RESUMEN
UNLABELLED: Thirty patients with primary cerebral tumors WHO III and IV previously treated, undergoing evaluation for tumoral recurrence, they underwent (18)FDG-PET study, MRI and PMRI. PET uptake was determined by visual inspection and was quantified by use of standard uptake values, the ratio of tumor uptake to normal tissue and were z scored using automated voxel-based comparison. PMRI was quantified by use of ratios of cerebral blood volume (rCBV). The accuracies were determined by comparing imaging data with histologic findings and clinical follow up of up to 21 mo. RESULTS: Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and accuracy were 100 %, 82 %, 90 %, 100 % and 93 % respectively for the PET/MRI fusion and 68 %, 82 %, 87 %, 60 % and 73 % respectively for PMRI. There were two false positive cases for PET/MRI fusion that were confirmed by biopsy: chronic inflammation; and foreign body granulomas. The receiver operating characteristic (ROC) curve analysis showed statistically significant difference (p = 0.0225). CONCLUSIONS: (18)FDG SUVs, glucose uptake ratios and 3D stereotactic surface projections in brain tumors were not a reliable measure for evaluating recurrent tumors. PET/MRI fusion was more sensitive and accurate than PMRI for imaging recurrent primary brain tumors. The region of interest can be visually analyzed on the PET/MRI fusion images and described as recurrent tumor when any activity (lower, equal or greater than the contralateral cortex) is presented in the zone of hyperintensity seen on the post-gadolinium T1-weighted MRI.
Asunto(s)
Neoplasias Encefálicas/diagnóstico , Fluorodesoxiglucosa F18 , Imagenología Tridimensional , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Recurrencia Local de Neoplasia/diagnóstico , Tomografía de Emisión de Positrones , Radiofármacos , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
INTRODUCTION: Malignant sinonasal tumors are very rare in Mexico. They ussually present as advanced disease because it is extremely difficult to make an early diagnosis; in addition, its treatment is complicated by a variety of lesions. Surgical resection remains the mainstay of treatment, but its relative therapeutic value compared with alternative treatments is controversial. OBJECTIVE: We undertook a retrospective analysis in order to evaluate results of craniofacial resections for sinonasal tumors. MATERIALS AND METHODS: A total of 20 patients, 11 men and 9 women were considered, median age was 49 years (18-74). Eleven had received previous treatment elsewhere. In 13 patients tumor was limited to maxillo-ethmoid complex, but in 6 cases tumor involved anteroinferior aspect of sphenoid sinus, in 7 extended to the orbit, in 3 to dura and two to the brain. One had cervical metastases. Median tumoral size was 5.8 cm (1-10). RESULTS: Overall complication rate was 50%. Major surgical complications occurred in 4 patients (20%): one patient developed isolated cerebrospinal fluid leakage (CEFL), 1 developed deterioration of mental status, and two developed meningitis associated with CEFL. Late complications occurred in 30% of the patients. There was not any operative death. Eleven patients received postoperative radiotherapy. Fifteen patients recurred. There were 11 local relapses, although one associated with a regional relapse, and another with regional and distant relapse. There were four isolated regional fails and six isolated distant failures. Three year overall survival was 65%, and 3-year disease free survival was 50%. Patients without previous treatment median survival was 28.3 months, meanwhile with previous treatment was 18.2 months. CONCLUSIONS: Craniofacial resection is a safe and valuable tool in the treatment of advanced sinonasal tumors involving cranial base.