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BACKGROUND: The worldwide dissemination of the coronavirus disease 2019 (COVID-19) pandemic has become a relevant problem for the German healthcare system and the whole of society within only a few weeks. Because visceral medicine is at the focal point many adjustments in procedures are necessary. MATERIAL AND METHODS: Necessary organizational structures and challenges in visceral medicine are described for urgent abdominal surgery after screening and for patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Therefore, an analysis of the current and relevant literature was performed and changes in the procedures in a hospital for basic and standard healthcare in Lower Rhine are described. RESULTS: This article describes the organizational structures and changes in a German hospital facing the crisis and management during the pandemic. These include establishment of a corona screening center at the hospital's main entrance and a multidisciplinary crisis management team. Specific internal guidelines were formulated for the management, confirmed by international experience and studies and regularly changed due to the requirements of the situation. CONCLUSION: In comparison to other countries the crisis reached hospitals in Germany with a clear delay and a relatively mild course. In order to be prepared for severely ill patients, adequate preparations could be made to meet the challenges on intensive care units, isolation wards, operating theaters and in endoscopy. The primary goal was the safeguarding of patients and employees. In the light of the pandemic medical rituals and habits need to be reconsidered.
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The European sea bass is one of the most important cultured fish in Europe and has a marked sexual growth dimorphism in favor of females. It is a gonochoristic species with polygenic sex determination, where a combination between still undifferentiated genetic factors and environmental temperature determines sex ratios. The molecular mechanisms responsible for gonadal sex differentiation are still unknown. Here, we sampled fish during the gonadal developmental period (110 to 350 days post fertilization, dpf), and performed a comprehensive transcriptomic study by using a species-specific microarray. This analysis uncovered sex-specific gonadal transcriptomic profiles at each stage of development, identifying larger number of differentially expressed genes in ovaries when compared to testis. The expression patterns of 54 reproduction-related genes were analyzed. We found that hsd17ß10 is a reliable marker of early ovarian differentiation. Further, three genes, pdgfb, snx1, and nfy, not previously related to fish sex differentiation, were tightly associated with testis development in the sea bass. Regarding signaling pathways, lysine degradation, bladder cancer, and NOD-like receptor signaling were enriched for ovarian development while eight pathways including basal transcription factors and steroid biosynthesis were enriched for testis development. Analysis of the transcription factor abundance showed an earlier increase in females than in males. Our results show that, although many players in the sex differentiation pathways are conserved among species, there are peculiarities in gene expression worth exploring. The genes identified in this study illustrate the diversity of players involved in fish sex differentiation and can become potential biomarkers for the management of sex ratios in the European sea bass and perhaps other cultured species.
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Bass/genética , Gônadas/crescimento & desenvolvimento , Desenvolvimento Sexual/genética , Transcriptoma/genética , Animais , Bass/crescimento & desenvolvimento , Feminino , MasculinoRESUMO
Nosocomial pneumonia (HAP) is a frequent complication of hospital care. Most data are available on ventilator-associated pneumonia. However, infections on general wards are increasing. A central issue are infections with multidrug resistant (MDR) pathogens which are difficult to treat in the empirical setting potentially leading to inappropriate use of antimicrobial therapy.This guideline update was compiled by an interdisciplinary group on the basis of a systematic literature review. Recommendations are made according to GRADE giving guidance for the diagnosis and treatment of HAP on the basis of quality of evidence and benefit/risk ratio.This guideline has two parts. First an update on epidemiology, spectrum of pathogens and antimicrobials is provided. In the second part recommendations for the management of diagnosis and treatment are given. New recommendations with respect to imaging, diagnosis of nosocomial viral pneumonia and prolonged infusion of antibacterial drugs have been added. The statements to risk factors for infections with MDR pathogens and recommendations for monotherapy vs combination therapy have been actualised. The importance of structured deescalation concepts and limitation of treatment duration is emphasized.
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Pneumonia Associada a Assistência à Saúde/diagnóstico , Pneumonia Associada a Assistência à Saúde/terapia , Adulto , Estudos Transversais , Alemanha , Pneumonia Associada a Assistência à Saúde/epidemiologia , HumanosRESUMO
Sunitinib treatment leads to improvement in progression-free survival in patients with advanced pancreatic neuroendocrine tumours (pNETs). However, limited data exist regarding the effectiveness, safety and tolerability in clinical practice. We present the results of the first detailed pNET cohort analysis since sunitinib was approved. Patients with advanced, differentiated pNET treated with sunitinib were retrospectively analysed. All patients had progressive disease before start of sunitinib treatment. Twenty-one patients, with a median age of 64 years (range 28-78), were included in this study. Nineteen patients could be analysed for treatment effectiveness. Twelve (57%) patients exhibited either a partial response (1 patient) or stable disease (11 patients) according to the RECIST criteria. The median progression-free survival was 7.0 months (95% CI 3.0-12.0); the probability of being event-free at 6 months was 52.6% (95% CI 28.4-72.1). Potential influencing factors as Ki-67 index, age or duration of disease did not show significant correlations with the response to sunitinib therapy. Considering the differences in patients' characteristics, sunitinib in daily practice showed effectiveness parameters similar to the phase III trial.
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Antineoplásicos/uso terapêutico , Indóis/uso terapêutico , Tumores Neuroendócrinos/tratamento farmacológico , Neoplasias Pancreáticas/tratamento farmacológico , Padrões de Prática Médica , Pirróis/uso terapêutico , Adulto , Idoso , Feminino , Seguimentos , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Tumores Neuroendócrinos/secundário , Neoplasias Pancreáticas/patologia , Estudos Retrospectivos , Sunitinibe , Resultado do TratamentoRESUMO
PURPOSE: To compare the apparent diffusion coefficient (ADC) in non-small cell lung cancer lesions with standardized uptake values (SUV) derived from combined 18F-fluoro-deoxy-glucose-positron emission tomography/magnetic resonance imaging (FDG-PET/MRI) and those derived from FDG-PET/CT. MATERIALS AND METHODS: In 18 consecutive patients with histologically proven NSCLC (17 men, 1 woman; mean age, 61 ± 12 years), whole-body FDG-PET/MRI was performed after whole-body FDG-PET/CT. Regions of interest (ROI) encompassing the entire primary tumor were drawn into FDG-PET/CT and FDG-PET/MR images to determine the maximum and mean standardized uptake value (SUVmax; SUVmean) and into ADC parameter maps to assess mean ADC values. Pearson's correlation coefficients were calculated to compare SUV and ADC values. RESULTS: The SUVmax of NSCLC was 12.3 ± 4.8 [mean ±SD], and the SUVmean was 7.2 ± 2.8 as assessed by FDG-PET/MRI. The SUVmax and SUVmean derived from FDG-PET/CT and FDG-PET/MRI correlated well (R = 0.93; p < 0.001 and R = 0.92; p < 0.001, respectively). The ADCmean of the pulmonary tumors was 187.9 ± 88.8 × 10-5 mm²/s [mean ± SD]. The ADCmean exhibited a significant inverse correlation with the SUVmax (R = -0.72; p < 0.001) as well as with the SUVmean assessed by FDG-PET/MRI (R = -0.71; p < 0.001). CONCLUSION: This simultaneous PET/MRI study corroborates the assumed significant inverse correlation between increased metabolic activity on FDG-PET and restricted diffusion on DWI in NSCLC.Citation Format:
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Carcinoma Pulmonar de Células não Pequenas/metabolismo , Fluordesoxiglucose F18/farmacocinética , Neoplasias Pulmonares/metabolismo , Imageamento por Ressonância Magnética/métodos , Imagem Multimodal/métodos , Tomografia por Emissão de Pósitrons/métodos , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Taxa de Depuração Metabólica , Pessoa de Meia-Idade , Variações Dependentes do Observador , Projetos Piloto , Compostos Radiofarmacêuticos/farmacocinética , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estatística como AssuntoRESUMO
Based on the results of a French cohort of postmenopausal women, it has been claimed that micronized progesterone does not enhance breast cancer risk. The impact of reproductive factors on breast cancer risk and a high prevalence of occult breast carcinomas at the time of menopause suggest an involvement of endogenous progesterone in the development of breast cancer. High mammographic density in the luteal phase and during treatment with estrogen/progestogen combinations reflect a change in the composition of mammary stroma and an increased water accumulation in the extracellular matrix which is caused by hygroscopic hyaluronan-proteoglycan aggregates. Proteoglycans are also involved in the regulation of proliferation, migration, and differentiation of epithelial cells and angiogenesis, and may influence malignant transformation of breast cells and progression of tumors. Reports on a lack of effect of estrogen/progesterone therapy on breast cancer risk may be rooted in a selective prescription to overweight women and/or to the very low progesterone serum levels after oral administration owing to a strong inactivation rate. The contradictory results concerning the proliferative effect of progesterone may be associated with a different local metabolism in normal compared to malignant breast tissue. Similar to other progestogens, hormone replacement therapy with progesterone seems to promote the development of breast cancer, provided that the progesterone serum levels have reached the threshold for endometrial protection.
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Neoplasias da Mama/etiologia , Neoplasias da Mama/prevenção & controle , Terapia de Reposição de Estrogênios/efeitos adversos , Progesterona/efeitos adversos , Adulto , Idoso , Densidade da Mama , Neoplasias da Mama/complicações , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Proliferação de Células , Estrogênios/análise , Estrogênios/sangue , Feminino , Hormônios Esteroides Gonadais/fisiologia , Humanos , Glândulas Mamárias Humanas/anormalidades , Glândulas Mamárias Humanas/embriologia , Glândulas Mamárias Humanas/crescimento & desenvolvimento , Glândulas Mamárias Humanas/patologia , Pessoa de Meia-Idade , Pós-Menopausa , Gravidez , Progesterona/uso terapêutico , Fatores de RiscoRESUMO
Endobronchial ultrasound-guided transbronchial fine needle aspiration (EBUS-TBNA) has become an important tool in the diagnosis and staging of malignant tumors of the lungs and mediastinum. Rapid on-site evaluation (ROSE) denotes a cytomorphological diagnostic procedure that allows assessment of the adequacy and accuracy of the material obtained during bronchoscopy within a few minutes in or near the bronchoscopy suite (on-site) using a quick staining of smears. This results in a significant decrease in the number of repeated bronchoscopy procedures required to recover an adequate biopsy sample and is therefore both time and cost effective. The obtained material can be further assessed as conventional cytological specimens or alternatively using the thin-prep technique for definitive cytopathology diagnosis and/or embedded in paraffin for immunohistochemical or molecular analyses such as DNA sequencing or flow cytometry.
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Neoplasias Pulmonares/patologia , Neoplasias do Mediastino/patologia , Algoritmos , Biópsia por Agulha Fina/instrumentação , Biópsia por Agulha , Broncoscopia/instrumentação , Técnicas Citológicas/métodos , Desenho de Equipamento , Humanos , Pulmão/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Metástase Linfática/patologia , Neoplasias do Mediastino/diagnóstico por imagem , Mediastinoscopia , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Estudos de Tempo e Movimento , Tomografia Computadorizada por Raios X , Ultrassonografia de Intervenção/instrumentaçãoRESUMO
BACKGROUND: Segmental resection in stage I non-small cell lung cancer (NSCLC) has been well described and is considered to have similar survival rates as lobectomy but with increased rates of local tumour recurrence due to inadequate parenchymal margins. In consequence, today segmentectomy is only performed when the tumour is smaller than 2 cm. METHODS: Three-dimensional reconstructions from 11 thin-slice CT scans of bronchopulmonary segments were generated, and virtual spherical tumours were placed over the segments, respecting all segmental borders. As a next step, virtual parenchymal safety margins of 2 cm and 3 cm were subtracted and the size of the remaining tumour calculated. RESULTS: The maximum tumour diameters with a 30-mm parenchymal safety margin ranged from 26.1 mm in right-sided segments 7 + 8 to 59.8 mm in the left apical segments 1-3. CONCLUSIONS: Using a three-dimensional reconstruction of lung CT scans, we demonstrated that segmentectomy or resection of segmental groups should be feasible with adequate margins, even for larger tumours in selected cases.
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Brônquios/cirurgia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Simulação por Computador , Neoplasias Pulmonares/cirurgia , Recidiva Local de Neoplasia/prevenção & controle , Pneumonectomia , Brônquios/patologia , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/patologia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Estadiamento de Neoplasias , Neoplasia Residual , Seleção de Pacientes , Valor Preditivo dos Testes , Interpretação de Imagem Radiográfica Assistida por Computador , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Carga TumoralRESUMO
HISTORY AND CLINICAL SYMPTOMS: A 58-year-old man was admitted to our hospital with acute chest pain and subfebrile temperatures. Two years ago, endovascular aortic stent-graft placement had been performed for acute type B aortic dissection complicated by malperfusion syndrome. DIAGNOSTIC ASSESSMENT: CT angiography showed a discrete soft-tissue attenuation mass between the aorta and esophagus. The patient developed progressive swallow disorder and esophago-gastro-duodenoscopy demonstrated deep esophageal ulcerations at the level of the implanted aortic stent-graft. Intravenous treatment with broad spectrum antibiotics was started. The FDG-PET/CT scan showed increased FDG uptake and air entrapment in the affected region establishing the diagnosis of aortoesophageal fistula formation. THERAPY AND OUTCOME: Given the generally poor condition of the patient and the high risk of any aggressive surgical intervention, a new limited surgical approach was chosen consisting of open transthoracic esophageal resection, blind closure of the stomach and cervical esophagostomy. A percutaneous endoscopic gastrostomy tube was placed. After three months, esophageal continuity was restored by retrosternal colon interposition. The presented therapeutic management resulted in a full recovery of the patient. CONCLUSION: Aortoesophageal fistula is a rare complication of thoracic aortic stent-graft placement. Patient may present with unspecific symptoms such as fever and rised inflammatory markers, but may also present with massive upper gastrointestinal bleeding. The herein presented limited therapy with esophageal resection represents a promising to the otherwise difficult therapy of aortoesophageal fistula.
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Angioplastia , Aneurisma da Aorta Torácica/cirurgia , Doenças da Aorta/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Aortografia , Implante de Prótese Vascular , Fístula Esofágica/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Stents , Tomografia Computadorizada por Raios X , Fístula Vascular/diagnóstico por imagem , Anastomose Cirúrgica , Doenças da Aorta/cirurgia , Colo/transplante , Endoscopia do Sistema Digestório , Fístula Esofágica/cirurgia , Esôfago/cirurgia , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Mediastinite/diagnóstico por imagem , Mediastinite/cirurgia , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Complicações Pós-Operatórias/cirurgia , Reoperação , Fístula Vascular/cirurgiaRESUMO
OBJECTIVES: The superiority of left internal thoracic artery (LITA) grafting to the left anterior descending artery (LAD) is well established. Patency rates of 80%-90% have been reported at 10-year follow-up. However, the superiority of sequential LITA grafting has not been proven. Our aim was to compare patency rates after sequential LITA grafting to a diagonal branch and the LAD with patency rates of LITA grafting to the LAD and separate vein grafting to a diagonal branch. METHODS: A total of 58 coronary artery bypass graft (CABG) patients, operated on between 01/2000 and 12/2002, underwent multi-slice computed tomography (MSCT) between 2006 and 2008. Of these patients, 29 had undergone sequential LITA grafting to a diagonal branch and to the LAD ("Sequential" Group), while in 29 the LAD and a diagonal branch were separately grafted with LITA and vein ("Separate" Group). Patencies of all anastomoses were investigated. RESULTS: Mean follow-up was 1958±208 days. The patency rate of the LAD anastomosis was 100% in the Sequential Group and 93% in the Separate Group (p=0.04). The patency rate of the diagonal branch anastomosis was 100% in the Sequential Group and 89% in the Separate Group (p=0.04). Mean intraoperative flow on LITA graft was not different between groups (69±8ml/min in the Sequential Group and 68±9ml/min in the Separate Group, p=n.s.). CONCLUSION: Patency rates of both the LAD and the diagonal branch anastomoses were higher after sequential arterial grafting compared with separate arterial and venous grafting at 5-year follow-up. This indicates that, with regard to the antero-lateral wall of the left ventricle, there is an advantage to sequential arterial grafting compared with separate arterial and venous grafting.
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Angiografia Coronária , Ponte de Artéria Coronária/métodos , Doença das Coronárias/cirurgia , Reestenose Coronária/diagnóstico por imagem , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Anastomose de Artéria Torácica Interna-Coronária/métodos , Tomografia Computadorizada Espiral , Veias/transplante , Idoso , Terapia Combinada , Doença das Coronárias/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: Traumatic injury of supra-aortic vessels remains a challenge in the initial diagnostics of severely injured patients. The presented prospective study analyzed the impact of multislice computed tomography angiography (CTA) as the primary diagnostic method. METHODS: Patients with the following criteria were included and screened for a dissection of the supra-aortic vessels: a) admission directly from the scene, b) resuscitation room treatment indicated by the official criteria of the DGU (German Society for the Surgery of Trauma), c) suspected blunt trauma to head or trunk as well as d) age over 16 years. RESULTS: During a period of 18 months 374 patients were treated for blunt trauma in the resuscitation room. In 176 cases CTA of the supra-aortic vessels was performed and pathological findings were observed in 16 patients. In 4 cases (2%) a traumatic dissection of supra-aortal vessels was diagnosed and confirmed by magnetic resonance imaging (MRI). All patients received heparin in a PTT effective dosage for 2 weeks and after rehabilitation there were no neurologic deficits. CONCLUSION: Traumatic supra-aortic dissection was found in 2% of cases in the presented study group. The mechanisms of injury were not distinct in this group. Essentially MSCT angiography screening was demonstrated to be a safe diagnostic tool.
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Angiografia/estatística & dados numéricos , Aorta/lesões , Aortografia/estatística & dados numéricos , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/epidemiologia , Programas de Rastreamento/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/epidemiologiaRESUMO
The effects of extended regimens of combined oral contraceptives (COCs) on carbohydrate metabolism are largely unknown. The present study compared the effects of a COC containing 30 microg ethinylestradiol and 2 mg dienogest (EE/DNG) in conventional and extended-cycle regimen over 1 year. Parameters of carbohydrate metabolism were measured in 59 women treated with EE/DNG either conventionally (13 cycles of 21+7 days) or in extended-cycle regimen (4 cycles of 84+7 days). Blood samples were taken in a control cycle, and at 3 and 12 months of treatment. The mean levels of HbA1c and fasting glucose levels remained stable in both conventional and extended-regimen of EE/DNG. The mean levels of fasting insulin and C-peptide underwent comparable increases in both regimens, suggesting a similar readjustment of glucose metabolism via slightly increased insulin secretion. For both regimens, the response to the oral glucose tolerance test (OGTT) showed a slightly impaired glucose tolerance and insulin resistance at 3 months. These changes improved or returned to baseline at 12 months. Accordingly, the mean index for insulin resistance (homeostasis model assessment of insulin resistance, HOMA-IR) increased and the mean insulin sensitivity index [ISI (composite)] decreased modestly in both groups. The present study demonstrates that there are no statistically significant differences between the effects of conventional and extended-cycle treatment on carbohydrate metabolism over 1 year of treatment. In general, the effects of both regimens were moderate and mostly transient.
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Metabolismo dos Carboidratos/efeitos dos fármacos , Anticoncepcionais Orais Hormonais/efeitos adversos , Etinilestradiol/efeitos adversos , Nandrolona/análogos & derivados , Adolescente , Adulto , Glicemia/metabolismo , Peptídeo C/sangue , Feminino , Teste de Tolerância a Glucose , Hemoglobinas Glicadas/metabolismo , Humanos , Insulina/sangue , Resistência à Insulina/fisiologia , Menstruação/efeitos dos fármacos , Nandrolona/efeitos adversos , Estudos Prospectivos , Adulto JovemAssuntos
Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/prevenção & controle , Anticoncepcionais Orais Hormonais/efeitos adversos , Estrogênios/efeitos adversos , Pós-Menopausa , Progestinas/administração & dosagem , Trombose Venosa/induzido quimicamente , Trombose Venosa/prevenção & controle , Climatério , Feminino , Humanos , SuíçaRESUMO
AIMS: To elucidate the relationship between tobacco smoking and depression, and to estimate the impact of other substance dependencies. DESIGN: Cross-sectional. PARTICIPANTS: A total of 1,849 men and women were interviewed face-to-face using a validated structured questionnaire. According to their tobacco smoking behavior, participants were grouped into never smokers, ex-smokers and current smokers. MEASUREMENTS: Data were generated through the WHO/ISBRA study, an international multicenter study with a cross-sectional design. A standardized questionnaire was administered face-to-face by trained interviewers. Logistic regression analysis was used to predict depression. RESULTS: There was a significant difference across the 3 smoking groups in the number of subjects who had major depression (DSM-IV) during their lifetime. The highest rate of depressives was found in current smokers (23.7%), the lowest rate in never smokers (6.2%), while the rate of those who had quit smoking (14.6%) was between both. In a logistic regression analysis, alcohol dependence (both current and during lifetime) as well as cocaine dependence were significant predictors of depression. However, the association between smoking and depression still remained statistically significant. CONCLUSIONS: This study adds support to the evidence that smoking is linked to depression. It also elucidates the importance of taking into account alcohol and cocaine dependence since they have a significant impact on the relationship between smoking and depression.
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Transtorno Depressivo Maior/epidemiologia , Tabagismo/epidemiologia , Adulto , Alcoolismo/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Estudos Transversais , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Prevalência , Inquéritos e Questionários , Organização Mundial da SaúdeRESUMO
An accessory liver is a rare developmental anomaly. There are two subtypes: the accessory liver lobe (ALL), which is connected to the liver and the true ectopic liver. An accessory liver is usually of no clinical relevance in spite of the very rare cases in which torsion or other complications may cause serious problems. This anomaly should not be misinterpreted as a malignant tumour. We report the case of an accessory liver lobe, located below the left diaphragm, which was misdiagnosed as a metastasis of a known malignant melanoma. The diagnosis ALL was established by a biopsy under guidance of magnetic resonance tomography (MRT). In our opinion, an accessory liver and its appearance should be known, to include this entity in differential diagnosis of perihepatic masses.
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Neoplasias Hepáticas/diagnóstico , Fígado/anormalidades , Biópsia , Diagnóstico Diferencial , Feminino , Humanos , Perna (Membro) , Fígado/diagnóstico por imagem , Fígado/patologia , Neoplasias Hepáticas/secundário , Imageamento por Ressonância Magnética , Melanoma/diagnóstico , Melanoma/patologia , Melanoma/secundário , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Radiografia Abdominal , Tomografia Computadorizada por Raios XRESUMO
UNLABELLED: We investigated the efficacy of combined FDG-PET/CT imaging for the diagnosis of small-size uveal melanomas and the feasibility of combining separate, high-resolution (HR) FDG-PET with MRI for its improved localization and detection. PATIENTS, METHODS: 3 patients with small-size uveal melanomas (0.2-1.5 ml) were imaged on a combined whole-body PET/CT, a HR brain-PET, and a 1.5 T MRI. Static, contrast-enhanced FDG-PET/CT imaging was performed of head and torso with CT contrast enhancement. HR PET imaging was performed in dynamic mode 0-180 min post-injection of FDG. MRI imaging was performed using a high-resolution small-loop-coil placed over the eye in question with T2-3D-TSE and T1-3D-SE with 18 ml Gd-contrast. Patients had their eyes shaded during the scans. Lesion visibility on high-resolution FDG-PET images was graded for confidence: 1: none, 2: suggestive, 3: clear. Mean tumour activity was calculated for summed image frames that resulted in confidence grades 2 and 3. Whole-body FDG-PET/CT images were reviewed for lesions. PET-MRI and PET/CT-MRI images of the head were co-registered for potentially improved lesion delineation. RESULTS: Whole-body FDG-PET/CT images of 3/3 patients were positive for uveal melanomas and negative for disseminated disease. HR FDG-PET was positive already in the early time frames. One patient exhibited rising tumour activity with increasing uptake time on FDG-PET. MRI images of the eye were co-registered successfully to FDG-PET/CT using a manual alignment approach. CONCLUSIONS: Small-size uveal melanomas can be detected with whole-body FDG-PET/CT. This feasibility study suggests the exploration of HR FDG-PET in order to provide additional diagnostic information on patients with uveal melanomas. First results support extended uptake times and high-sensitivity PET for improved tumour visibility. MRI/PET co-registration is feasible and provides correlated functional and anatomical information that may support alternative therapy regimens.
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Neoplasias Uveais/diagnóstico por imagem , Fluordesoxiglucose F18 , Humanos , Imageamento por Ressonância Magnética/métodos , Melanoma/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Radiografia , Radioisótopos , Sensibilidade e Especificidade , Neoplasias Uveais/diagnóstico , Irradiação Corporal TotalRESUMO
PURPOSE: This study sought to compare iodine-124 positron emission tomography/computed tomography (124I-PET/CT) and 2-[18F]fluoro-2-deoxy-D: -glucose- (FDG-) PET in the detection of recurrent differentiated thyroid carcinoma (DTC) lesions in patients with increasing serum thyroglobulin (Tg), Tg-antibodies, or both, but without pathological cervical ultrasonography. We assessed the lesion detection accuracy of 124I-PET alone, CT alone, (124)I-PET/CT, FDG-PET, and all these modalities combined. MATERIAL AND METHODS: The study included 21 patients (9 follicular, 12 papillary DTC) who had been rendered disease-free by thyroidectomy and radioiodine treatment (RIT) and followed up for 21-275 months after the last RIT. In all patients, FDG-PET was performed first. Within 1 week, 124I-PET/CT was performed 24 h after oral administration of 43 +/- 11 MBq 124I. Imaging results were correlated with further clinical follow-up with (n = 12) or without (n = 9) post-study histology as the reference standard. RESULTS: The sensitivities for DTC lesion detection were: 124I-PET, 49%; CT, 67%; 124I-PET/CT, 80%; FDG-PET, 70%; and all modalities combined, 91%. For local recurrences (distant metastases), the sensitivities were: 124I-PET, 60% (45%); CT, 20% (84%); and FDG-PET, 65% (71%). One-third of lesions demonstrated pathological tracer uptake with both 124I- and FDG-PET, while two-thirds were positive with only one of these modalities. CONCLUSION: Used together, 124I-PET and CT allow localization of foci of highly specific 124I uptake as well as non-iodine-avid lesions. The combination of 124I-PET/CT and FDG-PET improves restaging in recurrent DTC by enabling detection on whole-body scans of local recurrence or metastases that are often not found if only one of the methods or other imaging modalities are applied.