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1.
Ann Hematol ; 99(4): 819-828, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32025840

RESUMO

Autologous stem cell transplant (ASCT) is an effective treatment for non-Hodgkin lymphoma (NHL). However, recent supply issues and toxicity of carmustine have necessitated a new conditioning regimen. We conducted a multicenter, phase II study of BEB (busulfan, etoposide, and bendamustine) conditioning regimen for ASCT in patients with NHL. Thirty-one patients were enrolled and underwent ASCT with the BEB conditioning regimen. The most common subtype was diffuse large B-cell lymphoma (n = 23, 74.2%). Nine patients (29.0%) had a history of relapse, and 18 patients (58.1%) received more than 2 lines of chemotherapy before ASCT. A median number of 6.05 × 106/kg CD34 cells were infused, and all patients engrafted after a median period of 11 days. Thirteen patients (41.9%) experienced neutropenic fever, and 16 patients (51.6%) had grade 3 or 4 toxicities during ASCT. No one had a documented infection, veno-occlusive disease, or treatment-related death. Three-month complete remission rate was 81.8%. Median follow-up period of 15 months showed 6 patients (19.4%) relapsed or progressed and 3 patients died. The estimated 2-year progression-free survival and overall survival rate were 73.0% and 89.8%, respectively. Our results show that BEB conditioning regimens for ASCT are feasible with tolerable toxicity in patients with NHL.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Transplante de Células-Tronco Hematopoéticas , Linfoma não Hodgkin/tratamento farmacológico , Condicionamento Pré-Transplante/métodos , Adulto , Antifúngicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Cloridrato de Bendamustina/administração & dosagem , Cloridrato de Bendamustina/efeitos adversos , Bussulfano/administração & dosagem , Bussulfano/efeitos adversos , Terapia Combinada , Etoposídeo/administração & dosagem , Etoposídeo/efeitos adversos , Neutropenia Febril/induzido quimicamente , Feminino , Seguimentos , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Humanos , Estimativa de Kaplan-Meier , Linfoma não Hodgkin/diagnóstico por imagem , Linfoma não Hodgkin/terapia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Pré-Medicação , Intervalo Livre de Progressão , Estudos Prospectivos , Indução de Remissão , Condicionamento Pré-Transplante/efeitos adversos , Transplante Autólogo , Adulto Jovem
2.
Medicine (Baltimore) ; 99(4): e18807, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977874

RESUMO

RATIONALE: Primary lymphoma of the bones (PLB) is a rare extranodal non-Hodgkin lymphoma (NHL) that is particularly rare in children. The clinical presentation and radiological features of PLB are often nonspecific, making clinical diagnosis challenging and misdiagnosis frequent. Here, we report 2 children with PLB focusing on clinical presentation, differential diagnosis, and treatment outcomes. PATIENTS CONCERNS: A 9-year-old boy presented with left knee swelling and pain for 4 months after a fall. He was previously misdiagnosed with traumatic soft tissue injury. The second patient was an 11-year-old boy with a 6-month history of intermittent left knee pain. He was previously misdiagnosed with bone tuberculosis and chronic osteomyelitis. DIAGNOSES: A 9-year-old boy showed an abnormal signal of the left tibia metaphysis, diaphysis, and epiphysis, and tibia with periosteal reactions and surrounding soft tissue swelling. Tumor biopsy and immunohistochemistry confirmed a diagnosis of B-cell lymphoblastic lymphoma.An 11-year-old boy showed a permeative lesion in the metaphysis and diaphysis of the left proximal tibia. Tumor biopsy and immunohistochemistry confirmed the diagnosis of diffuse large B-cell lymphoma. INTERVENTIONS: Both patients were treated with 6 courses of NHL-Berlin-Frankfurt-Münster-95. OUTCOMES: Both patients are in complete clinical remission with a follow-up of 27 and 18months after treatment, respectively. LESSONS: PLB is a rare malignancy that is difficult to diagnose, particularly in children. Clinicians should increase the awareness of the disease and consider a differential diagnosis of bone lesions. Chemotherapy combined with radiotherapy is a favorable treatment for children with PLB. Early diagnosis and active treatment can improve patient prognosis.


Assuntos
Linfoma Difuso de Grandes Células B/patologia , Linfoma não Hodgkin/patologia , Tíbia/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Asparaginase/uso terapêutico , Criança , Ciclofosfamida/uso terapêutico , Citarabina/uso terapêutico , Dexametasona/uso terapêutico , Doxorrubicina/uso terapêutico , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma não Hodgkin/diagnóstico por imagem , Linfoma não Hodgkin/tratamento farmacológico , Imagem por Ressonância Magnética , Masculino , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Indução de Remissão , Tioguanina/uso terapêutico , Tíbia/diagnóstico por imagem , Vincristina/uso terapêutico
3.
BMC Neurol ; 19(1): 311, 2019 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-31795989

RESUMO

BACKGROUND: Primary central nervous system lymphoma (PCNSL) is a rare, malignant, non-Hodgkin's lymphoma of the brain, leptomeninges, and rarely the spinal cord. PCNSL has characteristic magnetic resonance imaging (MRI) findings, and effective treatment strategies are available. It is characterized predominately by neurological symptoms, which are caused by tumor infiltration into the nervous system as well as ischemia. Chemotherapy is an effective treatment, if started prior to the ischemic damage. CASE PRESENTATION: A 62-year-old male patient with PCNSL presented with altered mental status. The initial brain MRI revealed high signal intensity on the T2-weighted images (T2WIs) of the putamen area of the right basal ganglia, and the clinical symptoms improved after steroid administration. However, the symptoms were later deteriorated, we considered the possibility of autoimmune encephalitis and, consequently, conducted an immunomodulatory therapy. In a follow-up brain MRI, enlargement lesions of T2WI in basal ganglia and pons were simultaneously enhanced. Subsequently, the patient's mental status deteriorated to a semi-coma and PCNSL was diagnosed after a surgical biopsy. Chemotherapy was started immediately; however, the patient died. CONCLUSIONS: Effective treatments are available for PCNSL and intravascular lymphoma; thus, their prognosis is generally good if they are diagnosed early. Herein, we report the case of a patient suspected with autoimmune encephalitis after brain MRI and treated with immunomodulation therapy. However, PCNSL was confirmed by a surgical biopsy. It is, therefore recommended to consider lymphoma in patients with neurological symptoms that are difficult to localize and rapidly progressive enhancing lesions showing a mass effect on brain MRI.


Assuntos
Neoplasias do Sistema Nervoso Central/diagnóstico por imagem , Encefalite/diagnóstico por imagem , Doença de Hashimoto/diagnóstico por imagem , Linfoma não Hodgkin/diagnóstico por imagem , Biópsia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Neoplasias do Sistema Nervoso Central/patologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
4.
Urologiia ; (5): 105-108, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808641

RESUMO

A description of specific features of CT-MRI in rare patient with perirenal non-Hodgkins lymphoma is presented in the article. CT scan was used to determine the accumulation of contrast medium and pathological vessels along the right kidneys border. Diffusion weighted MRI revealed the low values of the measured diffusion coefficient (MDC) and high accumulation index of the paramagnetic in the tumor tissue (0.59-0.62). The specific features of perirenal non-Hodgkins lymphoma on CT/MRI, an evaluation of the tumors volume and stage, and signs of malignancy are described.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Neoplasias Renais/diagnóstico por imagem , Linfoma não Hodgkin/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Meios de Contraste , Humanos
5.
Einstein (Sao Paulo) ; 17(4): eMD5157, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31826074

RESUMO

Elastography is a widely used procedure in conventional ultrasonography that has recently been incorporated in echoendoscopy. This is an innovative and promising technology that aims to increase the negative predictive value of endoscopic ultrasonography and fine-needle aspiration punctures. It is useful for directing punctures in suspect areas and, consequently, improves diagnostic performance. This is a non-invasive technique, easy to perform, without additional costs or complications. The main indications are the analysis of solid pancreatic masses, lymph nodes, subepithelial lesions, lesions in the left hepatic lobe and in the left adrenal. Negative or inconclusive cases of fine-needle aspiration can be submitted to elastography when there is a strong suspicion of malignancy. Elastography has a high precision for the differential diagnosis of solid masses and in difficult-to-access anatomic sites, as well as in mediastinal lymph nodes and pancreatic tumors. The procedure is based on the degree of tissue elasticity measurement, with a good correlation between the elasticity index and histopathological features. We report the case of four patients evaluated by echoendoscopy and qualitative elastography who had differential diagnoses in mediastinal lymph nodes: sarcoidosis, lymphoma, histoplasmosis and esophageal neoplasia.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Endossonografia/métodos , Linfonodos/diagnóstico por imagem , Linfoma não Hodgkin/diagnóstico por imagem , Sarcoidose/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Adulto , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes
6.
Gac Med Mex ; 155(4): 386-390, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31486785

RESUMO

Introduction: The assessment of lymphoma response to treatment is based on imaging studies. Objective: To correlate the assessment of lymphoma treatment response by computed tomography (CT) and by positron emission tomography/computed tomography (PET/CT). Method: Cross-sectional, observational study, where records of patients with lymphoma under surveillance by CT and PET/CT were reviewed. Results: The study population consisted of 43 patients with a mean age of 32.7 ± 22.4 years; 26 (60.5 %) had a diagnosis of Hodgkin's lymphoma and 17 (9.5 %) had non-Hodgkin lymphoma. By CT, 34 (79.1 %) were diagnosed with disease and nine (20.9 %) without disease. The criteria used to assess the response was radiologist experience in 39 (90.7 %) and RECIST 1.1 criteria in four (9.3 %). The diagnosis by 18-FDG PET/CT was no response to treatment or partial response-recurrence in 32 (74.4 %) and response to treatment in 11 (25.6 %); with PERCIST criteria in 13 (30.2 %) and Deuaville criteria in 30 (69.8 %). When the diagnosis by CT versus 18-FDG PET/CT was compared, out of 11 patients with complete response on PET/CT, three had a similar CT diagnosis. Of the 34 patients with data consistent disease diagnosed by CT, 26 had similar results by 18-FDG PET/CT (p = 0.54). Conclusion: The value of lymphoma treatment response on CT does not agree with that obtained by 18-FDG PET/CT.


Assuntos
Doença de Hodgkin/diagnóstico por imagem , Linfoma não Hodgkin/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Criança , Estudos Transversais , Feminino , Fluordesoxiglucose F18 , Doença de Hodgkin/terapia , Humanos , Linfoma não Hodgkin/terapia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
7.
Medicine (Baltimore) ; 98(35): e16841, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464910

RESUMO

RATIONALE: Multiple primary central nervous system lymphoma (MPCNSL) is a rare disease with differential diagnosis and treatment. As the underlying pathogenesis is not yet clarified, the early-stage clinical manifestations are occult and atypical. Also, the imaging manifestations are not specific, which is challenging for the clinical diagnosis and treatment. Therefore, additional clinical research is essential to understand the etiology of the disease. PATIENT CONCERNS: A 63-year-old male patient suffered from MPCNSLs but without typical clinical manifestations. The findings of the imaging examination were as follows. Magnetic resonance imaging (MRI) showed long T1 and T2 signal shadows in the right frontal lobe, right hippocampus, right cerebellar hemisphere, and the left occipital lobe. In addition, patchy T1-enhanced signal shadows were observed in the right frontal lobe and around the midline. Frontal lesions were detected in the magnetic resonance spectroscopy (MRS), Cho peak increased, and N-acetylaspartate (NAA) peak decreased. On the other hand, in the diffusion weighted imaging (DWI), apparent dispersion coefficient (ADC) showed low-value changes and high signal changes. The positron emission tomography-computed tomography (PET-CT) displayed radioactive accumulation in the right frontal lobe. DIAGNOSIS: Multiple primary central nervous system lymphoma. INTERVENTIONS: The patient received some conservative medical treatment, but his condition continued to worsen. Finally, he received a pathological biopsy, and refused further treatment after the result was reported. OUTCOMES: The patient died 1 week after biopsy, and the course of disease was about 100 days. LESSONS: PCNSL is a primary intracranial malignancy with low incidence and a high degree of malignancy and specificity in clinical manifestations. To facilitate early clinical treatment and improve the long-term survival of patients, it is necessary to master the imaging diagnostic methods and its features. The comprehensive application of multiple imaging examinations, such as CT, MRI, PET/CT, and PET/MRI, as well as, cerebrospinal fluid cytology can greatly improve the diagnosis of PCNSL.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Linfoma não Hodgkin/diagnóstico por imagem , Imagem Multimodal/métodos , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Cerebelo/diagnóstico por imagem , Cerebelo/patologia , Imagem de Difusão por Ressonância Magnética , Evolução Fatal , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/patologia , Hipocampo/diagnóstico por imagem , Hipocampo/patologia , Humanos , Linfoma não Hodgkin/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/patologia , Lobo Occipital/diagnóstico por imagem , Lobo Occipital/patologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons
9.
Int J Hematol ; 110(3): 370-374, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31090035

RESUMO

Granulocyte colony-stimulating factor (G-CSF) is commonly administered to prevent serious complications caused by chemotherapy-induced neutropenia; however, several cases of arteritis following the administration of G-CSF have been reported. Here, we report three cases of patients with non-Hodgkin lymphomas (NHLs) who developed arteritis after the administration of G-CSF, estimate the probability of adverse drug reaction caused by G-CSF with two distinct algorithms, and review the literatures. Both algorithms indicated a causal relationship between G-CSF and arteritis. In a literature review of seven reported cases, including our three patients, the time from the administration of G-CSF to the onset of arteritis ranged from 9 days to 6 months, and five patients were treated with steroids. In one of our three cases, a 62-year-old female with NHL developed arteritis twice in different courses of chemotherapy. Hydrocortisone was administered in the second event, leading to prompt relief of the manifestation and abnormal laboratory data. This finding suggests steroids may be effective for arteritis. In conclusion, although the number of reported cases is limited, there appears to be an association between arteritis and the administration of G-CSF, and steroids are an effective therapeutic option.


Assuntos
Arterite , Fator Estimulador de Colônias de Granulócitos/efeitos adversos , Linfoma não Hodgkin , Idoso , Arterite/diagnóstico por imagem , Feminino , Fator Estimulador de Colônias de Granulócitos/administração & dosagem , Humanos , Linfoma não Hodgkin/diagnóstico por imagem , Linfoma não Hodgkin/tratamento farmacológico , Masculino , Pessoa de Meia-Idade
10.
Eur J Radiol ; 113: 110-115, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30927934

RESUMO

OBJECTIVE: To investigate the MDCT features of primary adrenal lymphoma (PAL) and correlate the results with clinicopathological findings. MATERIALS AND METHODS: Twenty eight patients (17 men, 11 women; median age, 61.5years) with pathologically confirmed PAL were included in this study. MDCT features of the lesions were retrospectively reviewed and correlated with clinicopathological findings. RESULTS: All of the 28 cases were non-Hodgkin's lymphoma (NHL), in which 25 cases were diffuse large B-cell lymphoma and 3 cases T-cell lymphoma. 21 (75%) patients had bilateral tumors with maximum diameter of 3.9-17.7 cm (median, 9.18 cm), and 7 (25%) patients had unilateral tumors with maximum diameter of 4.3-14.9 cm (median, 8.6 cm). The sign of infiltrating adjacent organs and encasing adjacent vessels were appeared in 10 and 15 patients respectively, in which 9 patients had both signs. 20 (71.4%) patients had the appearance of adeniform, and 3 (10.7%) patients showed infiltrating and embedding the adrenal gland. Among all the patients, 27 (96.4%) and 26 (92.9%) patients had mild enhancement on arterial and parenchymal phase, respectively; and 12 (42.8%) were homogenous, 14 (50%) slightly inhomogeneous and 2 (7.1%) heterogeneous on both phase. In addition, adrenal insufficiency was found in 33.3% (7/21) of the patients with bilateral lesions, and none in unilateral lesions. CONCLUSION: Large adrenal soft tissue mass with maintenance of adreniform shape, encasing vessels, homogenous or slightly inhomogeneous density with no calcification, and mild enhancement on both arterial and parenchymal phase could be seen as the main MDCT features of PAL. In addition, infiltrating and embedding the adrenal gland may be specific imaging characteristics of PAL.


Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Linfoma não Hodgkin/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Calcinose/diagnóstico por imagem , Calcinose/patologia , Feminino , Humanos , Linfoma Difuso de Grandes Células B/patologia , Linfoma não Hodgkin/patologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Estudos Retrospectivos
11.
Clin Nucl Med ; 44(6): e409-e412, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30985428

RESUMO

A 64-year-old man was treated with multiagent chemotherapy owing to high-grade non-Hodgkin lymphoma presenting as a bulky disease involving the spleen. Interim and posttreatment sequential FDG PET/CT scans revealed a residual splenic mass showing markedly intense FDG uptake suspected of a residual viable lymphoma. To definitely decide about the appropriate treatment, a laparoscopic splenectomy was performed. Histopathologic specimen was compatible with the rare diagnosis of postchemotherapy histiocyte-rich pseudotumor of the spleen, a potential pitfall simulating viable disease on FDG PET/CT.


Assuntos
Granuloma de Células Plasmáticas/diagnóstico por imagem , Linfoma não Hodgkin/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Baço/diagnóstico por imagem , Antineoplásicos/efeitos adversos , Diagnóstico Diferencial , Fluordesoxiglucose F18 , Granuloma de Células Plasmáticas/induzido quimicamente , Histiócitos , Humanos , Linfoma não Hodgkin/complicações , Masculino , Pessoa de Meia-Idade , Neoplasia Residual/diagnóstico por imagem , Compostos Radiofarmacêuticos , Baço/patologia
12.
Eur Radiol ; 29(10): 5539-5548, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30877463

RESUMO

OBJECTIVES: To test if adding permeability measurement to perfusion obtained from dynamic susceptibility contrast MRI (DSC-MRI) improves diagnostic performance in the differentiation of primary central nervous system lymphoma (PCNSL) from glioblastoma. MATERIALS AND METHODS: DSC-MRI was acquired in 145 patients with pathologically proven glioblastoma (n = 89) or PCNSL (n = 56). The permeability metrics of contrast agent extraction fraction (Ex), apparent permeability (Ka), and leakage-corrected perfusion of normalized cerebral blood volume (nCBVres) and cerebral blood flow (nCBFres) were derived from a tissue residue function. For comparison purposes, the leakage-corrected normalized CBV (nCBV) and relative permeability constant (K2) were also obtained using the established Weisskoff-Boxerman leakage correction method. The area under the receiver operating characteristics curve (AUC) and cross-validation were used to compare the diagnostic performance of the single DSC-MRI parameters with the performance obtained with the addition of permeability metrics. RESULTS: PCNSL demonstrated significantly higher permeability (Ex, p < .001) and lower perfusion (nCBVres, nCBFres, and nCBV, all p < .001) than glioblastoma. The combination of Ex and nCBVres showed the highest performance (AUC, 0.96; 95% confidence interval, 0.92-0.99) for differentiating PCNSL from glioblastoma, which was a significant improvement over the single perfusion (nCBV: AUC, 0.84; nCBVres: AUC, 0.84; nCBFres: AUC, 0.82; all p < .001) or Ex (AUC, 0.80; p < .001) parameters. CONCLUSIONS: Analysis of the combined permeability and perfusion metrics obtained from a single DSC-MRI acquisition improves the diagnostic value for differentiating PCNSL from glioblastoma in comparison with single-parameter nCBV analysis. KEY POINTS: • Permeability measurement can be calculated from DSC-MRI with a tissue residue function-based leakage correction. • Adding Exto CBV aids in the differentiation of PCNSL from glioblastoma. • CBV and Exmeasurements from DSC-MRI were highly reproducible.


Assuntos
Neoplasias do Sistema Nervoso Central/diagnóstico por imagem , Glioblastoma/diagnóstico por imagem , Linfoma não Hodgkin/diagnóstico por imagem , Adulto , Idoso , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/fisiopatologia , Neoplasias do Sistema Nervoso Central/fisiopatologia , Volume Sanguíneo Cerebral/fisiologia , Circulação Cerebrovascular/fisiologia , Meios de Contraste , Diagnóstico Diferencial , Feminino , Glioblastoma/fisiopatologia , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Linfoma não Hodgkin/fisiopatologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Perfusão , Permeabilidade , Curva ROC , Estudos Retrospectivos
14.
Clin Nucl Med ; 44(4): 276-281, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30688736

RESUMO

PURPOSE: The aim of this study was to investigate the diagnostic performance of whole-body [C]acetate PET/CT in less aggressive or indolent lymphomas, wherein [F]FDG PET/CT would exhibit limited sensitivity. METHODS: Between September 2016 and May 2018, we prospectively evaluated 17 patients (9 men, 8 women; mean age [range], 71 [45-87] years) with pathologically proven less aggressive or indolent lymphomas according to Non-Hodgkin's Lymphoma Classification Project, using both [F]FDG PET/CT and [C]acetate PET/CT (performed on the same day). Detected nodal lesions were recorded according to the Ann Arbor classification. Extranodal (EN) lesions were also evaluated. We compared whole-body lesion detection between [F] FDG PET/CT and [C]acetate PET/CT using the McNemar test. RESULTS: In all patients, significantly more nodal and EN lesions were detected using [C]acetate PET/CT than [F]FDG PET/CT (nodal: 84 vs 64 regions; P < 0.001; EN: 26 vs 19 regions, P = 0.039). Bone lesions were detected in 8 and 5 patients using [C]acetate PET/CT and [F]FDG PET/CT, respectively (P = 0.25). Among the 14 patients (82.4%) who underwent bone marrow biopsy, bone marrow involvement was detected with sensitivities of 100% (6/6 patients) and 80% (5/6 patients) using [C]acetate PET/CT and [F]FDG PET/CT, respectively. Multiple areas of focal uptake in the spleen of 1 patient were exhibited on [F]FDG PET/CT but not [C]acetate PET/CT. CONCLUSIONS: [C]acetate PET/CT exhibited greater sensitivity than [F]FDG PET/CT for lesion detection in patients with less aggressive or indolent lymphomas, thus promising applicability as a physiological tracer in the study of such lesions.


Assuntos
Acetatos , Carbono , Linfoma não Hodgkin/diagnóstico por imagem , Linfoma não Hodgkin/patologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Imagem Corporal Total , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
Br J Radiol ; 92(1095): 20180904, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30608186

RESUMO

BACKGROUND:: Primary cutaneous lymphoma is a rare extranodal non-Hodgkin's lymphoma confined to the skin. The data on the imaging findings of primary cutaneous lymphomas are largely lacking and the current diagnosis is based on clinical and histopathological examination. With the advances in dermatological ultrasound and molecular imaging, newer perspectives in the evaluation of cutaneous lymphomas are available. OBJECTIVE:: To review and describe the imaging findings in patient's with the diagnosis of primary cutaneous lymphoma. METHODS:: A multicentric, retrospective observational study was undertaken in four countries to review the high resolution ultrasonography (HRUS) and fluorine 18-fludeoxyglucose positron emission tomography-computed tomography (PET-CT) imaging findings. RESULTS:: We had 41 patients, Female:Male 1:4.1; mean age, 57 years; range, 13-94 years. High resolution ultrasonography of the primary cutaneous lesions revealed thickening of the dermis in all the cases and the lesions were hypoechoic without any calcifications or central necrosis. The sonographic appearances of the lesions were categorised into focal infiltrative, nodular, pseudonodular, and diffusely infiltrative patterns. Nodular and pseudonodular lesions were predominant in B cell lymphomas, while diffusely infiltrative lesions were more common in T-cell lymphomas. On colour Doppler imaging, the lesions were hypervascular. Whole body 18F-fludeoxyglucose PET-CT imaging of the patients revealed increased uptake of the metabolite in the lesions. CONCLUSION:: Sonographic patterns based on high resolution ultrasonography provide early clues to the non-invasive diagnosis of primary cutaneous lymphomas and PET-CT is the recommended modality of imaging for staging and follow-up. ADVANCES IN KNOWLEDGE:: High resolution ultrasound with colour Doppler and PET-CT imaging are complimentary to the clinical diagnosis of primary cutaneous lymphomas.


Assuntos
Linfoma não Hodgkin/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Neoplasias Cutâneas/diagnóstico por imagem , Ultrassonografia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fluordesoxiglucose F18 , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Pele/diagnóstico por imagem , Pele/patologia , Neoplasias Cutâneas/patologia , Adulto Jovem
16.
Radiology ; 290(2): 488-495, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30511907

RESUMO

Purpose To determine the relationship of PET/CT staging to the management and outcomes of participants with apparent limited-stage (LS) Hodgkin lymphoma (HL) or aggressive non-HL (ANHL) treated with curative intent. Materials and Methods This prospective multicenter registry included 850 participants (467 men and 383 women; median age, 54.1 years) from nine centers who had LS HL or ANHL on the basis of clinical data and CT, or with equivocal CT for advanced stage, who were considered for curative-intent first-line therapy. Participants were recruited between May 1, 2013, and December 31, 2015. Pre-PET/CT treatment plan was compared with treatment provided. Survival and second-line therapy initiation were compared with an historical control pool staged by using CT alone. Administrative data sources were used to control for baseline characteristics. Outcomes were assessed by using adjusted Cox proportional hazards regression and propensity score matching. Results PET/CT helped to upstage 150 of 850 participants (17.6%). There was a change in planned therapy in 224 of 580 (38.6%) of participants after PET/CT. There was a lower 1-year mortality for participants with ANHL in the PET/CT versus CT cohort (hazard ratio, 0.63; 95% confidence interval: 0.40, 1.0; P < .05) and for those with LS at PET/CT compared with those with LS at CT (hazard ratio, 0.40; 95% confidence interval: 0.21, 0.74; P = .004). For participants with HL, no 1-year outcome difference was found (P = .16). Conclusion PET/CT helped to upstage approximately 18% of participants and planned management was frequently altered. Participants with aggressive non-Hodgkin lymphoma whose first-line therapy was guided by PET/CT had significantly better survival compared with participants whose treatment was guided by CT. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Scott in this issue.


Assuntos
Doença de Hodgkin , Linfoma não Hodgkin , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Doença de Hodgkin/diagnóstico por imagem , Doença de Hodgkin/mortalidade , Doença de Hodgkin/terapia , Humanos , Linfoma não Hodgkin/diagnóstico por imagem , Linfoma não Hodgkin/mortalidade , Linfoma não Hodgkin/terapia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Resultado do Tratamento , Adulto Jovem
17.
Clin Physiol Funct Imaging ; 39(1): 78-84, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30284376

RESUMO

BACKGROUND: 18F-FDG-PET/CT has become a standard for assessing treatment response in patients with lymphoma. A subjective interpretation of the scan based on the Deauville 5-point scale has been widely adopted. However, inter-observer variability due to the subjectivity of the interpretation is a limitation. Our main goal is to develop an objective and automated method for evaluating response. The first step is to develop and validate an artificial intelligence (AI)-based method, for the automated quantification of reference levels in the liver and mediastinal blood pool in patients with lymphoma. METHODS: The AI-based method was trained to segment the liver and the mediastinal blood pool in CT images from 80 lymphoma patients, who had undergone 18F-FDG-PET/CT, and apply this to a validation group of six lymphoma patients. CT segmentations were transferred to the PET images to obtain automatic standardized uptake values (SUV). The AI-based analysis was compared to corresponding manual segmentations performed by two radiologists. RESULTS: The mean difference for the comparison between the AI-based liver SUV quantifications and those of the two radiologists in the validation group was 0·02 and 0·02, respectively, and 0·02 and 0·02 for mediastinal blood pool respectively. CONCLUSIONS: An AI-based method for the automated quantification of reference levels in the liver and mediastinal blood pool shows good agreement with results obtained by experienced radiologists who had manually segmented the CT images. This is a first, promising step towards objective treatment response evaluation in patients with lymphoma based on 18F-FDG-PET/CT.


Assuntos
Fluordesoxiglucose F18/administração & dosagem , Doença de Hodgkin/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/métodos , Fígado/diagnóstico por imagem , Linfoma não Hodgkin/diagnóstico por imagem , Mediastino/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Automação , Feminino , Fluordesoxiglucose F18/metabolismo , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/metabolismo , Humanos , Fígado/metabolismo , Linfoma não Hodgkin/tratamento farmacológico , Linfoma não Hodgkin/metabolismo , Masculino , Mediastino/irrigação sanguínea , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/normas , Valor Preditivo dos Testes , Compostos Radiofarmacêuticos/metabolismo , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
18.
Int J Hematol ; 109(1): 91-97, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30203253

RESUMO

90Y-ibritumomab tiuxetan (90Y-IT) is widely used, but the factors responsible for its optimal treatment effects are unknown. We enrolled 34 patients with relapsed indolent lymphoma treated with 90Y-IT monotherapy at Gunma University Hospital between 2003 and 2014 in the present study. Clinical data including computed tomography and 18-Fluoro-deoxyglucose positron emission tomography were retrospectively analyzed. The overall response rate and complete response rate were 91% and 82%, respectively. The median progression-free survival (PFS) and overall survival were 32 months and not reached, respectively. In univariate analysis, tumor long-axis diameter ≤ 2.5 cm, maximum standardized uptake value (SUVmax) ≤ 6.5, localized disease, normal levels of serum soluble interleukin-2 receptor, and the number of involved nodal sites ≤ 3 immediately prior to 90Y-IT were associated with median PFS greater than 6 years. However, in multivariate analysis, only tumor long-axis diameter ≤ 2.5 cm and SUVmax ≤ 6.5 affected PFS [hazard ratio (HR) 0.130, P = 0.0021 and HR 0.283, P = 0.0311, respectively]. Patients with only one prior regimen needed less granulocyte colony-stimulating factor and platelet transfusion. Thus, 90Y-IT treatment should be considered for patients with indolent lymphoma in first relapse who have tumor long-axis diameter ≤ 2.5 cm and SUVmax ≤ 6.5.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Linfoma não Hodgkin/radioterapia , Diagnóstico por Imagem , Linfoma não Hodgkin/diagnóstico por imagem , Linfoma não Hodgkin/mortalidade , Linfoma não Hodgkin/patologia , Tomografia por Emissão de Pósitrons , Valor Preditivo dos Testes , Recidiva , Indução de Remissão , Estudos Retrospectivos , Análise de Sobrevida , Fatores de Tempo , Tomografia Computadorizada por Raios X , Radioisótopos de Ítrio/uso terapêutico
19.
J Int Med Res ; 47(2): 986-991, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30465451

RESUMO

Lymphoma with hepatic involvement can present with three morphological patterns: diffuse infiltrative, nodular, and mixed infiltrative-nodular. However, lymphoma with periportal infiltrative hepatic involvement is rare. There have been a few reports of cases with this type of hepatic involvement including ultrasound or computed tomography (CT) findings. In this case report, we present CT, magnetic resonance imaging (MRI), and diffusion-weighted MRI findings together with the histopathological results for a patient with periportal hepatic lymphoma presenting with obstructive jaundice.


Assuntos
Neoplasias Hepáticas/patologia , Linfoma não Hodgkin/patologia , Imagem por Ressonância Magnética/métodos , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Linfoma não Hodgkin/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Tomografia Computadorizada por Raios X
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