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1.
Br J Radiol ; 93(1105): 20190455, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31617737

RESUMO

OBJECTIVE: This study explored the value of serial 18-fludeoxyglucose-positron emission tomography (18F-FDG-PET/CT) in predicting disease-free survival (DFS) in locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiation (NCRT) and surgery. METHODS: We prospectively studied 46 patients with LARC who underwent NCRT and surgery. 18F-FDG-PET/CT scans were performed at three time-points before surgery (pre-NCRT-PET1, during NCRT-PET2 and following completion of NCRT-PET3). The following semi-quantitative PET parameters were analysed at each time point: maximum standardized uptake value (SUVmax), SUVmean, metabolic tumour volume (MTV) and tumour lesion glycolysis (TLG). Absolute and percentage changes in these parameters were analysed between time points. Statistical analysis consisted of median tests, Cox regression and Kaplan-Meier analysis for DFS. RESULTS: The median follow-up time was 24 months. A reduction in PET parameters showed statistically significant differences for patients with recurrence compared to those without; percentage changes in MTV between PET1 and PET3 (cut-off: 87%, p = 0.023), percentage changes in TLG between PET1 and PET3 (cut-off: 94%, p = 0.02) and absolute change in MTV PET1 and PET2 (cut-off: 10.25, p = 0.001).An absolute reduction in MTV between PET1 and PET3 (p=0.013), a percentage reduction in TLG between PET1 and PET2 (p=0.021), SUVmax and SUVmean at PET2 (p = 0.01, p = 0.027 respectively)were also prognostic indicators of recurrence.MTV percentage change between PET1 and PET2 and SUVmean percentage change between PET1 and PET3 were also trending towards significance (p = 0.052, p = 0.053 respectively). CONCLUSION: Serial 18F-FDG-PET/CT is a potentially reliable non-invasive method to predict recurrence in patients with LARC. Volumetric parameters were the best predictors. This could allow risk-stratification in patients who may benefit from conservative management. ADVANCES IN KNOWLEDGE: This paper will add to the literature in risk-stratifying patients with LARC based on prognosis, using 18F-FDG-PET/CT. This may improve patient outcomes by selecting suitable candidates for conservative management.


Assuntos
Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/terapia , Idoso , Quimiorradioterapia , Terapia Combinada , Feminino , Fluordesoxiglucose F18 , Glicólise , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Estudos Prospectivos , Compostos Radiofarmacêuticos , Neoplasias Retais/patologia , Carga Tumoral
2.
Br J Radiol ; 93(1105): 20190069, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31642702

RESUMO

OBJECTIVE: To evaluate the impact of different metal artifact reduction (MAR) algorithms on Hounsfield unit (HU) and standardized uptake values (SUV) in a phantom setting and verify these results in patients with metallic implants undergoing oncological PET/CT examinations. METHODS AND MATERIALS: In this prospective study, PET-CT examinations of 28 oncological patients (14 female, 14 male, mean age 69.5 ± 15.2y) with 38 different metal implants were included. CT datasets were reconstructed using standard weighted filtered back projection (WFBP) without MAR, MAR in image space (MARIS) and iterative MAR (iMAR, hip algorithm). The three datasets were used for PET attenuation correction. SUV and HU measurements were performed at the site of the most prominent bright and dark band artifacts. Differences between HU and SUV values across the different reconstructions were compared using paired t-tests. Bonferroni correction was used to prevent alpha-error accumulation (p < 0.017). RESULTS: For bright band artifacts, MARIS led to a non-significant mean decrease of 12.0% (345 ± 315 HU) in comparison with WFBP (391 ± 293 HU), whereas iMAR led to a significant decrease of 68.3% (125 ± 185 HU, p < 0.017). For SUVmean, MARIS showed no significant effect in comparison with WFBP (WFBP: 0.99 ± 0.40, MARIS: 0.96 ± 0.39), while iMAR led to a significant decrease of 11.1% (0.88 ± 0.35, p < 0.017). Similar results were observed for dark band artifacts. CONCLUSION: iMAR significantly reduces artifacts caused by metal implants in CT and thus leads to a significant change of SUV measurements in bright and dark band artifacts compared with WFBP and MARIS, thus probably improving PET quantification. ADVANCES IN KNOWLEDGE: The present work indicates that MAR algorithms such as iMAR algorithm in integrated PET/CT scanners are useful to improve CT image quality as well as PET quantification in the evaluation of tracer uptake adjacent to large metal implants. A detailed analysis of oncological patients with various large metal implants using different MAR algorithms in PET/CT has not been conducted yet.


Assuntos
Artefatos , Metais , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Próteses e Implantes , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Idoso , Algoritmos , Feminino , Fluordesoxiglucose F18 , Humanos , Masculino , Imagens de Fantasmas , Estudos Prospectivos , Compostos Radiofarmacêuticos
3.
Medicine (Baltimore) ; 98(50): e18093, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852068

RESUMO

RATIONALE: Papillary renal cell carcinoma (PRCC) accounts for about 15% to 20% of renal cell carcinoma and is histologically distinguished in type I and type II. The last one is associated with poorer prognosis.Treatment options for PRCC patients are surgery, immunotherapy, revolutionized by Nivolumab, and other target-therapy with an improvement in overall survival. Heterogenous response and a pseudo-progression may be observed in the initial phase of biological treatment that could induce premature discontinuation. PATIENT CONCERNS: We present the case of a 44-year-old woman with left cervical palpable mass increased in size and without concomitant disease or previous surgery. DIAGNOSIS: Neck ultrasonography, contrast-enhanced Computed Tomography, and 18F-FDG PET/CT were performed with the detection of lymph nodes involvement and a left renal lesion. INTERVENTIONS: The patients underwent left radical nephrectomy and homolateral cervical and para-aortic lymphadenectomy, with histological diagnosis of PRCC, type II. After disease relapse, the inter-aortocaval lymph node was laparoscopically removed. Following the detection of further disease relapse in several lymph nodes and the lung, several lines of target-therapy were started; then disease progression and worsening of clinical and hematological status led us to start Nivolumab as last-line therapy. OUTCOMES: A heterogeneous response to therapies was documented with morphological and nuclear medicine imaging, however the concomitant deterioration of performance status and liver function led to discontinuation of Nivolumab; then the patient died, 30 months after diagnosis. LESSONS: Here we describe the clinical case and radiological and nuclear medicine imaging investigations performed by our patient, highlighting that 18F-FDG PET/CT shows greater adequacy in assessing the response to therapy, avoiding premature drug discontinuation, and ensuring better management of a patient with advanced PRCC.


Assuntos
Neoplasias Ósseas/diagnóstico , Carcinoma de Células Renais/diagnóstico , Fluordesoxiglucose F18/farmacologia , Neoplasias Renais/diagnóstico , Imagem Multimodal , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Adulto , Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/terapia , Terapia Combinada , Evolução Fatal , Feminino , Humanos , Neoplasias Renais/terapia , Laparoscopia , Excisão de Linfonodo/métodos , Linfonodos/patologia , Metástase Linfática , Pescoço , Estadiamento de Neoplasias , Nefrectomia/métodos , Compostos Radiofarmacêuticos/farmacologia , Vértebras Torácicas
4.
Zhonghua Zhong Liu Za Zhi ; 41(11): 831-836, 2019 Nov 23.
Artigo em Chinês | MEDLINE | ID: mdl-31770850

RESUMO

Objective: To investigate the prognostic values of the maximum standardized uptake value (SUV(max)), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) calculated from pretreatment (18)F-fluorodeoxy glucose ((18)F-FDG) PET-CT results of patients with advanced extranodal NK/T cell lymphoma (ENKTL). Methods: The clinic data, follow-up data and pretreatment (18)F-FDG PET-CT data of 45 patients with ENKTL of stage Ⅳ were collected. The optimal cutoff value of progression-free survival (PFS) of SUV(max), MTV and TLG were analyzed by using receiver-operating characteristic (ROC) curve. The Kaplan-Meier method, Log-rank test and COX proportional hazards model were used for survival analysis, univariate analysis and multivariate analysis, respectively. Results: The median SUV(max), MTV and TLG of 45 ENKTL patients were 17.98, 70.18 and 755.42, respectively. ROC curve showed that the area under the curve (AUC) of SUV(max), MTV and TLG were 0.504 (P=0.970), 0.868 (P<0.001) and 0.848 (P=0.001), respectively. The value of SUV(max) was too small to fit for calculating the cutoff value of AUC. The cutoff value of MTV was 42.54 (sensitivity =78.1% and specificity =84.6%), and the cutoff value of TLG was 435.15 (sensitivity=75.0% and specificity =76.9%). Univariate analysis showed that lactate dehydrogenase (LDH) level, epstein-barr virus (EBV)-DNA, Eastern Cooperative Oncology Group (ECOG) score, bone marrow, Korean prognostic index (KPI), MTV, TLG were significantly related with PFS (all P<0.05), and lactate dehydrogenase (LDH) level, EBV-DNA, ECOG score, primary tumor location, KPI, MTV, TLG were significantly related with overall survival (OS) (all P<0.05). Multivariate analysis showed that KPI, MTV and TLG were independent prognostic predictors of PFS and OS (all P<0.05). Conclusions: MTV and TLG of pretreatment (18)F-FDG PET-CT are independent prognostic factors for PFS and OS of patients with advanced ENKTL. MTV and TLG may be more fit for evaluating the prognosis of ENKTL patients than SUV(max).


Assuntos
Linfoma Extranodal de Células T-NK/diagnóstico , Linfoma Extranodal de Células T-NK/metabolismo , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Fluordesoxiglucose F18/metabolismo , Glicólise , Humanos , Tomografia por Emissão de Pósitrons , Prognóstico , Intervalo Livre de Progressão , Compostos Radiofarmacêuticos/metabolismo , Estudos Retrospectivos , Análise de Sobrevida , Carga Tumoral
5.
Zhonghua Nei Ke Za Zhi ; 58(11): 808-813, 2019 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-31665855

RESUMO

Objective: Positron emission tomography-computed tomography (PET-CT) has been used to quantify inflammatory response in the body. The aim of the present study was to explore the possibility of using this method to evaluate the stability of atherosclerotic plaques and the efficacy of atorvastatin in stabilizing atherosclerotic plaques. Methods: Twenty New Zealand male white rabbits were included and divided into the atorvastatin intervention group and the control group, with 10 rabbits in each group. Rabbits in both groups were fed with a high fat diet for 20 weeks, and treated with thoracoabdominal aortic balloon-pulling to establish atherosclerosis model at the end of the 2nd week. Rabbits in atorvastatin intervention group was given atorvastatin intragastrically once a day. At the 8th week, thoracoabdominal aortic ultrasound was used to detect plaques in all rabbits. Blood was drawn at the 3rd and the 20th week, respectively, to measure blood lipids, high-sensitive C-reactive protein (hs-CRP) and matrix metalloproteinase-9 (MMP-9). At the end of experiment, survival animals were scanned by (18)F-FDG PET-CT, and the average and maximum standard uptake values (SUVmean, SUVmax) of aortic segments were measured. Thereafter, the animals were sacrificed and aortic specimens of rabbits were taken and examined by immunohistochemistry. The pathological indexes were measured and compared. Results: At the end of experiment, the total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), hs-CRP [ (4.58±0.51) ng/ml vs.(5.87±0.66) ng/ml, P<0.01], MMP-9[ (43.93±2.16) ng/ml vs. (50.77±2.32) ng/ml, P<0.01], SUVmean (0.59±0.15 vs. 0.68±0.20, P<0.05) , SUVmax (0.68±0.20 vs. 0.81±0.27, P<0.05) , plaque area [ (0.36±0.24) mm(2) vs. (0.50±0.34) mm(2), P<0.05) ] and density of macrophage[ (4.34±1.54) % vs. (5.65±1.89) %, P<0.01] in the atorvastatin intervention group were significantly lower than those in the control group. In contrast, fiber cap thickness of the plaque[ (4.12±0.66) µm vs. (2.96±0.37) µm, P<0.01] in the atorvastatin intervention group was higher than that of the control group, and the difference was statistically significant. The arterial plaque areas were positively correlated with SUVmean (r=0.27, P<0.05) and SUVmax (r=0.43, P<0.01) . Fiber cap thickness was negatively correlated with SUVmean (r=-0.38, P<0.05) and SUVmax (r=-0.47, P<0.01) . The density of macrophage were positively correlated with SUVmean (r=0.52, P<0.01) and SUVmax (r=0.51, P<0.01) . Conclusion: (18)F-FDG PET/CT can be used to evaluate the efficacy of atorvastatin by the stability of atherosclerotic plaques.


Assuntos
Aorta/diagnóstico por imagem , Fluordesoxiglucose F18/administração & dosagem , Placa Aterosclerótica/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Animais , Aorta/patologia , Masculino , Placa Aterosclerótica/patologia , Coelhos , Compostos Radiofarmacêuticos
6.
J Surg Oncol ; 120(8): 1391-1396, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31667855

RESUMO

BACKGROUND: Sentinel lymph node biopsy is a standard staging procedure for early axillary lymph node-negative breast cancer. As an alternative to the currently used radioactive tracers for sentinel lymph node (SLN) detection during the surgical procedure, a number of studies have shown promising results using superparamagnetic iron oxide (SPIO) nanoparticles. Here, we developed a new handheld, cordless, and lightweight magnetic probe for SPIO detection. METHODS: Resovist (SPIO nanoparticles) were detected by the newly developed handheld probe, and the SLN detection rate was compared to that of the standard radioisotope (RI) method using radioactive colloids (99m Tc) and a blue dye (indigo carmine). This was a multicenter prospective clinical trial that included 220 patients with breast cancer scheduled for sentinel node biopsy after a clinical diagnosis of negative axillary lymph node from three facilities in Japan. RESULTS: Of the 210 patients analyzed, SLN was detected in 94.8% (199/210 cases, 90% confidence interval [CI]) with our magnetic method and in 98.1% (206/210 cases, 90% CI) with the RI method. The magnetic method exceeded the threshold identification rate of 90%. CONCLUSION: This was the first clinical study to use a novel handheld magnetometer to detect SLN, which we demonstrate to be not inferior to the RI method.


Assuntos
Compostos Férricos , Nanopartículas de Magnetita , Magnetometria/instrumentação , Biópsia de Linfonodo Sentinela/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Corantes , Meios de Contraste , Dextranos , Feminino , Humanos , Índigo Carmim , Pessoa de Meia-Idade , Estudos Prospectivos , Compostos Radiofarmacêuticos , Linfonodo Sentinela/patologia
7.
Medicine (Baltimore) ; 98(46): e16525, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725599

RESUMO

To evaluate the clinical value of NeuroGam software in assessing the brain foci perfusion changes by TC-ECD single photon emission computed tomography/computed tomography (SPECT/CT) brain imaging in patients with Moyamoya Disease (MMD).Seventy-two patients with MMD who underwent superficial temporal artery-middle cerebral artery (STA-MCA) bypass combined with encephalo-duro-myo-synangiosis (EDMS) surgical revascularization were included. Baseline and follow-up TC-ECD SPECT/CT brain scans were performed on all patients at least twice before and after operation. Pre- and post-SPECT dicom images were reoriented into Talairach space using NeuroGam Software package. Additional visual analysis was performed. Differences mean pixel value between pre- and post- operation brain perfusion were assessed with paired t test and McNemar test.Significant differences in the number of hypoperfusion foci were found between visual assessment and NeuroGam aided assessment. More hypoperfusion foci were found by NeuroGam software aided assessment in the frontal, parietal, temporal, occipital lobe, thalamus, basal ganglia and cerebellum before and after surgery (P < .0001). According to NeuroGam software assessment, the perfusion of frontal, parietal, temporal lobe, anterior and middle cerebral regions on the operative side significantly improved before and after surgery (t = -3.734, t = -3.935, t = -5.099, t = -4.006, t = -5.170, all P < .001). However, no significant differences were found in the occipital lobe (t = -1.962, P = .054), thalamus (t = 1.362, P = .177), basal ganglia (t = -2.394, P = .019), and cerebellum (t = 1.383, P = .171) before and after surgery.The NeuroGam software provides a quantitative approach for monitoring surgical effect of MMD in a variable time (3-12 months after surgery). It could discover the perfusion changes that are neglected in conventional visual assessment.


Assuntos
Cisteína/análogos & derivados , Interpretação de Imagem Assistida por Computador/métodos , Doença de Moyamoya/diagnóstico por imagem , Compostos de Organotecnécio , Compostos Radiofarmacêuticos , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/estatística & dados numéricos , Adolescente , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/cirurgia , Revascularização Cerebral/métodos , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/cirurgia , Doença de Moyamoya/cirurgia , Período Pós-Operatório , Período Pré-Operatório , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/métodos , Software , Artérias Temporais/cirurgia , Resultado do Tratamento , Adulto Jovem
8.
Chem Commun (Camb) ; 55(86): 12932-12935, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31599282

RESUMO

Here, we report the development of novel PET radiotracer ([11C]CW22) of BET proteins. In vivo imaging results in rodents and nonhuman primates (NHP) demonstrate that [11C]CW22 has excellent brain uptake, good specificity, good selectivity, suitable metabolism, appropriate kinetics and distribution in the brain. Our studies demonstrated that [11C]CW22 exhibits ideal properties as a PET imaging probe of BET proteins for further validation.


Assuntos
Encéfalo/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos/química , Animais , Barreira Hematotesticular/metabolismo , Encéfalo/metabolismo , Radioisótopos de Carbono/química , Cristalografia por Raios X , Cinética , Macaca , Camundongos , Conformação Molecular , Proteínas do Tecido Nervoso/química , Neurônios , Domínios Proteicos , Compostos Radiofarmacêuticos/metabolismo , Receptores de Superfície Celular/química
9.
Br J Radiol ; 92(1104): 20190380, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31600089

RESUMO

OBJECTIVE: To evaluate the therapeutic response, progression free survival (PFS), overall survival (OS) and clinical toxicity of 177Lu-PSMA-617 PSMA targeted radioligand therapy (PRLT) in the setting of heavily pre-treated metastatic castrate-resistant prostate cancer (mCPRC) patients and also examine the association of prognostic variables with therapeutic outcome in such patient cohort. METHODS: We examined the medical records of mCRPC patients who had undergone 177Lu-PSMA-617 PRLT from March 2017 to February 2019 in our institute. Patients receiving equal to or more than two cycles were included and analyzed in this retroprospective study.The 68Ga-PSMA-11 PET-CT and 18-fludeoxyglucose positron emission tomography (18FDG PET)-CT scan findings, serum prostate-specific antigen (PSA) change, health-related quality of life (HRQoL) scales (Eastern Cooperative Oncology Group/Karnofsky score) and Gleason score were assessed for their implications on the outcome of therapy. The treatment response was evaluated under three categories: (a) symptomatic (b) biochemical and (c) imaging response.The PFS and OS following first PRLT were determined and the association of various variables with PSA doubling time (DT) and FDG uptake in the lesions were analyzed. Toxicity assessment was undertaken objectively by National Cancer Institute-Common Terminology Criteria for Adverse Events scale v. 5.0 for haematological and nephrotoxicity, and salivary gland toxicity assessed by xerostomia inventory score. RESULTS: A total of 40 mCRPC patients (age range: 46-84 years; median 63 years), who had undergone 177Lu-PSMA-617 PRLT, of at least two cycles was identified and selected for the analysis. FDG uptake was noted in 87.5% of patients (n = 35). Out of 40 cases, 21 were responders (CR, PR and SD) and 19 were non-responders (PD) on symptomatic and biochemical scales while on molecular imaging response, 16 (43%) were responders and remaining 21 (57%) were non-responders. Lesion-wise, 68Ga-PSMA-11 avid metastatic nodal disease responded well with 177Lu PSMA-617 PRLT, as compared to hepatic and skeletal lesions. The median OS and PFS was 12 and 7 months respectively following first PRLT. Patients with negative serum PSA-DT demonstrated superior 1 year PFS as compared to those with positive serum PSA-DT (52.5 vs 47.5%) (p = 0.029). Patients receiving greater than two cycles PRLT demonstrated a higher negative PSA-DT as compared to those receiving two cycles (p-value = 0.03). Grade 1 xerostomia was observed in two patients (5%) (mean xerostomia score of 23), haematotoxicity in seven patients [Grade I (n = 2, 5%) and Grade II (n = 5, 14%)]. CONCLUSION: 177Lu-PSMA-617 PRLT was well-tolerated and able to produce disease control with good symptomatic and biochemical responses in the context of heavily pre-treated mCRPC with progressive disease, with low toxicity profile. Evident association of high FDG uptake was observed with aggressive disease biology coupled with increasing Gleason score and poorer 12 months PFS. Negative PSA-DT following therapy demonstrated longer PFS. The results demonstrate important future role of 177Lu-PSMA-617 PRLT in the treatment of mCRPC. ADVANCES IN KNOWLEDGE: The present work explored in a large teriary cancer care setting, the efficacy of 177Lu-PSMA-617 PRLT, in an aggressive and unselected subset of mCRPC. The response and outcome was correlated with a number of prognostic variables, including molecular imaging findings (FDG uptake in the metastatic lesions), PSA DT and Gleason score.


Assuntos
Dipeptídeos/uso terapêutico , Fluordesoxiglucose F18/farmacocinética , Glutamato Carboxipeptidase II/antagonistas & inibidores , Compostos Heterocíclicos com 1 Anel/uso terapêutico , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico , Neoplasias de Próstata Resistentes à Castração/metabolismo , Compostos Radiofarmacêuticos/farmacocinética , Idoso , Idoso de 80 Anos ou mais , Antígenos de Superfície , Dipeptídeos/efeitos adversos , Radioisótopos de Gálio/uso terapêutico , Compostos Heterocíclicos com 1 Anel/efeitos adversos , Humanos , Lutécio/uso terapêutico , Masculino , Pessoa de Meia-Idade , Terapia de Alvo Molecular/métodos , Gradação de Tumores , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Prognóstico , Intervalo Livre de Progressão , Antígeno Prostático Específico/sangue , Neoplasias de Próstata Resistentes à Castração/mortalidade , Neoplasias de Próstata Resistentes à Castração/patologia , Qualidade de Vida , Radioisótopos/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento
10.
Medicine (Baltimore) ; 98(41): e17446, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593099

RESUMO

RATIONALE: The infiltration of tumor cells to pulmonary lymphatic system, as known as pulmonary lymphangitis carcinomatosis (PLC), is a rare presentation of pulmonary metastases. PATIENT CONCERNS: We reported a case of a 66-year-old man after surgery, chemotherapy, and radiation therapy for colon cancer. Two months after these therapies, the patient complained of nonproductive cough for 1 week. DIAGNOSES: 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) scanning revealed increased FDG uptake along the thickened bronchovascular bundles, in bilaterally scattered ground-glass opacities and in mediastinal lymphadenopathy. The transbronchial biopsy and pathological study confirmed the diagnosis of PLC. INTERVENTIONS: Antineoplastic treatment (cetuximab) were administered after the patient was diagnosed with PLC. OUTCOMES: The patient died of respiratory failure within 3 months after the onset of his symptom. LESSONS: 18F-FDG PET/CT play an important role in identifying PLC, in selecting possible biopsy sites, and in accessing the extent of metastatic disease.


Assuntos
Carcinoma/diagnóstico por imagem , Neoplasias do Colo/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Linfangite/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Idoso , Carcinoma/secundário , Neoplasias do Colo/complicações , Neoplasias do Colo/patologia , Fluordesoxiglucose F18 , Humanos , Pulmão/diagnóstico por imagem , Neoplasias Pulmonares/secundário , Linfangite/etiologia , Masculino , Compostos Radiofarmacêuticos
11.
Radiologe ; 59(11): 968-974, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31570965

RESUMO

CLINICAL/METHODICAL ISSUE: Pulmonary carcinoids and carcinoids of the small intestine (jejunum and ileum) are often asymptomatic and can affect various parts of the body, which makes diagnosis difficult. STANDARD RADIOLOGICAL METHODS: Contrast-enhanced computed tomography (CE-CT) is commonly used for primary diagnostics. In case of concomitant pulmonary consolidation (e.g., atelectasis or pneumonia), tumor lesions can be obscured. In addition, differentiation between atypical (AC) and typical carcinoids (TC) is not possible using CT. Small tumors of the small intestine are easily overlooked (sensitivity: 50-85%, specificity: 25-97%, based on the literature). Additional functional imaging evaluation using hybrid imaging techniques can be applied, e.g., positron emission tomography/computed tomography (PET/CT). METHODICAL INNOVATIONS/PERFORMANCE: Depending on the histological characteristics of the tumor, PET/CT scans can be performed with different tracers. Since most carcinoids (e.g., TC) express somatostatin receptors (SSR), 68 gallium-radiolabeled PET tracers (e.g. 68 Ga-DOTA-TOC) are commonly used (sensitivity: 88-93%, specificity: 88-95%, based on the literature). Poorly differentiated carcinoids (e.g., AC) demonstrate lower SSR expression; thus, use of 18F­FDG (sensitivity: 37-72%, based on the literature) is indicated. In principle, these methods enable a noninvasive prognostic differentiation based on SSR expression and 18F­FDG uptake. However, the diagnosis must always be histologically confirmed. ACHIEVEMENTS/PRACTICAL RECOMMENDATIONS: Hybrid imaging with CE-CT and PET is useful to detect pulmonary carcinoids and carcinoids of the small intestine, respectively, and can be utilized for primary diagnostics and restaging.


Assuntos
Tumor Carcinoide , Neoplasias Intestinais/diagnóstico por imagem , Neoplasias Pulmonares , Tumores Neuroendócrinos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Tumor Carcinoide/diagnóstico por imagem , Fluordesoxiglucose F18 , Humanos , Intestino Delgado , Neoplasias Pulmonares/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Tomografia Computadorizada por Raios X/métodos
12.
Medicine (Baltimore) ; 98(40): e17067, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577699

RESUMO

Hypoxia is a well-recognized biological characteristic to therapy resistance and negative prognostic factor in patients with head and neck squamous cell carcinoma (HNSCC). This study aims to investigate the changes of hypoxia measured by F-fluoroerythronitroimidazole (FETNIM) uptake on integrated positron emission tomography and computed tomography (PET/CT) during chemoradiotherapy and its prognostic value of clinical outcome in locoregionally advanced HNSCC.Thirty-two patients with locoregionally advanced HNSCC who received definitive treatment with concurrent chemoradiotherapy underwent FETNIM PET/CT scans before and after 5 weeks of treatment. The intensity of hypoxia using the maximum standardized uptake value (SUVmax) was evaluated both on primary lesion and metastatic lymph node (MLN). The pre-SUVmax and mid-SUVmax were defined as SUVmax on pre- and mid-FETNIM PET/CT. The local control (LC), regional control (RC), distant metastatic-free survival (DMFS), and overall survival (OS) were collected in patient follow-ups.Mid-SUVmax decreased significantly both in the primary tumor (t = 8.083, P < .001) and MLN (t = 6.808, P < .001) compared to pre-SUVmax. With a median follow-up of 54 months, the 5-year LC, RC, DMFS, and OS rates were 55%, 66.7%, 64.7%, and 55%, respectively, for all of the patients. On univariate analysis, patients with high pre-SUVmax in primary tumor had significantly worse LC (56.3% vs 87.5%, P = .046) and OS (43.8% vs 87.5%, P = .023) than other patients. Patients with high mid-SUVmax had significantly worse DMFS (50% vs 84.6%, P = .049) and OS (33.3% vs 73.1%, P = .028) than other patients. The tumor grade and mid-SUVmax were the significant predictors of OS on multivariate analysis.In this study, hypoxia in tumor significantly decreased during chemoradiotherapy. The persistent hypoxia predicted poor OS. The data provided evidence that FETNIM PET/CT could be used dynamically for selecting appropriate patients and optimal timing of hypoxia-adapted therapeutic regimens.


Assuntos
Hipóxia Celular/efeitos dos fármacos , Hipóxia Celular/efeitos da radiação , Quimiorradioterapia/efeitos adversos , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/terapia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia/métodos , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Nitroimidazóis/administração & dosagem , Compostos Radiofarmacêuticos/administração & dosagem , Análise de Sobrevida , Adulto Jovem
13.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(10): 977-983, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31630497

RESUMO

Objective: To explore the value of dual-energy CT-based volumetric iodine-uptake (VIU) in the evaluation of chemotherapy efficacy in advanced gastric cancer. Methods: Inclusion criteria of subjects: (1) without previous systematic therapy; (2) with complete clinical information before and after chemotherapy; (3) without contraindications of chemotherapy. Exclusion criteria of subjects: (1) unfinished duration and times of chemotherapy; (2) unmeasurable primary lesions; (3) poor imaging quality or poor gastric filling. Clinical and image data of 52 patients with advanced gastric cancer who were diagnosed by pathology from gastroscopic biopsy, and needed chemotherapy evaluated by imaging and clinical information in the First Affiliated Hospital of Wenzhou Medical University from February 2017 to February 2018 were collected and analyzed. Of 52 patients, 38 were male and 14 were female with the median age of 65 (31-88) years old. All the patients underwent a dual-energy, dual phase-enhanced CT scanning before chemotherapy and after the third chemotherapy session. The parameters of the lesions measured before and after chemotherapy in portal vein phase were as follows: the maximum diameter (the largest diameter among those measured in the cross-sectional, coronal, and sagittal planes), average CT value (the regions of interest were manually pinpointed under cross-sectional planes with largest diameter of the tumor, which did not include regions less than 2 mm to the edge of the tumor) and VIU (lesion volume × iodine concentration). The change rates of maximum lesion diameter, average CT value and VIU before and after chemotherapy were calculated [(post-chemotherapy parameters-pre-chemotherapy parameters)/ pre-chemotherapy parameters]. The efficacy of chemotherapy was evaluated by RECIST 1.1 (the change of maximum tumor diameter after chemotherapy), Choi (the change of average CT value after chemotherapy) and VIU (the change of VIU after chemotherapy), respectively, which was categorized by complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD). Patients with CR, PR, and SD were assigned to the effective group, while those with PD were classified as the ineffective group. Paired t - test or Wilcoxon signed ranks test was used to compare the changes of parameters before and after chemotherapy, whereas Spearman correlation analysis and Kappa test were used for the correlation analysis and the consistency test between the three evaluation criteria (Kappa≥0.75 indicated good consistency). Results: After chemotherapy, the average CT value [(74.01±16.75) HU vs. (81.06±15.87) HU, t=2.202, P=0.030] and median VIU (668.53×10(2) µg vs. 272.52×10(2) µg, Z=4.761, P<0.001) decreased significantly, while the difference of the maximum diameter was not statistically significant [(66.71±34.49) mm vs. (78.45±35.62) mm, t=1.708, P=0.091]. The median change rate of VIU (-53.33%) was greater than that of CT values (-5.75%) with significant difference (Z=-5.408, P<0.001). According to the RECIST 1.1 criteria, 47 patients (90.4%, including 19 with PR and 28 with SD) were effective and 5 patients (9.6%) were ineffective. According to the Choi criteria, 45 patients (86.5%, including 37 with PR and 8 with SD) were effective and 7 patients (13.5%) were ineffective. According to the VIU criteria, 46 patients (88.5%, including 41 with PR and 5 with SD) were effective and 6 patients (11.5%) were ineffective. Efficacy comparison among these three criteria showed no significant difference (χ(2)=0.377, P=0.828). As compared to RECIST 1.1 evaluation, the proportion of PR evaluated by Choi and VIU was significantly higher (χ(2)=16.861, P<0.001), whereas the proportion of SD was significantly lower (χ(2)=24.089, P<0.001). There was no significant difference in the proportions of PR and SD between VIU and Choi criteria (χ(2)=0.887, P=0.346). Consistency and correlation analysis showed that the VIU and Choi evaluation criteria presented the highest consistency and correlation (Kappa=0.912, P<0.001; r=0.916, P<0.001). Conclusion: VIU is a feasible parameter for the evaluation of chemotherapy efficacy in advanced gastric cancer, and may be more sensitive than the evaluation criteria based on maximum diameter or change of CT value in the tumor.


Assuntos
Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/tratamento farmacológico , Tomografia Computadorizada por Raios X/métodos , Absorciometria de Fóton , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Radioisótopos do Iodo/farmacologia , Masculino , Pessoa de Meia-Idade , Compostos Radiofarmacêuticos/farmacologia , Indução de Remissão , Neoplasias Gástricas/patologia , Resultado do Tratamento
14.
Nihon Hoshasen Gijutsu Gakkai Zasshi ; 75(10): 1158-1164, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31631109

RESUMO

PURPOSE: To calculate the quantitative values in bone single-photon emission computed tomography, it is necessary to measure the amount of syringe radiation before and after the administration of a radiopharmaceutical. We proposed a method to omit the measurement of radioactivity. In this study, we clarified the effects of adopting this method and calculated its influence on quantitative values in a clinical setting. METHODS: We derived a relational expression of the administration time and dose of radioactivity from the measured value and the administration time of the syringe dose before and after the administration in each patient. Next, we determined the differences for radioactivity calculated from this relational expression (estimated dose) and actual administered radioactivity (actual dose). Furthermore, we calculated the differences in the quantitative values of a normal region (the fourth lumbar vertebra) on adopting these data. RESULTS: No significant differences between the estimated dose and actual dose were noted. Additionally, no significant differences in the quantitative values were observed. CONCLUSION: Our findings suggest that adoption of the estimated dose does not affect the quantitative value. When the estimated dose is adopted, it can be administered with an accuracy of 0.80%. Thus, it is possible to omit the actual measurement of radioactivity by using our proposed method.


Assuntos
Compostos Radiofarmacêuticos , Tomografia Computadorizada de Emissão de Fóton Único , Humanos , Compostos Radiofarmacêuticos/administração & dosagem
15.
ABC., imagem cardiovasc ; 32(4): 309-317, out.-dez. 2019. ilus, graf
Artigo em Português | LILACS | ID: biblio-1023941

RESUMO

As neoplasias cardíacas são divididas em primárias e secundárias. As secundárias são 20 a 40 vezes mais comuns do que as primárias. Embora raras, as neoplasias cardíacas primárias podem ser benignas e malignas, sendo as benignas responsáveis por 75% dos casos. Os principais objetivos da imagem cardiovascular são definir a morfologia e etiologia do tumor, identificar potenciais complicações e auxiliar na definição de tratamento. Para o diagnóstico de neoplasias cardíacas, a tomografia por emissão de pósitrons acoplada à tomografia computadorizada (PET-TC) com a fluordesoxiglicose-F18 (18F-FDG) é uma técnica ainda pouco utilizada, principalmente nos tumores cardíacos primários. Entretanto, ela pode ajudar na diferenciação entre tumores malignos e benignos e, assim, evitar biópsias cardíacas e tratamentos invasivos desnecessários. Para esta revisão, realizamos pesquisa na base de dados PubMed, considerando as publicações sobre o tema nos últimos 10 anos. A PET-TC 18F-FDG é um exame útil para diferenciar massas cardíacas benignas das malignas, de acordo com o maior grau de metabolismo glicolítico encontrado nas neoplasias malignas. Além do mais, nos tumores malignos, a PET-TC 18F-FDG tem papel central no estadiamento da doença e pode ajudar na avaliação de resposta ao tratamento


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Diagnóstico por Imagem/métodos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Neoplasias Cardíacas/diagnóstico , Sarcoma , Glicemia , Ecocardiografia/métodos , Espectroscopia de Ressonância Magnética/métodos , Doenças Cardiovasculares/diagnóstico , Compostos Radiofarmacêuticos , Fluordesoxiglucose F18 , Linfoma
17.
Chirurgia (Bucur) ; 114(4): 443-450, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31511130

RESUMO

Background: To evaluate the prognostic role of Positron Emission Tomography/Computed Tomography (PET/CT) and Endoscopic Ultrasound (EUS) performed before neoadjuvant chemotherapy (NAC) and surgery for oesophageal adenocarcinoma (OAC) patients, focusing on lymph node (LN) assessment. Methods: OAC patients treated in a single tertiary center during January 2008 until December 2014 were retrospectively studied. All patients had PET/CT and EUS before NAC and oesophagectomy. PET-FDG-avid local LNs and maximum standardized uptake value (SUVmax) of the primary tumour, EUS positive LNs and EUS tumour length were recorded. Univariate, multivariate and survival analyses were performed. Results: Following exclusions 151consecutive patients met the inclusion criteria, (median age 62 years). PET/CT and EUS sensitivity for local LNs metastasis was 39.2% and 88.6%, with specificities of 83.33% and 19.15% respectively. No overall survival (OS) difference was found between patients with PET/CT FDG-avid LNs and those with negative LNs (p=0.347). SUVmax uptake was divided into high and low (median cut-off value: 10) with no significant difference in OS between groups (p=0.141). EUS tumour length was not prognostic (OS, p=0.455). Conclusions: Initial LN staging in OA is inaccurate. Although PET/CT and EUS assessments may be complimentary, none independently predicted survival.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Endossonografia , Neoplasias Esofágicas/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/mortalidade , Adenocarcinoma/cirurgia , Antineoplásicos/administração & dosagem , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/cirurgia , Fluordesoxiglucose F18 , Humanos , Linfonodos/diagnóstico por imagem , Metástase Linfática/diagnóstico por imagem , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias/métodos , Cuidados Pré-Operatórios , Prognóstico , Compostos Radiofarmacêuticos , Estudos Retrospectivos , Resultado do Tratamento
19.
Z Rheumatol ; 78(9): 847-858, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31541286

RESUMO

Imaging procedures have become an important diagnostic tool in vasculitis. In large vessel vasculitides, such as giant-cell arteritis (GCA) and Takayasu arteritis, ultrasound, magnetic resonance imaging (MRI), computed tomography (CT) and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) can depict specific abnormalities of the arterial wall. A clinically suspected diagnosis can be confirmed by imaging if performed by a trained specialist using appropriate equipment, without histological investigations. Ultrasound, MRI and CT show a homogeneous, concentric thickening of the arterial wall and PET can detect increased glucose metabolism of the arterial wall. Ultrasound is the method of choice, especially in predominantly cranial GCA. Imaging should be performed before or within the first few days of glucocorticoid treatment as the PET findings of all arteries as well as ultrasound and MRI findings in temporal arteries normalize quickly with treatment. A planned imaging examination must not delay initiation of glucocorticoid treatment.


Assuntos
Arterite de Células Gigantes , Imagem Multimodal , Arterite de Takayasu , Fluordesoxiglucose F18 , Arterite de Células Gigantes/diagnóstico por imagem , Humanos , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Arterite de Takayasu/diagnóstico por imagem , Tomografia Computadorizada por Raios X
20.
Isr Med Assoc J ; 21(9): 580-584, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31542900

RESUMO

BACKGROUND: Whole-body integrated positron emission tomography / contrast-enhanced computed tomography (PET/CT) scan is increasingly used in cutaneous lymphomas. However, the value of PET/CT in the detection of cutaneous lesions in primary cutaneous B-cell lymphoma (PCBCL) has barely been investigated. OBJECTIVES: To investigate the diagnostic accuracy of PET/CT in tracking cutaneous involvement in PCBCL. METHODS: A retrospective study was conducted on 35 consecutive patients diagnosed with cutaneous B-cell lymphoma according to the World Health Organization classification who were evaluated with PET/CT as the initial staging procedure before treatment. RESULTS: Thirty-five patients met the study criteria. In two patients extracutaneous disease was detected by PET/CT and CT and confirmed by biopsy. Of the 33 patients with PCBCL, 26 (79%) had small cell PCBCL (18 marginal-zone, 8 follicle-center lymphoma) and 7 (21%) had large cell PCBCL (3 follicle-center, 3 leg-type, 1 indeterminate). PET/CT detected skin lesions in 3 of 26 patients (12%) with small-cell PCBCL as compared to 6 of 7 patients with large-cell PCBLC (86%), a 7.4-fold detection risk (95% confidence interval, 2.4-22, P = 0.004). The PET-positive subgroup was characterized by larger lesion size (P < 0.001) and a higher Ki-67 proliferation index (P < 0.001). CONCLUSIONS: The sensitivity of PET/CT for detecting cutaneous involvement of lymphomas is low for small-cell PCBCL but high for large-cell types, and thus may facilitate therapeutic strategies.


Assuntos
Fluordesoxiglucose F18 , Linfoma de Células B/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos , Neoplasias Cutâneas/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Pele/diagnóstico por imagem , Adulto Jovem
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