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1.
Medicine (Baltimore) ; 99(5): e18990, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000435

RESUMO

RATIONALE: Thymic neuroendocrine tumor (TNET) is very rare and characterized by a tendency to invade adjacent structures, frequent metastasis, resistance to therapy, and a poor prognosis. Viscum album extracts (VAE) have shown immunological, apoptogenic, and cytotoxic properties. PATIENT CONCERNS: A 54-year-old Peruvian man was suffering from constant fatigue, cough, dyspnea, and fever for a couple of months. DIAGNOSES: He was diagnosed with TNET (12.8 cm × 10 cm × 7 cm) stage IIIa, G1. Due to the size and extensive invasiveness (vena cava superior, also obstructing 85% of its lumen, pericardium, and pleura), the TNET was inoperable. INTERVENTIONS: We report the case of this patient who declined chemotherapy and was treated instead with sole subcutaneous VAE 3 times per week for 85 months. No other tumor-specific intervention was applied. OUTCOMES: Quality of life (QoL) improved substantially. The patient returned to work, and the tumor remained stable for 71 months. Thereafter, the tumor progressed, and the patient died 90 months after initial diagnosis. Besides self-limited local skin reactions around the application site, no side effects occurred. LESSONS: This is an exceptionally good course of disease of an inoperable, large, obstructing, and invasive TNET with a reduced baseline condition (Karnofsky index: 50-60) due to pronounced symptoms. Given the considerable reduction of symptoms and improved QoL following the onset of VAE therapy and other reports describing long disease stability and improvement of the QoL using VAE in different cancer types, we presume that the VAE treatment was supportive in this case. As TNETs are rare and few trials are available, future treatments of TNETs using VAE should be carefully documented and published to help determine whether further investigation of the use of VAE in TNET treatment is worthwhile.


Assuntos
Antineoplásicos Fitogênicos/uso terapêutico , Tumores Neuroendócrinos/tratamento farmacológico , Neoplasias do Timo/tratamento farmacológico , Viscum album , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Tumores Neuroendócrinos/diagnóstico por imagem , Qualidade de Vida , Neoplasias do Timo/diagnóstico por imagem , Tomografia Computadorizada por Raios X
2.
Medicine (Baltimore) ; 99(7): e19162, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049844

RESUMO

RATIONALE: In the diagnostics of neuroendocrine tumors (NETs), scintigraphy and Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) with Indium-Octreotide occupy a prominent place.The introduction in clinical practice of Gallium-labelled somatostatin analogues (DOTA-TOC, DOTA-TATE, DOTA-NOC) for Positron Emission Tomography/Computed Tomography (PET/CT), significantly improved NETs diagnostics due to greater sensitivity and improved lesion detection in addition to better patient convenience and decreased radiation dose. PATIENT CONCERNS: We report a case of a patient who was diagnosed with a neuroendocrine tumor of the ileocecal valve. DIAGNOSES: Diagnosis was made by ultrasonography, CT, and colonoscopy. Hystology after surgery was G2 NET of ileo-cecal valve. Restaging was carried out by In-Octreotide SPECT/CT and, 1 month later, by Ga-DOTATOC PET/CT. F-FDG PET/C was also carried out. INTERVENTIONS: Ga-DOTATOC PET/CT showed larger disease that modified disease management from surgery to medical treatment. OUTCOMES: After an initial improvement in the patient clinical condition, the tumor caused a worsening with the appearance of ascites. LESSONS: Ga-DOTA-conjugate PET/CT is appropriate in low and intermediate NET (Ki67 index respectively ≤3% and 3%-20%) characterized by better survival and better response after Peptide Receptor Radionuclide Therapy.F-FDG is mostly useful in high grade (G3) of disease, so that Ga-DOTA-conjugate SUV and F-FDG SUV have an opposite trend in relation to the tumor grade. Ga-DOTATOC PET/CT changes, as in our case, therapeutic management in about 40% of cases.


Assuntos
Valva Ileocecal/diagnóstico por imagem , Tumores Neuroendócrinos/diagnóstico por imagem , Octreotida/análogos & derivados , Compostos Organometálicos , Idoso , Humanos , Masculino , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único
3.
Clin Nucl Med ; 45(3): 250-251, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31977492

RESUMO

We report of a 71-year-old woman with a 2-cm somatostatin receptor-positive intrapancreatic lesion almost misdiagnosed as neuroendocrine neoplasm. By additional red blood cell scintigraphy with heat-damaged erythrocytes, the lesion was identified as an intrapancreatic accessory spleen, and unnecessary operation (which was already planned) could be avoided. This case report reminds colleagues to consider accessory spleen as differential diagnosis for somatostatin receptor-positive lesions even when located inside the pancreas. In doubtful cases, a scintigraphy with heat-damaged erythrocytes is a very useful and complementary imaging method and should be performed before any planning of surgery.


Assuntos
Tumores Neuroendócrinos/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Esplenopatias/diagnóstico por imagem , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Octreotida/análogos & derivados , Compostos de Organotecnécio , Compostos Radiofarmacêuticos
4.
Br J Radiol ; 93(1106): 20190735, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31922897

RESUMO

OBJECTIVE: To assess the usefulness of a single-phase contrast-enhanced CT to differentiate subtypes of neuroendocrine tumour (NET) liver metastases and to evaluate the correlation between CT features and Ga-68 DOTATATE positron emission tomography/CT (PET/CT) findings. METHODS: Between December 2017 and April 2019 patients with liver metastases of neuroendocrine tumours who underwent CT and Ga-68 DOTATATE PET/CT were enrolled in the study. All patients involved in the study had undergone a standardised single-phase contrast-enhanced CT. Whole body PET/CT images were obtained with a combined PET/CT scanner. All CT images were retrospectively analysed by two radiologists. Enhancement patterns of lesions were assessed. For quantitative examination; CT attenuation values of metastatic lesions, liver parenchyma and aorta were measured using a freehand ROI and tumour-to-liver ratio [T-L = (Tumour-Liver) / Liver] and tumour-to-aorta ratio [T-A = (Tumour-Aorta) / Aorta] were calculated. The lesion with the highest Ga-68 DOTATATE uptake in the liver was used for calculations. The metabolic tumour volume (MTV), maximum standardised uptake value (SUV max) and SUV mean were calculated for the target liver lesion. RESULTS: A total of 137 NET liver metastases divided into in three groups: 49 (35.7%) pancreatic, 60 (44.5%) gastroenteric and 26 (18.9%) lung NET liver metastases were analysed. Gastroenteric NET metastases often showed heterogeneous enhancement which was significantly higher than in the pancreas and lung NET liver metastases (p < 0.001). 96.72% (n = 59) of the gastroenteric NET liver metastases were hypoattenuating whereas the most frequent presentation for the pancreatic group was hyperattenuation (63.26%,n = 31). The difference in enhancement patterns of the liver metastases was statistically significant (p < 0.001) with respect to the location of the primary tumour. For quantitative analysis; tumour CT values were significantly different between the groups (p < 0.001). The T-L ratio was statistically different between gastroenteric and pancreatic NET liver metastases and pancreatic and lung NET groups (p < 0.001). The T-A ratio was significantly higher in the pancreatic NET metastases (p < 0.001). SUVmax, SUVmean and MTV values, however, were not significantly different between the subgroups. There was a weak positive correlation between T-L ratio and SUV meanvalues. CONCLUSION: We noticed statistically significant differences in both qualitative and quantitative CT features between histologic subgroups of neuroendocrine tumour liver metastases at a single phase contrast-enhanced CT. ADVANCES IN KNOWLEDGE: Our study will be the first in the literature which extensively focus on assessing the CT features of liver metastases of NETs at a single phase CT and Ga-68DOTATATE PET/CT. As the different histological subtypes of NET liver metastases exhibit different clinical outcomes, these features might help to identify the primary tumour to provide optimal treatment.


Assuntos
Neoplasias Gastrointestinais , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares , Tumores Neuroendócrinos/secundário , Neoplasias Pancreáticas , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/patologia , Variações Dependentes do Observador , Compostos Organometálicos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Estudos Retrospectivos , Imagem Corporal Total
5.
J Surg Oncol ; 121(3): 480-485, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31853990

RESUMO

BACKGROUND: Somatostatin analog functional imaging with gallium-68 (Ga-68) dotatate positron emission tomography/computed tomography (PET/CT) has demonstrated superiority in lesion detection in patients with neuroendocrine tumors (NETs). The clinical impact of this imaging modality on US surgical and medical oncology practices has not been established. METHODS: Consecutive patients with NET at our institution who received an initial Ga-68 dotatate PET/CT between July 2017 and September 2018 were included. Ga-68 dotatate PET/CT was compared with prior imaging. RESULTS: Among 101 eligible patients, 51 of 50 were female/male, site of origin was gastroenteropancreatic (75%), unknown primary (13%), lung (8%), thymus (2%), and other (2%). All NETs were histologically well/moderately differentiated. Ga-68 dotatate imaging findings altered management in 36 (35.6%) patients: documentation of progression led to the initiation of systemic therapy in 14 patients, obviated the need for biopsy in four patients, and altered surgical plans in 7 of 14 (50%) patients referred for surgery. In 11 patients, decisions regarding peptide receptor radionucleotide therapy and somatostatin analogs were altered. CONCLUSIONS: In this series, Ga-68 dotatate PET/CT altered diagnosis and management in one-third of patients and changed operative plans in half of the patients who were referred for surgical evaluation. These results support the routine use of this imaging in the care of patients with early-stage and advanced NETs.


Assuntos
Neoplasias Intestinais/diagnóstico por imagem , Neoplasias Intestinais/terapia , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/terapia , Compostos Organometálicos , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/terapia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/terapia , Feminino , Radioisótopos de Gálio , Humanos , Neoplasias Intestinais/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Desconhecidas/diagnóstico por imagem , Neoplasias Primárias Desconhecidas/patologia , Neoplasias Primárias Desconhecidas/terapia , Tumores Neuroendócrinos/patologia , Neoplasias Pancreáticas/patologia , Compostos Radiofarmacêuticos , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/patologia , Neoplasias do Timo/terapia
6.
Surgery ; 167(1): 189-196, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31629542

RESUMO

BACKGROUND: Neuroendocrine tumors are found throughout the body, including the pancreas. These tumors are phenotypically and genetically heterogeneous and can be difficult to accurately image using current imaging standards. However, positron emission tomography/computed tomography with radiolabeled somatostatin analogs has shown clinical success because many neuroendocrine tumors overexpress somatostatin receptor subtype 2. Unfortunately, patients with poorly differentiated neuroendocrine tumors often have a diminished level of somatostatin receptor subtype 2. We found that histone deacetylase inhibitors can upregulate the functional expression of somatostatin receptor subtype 2. METHODS: We evaluated the effect of histone deacetylase inhibitors on somatostatin receptor subtype 2 expression at the mRNA and protein level in neuroendocrine tumor cell lines. The effect of histone deacetylase inhibitors on surface somatostatin receptor subtype 2 was also investigated by fluorescence-activated cell sorting analysis. Changes in somatostatin receptor subtype 2 expression in neuroendocrine tumor xenografts after treatment were imaged using Ga68-DOTATATE positron emission tomography/computed tomography. RESULTS: The functional increase of somatostatin receptor subtype 2 in neuroendocrine tumors after histone deacetylase inhibitor treatment was confirmed through in vitro experiments and small animal Ga68-DOTATATE positron emission tomography/computed tomography imaging. Histone deacetylase inhibitors increased somatostatin receptor subtype 2 transcription and protein expression in neuroendocrine tumor cell lines. Small animal Ga68-DOTATATE positron emission tomography/computed tomography imaging confirmed the enhancement of radiopeptide uptake after histone deacetylase inhibitor administration. CONCLUSION: This study demonstrates a new method to potentially improve imaging and treatments that target somatostatin receptor subtype 2 in neuroendocrine tumors.


Assuntos
Inibidores de Histona Desacetilases/administração & dosagem , Imagem Molecular/métodos , Tumores Neuroendócrinos/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Receptores de Somatostatina/metabolismo , Animais , Linhagem Celular Tumoral , Separação Celular , Depsipeptídeos/administração & dosagem , Citometria de Fluxo , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Humanos , Masculino , Camundongos , Tumores Neuroendócrinos/patologia , Compostos Organometálicos/administração & dosagem , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Neoplasias Pancreáticas/patologia , Análise Serial de Tecidos , Transcrição Genética/efeitos dos fármacos , Ensaios Antitumorais Modelo de Xenoenxerto
7.
Clin Nucl Med ; 45(1): 74-75, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31693612

RESUMO

A 57-year-old man, on octreotide treatment for metastatic neuroendocrine tumor pancreas, was referred for whole-body Ga-DOTANOC PET/CT scan to evaluate treatment response. PET/CT scan revealed DOTANOC-avid lesion in the head of the pancreas with multiple tracer-avid soft tissue lesions in the liver, bilateral adrenal glands, and periportal lymph nodes. In addition, diffuse intense DOTANOC-avid mural thickening with intraluminal polypoidal mass formation was noted within the stomach causing significant luminal compromise, histopathological examination of which turned out be hypertrophic hypersecretory gastropathy. This case highlights the possibility of overexpression of somatostatin receptors in gastric hypertrophy, which has been little explored in literature.


Assuntos
Gastrite Hipertrófica/diagnóstico por imagem , Tumores Neuroendócrinos/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Tumores Neuroendócrinos/patologia , Compostos Organometálicos , Neoplasias Pancreáticas/patologia , Compostos Radiofarmacêuticos
8.
Clin Nucl Med ; 45(2): 136-138, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31876827

RESUMO

Ectopic adrenocorticotropic hormone Cushing syndrome is a relatively rare condition. We present the case of a 39-year-old man with ectopic adrenocorticotropic hormone Cushing syndrome due to a cardiac neuroendocrine tumor (NET), which was localized with the help of Ga-DOTATATE. F-FDG PET/CT revealed a hypermetabolic lesion in the heart, while the distinction between physiological and pathological FDG uptake is difficult. Ga-DOTATATE PET/CT revealed focal uptake corresponding to the cardiac focus found on FDG PET/CT, providing evidence of cardiac NET. This case illustrates that Ga-DOTATATE could play a role in the evaluation of cardiac NET as it lacks significant physiological myocardial uptake.


Assuntos
Neoplasias Cardíacas/diagnóstico por imagem , Tumores Neuroendócrinos/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Adulto , Humanos , Masculino , Compostos Organometálicos , Compostos Radiofarmacêuticos
9.
Medicine (Baltimore) ; 98(49): e18174, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31804333

RESUMO

RATIONALE: Neuroendocrine tumors (NETs) of the lung account for 5% of all cases of lung cancer, which itself is the leading cause of cancer-related death worldwide. In accordance to its rarity, only few cell lines of NETs exist, which even often lack key characteristics of the primary tumor, making it difficult to study underlying molecular mechanisms. PATIENT CONCERNS: The patient reported in this case is a 71-year old woman, which never smoked but suffered under dry cough. DIAGNOSES: Chest CT-scan showed a paracardiac nodule of the lingula with 2 × 1.8 cm in diameter. INTERVENTIONS: The detected paracardiac nodule of the lingula was anatomically resected using video assisted thoracic surgery. OUTCOMES: Histopathological diagnostic of the removed tissue identified the tumor as a well-differentiated typical carcinoid (TC), which represents one of the four subgroups of pulmonary NETs. Next to the successful treatment of the patient, we were able to propagate cancer stem cells (CSCs) out of the resected tumor tissue. To the best of our knowledge, we firstly isolated CSCs of a typical carcinoid, which were positive for the prominent CSC markers CD44, CD133 and nestin, confirming their stem cell properties. Additionally, CSCs, further referred as BKZ1, expressed the neuroendocrine marker synaptophysin, verifying their neuroendocrine origin. However, nuclear synaptophysin protein was also present in other stem cell populations, suggesting a role as general stem cell marker. LESSON: In line with the importance of CSCs in cancer treatment and the lack of CSC-models for neuroendocrine neoplasms, the here described BKZ1 cancer stem cell line of a typical carcinoid represents a promising new model to study pulmonary carcinoids and particular NETs.


Assuntos
Neoplasias Pulmonares/patologia , Células-Tronco Neoplásicas/patologia , Tumores Neuroendócrinos/patologia , Idoso , Biomarcadores Tumorais , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Tumores Neuroendócrinos/diagnóstico por imagem , Tomografia Computadorizada por Raios X
10.
Clin Nucl Med ; 44(11): 876-878, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31584494

RESUMO

Prostate cancer with neuroendocrine differentiation is associated with a poor prognosis, rapid disease progression, and treatment resistance, and constitutes a diagnostic and therapeutic dilemma. We present images of Lu-DOTATATE scan and Ga-DOTATATE PET/CT scan conducted on a 65-year-old man with prostate cancer with neuroendocrine differentiation, whose disease progressed despite conventional treatment and Lu-PSMA radioligand therapy; however, an extraordinary radiographic tumor remission, biochemical response, and improvement of clinical symptoms were observed after the patient underwent Lu-DOTATATE peptide receptor radionuclide therapy.


Assuntos
Dipeptídeos/uso terapêutico , Compostos Heterocíclicos com 1 Anel/uso terapêutico , Tumores Neuroendócrinos/radioterapia , Tumores Neuroendócrinos/secundário , Octreotida/análogos & derivados , Compostos Organometálicos , Neoplasias de Próstata Resistentes à Castração/patologia , Receptores de Peptídeos/metabolismo , Idoso , Humanos , Masculino , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/metabolismo , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Resultado do Tratamento
12.
J Zhejiang Univ Sci B ; 20(10): 861-864, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31489805

RESUMO

Rectal neuroendocrine neoplasms (NENs) are low-grade malignancies, which are slow-growing and usually become symptomatic late in the course of the disease (Basuroy et al., 2016). In recent years, rectal NENs are increasingly frequently detected, with the widespread availability and accessibility of endoscopy and cross-sectional imaging modalities (Kos-Kudla et al., 2017). Multiple studies have shown that endoscopic ultrasound (EUS) is an advanced endoscopic technique and is currently used in the diagnosis and preoperative assessment of NENs (Kim, 2012; Liu et al., 2013; Zhang et al., 2017). However, EUS imaging of rectal NEN and differential diagnosis with other submucosal tumors (SMTs) has not been adequately reported. In this study, we reviewed and summarized the EUS imaging and pathological features of rectal NENs of 38 cases to improve preoperative diagnosis rate and reduce unreasonable treatment.


Assuntos
Endossonografia/métodos , Tumores Neuroendócrinos/diagnóstico por imagem , Neoplasias Retais/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/terapia , Neoplasias Retais/terapia
13.
Oral Maxillofac Surg Clin North Am ; 31(4): 627-635, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31473063

RESUMO

This article discusses the application of fludeoxyglucose PET/computed tomography (CT) technology in head and neck cancer diagnosis and management, as well as advantages and disadvantages relative to traditional imaging modalities. A successful scan relies on precise patient preparation, and compliance to specific protocols before and during the scan. Finally, this article briefly introduces a PET/CT scan recently approved by the Food and Drug Administration for neuroendocrine tumors.


Assuntos
Fluordesoxiglucose F18 , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Tumores Neuroendócrinos/diagnóstico por imagem , Compostos Organometálicos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos , Tomografia Computadorizada por Raios X/métodos , Humanos , Tumores Neuroendócrinos/metabolismo , Traçadores Radioativos , Sensibilidade e Especificidade
14.
Clin Nucl Med ; 44(11): 851-854, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31524686

RESUMO

PURPOSE: To measure the SUVs in the tail of the pancreas compared with normal liver parenchyma and somatostatin receptor-positive lesions. MATERIALS AND METHODS: Ga-DOTATATE PET/low mAs CT of 35 patients were reviewed. RESULTS: There was no significant difference (P = 0.59) between the SUVaverage of normal liver and the SUVpeak of normal tail. Five patients had uptake in the tail slightly above that of normal liver that were interpreted equivocally. In one of these patients with Ga-DOTATATE uptake in a peripancreatic lymph node, proven neuroendocrine tumor underwent a distal pancreatectomy and pathologic examination revealed islet cell hyperplasia. CONCLUSIONS: Ga-DOTATATE uptake in the tail of the pancreas above that of normal liver indicates a somatostatin receptor-avid lesion. Uptake in the tail of the pancreas equal to the liver can be normal. Patients with uptake equivalent to the liver should undergo further anatomical imaging before procedural intervention.


Assuntos
Compostos Organometálicos/metabolismo , Pâncreas/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Transporte Biológico , Feminino , Humanos , Fígado/diagnóstico por imagem , Fígado/metabolismo , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/metabolismo , Tumores Neuroendócrinos/patologia , Pâncreas/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Receptores de Somatostatina/metabolismo
15.
Radiologe ; 59(11): 961-967, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31515568

RESUMO

CLINICAL/METHODICAL ISSUE: Neuroendocrine tumors (NET) of the stomach, duodenum and pancreas are rare tumors with a low incidence but the exact tumor localization and staging diagnostics are of critical importance for further planning of treatment. STANDARD RADIOLOGICAL METHODS: Standard primary diagnostic methods include multimodal imaging with computed tomography (CT) and magnetic resonance imaging (MRI) but in 20-50% of the cases the localization of the primary tumor cannot be identified. METHODICAL INNOVATIONS: Modern hybrid imaging procedures combine radiological procedures and functional imaging, e.g. using somatostatin receptor (SSR) positron emission tomography CT (PET)/CT imaging. For the exact diagnostics of the primary tumor and distant metastases morphological and functional aspects can be combined for targeted diagnostics. For primary tumor staging a sensitivity of 80.0% and a specificity of 88.4% are given in the literature. PERFORMANCE: The application of SSR PET/CT led to a change in patient management in 44% of all cases according to a recently published meta-analysis and therefore had a significant influence on the further procedure. ASSESSMENT: The use of SSR PET/CT can provide critical information for further treatment and can lead to a significant change in treatment management in a relevant proportion of patients. PRACTICAL RECOMMENDATIONS: Radiological imaging diagnostics and in particular hybrid functional imaging procedures using PET/CT will become increasingly more relevant for the diagnostics, treatment and follow-up of NET patients.


Assuntos
Tumores Neuroendócrinos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias Duodenais/diagnóstico por imagem , Duodeno , Humanos , Imagem Multimodal , Tumores Neuroendócrinos/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Tomografia por Emissão de Pósitrons , Estômago , Neoplasias Gástricas/diagnóstico por imagem
17.
Cardiovasc Intervent Radiol ; 42(11): 1571-1578, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31410534

RESUMO

PURPOSE: To retrospectively assess safety and efficacy of laser ablation (LA) of multiple liver metastases (LM) from neuroendocrine neoplasms (NEN). METHODS: Twenty-one patients with NEN and at least 3 LM ≤ 4 cm in diameter underwent ultrasonography-guided LA. Up to seven LM were ablated in a single session; if the number of LM exceeded seven, the remaining LM were ablated in further LA sessions with a time interval of 3-4 weeks. LA was performed according to the multifiber technique. The patients underwent contrast-enhanced CT 1 month after LA, and were subsequently monitored every 3 months for the first 2 years and then every 6 months. RESULTS: In total, 189 LM were treated in 21 patients (mean 9 ± 8.2, median 6) in 41 LA sessions (range 1-5). The diameter of LM ranged from 5 to 35 mm (median 19 mm, mean 17.9 ± 6.4 mm). One grade 4 complication occurred (0.53%): a bowel perforation managed by surgery. Technical efficacy was 100%, primary efficacy rate 94.7%, and secondary efficacy rate 100%. Complete relief of hormone-related symptoms was obtained in all the 13 symptomatic patients. Median follow-up was 39 months (range 12-99). 1-, 2-, 3-, and 5-year survival rates were 95%, 86%, 66%, and 40%, respectively. Overall survival resulted higher for patients with Ki-67 expression ≤ 7% than for those with Ki-67 > 7% (p = 0.0347). CONCLUSIONS: LA is a promising and safe technique to treat LM from NEN. A longer follow-up should provide definitive information on the long-term efficacy of this liver-directed therapy. LEVEL OF EVIDENCE: Retrospective study, local non-random sample, level 3.


Assuntos
Terapia a Laser/métodos , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Tumores Neuroendócrinos/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Fígado/diagnóstico por imagem , Fígado/cirurgia , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos
18.
Medicine (Baltimore) ; 98(35): e16960, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464937

RESUMO

To assess the duct-road sign and tumor-to-duct ratio (TDR) in MRI for differentiating pancreatic neuroendocrine tumors (PNETs) from pancreatic ductal-adenocarcinomas (PDACs).Retrospectively reviewed MRI characteristics of 78 pancreatic masses (histopathology-proven 25 PNETs and 53 PDACs). Receiver operating characteristics with TDR and diagnostic performance of the duct-road sign for differential diagnosis were performed.The prevalence of duct-road sign in PNETs was higher than that for PDACs (84% vs 0%; P < .001). A strong correlation (r = 0.884, P < .001) was observed between MRI for PNETs and the frequency of this sign. Performance characteristics of the duct-road sign in MRI for PNET diagnosis were sensitivity (84%, [21 of 25]), specificity (100%, [53 of 53]), positive predictive value (100%, [21 of 21]), negative predictive value (92.9%, [53 of 57]), and accuracy (94.8%, [74 of 78]). In the intention-to-diagnose analysis, the corresponding values were 67.7% (21 of 31), 100% (53 of 53), 100% (21 of 21), 84.1% (53 of 63), and 88.1% (74 of 84). The TDR in PNETs was observed to be greater than that in PDACs (14.6 ±â€Š9.3 vs 6.9 ±â€Š3.8, P = .001). TDR with a cut-off value of 7.7 had high sensitivity (84%) and specificity (66%) with area under curve (0.802, 95% CI: 0.699, 0.904; P < .001) for distinguishing PNETs from PDACs.The presence of duct-road sign and TDR > 7.7 on MRI may assist in diagnosis for PNET instead of PDAC.


Assuntos
Adenocarcinoma/patologia , Tumores Neuroendócrinos/patologia , Ductos Pancreáticos/patologia , Neoplasias Pancreáticas/patologia , Adenocarcinoma/diagnóstico por imagem , Adulto , Idoso , Carcinoma Ductal Pancreático/diagnóstico por imagem , Carcinoma Ductal Pancreático/patologia , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/diagnóstico por imagem , Ductos Pancreáticos/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Reprodutibilidade dos Testes , Estudos Retrospectivos , Carga Tumoral
19.
Radiologe ; 59(11): 1002-1009, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31440790

RESUMO

BACKGROUND: Radiological and nuclear medical diagnostics play an important role in the work-up of patients with gastroenteropancreatic neuroendocrine tumors (GEP-NET). The sonographic examination, including contrast-enhanced examination, depicts an initial imaging modality to screen for NET. This report describes the sonomorphological behavior of ileal and pancreatic NET as well as hepatic metastases from NET. CLINICAL/METHODICAL ISSUE: Sonographic evaluation of NET of the small intestine, pancreas and neuroendocrine hepatic metastases. STANDARD RADIOLOGICAL METHODS: Contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI), unenhanced ultrasonography. METHODICAL INNOVATIONS: Contrast-enhanced ultrasound (CEUS). PERFORMANCE: CEUS supports unenhanced ultrasound in the detection of NET and the differential diagnosis of unclear lesions, and is more sensitive for liver metastases (sensitivity according to the literature, 99% vs. 68%) PRACTICAL RECOMMENDATIONS: CEUS allows initial evaluation of NET and differentiation of benign vs. malignant lesions. Nevertheless, CEUS cannot replace more elaborate imaging modalities like CT or MRI for thorough staging examinations.


Assuntos
Neoplasias Hepáticas , Tumores Neuroendócrinos , Ultrassonografia/métodos , Abdome , Meios de Contraste , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Imagem por Ressonância Magnética , Tumores Neuroendócrinos/diagnóstico por imagem , Tomografia Computadorizada por Raios X
20.
Nucl Med Commun ; 40(10): 1005-1010, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31365494

RESUMO

OBJECTIVE: Our purpose is to investigate whether the tumor uptake of Tc-HYNIC-TOC in patients with neuroendocrine tumor would be influenced when the patients were treated with long-acting octreotide. METHODS: Sixty G2 neuroendocrine tumor patients who underwent Tc-HYNIC-TOC single-photon emission computed tomography/computed tomography imaging were retrospectively analyzed. The ratios of target/muscle of normal organs and tumors were compared between the patients with (n = 30) and without octreotide treatment (n = 30). In addition, the octreotide treatment group was divided into two subgroups based on whether the time intervals were more than 14 days between the last time of octreotide administration and the day of imaging. RESULTS: There was no statistical significance in target/muscle of primary tumors (23.86 ± 4.49 vs. 20.72 ± 5.37, P = 0.070), metastases in the liver (20.74 ± 6.14 vs. 19.72 ± 6.54, P = 0.211), lymph nodes (16.29 ± 9.45 vs. 15.52 ± 7.67, P = 0.867), bone (9.18 ± 3.83 vs. 9.07 ± 3.61, P = 0.989) and lung (16.99 ± 6.06 vs. 12.40 ± 5.97, P = 0.133) between octreotide treated and untreated group. However, target/muscle of normal liver and bone were lower in the octreotide treated group than in untreated group (P = 0.003, and 0.0001, respectively). There was also no significant difference in target/muscle of normal organs, primary tumors and metastases between the two subgroups. CONCLUSION: Octreotide treatment had no impact on the results of Tc-HYNIC-TOC single-photon emission computed tomography/computed tomography to detect tumors and metastasis in patients with neuroendocrine tumor. However, the uptake in normal liver and bone can be reduced, which might increase the detection rate of lesions in corresponding organs.


Assuntos
Tumores Neuroendócrinos/tratamento farmacológico , Tumores Neuroendócrinos/metabolismo , Octreotida/análogos & derivados , Octreotida/farmacologia , Octreotida/farmacocinética , Compostos de Organotecnécio/metabolismo , Adulto , Transporte Biológico/efeitos dos fármacos , Feminino , Humanos , Masculino , Tumores Neuroendócrinos/diagnóstico por imagem , Octreotida/metabolismo , Octreotida/uso terapêutico , Estudos Retrospectivos , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único
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