplan-Meier method and compared using the log-rank test. RESULTS: The study included sixteen MBC patients who received CDK 4/6 inhibitors therapy. According to PERCIST, partial metabolic response (PMR) was found in seven patients, stable metabolic disease (SMD) in seven patients, and progressive metabolic disease (PMD) in two patients. According to EORTC, PMR was detected in eight patients, SMD in seven patients, and PMD in one patient. According to WBTLG, PMR was found in 10 patients, SMD in four patients, and PMD in two patients. There was a fair agreement between the three criteria. While progression was detected in seven of the patients during follow-up, no progression was detected in nine of them. Kaplan-Meier analysis revealed that the responders according to WBTLG showed significantly longer PFS than non-responders. CONCLUSION: Treatment response according to WBTLG criteria during treatment appears to be associated with prolonged PFS in patients treated with CDK 4/6 inhibitors for MBC.

The role of PET-PSMA in guiding prostate cancer radiation therapy: experience in a salvage and curative setting / Radioterapia guiada por PET-PSMA en cáncer de próstata: experiencia en el escenario curativo y en el salvamento

Introduction: The role of positron emission tomography (PET) prostate-specific membrane antigen (PSMA) in guiding radiation therapy treatment plans remains to be defined. Methods: We conducted a retrospective observational study of patients with prostate cancer referred for radiotherapy. Our objective was to establish the role of PET-PSMA in decision-making and changes in the radiotherapy treatment plan. Results: In the entire cohort, 26.8% had lymph node involvement outside the conventional field. The PET results upstaged and changed radiotherapy treatment plans for 75% in primary radiotherapy and 50% in salvage radiation. Conclusions: PET-PSMA changes decision-making and treatment planning for radiotherapy, including treatment volumes not traditionally delimited in contour atlases.

Introducción: El rol del PET-PSMA para guiar los planes de radioterapia aún debe definirse. Métodos: Realizamos un estudio observacional retrospectivo de pacientes con cáncer de próstata localizado remitidos para radioterapia. Nuestro objetivo fue establecer el rol del PET-PSMA en la toma de decisiones y cambios en el plan de tratamiento de radioterapia. Resultados: En toda la cohorte el 26,8% presentaba afectación ganglionar fuera del campo convencional. Los resultados del PET cambiaron los planes de tratamiento en el 75% para radioterapia primaria y en el 50% para salvamento. Conclusiones: El PET-PSMA cambia la toma de decisiones y planificación del tratamiento de radioterapia, incluyendo volúmenes de tratamiento no delimitados tradicionalmente en los atlas de contorneo.

Hallazgos incidentales de COVID-19 en PET/CT 18F-FDG de pacientes asintomáticos con cáncer en dos instituciones de salud de Bogotá, Colombia / Incidental findings of COVID-19 in F18-FDG PET/CT from asymptomatic patients with cancer in two healthcare institutions in Bogotá, Colombia

La COVID-19 es la infección viral causada por el SARS-CoV-2 y declarada por la Organización Mundial de la Salud (OMS) como pandemia. Los pacientes con cáncer tienen un mayor riesgo de adquirir la infección y un peor pronóstico, ya que deben asistir a visitas médicas en diferentes centros hospitalarios, reciben tratamientos médicos y quirúrgicos y deben someterse a estudios diagnósticos como la PET/CT en servicios de medicina nuclear, lo que es ocasión para el hallazgo incidental de la infección. Se presentan las imágenes de tomografías computarizadas por emisión de positrones con 18-fluorodesoxiglucosa (F18) (Positron Emission Tomography and Computed Tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose, PET/CT F18-FDG) en las que se evidenció la COVID-19 en pacientes con diversas enfermedades oncológicas, pero sin sintomatología respiratoria.

COVID-19 is the viral infection caused by SARS-CoV-2 declared by the World Health Organization (WHO) as a pandemic. Patients with cancer have a higher risk to acquire the infection and worse prognosis as they have to attend more medical visits in healthcare institutions, receive medical and surgical treatments, and be subjected to diagnostic studies such as PET/CT in nuclear medicine services where the infection may be an incidental finding. We present here F18-FDG PET/CT (Positron Emission Tomography and Computed Tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose), images with findings of COVID-19 from patients with different oncological conditions but no respiratory symptoms.

Cortical metabolic changes and clinical outcome in normal pressure hydrocephalus after ventriculoperitoneal shunt: Our preliminary results. / Cambios metabólicos corticales y resultado clínico en la hidrocefalia normotensiva después de la derivación ventrículo-peritoneal: nuestros resultados preliminares.

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.

Tomografía por emisión de positrones en endocarditis infecciosa asociada a dispositivos y válvulas protésicas / Positron emission tomography in infective endocarditis associated with intracardiac devices and prosthetic valves

La endocarditis infecciosa (EI) es una enfermedad grave y potencialmente letal. La capacidad diagnóstica de los criterios de Duke modificados es alta para válvulas nativas, pero decae en el caso de EI de válvulas protésicas o EI asociadas a dispositivos. El ecocardiograma y los hallazgos microbiológicos son fundamentales para el diagnóstico, pero pueden resultar insuficientes en este grupo de pacientes. Nuestro objetivo fue evaluar la utilidad de la tomografía por emisión de positrones y fusión con tomografía computarizada (PET/TC) en pacientes con sospecha de EI, portadores de válvulas protésicas o dispositivos intracardiacos. Se estudiaron 32 pacientes, a los cuales se les realizó un PET/CT con 18F-Flúor desoxiglucosa (18F-FDG). Se consideraron sugestivos de infección aquellos con captación intensa de tipo focal y/o heterogénea con un punto de corte de Standard Uptake Value (SUV) mayor o igual a 3.7. Los diagnósticos iniciales según los criterios de Duke modificados, se compararon con el diagnóstico final establecido por la Unidad de Endocarditis institucional. El agregado del PET/CT a esos criterios, proporcionó un diagnóstico concluyente en 22 de los 32 casos iniciales, reclasificando a 11 casos en EI definitivas y a otros 5 casos como negativos para ese diagnóstico. La EI continúa siendo un grave problema clínico. En aquellos casos donde los criterios de Duke no son suficientes para establecer el diagnóstico y la sospecha clínica persiste, el PET/CT puede ser una herramienta complementaria útil para aumentar la sensibilidad diagnóstica.

Infective endocarditis (IE) is a serious and potentially lethal condition. The diagnostic capacity of the modified Duke criteria is high for native valves, but it declines in the case of EI of prosthetic valves or EI associated with devices. Echocardiography and microbiological findings are essential for diagnosis but may be insufficient in this group of patients. Our objective was to evaluate the usefulness of positron emission tomography and fusion with computed tomography (PET / CT) in patients with suspected IE, carriers of prosthetic valves or intracardiac devices; 32 patients were studied, who underwent PET / CT with 18F-Fluorine deoxyglucose (18F-FDG). Those with intense focal and/or heterogeneous uptake with a Standard Uptake Value (SUV) cut-off point greater than or equal to 3.7 were considered suggestive of infection. The initial diagnoses according to the modified Duke criteria were compared with the final diagnosis established by the Institutional Endocarditis Unit. The addition of PET / CT to these criteria, provided a conclusive diagnosis in 22 of the 32 initial cases reclassifying 11 cases in definitive EI; another 5 cases were negative for that diagnosis. EI continues to be a serious clinical problem. In those cases where the Duke criteria are not sufficient to establish the diagnosis and clinical suspicion persists, PET / CT can be a useful complementary tool to increase the diagnostic sensitivity.

False positive in fluorodeoxyglucose-F18 positron emission tomography computed tomography scan of inferior vena cava leiomyoma in patient with a suspected paraganglioma. / Falso positivo en estudio de tomografía de emisión de positrones con fluorodesoxiglucosa-F18 de un leiomioma de vena cava inferior en paciente con sospecha de paraganglioma.

Leiomyomas are benign tumors derived from smooth muscle tissue that rarely present outside the uterus. These tumors do not usually show FDG uptake. We present the case of a patient with hypertension refractory to treatment and a lesion arising from inferior vena cava, that shows intense FDG uptake in PET/CT scan, suggestive of paraganglioma, with a final histological diagnosis of leiomyoma.

Valor de la imagenología (TC y PET-TC) en el diagnóstico de la carcinomatosis peritoneal. Estudio preliminar / Diagnostic value of CT and Pet CT for detection of peritoneal carcinomatosis. Preliminary study / Valor das técnicas de imagem (TC y Pet-TC) no diagnóstico da carcinomatose peritoneal. Estudo preliminar

Resumen: En la evaluación de la carcinomatosis peritoneal (CP) la imagenología contribuye al diagnóstico preciso de compromiso peritoneal, aunque su eficacia es aún limitada. La tomografía computada (TC) es el estudio de imagen más utilizado y el PET-TC es cada vez más solicitado en la valoración de diferentes neoplasias. El objetivo del presente trabajo es evaluar el rendimiento de la TC y el PET-TC en el diagnóstico de CP en tumores digestivos y ginecológicos. Material y método: estudio retrospectivo, observacional, de 11 casos operados de CP en los que previamente se había realizado TC o PET-TC, o ambos. Se analizan los resultados de los estudios imagenológicos por separado y en conjunto, y se comparan con los hallazgos intraoperatorios y anatomopatológicos. Resultados: la TC fue concordante en 8 de 10 casos (S 78%, E 100%, VPP 100%, VPN 33%), mientras que el PET-TC lo fue en 9 de 11 pacientes (S 100%, VPP 81%). Al considerar en conjunto la TC y el PET-TC, la sensibilidad fue de 100% y el VPP de 82%. Conclusiones: en los resultados obtenidos se constata una subestimación de la CP en la imagenología a causa de las características de los nódulos y su patrón de captación. En el PET-TC, un SUV > 6 podría aumentar la probabilidad diagnóstica de carcinomatosis. Esta breve serie de casos permite sugerir que TC y el 18FGD PET-TC deben ser solicitados y analizados en forma conjunta para incrementar su rendimiento, aunque la exploración quirúrgica continúa siendo el método más eficaz para el diagnóstico y evaluación de la CP.

Summary: Imagenology contributes to the accurate diagnosis of peritoneal compromise in the assessment of peritoneal carcinomatosis, although its effectiveness is still limited. CT is the most frequently used study and PET/CT is graduallly more requested in the assessment of different neoplasms. This study aims to assess performance of CT and PET/CT for diagnosis of peritoneal carcinomatosis in digestive and gynecological tumours. Method: retrospective, observational study of 11 cases operated on peritoneal carcinomatosis after a CT and/or PET/CT had been performed. The results of both image studies were analysed separately and altogether and they were subsequently compared to intraoperative and pathology studies. Results: CT matched findings in 8 out of 10 cases (sensitivity 78%, specificity 100%, positive predictive value 100%, negative predictive value 33%), whereas PET/TC matched in 9 out of 11 patients (sensitivity 100%, PPV 81%). When considered together, sensitivity was 100% y el PPV de 82%. Conclusions: the results of the study confirm imagenology studies overestimate peritoneal carcinomatosis based on the characteristics of nodules and its uptake pattern. In CT/PET, SUV> 6 could increase the probability of diagnosing carcinomatosis. This small series of cases enables our suggesting CT and 18F-FDG PET-TC to be requested and analysed together to increase its efficiency, although surgical exploration continues to be the most effective method to diagnose and assess peritoneal carcinomatosis.

Resumo: Na avaliação da carcinomatose peritoneal (CP) as técnicas de imagem contribuem ao diagnóstico preciso do compromisso peritoneal, embora sua eficácia ainda seja limitada. A tomografia computadorizada (TC) é o estudo de imagens mais utilizado e a tomografia computadorizada por emissão de pósitrons (PET-TC) é cada vez mais solicitado na avaliação de diferentes neoplasias. O objetivo do presente trabalho, é avaliar o rendimento da TC e do PET-TC no diagnóstico de CP em tumores digestivos e ginecológicos. Material e método: estudo retrospectivo, observacional de 11 casos de carcinomatose peritoneal operados nos quais previamente se havia realizado TC e/ou PET-TC. Os resultados de ambos estudos foram estudados isoladamente e em conjunto e foram comparados com os achados intraoperatórios e histopatológicos. Resultados: a TC foi concordante em 8 de 10 casos (S 78%, E 100%, VPP 100%, VPN 33%), e o PET-TC em 9 de 11 pacientes (S 100%, VPP 81%). A sensibilidade foi de 100% e o VPP de 82% quando ambos estudos foram analisados conjuntamente. Conclusoes: observa-se nos resultados uma subestimação da CP nas técnicas de imagem, devido às características dos nódulos e seu padrão de captação. No PET-TC, um SUV > 6 poderia aumentar a probabilidade de diagnosticar carcinomatose. Esta breve série de casos permite sugerir que a TC e o 18FGD PET-TC devem ser solicitados e analisados em forma conjunta para aumentar o rendimento. No entanto a exploração cirúrgica continua sendo o método mais eficaz para o diagnóstico e avaliação da CP.

Diagnóstico de neurolinfomatosis como complicación tardía de linfoma no Hodgkin por 18F-FDG PET-CT / Diagnosis of neurolymphomatosis as a late complication of non-Hodgkin lymphoma through 18F-FDG PET-CT

Resumen La neurolinfomatosis (NL) es una condición poco frecuente que se caracteriza por la invasión de células B en los nervios craneales y las raíces nerviosas periféricas y generalmente está vinculada con leucemia o linfoma no Hodking (LNH). En el presente reporte se destacará la importancia de la sospecha diagnóstica en este grupo de pacientes y la importancia de 18F-FDG PET/CT en el diagnóstico diferencial con otras entidades causantes de síntomas similares. Se presenta el caso de una mujer de 63 años con diagnóstico de linfoma difuso de células B grandes, quien, en el tercer ciclo de quimioterapia DA-EPOCH-R, refiere dolor de tipo neuropático en miembro superior derecho, progresivo en severidad y en extensión con compromiso de la extremidad contralateral, convulsiones y parálisis facial periférica.

Abstract Neurolinfomatosis (LN) is a strange condition, defined as Invasion of cranial nerves and peripheral nerve roots by leukemia or lymphoma. Most of the cases are caused by non-Hodgkin's lymphoma of B cells (BHL). The present paper aims to emphasize the importance of suspecting this entity in patients with NHL and neuropathic pain and the role of 18F-FDG PET-CT in the diagnosis. We present the case of a 63-year-old woman diagnosed with diffuse large B-cell lymphoma, who in her third chemotherapy session DA-EPOCH-R of neuropathic pain in the right upper limb, with a poor clinical outcome, due to worsening pain, contralateral limb involvement, seizures and peripheral facial paralysis.

Parámetros de la 18F-FDG PET/CT asociado con los factores pronósticos en la estadificación inicial del Cáncer de Mama / Parameters of the 18F-FDG PET/CT associated with the prognostic factors in the initial staging of Breast Cancer

Propósito de la revisión: Este artículo tiene la siguiente pregunta de investigación: ¿Se debe considerar la Biología, histología y el fenotipo para la estadificación inicial del Cáncer de Mama? Se realiza una revisión del estudio metabólico del cáncer de mama (CM) con la técnica de la captación de glucosa Fluorada 18-Fluoro-2-Desoxi-D-Glucosa y su medición de intensidad con tomografía por Emisión de positrones (18F-FDG PET/CT). Recientes Hallazgos: La 18F-FDG PET/CT puede detectar metástasis que no son visibles en otras modalidades, el carcinoma ductal invasivo muestra una mayor captación que el carcinoma lobular invasivo. La alta captación de 18F-FDG se ha asociado con un resultado peor y una supervivencia más corta. Extracto: El cáncer de mama es un tipo heterogéneo de malignidad porque varios factores afectan su comportamiento y pronóstico. Debido a esta heterogeneidad, el tratamiento óptimo y la respuesta esperada al tratamiento puede variar sustancialmente para cada paciente. 18F-FDG PET/CT puede proporcionar información relevante sobre el metabolismo, el diagnóstico y el pronóstico del cáncer de mama. Varios estudios han sugerido una correlación entre las características clínico-patológicas del cáncer de mama y los parámetros metabólicos obtenidos por 18F-FDG PET/CT.

Purpose of the review: This article has the following research question: Should biology, histology and phenotype be considered for initial staging of breast cancer? A review of the metabolic study of breast cancer (CM) is performed with the technique of glucose uptake Fluorada 18-Fluoro-2-Deoxy-D-Glucose and its intensity measurement with positron emission tomography (18F-FDG PET / CT). Recent Findings: 18F-FDG PET / CT can detect metastases that are not visible in other modalities, invasive ductal carcinoma shows a higher uptake than invasive lobular carcinoma. The high uptake of 18F-FDG has been associated with a worse outcome and shorter survival. Excerpt: Breast cancer is a heterogeneous type of malignancy because several factors affect its behavior and prognosis. Due to this heterogeneity, the optimal treatment and the expected response to treatment may vary substantially for each patient. 18F-FDG PET / CT can provide relevant information on the metabolism, diagnosis and prognosis of breast cancer. Several studies have suggested a correlation between the clinical-pathological characteristics of breast cancer and the metabolic parameters obtained by 18F-FDG PET / CT.

Estado del Arte Manejo Quirúrgico del Carcinoma Metastásico de Primario Desconocido de Cabeza y Cuello / State of the Art Surgical Management of Metastatic Carcinoma of Unknown Primary of Head and Neck

Propósito de la revisión: el objetivo de la revisión es delinear el rol del Manejo Quirúrgico del carcinoma metastásico primario de cabeza y cuello. Buscamos reportes en indicaciones, posibles hallazgos y subsecuentes tratamientos. Recientes hallazgos: La punción aspirativa con aguja fina, permite diferenciar la etiología de los nódulos del cuello: melanoma, carcinoma tiroideo, linfoma y otros tumores indiferenciados. La medición de tiroglobulina ayuda a diferenciar una neoplasia de tiroides. El nivel ganglionar afectado I al III incluye el protocolo de paratiroidectomia, amigadalectomía. El nivel ganglionar IV y V el primario es infraclavicular. Extracto: El cáncer metastásico de primario oculto es una neoplasia con confirmación histológica pero con lesión primaria desconocida. Su manejo es controversial y en la mayoría de los casos insuficiente para llegar al diagnóstico, incluso con la autopsia. La aproximación inicial comprende una serie de exámenes de laboratorio e imágenes de alta complejidad que incluyen la tomografía por emisión de positrones con el test de la Flúor 2-Deoxi Glucosa (FDG-PET/CT), los estudios de anatomía patológica son el segundo paso dentro del manejo estándar e incluyen la Punción y Aspiración con Aguja fina (PAAF). La microscopia tradicional no es suficiente para identificar el tumor primario, las tinciones inmunohistoquímicas aunque no son especificas ni sensibles ayudan con ese propósito y aún más la microscopia electrónica. La biopsia o procedimientos más agresivos como la amigdalectomía son conductas a seguir si aún no se ha logrado el diagnóstico. Se presenta una revisión del estado del arte del manejo del Carcinoma Metastásico de Primario Desconocido de Cabeza y Cuello.

Purpose of the review: the objective of the review is to delineate the role of Surgical Management of primary metastatic carcinoma of the head and neck. We look for reports on indications, possible findings and subsequent treatments. Recent findings: Fine-needle aspiration can differentiate the etiology of neck nodules: melanoma, thyroid carcinoma, lymphoma and other undifferentiated tumors. The measurement of thyroglobulin helps to differentiate a thyroid neoplasm. The affected lymph node level I to III includes the protocol of parathyroidectomy, amigdalectomy. The nodal level IV and V the primary is infraclavicular. Excerpt: Metastatic cancer of the occult primary is a neoplasm with histological confirmation but with an unknown primary lesion. Its management is controversial and in most cases insufficient to reach the diagnosis, even with autopsy. The initial approach involves a series of laboratory tests and highly complex images that include positron emission tomography with the Flucor 2-Deoxy Glucose test (FDG-PET / CT), pathology studies are the second step within standard handling and include Puncture and Fine Needle Aspiration (FNAP). Traditional microscopy is not enough to identify the primary tumor, immunohistochemical stains although they are not specific or sensitive help with this purpose and even more so electron microscopy. Biopsy or more aggressive procedures such as tonsillectomy are behaviors to follow if the diagnosis has not yet been achieved. A review of the state of the art of metastatic carcinoma of Unknown Head and Neck Primary is presented.

PET-CT en la Epilepsia Refractaria / PET-CT in Drug Resistant Epilepsy

La epilepsia es un trastorno neurológico frecuente en países en vías de desarrollo. Aproximadamente el 30 a 40% es refractaria al tratamiento. El tratamiento quirúrgico en la epilepsia refractaria es una opción en los pacientes con foco epileptógeno único localizado fuera de una zona elocuente. La selección adecuada del paciente es la clave para éxito del tratamiento. La tomografía por emisión de positrones (PET-CT) ha demostrado gran utilidad en la evaluación prequirúrgica en los pacientes con epilepsia refractaria al tratamiento.

Epilepsy is a frequent neurological disorder in developing countries. Approximately 30 to 40% is refractory to treatment. Surgical treatment in drug resistant epilepsy is an option in patients with a single epileptogenic focus located outside of an eloquent area. Adequate patient selection is the key to treatment success. Positron emission tomography (PET-CT) has shown great utility in pre-surgical evaluation in patients with epilepsy drug resistant epilepsy.

Uso de Tomografía por emisión de positrones en melanoma maligno cutáneo en el Hospital Carlos Andrade Marín / Use of Positron emission tomography for cutaneous malignant melanoma at the Carlos Andrade Marin Hospital

INTRODUCCIÓN. La Tomografía por Emisión de Positrones ­Tomografía Computarizada, 18 Flúor-Deoxiglucosa, es utilizado para estadiaje, re-estadiaje, seguimiento y respuesta a tratamiento del melanoma cutáneo. OBJETIVO. Valorar la utilidad de la Tomografía por Emisión de Positrones ­Tomografía Computarizada, en la detección de metástasis en los pacientes con melanoma cutáneo. MATERIALES Y MÉTODOS. Estudio observacional, retrospectivo. Información obtenida de la base estadística de la Unidad de Tomografía por Emisión de Positrones­Tomografía Computarizada del Hospital Carlos Andrade Marín, de Quito-Ecuador, desde enero de 2016 hasta junio de 2018. RESULTADOS. Se recopiló la información de 100 pacientes, 48 pacientes cumplieron los criterios de inclusión. La media de edad general fue 64 años (SD 12,5 años). El 35,4% de los pacientes tuvieron ganglio centinela positivo con una frecuencia de secundarismo en el 29,4% (p=0,43). El 60% de pacientes acudió por re-estadiaje. Pacientes con y sin melanoma ulcerado tuvieron un promedio de edad de 67,8 años y 59,8 años, respectivamente. La presencia de metástasis a distancia presenta una estimación de riesgo calculada de 1,57 (IC 95% 1,005 a 2,45) (p = 0,001). DISCUSIÓN. A mayor edad de los pacientes, mayor porcentaje de melanomas ulcerados, siendo estadísticamente significativo. Sin embargo, ninguna de las dos variables tuvo relación estadística con la presencia de metástasis a distancia. No se encontró relación con el espesor de Breslow y presencia de metástasis a distancia. CONCLUSIÓN. El estudio por Tomografía por Emisión de Positrones ­Tomografía Computarizada es el más sensible para la detección de metástasis a distancia, su presencia representa un mayor riesgo de mortalidad.

INTRODUCTION. Positron-Emission Tomography- Computerized Tomography, is used for staging, re-staging, follow-up and response to treatment in patients with cutaneous melanoma. OBJECTIVE. To evaluate the usefulness of Positron-Emission Tomography-Computer Tomography in the detection of metastasis in patients with cutaneous melanoma. MATERIALS AND METHODS. Observational retrospective study. Information obtained from the statistical base of Positron-Emission Tomography- Computerized Tomography Unit of the Carlos Andrade Marin, Hospital Specialty in Quito-Ecuador, from January 2016 to June 2018. RESULTS. Information was collected from 100 patients, 48 met the inclusion criteria. The general average age was 64,19 years (SD 12,5 years). 35,4% of the patients had a positive sentinel lymph node and 64,6% with a secondary frequency in 29,4% (p = 0,43). In 60% of patients, the reason for the request was re-staging. Patients with and without ulcerated melanoma had an average age of 67,8 years and 59,8 years, respectively. The presence of distant metastasis presents a calculated risk estimate of 1,57 (95% CI 1,005 to 2,45) (p = 0,001). DISCUSSION. The higher percentage of ulcerated melanomas was found in older people, being statistically significant; however, none of the two variables had a statistical relationship with the presence of distant metastases. No relationship was found with the Breslow thickness and the presence of distant metastasis. CONCLUSION. The study by Positron-Emission Tomography- Computerized Tomography, is the most sensitive for the detection of distant metastasis; they represent a higher risk of mortality.

Una revisión de técnicas básicas de neuroimagen para el diagnóstico de enfermedades neurodegenerativas / A review of basic neuroimaging techniques in diagnosis of neurodegenerative diseases

RESUMEN Actualmente los trastornos neurodegenerativos representan un grave problema de salud pública con una prevalencia en ascenso mundial, si bien se ha tratado de armonizar criterios de diagnóstico para estas enfermedades, aún existen obstáculos que dificultan su correcta diferenciación, dando lugar a errores posteriores en etapas terapéuticas. El objeto de esta revisión pretende mostrar el potencial de tres técnicas de neuroimagen (tomografía por emisión de positrones, resonancia magnética de difusión, resonancia magnética estructural), en la identificación de biomarcadores que apoyen el proceso diagnóstico, en tres de las afecciones neurodegenerativas más comunes (enfermedad de Alzheimer, deterioro cognitivo leve, demencia frontotemporal). Se realizó una revisión mediante búsqueda electrónica de literatura. Se destaca el uso de bases de datos como ScienceDirect, PubMed, SciELO, IEEE, para localizar información sobre hallazgos estructurales y funcionales representativos y el poder diagnóstico de estas técnicas. Como lo confirman los estudios, las neuroimágenes ponen en evidencia su potencial para el establecimiento de patrones en la diferenciación de trastornos neurodegenerativos. La resonancia magnética estructural permanece como herramienta central de diagnóstico, en la identificación de patrones de atrofia corticales y subcorticales. Por otro lado, los avances en la tomografía por emisión de positrones han abierto la puerta a un diagnóstico ante-mortem, y una identificación preclínica temprana. Asimismo, el enfoque reciente de la resonancia magnética de difusión posibilita la caracterización de la integridad microestructural de la materia blanca cerebral y su relación con el deterioro cognitivo en el contexto de la enfermedad neurodegenerativa. Al integrar información de diferentes dominios se apoya las herramientas clínicamente aceptadas, garantizando mejor precisión del diagnóstico y la predicción de la aparición de la enfermedad. Los resultados demuestran que, a través de enfoques multimodales, colaboraciones multicentro, armonización de las metodologías y parámetros de adquisición, es posible incluir estas herramientas en el arsenal clínico para la identificación de estas enfermedades.

ABSTRACT Currently, neurodegenerative disorders represent a serious public health problem, with an increasing prevalence worldwide. Even though there has been an attempt to harmonize the diagnostic criteria for these disorders, there are still obstacles that hinder their correct differentiation, leading to subsequent errors in therapeutic stages. This review aims to demonstrate the potential of three neuroimaging techniques (positron emission tomography, diffusion-weighted magnetic resonance, and structural magnetic resonance) in the identification of discriminating biomarkers that support the diagnostic process in three of the most common neurodegenerative disorders (Alzheimer's disease, Mild Cognitive Impairment, frontotemporal dementia). A review was done via an electronic literature search. The use of ScienceDirect, PubMed, SciELO, and IEEE databases to find information on representative structural and functional findings, as well as the diagnostic power of these techniques, is highlighted. As the studies confirm, neuroimages show their potential to establish patterns in the differentiation of neurodegenerative disorders. The structural magnetic resonance remains as a central tool in the identification of cortical and subcortical atrophy patterns. On the other hand, advances in positron emission tomography have enabled not only antemortem diagnosis but also early preclinical identification. Likewise, the recent approach of diffusion magnetic resonance allows to characterizing the microstructural integrity of the cerebral white matter and its relationship with cognitive deterioration in the context of the neurodegenerative disorder. By integrating information from different domains, the clinically accepted tools are supported, guaranteeing better diagnostic accuracy and the prediction of the onset of the disorder. The results show that through multimodal approaches, multicenter collaborations, harmonization of methodologies and acquisition parameters it is possible to include these tools in the clinical repertoire for the identification of these disorders.

PET/CT 18F-FDG en carcinomatosis peritoneal: revisión de la fisiopatología y presentación de dos casos / PET/CT 18F-FDG in peritoneal carcinomatosis: A review of the pathophysiology and a presentation of two cases

Resumen La carcinomatosis peritoneal corresponde a la diseminación o extensión en la cavidad peritoneal de un cáncer originado en algún órgano o viscera del abdomen, generalmente asociado a tumores digestivos o ginecológicos. También puede presentarse en forma primaria en patologías como el mesotelioma y el adenocarcinoma primario peritoneal. Las imágenes anatómicas son el pilar de la evaluación de las siembras peritoneales, pero pequeños implantes neoplásicos pueden ser difíciles de detectar con TAC o resonancia magnética. El PET/CT 18F-FDG tiene el poder de mejorar la detección de las metástasis peritoneales. Está indicado en pacientes con marcadores tumorales elevados, con imágenes anatómicas negativas o no conclusivas y en pacientes seleccionados para citorreducción completa. Se suma a las imágenes convencionales en la detección y estadificación de la carcinomatosis peritoneal, y es una herramienta diagnóstica útil en el monitoreo de la respuesta a la terapia y en el seguimiento a largo plazo.

Abstract Peritoneal carcinomatosis is the dissemination or extension in the peritoneal cavity of a cancer originated in some organ or abdominal viscera, generally associated with digestive or gynaecological neoplasms. It can also occur in primary form, as in mesothelioma and primary peritoneal adenocarcinoma. Anatomical images are essential for the evaluation of peritoneal seeding, but small neoplastic implants can be difficult to detect with CT or MR imaging. PET/CT 18F-FDG can improve the detection of peritoneal metastases. It is indicated in patients with elevated tumour markers, with negative or inconclusive anatomical images, and in patients selected for complete debulking. PET/CT 18F-FDG adds to conventional images in the detection and staging of peritoneal carcinomatosis, and is a useful diagnostic tool in monitoring the response to therapy and in long-term follow-up.

Utilidad clínica del Antígeno Carcinoembrionario (ACE), Tomografía convencional (TC) y PET-CT en el diagnóstico de adenocarcinoma colorrectal recidivante / Clinical utility of Carcinoembryonic Antigen (ACE), conventional tomography (CT) and PET-CT in the diagnosis of recurrent colorectal adenocarcinoma

Introduction: Colorectal cancer is one of the most prevalent tumors in the world. In the surveillance setting of recurrent colorectal cancer, laboratory test like carncinoembryonic antigen (CEA) and imaging tests like computed tomography (CT) and positron emission tomography (PET/CT) are available. We performed this study to establish the predictive accuracy of these tests to an early identification of recurrent colorectal cáncer. Materials and Methods: Thirty six patients at stages I , III and IV, after single metastasis resection of colorectal cáncer were identified. We assessed the utility of CEA, CT and PET-CT in the follow-up of these patients to improve the diagnosis of recurrent disease. Results: Of 36 studied patients, 27 /75%) had recurrence; the median age was 61 year-old and the median lap-time 16 months. The PET PET/CT scan obtained the following results: sensitivity 96.7%, specificity 88.9%, positive predictive value 96.3%, negative predictive value 88.9%, positive likekihood ratio 8.7 and negative likelihood ratio 0.04. Discusion: The best tool to make diagnosis of colorectal cancer and its recurrence is PET­CT, however, none of these tests could make the diagnosis by themselves. It has to be confirmed by histopathologic studies plus other exams.

¿Un camino sin señal? Alzheimer la enfermedad del siglo, hallazgos por imagen en PET-CT / A dark path? Alzheimer, Disease of the Century, PET-CT findings

Introducción: Revisión de la literatura acerca de la demencia tipo Alzheimer, estableciendo definición, signos, síntomas y clasificación. Objetivo: Determinar la importancia del PET-CT con 18 FDG en el algoritmo de abordaje diagnóstico, teniendo en cuenta que es un método que proporciona una información detallada de las áreas anatómicas de hipometabolismo cerebral, con un protocolo de rápida adquisición sin complicaciones y de fácil acceso. Materiales y métodos: Se realizó revisión exhaustiva de la literatura actual, y de la base de datos de los estudios realizados en el PET-CT del CT Scanner del Sur, en pacientes con deterioro cognitivo utilizando 18 F-FDG.

Introduction: Revision of literature regarding Alzheimer type dementia, establishing a definition, signs, symptoms, and classification. Objective: To determine the importance of PET-CT with 18 FDG in the algorithm of diagnostic approach, taking into account that it is a method that enables detailed information of the anatomical areas of cerebral hyper-metabolism without complications and with an easy access. Materials and methods: A thorough revision of current literature was performed, and of the database of the studies performed in the PET-CT of the CT Scanner del Sur, in patients with cognitive deterioration using 18 F-FDG.

Importância da PET/CT como método auxiliar de diagnóstico nos tumores da região de cabeça e pescoço: estudo na cidade de Bauru-SP / Importancia del PET/CT como método auxiliar de diagnóstico en los tumores de la region de cabeza y cuello. Estudio en la ciudad de Bauru-SP / Importance of PET/CT as an auxiliary diagnostic method of head and neck tumors. A study in the city of Bauru, São Paulo

Objetivos: Determinar la ocurrencia de cancer de cabeza y cuello en exámenes de PET-CT 18F(FDG-18F) atravéz de la Evaluación de cuestionarios de la clínica de medicina nuclear (CDM) en la ciudad de Bauru-SP. Métodos: Fueron seleccionados 137 cuestionarios de examenes PET-CT 18F(FDG-18F) del archivo de la clínica de medicina nuclear de Bauru­SP, referente al periodo de agosto de 2012 a julio de 2016, las variables evaluadas fueron: tumor primario, subtipo, género, edad, hábitos, metástasis, recidiva, radioterapia y quimioterapia. Resultados: La edad media de los individuos evaluados fue de 47,6 años, con una edad mínima de 3 años y un máximo de 85 años, 60 (43,79%) varones y 77 (56,20%) mujeres. Fue posible identificar 13 neoplasias, 10 de ellas correspondiendo a la región de cabeza y cuello, el linfoma de Hodgkin fue la incidencia más alta de neoplasia. Los individuos de esta categoría tenían una edad promedio de 21 años, la quimioterapia y la radioterapia fueron las modalidades de tratamiento más utilizadas en estos individuos. Conclusão: El linfoma de Hodgkin y el linfoma no Hodgkin aparecieron como las neoplasias de mayor ocurrencia en la muestra estudiada. La indicación de crecimiento del examen PETCT se basó en la financiación pública de este servicio que garantizaría el mayor acceso de pacientes en los exámenes PET-CT.(AU)

Objectives: To identify the occurrence of head and neck cancer in PET-CT 18F (FDG-18F) tests, through the Evaluation of Nuclear Medicine Clinic (CDM) surveys, at Bauru city-SP. Methods: A total of 137 PET-CT 18F (FDG-18F) surveys were selected, from the Bauru-SP nuclear medicine clinic archives from August 2012 to July 2016, the evaluated variables were: primary tumor, subtype, gender, age, habits, metastasis, relapse, radiotherapy and chemotherapy. Results: The average age of the evaluated individuals was 47.6 years old, with a minimum age of 3 years old and maximum of 85 years old, 60 individuals (43.79%) were from male gender and 77 (56.20%) were from female gender. It was possible to identify 13 neoplasias, 10 of them corresponded to the head and neck region, Hodgkin's lymphoma was the highest rate occurrence of neoplasia. Individuals in this category had a average age of 21 years old, chemotherapy and radiotherapy were the most used treatment modalities in these individuals.Conclusion: Hodgkin's lymphoma and the lymphoma non Hodgkin appeared as the highest occurrence neoplasias on the studied sample. The growth indication of the exam PETCT based itself on public financing of this service that would guarantee the highest access of patients at exams PET-CT.(AU)

Objetivos: Identificar a ocorrência de câncer de cabeça e pesçoco em exames de PET-CT (FDG-18F) através de questionários da clínica de medicina nuclear (CDM) da cidade de Bauru -SP. Métodos: Foram selecionados 137 questionários de exames PET-CT (FDG-18F) do arquivo da clínica de medicina nuclear de Bauru­SP, referente ao período de agosto de 2012 a julho de 2016, as variáveis avaliadas foram: tumor primário, subtipo, gênero, idade, hábitos, metástase, recidiva, radioterapia e quimioterapia. Resultados: A média de idade dos indivíduos avaliados foi de 47.6 anos, com idade mínima de 3 anos e máxima de 85 anos, 60 indivíduos (43,79%) eram do gênero masculino e 77 (56,20%) do gênero feminino. Foi possível identificar 13 neoplasias, das quais 10 correspondiam à região de cabeça e pescoço, sendo o linfoma de Hodgkin a neoplasia com maior índice de ocorrência. Os indivíduos com essa neoplasia apresentavam média de idade de 21 anos, a quimioterapia e a radioterapia foram as modalidades de tratamento mais empregadas nesses indivíduos. Conclusão: O linfoma de Hodgkin e o Linfoma não Hodgkin apareceram como as neoplasias com maior ocorrência na amostra estudada, respectivamente. A crescente indicação ao exame PET-CT baseia-se no financiamento público deste serviço que garantiria maior acesso dos pacientes aos exames PET-CT.(AU)

(18)F-FDG PET/CT, cytoreductive surgery and intraperitoneal chemohyperthermia for the therapeutic management in peritoneal carcinomatosis: A pilot study.

AIM: Peritoneal carcinomatosis is a common evolution of neoplasms and the terminal stage of disease. A new therapeutic technique, based on the total surgical removal of peritoneal lesions (peritonectomy procedure - PP) combined with the intraperitoneal chemohyperthermia (IPCH), has been developed. Proper patient selection is mandatory for optimizing the results of treatment. The aim of this study was to investigate the role of [(18)F]fluoro-2-deoxy-d-glucose Positron Emission Tomography/Computed Tomography ((18)F-FDG PET/CT) in patients with peritoneal carcinosis selected to undergo PP and IPCH. Furthermore, we aimed to identify characteristic patterns of abdominal(18)F-FDG uptake and to correlate these patterns with available anatomic findings after surgery. METHODS: Patients with either histologically confirmed peritoneal carcinosis or suspected upon clinical follow-up and/or imaging findings were prospectively submitted to pre-surgery (18)F-FDG PET/CT scan. Only those patients without evidence of extra-peritoneal metastases at PET/CT scan were treated with PP and IPCH. RESULTS: 11 patients with peritoneal carcinomatosis (5 colorectal, 4 ovarian, 1 pancreatic) and 1 unknown primitive cancer, were eligible for the study. In all cases PET/CT scan showed multiple peritoneal implants. In 6 out of 11 cases (54%) metastases were evidenced by (18)F-FDG PET/CT: 2 cases with liver metastases; 1 case with bone metastases; 3 patients with lymph-node lesions. Two distinct imaging patterns, with focal or diffuse increased (18)F-FDG uptake, were recognized. CONCLUSIONS: PP+IPCH of patients selected by (18)F-FDG PET/CT seems to be safe and feasible. PET/CT scan appears as a reliable tool for the detection, characterization of peritoneal implants with potential impact in the therapeutic management of these patients.

[Use of 18F-FDG-positron emission tomography in presurgical evaluation of nonspecific or suspectious adrenal masses in non-oncologic patients]. / Utilidad de la tomografía de emisión de positrones con 18F-fluorodesoxiglucosa en la evaluación prequirúrgica de masas adrenales con características radiológicas inespecíficas o sospechosas de malignidad en pacientes sin cáncer.

BACKGROUND AND OBJECTIVE: Our purpose was to assess the utility of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) in pre-surgical characterization of adrenal masses. These masses were incidentally discovered in non-oncologic patients or during the study of endocrine hormone overproduction. These nodular lesions showed nonspecific or suspicious radiological features in the imaging tests routinely performed (CT and/or MRI). PATIENTS AND METHODS: This is a cross-sectional and prospective study in 12 patients with adrenal masses which were radiologically non-specific or suspicious for malignancy before adrenalectomy. An 18F-FDG-PET was made and quantitative FDG uptake (SUVmax) in the adrenal region (adrenal SUVmax) and liver (liver SUVmax), and the ratio SUVmax adrenal/liver was calculated. These parameters were related to the pathological findings. We evaluated the accuracy of the test by receive operating curves (ROC). RESULTS: The ROC to discriminate between benign and malignant lesions showed that the SUVmax was a better parameter than size or SUVmax adrenal/liver ratio. Using a SUVmax cutoff value≥3.1, sensitivity, specificity, positive and negative predictive value of the test were 100, 67, 50 and 100%, while a SUVmax adrenal/liver ratio≥1.8 showed a sensitivity, specificity, positive and negative predictive value of 67, 100, 100 and 90%, respectively. The presence of a SUVmax adrenal/liver ratio≥1.8 showed a statistically significant association with carcinoma occurrence. CONCLUSION: 18F-FDG-PET may be useful in the characterization of nonspecific or suspicious adrenal masses discovered in patients without a previous history of cancer. Its use in some cases could avoid unnecessary interventions.