Variaciones en los parámetros cuantitativos y en la puntuación de la escala de Deauville aplicando diferentes algoritmos de reconstrucción en las imágenes PET/TC con [18F]FDG de pacientes con linfoma / The variation of quantitative parameters and Deauville scores with different reconstruction algorithms in FDG PET/CT imaging of lymphoma patients

Objetivos La escala de Deauville (DS) en la tomografía de emisión de positrones (PET) con [18F]fludeoxiglucosa ([18F]FDG) es un método semicuantitativo único para la evaluación del linfoma. Sin embargo, el tipo de algoritmo de reconstrucción empleado para el cálculo de los valores de captación estándar (max, medio y pico) podría afectar a la DS. Comparamos el algoritmo de reconstrucción de probabilidad penalizada bayesiano (BPL) con el de maximización de expectativas de subconjuntos ordenados (OSEM) respecto a los parámetros cuantitativos y en la DS en el linfoma. Investigamos el efecto del tamaño del ganglio linfático sobre la variación cuantitativa. Métodos Se reconstruyeron por separado los resultados de la PET sin procesar de 255 pacientes con linfoma utilizando la aplicación Q.Clear (General Electric Healthcare, Milwaukee, WI, EE. UU.), un algoritmo BPL, y la aplicación SharpIR (General Electric Healthcare, Milwaukee, WI, EE. UU.), un algoritmo OSEM. En ambas imágenes, para cada paciente, se valoró hígado, el pool sanguíneo mediastínico y los valores de captación estándar (SUV) (SUVmáx, SUVmedio y SUVpico) de un total de 487 lesiones seleccionadas. Se compararon DSmáx, DSmedio y DSpico. Resultados En nuestro estudio hubo un aumento significativo de la DS con el BPL (p<0,001) que pasó a una puntuación de 4 a 5 en 30 pacientes inicialmente catalogados como 1-2-3 mediante el algoritmo OSEM. Se observó que los valores cuantitativos de los ganglios linfáticos aumentaban de forma estadísticamente significativa con el BPL (p<0,001), mientras que la disminución de los valores de hígado fue notable respecto a las regiones de referencia (p<0,001). Además, la diferencia en los ganglios linfáticos se asoció de forma independiente con el tamaño de la lesión y fue considerablemente más pronunciada en las lesiones de pequeño tamaño (p<0,001) (AU)

Introduction and Objectives 18F-FDG PET with the Deauville score (DS) is a unique semiquantitative method for lymphoma. However, type of standard uptake values (max, mean, and peak) reconstruction algorithms could affect DS. We compared the Bayesian Penalized Likelihood reconstruction algorithm (BPL) with Ordered Subsets Expectation Maximization (OSEM) on quantitative parameters and DS in lymphoma. We investigated the effect of the size of the lymph node on quantitative variation. Patients and Methods Raw PET data of 255 lymphoma patients were reconstructed separately with Q.Clear (GE Healthcare), a BPL, and SharpIR (GE Healthcare), an OSEM algorithm. In both images, each patient's liver, mediastinal blood pool, and SUVs (SUVmax, SUVmean, and SUVpeak) of a total of 487 lesions selected from the patients were performed. DSmax, DSmean, and DSpeak were compared. Results In our study, DS increased significantly with BPL (p<0.001), and the DS increased to 4-5 in 30 patients evaluated as 1-2-3 with OSEM. It was found that the quantitative values of the lymph nodes increased statistically with BPL (p<0.001), and the liver from the reference regions were significantly decreased (p<0.001). In addition, difference in lymph node was independently associated with size of lesion and was significantly more pronounced in small lesions (p<0.001). The effects of BPL algorithm were more pronounced in SUVmax than in SUVmean and SUVpeak. DS-mean and DS-peak scores were less changed by BPL than DS-max. Conclusion Different reconstruction algorithms in FDG PET/CT affect the quantitative evaluation. That variation may affect the change in DS in lymphoma patients, thus affecting patient management (AU)

Hallazgos de la PET/TC con 18F-FDG en un paciente con paraganglioma: activación de la grasa parda debido a estimulación adrenérgica / 18F-FDG PET/CT findings in a patient with paraganglioma: Brown adipose tissue activation due to adrenergic stimulation

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FDG PET/CT imaging of metastatic renal squamous cell carcinoma / Imagen PET/TC de carcinoma renal de células escamosas metastásico

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18F-FDG PET/CT imaging of breast cancer in a lactating woman / Imagen de 18F-FDG PET/TC en una mujer con cáncer de mama que amamanta

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Incidental FDG uptake in bilateral salpingitis due to Morgagni cyst hydatids on PET/CT scan in a patient with solitary pulmonary nodule / Captación incidental de FDG en salpingitis bilateral debida a quiste hidatídico de Morgagni en PET/TC en una paciente con nódulo pulmonar solitario

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(18)F-FDG PET/CT findings in a case with HIV (-) Kaposi sarcoma.

Although mucocutaneous sites are the most frequently encountered sites of involvement, Kaposi Sarcoma (KS) may also occasionally involve the breast and the skeletal, endocrine, urinary and nervous systems.. Various imaging modalities may be used to delineate the extent of the disease by detecting unexpected sites of involvement. Herein, we report a case of classical type KS, in whom staging with (18)F-FDG PET/CT imaging disclosed widespread disease and unexpected findings of bone and salivary gland involvement.

Tomografía por emisión de positrones/tomografía computarizada de doble fase con 18F-fluorodeoxiglucosa y diuresis forzada en el diagnóstico por imagen del cáncer de vejiga / Dual phase 18F-fluorodeoxyglucose positron emission tomography/computed tomography with forced diuresis in diagnostic imaging evaluation of bladder cancer

Se considera que la 18F-FDG PET tiene un valor limitado en oncología urológica debido a la excreción urinaria del trazador. El propósito de este estudio retrospectivo fue investigar el valor clínico de FDG PET/TC de doble fase con protocolo de diuresis forzada (furosemida i.v. e hidratación oral) en el cáncer de vejiga invasivo o de alto grado. Métodos. El estudio incluyó a 51 pacientes con cáncer de vejiga. Todos ellos tuvieron un procedimiento estándar de estadificación y una FDG PET/TC antes de planificar el tratamiento. Los hallazgos de la PET/TC antes y después de la administración de furosemida i.v. se compararon para determinar la detección de patología pélvica en cada estudio. Los hallazgos de imagen se correlacionaron con el diagnóstico final (histología o seguimiento clínico durante al menos 12 meses). Resultados. La actividad intravesical de FDG se redujo significativamente en el 90% de los pacientes con el protocolo de diuresis forzada. El 88% de los hallazgos en vejiga, el 20% de las metástasis linfáticas regionales y otros hallazgos en los órganos pélvicos (invasión local y tumor síncrono de próstata) se detectaron solo en las imágenes de PET/TC adicionales de pelvis. La PET/TC de doble fase cambió la estadificación y/o la estrategia terapéutica en 16 pacientes (31%). Conclusión. La FDG PET/TC de doble fase contribuyó a la estadificación y a la toma de decisiones terapéuticas detectando enfermedad local y metástasis pélvicas con gran precisión cuando se combinó con el protocolo de diuresis forzada. Por consiguiente, recomendamos la técnica de doble fase en la PET/TC con protocolo de diuresis forzada para el estudio del cáncer vesical y otras neoplasias del aparato urogenital(AU)

Introduction. 18F-FDG PET has been regarded as a limited value in urooncology due to urinary excretion of the tracer. The purpose of this retrospective study was to investigate the clinical value of dual-phase FDG PET/CT with forced diuresis protocol (iv furosemide-voiding and oral hydration) in invasive or high grade bladder cancer. Methods. Fifty-one patients were included in this study. All patients underwent standard staging procedures and dual-phase FDG PET/CT before planned therapy. PET/CT findings before and after furosemide were compared with each other for pelvic region. Dual phase PET/CT findings were also compared with the results of prior imaging studies and all findings were correlated with final diagnosis (histopathology or clinical follow-up for at least 12 months). Results. Intravesical FDG activity significantly decreased in 90% of the patients with forced diuresis protocol. Eighty eight percent of the bladder findings and 20% of the local lymph node metastases, and other pelvic findings (local invasion and second primary malignancy of prostate) were detected only by the additional pelvic PET/CT images. As a result, dual phase PET/CT changed the staging and/or the therapy strategy in 16 patients (31%). Conclusion. Dual phase FDG PET/CT contributes staging and decision of therapy strategy by detecting local disease and pelvic metastases with high accuracy when combined with forced diuresis protocol. Thus, we recommend dual phase imaging method with forced diuresis protocol in FDG PET/CT for bladder cancer and all other urogenital system malignities(AU)

Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) for the detection of skeletal muscle and skin metastases in uterine leiomyosarcoma: a case report.

We report the clinical value of FDG PET/CT imaging in a 57-year-old woman who was diagnosed with uterine leimyosarcoma 6 years ago. In a staging procedure, whole body FDG PET/CT discloses the presence of both local recurrence and remote metastases at widespread musculocutaneous sites, liver and femur. With its advantage of scanning the whole body in a single procedure, we propose the use of PET/CT imaging for the evaluation of patients with uterine leimyosarcomas, a tumor with a propensity for widespread hematogenous spread to unusual sites.

Dual phase 18F-fluorodeoxyglucose positron emission tomography/computed tomography with forced diuresis in diagnostic imaging evaluation of bladder cancer.

INTRODUCTION: (18)F-FDG PET has been regarded as a limited value in urooncology due to urinary excretion of the tracer. The purpose of this retrospective study was to investigate the clinical value of dual-phase FDG PET/CT with forced diuresis protocol (iv furosemide-voiding and oral hydration) in invasive or high grade bladder cancer. METHODS: Fifty-one patients were included in this study. All patients underwent standard staging procedures and dual-phase FDG PET/CT before planned therapy. PET/CT findings before and after furosemide were compared with each other for pelvic region. Dual phase PET/CT findings were also compared with the results of prior imaging studies and all findings were correlated with final diagnosis (histopathology or clinical follow-up for at least 12 months). RESULTS: Intravesical FDG activity significantly decreased in 90% of the patients with forced diuresis protocol. Eighty eight percent of the bladder findings and 20% of the local lymph node metastases, and other pelvic findings (local invasion and second primary malignancy of prostate) were detected only by the additional pelvic PET/CT images. As a result, dual phase PET/CT changed the staging and/or the therapy strategy in 16 patients (31%). CONCLUSION: Dual phase FDG PET/CT contributes staging and decision of therapy strategy by detecting local disease and pelvic metastases with high accuracy when combined with forced diuresis protocol. Thus, we recommend dual phase imaging method with forced diuresis protocol in FDG PET/CT for bladder cancer and all other urogenital system malignities.

Tc-99m MDP scintimammography in palpable and nonpalpable breast lesions: comparison with mammographic probability of malignancy.

We evaluated the contribution of Tc-99m methylene diphosphonate (MDP) scintimammography (MDP-SMM) to the diagnosis of breast cancer in 96 patients with 109 (52 palpable, 57 nonpalpable) breast lesions and compared them with mammography. Mammographic classification of the lesions were done as probably malignant (29), indeterminate (29) and probably benign (51). There were 23 malignant and 86 benign lesions. MDP-SMM successfully detected 16 of 23 (70%) breast cancers. Twelve of the 13 palpable and 4 of the 10 nonpalpable cancers showed Tc-99m MDP accumulation. Eight of the 86 (9%) benign breast lesions showed Tc-99m MDP accumulation (false positives). In the mammographically indeterminate group, MDP-SMM changed 22 of the 24 false positives into true negatives and showed 2 false negatives. In the 35 lesions detected in dense breasts, 10 of the 13 false positives were changed into true negatives and showed 1 false negative. As a conclusion, combined use of MDP-SMM with mammography seems to be useful in cases with mammographically indeterminate breast lesions and dense breasts and may help to preclude unnecessary breast biopsies.