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1.
Rev. méd. Urug ; 35(4): 248-257, dic. 2019. tab, fig
Artigo em Espanhol | LILACS | ID: biblio-1026028

RESUMO

El PET (Positron Emission Tomography) con 18-flúor-desoxi-glucosa (18FDG) como radiofármaco es una técnica diagnóstica de medicina nuclear no invasiva cuyas indicaciones fundamentalmente se vinculan con patologías oncológicas. Objetivo: valorar la indicación y el impacto del PET con 18FDG en la atención de mujeres con patología oncológica ginecológica. Estudio: descriptivo retrospectivo mediante la revisión de historias clínicas de las pacientes con cáncer ginecológico asistidas en el Hospital de la Mujer (HM), a las cuales se les realizó un PET con 18FDG en la evaluación diagnóstica o en el seguimiento en el período comprendido entre 1/1/2014 y 31/12/2017. Se analizaron un total de 68 pacientes en las cuales se realizaron 112 PET con 18FDG. En cuanto a la indicación, en los casos de cáncer de cuello (CC), la mayoría (51,5%) de los PET se realizaron ante la sospecha de recidiva; en el cáncer de mama (CM) en el control evolutivo, (44,6%); en los cánceres de endometrio (CE) ante la sospecha de recidiva, (50%); en los cánceres de ovario el 37,5% ante sospecha de recidiva e igual porcentaje en control evolutivo; en los cánceres de vulva (CV) en control postratamiento o sospecha de recidiva, (50% c/u). En cuanto al impacto en la conducta clínica, globalmente, en los casos CC, el 60% de los estudios realizados determinaron modificaciones en la conducta clínica; en los CM, 49%; en los CE, 43%; en los CO, 50%; en los CV, 50%. El PET con 18FDG es una técnica que se ha incorporado a la práctica clínica ginecológica y que requiere aún incorporar las pautas de su utilización.


18 fluoro-2-deoxy-d-glucose (18FDG) PET (Positron Emission Tomography) is a diagnostic non- invasive nuclear medicine imaging technique, and it is usually associated to oncological pathologies. Objective: to assess the indication and impact of 18FDG PET in women with gynecologic cancer. Study: retrospective, descriptive study by reviewing the medical records of patients with gynecologic cancer who were seen at the Women's Hospital. They underwent an 18FDG PET in the diagnostic assessment or follow-up between January 1, 2014 and December 31, 2017. 68 patients were studied, and 112 18FDG PETS were carried out. As to indication, in the case of cervical cancer (CC) most PET studies (51.5%) were used upon suspicion of relapse; in breast cancer to control evolution (44.6%); in endometrial cancer upon suspicion of relapse (50%); in ovarian cancer 37.5% upon suspicion of relapse and same percentage to control evolution; in vulvar cancer in the post-treatment follow-up or upon suspicion of relapse (50% each). As to global impact in the clinical practice, in the case of cervical cancer 60% of the studies resulted in modifications of the clinical behavior; in breast cancer this percentage was 49%; in endometrial cancer it was 43%, in ovarian cancer 50%, and vulvar cancer 50%. 18FDG PET is a technique that has been included in the gynecological clinical practice and guidelines for its use are still required.


O PET (Positron Emission Tomography) com 18-Flúor-Desoxi-Glucosa (18FDG) como radio fármaco, é uma técnica diagnóstica de medicina nuclear não invasiva, cujas indicações fundamentalmente estão vinculadas às patologias oncológicas. Objetivo: avaliar a indicação e o impacto do PET com 18FDG na atenção de mulheres com patologia oncológica ginecológica. Estudo: descritivo retrospectivo feito pela revisão dos prontuários de pacientes com câncer ginecológico atendidas no Hospital de la Mujer (HM), que foram submetidas a PET com 18FDG na avaliação diagnóstica ou no seguimento durante o período compreendido entre 1/1/2014-31/12/2017. Foram analisadas 68 pacientes submetidas a PET com 18FDG. Com relação à indicação, nos casos de câncer de colo de útero (CC) a maioria (51,5%) dos exames PET foi realizada devido à suspeita de recidiva; no câncer de mama (CM) no controle evolutivo (44,6%); nos cânceres de endométrio (CE) devido à suspeita de recidiva (50%); nos cânceres de ovário 37,5% devido a suspeita de recidiva e a mesma proporção no controle evolutivo; nos cânceres de vulva (CV) tanto no controle pós-tratamento com também na suspeita de recidiva (50% c/u). Com relação ao impacto sobre a conduta clínica, de maneira geral nos casos CC, 60% dos estudos realizados determinaram modificações da conduta clínica; nos CM 49%; nos CE 43%; nos CO e nos CV em 50% dos casos. O PET com 18FDG é uma técnica que está sendo incorporar à prática clínica ginecológica sendo necessário incorporar pautas para sua utilização.


Assuntos
Feminino , Tomografia por Emissão de Pósitrons/instrumentação , Neoplasias dos Genitais Femininos/diagnóstico
2.
Rinsho Ketsueki ; 60(10): 1455-1461, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31695007

RESUMO

A 64-year-old woman was diagnosed with diffuse large B-cell lymphoma (DLBCL) in 2013. After eight courses of R-CHOP therapy followed by local irradiation of the remaining retroperitoneal soft tissue shadow, complete response was confirmed on 18F-2-fluoro-2-deoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT). Early in 2016, patient's serum LDH and soluble IL-2 receptor levels elevated. With suspected recurrence of DLBCL, FDG-PET/CT was performed that showed no lymphadenopathy or abnormal FDG uptake. By the end of July 2016, the patient developed fever and night sweating. Intravascular large B-cell lymphoma (IVLBCL) was suspected, and the patient underwent random skin biopsies, which revealed large atypical cells infiltrating peripheral and intravascular regions of the subcutaneous adipose tissue. Cell morphology, immunostaining, and PCR analysis of the immunoglobulin heavy chain gene suggested the recurrence of DLBCL. Despite salvage chemotherapy and autologous peripheral stem cell transplantation with high-dose chemotherapy, approximately 15 months later, DLBCL recurred and involved the lungs. The patient again received chemotherapy and achieved a second remission. Because DLBCL may recur like intravascular lymphoma, the same tests used for IVLBCL diagnosis are required in cases of suspected recurrence of DLBCL based on clinical and laboratory findings.


Assuntos
Linfoma Difuso de Grandes Células B/diagnóstico , Neoplasias Vasculares/diagnóstico , Idoso , Anticorpos Monoclonais Murinos , Protocolos de Quimioterapia Combinada Antineoplásica , Ciclofosfamida , Doxorrubicina , Feminino , Fluordesoxiglucose F18 , Humanos , Linfoma Difuso de Grandes Células B/terapia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Tomografia por Emissão de Pósitrons , Prednisona , Recidiva , Indução de Remissão , Terapia de Salvação , Transplante de Células-Tronco , Neoplasias Vasculares/terapia , Vincristina
3.
Zhonghua Zhong Liu Za Zhi ; 41(11): 831-836, 2019 Nov 23.
Artigo em Chinês | MEDLINE | ID: mdl-31770850

RESUMO

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


Assuntos
Linfoma Extranodal de Células T-NK/diagnóstico , Linfoma Extranodal de Células T-NK/metabolismo , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Fluordesoxiglucose F18/metabolismo , Glicólise , Humanos , Tomografia por Emissão de Pósitrons , Prognóstico , Intervalo Livre de Progressão , Compostos Radiofarmacêuticos/metabolismo , Estudos Retrospectivos , Análise de Sobrevida , Carga Tumoral
4.
BMJ ; 367: l5553, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31641045

RESUMO

Sarcoidosis is a highly variable granulomatous multisystem syndrome. It affects individuals in the prime years of life; both the frequency and severity of sarcoidosis are greater in economically disadvantaged populations. The diagnosis, assessment, and management of pulmonary sarcoidosis have evolved as new technologies and therapies have been adopted. Transbronchial needle aspiration guided by endobronchial ultrasound has replaced mediastinoscopy in many centers. Advanced imaging modalities, such as fluorodeoxyglucose positron emission tomography scanning, and the widespread availability of magnetic resonance imaging have led to more sensitive assessment of organ involvement and disease activity. Although several new insights about the pathogenesis of sarcoidosis exist, no new therapies have been specifically developed for use in the disease. The current or proposed use of immunosuppressive medications for sarcoidosis has been extrapolated from other disease states; various novel pathways are currently under investigation as therapeutic targets. Coupled with the growing recognition of corticosteroid toxicities for managing sarcoidosis, the use of corticosteroid sparing anti-sarcoidosis medications is likely to increase. Besides treatment of granulomatous inflammation, recognition and management of the non-granulomatous complications of pulmonary sarcoidosis are needed for optimal outcomes in patients with advanced disease.


Assuntos
Glucocorticoides/uso terapêutico , Hipertensão Pulmonar/prevenção & controle , Imunossupressores/uso terapêutico , Fibrose Pulmonar/prevenção & controle , Sarcoidose Pulmonar/diagnóstico , Biomarcadores/sangue , Broncoscopia/métodos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Fluordesoxiglucose F18/administração & dosagem , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/mortalidade , Incidência , Pulmão/diagnóstico por imagem , Pulmão/patologia , Tomografia por Emissão de Pósitrons/métodos , Prognóstico , Fibrose Pulmonar/etiologia , Fibrose Pulmonar/mortalidade , Sarcoidose Pulmonar/complicações , Sarcoidose Pulmonar/tratamento farmacológico , Sarcoidose Pulmonar/epidemiologia , Resultado do Tratamento
5.
Medicine (Baltimore) ; 98(40): e17472, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577779

RESUMO

BACKGROUND: FDG-PET might be able to reflect histopathology features of tumors. Ki 67 in head and neck carcinomas (HNSCC). The present study sought to elucidate the association between Ki 67 index and SUVmax based upon a large patient sample. METHODS: PubMed database was screened for studies analyzed the relationship between Ki 67 and SUV in HNSCC. Nine studies comprising 211 patients were suitable for analysis. RESULTS: SUVmax increased with tumor grade and was statistically significant different between G1, G2, and G3 tumors. The ROC analysis for discrimination between G1/G2 and G3 tumors revealed an area under curve of 0.71. In the overall patient sample, SUVmax correlated statistically significant with Ki 67 index (r = 0.154, P = .032). CONCLUSION: The present study identified a weak correlation between SUV values and proliferation index Ki 67 index in HNSCC in a large patient sample. Therefore, SUVmax cannot be used as surrogate parameter for proliferation activity in HNSCC.


Assuntos
Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/metabolismo , Antígeno Ki-67/metabolismo , Tomografia por Emissão de Pósitrons , Carcinoma de Células Escamosas de Cabeça e Pescoço/diagnóstico por imagem , Carcinoma de Células Escamosas de Cabeça e Pescoço/metabolismo , Fluordesoxiglucose F18 , Humanos
6.
Radiologe ; 59(11): 968-974, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31570965

RESUMO

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


Assuntos
Tumor Carcinoide , Neoplasias Intestinais/diagnóstico por imagem , Neoplasias Pulmonares , Tumores Neuroendócrinos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Tumor Carcinoide/diagnóstico por imagem , Fluordesoxiglucose F18 , Humanos , Intestino Delgado , Neoplasias Pulmonares/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Tomografia Computadorizada por Raios X/métodos
8.
Chem Commun (Camb) ; 55(86): 12932-12935, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31599282

RESUMO

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


Assuntos
Encéfalo/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos/química , Animais , Barreira Hematotesticular/metabolismo , Encéfalo/metabolismo , Radioisótopos de Carbono/química , Cristalografia por Raios X , Cinética , Macaca , Camundongos , Conformação Molecular , Proteínas do Tecido Nervoso/química , Neurônios , Domínios Proteicos , Compostos Radiofarmacêuticos/metabolismo , Receptores de Superfície Celular/química
9.
Br J Radiol ; 92(1104): 20190425, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31593482

RESUMO

OBJECTIVE: Overexpression of human epidermal growth factor receptor-2 (HER2) in breast cancers provides promising opportunities for imaging and targeted therapy. Developing HER2 targeted positron emission tomography (PET) probes might be benefit for management of the disease. Small high-affinity scaffold proteins, affibodies, are ideal vectors for imaging HER2 overexpressed tumors. Despite of the initial success on development of 18F labeled ZHER2:342 affibody, the tedious synthesis producers, low yields and unfavorable pharmacokinetics may hinder the clinical use. 68Ga is an attractive positron emitter for PET imaging. A simple preparation of 68Ga labeled ZHER2:342 analog, 68Ga-NOTA-MAL-Cys-MZHER2:342, was reported in the study. The in vivo performances of the tracer for assessing HER2 status in breast cancers were also evaluated. METHODS: NOTA-MAL conjugated Cys-MZHER2:342 was radiolabeled with 68Ga. The probe was evaluated by in vitro tests including stability and cell binding studies in breast cancer cells with different HER2 levels. In vivo evaluation was performed in mice bearing tumors using microPET imaging and biodistribution experiments. A PET/CT imaging study was initially performed in patients with breast cancers. RESULTS: The tracer was synthesized in a straightforward chelation method with satisfactory non-decay corrected yield (81±5%) and radiochemical purity (>95%). In vivo micro-PET imaging showed that HER2 high levels expressed BT474 xenografts were more clear visualized than HER2 low levels expressed MCF-7 tumors (16.12 ± 2.69 ID%/g vs 1.32 ± 0.19 ID%/g at 1 h post-injection). The outcome was consistent with the immunohistochemical analysis. No significant radioactivity was accumulated in healthy tissues (less than 2% ID/g) except kidneys. In a preliminary clinical study, 68Ga-NOTA-MAL-Cys-MZHER2:342 PET imaging allowed more high-contrast detection of HER2 positive primary tumors (maximum standardized uptake value = 2.16±0.27) than those in HER2 negative primary focus (maximum standardized uptake value = 0.32±0.05). No detectable side-effects were found. CONCLUSION: In summary, this study indicates the significant efficiency of the 68Ga labeled HER2 affibody. Preclinical and clinical studies support the possibility of monitoring HER2 levels in breast cancers using 68Ga-NOTA-MAL-Cys-MZHER2:342. ADVANCES IN KNOWLEDGE: The research investigated the feasibility of a 68Ga labeled HER2 affibody modified with a hydrophilic linker for breast cancer PET imaging. Favorable outcomes showed that the probe might be valuable for determining HER2 status of the disease.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/metabolismo , Radioisótopos de Gálio/farmacocinética , Tomografia por Emissão de Pósitrons/métodos , Receptor ErbB-2/metabolismo , Proteínas Recombinantes de Fusão/farmacocinética , Animais , Neoplasias da Mama/patologia , Cromatografia Líquida de Alta Pressão , Estudos de Viabilidade , Feminino , Xenoenxertos , Humanos , Rim/diagnóstico por imagem , Rim/metabolismo , Células MCF-7 , Camundongos , Camundongos Nus , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Proteínas Recombinantes de Fusão/síntese química , Distribuição Tecidual
10.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 54(10): 712-716, 2019 Oct 09.
Artigo em Chinês | MEDLINE | ID: mdl-31607011

RESUMO

Depth of invasion is a newly added index for TNM staging of oral cancer in the eighth edition. Preoperative evaluation of depth of invasion not only provides a reference for surgical margin, but also serves as an independent prognostic factor for predicting lymph node metastases. At present, the main methods for assessing the depth of invasion of tongue squamous cell carcinoma include ultrasound examination, MRI, CT, positron emission tomography (PET) and histopathological examination. This paper summarizes the evaluation method and clinical effect of depth of invasion of tongue cancer, and analyzes its advantages and boundedness. In addition, this study is expected to provide a reference for the surgical treatment of tongue squamous cell carcinoma.


Assuntos
Carcinoma de Células Escamosas , Invasividade Neoplásica , Neoplasias da Língua , Carcinoma de Células Escamosas/patologia , Humanos , Metástase Linfática , Invasividade Neoplásica/diagnóstico por imagem , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons , Neoplasias da Língua/patologia
11.
Zhongguo Yi Liao Qi Xie Za Zhi ; 43(5): 365-368, 2019 Sep 30.
Artigo em Chinês | MEDLINE | ID: mdl-31625338

RESUMO

PET/MR is a high-end medical imaging equipment with integrating PET and MR equipment into the highly sophisticated one and has rich clinical and molecular diagnosis functions, can obtain comprehensive information about the human body structure, function and metabolism, is of great value for the diagnosis and treatment of disease improvement. In this paper, through the analysis of existing production risk points on one of the primary stages of the whole product life cycle, combining with the medical device good manufacture practice, some suggestions have been put forward exploratively to field inspection for PET/MR manufacturers. It has certain significance for regulators of medical devices to clear the production risk point and improve verification efficiency during field inspection.


Assuntos
Imagem por Ressonância Magnética , Tomografia por Emissão de Pósitrons , Desenho de Equipamento , Humanos , Imagem por Ressonância Magnética/instrumentação , Tomografia por Emissão de Pósitrons/instrumentação
12.
Nihon Yakurigaku Zasshi ; 154(4): 210-216, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31597901

RESUMO

Drug transporters play important roles in determining drug pharmacokinetics. Organic anion transporting polypeptides 1B1/1B3 (OATP1B1/1B3) are transporters mediating hepatic uptake of various anionic drugs. OATP1B1/1B3 activities are changed by genetic mutation and drug-drug interaction (DDI) that could lead to severe adverse reactions. Methods to address the precise DDI risk assessment have been developed in addition to the translational assessment from the results of in vitro studies. Using endogenous substrates as probes is an emerging approach that allows clinical assessment of the DDI risk in the early phase of drug development. Then, the clinical data will be subjected to the pharmacokinetic analysis using physiologically-based pharmacokinetic models to perform the more realistic DDI risk assessment with OATP1B1/1B3 substrate drugs. When drug targets are located inside the hepatocytes, DDI impact on the intrahepatic concentration is critical for their pharmacological actions. Positron emission tomography (PET) allows researchers to determine tissue concentration time profiles of the PET probe upon the inhibition of OATP1B1/1B3, and to estimate the change in kinetic parameter for each intrinsic process of hepatic elimination of PET probe. Integration of the clinical data into the PBPK model realizes more precise prediction of DDI impact on the pharmacokinetics of drugs, and their therapeutic effects.


Assuntos
Interações de Medicamentos , Transportador 1 de Ânion Orgânico Específico do Fígado/fisiologia , Membro 1B3 da Família de Transportadores de Ânion Orgânico Carreador de Soluto/fisiologia , Humanos , Farmacocinética , Tomografia por Emissão de Pósitrons
13.
Radiol Clin North Am ; 57(6): 1199-1216, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582045

RESUMO

Radiographic monitoring of posttreatment glioblastoma is important for clinical trials and determining next steps in management. Evaluation for tumor progression is confounded by the presence of treatment-related radiographic changes, making a definitive determination less straight-forward. The purpose of this article was to describe imaging tools available for assessing treatment response in glioblastoma, as well as to highlight the definitions, pathophysiology, and imaging features typical of true progression, pseudoprogression, pseudoresponse, and radiation necrosis.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/radioterapia , Diagnóstico por Imagem/métodos , Glioblastoma/diagnóstico por imagem , Glioblastoma/radioterapia , Lesões por Radiação/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Neoplasias Encefálicas/patologia , Progressão da Doença , Glioblastoma/patologia , Humanos , Imagem por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Imagem Multimodal , Necrose , Tomografia por Emissão de Pósitrons , Lesões por Radiação/patologia
15.
Eur J Endocrinol ; 181(5): 473-480, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31491743

RESUMO

Objective: To evaluate whether brown adipose tissue (BAT) activity is altered in women with polycystic ovary syndrome (PCOS), and whether BAT activity correlates with plasma levels of irisin, a myokine that can induce BAT formation. Design: We performed a cross-sectional study including women with PCOS (n = 45) and a healthy control group (n = 25) matched by age and body mass index (BMI). Methods: BAT activity was measured using 18F-FDG positron emission tomography-computed tomography (PET-CT) and plasma irisin levels were measured by a validated enzyme immunoassay. Results: Total BAT activity was significantly reduced in women with PCOS (maximal standardized uptake value (SUVmax): median 7.4 g/mL, interquartile range 0.9-15.4) compared to controls (median 13.0 g/mL, interquartile range 4.7-18.4, P = 0.047). However, this difference was no longer significant after adjustment for waist circumference, a surrogate marker of central adiposity. In the PCOS group, BAT activity correlated negatively with BMI (Spearman's r = -0.630, P = 0.000) and waist circumference (r = -0.592, P = 0.000) but not with plasma irisin levels. Conclusions: BAT activity was reduced in women with PCOS possibly due to increased central adiposity. In PCOS women, BAT activity did not correlate with plasma irisin levels.


Assuntos
Tecido Adiposo Marrom/fisiopatologia , Síndrome do Ovário Policístico/fisiopatologia , Tecido Adiposo Marrom/diagnóstico por imagem , Adiposidade , Adolescente , Adulto , Índice de Massa Corporal , Estudos Transversais , Feminino , Fibronectinas/sangue , Fluordesoxiglucose F18 , Humanos , Estilo de Vida , Pessoa de Meia-Idade , Síndrome do Ovário Policístico/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Resultado do Tratamento , Circunferência da Cintura , Adulto Jovem
16.
BMC Neurol ; 19(1): 218, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481008

RESUMO

BACKGROUND: There are no established theories regarding the role of the cerebellum in dystonia. We report a case of focal limb dystonia secondary to a vasogenic edema of the dentate nucleus caused by a symptomatic developmental venous anomaly. CASE PRESENTATION: A 44-year-old woman presented with sudden onset dystonia in her left arm for 1 week. Brain imaging revealed vasogenic edema in the deep white matter of the left cerebellar hemisphere, including the left dentate nucleus, secondary to a developmental venous anomaly. 18F-fluorodeoxyglucose positron emission tomography images showed hypometabolism in the corresponding cerebellar deep nuclei without the involvement of other brain regions. She was treated with a steroid. At the one-month follow-up, computed tomography scan demonstrated remission of the cerebellar edema, which was thought to be the cause of dystonia. CONCLUSIONS: This case demonstrates that the cerebellum has an important role in the development of dystonia. Further studies are needed to elucidate the relationship between dystonia and cerebellar dysfunction.


Assuntos
Doenças Cerebelares/etiologia , Distonia/etiologia , Distúrbios Distônicos/etiologia , Adulto , Encéfalo/diagnóstico por imagem , Cerebelo/anormalidades , Feminino , Humanos , Tomografia por Emissão de Pósitrons/efeitos adversos , Tomografia Computadorizada por Raios X , Veias/anormalidades
17.
Cochrane Database Syst Rev ; 9: CD012643, 2019 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-31525824

RESUMO

BACKGROUND: Hodgkin lymphoma (HL) is one of the most common haematological malignancies in young adults and, with cure rates of 90%, has become curable for the majority of individuals. Positron emission tomography (PET) is an imaging tool used to monitor a tumour's metabolic activity, stage and progression. Interim PET during chemotherapy has been posited as a prognostic factor in individuals with HL to distinguish between those with a poor prognosis and those with a better prognosis. This distinction is important to inform decision-making on the clinical pathway of individuals with HL. OBJECTIVES: To determine whether in previously untreated adults with HL receiving first-line therapy, interim PET scan results can distinguish between those with a poor prognosis and those with a better prognosis, and thereby predict survival outcomes in each group. SEARCH METHODS: We searched MEDLINE, Embase, CENTRAL and conference proceedings up until April 2019. We also searched one trial registry (ClinicalTrials.gov). SELECTION CRITERIA: We included retrospective and prospective studies evaluating interim PET scans in a minimum of 10 individuals with HL (all stages) undergoing first-line therapy. Interim PET was defined as conducted during therapy (after one, two, three or four treatment cycles). The minimum follow-up period was at least 12 months. We excluded studies if the trial design allowed treatment modification based on the interim PET scan results. DATA COLLECTION AND ANALYSIS: We developed a data extraction form according to the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS). Two teams of two review authors independently screened the studies, extracted data on overall survival (OS), progression-free survival (PFS) and PET-associated adverse events (AEs), assessed risk of bias (per outcome) according to the Quality in Prognosis Studies (QUIPS) tool, and assessed the certainty of the evidence (GRADE). We contacted investigators to obtain missing information and data. MAIN RESULTS: Our literature search yielded 11,277 results. In total, we included 23 studies (99 references) with 7335 newly-diagnosed individuals with classic HL (all stages).Participants in 16 studies underwent (interim) PET combined with computed tomography (PET-CT), compared to PET only in the remaining seven studies. The standard chemotherapy regimen included ABVD (16) studies, compared to BEACOPP or other regimens (seven studies). Most studies (N = 21) conducted interim PET scans after two cycles (PET2) of chemotherapy, although PET1, PET3 and PET4 were also reported in some studies. In the meta-analyses, we used PET2 data if available as we wanted to ensure homogeneity between studies. In most studies interim PET scan results were evaluated according to the Deauville 5-point scale (N = 12).Eight studies were not included in meta-analyses due to missing information and/or data; results were reported narratively. For the remaining studies, we pooled the unadjusted hazard ratio (HR). The timing of the outcome measurement was after two or three years (the median follow-up time ranged from 22 to 65 months) in the pooled studies.Eight studies explored the independent prognostic ability of interim PET by adjusting for other established prognostic factors (e.g. disease stage, B symptoms). We did not pool the results because the multivariable analyses adjusted for a different set of factors in each study.Overall survivalTwelve (out of 23) studies reported OS. Six of these were assessed as low risk of bias in all of the first four domains of QUIPS (study participation, study attrition, prognostic factor measurement and outcome measurement). The other six studies were assessed as unclear, moderate or high risk of bias in at least one of these four domains. Nine studies were assessed as high risk, and three studies as moderate risk of bias for the domain study confounding. Eight studies were assessed as low risk, and four studies as high risk of bias for the domain statistical analysis and reporting.We pooled nine studies with 1802 participants. Participants with HL who have a negative interim PET scan result probably have a large advantage in OS compared to those with a positive interim PET scan result (unadjusted HR 5.09, 95% confidence interval (CI) 2.64 to 9.81, I² = 44%, moderate-certainty evidence). In absolute values, this means that 900 out of 1000 participants with a negative interim PET scan result will probably survive longer than three years compared to 585 (95% CI 356 to 757) out of 1000 participants with a positive result.Adjusted results from two studies also indicate an independent prognostic value of interim PET scan results (moderate-certainty evidence).Progression-free survival Twenty-one studies reported PFS. Eleven out of 21 were assessed as low risk of bias in the first four domains. The remaining were assessed as unclear, moderate or high risk of bias in at least one of the four domains. Eleven studies were assessed as high risk, nine studies as moderate risk and one study as low risk of bias for study confounding. Eight studies were assessed as high risk, three as moderate risk and nine as low risk of bias for statistical analysis and reporting.We pooled 14 studies with 2079 participants. Participants who have a negative interim PET scan result may have an advantage in PFS compared to those with a positive interim PET scan result, but the evidence is very uncertain (unadjusted HR 4.90, 95% CI 3.47 to 6.90, I² = 45%, very low-certainty evidence). This means that 850 out of 1000 participants with a negative interim PET scan result may be progression-free longer than three years compared to 451 (95% CI 326 to 569) out of 1000 participants with a positive result.Adjusted results (not pooled) from eight studies also indicate that there may be an independent prognostic value of interim PET scan results (low-certainty evidence).PET-associated adverse eventsNo study measured PET-associated AEs. AUTHORS' CONCLUSIONS: This review provides moderate-certainty evidence that interim PET scan results predict OS, and very low-certainty evidence that interim PET scan results predict progression-free survival in treated individuals with HL. This evidence is primarily based on unadjusted data. More studies are needed to test the adjusted prognostic ability of interim PET against established prognostic factors.


Assuntos
Quimiorradioterapia/métodos , Doença de Hodgkin/diagnóstico por imagem , Doença de Hodgkin/tratamento farmacológico , Tomografia por Emissão de Pósitrons/métodos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Progressão da Doença , Intervalo Livre de Doença , Humanos , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
Cancer Radiother ; 23(6-7): 761-764, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31471254

RESUMO

The arrival of new hybrid radiotherapy machines with MRI or PET is announced as a milestone in radiotherapy management. Based on recent literature, we will describe the contribution of each of these modalities and the technological challenges that have already been or are still to be addressed.


Assuntos
Desenho de Equipamento , Imagem por Ressonância Magnética Intervencionista/instrumentação , Imagem Multimodal/métodos , Aceleradores de Partículas , Tomografia por Emissão de Pósitrons/instrumentação , Radioterapia Guiada por Imagem/instrumentação , Humanos , Imagem por Ressonância Magnética Intervencionista/tendências , Imagem Multimodal/tendências , Tomografia por Emissão de Pósitrons/tendências , Radioterapia Guiada por Imagem/tendências
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