RESUMEN
OBJECTIVES: We evaluated the prognostic significance of the combined use of F-18 FDG (FDG) and F-18 FLT (FLT) PET/CT (PET/CT) in patients (pts) with multiple myeloma (MM) suspected relapse after a first line chemotherapy. METHODS: twenty-eight patients (57 ± 12 years) underwent both PET/CT scans over 2-4 weeks. Patients were grouped according to imaging results (FDG+/-; FLT+/-) and the findings compared to the event free survival (EFS). RESULTS: five pts had FDG+; FLT+, 8 showed FDG+;FLT-, two had FDG-;FLT + and 13 presented FDG-;FLT-, mostly (87 %) of FDG+;FLT- pts had destructive lytic bone lesions. At Cox regression analysis the FDG PET/CT (HR 4.4, 95 % CI 1.3-15.4, p < 0.05) and FLT PET/CT (HR 5.8, 95 % CI 1.7-19.3, p < 0.01) were predictive of worst prognosis. The Kaplan-Meier analysis showed that FDG and FLT PET/CT independently influenced the survival. FDG-;FLT-patients had better EFS as compared to FDG+; FLT + pts and FDG-;FLT + pts, those of FDG+;FLT- group also had worsened EFS. CONCLUSIONS: results from the aggregate use of PET/CT FDG and FLT in MM represent a valuable prognostic indicator for identifying patients at higher risk of undue events and may help to correctly stratify the patients with suspected relapse.
Asunto(s)
Fluorodesoxiglucosa F18 , Mieloma Múltiple , Didesoxinucleósidos , Humanos , Mieloma Múltiple/diagnóstico por imagen , Recurrencia Local de Neoplasia , Proyectos Piloto , Tomografía Computarizada por Tomografía de Emisión de Positrones , Tomografía de Emisión de Positrones , RadiofármacosRESUMEN
Objective: To investigate the feasibility of using a wireless wearable device (WD) in differentiated thyroid cancer (DTC) patients undergoing radionuclide therapy with I-131 (RAI) and protected hospitalization, this study compared the measurements of residual radioactivity obtained with those registered by a permanent environmental home device (HD). Methods: Twenty consecutive patients undergoing RAI hospitalized in restricted, controlled areas were enrolled. The patients underwent comprehensive monitoring of vital/nonvital parameters. We obtained 45580± 13 measurements from the WD, detecting the residual radioactivity for each patient during approximately 56 hours of hospitalization, collecting data 53 times per hour. The samples, collected during daily activities, were averaged every two hours, and the results correlated with those from the HD. Bland-Altman analysis was also used to evaluate the agreement between the two techniques. Results: A significant relationship between the WD and HD was observed (r = 0.96, p < 0.0001). Bland-Altman analysis recognized the agreement between measurements by the WD and HD. The mean value at the end of the first day of hospitalization was 80.81 microSv/h and 60.77 microSv/h (p = ns for WD and HD), whereas those at the end of the second day were 47.08 and 24.96 (p = ns). In the generalized linear model (GLM), a similar trend in performance across time was found with the two techniques. Conclusion: This study demonstrates good agreement between the residual radioactivity measures estimated by the WD and HD modalities, rendering them interchangeable. This approach will allow both the optimization of medical staff exposure and safer patient discharge. Abbreviations: wireless device (WD); differentiated thyroid cancer (DTC); radionuclide therapy with I-131 (RAI); home device (HD); generalized linear model (GLM).
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Radiactividad , Neoplasias de la Tiroides , Dispositivos Electrónicos Vestibles , Estudios de Factibilidad , Humanos , Radioisótopos de Yodo/uso terapéutico , Neoplasias de la Tiroides/radioterapiaRESUMEN
Patients with hepatocellular carcinoma (HCC) comply with an advanced disease and are not eligible for radical therapy. In this distressed scenario new treatment options hold great promise; among them transarterial chemoembolization (TACE) and transarterial metabolic radiotherapy (TAMR) have shown efficacy in terms of both tumor shrinking and survival. External radiation therapy (RTx) by using novel three-dimensional conformal radiotherapy has also been used for HCC patients with encouraging results while its role had been limited in the past for the low tolerance of surrounding healthy liver. The rationale of TAMR derives from the idea of delivering exceptional radiation dose locally to the tumor, with cell killing intent, while preserving normal liver from undue exposition and minimizing systemic irradiation. Since the therapeutic efficacy of TACE is being continuously disputed, the TAMR with (131)I Lipiodol or (90)Y microspheres has gained consideration providing adequate therapeutic responses regardless of few toxicities. The implementation of novel radioisotopes and technological innovations in the field of RTx constitutes an intriguing field of research with important translational aspects. Moreover, the combination of different therapeutic approaches including chemotherapy offers captivating perspectives. We present the role of the radiation-based therapies in hepatocellular carcinoma patients who are not entitled for radical treatment.
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Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica/métodos , Quimioradioterapia/métodos , Neoplasias Hepáticas/terapia , Carcinoma Hepatocelular/patología , Humanos , Hígado/patología , Neoplasias Hepáticas/patologíaRESUMEN
AIM: Patients with hypertension may exhibit abnormal vasodilator capacity during pharmacological vasodilatation. We assessed coronary flow reserve (CFR) by sestamibi imaging in hypertensive patients with normal coronary vessels. METHODS: Twenty-five patients with untreated mild essential hypertension and normal coronary vessels and 10 control subjects underwent dipyridamole-rest Tc-99m sestamibi imaging. Myocardial blood flow (MBF) was estimated by measuring first transit counts in pulmonary artery and myocardial counts from tomograhic images. CFR was expressed as the ratio of stress to rest MBF. Coronary vascular resistances (CVR) were computed as the ratio between mean arterial pressure and MBF. RESULTS: Estimated MBF at rest was not different in patients and controls (1.11 ± 0.59 vs. 1.14 ± 0.28 counts/pixel/s; P=0.87). Conversely, stress MBF was lower in patients than in controls (1.55 ± 0.47 vs. 2.68 ± 0.53 counts/pixel/s; P<0.001). Thus, CFR was reduced in patients compared to controls (1.61 ± 0.58 vs. 2.43 ± 0.62; P<0.001). Rest and stress CVR values were higher in patients (P<0.001), while stress-induced changes in CVR were not different (P=0.08) between patients (-51%) and controls (-62%). In the overall study population, a significant relation between CFR and stress-induced changes in CVR was observed (r=-0.86; P<0.001). CONCLUSION: Sestamibi imaging may detect impaired coronary vascular function in response to dipyridamole in patients with untreated mild essential hypertension and normal coronary arteries. A mild increase in arterial blood pressure does not affect baseline MBF, but impairs coronary reserve due to the amplified resting coronary resistances.
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Circulación Coronaria , Vasos Coronarios/diagnóstico por imagen , Hipertensión/complicaciones , Hipertensión/diagnóstico por imagen , Radiofármacos/química , Tecnecio Tc 99m Sestamibi/química , Adulto , Angiografía , Velocidad del Flujo Sanguíneo , Estudios de Casos y Controles , Vasos Coronarios/patología , Prueba de Esfuerzo , Femenino , Corazón/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Análisis de Regresión , Programas Informáticos , Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
PURPOSE: We evaluated the role of quantitative assessment by maximum standardized uptake value (SUVmax) on F-18 fluorodeoxyglucose [F-18]FDG positron emission tomography/computed tomography (PET/CT) in stratifying colorectal cancer (CRC) patients with unexplained carcinoembryonic antigen (CEA) rise after surgical curative resection. MATERIAL AND METHODS: Forty asymptomatic patients (mean age, 64 ± 12 years) with previous CRC and current serum CEA levels >5 ng/ml underwent [F-18] FDG PET/CT 13 ± 3 months after complete surgical resection. The SUVmax was registered on anastomosis and peri-anastomotic tissue lesions, if present. The patients were followed for 24 ± 9 months thereafter. Re-intervention, evidence of newly discovered distant metastases, and death were recognized as main events and constituted surrogate end points. The receiver-operator-curve (ROC) analysis was performed to estimate the optimal SUVmax cut-off to predict patients at high risk of main events. PET/CT results were then related to disease outcome (overall survival; OS). RESULTS: The mean SUVmax at the anastomotic site was 6.2 ± 3 (range 2.6-15). At multivariate logistic regression analysis, the anastomotic SUVmax remained as the only significant contributor to the prediction of the events (p = 0.004; OR 1.97). The ROC analysis recognized that the optimal threshold of SUVmax to differentiate patients was 5.7. A worse OS was observed in patients presenting with a SUVmax greater than 5.7 as compared to those having lesser (median survival: 16 vs. 31 months; p = 0.002). CONCLUSIONS: The quantitative assessment by SUVmax on [F-18]FDG PET/CT may be helpful in patients presenting with unexplained CEA rise after curative resection of CRC, by identifying those at risk of main events.
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Antígeno Carcinoembrionario/sangre , Neoplasias Colorrectales/diagnóstico por imagen , Neoplasias Colorrectales/cirugía , Fluorodesoxiglucosa F18 , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/sangre , Determinación de Punto Final , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Curva ROCRESUMEN
The time-dependent changes in the antero-posterior (A-P) diamter and length (L) of fetal kidneys has been evaluated by means of statistical analysis of measurements made during the third trimester in a normal population. Two hundred eighty pregnant women were examined between 22 and 40 weeks of gestation. Differences between operator-scanner combinations were evaluated. The relationships of the A-P diameter and length to menstrual age were determined in cross-sectional and longitudinal studies of kidney growth. The results obtained confirmed that measurements of fetal kidney can be used as an additional parameter in the routine assessment of fetal well being and to rule out kidney malformations characterized by changes in kidney size.
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Riñón/embriología , Femenino , Edad Gestacional , Humanos , Riñón/anomalías , Embarazo , Diagnóstico Prenatal/métodos , Valores de Referencia , UltrasonografíaRESUMEN
Prenatal diagnosis of different fetal malformations have been performed by echography. The authors report a case of recurrence of monolateral diaphragmatic agenesy in sibs. The diagnosis was achieved at the 23 degrees week of gestation. Some methodological details are also proposed to improve the possibility of early diagnosis. Embryological and epidemiological data have been evaluated.