Diagnóstico de recurrencia de un glioma y respuesta al tratamiento antiangiogénico mediante PET con 11C-metionina / Diagnosed recurrent glioma and antiangiogenic treatment response by 11C-Methionine PET

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Estudio de pacientes con síndrome febril prolongado con 18F-FDG PET-TC / Study of patients with prolonged fever with 18F-FDG PET/CT

Objetivo. Revisar el resultado de la tomografía por emisión de positrones (PET)-tomografía computarizada (TC) con flúor-18-fluorodesoxiglucosa (18F-FDG) en pacientes con fiebre de origen desconocido de más de 7 días de evolución. Material y métodos. Estudio observacional descriptivo retrospectivo de 93 estudios de PET-TC con 18F-FDG solicitados para detectar el foco causante de la fiebre en tres centros de medicina nuclear entre octubre de 2006 y febrero de 2014. Un especialista en medicina nuclear y un radiólogo revisaron las imágenes buscando focos de captación patológica. Las discrepancias se resolvieron con la opinión de un nuevo especialista. El resultado de la 18F-FDG PET-TC se comprobó clínica y/o anatomopatológicamente. Resultados. En la PET-TC se observaron captaciones anómalas de la 18F-FDG que podían justificar la causa de la fiebre en 52 de los 93 estudios (56%). La causa se confirmó en 50 de estos 52 estudios. De las 50 causas de fiebre diagnosticadas, la infección (54%) fue la más frecuente, seguida de la enfermedad inflamatoria no infecciosa (28%) y la enfermedad tumoral (18%). Conclusión. La PET-TC con 18F-FDG es útil para diagnosticar la causa del síndrome febril prolongado, por lo que puede ser práctico emplearla en una etapa más precoz del proceso diagnóstico (AU)

Objective. To review the findings on 18F-FDG PET-CT in patients with fever of unknown origin lasting more than 7 days. Material and methods. This retrospective descriptive observational study included 93 18F-FDG PET-CT studies to detect a fever-causing focus done at three nuclear medicine centers from October 2006 through February 2014. A nuclear medicine specialist and a radiologist reviewed the images for foci of pathological uptake; another specialist's opinion resolved discrepancies. The findings on 18F-FDG PET-CT studies were checked against clinical and/or histological findings. Results. Abnormal 18F-FDG uptake on PET-CT that could explain the cause of the fever was found in 52 (56%) of the 93 studies, and the cause of the fever was confirmed in 50 of these 52 studies. In the 50 cases in which the cause of the fever was confirmed, infection was the most common cause (54%), followed by noninfectious inflammatory disease (28%) and tumors (18%). Conclusion. 18F-FDG PET-CT is useful in diagnosing the cause of prolonged febrile illness, so it might be practical to use it earlier in the diagnostic process (AU)

Utilidad de la PET con 11C-metionina en el diagnóstico diferencial de los tumores epileptógenos / Usefulness of 11C-Methionine PET in diferential diagnosis of epileptogenic brain neoplasms

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Rendimiento diagnóstico de la gammagrafía ósea y la PET/TAC con 11C-colina en la detección de metástasis óseas en pacientes con recidiva bioquímica de cáncer de próstata / Diagnostic performance of bone scintigraphy and 11C-Choline PET/CT in the detection of bone metastases in patients with biochemical recurrence of prostate cancer

Objetivo: Comparamos la gammagrafía ósea (GO) y la 11C-colina-PET/TAC en la detección de metástasis óseas en pacientes con recidiva bioquímica de cáncer de próstata (CaP). Material y métodos: Ciento sesenta y nueve pacientes que acudieron para realizar ambas exploraciones (0-15 días) por recidiva bioquímica (PSA: 2,4-58 ng/ml) de CaP. Analizamos la tasa de detección de GO y 11C-colina-PET/TAC por pacientes y lesiones. El diagnóstico de metástasis se realizó por: biopsia, confirmación TAC/18F-fluoruro PET/RM, progresión por técnicas de imagen. Resultados: Noventa y una lesiones captantes mediante GO y/o 11C-colina-PET/TAC (40 pacientes), 78 de ellas metastásicas. GO detectó 38 blásticas, 2 líticas y 10 sin traducción-TAC. 11C-colina-PET/TAC: 41 blásticas, 4 líticas y 29 sin traducción-TAC. La sensibilidad de GO y 11C-colina-PET/TAC fue del 65,4 y 96,1%; la especificidad del 38,5 y 92,3% (χ2 8,27, p < 0,04). En 118 pacientes ambas exploraciones fueron negativas. En 51 pacientes mostraron lesiones captantes: 30/51 GO y 11C-colina-PET/TAC concordantes. En 21/51 mostraron lesiones discordantes (kappa 0,712, p = 0,00). En 10/19 pacientes la discordancia fue total: 5 FN GO, 2 FP GO (degenerativa; displasia), uno FN 11C-colina-PET/TAC (blástica), uno FP 11C-colina-PET/TAC (degenerativa), uno fuera campo 11C-colina-PET/TAC (tibial única). 11C-colina PET/TAC detectó enfermedad extraósea en 26/51 pacientes con metástasis óseas: 9 local, 5 adenopatías infradiafragmáticas, 2 supradiafragmáticas, 5 local e infradiafragmática, 4 infra y supradiafragmáticas, una supradiafragmáticas y metástasis pulmonares. Conclusión: La 11C-colina-PET/TAC muestra una mayor sensibilidad y especificidad que la GO en la detección de metástasis óseas en pacientes con recidiva bioquímica de CaP. Además, permite la reestadificación extraósea, con impacto en el manejo de estos pacientes (AU)

Aim: To compare bone scan (BS) with 11C-Choline PET/CT for the detection of bone metastases in patients with biochemical recurrence of prostate cancer (PC). Material and Methods: A total of 169 patients with biochemical recurrence of PC(PSA:2.4-58 ng/ml) who were referred for both exams (0-15 days-in-between) were included. Lesion-detection-rate per patients and lesions were analyzed for both BS and 11C-Choline PET/CT. Metastasis diagnosis was reached by: biopsy, CT/18F-Fluoride PET/MRI confirmation, or evidence of progression in subsequent imaging procedures. Results: A total of 91 lesions were found to be active in BS and/or 11C-choline PET/CT (40 patients), with 78 of which were metastatic. BS detected 38 blastic, 2 lytic and 10 non-CT-evident lesions. 11C-Choline PET/CT detected 41 blastic, 4 lytic and 29 non-CT-evident lesions. BS and 11C-Choline PET/CT sensitivities were 65.4% and 96.1%; specificities ere 38.5 and 92.3% (χ2 8.27, p < 0.04). Both imaging techniques were negative in 118 patients. Tracer avid lesions were found in 51 patients: with 30/51 being BS and 11C-Choline PET/CT concordant; in 21/51 patients had discordant lesions (kappa 0.712, p = 0.00). Lesions were absolutely discordant in 10/19 patients,: 5 FN BS, 2 FP BS (degenerative changes; dysplasia), 1 FN 11C-Choline PET/CT (blastic), 1 FP 11C-Choline PET/CT ( degenerative), 1 out of field-of-view lesion with 11C-Choline PET/CT (tibia alone). 11C-Choline PET/CT showed extraosseous involvement in 26/51 patients with bone metastases: 9 local recurrences, 5 infra-diaphragmatic-lymph-nodes, 2 supra-diaphragmatic, 5 local and infra-diaphragmatic, 4 infra- and supra-diaphragmatic, 1 supra-diaphragmatic and lung metastases. Conclusion: 11C-Choline PET/CT yielded better sensitivity and specificity than BS for the detection of bone involvement in patients with biochemical recurrence of PC and allowed extraosseous restaging, with an impact in the clinical management of these patients (AU)

Infiltración difusa del árbol traqueo-bronquial diagnosticada por tomografía por emisión de positrones/tomografía computada con 18F-fluordesoxiglucosa / Diffuse tracheobronchial tree infiltration diagnosed by 18-fluoro-2-deoxyglucose positron emission tomography/computed tomography

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11C-colina PET/TAC y RM multiparamétrica en la recidiva bioquímica del cáncer de próstata / 11C-choline PET/CT and multiparametric MRI in patients with biochemical relapse of prostate cancer

Problema clínico con casuística: Comparar la utilidad diagnóstica de la PET/TC con 11C-colina y la RM multiparamétrica en la detección de la recidiva del cáncer de próstata a nivel pélvico. Hemos estudiado retrospectivamente 21 pacientes con antecedente de cáncer de próstata, tratados inicialmente con cirugía (n = 12) o radioterapia (n = 9), que presentaban elevación del PSA (poscirugía 0,3-3,6 ng/ml; posradioterapia 2,4-8,8 ng/ml). A todos ellos, en un periodo de tiempo inferior a 15 días, se les realizó: estudio PET/TC «doble fase» de cuerpo completo, inmediatamente tras la administración de11C-colina (296 ± 29 MBq) y RM prostática multiparamétrica, empleando secuencias anatómicas, estudio de difusión y estudio dinámico tras la administración de contraste intravenoso paramagnético. A partir de nuestros resultados, a todos ellos se les realizó estudio diagnóstico dirigido y/o seguimiento clínico, analítico y de imagen. En 15 pacientes (71,4%) ambas exploraciones fueron concordantes, 4 negativas y 11 positivas: 7 recidivas locales, 3 adenopatías pélvicas únicas (2 infracentimétricas), una recidiva local y una M1 ósea única. En 6 pacientes (28,6%) ambas exploraciones fueron discordantes: 3 recidivas locales identificadas en la RM y sin significación en la PET, una recidiva local identificada en la PET sin significación en la RM y 2 M1 óseas identificadas en la PET fuera del campo de RM. Comentario: La PET/TC con 11C-colina y la RM multiparamétrica tienen un papel complementario para la detección de recidiva local del cáncer de próstata, con sensibilidad similar para la detección de inflitración ganglionar. La PET/TC con 11C-colina, como técnica de cuerpo completo, permite la estadificación ósea

Clinic problem and case series: To assess the diagnostic usefulness of 11C-choline PET/CT vs. multi-parametric MRI in the prostate cancer relapse. A retrospective study of 21 patients with prostate cancer treated initially with surgery (n = 12), radiotherapy (n = 9). PSA levels were increased (post-surgery: .3-3.6 ng/ml; post-radiotherapy: 2.4-8.8 ng/ml). In an interval of time of 15 days all patients were underwent to: whole-body-dual-modality PET-CT carried out early after 11C-choline (296 ± 29 MBq) injection, and multiparametric prostate MRI with paramagnetic intravenous contrast (using anatomical imaging sequences, diffusion-weighted imaging and dynamic contrast-enhanced imaging). On the basis of our results, all patients were underwent to directed diagnosis and/or clinical, analytic and imaging follow-up. In 15 patients (71.4%) both procedures showed concordant results: 4 negative and 11 positive cases [7 local recurrences, 3 isolated pelvic lymph nodes (2 infracentimetric), 1 local relapse and only one M1 bone metastases]. The results were discordant in 6 patients (28.6%): 3 local relapses in MRI with no PET significance, 1 local relapse in PET with no MRI significance. 2 bone metastases were identified with PET (out of the field-of-view of MRI). Coment 11C-choline PET/CT and multi-parametric MRI play a complementary role in the detection of local relapse in prostate cancer patients, with similar sensitivity for the detection of lymph involvement. Whole-body 11C-choline PET/CT technique is also useful for bone staging

[Study of patients with prolonged fever with (18)F-FDG PET/CT]. / Estudio de pacientes con síndrome febril prolongado con 18F-FDG PET-TC.

OBJECTIVE: To review the findings on (18)F-FDG PET-CT in patients with fever of unknown origin lasting more than 7 days. MATERIAL AND METHODS: This retrospective descriptive observational study included 93 (18)F-FDG PET-CT studies to detect a fever-causing focus done at three nuclear medicine centers from October 2006 through February 2014. A nuclear medicine specialist and a radiologist reviewed the images for foci of pathological uptake; another specialist's opinion resolved discrepancies. The findings on (18)F-FDG PET-CT studies were checked against clinical and/or histological findings. RESULTS: Abnormal (18)F-FDG uptake on PET-CT that could explain the cause of the fever was found in 52 (56%) of the 93 studies, and the cause of the fever was confirmed in 50 of these 52 studies. In the 50 cases in which the cause of the fever was confirmed, infection was the most common cause (54%), followed by noninfectious inflammatory disease (28%) and tumors (18%). CONCLUSION: (18)F-FDG PET-CT is useful in diagnosing the cause of prolonged febrile illness, so it might be practical to use it earlier in the diagnostic process.

Prevalence of HLA-B*57:01 allele in Argentinean HIV-1 infected patients.

Hypersensitivity reaction to abacavir (ABC hypersensitivity syndrome, AHS) is strongly associated with the presence of the HLA-B*57:01 allele. This study was designed to estimate the prevalence of HLA-B*57:01 allele in Argentinean HIV-1 infected patients. We analyzed the presence of HLA-B*57:01 allele in 1646 HIV-1 infected patients from different regions of Argentina. This allele was detected in 81 patients; most of them corresponded to patients living in the central region of the country. The prevalence of HLA-B*57:01 was 4.9%, similar to other Caucasian populations and higher than other data reported for South American populations. This strongly supports screening for the presence of HLA-B*57:01 in abacavir treatment of HIV-1 in our country.

Estadificación por PET/TC con 18F-FDG del mesotelioma. A propósito de un caso con infiltración simultánea pleural y peritoneal / Mesothelioma staging with 18F-FDG PET/CT. A case report with simultaneous pleural and peritoneal infiltration

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Encefalitis límbica anti-NMDAR (receptor de N-methy-D-aspartate) diagnosticada mediante 18F-FDG PET/TAC / Anti-NMDAR (N-methy-D-aspartate receptor) limbic encephalitis diagnosed by 18F-FDG PET/CT

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Estudio de extensión y valoración de la respuesta terapéutica en un paciente con adenocarcinoma pulmonar metastásico mediante estudio secuencial con 18F-FDG PET-TC y 18F-fluoruro PET-TC / Extension study and evaluation of the therapeutic response in a patient with metastatic lung adenocarcinoma using sequential study with 18F-FDG PET-CT and 18F-fluoride PET-CT

Se presenta un caso de una paciente con adenocarcinoma pulmonar y múltiples metástasis óseas y extraóseas estudiado con 18F-FDG PET-TC, 99mTc-HMDP y 18F-fluoruro PET-TC. Se valora la utilidad de la 18F-FDG PET-TC para la estadificación inicial de la enfermedad y control de respuesta a la terapéutica. Para el estudio de las metástasis óseas escleróticas se muestra la superioridad de la gammagrafía ósea con 99mTc-HMDP y la 18F-fluoruro PET-TC sobre la 18F-FDG PET-TC, y la 18F-fluoruro PET-TC sobre la gammagrafía ósea. Asimismo se presenta la utilidad de la 18F-fluoruro PET-TC para el seguimiento de las metástasis óseas (AU)

We report a case of a patient with lung adenocarcinoma and bone and extraosseus metastases studied with 18F-FDG PET-CT, 99mTc-HMDP and 18F-fluoride PET-CT. It assesses the usefulness of 18F-FDG PET-CT for initial staging of the disease and monitoring response to therapy. For the study of the sclerotic bone metastases it shows the superiority of 99mTc-HMDP bone scintigraphy and 18F-fluoride PET-CT over 18F-FDG PET-CT, and 18F-fluoride PET-CT over bone scintigraphy. It also shows the usefulness of 18F-fluoride PET-CT for monitoring the bone metastases (AU)

11C-Choline PET/CT in the primary diagnosis of prostate cancer: impact on treatment planning.

AIM: Aim of the present study was to evaluate the usefulness of 11C-choline PET/CT for detecting lymphatic or haematogenous spread and for planning radiotherapy in patients with medium-to-high risk prostate cancer. METHODS: We have included 61 consecutive patients recently diagnosed with cancer prostate by biopsy. All patients were classified as medium-to-high risk: Gleason: 7-9; PSA: 6.3-30.4 ng/mL; stage T2c (N.=20) or stage T3 (N.=41). Image acquisition began 5 min after intravenous injection of 11C-choline (656+119 MBq), starting at the pelvis and continuing craniocaudally. Images were interpreted visually to evaluate uptake by the prostate gland. Lymph nodes with 11C-choline uptake were considered invaded, regardless of their size. Bone lesions were considered positive when they showed greater focal uptake than the surrounding bone. In patients with evidence of lymph-node invasion or bone metastases (15 patients), disease was classified as locoregional, oligometastatic, or multimetastatic. RESULTS: All patients had prostate gland uptake (20 focal, 8 bifocal, and 33 multifocal). Extraprostatic disease was present in 15 patients (24.6%), as follows: 9 (60%) in a single location: in an infradiaphragmatic lymph node (N.=6), in a supradiaphragmatic lymph node (N.=1), and in bone (M1) (N.=2). Six (40%) as multifocal invasion: with both infra- and supradiaphragmatic lymph node involvement (N.=2); with infradiaphragmatic lymph node involvement and M1 bone metastases (N.=3); and infra- and supradiaphragmatic lymph node involvement plus M1 bone metastases (N.=1). Disease was classified as locoregional (N.=6), oligometastatic (N.=5), and multimetastatic (N.=4). The 11 (73.3%) patients with locoregional and oligometastatic disease were selected to undergo intensity-modulated radiation therapy with dose escalation based on the PET findings. CONCLUSION: Our results suggest that 11C-choline PET/CT is a useful one-stop diagnostic procedure for evaluating patients with medium/high risk prostate cancer scheduled for radical treatment. 11C-choline PET/CT can reliably rule out lymph node involvement and remote metastases, allowing to select candidates for radiotherapy and to plan their treatment.

[Extension study and evaluation of the therapeutic response in a patient with metastatic lung adenocarcinoma using sequential study with ¹8F-FDG PET-CT and ¹8F-fluoride PET-CT]. / Estudio de extensión y valoración de la respuesta terapéutica en un paciente con adenocarcinoma pulmonar metastásico mediante estudio secuencial con (18)F-FDG PET-TC y (18)F-fluoruro PET-TC.

We report a case of a patient with lung adenocarcinoma and bone and extraosseus metastases studied with (18)F-FDG PET-CT, (99m)Tc-HMDP and (18)F-fluoride PET-CT. It assesses the usefulness of (18)F-FDG PET-CT for initial staging of the disease and monitoring response to therapy. For the study of the sclerotic bone metastases it shows the superiority of 99mTc-HMDP bone scintigraphy and (18)F-fluoride PET-CT over (18)F-FDG PET-CT, and (18)F-fluoride PET-CT over bone scintigraphy. It also shows the usefulness of (18)F-fluoride PET-CT for monitoring the bone metastases.

[Diagnostic performance of bone scintigraphy and (11)C-Choline PET/CT in the detection of bone metastases in patients with biochemical recurrence of prostate cancer]. / Rendimiento diagnóstico de la gammagrafía ósea y la PET/TAC con (11)C-colina en la detección de metástasis óseas en pacientes con recidiva bioquímica de cáncer de próstata.

AIM: To compare bone scan (BS) with (11)C-Choline PET/CT for the detection of bone metastases in patients with biochemical recurrence of prostate cancer (PC). MATERIAL AND METHODS: A total of 169 patients with biochemical recurrence of PC(PSA:2.4-58 ng/ml) who were referred for both exams (0-15 days-in-between) were included. Lesion-detection-rate per patients and lesions were analyzed for both BS and (11)C-Choline PET/CT. Metastasis diagnosis was reached by: biopsy, CT/(18)F-Fluoride PET/MRI confirmation, or evidence of progression in subsequent imaging procedures. RESULTS: A total of 91 lesions were found to be active in BS and/or (11)C-choline PET/CT (40 patients), with 78 of which were metastatic. BS detected 38 blastic, 2 lytic and 10 non-CT-evident lesions. (11)C-Choline PET/CT detected 41 blastic, 4 lytic and 29 non-CT-evident lesions. BS and (11)C-Choline PET/CT sensitivities were 65.4% and 96.1%; specificities ere 38.5 and 92.3% (χ(2) 8.27, p<0.04). Both imaging techniques were negative in 118 patients. Tracer avid lesions were found in 51 patients: with 30/51 being BS and (11)C-Choline PET/CT concordant; in 21/51 patients had discordant lesions (kappa 0.712, p=0.00). Lesions were absolutely discordant in 10/19 patients,: 5 FN BS, 2 FP BS (degenerative changes; dysplasia), 1 FN (11)C-Choline PET/CT (blastic), 1 FP (11)C-Choline PET/CT (degenerative), 1 out of field-of-view lesion with (11)C-Choline PET/CT (tibia alone). (11)C-Choline PET/CT showed extraosseous involvement in 26/51 patients with bone metastases: 9 local recurrences, 5 infra-diaphragmatic-lymph-nodes, 2 supra-diaphragmatic, 5 local and infra-diaphragmatic, 4 infra- and supra-diaphragmatic, 1 supra-diaphragmatic and lung metastases. CONCLUSION: (11)C-Choline PET/CT yielded better sensitivity and specificity than BS for the detection of bone involvement in patients with biochemical recurrence of PC and allowed extraosseous restaging, with an impact in the clinical management of these patients.

(11)C-choline PET/CT and multiparametric MRI in patients with biochemical relapse of prostate cancer.

CLINIC PROBLEM AND CASE SERIES: To assess the diagnostic usefulness of (11)C-choline PET/CT vs. multi-parametric MRI in the prostate cancer relapse. A retrospective study of 21 patients with prostate cancer treated initially with surgery (n=12), radiotherapy (n=9). PSA levels were increased (post-surgery: .3-3.6 ng/ml; post-radiotherapy: 2.4-8.8 ng/ml). In an interval of time of 15 days all patients were underwent to: whole-body-dual-modality PET-CT carried out early after (11)C-choline (296 ± 29 MBq) injection, and multiparametric prostate MRI with paramagnetic intravenous contrast (using anatomical imaging sequences, diffusion-weighted imaging and dynamic contrast-enhanced imaging). On the basis of our results, all patients were underwent to directed diagnosis and/or clinical, analytic and imaging follow-up. In 15 patients (71.4%) both procedures showed concordant results: 4 negative and 11 positive cases [7 local recurrences, 3 isolated pelvic lymph nodes (2 infracentimetric), 1 local relapse and only one M1 bone metastases]. The results were discordant in 6 patients (28.6%): 3 local relapses in MRI with no PET significance, 1 local relapse in PET with no MRI significance. 2 bone metastases were identified with PET (out of the field-of-view of MRI). COMMENT: (11)C-choline PET/CT and multi-parametric MRI play a complementary role in the detection of local relapse in prostate cancer patients, with similar sensitivity for the detection of lymph involvement. Whole-body 11C-choline PET/CT technique is also useful for bone staging.