Los retos en la evaluación radiológica de las metástasis cerebrales, más allá de la progresión / Challenges in radiological evaluation of brain metastases, beyond progression

La resonancia magnética es la piedra angular en la evaluación de las metástasis cerebrales. Los retos clínicos residen en discriminar las metástasis de imitadores como infecciones o tumores primarios y en evaluar la respuesta al tratamiento. Este, en ocasiones, condiciona un crecimiento, que debe encuadrarse como una pseudoprogresión o una radionecrosis, ambos fenómenos inflamatorios atribuibles al mismo, o bien considerarse como una recurrencia. Para responder a estas necesidades, las técnicas de imagen son objeto de constantes investigaciones. No obstante, un crecimiento exponencial tras la radioterapia debe interpretarse con cautela, incluso ante resultados sospechosos de progresión por técnicas avanzadas, ya que puede tratarse de una radionecrosis. El objetivo de este trabajo es familiarizar al lector con los fenómenos inflamatorios de las metástasis cerebrales tratadas con radioterapia y describir dos signos radiológicos relacionados: la «nube inflamatoria» y el «realce en anillo incompleto», con el fin de adoptar un manejo conservador en estos casos.(AU)

MRI is the cornerstone in the evaluation of brain metastases. The clinical challenges lie in discriminating metastases from mimickers such as infections or primary tumors and in evaluating the response to treatment. The latter sometimes leads to growth, which must be framed as pseudo-progression or radionecrosis, both inflammatory phenomena attributable to treatment, or be considered as recurrence. To meet these needs, imaging techniques are the subject of constant research. However, an exponential growth after radiotherapy must be interpreted with caution, even in the presence of results suspicious of tumor progression by advanced techniques, because it may be due to inflammatory changes. The aim of this paper is to familiarize the reader with inflammatory phenomena of brain metastases treated with radiotherapy and to describe two related radiological signs: «the inflammatory cloud» and «incomplete ring enhancement», in order to adopt a conservative management with close follow-up.(AU)

Challenges in radiological evaluation of brain metastases, beyond progression.

MRI is the cornerstone in the evaluation of brain metastases. The clinical challenges lie in discriminating metastases from mimickers such as infections or primary tumors and in evaluating the response to treatment. The latter sometimes leads to growth, which must be framed as pseudo-progression or radionecrosis, both inflammatory phenomena attributable to treatment, or be considered as recurrence. To meet these needs, imaging techniques are the subject of constant research. However, an exponential growth after radiotherapy must be interpreted with caution, even in the presence of results suspicious of tumor progression by advanced techniques, because it may be due to inflammatory changes. The aim of this paper is to familiarize the reader with inflammatory phenomena of brain metastases treated with radiotherapy and to describe two related radiological signs: "the inflammatory cloud" and "incomplete ring enhancement", in order to adopt a conservative management with close follow-up.

PET/RM con 18F-colina en la sospecha de recurrencia del carcinoma de próstata / 18F-choline PET/MRI in suspected recurrence of prostate carcinoma

Objetivo: Evaluar la utilidad de la PET/RM con 18F-colina simultánea en la sospecha de recurrencia del carcinoma de próstata y relacionar su tasa de detección de enfermedad con variables analíticas y anatomopatológicas. Material y métodos: Estudio retrospectivo de 27 pacientes con carcinoma de próstata que recibieron terapia local como tratamiento primario, a quienes se les realizó una PET/RM con 18F-colina por sospecha de recurrencia (elevación mantenida de los niveles de PSA). Los hallazgos patológicos de la PET/RM con 18F-colina fueron validados mediante el análisis anatomopatológico, otras pruebas de imagen o por la respuesta bioquímica al tratamiento oncológico. Resultados: La PET/RM con 18F-colina detectó enfermedad en 15 de los 27 pacientes (tasa de detección del 55,56%); 4 (15%) presentaron recurrencia exclusivamente local, 5 (18%) metástasis ganglionares y 7 (26%) metástasis óseas. El PSA medio (PSAmed) a la realización del estudio fue de 2,94ng/mL (rango 0,18-10ng/mL). Los pacientes con PET/RM positiva presentaron un PSAmed de 3,70ng/mL (rango 0,24-10ng/mL), mayor que los pacientes con PET/RM negativa, PSAmed de 1,97ng/mL (rango 0,18-4,38ng/mL), aunque sin diferencias estadísticamente significativas. La puntuación Gleason al diagnóstico de los pacientes con estudio positivo fue de 7,33 (rango 6-9), y la de los pacientes con estudio negativo fue de 7 (rango 6-9), sin diferencias estadísticamente significativas. Conclusión: La tasa de detección de la PET/RM con 18F-colina fue considerable pese a los valores relativamente bajos de PSA en nuestra muestra. La influencia de la puntuación Gleason y del nivel de PSA en la tasa de detección de la PET/RM con 18F-colina no fue estadísticamente significativa

Objective: To evaluate the usefulness of simultaneous 18F-choline PET/MRI in the suspicion of prostate cancer recurrence and to relate 18F-choline PET/MRI detection rate with analytical and pathological variables. Material and methods: 27 patients with prostate cancer who received local therapy as primary treatment underwent a 18F-choline PET/MRI due to suspicion of recurrence (persistently rising serum PSA level). 18F-choline PET/MRI findings were validated by anatomopathological analysis, other imaging tests or by biochemical response to oncological treatment. Results: 18F-choline PET/MRI detected disease in 15 of 27 patients (detection rate 55.56%). 4 (15%) presented exclusively local recurrence, 5 (18%) lymph node metastases and 7 (26%) bone metastases. Mean PSA (PSAmed) at study time was 2.94ng/mL (range 0.18-10ng/mL). PSAmed in patients with positive PET/MRI was 3.70ng/mL (range 0.24-10ng/mL), higher than in patients with negative PET/MRI, PSAmed 1.97ng/mL (range 0.18-4.38ng/mL), although without statistically significant differences. Gleason score at diagnosis in patients with a positive study was 7.33 (range 6-9) and in patients with a negative study was 7 (range 6-9), without statistically significant differences. Conclusion: 18F-choline PET/MRI detection rate was considerable despite the relatively low PSA values in our sample. The influence of Gleason score and PSA level on 18F-choline PET/MRI detection rate was not statistically significant

18F-choline PET/MRI in suspected recurrence of prostate carcinoma. / PET/RM con 18F-colina en la sospecha de recurrencia del carcinoma de próstata.

OBJECTIVE: To evaluate the usefulness of simultaneous 18F-choline PET/MRI in the suspicion of prostate cancer recurrence and to relate 18F-choline PET/MRI detection rate with analytical and pathological variables. MATERIAL AND METHODS: 27 patients with prostate cancer who received local therapy as primary treatment underwent a 18F-choline PET/MRI due to suspicion of recurrence (persistently rising serum PSA level). 18F-choline PET/MRI findings were validated by anatomopathological analysis, other imaging tests or by biochemical response to oncological treatment. RESULTS: 18F-choline PET/MRI detected disease in 15 of 27 patients (detection rate 55.56%). 4 (15%) presented exclusively local recurrence, 5 (18%) lymph node metastases and 7 (26%) bone metastases. Mean PSA (PSAmed) at study time was 2.94ng/mL (range 0.18-10ng/mL). PSAmed in patients with positive PET/MRI was 3.70ng/mL (range 0.24-10ng/mL), higher than in patients with negative PET/MRI, PSAmed 1.97ng/mL (range 0.18-4.38ng/mL), although without statistically significant differences. Gleason score at diagnosis in patients with a positive study was 7.33 (range 6-9) and in patients with a negative study was 7 (range 6-9), without statistically significant differences. CONCLUSION: 18F-choline PET/MRI detection rate was considerable despite the relatively low PSA values in our sample. The influence of Gleason score and PSA level on 18F-choline PET/MRI detection rate was not statistically significant.

PET/RM simultánea vs. PET/TC en oncología. Una revisión sistemática / Simultaneous PET/MRI vs PET/CT in oncology. A systematic review

Objetivo. El objetivo de esta revisión fue evaluar la capacidad diagnóstica de la PET/RM simultánea en oncología, comparándola con la de la PET/TC, basándonos en la evidencia disponible. Material y métodos. Se realizó una búsqueda sistemática en las bases de datos Medline y Embase hasta el 21 de enero de 2016, para identificar artículos clínicos originales que realizasen un análisis comparativo entre PET/RM simultánea y PET/TC en pacientes oncológicos. Resultados. Se obtuvo un total de 57 artículos, distribuidos por enfermedades del siguiente modo: carcinoma de cabeza y cuello (5), pulmón y nódulos pulmonares (13), carcinoma colorrectal (1), lesiones hepáticas (2), incidentalomas abdominales (1), tumores neuroendocrinos (2), carcinoma de tiroides (2), carcinoma de mama (3), tumores ginecológicos (2), carcinoma de próstata (4), linfoma (2), mieloma múltiple (1), metástasis óseas (3), tumores intracraneales (2), oncología pediátrica (1) y neoplasias diversas (13). En la mayoría de las enfermedades oncológicas, el rendimiento diagnóstico de la PET/RM simultánea fue similar o incluso superior al de la PET/TC. Sin embargo, la PET/TC fue superior en la detección de pequeños nódulos pulmonares. Conclusión. La PET/RM simultánea en oncología es factible, obteniendo resultados al menos equiparables a los de la PET/TC, con menor exposición a radiaciones ionizantes. No obstante, la evidencia disponible aún es limitada, y son necesarios estudios que incluyan a un mayor número de pacientes y neoplasias para establecer las indicaciones de la PET/RM e identificar los protocolos adecuados a cada enfermedad (AU)

Objective. The aim of this review was to evaluate the diagnostic performance of simultaneous PET/MRI in oncology compared with that of PET/CT, based upon the available evidence. Material and methods. A systematic search was performed in the Medline and Embase databases to identify original clinical articles published up to 21 January 2016, in order to compare simultaneous PET/MRI and PET/CT in oncology patients. Results. A total of 57 articles were obtained that included various diseases: head and neck cancer (5), lung cancer and lung nodules (13), colorectal cancer (1), liver lesions (2), abdominal incidentalomas (1), neuroendocrine tumours (2), thyroid carcinoma (2), breast cancer (3), gynaecological cancer (2), prostate cancer (4), lymphoma (2), multiple myeloma (1), bone metastases (3), intracranial tumours (2), paediatric oncology (1) and various tumours (13). Diagnostic performance of simultaneous PET/MRI was similar or even better to that of PET/CT in most oncological diseases. However, PET/CT was superior for small lung nodule detection. Conclusion. Simultaneous PET/MRI in oncology is feasible, performing at least equally as well as PET/CT, with lower radiation exposure. However, available evidence is still limited. Studies including more patients and tumours are needed to establish PET/MRI indications and to identify appropriate protocols for each disease (AU)

PET/RM: ¿un lujo o una necesidad? / PET/MRI: a luxury or a necessity?

La PET/RM es una nueva técnica multimodalidad con un futuro prometedor en el diagnóstico por imagen. Las limitaciones técnicas se están superando. La interferencia entre ambos sistemas (PET y RM) parece estar resuelta. La corrección de atenuación de PET mediante los datos de RM se puede realizar con garantía. El tiempo por estudio es aceptable y el estudio es tolerable con porcentajes de claustrofobia similares a los de RM. La cuantificación mediante los parámetros habituales como el Standardized Uptake Value (SUV) se correlaciona bastante bien entre ambos sistemas. Sin embargo, la PET/TC ofrece en estos momentos mejores datos de tiempo por estudio, costo por estudio y confortabilidad. Una gran ventaja de la PET/RM respecto a la PET/TC es la menor exposición del paciente a radiaciones, lo que la hace especialmente recomendable en pacientes pediátricos o adolescentes que requieran uno o varios estudios PET. Las indicaciones de la PET/RM en principio son las mismas que las de la PET/TC, teniendo en cuenta que en los casos en que la RM es superior a la TC, la PET/RM es superior a la PET/TC. Esta superioridad es clara en muchos de los tumores de tejidos blandos. Por otro lado, en patología neurológica y en algunos tumores como los de mama es habitual realizar, por un lado, un estudio PET/TC, y por otro, una RM. La realización de un único estudio PET/RM sustituye con evidente ventaja a los otros dos. La aplicación de la RM permite además aplicar otras correcciones a la PET, como la corrección del movimiento o del efecto de volumen parcial. La mejor resolución espacial de la RM hace posible transferir a las imágenes de PET áreas o volúmenes de interés de pequeño tamaño bien delimitados en la RM, para medir biomarcadores de la PET en esas áreas. La riqueza de información de ambas técnicas abre unas inmensas posibilidades de correlación entre ambas (AU)

PET/MRI is a new multimodality technique with a promising future in diagnostic imaging. Technical limitations are being overcome. Interference between the two systems (PET and MRI) seems to have been resolved. MRI-based PET attenuation correction can be performed safely. Scan time is acceptable and the study is tolerable, with claustrophobia prevalence similar to that of MRI. Quantification with common parameters, such as Standardized Uptake Value (SUV), shows a fairly good correlation between both systems. However, PET/CT currently provides better results in scan time, scan costs, and patient comfort. Less patient radiation exposure is a big advantage of PET/MRI over PET/CT, which makes it particularly recommended in paediatric and adolescent patients requiring one or more studies. PET/MRI indications are the same as those of PET/CT, given that in cases where MRI is superior to CT, PET/MRI is superior to PET/CT. This superiority is clear in many soft tissue tumours. Moreover, it is common to perform both PET/CT and MRI in neurological diseases, as well as in some tumours, such as breast cancer. A single PET/MRI study replaces both with obvious benefit. MRI also allows other MRI-based PET corrections, such as motion or partial volume effect corrections. The better spatial resolution of MRI allows the transfer of well-defined MRI areas or small volumes of interest to PET image, in order to measure PET biomarkers in these areas. The richness of information of both techniques opens up immense possibilities of synergistic correlation between them (AU)

Simultaneous PET/MRI vs PET/CT in oncology. A systematic review. / PET/RM simultánea vs. PET/TC en oncología. Una revisión sistemática.

OBJECTIVE: The aim of this review was to evaluate the diagnostic performance of simultaneous PET/MRI in oncology compared with that of PET/CT, based upon the available evidence. MATERIAL AND METHODS: A systematic search was performed in the Medline and Embase databases to identify original clinical articles published up to 21 January 2016, in order to compare simultaneous PET/MRI and PET/CT in oncology patients. RESULTS: A total of 57 articles were obtained that included various diseases: head and neck cancer (5), lung cancer and lung nodules (13), colorectal cancer (1), liver lesions (2), abdominal incidentalomas (1), neuroendocrine tumours (2), thyroid carcinoma (2), breast cancer (3), gynaecological cancer (2), prostate cancer (4), lymphoma (2), multiple myeloma (1), bone metastases (3), intracranial tumours (2), paediatric oncology (1) and various tumours (13). Diagnostic performance of simultaneous PET/MRI was similar or even better to that of PET/CT in most oncological diseases. However, PET/CT was superior for small lung nodule detection. CONCLUSION: Simultaneous PET/MRI in oncology is feasible, performing at least equally as well as PET/CT, with lower radiation exposure. However, available evidence is still limited. Studies including more patients and tumours are needed to establish PET/MRI indications and to identify appropriate protocols for each disease.

PET/MRI: A luxury or a necessity? / PET/RM: ¿un lujo o una necesidad?

PET/MRI is a new multimodality technique with a promising future in diagnostic imaging. Technical limitations are being overcome. Interference between the two systems (PET and MRI) seems to have been resolved. MRI-based PET attenuation correction can be performed safely. Scan time is acceptable and the study is tolerable, with claustrophobia prevalence similar to that of MRI. Quantification with common parameters, such as Standardized Uptake Value (SUV), shows a fairly good correlation between both systems. However, PET/CT currently provides better results in scan time, scan costs, and patient comfort. Less patient radiation exposure is a big advantage of PET/MRI over PET/CT, which makes it particularly recommended in paediatric and adolescent patients requiring one or more studies. PET/MRI indications are the same as those of PET/CT, given that in cases where MRI is superior to CT, PET/MRI is superior to PET/CT. This superiority is clear in many soft tissue tumours. Moreover, it is common to perform both PET/CT and MRI in neurological diseases, as well as in some tumours, such as breast cancer. A single PET/MRI study replaces both with obvious benefit. MRI also allows other MRI-based PET corrections, such as motion or partial volume effect corrections. The better spatial resolution of MRI allows the transfer of well-defined MRI areas or small volumes of interest to PET image, in order to measure PET biomarkers in these areas. The richness of information of both techniques opens up immense possibilities of synergistic correlation between them.

Aplicación clínica de la tomografía por emisión de positrones con fluorocolina en el cáncer de próstata recurrente / Clinical Application of Fluorocholine Positron Emission Tomography in Relapsed Prostate Cancer

No disponible

Detección de recidiva pleuropulmonar en carcinoma de mama / Detection of pleuropulmonary relapse in breast cancer

No disponible

[Helical CT and perfusion scintigraphy: diagnosis of pulmonary embolus in the clinical practice]. / TAC helicoidal y gammagrafía de perfusión pulmonar: diagnóstico de tromboembolismo pulmonar en la práctica clínica.

UNLABELLED: The purpose of this study was to compare helical CT with lung perfusion scintigraphy (LPS) as the initial investigations of patients with suspected pulmonary embolism (PE). PATIENTS AND METHOD: A total of 54 patients with clinically suspected acute PE were studied retrospectively. Each patient was assigned a pretest clinical probability of acute PE (very likely, 90%; possible, 50%; unlikely, 10%). Within 72 hours of presentation, patients underwent LPS and contrast material-enhanced helical CT. Perfusion LS was classified following the PISAPED criteria as normal or near normal; abnormal consistent with PE or abnormal not consistent with PE. Helical CT studies were categorized as positive for PE, negative for PE or non-diagnostic. The standard reference was a consensus based on LS, helical CT and clinical outcome. RESULTS: In 38 of the 54 patients, the results of LS a hCT were concordant, 13 with PE and 25 without. There were 4 indeterminate hCT. In 12 patients LS and hCT were discordant. There were 4 LS false negative; 2 with parenchyma damage and 2 chronic PE. There were 5 LS false negative; 3 extrinsic vascular compressions and one low clinical probability. There was 1 hCT false positive because of breathing artifact and 2 false negatives because of subsegmental emboli. CONCLUSION: Accurate diagnosis of acute PE is possible combining perfusion scanning and clinical probability. Helical CT has added information in patients with discordant clinical probability and perfusion lung scan results. Helical CT demonstrated lesions other than PE considered responsible for the patient's symptoms, but it was insensitive to embolism of subsegmental branches.