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1.
Rev. esp. med. nucl. imagen mol. (Ed. impr.) ; 39(5): 299-302, sept.-oct. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-192565

RESUMO

INTRODUCCIÓN: El 30 de enero de 2020 la organización mundial de la salud (OMS) declaró una emergencia internacional por la pandemia causada por un nuevo coronavirus. Existen algunas indicaciones oncológicas que tienen especial prioridad y se siguen realizando estudios a pesar de la situación actual. En estos estudios hemos encontrado hallazgos sospechosos de neumonía COVID-19 en pacientes asintomáticos. El objetivo de este trabajo es valorar la incidencia de estos hallazgos, describir sus características y valorar la evolución de los pacientes sospechosos. MATERIAL Y MÉTODOS: Se han revisado los estudios PET oncológicos realizados entre el 18 de marzo y el 8 de abril de 2020. Se han identificado los pacientes que presentaban hallazgos sugerentes de corresponder con un proceso infeccioso pulmonar de forma incidental en pacientes asintomáticos. Se han revisado las historias clínicas de estos pacientes para confirmar o descartar la infección por SARS-CoV-2. RESULTADOS: Durante el periodo especificado se realizaron un total de 129 estudios PET/TC con indicación oncológica. De ellos, en 11 (8,5%) se encontraron hallazgos sospechosos de proceso infeccioso pulmonar. Se trataba de 8 varones y 3 mujeres con edades comprendidas entre los 30 y los 79 años (media: 62,2). CONCLUSIONES: Los pacientes con COVID-19 pueden presentar escasos síntomas de la enfermedad, y en los estudios PET/TC se pueden detectar tanto pacientes presintomáticos como pacientes casi asintomáticos por lo que los médicos nucleares deben prestar especial atención en la valoración pulmonar de los estudios PET/TC


INTRODUCTION: On January 30, 2020, the World Health Organization (WHO) declared an international emergency due to the pandemic caused by a new coronavirus. There are some oncological indications that have special priority and studies are still being carried out despite the current situation. In these studies we have found suspicious findings of COVID-19 pneumonia in asymptomatic patients. The objective of this work is to assess the incidence of these findings, describe their characteristics and the evolution of suspected patients. MATERIAL AND METHODS: Oncological PET studies carried out in asymptomatic patients between March 18 and April 8, 2020 have been reviewed. Patients who presented findings suggestive of corresponding to an pulmonary infectious process were selected. Clinical findings have been reviewed to confirm or rule out SARS-CoV-2 infection. RESULTS: During the specified period, a total of 129 PET/CT studies were performed. Of these, 11 (8.5%) found suspicious findings of a pulmonary infectious process. These were 8 men and 3 women aged between 30 and 79 years (mean 62.2). CONCLUSIONS: Patients with COVID-19 can present few symptoms of the disease, and in PET/CT studies both presymptomatic and almost asymptomatic patients can be detected, so nuclear medicine physicians should take special attention to the pulmonary evaluation of PET/CT studies


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Pneumonia Viral/diagnóstico por imagem , Síndrome Respiratória Aguda Grave/diagnóstico por imagem , Vírus da SARS/isolamento & purificação , Estudos Retrospectivos , Infecções por Coronavirus/diagnóstico por imagem , Pandemias/estatística & dados numéricos , Reação em Cadeia da Polimerase/métodos , Avaliação de Sintomas/métodos , Infecções Assintomáticas/epidemiologia
2.
Medicine (Baltimore) ; 99(36): e20755, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32898989

RESUMO

Ga-PSMA-11 positron emission computed tomography /computed tomography (PET/CT) is more sensitive than magnetic resonance imaging (MRI) in detecting prostate cancer (PCa). We evaluated the value of Ga-PSMA-11 PET/CT with MRI in treatment-naive PCa.This retrospective study was approved by the hospital ethics committee. The MRI and Ga-PSMA-11 PET/CT imaging data of 63 cases of highly suspected PCa were enrolled in this study. The SUVmax and apparent diffusion coefficient (ADC), and their ratio, were assessed as diagnostic markers to distinguish PCa from benign disease.There were 107 prostate lesions detected in 63 cases. Forty cases with 64 malignant primary lesions were confirmed PCa, whereas 23 cases had 43 benign lesions. PSMA-avid lesions correlated with hypointense signal on ADC maps and hyperintense signal on diffusion-weighted imaging. The ADC of PCa was lower than that of benign lesions, and SUVmax and SUVmax/ADC of PCa was higher than that of benign lesions (P < .01). ADC had significant negative correlation with Gleason score (GS) and SUVmax, SUVmax, and SUVmax/ADC positively correlated with GS. From ROC analysis, we established cutoff values of ADC, SUVmax, and SUVmax/ADC at 1.02 × 10mm/s, 11.72, and 12.35, respectively, to differentiate PCa from benign lesions. The sensitivity, specificity, and AUC were 90.6%, 58.1%, and 0.816 for ADC, 67.2%, 97.7%, and 0.905 for SUVmax, and 81.2%, 88.4%, and 0.929 for SUVmax/ADC, respectively.Ga-PSMA-11 PET/CT combined with MRI offers higher diagnostic efficacy in the detection of PCa than either modality alone.


Assuntos
Espectroscopia de Ressonância Magnética/métodos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Antígeno Prostático Específico/análise , Neoplasias da Próstata/patologia , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/diagnóstico por imagem , Estudos Retrospectivos
3.
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
4.
Medicine (Baltimore) ; 99(33): e20021, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32871968

RESUMO

To evaluate the diagnostic performance of net influx rate (Ki) values from a whole-body dynamic (WBD) Ga-DOTATOC-PET/CT acquisition to differentiate pancreatic neuroendocrine tumors (pNETs) from physiological uptake of pancreatic uncinate process (UP).Patients who were benefited from a WBD acquisition for the assessment of a known well-differentiated neuroendocrine tumor (NET)/suspicion of disease in the prospective GAPET-NET cohort were screened. Only patients with a confirmed pNET/UP as our gold standard were included. The positron emission tomography (PET) procedure consisted in a single-bed dynamic acquisition centered on the heart, followed by a whole-body dynamic acquisition and then a static acquisition. Dynamic (Ki calculated according to Patlak method), static (SUVmax, SUVmean, SUVpeak) parameters, and tumor-to-liver and tumor-to-spleen ratio (TLRKi and TSRKi (according to hepatic/splenic Ki)), tumor SUVmax to liver SUVmax (TM/LM), tumor SUVmax to liver SUVmean (TM/Lm), tumor SUVmax to spleen SUVmax (TM/SM), and tumor SUVmax to spleen SUVmean (TM/Sm) (according to hepatic/splenic SUVmax and SUVmean respectively) were calculated. A Receiver Operating Characteristic (ROC) analysis was performed to evaluate their diagnostic performance to distinguish UP from pNET.One hundred five patients benefited from a WBD between July 2018 and July 2019. Eighteen (17.1%) had an UP and 26 (24.8%) a pNET. For parameters alone, the Ki and SUVpeak had the best sensitivity (88.5%) while the Ki, SUVmax, and SUVmean had the best specificity (94.4%). The best diagnostic accuracy was obtained with Ki (90.9%). For ratios, the TLRKi and the TSRKi had the best sensitivity (95.7%) while the TM/SM and TM/Sm the best specificity (100%). TLRKi had the best diagnostic accuracy (95.1%) and the best area under the curve (AUC) (0.990).Our study is the first one to evaluate the interest of a WBD acquisition to differentiate UP from pNETs and shows excellent diagnostic performances of the Ki approach.


Assuntos
Tumores Neuroendócrinos/diagnóstico por imagem , Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Imagem Corporal Total , Diagnóstico Diferencial , Feminino , Humanos , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Octreotida/análogos & derivados , Compostos Organometálicos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Estudos Prospectivos , Compostos Radiofarmacêuticos , Sensibilidade e Especificidade , Baço/diagnóstico por imagem , Imagem Corporal Total/métodos
5.
Internist (Berl) ; 61(9): 964-968, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32734334

RESUMO

BACKGROUND: We report the case of a 46-year-old female patient who presented in the emergency department with intermittent disturbances of perception when fasting. DIAGNOSTICS: In the diagnostic fasting test, a hyperinsulinemic hypoglycemia already occurred after 7h. A sonographic examination was inconspicuous, therefore, a Ga 68-HA-DOTATATE positron emission tomography computed tomography (PET-CT) was carried out. The results were indicative of a neuroendocrine neoplasm, which gave rise to the suspicion of an insulinoma. CLINICAL COURSE: For surgical treatment the patient was transferred to an external hospital. Following surgery, the patient was free of symptoms. CONCLUSION: If multiple symptoms of hypoglycemia are present, an insulinoma as the cause must be considered in the differential diagnostics.


Assuntos
Jejum/efeitos adversos , Hipoglicemia/diagnóstico , Hipoglicemia/etiologia , Insulinoma/complicações , Insulinoma/diagnóstico por imagem , Tumores Neuroendócrinos/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/cirurgia , Compostos Organometálicos , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Tomografia por Emissão de Pósitrons , Cintilografia
6.
Hell J Nucl Med ; 23 Suppl: 51-56, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32860397

RESUMO

In December 2019 a new ß-CoV, Severe Acute Respiratory Coronavirus- 2 (SARS-CoV-2), has been identified in Wuhan Hubei Province, China. Within a few months it spread rapidly to more than 114 countries and the disease, Coronavirus disease 2019 (COVID-19), was declared pandemic on 11th February 2020 by the World Health Organization (WHO). Until 20 June 2020 8:09 am, 8,465,085 cases of COVID-19 were confirmed globally, with 454,258 deaths. The first incidence in Greece was documented on 26 February 2020 in Thessaloniki and up to 20 June 2020 8:09 am, 3,227 confirmed cases of COVID-19 were reported, with 188 deaths. At the time of writing USA and Brazil, are the countries with the highest disease burden. Governments have imposed a variety of suggestions and restrictions in order to control the spread of the virus, focusing mainly on social distancing, self-isolation, personal hygiene and personal protective equipment (PPE). Greece was one of the countries that implemented early drastic measures thus succeeding in controlling the virus transmission; having a profound economical effect though.


Assuntos
Infecções por Coronavirus/transmissão , Controle de Infecções/métodos , Serviço Hospitalar de Medicina Nuclear/normas , Pneumonia Viral/transmissão , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/normas , Guias de Prática Clínica como Assunto , Agendamento de Consultas , Infecções por Coronavirus/epidemiologia , Tomada de Decisões , Humanos , Controle de Infecções/normas , Serviço Hospitalar de Medicina Nuclear/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos
7.
Asia Pac J Clin Oncol ; 16 Suppl 3: 7-11, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32852899

RESUMO

The past decade has witnessed the rising popularity and acceptance of molecular definitions on disease management. Prostate-specific membrane antigen (PSMA), in light of its molecular nature and cytokinetic properties, has rapidly become the target for development of a variety of functional tracers for PET/CT evaluation of prostate cancer. The most commonly used PSMA-binding analog is 68 Ga-labeled PSMA-11, which is now widely applied in both research and clinical settings. Literature data in the recent years have been enriched by a number of meta-analyses and systemic reviews on the evolving role of PSMA PET in primary diagnosis, staging, detection of biochemical recurrence after primary cancer treatment, identification, and significance of oligometastasis, as well as in restaging and treatment monitoring. Being a highly sensitive and reasonably specific molecular tracer, PSMA-binding analogs have a high potential to possess the majority of imaging characteristics required for a variety of management decisions in prostate malignancy.


Assuntos
Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Neoplasias da Próstata/diagnóstico por imagem , Humanos , Masculino , Estadiamento de Neoplasias , Neoplasias da Próstata/patologia
9.
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
10.
J Laryngol Otol ; 134(8): 680-683, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32613916

RESUMO

BACKGROUND: The coronavirus disease 2019 pandemic requires urgent modification to existing head and neck cancer diagnosis and management practices. A protocol was established that utilises risk stratification, early investigation prior to clinical review and a reduction in aerosol generating procedures to lessen the risk of coronavirus disease 2019 spread. METHODS: Two-week wait referrals were stratified into low, intermediate and high risk. Low risk patients were referred back to primary care with advice; intermediate and high risk patients underwent investigation. Clinical encounters and aerosol generating procedures were minimised. A combined diagnostic and therapeutic surgical approach was undertaken where possible. RESULTS: Forty-one patients were used to assess feasibility. Thirty-one per cent were low risk, 35 per cent were intermediate and 33 per cent were high risk. Thirty-three per cent were discharged with no imaging. CONCLUSION: Implementing this protocol reduces the future burden on tertiary services, by empowering primary care physicians to re-refer low risk patients. The protocol is applicable across the UK and avoids diagnostic delay.


Assuntos
Infecções por Coronavirus/transmissão , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/patologia , Procedimentos Cirúrgicos Otorrinolaringológicos/estatística & dados numéricos , Pneumonia Viral/transmissão , Aerossóis , Betacoronavirus/isolamento & purificação , Biópsia por Agulha Fina/instrumentação , Protocolos Clínicos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Diagnóstico Tardio/prevenção & controle , Estudos de Viabilidade , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Londres/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Encaminhamento e Consulta , Medição de Risco , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Ultrassonografia de Intervenção/métodos
11.
Cancer Radiother ; 24(5): 444-452, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32620457

RESUMO

The aim of the present paper is to systematically review all available literature on preradiotherapy high uptake areas (hotspots) as a potential target for dose escalation in different tumour sites, and to understand the potential role and limitations of fluorodeoxyglucose (FDG)-positron-emission tomography (PET)/computed tomography (CT) in this context. An electronic database (Medline) search was conducted to identify articles reporting on a correlation between high tracer uptake on pretreatment PET and preferential sites of local recurrence after radiotherapy. Search was limited to English language. No date range limitation was applied. Among 45 studies initially identified, nine series matching with inclusion criteria have finally been retained from the literature after reviewing (5 retrospective and 4 prospective). Primary tumour locations were head-neck (n=2), lung (n=4), oesophageal (n=2) and rectal (n=1) areas. Overlaps between FDG hotspot on preradiotherapy PET/CT and site of local recurrence on post-treatment scan showed good to excellent agreement. Only studies on head-neck cancer reported moderate agreement probably explained by the lack of reproducibility of the patients positioning between pre- and post-treatment FDG-PET/CT; and by the rigid registration process of images limited by post-therapeutic changes that highly affect anatomical landmarks. FDG hotspot-guided radiotherapy may allow dose escalation in respecting a robust methodology (treatment position, co-registration method, four-dimensional PET).


Assuntos
Fluordesoxiglucose F18 , Recidiva Local de Neoplasia/diagnóstico por imagem , Neoplasias/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos , Pontos de Referência Anatômicos/diagnóstico por imagem , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/radioterapia , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/radioterapia , Neoplasias/radioterapia , Posicionamento do Paciente , Estudos Prospectivos , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/radioterapia , Estudos Retrospectivos
12.
Cancer Radiother ; 24(5): 423-428, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32620459

RESUMO

Prostate cancer is the most common malignant tumour and represents the third cause of cancer-mortality in men. The management of prostate cancer has dramatically changed over the last decades, mainly due to improvement of diagnostic modalities and development of new therapeutic strategies. Imaging plays a key role in all the steps of prostate cancer management. In recent years, magnetic resonance imaging (MRI) and positron-emission tomography (PET) - computed tomography (CT) have emerged as two major tools for the detection of prostate cancer, tumour staging and treatment choice. Both MRI and PET-CT - using choline or prostate-specific membrane antigen (PSMA) as radiotracer - have become mandatory. This article presents the contribution of the latest advances in these two imaging techniques of prostate cancer and their future developments.


Assuntos
Antígenos de Superfície , Glutamato Carboxipeptidase II , Imagem por Ressonância Magnética/métodos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Neoplasias da Próstata/diagnóstico por imagem , Adenocarcinoma/química , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/radioterapia , Idoso , Radioisótopos de Carbono , Colina/análogos & derivados , Radioisótopos de Flúor , Humanos , Masculino , Imagem Multimodal/métodos , Recidiva Local de Neoplasia/diagnóstico por imagem , Neoplasias da Próstata/química , Neoplasias da Próstata/radioterapia , Compostos Radiofarmacêuticos , Ultrassonografia/métodos
13.
Medicine (Baltimore) ; 99(29): e21201, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702884

RESUMO

RATIONALE: We hypothesize that with the determination of lymph fistula location 3-dimensionally, application of appropriate pressure would promote fistula healing, and a secondary surgery may be avoided. Ga-labeled 1,4,7-triazacyclononane-N, N', N"-triacetic acid (NOTA) conjugated with truncated Evan blue (NEB) forms a complex with serum albumin in the interstitial fluid after it is locally injected and allows rapid visualization of the lymphatic system. PATIENT CONCERNS: A 44-year-old woman had a chief complaint of left nipple discharge. A 38-year-old woman came to the hospital after sensing a right breast mass. DIAGNOSES: The 2 patients were diagnosed with chylous fistula after breast cancer surgery based on the findings of a novel method, Ga-NOTA-Evans Blue (NEB) positron emission tomography/computed tomography. INTERVENTIONS: We successfully obtained clear images to locate the fistula using Ga-NEB positron emission tomography/computed tomography (PET/CT) for both patients. The lymphatic vessels and lymph nodes could be clearly visualized owing to the Ga-NEB activity during PET/CT. OUTCOMES: Three-dimensional positioning to locate the fistula could direct the application of the pressure dressing and reduce drainage markedly. LESSONS: Ga-NEB PET/CT may be a new method for diagnosing chylous fistula and providing guidance for treatment.


Assuntos
Axila/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Fístula/etiologia , Mastectomia/efeitos adversos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/normas , Adulto , Axila/anormalidades , Axila/cirurgia , Neoplasias da Mama/complicações , Feminino , Fístula/cirurgia , Humanos , Mastectomia/métodos , Derrame Papilar , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia
14.
J Comput Assist Tomogr ; 44(4): 605-609, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32697532

RESUMO

OBJECTIVE: The aim of the study was to determine abdominal and breast adipose tissue parameters on 18-fluorodeoxyglucose positron emission tomography/computed tomography (CT) that may serve as outcome predictors in breast angiosarcoma patients. MATERIALS: Women with breast angiosarcoma (n = 13) who underwent 18-fluorodeoxyglucose positron emission tomography/CT were identified. A control group was selected (n = 25). Abdominal subcutaneous (SAT) and visceral adipose tissue (VAT) were assessed on unenhanced computed tomographies. Breast adipose tissue (BAT) volumes of the uninvolved breast were quantified. Metabolic activity of VAT, SAT, and BAT was calculated (standardized uptake value [SUV]). RESULTS: Breast angiosarcoma patients had higher metabolic activity of VAT compared with controls (SUV 0.93 ± 0.39 vs 0.64 ± 0.11, P = 0.044). Within the patient group, there were 6 deaths (46.2%). Patients who died had higher SAT activity (SUV 0.52 ± 0.24 vs 0.29 ± 0.06, P = 0.027) and higher BAT metabolic activity (SUV 0.48 ± 0.20 vs 0.27 ± 0.11, P = 0.045) compared with nondeceased patients. CONCLUSIONS: Patients with breast angiosarcoma have higher metabolic activity of VAT. Higher abdominal SAT and higher BAT metabolic activity of the uninvolved breast might predict mortality.


Assuntos
Gordura Abdominal/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/mortalidade , Hemangiossarcoma/diagnóstico por imagem , Hemangiossarcoma/mortalidade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Idoso , Idoso de 80 Anos ou mais , Composição Corporal , Estudos de Casos e Controles , Feminino , Fluordesoxiglucose F18/administração & dosagem , Humanos , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
15.
Ann Surg ; 272(2): 311-318, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32675544

RESUMO

OBJECTIVE: We aimed to determine whether tumor metabolism could be prognostic of cure in L-EAC patients who receive definitive chemoradiation. SUMMARY BACKGROUND DATA: Patients with inoperable localized esophageal adenocarcinoma (L-EAC) often receive definitive chemoradiation; however, biomarkers and/or imaging variables to prognosticate cure are missing. METHODS: Two hundred sixty-six patients with L-EAC who had chemoradiation but not surgery were analyzed from the prospectively maintained EAC databases in the Department of Gastrointestinal Medical Oncology at The University of Texas MD Anderson Cancer Center (Texas, USA) between March 2002 and April 2015. Maximum standardized uptake value (SUVmax) and total lesion glycolysis (TLG) from the positron emission tomography data were evaluated. RESULTS: Of 266 patients, 253 (95%) were men; the median age was 67 years (range 20-91 yrs) and 153 had poorly differentiated L-EAC. The median SUVmax was 10.3 (range 0-87) and the median TLG was 85.7 (range 0-3227). Both SUVmax and TLG were higher among those with: tumors >5 cm in length, high clinical stage, and high tumor and node categories by TNM staging (all P < 0.0001). Of 234 patients evaluable for cure, 60 (25.6%) achieved cure. In the multivariable logistic regression model, low TLG (but not low SUVmax) was associated with cure (continuous TLG value: odds ratio 0.70, 95% confidence interval (CI) 0.54-0.92). TLG was quantified into 4 quartile categorical variables; first quartile (Q1; <32), second quartile (Q2; 32.0-85.6), third quartile (Q3; 85.6-228.4), and fourth quartile (Q4; >228.4); the cure rate was only 10.3% in Q4 and 5.1% in Q3 but increased to 28.8% in Q2, and 58.6% in Q1. The cross-validation resulted in an average accuracy of prediction score of 0.81 (95% CI, 0.75-0.86). CONCLUSIONS: In this cross-validated model, 59% of patients in the 1st quartile were cured following definitive chemoradiation. Baseline TLG could be pursued as one of the tools for esophageal preservation.


Assuntos
Adenocarcinoma/patologia , Adenocarcinoma/terapia , Quimiorradioterapia/métodos , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/terapia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Institutos de Câncer , Estudos de Coortes , Bases de Dados Factuais , Intervalo Livre de Doença , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/mortalidade , Feminino , Seguimentos , Glicólise/efeitos dos fármacos , Glicólise/efeitos da radiação , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Análise de Sobrevida , Texas , Fatores de Tempo , Resultado do Tratamento , Carga Tumoral/efeitos dos fármacos , Carga Tumoral/efeitos da radiação
16.
Clin Ter ; 171(4): e283-e287, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614358

RESUMO

An early identification of non-responders in oncology is of crucial importance to rapidly switch treatment regimens. Here we report a positron emission tomography, (PET)-guided switch from immunotherapy to targeted therapy in a patient affected by metastatic melanoma. We describe the case of a 78-years-old male patient diagnosed with nodular melanoma, submitted to baseline PET/CT with 18fluorodeoxyglucose (18F-FDG) that showed cutaneous and skeletal metastases (stage IV). The patients started immunotherapy with pembrolizumab. A PET/CT performed 3 months after the start of immunotherapy demonstrated progressive metabolic disease both at skeletal and cutaneous level, confirmed also by the biopsy. As patients resulted positive for BRAF V600k mutation, treatment regimen was rapidly switched to combined anti-BRAF/MEK targeted therapy. The PET/CT performed 3 months later, showed almost complete metabolic response. Ten months after the beginning of targeted therapy, the patient continues to present a durable metabolic response. PET/CT with 18F-FDG may help in monitoring the response to treatment in metastatic melanoma thus defining personalized therapeutic pathways.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Antineoplásicos/uso terapêutico , Imunoterapia , Melanoma/terapia , Neoplasias Cutâneas/terapia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica , Humanos , Imidazóis/uso terapêutico , Imunoterapia/métodos , Masculino , Oximas/uso terapêutico , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Tomografia por Emissão de Pósitrons , Inibidores de Proteínas Quinases/uso terapêutico , Piridonas/uso terapêutico , Pirimidinonas/uso terapêutico , Resultado do Tratamento
17.
J Cancer Res Clin Oncol ; 146(10): 2621-2630, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32661602

RESUMO

PURPOSE: The epithelial-to-mesenchymal transition (EMT) phenotype-based subsets of circulating tumor cells (CTCs) might be predictors of tumor progression. We evaluated the clinical properties of different phenotypic CTCs in patients with non-small cell lung cancer (NSCLC). Secondly, we explored the association between different phenotypic CTCs and the uptake of 18F-fluorodeoxyglucose (FDG) by the primary tumor on a positron emission tomographic (PET) scan. METHODS: Venous blood samples from 34 pathologically confirmed Stage IIB-IVB NSCLC patients were collected prospectively. CTCs were immunoassayed using a SE-i·FISH®CTC kit. We identified CTCs into cytokeratin positive (CK+) and cytokeratin negative (CK-) phenotypes. CTC classifications were correlated with the maximum standardized uptake value (SUVmax) measured by 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). Overall survival (OS) and progression-free survival (PFS) curves were produced using the Kaplan-Meier method. RESULTS: CTCs were detected in 91.2% of NSCLC patients. CTC counting was associated with TNM stage (P = 0.014) and distant metastasis (P = 0.007). The number of CK-CTCs was also positively associated with TNM stage (P = 0.022) and distant metastasis (P = 0.007). Both total CTC counting and CK-CTC counting did not show association with SUVmax value (P = 0.959, P = 0.903). Kaplan-Meier survival analysis demonstrated that patients with ≥ 7 CTCs had shorter OS (P = 0.003) and PFS (P = 0.001) relative to patients with < 7 CTCs). Notably, the number of CK-CTCs can act as independent risk factors for PFS (P = 0.044) and OS (P = 0.043) in NSCLC patients. However, SUVmax value was not associated with OS (P = 0.895) and PFS (P = 0.686). CONCLUSION: The CTC subpopulations could be useful evidence for testing metastasis and prognosis in NSCLC patients. The SUVmax value of the primary tumor was not related to prognosis in patients with NSCLC.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/patologia , Fluordesoxiglucose F18/farmacocinética , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Células Neoplásicas Circulantes/patologia , Carcinoma Pulmonar de Células não Pequenas/sangue , Carcinoma Pulmonar de Células não Pequenas/metabolismo , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/sangue , Neoplasias Pulmonares/metabolismo , Masculino , Pessoa de Meia-Idade , Células Neoplásicas Circulantes/metabolismo , Fenótipo , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos
18.
Recent Results Cancer Res ; 216: 283-318, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32594390

RESUMO

Noninvasive molecular imaging of cancer by means of the scintigraphic imaging modalities PET, PET/CT, and PET/MRI represents a powerful diagnostic tool in modern nuclear medicine. Radiotracers labeled with the prominent positron emitter fluorine-18 are routinely used to target and visualize discrete biological structures dysregulated in the progression of cancer. Such tracers are therefore capable of detecting oncological pathologies in vivo at the cellular and subcellular level in a timely manner and are thereby used for early detection of cancer as well as monitoring for treatment response. This chapter describes a variety of important 18F-labeled radiopharmaceuticals that are frequently used in oncological PET imaging. Small-molecule and low-molecular-weight radiotracers for the detection of glucose utilization, amino acid transport, protein synthesis, membrane lipid synthesis, cell proliferation, cell death, hypoxia, estrogen receptor status, prostate-specific membrane antigen (PSMA) expression, and bone mineralization of tumors are introduced. The structural properties, common radiochemical synthesis approaches as well as in vivo metabolism and accumulation mechanisms of the clinically most important 18F-labeled radiotracers are described.


Assuntos
Radioisótopos de Flúor , Neoplasias/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Humanos , Compostos Radiofarmacêuticos
19.
Recent Results Cancer Res ; 216: 669-718, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32594402

RESUMO

The major applications for molecular imaging with PET in clinical practice concern cancer imaging. Undoubtedly, 18F-FDG represents the backbone of nuclear oncology as it remains so far the most widely employed positron emitter compound. The acquired knowledge on cancer features, however, allowed the recognition in the last decades of multiple metabolic or pathogenic pathways within the cancer cells, which stimulated the development of novel radiopharmaceuticals. An endless list of PET tracers, substantially covering all hallmarks of cancer, has entered clinical routine or is being investigated in diagnostic trials. Some of them guard significant clinical applications, whereas others mostly bear a huge potential. This chapter summarizes a selected list of non-FDG PET tracers, described based on their introduction into and impact on clinical practice.


Assuntos
Neoplasias/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Fluordesoxiglucose F18 , Humanos , Oncologia , Compostos Radiofarmacêuticos
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