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1.
Molecules ; 26(5)2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33652938

RESUMO

PET of ß-Amyloid plaques (Aß) using [18F]florbetaben ([18F]FBB) and [18F]fluorodeoxyglucose ([18F]FDG) increasingly aid clinicians in early diagnosis of dementia, including Alzheimer's disease (AD), frontotemporal disease, dementia with Lewy bodies, and vascular dementia. The aim of this retrospective analysis was to evaluate clinical relevance of [18F]FBB, [18F]FDG PET and complimentary CSF measurements in patients with suspected dementia. In this study, 40 patients with clinically suspected or history of dementia underwent (1) measurement of Aß peptides, total tau, and p-tau protein levels in the cerebrospinal fluid (CSF) compared with healthy controls (HC); (2) clinical and neuropsychological assessment, which included Consortium to Establish a Registry for Alzheimer's Disease neuropsychological assessment battery (CERAD-NAB); (3) [18F]FBB and [18F]FDG PET imaging within an average of 3 weeks. The subjects were within 15 days stratified using PET, CSF measurements as HC, mild cognitive impaired (MCI) and dementia including Alzheimer´s disease. The predictive dementia-related cognitive decline values were supporting the measurements. PET images were evaluated visually and quantitatively using standard uptake value ratios (SUVR). Twenty-one (52.5%) subjects were amyloid-positive (Aß+), with a median neocortical SUVR of 1.80 for AD versus 1.20 relative to the respective 19 (47.5 %) amyloid-negative (Aß-) subjects. Moreover, the [18F]FDG and [18F]FBB confirmed within a sub-group of 10 patients a good complimentary role by correlation between amyloid pathology and brain glucose metabolism in 8 out of 10 subjects. The results suggest the clinical relevance for [18F]FBB combined with [18F]FDG PET retention and CFS measurements serving the management of our patients with dementia. Therefore, [18F]FBB combined with [18F]FDG PET is a helpful tool for differential diagnosis, and supports the patients' management as well as treatment.


Assuntos
Doença de Alzheimer/diagnóstico por imagem , Disfunção Cognitiva/diagnóstico por imagem , Demência/diagnóstico por imagem , Fluordesoxiglucose F18/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/genética , Doença de Alzheimer/fisiopatologia , Peptídeos beta-Amiloides/genética , Peptídeos beta-Amiloides/isolamento & purificação , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/fisiopatologia , Demência/diagnóstico , Demência/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Proteínas tau/genética , Proteínas tau/isolamento & purificação
3.
Medicine (Baltimore) ; 100(10): e25088, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725899

RESUMO

ABSTRACT: Diagnosis of unicentric Castleman disease (UCD) is not easy before the resection and obtainment of pathological result. We retrospectively summarized 10-year experience of clinical evaluation and management for retroperitoneal UCD in Peking Union Medical College Hospital (PUMCH) between December 1, 2009 and December 31, 2019. Seventy two UCD patients with pathological diagnosis after resection were screened out. Among them 25 patients had retroperitoneal UCD. The average age of the 25 patients was 43.80 ±â€Š12.79, and 52.00% were male. No patients had systemic symptoms, and 1 patient got preoperative treatment. The average size of masses was 5.59 ±â€Š2.86 cm. The UCD sites included kidney, adrenal area, perinephric area, pancreas, peripancreatic area, area of descending part of duodenum, periaortic area or beside iliac artery, and others. The masses presented different degree of enhancement on CT scans and hypoecho or isoecho on ultrasound. Increased metabolism could be found on 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT). Some patients had positive results on somatostatin receptor imaging, but none had positive results on 131I-metaiiodo-benzylguanidine (131I-MIBG). Some patients presented the elevated level of interleukin-6 (IL-6), 24hour-urinary catecholamine and tumor markers. All the patients received complete resection of masses and 96.00% had hyaline-vascular type pathology except 1 patient (plasma cell-type). Ninety two percent patients received a long-term follow-up with an average follow-up time of 35.48 ±â€Š33.90 months. No patients died or experienced relapse during follow-up. Differential diagnosis of retroperitoneal UCD may be difficult according to imaging and laboratorial examinations. Differential diagnosis with pheochromocytomas/paragangliomas should be taken into special consideration. Different imaging examinations, such as CT/MRI, 18F-PET/CT, somatostatin receptor imaging and 131I-MIBG, can be combined for differential analysis. Complete resection is the best treatment and could provide a final pathological diagnosis.


Assuntos
Hiperplasia do Linfonodo Gigante/diagnóstico por imagem , Excisão de Linfonodo , Neoplasias das Glândulas Suprarrenais/diagnóstico , Adulto , Hiperplasia do Linfonodo Gigante/sangue , Hiperplasia do Linfonodo Gigante/patologia , Hiperplasia do Linfonodo Gigante/cirurgia , Diagnóstico Diferencial , Feminino , Fluordesoxiglucose F18/administração & dosagem , Seguimentos , Humanos , Interleucina-6/sangue , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade , Paraganglioma/diagnóstico , Feocromocitoma/diagnóstico , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Espaço Retroperitoneal/diagnóstico por imagem , Espaço Retroperitoneal/patologia , Espaço Retroperitoneal/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia
4.
Medicine (Baltimore) ; 100(8): e24803, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663098

RESUMO

RATIONALE: Melanotic schwannoma (MS) is an unusual variant of a nerve sheath neoplasm that accounts for less than 1% of all primary peripheral nerve sheath tumors. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has unique value in detecting malignant MS lesions. To date, only 4 cases of MS with hepatic metastasis have been reported. Herein, we report the fifth case, which is the first reported patient with MS of Asian ethnicity with hepatic metastasis. PATIENT CONCERNS: A 29-year-old woman with a 1-day history of backache was admitted to our hospital. PET/CT showed a paravertebral heterogeneous soft tissue mass along the spinal nerve at the L2-L3 level with strong FDG uptake, and a nodule with increased FDG uptake in the lateral lobe of the left liver. DIAGNOSIS: A puncture biopsy of the L3 bony destruction and surrounding soft tissue mass was performed. The final diagnosis was spinal MS with hepatic metastasis. INTERVENTIONS: The patient underwent 6 courses of systemic chemotherapy. OUTCOMES: The patient did not receive further treatment for half a year after the end of chemotherapy and recovered well. LESSONS: Unlike conventional schwannomas, which are completely benign, MS has an unpredictable prognosis. It is thought to have low malignant potential, and the malignant type tends to metastasize. FDG PET/CT has a unique and important value in the differential diagnosis of benign and malignant lesions, in detecting occult metastases, monitoring the treatment response, and assessing the prognosis of MS.


Assuntos
Fluordesoxiglucose F18/administração & dosagem , Neurilemoma/diagnóstico , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos/administração & dosagem , Neoplasias da Coluna Vertebral/diagnóstico , Adulto , Antineoplásicos/uso terapêutico , Feminino , Humanos , Neoplasias Hepáticas/secundário , Vértebras Lombares/fisiologia , Neurilemoma/diagnóstico por imagem , Neurilemoma/tratamento farmacológico , Neurilemoma/patologia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/tratamento farmacológico , Neoplasias da Coluna Vertebral/patologia , Raízes Nervosas Espinhais/patologia
6.
Cancer Sci ; 112(3): 1114-1122, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33415792

RESUMO

The purposes of this study were to re-confirm the usefulness of PET/CT in the differentiation of benignity/malignancy of neurogenic tumors in NF1 patients, and to analyze the natural course of plexiform neurofibroma (pNF) and clarify whether PET/CT is also useful for detecting tumors other than neurogenic tumors. PET/CT was prospectively imaged in 36 NF1 patients. There were 14 malignant peripheral nerve sheath tumors (MPNSTs) in 14 patients, and 54 pNFs in 30 patients. Nine patients had both MPNST and pNF. Maximal standardized uptake value (SUVmax) was significantly higher in MPNST (median 7.6: range 4.1-10.4) (P < .001) compared with that of pNF (median 3.7: range 1.6-9.3). The cut-off value of 5.8 resulted in a sensitivity of 78.6% and specificity of 88.9%. Median age was 29 y, and median maximum tumor diameter was 82 mm in 14 MPNST patients. The 5-y overall survival rate was 46.8%. Three patients with low-grade MPNST were alive without disease at the time of this report. In 9 patients in which pNF and MPNST co-existed, 2 showed a higher SUVmax of pNF than that of MPNST. Natural history analysis of pNF (n = 43) revealed that no factors significantly correlated with increased tumor size. Nine lesions other than neurogenic tumors were detected by PET/CT including 5 thyroid lesions and 3 malignant neoplasms. This study revealed the usefulness and limitation of PET/CT for NF1 patients. In the future, it will be necessary to study how to detect over time the malignant transformation of pNF to MPNST, via an intermediate tumor.


Assuntos
Neoplasias da Bainha Neural/diagnóstico , Neurofibroma Plexiforme/diagnóstico , Neurofibromatose 1/diagnóstico , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Adolescente , Adulto , Idoso , Carcinogênese , Criança , Estudos Transversais , Estudos de Viabilidade , Feminino , Fluordesoxiglucose F18/administração & dosagem , Humanos , Estimativa de Kaplan-Meier , Estudos Longitudinais , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias da Bainha Neural/mortalidade , Neoplasias da Bainha Neural/patologia , Neurofibroma Plexiforme/mortalidade , Neurofibroma Plexiforme/patologia , Neurofibromatose 1/mortalidade , Neurofibromatose 1/patologia , Prognóstico , Estudos Prospectivos , Curva ROC , Adulto Jovem
7.
Medicine (Baltimore) ; 99(50): e23210, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327238

RESUMO

PURPOSE: This retrospective study aimed to investigate the clinical value of -deoxy-2-(F)-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) in detecting primary lesions of hepatic metastases. METHODS: A total of 124 patients with hepatic metastatic carcinoma of unknown primary underwent whole body F-FDG PET/CT imaging. According to the final diagnoses for both primary sites and hepatic metastases that were confirmed either histopathologically or by clinical follow up, all patients were divided into 4 groups: a true positive group (TP, 95 cases), a false positive group (FP, 9), a true negative group (TN, 8) and a false negative group (FN, 12). RESULTS: The TP rate of primary lesions, detected by F-FDG PET/CT, was 76.61%, the FP rate 7.26%, the TN rate 6.45% and the FN rate 9.68%. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of F-FDG PET/CT in the detection of primary tumors were 88.78%, 52.94%, 91.35%, 40%, and 83.06%, respectively. Accurate diagnosis groups (TP, TN) showed a significantly higher SUVmax (standard uptake maximum value) level than that in error diagnosis groups (FP, FN). The SUVmax between hepatic metastases and primary lesions had a positive correlation. The primary tumor sites of hepatic metastases were mainly located in the gastrointestinal organs and the lungs. CONCLUSIONS: Whole body F-FDG PET/CT imaging was sensitive for detecting primary sites/lesions with hepatic metastatases of unknown primary, especially when the SUVmax of hepatic metastases were greater than 4.7.


Assuntos
Carcinoma/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/secundário , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Fluordesoxiglucose F18/administração & dosagem , Fluordesoxiglucose F18/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica/diagnóstico por imagem , Metástase Neoplásica/patologia , Neoplasias Primárias Desconhecidas/patologia , Valor Preditivo dos Testes , Compostos Radiofarmacêuticos/administração & dosagem , Compostos Radiofarmacêuticos/metabolismo , Estudos Retrospectivos , Sensibilidade e Especificidade
8.
Medicine (Baltimore) ; 99(51): e23395, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371068

RESUMO

BACKGROUND: Parkinson's disease (PD) has a high incidence in the elderly, and the late stage seriously affects the daily life of the patients. Most of the initial symptoms of PD are not obvious or atypical, which brings difficulties to the early diagnosis. Replacement therapy and neuroprotection after early diagnosis can significantly improve the prognosis and quality of life of patients. More and more evidence shows that 11C-2ß-carbomethoxy-3ß-(4-fluorophenyl) tropane positron emission tomography ( 11C-CFT PET) combined with 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) can effectively improve the accuracy of early diagnosis. However, there is no consistent conclusion at present. The purpose of this study is to evaluate the efficacy of 11C-CFT PET combined with 18F-FDG PET in the diagnosis of early PD. METHODS: We will search 7 electronic databases (PubMed, EMBASE, Web of Science, Cochrane library, PsycINFO, AMED, Scopus), ongoing trials and grey literature to collect related randomized controlled trials and will use Review Manager Software 5.2 and STATA Software 16.0 for analysis and synthesis. RESULTS: We will integrate the existing randomized controlled trials to evaluate the value of 11C-CFT PET combined with 18F-FDG PET in the diagnosis of early PD. CONCLUSION: Our study may prove that 11C-CFT PET combined with 18F-FDG PET can effectively diagnose early PD. REGISTRATION NUMBER: International Prospective Register of Systematic Reviews (PROSPERO): CRD42020203442.


Assuntos
Fluordesoxiglucose F18/administração & dosagem , Doença de Parkinson/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos/administração & dosagem , Tropanos/administração & dosagem , Humanos , Imagem Multimodal , Doença de Parkinson/diagnóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Sensibilidade e Especificidade , Índice de Gravidade de Doença
9.
PLoS One ; 15(12): e0244502, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33370365

RESUMO

BACKGROUND: To investigate the survival prognostic value of the radiomic features of 18F-FDG PET in patients who had EGFR (epidermal growth factor receptor) mutated lung adenocarcinoma and received targeted TKI (tyrosine kinase inhibitor) treatment. METHODS: Fifty-one patients with stage III-IV lung adenocarcinoma and actionable EGFR mutation who received first-line TKI were retrospectively analyzed. All patients underwent pretreatment 18F-FDG PET/CT, and we calculated the PET-derived radiomic features. Cox proportional hazard model was used to examine the association between the radiomic features and the survival outcomes, including progression-free survival (PFS) and overall survival (OS). A score model was established according to the independent prognostic predictors and we compared this model to the TNM staging system using Harrell's concordance index (c-index). RESULTS: Forty-eight patients (94.1%) experienced disease progression and 41 patients (80.4%) died. Primary tumor SUV entropy > 5.36, and presence of pleural effusion were independently associated with worse OS (both p < 0.001) and PFS (p = 0.001, and 0.003, respectively). We used these two survival predictors to devise a scoring system (score 0-2). Patients with a score of 1 or 2 had a worse survival than those with a score of 0 (HR for OS: 3.6, p = 0.006 for score 1, and HR: 21.8, p < 0.001 for score 2; HR for PFS: 2.2, p = 0.027 for score 1 and HR: 8.8, p < 0.001 for score 2). Our scoring system surpassed the TNM staging system (c-index = 0.691 versus 0.574, p = 0.013 for OS, and c-index = 0.649 versus 0.517, p = 0.004 for PFS). CONCLUSIONS: In this preliminary study, combining PET radiomics with clinical risk factors may improve survival stratification in stage III-IV lung adenocarcinoma with actionable EFGR mutation. Our proposed scoring system may assist with optimization of individualized treatment strategies in these patients.


Assuntos
Adenocarcinoma de Pulmão/mortalidade , Interpretação de Imagem Assistida por Computador , Neoplasias Pulmonares/mortalidade , Pulmão/diagnóstico por imagem , Inibidores de Proteínas Quinases/uso terapêutico , Adenocarcinoma de Pulmão/diagnóstico , Adenocarcinoma de Pulmão/tratamento farmacológico , Adenocarcinoma de Pulmão/genética , Idoso , Receptores ErbB/antagonistas & inibidores , Receptores ErbB/genética , Estudos de Viabilidade , Feminino , Fluordesoxiglucose F18/administração & dosagem , Seguimentos , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/genética , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Mutação , Estadiamento de Neoplasias , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Prognóstico , Intervalo Livre de Progressão , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco
10.
Rev. esp. med. nucl. imagen mol. (Ed. impr.) ; 39(5): 273-278, sept.-oct. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-198288

RESUMO

ANTECEDENTES: El hiperparatiroidismo (HPT) se caracteriza por el aumento de los niveles de parathormona (PTH), siendo la exéresis quirúrgica la única opción curativa definitiva. Luego de establecida la necesidad de cirugía, la adecuada identificación de las glándulas paratiroides en el preoperatorio resulta esencial para un abordaje mínimamente invasivo. La negatividad y/o discordancia en los estudios de primera línea (ecografía y gammagrafía de paratiroides Tc99m-MIBI) exige imágenes de mayor precisión, para reducir la probabilidad de exploración cervical bilateral o reintervención. OBJETIVOS: a) Demostrar la sensibilidad de la tomografía por emisión de positrones (PET) / tomografía computarizada 4D (TC 4D) 18 fluorocolina (18F-colina) en HPT; b) comprobar si existe correlación entre la calcemia y la PTH preoperatoria versus el tamaño y SUV (standardized uptake value) máximo precoz y tardío de la glándula, determinado por PET/TC 4D 18F-colina, y c) analizar el comportamiento de las lesiones paratiroideas con el contraste endovenoso (EV). MATERIAL Y MÉTODOS: El número total de pacientes incluidos fue de 28 entre los años 2016 y 2019 en una única institución. Es un estudio observacional de tipo cohorte prospectiva. Las correlaciones se analizaron mediante el coeficiente de Pearson para variables con distribución normal y Spearman (rho) para aquellas con distribución no normal. El estándar de referencia para determinar la sensibilidad fue el análisis anatomopatológico. Se interpretó como significativa una p < 0,05. Se utilizó el software STATA 13. RESULTADOS: De los 28 pacientes con PET/TC 4D 18F-colina realizados, 18 fueron intervenidos quirúrgicamente. De las 26 lesiones diagnosticadas por PET/TC 4D 18F-colina como sugestivas de lesiones paratiroideas, 23 correspondieron a enfermedad glandular (adenoma o hiperplasia) estableciendo una sensibilidad del 88,5%. Existió correlación entre la PTH preoperatoria del paciente y el tamaño máximo de la glándula en PET/TC 4D 18F-colina. (Spearman=0,66; p = 0,0014). Las lesiones paratiroideas presentaron, además del realce ante la aplicación de contraste EV, características de comportamiento distintivas que permiten identificarlas de manera altamente sugestiva. CONCLUSIONES: El PET/TC 4D 18F-colina es un estudio anatómico y funcional con una alta sensibilidad en pacientes con HPT con estudios de primera línea negativos o discordantes. La PTH preoperatoria mostró correlación con el tamaño máximo de la glándula en PET/TC 4D 18F-colina. Las lesiones paratiroideas tienen un comportamiento altamente sugestivo y realzan ante el contraste EV


BACKGROUND: Hyperparathyroidism (HPT) is characterised by increased levels of parathyroid hormone (HPT), surgical excision being the only definitive curative option. After establishing the need for surgery, it is essential to identify the parathyroid glands in the preoperative period to use a minimally invasive approach. Negativity and / or discrepancy in first-line studies (ultrasound and Tc-99m MIBI parathyroid scintigraphy) require more accurate images to reduce the likelihood of bilateral cervical exploration or reintervention. OBJECTIVES: a) To demonstrate the sensitivity of 18F-fluorocholine (18F-choline) positron emission tomography (PET)/4D computed tomography (4D CT) in HPT. b) To check whether there is a correlation between calcaemia and preoperative PTH versus size and early and late SUVmax (Standardized Uptake Value) of the gland, determined by 18F-choline PET/4D CT and c) to study the behaviour of parathyroid lesions with intravenous contrast (IV). MATERIAL AND METHODS: A total of 28 patients were included between 2016 and 2019 in a single institution. Prospective observational cohort study. Correlations were analysed using Pearson's coefficient for variables with normal distribution and Spearman (rho) for those with non-normal distribution. Anatomopathological analysis was the benchmark standard to determine sensitivity was. A p<.05 was interpreted as significant. STATA 13 software was used. RESULTS: Of the 28 patients who underwent 18F-choline PET/4D CT, 18 were operated. Of the 26 lesions diagnosed by 18F-choline PET/4D CT as suggestive of parathyroid lesions, 23 corresponded to glandular disease (adenoma or hyperplasia) establishing a sensitivity of 88.5%. There was a correlation between the patient's preoperative PTH and the maximum size of the gland on 18F-choline PET/4D CT. (Spearman=.66; p=.0014). The parathyroid lesions showed, in addition to IV contrast enhancement, distinctive behavioural characteristics identified as highly suggestive. CONCLUSIONS: 18F-choline PET/CT 4D is an anatomical and functional study with high sensitivity in patients with HPT with negative or discrepant first-line studies. Preoperative PTH showed a correlation with maximum gland size on 18F-choline PET/CT 4D. Parathyroid lesions behave in a highly suggestive way and are enhanced by IV contrast


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Fluordesoxiglucose F18/administração & dosagem , Tomografia Computadorizada Quadridimensional/métodos , Hiperparatireoidismo/diagnóstico por imagem , Administração Intravenosa/métodos , Paratireoidectomia/métodos , Sensibilidade e Especificidade , Coristoma/diagnóstico por imagem
11.
Rev. esp. med. nucl. imagen mol. (Ed. impr.) ; 39(5): 284-291, sept.-oct. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-198290

RESUMO

OBJETIVO: Valorar la capacidad diagnóstica de la PET/TC con [18F]F-Fluormetilcolina en la recidiva bioquímica del cáncer de próstata (CP) y su impacto terapéutico. MATERIAL Y MÉTODOS: Se incluyeron 108 pacientes, diagnosticados de CP con criterios bioquímicos de recurrencia. Se realizó una PET/TC Colina mediante estudio dinámico de pelvis y estudio de cuerpo entero a los 60min postinyección del trazador. Se ha analizado la relación entre los estudios positivos y el valor del PSA clasificando a los pacientes en tres grupos (<1,2/1,2-2/>2ng/ml); se ha valorado la capacidad diagnóstica respecto a la RM pelviana y el impacto en la decisión terapéutica. RESULTADOS: Se identificó la localización de la recurrencia en 85 de 108 pacientes (78,7%): 34 local, 47 ganglionar pelviana y 58 lesiones a distancia, incluyendo ganglios retroperitoneales, mediastínicos y lesiones en órganos a distancia (hueso y pulmón). Se diagnosticaron segundos tumores en 4 pacientes. No se encontraron diferencias significativas en el porcentaje de estudios positivos dependiendo del tratamiento primario. Los pacientes con PSA>2ng/ml mostraron un porcentaje de detección de enfermedad más alto que los pacientes con un nivel de PSA inferior, con diferencias significativas (p < 0,0001). La PET/TC [18F]F-Colina fue capaz de detectar enfermedad local, no conocida previamente por la RM, en el 29,41% de los pacientes. La PET/TC Colina tuvo impacto en el manejo terapéutico en 67 de 108 pacientes (62%). CONCLUSIONES: La PET/TC [18F]F-Fluormetilcolina es una herramienta útil en la detección de enfermedad locorregional y diseminada del CP tratado con sospecha de recurrencia, proporcionando un cambio de manejo terapéutico en un 62% de los pacientes


OBJECTIVE: To assess the diagnostic capability of PET/CT with [18F]F-Fluoromethylcholine in prostate cancer (PC) with biochemical recurrence and its therapeutic impact. MATERIAL AND METHODS: We included 108 patients, diagnosed with PC with biochemical criteria for recurrence. A PET/CT Choline scan was performed by dynamic pelvic and whole body study at 60min post-tracer injection. The relationship between the positive studies and the PSA value was analysed by classifying patients into three groups (<1.2/1.2-2/>2ng/ml), and the diagnostic capacity was assessed with respect to pelvic MRI and the impact on the therapeutic decision. RESULTS: The location of recurrence was identified in 85 of 108 patients (78.7%): 34 local, 47 pelvic lymph nodes and 58 distant lesions, including retroperitoneal, mediastinal lymph nodes and distant organ lesions (bone and lung). Second tumors were diagnosed in 4 patients. No significant differences were found in the percentage of positive studies depending on primary treatment. Patients with PSA>2ng/ml showed a higher percentage of disease detection than patients with a lower PSA level, with significant differences (p < 0.0001). PET/CT [18F]F-Choline was able to detect local disease, not previously known from MRI, in 29.41% of patients. PET/CT Choline had an impact on therapeutic management in 67 of 108 patients (62%). CONCLUSIONS: PET/CT with [18F]F-Fluoromethylcholine is a useful tool in the detection of locoregional and disseminated disease of PC treated with suspicion of recurrence, providing a change in therapeutic management in 62% of patients


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Neoplasias da Próstata/diagnóstico por imagem , Recidiva Local de Neoplasia/diagnóstico por imagem , Sensibilidade e Especificidade , Fluordesoxiglucose F18/administração & dosagem , Compostos Radiofarmacêuticos/administração & dosagem , Prostatectomia/métodos , Antígeno Prostático Específico/análise , Estudos Prospectivos
13.
Medicine (Baltimore) ; 99(36): e22057, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899070

RESUMO

INTRODUCTION: Based on existing literature, the juxtaglomerular cell tumor (JGCT) is a rare renal tumor, typically present with hypertension and hypokalemia. Nonfunctioning JGCT, without hypertension or hypokalemia, is extremely rare. PATIENT CONCERNS: Herein, we report a case of nonfunctioning JGCT mimicking renal cell carcinoma. The 29-year-old woman with an unremarkable past medical history presented with a left renal tumor without hypertension or hypokalemia. DIAGNOSIS: Both CT and 18F-FDG-PET/CT suggested a malignancy, possibly renal cell carcinoma. INTERVENTIONS: The tumor was then removed completely via robotic assistant laparoscopic partial nephrectomy; and pathology result was JGCT. Since the patient had no hypertension or hypokalemia, a nonfunctional JGCT was diagnosed. OUTCOMES: The patient recovered uneventfully, and was in good health in 6-months' follow-up period. CONCLUSION: Preoperative identification of JGCT is very difficult due to the lack of specific clinical manifestations. This case teaches us that for young patients with renal tumors whose CT enhancement is not obvious at the early phase, JGCT should be considered as a differential diagnosis. Radical nephrectomy should be avoided for JGCT in consideration of its relatively good prognosis.


Assuntos
Carcinoma de Células Renais/diagnóstico , Sistema Justaglomerular/patologia , Neoplasias Renais/patologia , Neoplasias/cirurgia , Adulto , Assistência ao Convalescente , Diagnóstico Diferencial , Feminino , Fluordesoxiglucose F18/administração & dosagem , Humanos , Neoplasias Renais/diagnóstico por imagem , Laparoscopia/instrumentação , Nefrectomia/métodos , Nefrectomia/tendências , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento
14.
Anticancer Res ; 40(10): 5735-5738, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988899

RESUMO

BACKGROUND/AIM: Surgical staging is paramount to treatment of primary bone sarcomas. Often, bone scintigraphy and/or positron emission tomography-computed tomography (PET-CT) are used to exclude skeletal metastases; however, skeletal metastases in chondrosarcoma are rare. The purpose of this study was to assess the utility of these staging methods in patients with chondrosarcoma. PATIENTS AND METHODS: We reviewed 138 (87 males, 51 female) patients, mean age 54±20 years, with a chondrosarcoma, who had completed a bone scintigraphy or PET/CT as part of surgical staging. Sensitivity, specificity, and positive/negative predictive value of the scans was calculated. RESULTS: Seventeen (12%) patients had a positive bone scintigraphy or PET-CT for skeletal metastases. In cases of bone scintigraphy (n=11), 6 were benign and 5 were skeletal metastases. In cases of PET-CT, 6 were skeletal metastases, 3 were positive and 3 benign. All positive cases regarded dedifferentiated chondrosarcoma. The overall sensitivity and specificity of a bone scan or PET-CT was 100% and 93.1%; with a positive and negative predictive value of 47.1% and 100%, respectively. CONCLUSION: Skeletal metastases at presentation of chondrosarcoma are rare and associated with dedifferentiated chondrosarcoma. Bone scintigraphy or PET-CT should only be performed in cases of high grade and dedifferentiated histology.


Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Condrossarcoma/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Cintilografia , Neoplasias Ósseas/patologia , Neoplasias Ósseas/secundário , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/patologia , Condrossarcoma/patologia , Feminino , Fluordesoxiglucose F18/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Tomografia Computadorizada por Raios X
15.
Medicine (Baltimore) ; 99(35): e20932, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871859

RESUMO

BACKGROUND: Accurate clinical staging of patients with cholangiocarcinoma (CCA) has a significant impact on treatment decisions. In this study, we aimed to compare the diagnostic value of magnetic resonance imaging (MRI) and 18-fludeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) for staging of CCA. METHODS: We performed comprehensive systematic search in Web of Science (including MEDLINE) and Excerpta Medica Database for relevant diagnostic studies in accordance with the preferred reporting items for systematic reviews and meta-analysis statement. Based on data extracted from patient-based analysis, we calculated the pooled sensitivity and specificity with the 95% confidence intervals (CIs). In addition, the publication bias was assessed by Deek funnel plot of the asymmetry test. The potential heterogeneity was explored by threshold effect analysis and subgroup analyses. RESULTS: Thirty-two studies with 1626 patients were included in present analysis. In T stage, the pooled sensitivity and specificity of MRI were 0.90 (95% CI 0.86-0.93), 0.84 (95% CI 0.73-0.91) respectively. The pooled sensitivity and specificity of F-FDG PET/CT were 0.91 (95% CI 0.83-0.95) and 0.85 (0.64-0.95) respectively. In N stage, the pooled sensitivity and specificity of MRI were 0.64 (95% CI 0.52-0.74) and 0.69 (95% CI 0.51-0.87) respectively. The pooled sensitivity and specificity of PET/CT were 0.52 (95% CI 0.37-0.66) and 0.92 (95% CI 0.79-0.97) respectively. In M stage, the pooled sensitivity and specificity of F-FDG PET/CT were 0.56 (95% CI, 0.42-0.69) and 0.95 (95% CI, 0.91-0.97) respectively. The Deek test revealed no significant publication bias. No threshold effect was identified. The subgroup analyses showed that pathological type (extrahepatic cholangiocarcinoma vs hilar cholangiocarcinoma/intrahepatic cholangiocarcinoma), country (Asia vs non-Asia) and type of MRI (1.5T vs. 3.0T) were potential causes for the heterogeneity of MRI studies and country (Asia vs non-Asia) was a potential source for F-FDG PET/CT studies. CONCLUSION: The analysis suggested that both modalities provide reasonable diagnostic accuracy in T stage without significant differences between them. We recommend that both modalities be considered based on local availability and practice for the diagnosis of primary CCA tumors. In N stage, the diagnosis of lymph node metastasis (N) of CCA is still limited by MRI and F-FDG PET/CT, due to unsatisfactory diagnostic accuracy of both. Nevertheless, F-FDG PET/CT can be used to confirm lymph node metastasis while a negative result may not rule out metastasis. Furthermore, F-FDG PET/CT have a low sensitivity and a high specificity for detection of distant metastasis.


Assuntos
Neoplasias dos Ductos Biliares/patologia , Colangiocarcinoma/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Tomografia por Emissão de Pósitrons/métodos , Idoso , Colangiocarcinoma/epidemiologia , Feminino , Fluordesoxiglucose F18/administração & dosagem , Humanos , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Estadiamento de Neoplasias/métodos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/métodos
16.
Rev. esp. med. nucl. imagen mol. (Ed. impr.) ; 39(4): 220-224, jul.-ago. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-198278

RESUMO

ANTECEDENTES: El comportamiento metabólico del plasmocitoma en la PET/TC con 18F-FDG no está claro. OBJETIVO: Realizar una revisión sistemática sobre la utilidad diagnóstica de la PET o PET/TC con 18F-FDG en pacientes afectos de plasmocitoma. MÉTODOS: Se ha realizado una búsqueda exhaustiva bibliográfica de artículos relevantes en las bases de datos de Scopus, PubMed/MEDLINE, Embase y Cochrane Library desde julio de 2019. RESULTADOS: La búsqueda exhaustiva bibliográfica ha revelado 371 artículos; al revisar los títulos y los resúmenes, se excluyeron 363 artículos porque los datos que aportaban no estaban dentro del campo de interés de esta revisión. En total, en esta revisión sistemática se incluyeron 8 artículos. Los principales hallazgos del análisis de los artículos seleccionados han sido: 1) El plasmocitoma generalmente es un tumor ávido de 18F-FDG y la PET/TC muestra un buen rendimiento diagnóstico, con alta sensibilidad; 2) en la mayoría de los casos la PET/TC con 18F-FDG ha influido en el manejo de los pacientes, permitiendo seleccionar el tratamiento y evitando terapias ineficaces; 3) el valor pronóstico de los parámetros cualitativos y semicuantitativos de la PET/TC con 18F-FDG sigue mostrando un carácter controvertido con los resultados obtenidos. CONCLUSIÓN: A pesar de las limitaciones de estos hallazgos, dado el reducido número de trabajos y pacientes estudiados, el plasmocitoma parece ser un tumor ávido de 18F-FDG en la mayoría de los casos. La PET o PET/TC con 18F-FDG muestra un buen rendimiento diagnóstico, con impacto clínico significativo en el cambio de enfoque terapéutico. Finalmente, parece existir un probable valor pronóstico de la PET/TC con 18F-FDG


BACKGROUND: The metabolic behavior of plasmacytoma at 18F-FDG PET/CT is not yet clear. OBJECTIVE: The aim of this systematic review was to analyze published data about the role of 18F-FDG PET or PET/CT in patients affected by plasmacytoma. METHODS: Acomprehensive computer literature search of the Scopus, PubMed/MEDLINE, Embase and Cochrane Library databases was conducted including articles up to July 2019 to find relevant published papers about the performance of 18F-FDG PET and PET/CT in plasmacytoma. RESULTS: The comprehensive computer literature search revealed 371 articles. On reviewing the titles and abstracts, 363 articles were excluded because the reported data were not within the field of interest of this review. Eight articles were selected and retrieved in full-text version. From the analyses of the selected studies, the following main findings have been founded: 1) plasmacytoma generally is a 18F-FDG-avid tumor and PET/CT had good diagnostic performance with high sensitivity; 2) 18F-FDG PET/CT influenced patient management in most cases avoiding useless therapies and choosing the best therapeutic approach; 3) prognostic value of PET/CT qualitative and semiquantitative parameters is only suggested with controversial reports. CONCLUSION: Despite several limitations affect this analysis, especially related to the low number of articles and patients studied, plasmacytoma looks to be an 18F-FDG-avid tumor in most of the cases; 18F-FDG PET or PET/CT had good diagnostic performance and had a significant clinical impact in change of therapeutic approach. Moreover, a possible prognostic role of PET/CT features is described


Assuntos
Humanos , Fluordesoxiglucose F18/administração & dosagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Tomografia por Emissão de Pósitrons/métodos , Plasmocitoma/diagnóstico por imagem , Sensibilidade e Especificidade
17.
Rev. esp. med. nucl. imagen mol. (Ed. impr.) ; 39(4): 233-243, jul.-ago. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-198280

RESUMO

Los sarcomas de partes blandas (SPB) son un grupo heterogéneo y poco frecuente de tumores. Suponen el 1% de los tumores malignos sólidos en adultos y el 7% en niños, y son responsables del 2% de la mortalidad por cáncer. Requieren un abordaje multidisciplinar en centros con experiencia. Esta colaboración pretende actualizar la evidencia científica para fortalecer, junto con la experiencia clínica, las bases del uso y las limitaciones de la 18F-FDG-PET/TC en los SPB. Las recomendaciones generales del uso de la PET/TC en SPB en la actualidad se resumen en la valoración inicial de lesiones de partes blandas cuando la imagen convencional no establece con certeza benignidad y ello condiciona el abordaje; en la guía de biopsia en casos seleccionados; en la estadificación inicial, como prueba adicional, del rabdomiosarcoma y SPB de extremidades o superficiales del tronco y cabeza y cuello; en la sospecha de recurrencia local cuando la TC o la RM no son concluyentes y ante la presencia de material de osteosíntesis o protésico, y en la valoración de respuesta a la terapia local/sistémica en SPB estadios ii/iii. Además, la PET/TC tiene el valor añadido de ser un marcador subrogado de la respuesta histopatológica en la pieza quirúrgica y de aportar información pronóstica tanto en el estudio basal como postratamiento


Soft tissue sarcomas (STS) are a rare and heterogeneous group of tumors. They account for 1% of solid malignant tumors in adults and 7% in children and are responsible for 2% of cancer mortality. They require a multidisciplinary approach in centers with experience. This collaboration aims to update the scientific evidence to strengthen, together with clinical experience, the bases for the use and limitations of 18F-FDG-PET/CT in STSs. The general recommendations for the use of PET/CT in STS at present are summarized as the initial evaluation of soft tissue tumours when conventional image does not establish benignity with certainty and this determines the approach; in biopsy guiding in selected cases; in the initial staging, as additional tool, for rhabdomyosarcoma and STS of extremities or superficial trunk and head and neck tumours; in the suspicion of local recurrence when the CT or MRI are inconclusive and in the presence of osteosynthesis or prosthetic material and in assessment of therapy response to local/systemic therapy in stages ii/iii. In addition, PET/CT has the added value of being a surrogate marker of the histopathological response and it provides prognostic information, both in the baseline study and after treatment


Assuntos
Humanos , Neuroimagem Funcional/métodos , Sarcoma/diagnóstico por imagem , Neoplasias de Tecidos Moles/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Fluordesoxiglucose F18/administração & dosagem , Sensibilidade e Especificidade , Quimiorradioterapia/métodos , Equipe de Assistência ao Paciente/organização & administração , Diagnóstico Diferencial , Biópsia Guiada por Imagem/métodos
20.
PLoS One ; 15(7): e0236350, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32687531

RESUMO

PURPOSE: We evaluated that early metabolic response determined by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) during radiotherapy (RT), predicts outcomes in non-small cell lung cancer. MATERIAL AND METHODS: Twenty-eight patients evaluated using pretreatment 18F-FDG-PET/CT (PETpre) and interim 18F-FDG-PET/CT (PETinterim) after 11 fractions of RT were retrospectively reviewed. Maximum standardized uptake value (SUVmax) was calculated for primary lesion. Predictive value of gross tumor volume (ΔGTV) and SUVmax (ΔSUVmax) changes was evaluated for locoregional control (LRC), distant failure (DF), and overall survival (OS). Metabolic responders were patients with ΔSUVmax >40%. RESULTS: Metabolic responders showed better trends in 1-year LRC (90.9%) than non-responders (47.1%) (p = 0.086). Patients with large GTVpre (≥120 cc) demonstrated poor LRC (hazard ratio 4.14, p = 0.022), while metabolic non-responders with small GTVpre (<120 cc) and metabolic responders with large GTVpre both had 1-year LRC rates of 75.0%. Reduction of 25% in GTV was not associated with LRC; however, metabolic responders without a GTV response showed better 1-year LRC (83.3%) than metabolic non-responders with a reduction in GTV (42.9%). Metabolic responders showed lower 1-year DF (16.7%) than non-responders (50.0%) (p = 0.025). An ΔSUVmax threshold of 40% yielded accuracy of 64% for predicting LRC, 75% for DF, and 54% for OS. However, ΔGTV > 25% demonstrated inferior diagnostic values than metabolic response. CONCLUSIONS: Changes in tumor metabolism diagnosed using PETinterim during RT better predicted treatment responses, recurrences, and prognosis than other factors historically used.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/terapia , Quimiorradioterapia , Neoplasias Pulmonares/terapia , Pulmão/diagnóstico por imagem , Recidiva Local de Neoplasia/diagnóstico , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Fluordesoxiglucose F18/administração & dosagem , Seguimentos , Humanos , Pulmão/patologia , Pulmão/efeitos da radiação , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/prevenção & controle , Valor Preditivo dos Testes , Prognóstico , Intervalo Livre de Progressão , Compostos Radiofarmacêuticos/administração & dosagem , Estudos Retrospectivos , Taxa de Sobrevida , Carga Tumoral/efeitos dos fármacos , Carga Tumoral/efeitos da radiação
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