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INTRODUCTION: Radiosynovectomy (RS) with 90Y-hydroxyapatite (90Y-HyA) aims to control knee hemarthrosis in hemophiliac patients to prevent secondary arthropathy. However, knee RS using 153Sm-hydroxyapatite (153Sm-HyA) is considered less suitable due to the lower average soft tissue range and energy of 153Sm for large joints, such as the knees. PURPOSE: The objective of this investigation was to assess the efficacy and safety of knee RS with 153Sm-HyA, compared to 90Y-HyA. METHODS: Forty patients were prospectively assigned to undergo knee RS with 153Sm-HyA (n = 19) or with 90Y-HyA (n = 21). The frequency of hemarthrosis episodes before and after treatment were compared. RESULTS: After six months of knee RS, 153Sm-HyA and 90Y-HyA promoted a similar reduction of hemarthrosis episodes (50% and 66.7%, respectively). However, after 12 months of knee RS, the reduction of hemarthrosis episodes was significantly (p = 0.037) higher using 153Sm-HyA (87.5%) compared to 90Y-HyA (50.0%). This discrepancy was more pronounced (p = 0.002) for 153Sm-HyA compared to 90Y-HyA in adults/adolescents. CONCLUSION: Knee radiosynovectomy with 153Sm-HyA is safe, reduces hemarthrosis episodes after 12 months of treatments, especially in adults/adolescents and even with grades III/IV arthropathy, similar to 90Y-HyA. 90Y-HyA seems to promote better hemarthrosis control in small children.
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Durapatita/química , Hemartrosis/radioterapia , Articulación de la Rodilla/efectos de la radiación , Radioisótopos/química , Samario/química , Radioisótopos de Itrio/química , Adolescente , Adulto , Anciano , Niño , Preescolar , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Radioisótopos/efectos adversos , Radioisótopos/uso terapéutico , Medición de Riesgo , Samario/efectos adversos , Samario/uso terapéutico , Factores de Tiempo , Resultado del Tratamiento , Radioisótopos de Itrio/efectos adversos , Radioisótopos de Itrio/uso terapéuticoRESUMEN
Guidelines recommend true whole-body 18F-FDG PET/CT scans from vertex to toes in pediatric lymphoma patients, although this suggestion has not been validated in large clinical trials. The objective of the study was to evaluate the incidence and clinical impact of lesions outside the "eyes to thighs" regular field of view (R-FOV) in 18F-FDG PET/CT staging (sPET) and interim (iPET) scans in pediatric lymphoma patients. Methods: True whole-body sPET and iPET scans were prospectively obtained in pediatric lymphoma patients (11 worldwide centers). Expert panel central review of sPET and iPET scans were evaluated for lymphoma lesions outside the R-FOV and clinical relevance of these findings. Results: A total of 610 scans were obtained in 305 patients. The sPET scans did not show lesions outside the R-FOV in 91.8% of the patients, whereas in 8.2% patients the sPET scans demonstrated lesions also outside the R-FOV (soft tissue, bone, bone marrow, and skin); however, the presence of these lesions did not change the clinical stage of any patient and did not affect treatment decision. Among the 305 iPET scans, there were no new positive 18F-FDG-avid lesions outside the R-FOV, when compared with their paired sPET scans. A single lesion outside the R-FOV on iPET occurred in 1 patient (0.3%), with the primary lesion diagnosed in the femur on sPET that persisted on iPET. Conclusion: The identification of additional lesions outside the R-FOV (eyes to thighs) using 18F-FDG PET/CT has no impact in the definition of the clinical stage of disease and minimal impact in the treatment definition of patients with pediatric lymphoma. As so, R-FOV for both sPET and iPET scans could be performed.
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Fluorodesoxiglucosa F18/farmacología , Linfoma/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Adolescente , Niño , Preescolar , Femenino , Enfermedad de Hodgkin/diagnóstico por imagen , Humanos , Lactante , Linfoma no Hodgkin/diagnóstico por imagen , Masculino , Estudios Prospectivos , Reproducibilidad de los Resultados , Imagen de Cuerpo Entero/métodosRESUMEN
IMPORTANCE: Single-photon emission computed tomography/computed tomography (SPECT/CT) and radioguided sentinel lymph node biopsy (rSLNB) are techniques that could potentially benefit surgeons and pathologists in the identification of sentinel lymph node (SLN) metastases in patients with papillary thyroid carcinoma (PTC). Evidence suggests that these novel techniques lead to substantial changes in PTC management by reducing understaging and of occult lymph node (LN) metastases and optimizing neck surgery by increasing the necessity of lateral lymphadenectomy and decreasing central lymphadenectomy. OBJECTIVES: To correlate the presence of LN metastases in PTC with clinical and pathological features using SPECT/CT and rSLNB. DESIGN, SETTING, AND PARTICIPANTS: For this prospective cohort study from June 2010 to November 2013, 42 patients with thyroid nodules suspicious for papillary carcinoma or classified as malignant on cytology examination without suspicion of lymph node metastases by clinical and ultrasound examinations were recruited from a single public medical institution. INTERVENTIONS: All 42 patients underwent preoperative lymphoscintigraphy after an ultrasound-guided peritumoral injection of Technetium Tc 99m nanocolloid. Cervical images were acquired with a SPECT/CT scanner 15 minutes after radiotracer injection. Approximately 2 hours after lymphoscintigraphy, the patients were submitted to intraoperative rSLNB using a handheld gamma probe. All SLNs identified were removed alongside with non-SLNs from the same compartment. Papillary thyroid carcinoma, SLNs and non-SLNs were submitted for histopathology and immunohistochemical analyses. RESULTS: Of the 42 patients initially enrolled, 37 were included in analysis, including 6 men and 31 women with a mean (range) age of 47 (22-83) years. Overall, T stage was as follows: T1, 23 patients (62.2%); T2, 8 patients (21.6%); and T3, 6 patients (16.2%). Sentinel lymph nodes were identified in 92% of the patients, and among these metastases were present in 17 patients (46%). The SLNs were false-negative in 3 patients. Metastases in the lateral compartment ocurred in 7 patients (18%). There was a significant association between LN metastases and tumor size (odds ratio, 1.06; 95% CI, 1.00-1.13; P = .02), with a Cohen d effect of 0.683 (medium to large effect). Overall, 17 patients (46%) with LN metastases had management changed because they were submitted to higher radioiodine ablation doses and closer clinical surveillance. CONCLUSIONS AND RELEVANCE: Radioguided SLNB is able to detect occult cervical lymph node metastases in patients with papillary thyroid carcinoma, and in 7 patients (18%) rSLNB detected lymph node metastases in the lateral compartments. The rSLNB technique lead to management change in 14 patients (37.8%).
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Carcinoma/patología , Metástasis Linfática/diagnóstico , Biopsia del Ganglio Linfático Centinela/métodos , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único , Neoplasias de la Tiroides/patología , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Papilar , Estudios de Cohortes , Femenino , Humanos , Linfocintigrafia , Masculino , Persona de Mediana Edad , Radiofármacos , Agregado de Albúmina Marcado con Tecnecio Tc 99m , Cáncer Papilar Tiroideo , Adulto JovenRESUMEN
Purpose. To understand the role of polymorphisms in the LEP (rs7799039 and rs2167270) and LEPR (rs1137101 and rs1137100) genes in DTC susceptibility and their effect on leptin levels. Methods. We studied 153 patients with DTC and 234 controls through TaqMan SNP Genotyping and ELISA, comparing these data to the clinicopathological data of patients with DTC. Results. Patients with AA genotype of rs7799039 had higher levels of serum leptin (9.22 ± 0.98 ng/mL) than those with AG genotype (10.07 ± 0.60 ng/mL; P = 0.005). Individuals with AG genotype of rs2167270 also produced higher serum leptin levels (10.05 ± 0.59 ng/mL) than the subjects with GG genotype (9.52 ± 0.79 ng/mL; P < 0.05). A multivariate logistic regression adjusted for gender, age, and BMI showed that the AG genotype of rs7799039 was an independent risk for DTC (OR, 11.689; P = 0.0183; 95% CI, 1.516-90.119). Similarly, AG and GG genotypes of rs1137101 increased the susceptibility to DTC (OR, 3.747; P = 0.027; 95% CI, 1.161-12.092 and OR, 5.437; P = 0.013; 95% CI, 1.426-20.729). Conclusions. We demonstrated that rs7799039 and rs2167270 polymorphisms modify the serum leptin concentrations in patients with DTC. Furthermore, polymorphisms rs7799039 and rs1137101 increase the risk of DTC development, although they do not correlate with tumor aggressiveness.
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OBJECTIVE: Current guidelines have advised against the performance of (131)I-iodide diagnostic whole body scintigraphy (dxWBS) to minimize the occurrence of stunning, and to guarantee the efficiency of radioiodine therapy (RIT). The aim of the study was to evaluate the impact of stunning on the efficacy of RIT and disease outcome. SUBJECTS AND METHODS: This retrospective analysis included 208 patients with differentiated thyroid cancer managed according to a same protocol and followed up for 12-159 months (mean 30 ± 69 months). Patients received RIT in doses ranging from 3,700 to 11,100 MBq (100 mCi to 300 mCi). Post-RIT-whole body scintigraphy images were performed 10 days after RIT in all patients. In addition, images were also performed 24-48 hours after therapy in 22 patients. Outcome was classified as no evidence of disease (NED), stable disease (SD) and progressive disease (PD). RESULTS: Thyroid stunning occurred in 40 patients (19.2%), including 26 patients with NED and 14 patients with SD. A multivariate analysis showed no association between disease outcome and the occurrence of stunning (p = 0.3476). CONCLUSION: The efficacy of RIT and disease outcome do not seem to be related to thyroid stunning.
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Adenocarcinoma Folicular/radioterapia , Carcinoma Papilar/radioterapia , Radioisótopos de Yodo/uso terapéutico , Glándula Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/radioterapia , Adulto , Progresión de la Enfermedad , Femenino , Humanos , Radioisótopos de Yodo/administración & dosificación , Masculino , Persona de Mediana Edad , Análisis Multivariante , Cintigrafía , Estudios Retrospectivos , Glándula Tiroides/cirugía , Neoplasias de la Tiroides/clasificación , Tiroidectomía , Resultado del Tratamiento , Imagen de Cuerpo EnteroRESUMEN
Objective : Current guidelines have advised against the performance of 131I-iodide diagnostic whole body scintigraphy (dxWBS) to minimize the occurrence of stunning, and to guarantee the efficiency of radioiodine therapy (RIT). The aim of the study was to evaluate the impact of stunning on the efficacy of RIT and disease outcome.Subjects and methods : This retrospective analysis included 208 patients with differentiated thyroid cancer managed according to a same protocol and followed up for 12-159 months (mean 30 ± 69 months). Patients received RIT in doses ranging from 3,700 to 11,100 MBq (100 mCi to 300 mCi). Post-RIT-whole body scintigraphy images were performed 10 days after RIT in all patients. In addition, images were also performed 24-48 hours after therapy in 22 patients. Outcome was classified as no evidence of disease (NED), stable disease (SD) and progressive disease (PD).Results : Thyroid stunning occurred in 40 patients (19.2%), including 26 patients with NED and 14 patients with SD. A multivariate analysis showed no association between disease outcome and the occurrence of stunning (p = 0.3476).Conclusion : The efficacy of RIT and disease outcome do not seem to be related to thyroid stunning. Arq Bras Endocrinol Metab. 2014;58(3):292-300.
Objetivo : As diretrizes atuais alertam contra a execução da cintigrafia de corpo inteiro com iodo-131 (dxWBS) para minimizar a ocorrência de atordoamento e garantir a eficiência do tratamento com radioiodo (RIT). O objetivo deste estudo foi avaliar o impacto do atordoamento sobre a eficácia do RIT e desfechos da doença.Sujeitos e métodos : Esta análise retrospectiva incluiu 208 pacientes com câncer diferenciado de tireoide submetidos ao mesmo protocolo e acompanhados por 12-159 semanas (média de 30 ± 69 meses). Os pacientes receberam RIT com doses variando de 3.700 a 11.100 MBq (100 mCi a 300 mCi). As imagens da cintigrafia após a RIT foram feitas 10 dias depois da RIT em todos os pacientes. Além disso, as imagens foram também obtidas após 24-48h em 22 pacientes. O desfecho foi classificado como nenhuma evidência de doença (NED), doença estável (SD) e doença progressiva (PD).Resultados : O atordoamento da tireoide ocorreu em 40 pacientes (19,2%), incluindo 26 pacientes com NED e 14 pacientes com SD. A análise multivariada não mostrou associação entre o desfecho da doença e a ocorrência de atordoamento (p = 0,3476).Conclusão : A eficácia da RIT e o desfecho da doença não parecem estar relacionados com o atordoamento da tireoide. Arq Bras Endocrinol Metab. 2014;58(3):292-300.
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Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adenocarcinoma Folicular/radioterapia , Carcinoma Papilar/radioterapia , Radioisótopos de Yodo/uso terapéutico , Glándula Tiroides , Neoplasias de la Tiroides/radioterapia , Progresión de la Enfermedad , Radioisótopos de Yodo/administración & dosificación , Análisis Multivariante , Estudios Retrospectivos , Tiroidectomía , Resultado del Tratamiento , Glándula Tiroides/cirugía , Neoplasias de la Tiroides/clasificación , Imagen de Cuerpo EnteroRESUMEN
PURPOSE OF THE REPORT: Although MRI is utilized for planning the resection of soft-tissue tumors, it is not always capable of differentiating benign from malignant lesions. The risk of local recurrence of soft-tissue sarcomas is increased when biopsies are performed before resection and by inadequate resections. PET associated with computed tomography using fluorodeoxyglucose labeled with fluorine-18 ((18)F-FDG PET/CT) may help differentiate between benign and malignant tumors, thus avoiding inadequate resections and making prior biopsies unnecessary. The purpose of this study was to evaluate the usefulness of (18)F-FDG PET/CT in differentiating benign from malignant solid soft-tissue lesions. MATERIALS AND METHODS: Patients with solid lesions of the limbs or abdominal wall detected by MRI were submitted to (18)F-FDG PET/CT. The maximum standardized uptake value (SUVmax) cutoff was determined to differentiate malignant from benign tumors. Regardless of the (18)F-FDG PET/CT results all patients underwent biopsy and surgery. RESULTS: MRI was performed in 54 patients, and 10 patients were excluded because of purely lipomatose or cystic lesions. (18)F-FDG PET/CT was performed in the remaining 44 patients. Histopathology revealed 26 (59%) benign and 18 (41%) malignant soft-tissue lesions. A significant difference in SUVmax was observed between benign and malignant soft-tissue lesions. The SUVmax cutoff of 3.0 differentiated malignant from benign lesions with 100% sensitivity, 83.3% specificity, 89.6% accuracy, 78.3% positive predictive value, and 100% negative predictive value. CONCLUSION: (18)F-FDG PET/CT seems to be able to differentiate benign from malignant soft-tissue lesions with good accuracy and very high negative predictive value. Incorporating (18)F-FDG PET/CT into the diagnostic algorithm of these patients may prevent inadequate resections and unnecessary biopsies.
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Fluorodesoxiglucosa F18 , Imagen Multimodal , Tomografía de Emisión de Positrones , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Adulto JovenRESUMEN
Cerebrovascular lesions are frequently observed in patients with sickle-cell disease (SCD) and these structural lesions are preceded by insidious perfusion deficits. Our aim was to investigate the presence of brain perfusion deficits in neurologically asymptomatic SCD patients, especially affecting microvessels. For this study, 42 SCD patients [33 sickle-cell anemia (HbSS), 6 sickle hemoglobin C disease (HbSC), and 3 sickle ß-thalassemia disease (HbSß)] with mean hematocrit of 25.1 (±4.85; 15.6-38.5) underwent brain perfusion single photon emission computerized tomography (SPECT) using the tracer (99m)Tc-ECD. Images from SCD patients were compared to images of a healthy control group (29 females and 20 males, mean age 31 ± 8; range 25-49 years). Images underwent voxel-wise comparison of regional tracer uptake using paired t-test to estimate the probability of each voxel to have an increased or decreased tracer uptake. When compared to controls, SCD patients exhibited significantly reduced tracer uptake in basal ganglia and thalami, the anterior frontal region and the watershed region of the temporo-parietal-occipital transition (p < 0.05). Our study showed that neurologically asymptomatic adult SCD patients exhibit a pattern of reduced (99m)Tc-ECD tracer uptake demonstrated by SPECT. Early diagnosis of this cerebral vasculopathy has prognostic implications and can be determinant in considering therapeutic alternatives to avoid increasing brain lesion load and progressive disability.
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PURPOSE: Bone scintigraphy (BS) has been used extensively for many years for the diagnosis of bone metastases despite its low specificity and significant rate of equivocal lesions. (18)F-Fluoride PET/CT has been proven to have a high sensitivity and specificity in the detection of malignant bone lesions, but its effectiveness in patients with inconclusive lesions on BS is not well documented. This study evaluated the ability of (18)F-fluoride PET/CT to exclude bone metastases in patients with various malignant primary tumours and nonspecific findings on BS. METHODS: We prospectively studied 42 patients (34-88 years of age, 26 women) with different types of tumour. All patients had BS performed for staging or restaging purposes but with inconclusive findings. All patients underwent (18)F-fluoride PET/CT. All abnormalities identified on BS images were visually compared with their appearance on the PET/CT images. RESULTS: All the 96 inconclusive lesions found on BS images of the 42 patients were identified on PET/CT images. (18)F-Fluoride PET/CT correctly excluded bone metastases in 23 patients (68 lesions). Of 19 patients (28 lesions) classified by PET/CT as having metastases, 3 (5 lesions) were finally classified as free of bone metastases on follow-up. The sensitivity, specificity, and positive and negative predictive values of (18)F-fluoride PET/CT were, respectively, 100 %, 88 %, 84 % and 100 % for the identification of patients with metastases (patient analysis) and 100 %, 82 % and 100 % for the identification of metastatic lesions (lesion analysis). CONCLUSION: The factors that make BS inconclusive do not affect (18)F-fluoride PET/CT which shows a high sensitivity and negative predictive value for excluding bone metastases even in patients with inconclusive conventional BS.
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Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/secundario , Fluorodesoxiglucosa F18 , Imagen Multimodal , Tomografía de Emisión de Positrones , Radiofármacos , Tomografía Computarizada por Rayos X , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
PURPOSE: To investigate the factors influencing the success rate in a fixed, 15 mCi approach for treatment of Graves' hyperthyroidism. MATERIAL AND METHODS: The thyroid function outcome (hyperthyroidism or euthyroidism/hypothyroidism) was verified at least 1 year after radioiodine therapy (RIT) retrospectively and compared with presenting clinical characteristics and pre-RIT parameters in 87 patients treated with I-iodide for Graves' disease in a tertiary care center. RESULTS: After RIT, 16 patients (18.4%) became euthyroid, 54 patients (62.1%) became hypothyroid, and 17 (19.5%) remained hyperthyroid. We found no statistically significant association between thyroid function outcome and gender (P = 0.50), ophthalmopathy (P = 0.69), drug used (methimazole or propylthiouracil; P = 1.00), maintenance or withdrawal of thionamides pre-RIT (P = 0.98), or 99mTc sodium pertechnetate thyroid uptake prior to RIT (P = 0.75). The only variable associated with the success rate was thyroid mass <62 g (P < 0.001). CONCLUSIONS: Our study has shown that a fixed 15 mCi approach for treatment of Graves' disease was effective, but high failure rates were observed in patients presenting larger goiters, particularly those with estimated thyroid mass >62 g.
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Enfermedad de Graves/radioterapia , Adolescente , Adulto , Anciano , Femenino , Enfermedad de Graves/patología , Humanos , Radioisótopos de Yodo/uso terapéutico , Modelos Logísticos , Masculino , Persona de Mediana Edad , Tamaño de los Órganos/efectos de la radiación , Estudios Retrospectivos , Glándula Tiroides/patología , Glándula Tiroides/efectos de la radiación , Insuficiencia del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: Evaluate the efficacy of cumulative doses (CDs) of 131I-iodide therapy (RIT) in differentiated thyroid cancer (DTC). SUBJECTS AND METHODS: The probability of progressive disease according to CDs was evaluated in patients < 45 years old and > 45 years old and correlated to tumor-node-metastasis (TNM), thyroglobulin values, histological types and variants, age, and zduration of the disease. RESULTS: At the end of a follow-up period of 69 ± 56 months, 85 out of 150 DTC patients submitted to fixed doses RIT had no evidence of disease, 47 had stable disease and 18 had progressive disease. Higher CDs were used in the more aggressive variants (p < 0.0001), higher TNM stages (p < 0.0001), and follicular carcinomas (p = 0.0034). Probability of disease progression was higher with CDs > 600 mCi in patients > 45 years old and with CDs > 800 mCi in patients < 45 years. CONCLUSION: Although some patients may still respond to high CDs, the impact of further RIT should be carefully evaluated and other treatment strategies may be warranted.
OBJETIVO: Avaliar a eficácia de doses cumulativas (DCs) da terapia com iodeto-131I (RIT) no câncer diferenciado de tiroide (CDT). SUJEITOS E MÉTODOS: A probabilidade de doença em progressão conforme a DC foi calculada em pacientes com idade < 45 e > 45 anos e correlacionada com o TNM, valores de tiroglobulina sérica, tipos histológicos e variantes, idade e tempo de doença. RESULTADOS: Ao final de um seguimento de 69 ± 56 meses, 85 dos 150 pacientes CDT submetidos a doses fixas de RIT não tinham evidência de doença, 47 tinham doença estável e 18, doença progressiva. DCs mais elevadas foram usadas nas variantes agressivas (p < 0,0001), maior estágio TNM (p < 0,0001) e nos carcinomas foliculares (p = 0,0034). A probabilidade de doença em progressão foi maior com DCs > 600 mCi em pacientes > 45 anos e com DCs > 800 mCi em pacientes < 45 anos. CONCLUSÃO: Apesar de alguns pacientes ainda responderem a altas DCs, o impacto de RITs deve ser cuidadosamente avaliado e outras estratégias terapêuticas devem ser consideradas.
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Femenino , Humanos , Masculino , Persona de Mediana Edad , Carcinoma Papilar/radioterapia , Radioisótopos de Yodo/administración & dosificación , Neoplasias de la Tiroides/radioterapia , Carcinoma Papilar/metabolismo , Carcinoma Papilar/secundario , Progresión de la Enfermedad , Relación Dosis-Respuesta en la Radiación , Métodos Epidemiológicos , Radioisótopos de Yodo/efectos adversos , Resultado del TratamientoRESUMEN
PURPOSE: To assess the impact of [F-18] FDG-PET/CT on the restaging and changing management of patients with malignant melanoma. METHODS: Seventy-eight patients (32 female, 27-83 years) were reviewed. Treatment planning before and after [F-18] FDG-PET/CT scan was evaluated for changes in the management of the disease. Restaging was classified according to the disease extent as follows: local recurrence, locoregional recurrence or distant recurrence. Initial restaging of patients was as follows: local recurrence in 11 patients, locoregional recurrence in 23 patients and distant recurrence in 44 of 78 patients. All the patients were injected with 370 MBq of [F-18] FDG and imaged from the head to feet after 60 min. All the patients fasted for 4-6 h before imaging and blood glucose levels were below 140 mg/dl. Images were taken using a PET/CT scanner (Siemens Biograph). Two nuclear medicine physicians and a radiologist (all experienced in oncology) interpreted the images. RESULTS: In 27% of the patients the management was changed after the [F-18] FDG-PET/CT studies. Upstaging from locoregional recurrence to distant recurrence occurred in a striking 5 of 23 (22%) patients. The sensitivity, specificity and positive and negative predictive values for lesion detection were 95%, and accuracy was 94.9%. There were two false-positive and two false-negative studies. CONCLUSION: [F-18] FDG-PET/CT seems to be a valuable diagnostic tool in restaging and management of patients with malignant melanoma suspected of recurrence especially in patients with locoregional recurrence and distant recurrence.
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Fluorodesoxiglucosa F18 , Melanoma/patología , Melanoma/terapia , Estadificación de Neoplasias/métodos , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Melanoma/diagnóstico por imagen , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
OBJECTIVE: To evaluate the utility of diuretic dynamic renal scintigraphy (DDRS) with technetium-99m-L,L-ethylenedicysteine ((99m)Tc-EC) in patients with indeterminate or possible false-positive results for urinary obstruction by technetium-99m diethylenetriamine penta-acetic acid ((99m)Tc-DTPA) DDRS. METHODS: A total of 92 patients (63 male; mean age, 16.6 +/- 21.25 years) were studied, with a total of 103 kidneys presenting indeterminate (20/103) or possible false-positive results for obstruction attributable to reduced renal function or severe kidney dilation (83/103) by (99m)Tc-DTPA DDRS (<60% of radiopharmaceutical excreted in 20 minutes-half-time clearance [T(1/2)] >15 minutes). Patients were reimaged after intravenous injection of (99m)Tc-EC, with dynamic images before and after furosemide administration using the same acquisition parameters applied in the previous (99m)Tc-DTPA study. Time interval between (99m)Tc-DTPA and (99m)Tc-EC renograms was 2-64 days. The percentage of excreted material 20 minutes after furosemide was calculated using both radiopharmaceuticals, and were statistically compared using the paired samples t test. RESULTS: The excretion after furosemide injection was 25.3% +/- 18.2% for (99m)Tc-DTPA and 41.2% +/- 26.1% for (99m)Tc-EC, with a statistically significant difference between both radiopharmaceuticals (P <.0001). Using (99m)Tc-EC obstruction was excluded in 36 of 103 kidneys, which excreted >60%. A total of 10 of 83 kidneys (12.0%) with an obstructive pattern by (99m)Tc-DTPA study turned out to be indeterminate by (99m)Tc-EC DDRS. There was an agreement between (99m)Tc-EC and (99m)Tc-DTPA studies in 54 of 83 kidneys with obstructive (65.1%) and in 3 of 20 (15.0%) with indeterminate patterns. CONCLUSIONS: (99m)Tc-EC was more effective than (99m)Tc-DTPA for excluding obstruction, presenting less false-positive and indeterminate results. (99m)Tc-EC can substitute (99m)Tc-DTPA to evaluate patients with urinary tract dilation.
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Cisteína/análogos & derivados , Pelvis Renal , Compuestos de Organotecnecio , Radiofármacos , Pentetato de Tecnecio Tc 99m , Obstrucción Ureteral/diagnóstico por imagen , Adolescente , Adulto , Anciano , Niño , Preescolar , Dilatación Patológica , Reacciones Falso Positivas , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Cintigrafía , Adulto JovenRESUMEN
OBJECTIVE: Evaluate the efficacy of cumulative doses (CDs) of 131I-iodide therapy (RIT) in differentiated thyroid cancer (DTC). SUBJECTS AND METHODS: The probability of progressive disease according to CDs was evaluated in patients < 45 years old and > 45 years old and correlated to tumor-node-metastasis (TNM), thyroglobulin values, histological types and variants, age, and zduration of the disease. RESULTS: At the end of a follow-up period of 69 ± 56 months, 85 out of 150 DTC patients submitted to fixed doses RIT had no evidence of disease, 47 had stable disease and 18 had progressive disease. Higher CDs were used in the more aggressive variants (p < 0.0001), higher TNM stages (p < 0.0001), and follicular carcinomas (p = 0.0034). Probability of disease progression was higher with CDs > 600 mCi in patients > 45 years old and with CDs > 800 mCi in patients < 45 years. CONCLUSION: Although some patients may still respond to high CDs, the impact of further RIT should be carefully evaluated and other treatment strategies may be warranted.
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Carcinoma Papilar/radioterapia , Radioisótopos de Yodo/administración & dosificación , Neoplasias de la Tiroides/radioterapia , Carcinoma Papilar/metabolismo , Carcinoma Papilar/secundario , Progresión de la Enfermedad , Relación Dosis-Respuesta en la Radiación , Métodos Epidemiológicos , Femenino , Humanos , Radioisótopos de Yodo/efectos adversos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Nos últimos anos, a aplicação da tomografia por emissão de pósitrons (PET) com fluordesoxiglicose-18F (FDG-18F) tem melhorado significativamente a condução de pacientes com diferentes neoplasias malignas. Já se demonstrou que a associação das imagens metabólicas da PET com imagens de métodos anatômicos, como TC, pode aumentar a acurácia da PET isolada. Em nosso meio, esses equipamentos híbridos de PET/TC têm-se tornado cada vez mais disponíveis, ampliando a aplicação dessa metodologia em pacientes oncológicas. Nesta revisão, os possíveis impactos da PET e da PET/TC no manejo de pacientes com câncer de mama no diagnóstico primário, estadiamento pré-operatório, reestadiamento e na avaliação da resposta ao tratamento serão abordados. Apesar de alguns estudos terem demonstrado sua acurácia na detecção do tumor primário e no estadiamento axilar, as suas aplicações clínicas mais importantes têm sido na detecção e na definição da extensão do câncer de mama recorrente ou metastático e para a avaliação da resposta à terapia. No estadiamento, PET tem sido usada de forma complementar aos métodos convencionais de estadiamento, já que apresenta maior sensibilidade para a detecção de metástases linfonodais e osteolíticas; no entanto, não deve ser considerado um substituto para os estudos convencionais que incluem TC e cintilografia óssea.
Over the last few years, the widespread use of positron emission tomography has improved markedly the management of patients with various malignancies. It has been demonstrated, meanwhile, that the co-registration or fusion of the metabolic images obtained by PET with morphological images, such as computed tomography, improves the accuracy of stand alone PET imaging. These hybrid PET / CT equipments are becoming more and more available in Brazil, therefore increasing the use of this methodology in oncologic patients among us. In this review, we evaluate the possible impact of PET and PET / CT on the management of patients with breast cancer, with respect to primary diagnosis, preoperative staging, disease re-staging and treatment monitoring. Although studies have already proven the accuracy of PET in detecting the primary breast tumor and in axillary staging, its most important clinical applications are in re-staging, in the detection of distant metastases and in treatment monitoring. In tumor staging, PET has been used as a complementary tool to conventional imaging modalities due to its increased sensitivity in detecting nodal and lytic bone metastases; however, it should not be regarded as a substitute to conventional staging methods, including CT and bone scan.
Asunto(s)
Humanos , Femenino , Metástasis de la Neoplasia/diagnóstico , Neoplasias de la Mama/diagnóstico , Tomografía de Emisión de Positrones/métodos , Diagnóstico Precoz , /uso terapéutico , Estadificación de Neoplasias , Neoplasias de la Mama/prevención & control , Recurrencia Local de Neoplasia/diagnóstico , Resultado del Tratamiento , Tamoxifeno/uso terapéuticoRESUMEN
UNLABELLED: PET with (18)F-FDG has been considered of limited value for detection of bladder cancer because of the urinary excretion of the tracer. The purpose of this study was to investigate the role of PET/CT in the detection and restaging of bladder cancer using furosemide and oral hydration to remove the excreted (18)F-FDG from the bladder. METHODS: Seventeen patients with bladder cancer (11 without cystectomy, 6 with total cystectomy and urinary diversion) underwent (18)F-FDG PET/CT from head to the upper thighs 60 min after the intravenous injection of 370 MBq of (18)F-FDG. Additional pelvic images were acquired 1 h after the intravenous injection of furosemide and oral hydration. PET/CT findings were confirmed by MRI, cystoscopy, or biopsy. RESULTS: PET/CT was able to detect bladder lesions in 6 of 11 patients who had not undergone cystectomy. These images changed the PET/CT final reading in 7 patients: Recurrent bladder lesions were detected in 6 patients, pelvic lymph node metastases in 2 patients, and prostate metastasis in 1. This technique overcame the difficulties posed by the urinary excretion of (18)F-FDG. Hypermetabolic lesions could be easily detected by PET and precisely localized in the bladder wall, pelvic lymph nodes, or prostate by CT. Seven of 17 patients (41%) were upstaged only after delayed pelvic images. CONCLUSION: Detection of locally recurrent or residual bladder tumors can be dramatically improved using (18)F-FDG PET/CT with delayed images after a diuretic and oral hydration.
Asunto(s)
Fluorodesoxiglucosa F18 , Aumento de la Imagen/métodos , Tomografía de Emisión de Positrones/métodos , Técnica de Sustracción , Tomografía Computarizada por Rayos X/métodos , Neoplasias de la Vejiga Urinaria/diagnóstico , Neoplasias de la Vejiga Urinaria/cirugía , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Interpretación de Imagen Asistida por Computador/métodos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de Neoplasias , Pronóstico , Radiofármacos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Creatinine clearance has been reported to be inaccurate for the estimation of glomerular filtration rate (GFR) in patients with sickle cell anaemia (SCA). Inulin clearance, the reference method for GFR estimation, is impractical for routine use in these patients, and 51Cr-EDTA measurements of the GFR have been rarely reported in this disease. METHODS: In order to obtain reference 51Cr-EDTA values in this disease, we studied 70 patients (40 females; 13-59 years of age, mean: 31.6 years) with homozygous SCA, normal serum creatinine and urinary albumin excretion < or =200 microg x min(-1). All patients were submitted to single-injection 51Cr-EDTA GFR, urinary albumin and haematocrit measurements. 51Cr-EDTA clearances were calculated in different age groups (<20, 20-29, 30-39, 40-49 and >50 years). RESULTS: The mean GFR (+/-standard deviation) obtained for the 70 patients was 111.5+/-23.1 ml x min(-1). Analysis of variance for evaluation of the possible interaction effect between 51Cr-EDTA clearance and sex, age, urinary albumin and haematocrit demonstrated patient age as the only factor influencing 51Cr-EDTA clearance (P < 0.001). The Spearman correlation coefficient showed a significant relationship between 51Cr-EDTA clearance and patient age (r = -0.44, P = 0.0001), but not between 51Cr-EDTA and urinary albumin (r = -0.17, P = 0.1546) or haematocrit (r = 0.079, P = 0.5121). The group aged 20-29 years presented the highest 51Cr-EDTA clearance mean value (126.7+/-20.4 ml x min(-1)), with a progressive reduction in the older groups. CONCLUSION: Young adults with homozygous SCA, normal serum creatinine and micro-albuminuria or normo-albuminuria present supranormal 51Cr-EDTA GFR values. These values rapidly decrease after 30 years of age. We did not find association between urinary albumin and GFR in these patients.
Asunto(s)
Anemia de Células Falciformes/diagnóstico por imagen , Ácido Edético , Tasa de Filtración Glomerular , Interpretación de Imagen Asistida por Computador/métodos , Enfermedades Renales/diagnóstico por imagen , Renografía por Radioisótopo/métodos , Adolescente , Adulto , Anemia de Células Falciformes/complicaciones , Radioisótopos de Cromo , Femenino , Humanos , Enfermedades Renales/etiología , Masculino , Persona de Mediana Edad , Radiofármacos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
The assessment of the functional status of the salivary glands has been used in the scintigraphic evaluation of xerostomia. Several quantitative methods derived from standard dynamic scintigraphy have been suggested. However, the indices proposed are quite variable and unlikely to be useful in clinical practice. The objectives of this study were to obtain reference values of major salivary glands uptake and excretion fraction in healthy subjects and to obtain normal ratios of Tc-pertechnetate uptake by the major salivary glands in comparison to the thyroid gland uptake. The standardization of these values has the purpose of making this evaluation faster and more objective. Fifty volunteers without clinical evidence of xerostomia or thyroid disease underwent static salivary glands scintigraphy with Tc-pertechnetate. Static images were obtained at 20 minutes and then at 3 minutes after oral stimulation with lemon juice. Percent uptake, excretion fraction and salivary gland to thyroid ratio rates were calculated for the parotid and the submandibular glands. The mean of the uptake values at 20 minutes for the right and left parotid glands were respectively 0.31% and 0.26%, and for the submandibular glands 0.15%. The excretion fraction of the tracer after the lemon juice stimulation was 70% for the parotids glands, 50% for the right and 49% for the left submandibular glands. The mean+/-SD salivary gland to thyroid count ratio was 0.79+/-0.45 for the right parotid, 0.78+/-0.5 for the left parotid, 0.67+/-0.33 and 0.66+/-0.34 for the right and left submandibular glands, respectively. Salivary glands scintigraphy with uptake and excretion fraction calculation is an easy to perform, non-invasive and objective method to investigate salivary glands function. These findings help the nuclear physician to interpret salivary gland scintigraphy more objectively, even in patients with thyroid gland dysfunction in whom Tc-pertechnetate thyroid uptake may be abnormal.