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Radiopharmaceutical therapy using 177Lu-prostate-specific membrane antigen (PSMA) is an effective prostate cancer treatment that was recently approved by the U.S. Food and Drug Administration. This method leverages the success of PSMA-targeted PET imaging, enabling delivery of targeted radiopharmaceutical therapy; has demonstrated a clear benefit in large prospective clinical trials; and promises to become part of the standard armamentarium of treatment for patients with prostate cancer. This review highlights the evidence supporting the use of this agent, along with important areas under investigation. Practical information on technology aspects, dose administration, nursing, and the role of the treating physician is highlighted. Overall, 177Lu-PSMA treatment requires close collaboration among referring physicians, nuclear medicine technologists, radiopharmacists, and nurses to streamline patient care.

Asunto(s)

Lutecio , Neoplasias de la Próstata , Dipéptidos/uso terapéutico , Compuestos Heterocíclicos con 1 Anillo/uso terapéutico , Humanos , Lutecio/uso terapéutico , Masculino , Estudios Prospectivos , Antígeno Prostático Específico , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/radioterapia , Radiofármacos

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PURPOSE: The purpose of this article is to evaluate the effectiveness of fluorodeoxyglucose (FDG) positron emission tomography (PET)-computed tomography (CT) and PET-magnetic resonance imaging (MRI) with scalp and intracranial electroencephalogram (EEG) in predicting surgical outcomes in patients with refractory seizures. METHODS: Patients who underwent PET-CT and MRI fusion, scalp and intracranial EEG, and subsequent surgical intervention were retrospectively included. PET-CT were fused with MRI and interpreted by an experienced blinded reader. An area of hypometabolism on PET was identified as the location of the epileptic focus. The site of seizure focus was correlated with scalp and intracranial EEG findings. Surgical outcomes were evaluated. Thirty-six patients were included; all had presurgical PET-CT, scalp EEG, and PET-MRI fusion, and 28 of these patients had intracranial EEGs. RESULTS: PET-CT showed concordance of epileptic foci with scalp EEG in 7/36 patients (19%) and with intracranial EEG in 9/28 patients (32%). PET-MRI was concordant with scalp EEG in 6/36 patients (17%) and with intracranial EEG in 8/28 patients (29%). All patients with concordance of epileptic foci between PET-CT and PET-MRI and scalp EEG had improvement or resolution of seizures postintervention, and 89% of patients had concordance between intracranial EEG and PET studies. However, 45% of patients with discordant PET-CT and scalp EEG, 37% with discordance PET-CT and intracranial EEG, 43% with discordant PET-MRI and scalp EEG, and 35% of patients with discordant PET-MRI and intracranial EEG did not improve postsurgically. CONCLUSION: Concordance of epileptic foci localization between PET imaging and EEG yields favorable postoperative outcome in nearly all patients, whereas discordance has an equal probability of favorable vs unfavorable outcomes.

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Epilepsia Refractaria/diagnóstico por imagen , Epilepsia Refractaria/cirugía , Neuroimagen/métodos , Resultado del Tratamiento , Adulto , Electroencefalografía , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Imagen Multimodal/métodos , Procedimientos Neuroquirúrgicos , Tomografía Computarizada por Tomografía de Emisión de Positrones , Estudios Retrospectivos , Convulsiones/diagnóstico por imagen , Convulsiones/cirugía

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This study aims at prospectively evaluating the difference in the effect of cholecystokinin (CCK) and half-and-half milk (HHM) administered in the same patient on gallbladder contractility and correlation with clinical outcomes. Upon gallbladder visualization during standard hepatobiliary imaging, 0.02 µg/kg of CCK was injected over 3 min, and additional 30 min of dynamic imaging was obtained. Patients with gallbladder ejection fraction (GBEF) <35% after CCK were administered 8 oz of HHM followed by 30 min of imaging. The GBEF was recalculated. The number of patients whom GBEF changed from below 35% (abnormal) after CCK to above 35% (normal) after HHM was recorded. Follow-up of the clinical outcome at 6 months was performed. Fifty patients with abnormal GBEF were prospectively included. The average GBEF after CCK was 14.7% ± 8.5% and after HHM was 30.7% ± 20.8%. The average increase in GBEF with HHM was 16.0% ± 22.2%. The GBEF changed from abnormal to normal in 17 patients (34%). The remaining 33 patients remained abnormal. Clinical outcomes at 6 months were available in 47 patients. Cholecystectomy was performed in 60% of patients with abnormal GBEF with CCK and HHM with resolution or improvement of pain. Two of 16 patients (12%) with abnormal GBEF after CCK but normal after HHM had cholecystectomies with pain improvement, while 8 out of these patients (50%) were diagnosed and treated with other disorders and improved. Hepatobiliary imaging with HHM stimulation is a superior physiologic test which can lower the number of unnecessary cholecystectomies and misdiagnoses as functional cholecystitis.

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BACKGROUND: Radium-223 dichloride (Ra-223 Xofigo) has recently been approved as an addition to the host of available therapies in the USA as a treatment option for metastatic castrate-resistant prostate cancer (mCRPC) with bone metastases. This study describes our initial experience in patients treated with Ra-223 dichloride. It attempts to optimize patients' selection for the best outcome from Ra-223 dichloride therapy. METHODS: Consecutive patients who were referred for treatment with Ra-223 dichloride were prospectively followed. Patients' demographics, functional status per the Eastern Cooperative Oncology Group (ECOG) performance score, pain level per the numeric rating score (NRS), prostate-specific antigen (PSA), creatinine, and hematological values were compared at baseline and at the end of therapy. Patients also had a bone scan before starting therapy and at the end of therapy. Patients were divided into the favorable response (FR) group if their pain and/or functional status improved and the unfavorable response (UR) group if they did not improve, deteriorated, or deceased. Bone scan findings before and after Ra-223 dichloride therapy were compared in both the FR and UR groups. RESULTS: Twenty patients were treated with Ra-223 dichloride. Twelve patients had innumerable bone metastases, three patients had super scans, and three patients had two to seven bone lesions. Two patients were lost to follow-up after the first injection. There were eight patients in the FR group and 10 patients in the UR group. Patients with UR had mean ECOG and NRS pain scores of 1.3 and 5.0 versus 0.8 and 4.4 in the FR group. The mean PSA and creatinine levels in the UR group were 445.2 ng/mL and 1.2 mg/dL versus 22.7 ng/mL and 1.1 mg/dL in the FR group. The mean hemoglobin, platelets, and absolute neutrophil values were 11.2 g/dL, 314.9 K/cmm, and 7.3 K/cmm in the UR group versus 11.6 g/dL, 207.0 K/cmm, and 6.2 K/cmm in the FR group. Seven of the eight patients with FR had a bone scan at the end of therapy showing improvement in five patients, a mixed response in one patient, and progression in another patient. Five patients in the UR group completed five or six injections and had bone scans showing flare of bone metastases in three patients, progression in one patient, and improvement in the fifth patient. Three patients in the UR group died after the first or second injections. Two of these patients had baseline super scans and the third one had widespread bone metastases. CONCLUSION: mCRPC patients with lower PSA levels at baseline and fewer bone lesions are more likely to respond favorably to Ra-223 dichloride therapy.

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PURPOSE: The aim of this study was to evaluate the impact of DaTscan in a heterogeneous group of patients with movement disorders as well as the degree of confidence in scan findings between different readers. PROCEDURES: A retrospective evaluation of consecutive patients who underwent DaTscan during 1 year was performed. The patients' demographics, symptoms, duration, clinical diagnosis, and medications were collected. The scan findings were categorized by 2 blinded observers on a semiquantitative scale as follows: 0, normal; 1, mild; 2, moderate; 3, marked; and 4, absent uptake for each of the caudate heads and putamina separately. A correlation of the scan findings with the clinical symptoms and diagnosis as well as interobserver agreement was performed. Disagreement was considered when a difference greater than 2 in more than 1 area of the basal ganglia was recorded. Descriptive statistics and κ test for interobserver agreement were used for data analysis. RESULTS: Fifty-seven patients were included (mean age, 63.4 years; 29 men, 28 women). Clinical diagnosis of Parkinson disease (PD) was certain in 26 and uncertain in 31 patients. DaTscan was markedly abnormal in 24 (92%) of 26 patients with certain clinical diagnosis of PD and normal in the remaining 2 (8%). In 31 patients with uncertain diagnosis, 15 (48%) had markedly abnormal scans, 5 (16%) had mild abnormalities, and 11 (36%) had normal scans. Each of the sensitivity and positive predictive value of DaTscan in patients who had certain clinical diagnosis of PD (26 patients) is 92%. Interobserver agreement occurred in 52 (91%) of 57 scans and disagreement in 5 (9%) of 57 (κ = 0.82). There was also a good correlation with laterality of symptoms in 32 (82%) of 39 positive studies. CONCLUSIONS: Markedly abnormal DaTscan is confirmed as the diagnostic pattern for PD. This pattern helps confirm the diagnosis in patients with unclear clinical diagnosis. Good interobserver agreement is easily obtained in reading DaTscans.

Asunto(s)

Nortropanos , Enfermedad de Parkinson/diagnóstico por imagen , Radiofármacos , Tomografía Computarizada de Emisión de Fotón Único , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad

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PURPOSE: The study aimed to evaluate the efficacy of PET/CT in detecting peritoneal carcinomatosis in patients with ovarian cancer and to compare the diagnostic accuracy of FDG PET/CT with that of enhanced abdominal CT. METHODS: The medical records of 46 consecutive patients with ovarian cancer were reviewed, and the presence of peritoneal tumor on (18)F-FDG PET/CT and enhanced abdominal CT scans was also assessed. Imaging results were compared with the pathologic findings obtained by surgery. RESULTS: Pathologic results were positive for peritoneal carcinomatosis in 26 patients and negative in 20 patients. PET/CT correctly detected 25 of 26 patients with peritoneal carcinomatosis and enhanced abdominal CT correctly detected 23 of 26 patients. Sensitivity and specificity for the diagnosis of peritoneal carcinomatosis were 96.2% and 90%, respectively, for PET/CT and 88.5% and 65%, respectively, for enhanced abdominal CT. The accuracy of PET/CT was statistically higher than that of enhanced abdominal CT (93.5% vs 78.3%, P = 0.039). Four distinctly abnormal PET/CT findings of single nodular, multiple nodular, diffuse, and mixed FDG uptakes were identified and corresponded to pathologic findings. CONCLUSIONS: (18)F-FDG PET/CT imaging is efficient in the diagnosis of peritoneal carcinomatosis and its performance is superior to that of enhanced abdominal CT.

Asunto(s)

Fluorodesoxiglucosa F18 , Imagen Multimodal , Neoplasias Ováricas/patología , Neoplasias Peritoneales/diagnóstico , Neoplasias Peritoneales/secundario , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Adulto , Anciano , Anciano de 80 o más Años , Transporte Biológico , Femenino , Fluorodesoxiglucosa F18/metabolismo , Humanos , Persona de Mediana Edad , Neoplasias Peritoneales/diagnóstico por imagen , Radiografía Abdominal , Estudios Retrospectivos , Sensibilidad y Especificidad

RESUMEN

AIM: The aim of this study was to evaluate the role of single photon emission computed tomography and/or computed tomography (SPECT/CT) in differentiating metastatic from benign solitary skull lesions. MATERIALS AND METHODS: Consecutive patients who had a SPECT/CT of the head subsequent to a whole-body bone scan (WBS) for the evaluation of a single skull lesion were selected. A single skull lesion on the WBS was further evaluated with SPECT/CT to characterize the lesion. The results of the SPECT/CT were correlated with other radiologic examinations performed within 2 weeks. An average follow-up interval after the SPECT/CT was 8.9 months to correlate with additional radiologic imaging studies and clinical information. RESULTS: A total of 19 lesions in 19 patients were seen on the WBS and 2 additional lesions on the SPECT/CT. All lesions demonstrated focal increased tracer uptake. The SPECT/CT correctly identified 3 out of 3 metastatic lesions and 12 out of 17 benign lesions, that is 71% of lesions were correctly classifised as metastatic or benign lesions. Only 1 patient was classified incorrectly as metastatic lesion with SPECT/CT when it was proven benign by other imaging modalities and follow-up. The sensitivity, specificity, positive and negative predictive values of SPECT/CT images in identifying metastatic lesions were 100%, 92%, 75%, and 100%, respectively. Five lesions remained indeterminate even after the SPECT/CT interpretation and were confirmed benign by other imaging modalities. CONCLUSION: SPECT/CT can help identify benign versus metastatic solitary skull lesions in most of the patients with high sensitivity and specificity.

Asunto(s)

Cráneo/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos X , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cráneo/patología , Imagen de Cuerpo Entero

RESUMEN

BACKGROUND: Evaluate the significance of coronary arteries calcifications detected using contrast-enhanced chest computed tomography (CECCT) scans. METHODS: A total of 145 patients who underwent both CECCT and gated stress myocardial perfusion imaging (MPI) within 2 weeks were included. The chest CT scans were reviewed for the presence of coronary artery calcium (CAC) by 2 experienced blinded readers. The degree of calcifications seen in any visualized area of the major coronary arteries was graded on a scale of 1 to 3 (1 when 0 to 4 small scattered plaques were seen, 2 when 5 or more scattered plaques were seen, and 3 when diffuse contiguous calcification were seen). The grade of CAC was correlated with the presence of MPI abnormalities. Additionally, the locations of the MPI abnormality was correlated with the CAC grade in the culprit coronary artery. RESULTS: Of 580 major coronary arteries evaluated, 79% had grade 1 CAC, 10% had grade 2, 11% had grade 3, and 1% were inevaluable. Of the 145 patients, 33 (23%) had abnormal MPI results. Twenty-three of the patients with abnormal MPI results (70%) had more than 4 calcified plaques (CAC grade of 2 or 3) in one or more of their coronary arteries, whereas 41 of 122 patients with normal MPI results (37%) had similar CAC grades (P=0.001). Seventeen of the 33 patients (52%) who had MPI defects also had significant CAC in the culprit coronary artery, 7 patients (21%) had significant CAC in a different coronary artery from the MPI defect territory, 8 patients (24%) had no significant CAC visualized, and in 1 patient a pacemaker wire interfered with CAC grading in the culprit coronary artery (RCA). The sensitivity, specificity, the positive, and negative predictive values of grade 2 or 3 CAC for an abnormal MPI results were 70%, 63%, 36%, and 88%, respectively. When a subgroup of patients above 60 years old with grade 3 CAC was reanalyzed, the sensitivity, specificity, the positive, and negative predictive values for an abnormal MPI results were 69%, 73%, 41%, and 90%, respectively. CONCLUSION: Multiple diffuse CAC as detected during the interpretation of CECCT scans in combination with advanced age is a significant finding that warrants further investigation for functionally significant CAD.

Asunto(s)

Calcinosis/diagnóstico por imagen , Medios de Contraste , Angiografía Coronaria , Vasos Coronarios , Tomografía Computarizada por Rayos X , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Imagen de Perfusión Miocárdica , Proyectos Piloto , Radiografía Torácica , Estrés Fisiológico

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BACKGROUND: Controversy exists in the literature regarding the optimal site for lymphatic mapping in breast cancer. This study was designed to characterize lymphatic drainage patterns within the same patient after subareolar (SA) and peritumoral (PT) radiopharmaceutical injections and examine the impact of reader interpretation on reported drainage. METHODS: In this prospective trial, 27 women with breast cancer underwent sequential preoperative SA and PT injections of 0.5 to 2.7 mCi of technetium-99 m filtered sulfur colloid 3 days or more apart. Patterns of radiopharmaceutical uptake were reviewed independently by two nuclear medicine physicians. Inter-reader agreement and injection success were assessed in conjunction with observed drainage patterns. RESULTS: There was near perfect inter-reader agreement observed on identification of axillary LN drainage after PT injection (P = 0.0004) and substantial agreement with SA injection (P = 0.0344). SA injection was more likely to drain to only axillary LNs, whereas PT injection appeared more likely to drain to both axillary and extra-axillary LNs, although no statistically significant differences were found. All patients with extra-axillary drainage after PT injection (n = 6 patients) had only axillary drainage after SA injection. Dual drainage was observed for six patients with PT injection and one patient with SA injection. CONCLUSIONS: Our findings suggest that radiopharmaceutical injected in the SA location has a high propensity to drain to axillary LNs only. After controlling for patient factors and demonstrating inter-reader agreement, the inability to demonstrate statistically significant differences in drainage based on injection site suggests that lymphatic drainage patterns may be a function of patient and tumor-specific features.

Asunto(s)

Neoplasias de la Mama/diagnóstico por imagen , Carcinoma Ductal de Mama/diagnóstico por imagen , Ganglios Linfáticos/diagnóstico por imagen , Radiofármacos , Azufre Coloidal Tecnecio Tc 99m , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/secundario , Carcinoma Ductal de Mama/cirugía , Femenino , Humanos , Inyecciones , Metástasis Linfática , Persona de Mediana Edad , Estudios Prospectivos , Cintigrafía , Tasa de Supervivencia , Resultado del Tratamiento

RESUMEN

PURPOSE: This pilot clinical trial explored the feasibility, safety, and efficacy of regional hepatic therapy combined with systemic anticancer agents in patients with refractory solid tumors and extensive unresectable liver involvement, including those with compromised hepatic function. PATIENTS AND METHODS: Six patients with colorectal (N = 3), ovarian (N = 2), and hepatocellular carcinoma (N = 1) received intra-arterial hepatic oxaliplatin followed by intravenous 5-fluorouracil, leucovorin, and bevacizumab every 2 weeks until disease progression. All had extensive liver metastases; four had elevated baseline serum total bilirubin. Median total bilirubin was 2.8 mg/dL (range, 0.2-5.2 mg/dL). Median Child-Pugh score was 7 (range, 5-10). RESULTS: Thirty treatments were delivered (2-7 per patient). Median age of patients was 57 years (range, 25-69 years). Three patients (1 with colorectal, 1 with hepatocellular, and 1 with ovarian cancer) attained partial responses. Two had failed previous oxaliplatin and cisplatin treatment. Some with elevated bilirubin at baseline had a significant drop in bilirubin with treatment (bilirubin 5.2 → 1 mg/dL, 4.8 → 1.1 mg/dL, and 5.2 → 1.8 mg/dL). The regimen was generally well tolerated; the most common side effects were grade 1 fatigue, anorexia, and/or hypertension. One patient died of enzyme-linked, immunoassay-confirmed, heparin-induced thrombocytopenia during the sixth cycle of therapy. CONCLUSION: At doses tested, this regimen was safe and demonstrated antitumor activity in patients with advanced refractory malignancies involving the liver, including those with hepatic insufficiency. Further study is warranted.

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Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Neoplasias Colorrectales/tratamiento farmacológico , Resistencia a Antineoplásicos , Arteria Hepática , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Ováricas/tratamiento farmacológico , Adulto , Anciano , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales Humanizados , Bevacizumab , Neoplasias Colorrectales/patología , Femenino , Fluorouracilo/administración & dosificación , Humanos , Infusiones Intraarteriales , Leucovorina/administración & dosificación , Neoplasias Hepáticas/secundario , Masculino , Persona de Mediana Edad , Compuestos Organoplatinos/administración & dosificación , Neoplasias Ováricas/patología , Oxaliplatino , Proyectos Piloto , Terapia Recuperativa , Tasa de Supervivencia , Tomografía Computarizada por Rayos X , Resultado del Tratamiento

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BACKGROUND: It is well recognized that colorectal cancer does not frequently metastasize to bone. The aim of this retrospective study was to establish whether colorectal cancer ever bypasses other organs and metastasizes directly to bone and whether the presence of lung lesions is superior to liver as a better predictor of the likelihood and timing of bone metastasis. METHODS: We performed a retrospective analysis on patients with a clinical diagnosis of colon cancer referred for staging using whole-body 18F-FDG PET and CT or PET/CT. We combined PET and CT reports from 252 individuals with information concerning patient history, other imaging modalities, and treatments to analyze disease progression. RESULTS: No patient had isolated osseous metastasis at the time of diagnosis, and none developed isolated bone metastasis without other organ involvement during our survey period. It took significantly longer for colorectal cancer patients to develop metastasis to the lungs (23.3 months) or to bone (21.2 months) than to the liver (9.8 months). CONCLUSION: Metastasis only to bone without other organ involvement in colorectal cancer patients is extremely rare, perhaps more rare than we previously thought. Our findings suggest that resistant metastasis to the lungs predicts potential disease progression to bone in the colorectal cancer population better than liver metastasis does.

Asunto(s)

Neoplasias Óseas/secundario , Neoplasias del Colon/patología , Metástasis de la Neoplasia , Anciano , Neoplasias del Colon/diagnóstico por imagen , Neoplasias Colorrectales/diagnóstico por imagen , Neoplasias Colorrectales/patología , Progresión de la Enfermedad , Femenino , Humanos , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/secundario , Masculino , Persona de Mediana Edad , Tomografía de Emisión de Positrones , Radiografía , Estudios Retrospectivos , Imagen de Cuerpo Entero

RESUMEN

PURPOSE: This study aims to identify the clinical implications of myocardial perfusion defects after chemoradiation therapy (CRT) in patients with esophageal and lung cancer. METHODS: We retrospectively compared myocardial perfusion imaging (MPI) results before and after CRT in 16 patients with esophageal cancer and 24 patients with lung cancer. New MPI defects in the radiation therapy (RT) fields were considered related to RT. Follow-up to evaluate for cardiac complications and their relation with the results of MPI was performed. Statistical analysis identified predictors of cardiac morbidities. RESULTS: Eleven females and twenty nine males at a mean age of 66.7 years were included. Five patients (31%) with esophageal cancer and seven patients (29%) with lung cancer developed myocardial ischemia in the RT field at mean intervals of 7.0 and 8.4 months after RT. The patients were followed-up for mean intervals of 15 and 23 months in the esophageal and lung cancer groups, respectively. Seven patients in each of the esophageal (44%) and lung (29%) cancer patients (P = 0.5) developed cardiac complications of which one patient with esophageal cancer died of complete heart block. Six out of the fourteen patients (43%) with cardiac complication had new ischemia on MPI after CRT of which only one developed angina. The remaining eight patients with cardiac complications had normal MPI results. MPI result was not a statistically significant predictor of future cardiac complications after CRT. A history of congestive heart failure (CHF) (P = 0.003) or arrhythmia (P = 0.003) is a significant predictor of cardiac morbidity after CRT in univariate analysis but marginal predictors when multivariate analysis was performed (P = 0.06 and 0.06 for CHF and arrhythmia, respectively). CONCLUSIONS: Cardiac complications after CRT are more common in esophageal than lung cancer patients but the difference is not statistically significant. MPI abnormalities are frequently seen after CRT but are not predictive of future cardiac complications. A history of arrhythmia or CHF is significantly associated with cardiac complications after CRT.

Asunto(s)

Antineoplásicos/efectos adversos , Neoplasias Esofágicas/terapia , Cardiopatías/diagnóstico , Neoplasias Pulmonares/terapia , Imagen de Perfusión Miocárdica , Traumatismos por Radiación/diagnóstico , Anciano , Anciano de 80 o más Años , Arritmias Cardíacas/complicaciones , Quimioterapia Adyuvante/efectos adversos , Neoplasias Esofágicas/tratamiento farmacológico , Neoplasias Esofágicas/radioterapia , Femenino , Cardiopatías/etiología , Cardiopatías/mortalidad , Cardiopatías/fisiopatología , Insuficiencia Cardíaca/complicaciones , Humanos , Modelos Logísticos , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/radioterapia , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Traumatismos por Radiación/etiología , Traumatismos por Radiación/mortalidad , Traumatismos por Radiación/fisiopatología , Radioterapia Adyuvante/efectos adversos , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo

RESUMEN

OBJECTIVE: We evaluated the prevalence of myocardial perfusion defects using myocardial perfusion imaging (MPI) after chemoradiation or radiation therapy (CRT/RT) in lung cancer patients and described their patterns in relation to tumor location. METHODS: MPI in 44 patients who received RT for lung cancer and 44 control patients were compared. The two groups were comparable in risk factors for coronary artery disease. Data regarding tumor stage and location, interval between CRT/RT and MPI, and mean radiation dose to the heart was collected. The level of radiation delivered to the affected segments of the left ventricle versus the normal segments was compared using the isodose lines on the simulation computed tomography. RESULTS: Considering all tumor locations, 8 patients (18%) demonstrated MPI defects after CRT/RT versus 9 (20%) in the controls. However, 7 of 18 patients (39%) with centrally located tumors in the CRT/RT group versus only 1 of 15 patients (7%) in the control group demonstrated MPI defect (p= 0.04). The defects in the CRT/RT group were in the anterior and septal segments while the defects were in different segments in the controls. The median interval between end of RT and MPI was 12.3 months. The affected segments in the CRT/RT group received a mean radiation dose of 39.6 versus 11.4 Gy (p = 0.003) to the normal segments. CONCLUSIONS: CRT/RT to centrally located lung tumors tends to cause anterior/septal MPI defects. Abnormal MPI segments in the CRT/RT group have received significantly higher radiation than normal segments.

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Carcinoma de Pulmón de Células no Pequeñas/terapia , Circulación Coronaria/efectos de la radiación , Defectos de los Tabiques Cardíacos/etiología , Neoplasias Pulmonares/terapia , Isquemia Miocárdica/etiología , Traumatismos por Radiación/etiología , Carcinoma Pulmonar de Células Pequeñas/terapia , Anciano , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Terapia Combinada , Femenino , Defectos de los Tabiques Cardíacos/diagnóstico por imagen , Humanos , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/radioterapia , Masculino , Isquemia Miocárdica/diagnóstico por imagen , Imagen de Perfusión Miocárdica , Pronóstico , Estudios Prospectivos , Traumatismos por Radiación/diagnóstico por imagen , Radioterapia de Intensidad Modulada , Factores de Riesgo , Carcinoma Pulmonar de Células Pequeñas/tratamiento farmacológico , Carcinoma Pulmonar de Células Pequeñas/radioterapia , Tomografía Computarizada por Rayos X , Resultado del Tratamiento

RESUMEN

BACKGROUND: A uniform and reliable description of the exact locations of adenomatous parathyroid glands is necessary for accurate communications between surgeons and other specialists. We developed a nomenclature that provides a precise means of communicating the most frequently encountered parathyroid adenoma locations. METHODS: This classification scheme is based on the anatomic detail provided by imaging and can be used in radiology reports, operative records, and pathology reports. It is based on quadrants and anterior-posterior depth relative to the course of the recurrent laryngeal nerve and the thyroid parenchyma. The system uses the letters A-G to describe exact gland locations. RESULTS: A type A parathyroid gland is a gland that originates from a superior pedicle, lateral to the recurrent laryngeal nerve compressed within the capsule of the thyroid parenchyma. A type B gland is a superior gland that has fallen posteriorly into the tracheoesophageal groove and is in the same cross-sectional plane as the superior portion of the thyroid parenchyma. A type C gland is a gland that has fallen posteriorly into the tracheoesophageal groove and on a cross-sectional view lies at the level of or below the inferior pole of the thyroid gland. A type D gland lies in the midregion of the posterior surface of the thyroid parenchyma, near the junction of the recurrent laryngeal nerve and the inferior thyroid artery or middle thyroidal vein; because of this location, dissection is difficult. A type E gland is an inferior gland close to the inferior pole of the thyroid parenchyma, lying in the lateral plane with the thyroid parenchyma and anterior half of the trachea. A type F gland is an inferior gland that has descended (fallen) into the thyrothymic ligament or superior thymus; it may appear to be "ectopic" or within the superior mediastinum. An anterior-posterior view shows the type F gland to be anterior to the trachea. A type G gland is a rare, truly intrathyroidal parathyroid gland. CONCLUSIONS: A reproducible nomenclature can provide a means of consistent communication about parathyroid adenoma location. If uniformly adopted, it has the potential to reliably communicate exact gland location without lengthy descriptions. This system may be beneficial for surgical planning as well as operative and pathology reporting.

Asunto(s)

Comunicación Interdisciplinaria , Neoplasias de las Paratiroides/clasificación , Humanos , Neoplasias de las Paratiroides/patología , Neoplasias de las Paratiroides/cirugía , Terminología como Asunto

RESUMEN

We report 2 cases of vulvovaginal melanoma in which sentinel node mapping, performed using Tc-99m filtered sulfur colloid SPECT/CT lymphoscintigraphy, added important information to that provided by planar imaging and played a critical role in surgical planning and subsequent management. In the first case, lymphoscintigraphy planar imaging showed only foci of tracer uptake in the right groin and an equivocal focus in the left groin. SPECT/CT precisely localized these radioactive foci to the right and left inguinal sentinel nodes. The patient then underwent bilateral inguinal sentinel node sampling. In the second case, F-18 FDG PET/CT performed prior to lymphoscintigraphy demonstrated a moderately FDG-avid right inguinal lymph node that was indeterminate in nature. SPECT/CT revealed this lymph node to be a radioactive sentinel lymph node that was seen in the right groin on planar imaging. The patient then underwent right inguinal sentinel node sampling. Because pathologic study showed metastasis to the sentinel node, a planned pelvic exenteration was canceled, and the patient was referred for systemic treatment. Preoperative SPECT/CT lymphoscintigraphy is ideal for mapping the unpredicted lymphatic drainage pathways within the complex pelvic anatomy and this technique may also be used in the preoperative workup of other gynecologic malignancies.

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Ganglios Linfáticos/diagnóstico por imagen , Melanoma/diagnóstico , Melanoma/secundario , Tomografía Computarizada de Emisión de Fotón Único/métodos , Tomografía Computarizada por Rayos X/métodos , Neoplasias Vaginales/diagnóstico , Neoplasias de la Vulva/diagnóstico , Anciano , Femenino , Humanos , Metástasis Linfática , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Biopsia del Ganglio Linfático Centinela/métodos

RESUMEN

INTRODUCTION: We investigated the value of lung perfusion imaging in predicting the risk of developing pulmonary complications after chemoradiation (CRT) or radiation therapy (RT) for lung cancer. METHODS: Fifty patients who underwent lung perfusion imaging before RT for lung cancer were included. Planar and single photon emission computed tomography/computed tomography images of the lungs were obtained. Lung perfusion score (LPS) was developed to visually grade localized perfusion defect per lung on a scale of 0 to 4 and perfusion pattern in the remaining lungs on a scale of 1 to 4. The LPS is the sum of the score for the localized perfusion defect in each lung plus the score for the remaining lungs perfusion. LPSs were correlated with pulmonary function tests and the patients were followed for 8 months after therapy to determine the incidence of grade 2 to 5 symptomatic therapy related pulmonary complications according to the common terminology criteria for adverse events (CTCAE 3.0). RESULTS: Thirty-four patients underwent CRT and 16 underwent RT. The mean total radiation dose delivered was 56.1 +/- 10.4 Gy. Eighteen patients (36%) suffered from pulmonary complications at a mean interval of 3.4 months after therapy. Nine patients had grade 2, 7 had grade 3, 1 had grade 4, and 1 had grade 5 pulmonary complications. The mean LPS was 4.9 in patients who developed pulmonary complications versus 3.5 in patients who did not (p = 0.01). There were no significant difference between pulmonary function tests in the patients with pulmonary complications and the patient without. In addition, there were no significant differences between the mean lung radiation dose, the volume of lung irradiated or the percentage of lung receiving greater than 20 Gy between the two groups. CONCLUSIONS: LPS using lung perfusion imaging is useful for predicting possible pulmonary complications after CRT or RT in lung cancer patients.

Asunto(s)

Neoplasias Pulmonares/terapia , Traumatismos por Radiación/diagnóstico por imagen , Anciano , Terapia Combinada , Femenino , Humanos , Interpretación de Imagen Asistida por Computador , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/radioterapia , Masculino , Perfusión , Pronóstico , Estudios Prospectivos , Traumatismos por Radiación/etiología , Dosificación Radioterapéutica , Factores de Riesgo , Tomografía Computarizada de Emisión de Fotón Único/métodos , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento

RESUMEN

OBJECTIVE: To determine the patterns of lymphatic drainage from primary vaginal cancers utilizing lymphoscintigraphy and to determine if this clinical information would affect treatment planning. METHODS: For women with newly diagnosed vaginal cancer, pretreatment lymphatic mapping and sentinel lymph node identification were performed using lymphoscintigraphy. In patients who underwent surgery, sentinel lymph nodes were identified intraoperatively using radiocolloid and patent blue dye. The impact of pretreatment lymphoscintigraphy findings on radiation planning in women who received radiation as initial treatment was noted. RESULTS: Fourteen women were enrolled during the study period. At least 1 sentinel lymph node was identified on pretreatment lymphoscintigraphy in 11 patients (79%). The median number of sentinel nodes found per patient was 2, and bilateral sentinel nodes were found in 6 (55%) of the 11 patients with sentinel nodes identified. Among these 11 patients, 5 (45%) had sentinel nodes identified in the groin only, 4 (36%) had sentinel nodes identified in the pelvis only, and 2 (18%) had sentinel nodes identified in both the groin and the pelvis. No relationship was observed between sentinel lymph node location and primary tumor histologic subtype or location. Three (33%) of the 9 women treated initially with radiation therapy had their radiation field altered as a result of the lymphoscintigraphy findings. CONCLUSION: In women with vaginal cancer, lymphatic drainage from the primary lesion does not always follow the lymphatic channels that would have been predicted anatomically. The addition of lymphoscintigraphy to the pretreatment evaluation for women with vaginal cancer may significantly improve comprehensive treatment planning.

Asunto(s)

Ganglios Linfáticos/patología , Pelvis/patología , Biopsia del Ganglio Linfático Centinela , Neoplasias Vaginales/patología , Adenocarcinoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/patología , Femenino , Humanos , Ganglios Linfáticos/diagnóstico por imagen , Metástasis Linfática , Melanoma/patología , Persona de Mediana Edad , Pelvis/diagnóstico por imagen , Valor Predictivo de las Pruebas , Cintigrafía/métodos , Estudios Retrospectivos , Sensibilidad y Especificidad , Biopsia del Ganglio Linfático Centinela/métodos , Azufre Coloidal Tecnecio Tc 99m

RESUMEN

BACKGROUND AND OBJECTIVE: An observational case series to assess the value of positron emission tomography (PET) in staging ocular adnexal lymphomas and evaluating their response to therapy. PATIENTS AND METHODS: The clinical records of 16 consecutive patients with ocular adnexal lymphoma for whom pretreatment and posttreatment PET scans and corresponding computed tomography (CT) and magnetic resonance imaging (MRI) scans were available were compared. RESULTS: Pretreatment PET scans demonstrated fluorine 18-fluorodeoxyglucose (FDG) positive lesions in 15 orbits of 12 patients. In 1 patient with low-grade follicular lymphoma of the orbit, PET revealed an additional focus of lymphoma in the deltoid muscle that was missed on clinical examination and conventional radiography. All of the posttreatment PET scans showed complete resolution of FDG uptake, suggesting good response to therapy. However, posttreatment CT and MRI scans demonstrated residual masses in 3 patients. CONCLUSIONS: PET is valuable for initial staging of ocular adnexal lymphomas and may be a good adjunct to conventional imaging in evaluation of response to therapy.

Asunto(s)

Fluorodesoxiglucosa F18 , Linfoma no Hodgkin/diagnóstico por imagen , Neoplasias Orbitales/diagnóstico por imagen , Tomografía de Emisión de Positrones , Radiofármacos , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , Preescolar , Femenino , Humanos , Linfoma no Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Orbitales/tratamiento farmacológico , Neoplasias Orbitales/patología , Tomografía Computarizada por Rayos X

RESUMEN

PURPOSE: To assess quantitatively the impact of incorporating functional lung imaging into intensity-modulated radiation therapy planning for locally advanced non-small cell lung cancer (NSCLC). METHODS AND MATERIALS: Sixteen patients with advanced-stage NSCLC who underwent radiotherapy were included in this study. Before radiotherapy, each patient underwent lung perfusion imaging with single-photon-emission computed tomography and X-ray computed tomography (SPECT-CT). The SPECT-CT was registered with simulation CT and was used to segment the 50- and 90-percentile hyperperfusion lung (F50 lung and F90 lung). Two IMRT plans were designed and compared in each patient: an anatomic plan using simulation CT alone and a functional plan using SPECT-CT in addition to the simulation CT. Dosimetric parameters of the two types of plans were compared in terms of tumor coverage and avoidance of normal tissues. RESULTS: In incorporating perfusion information in IMRT planning, the median reductions in the mean doses to the F50 and F90 lung in the functional plan were 2.2 and 4.2 Gy, respectively, compared with those in the anatomic plans. The median reductions in the percentage of volume irradiated with >5 Gy, >10 Gy, and >20 Gy in the functional plans were 7.1%, 6.0%, and 5.1%, respectively, for F50 lung, and 11.7%, 12.0%, and 6.8%, respectively, for F90 lung. A greater degree of sparing of the functional lung was achieved for patients with large perfusion defects compared with those with relatively uniform perfusion distribution. CONCLUSION: Function-guided IMRT planning appears to be effective in preserving functional lung in locally advanced-stage NSCLC patients.

Asunto(s)

Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Neoplasias Pulmonares/radioterapia , Pulmón/efectos de la radiación , Radioterapia de Intensidad Modulada , Adulto , Anciano , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Carcinoma de Pulmón de Células no Pequeñas/fisiopatología , Estudios de Factibilidad , Femenino , Humanos , Pulmón/diagnóstico por imagen , Pulmón/fisiopatología , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/fisiopatología , Masculino , Persona de Mediana Edad , Dosis de Radiación , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos X

RESUMEN

UNLABELLED: Cancer patients frequently have anemia or an altered coagulation state that may affect their risk stratification for perioperative cardiac events. We performed this study to investigate the incidence of perioperative cardiac events in cancer patients who had abnormal stress myocardial perfusion imaging (MPI) results versus cancer patients with normal MPI results. METHODS: We included 394 consecutive cancer patients with normal (n = 201) or abnormal (n = 193) results on MPI studies performed for preoperative risk stratification. MPI was performed within 6 mo before each patient's scheduled operation. All the patients had surgical procedures requiring general anesthesia, except for 18 who had endoscopic or colonoscopic procedures. We retrospectively reviewed their data for the incidence of major cardiac events intraoperatively and for 1 mo postoperatively. We collected data on their cancer type, risk factors for coronary artery disease, MPI findings, risk of operation, and intraoperative or postoperative major cardiac events, which included death, myocardial infarction (MI), and congestive heart failure (CHF). RESULTS: The patients with abnormal MPI results included 97 with ischemia, 80 with scarring, and 16 with mixed scarring and ischemia. The mean left ventricular ejection fraction and end-diastolic volume were 63.8% +/- 9.8% and 82.0 +/- 53.5 mL in the normal MPI group versus 52.1% +/- 13.1% and 118.1 +/- 53.4 mL in the abnormal-MPI group (P < 0.001). There were 9 major intraoperative or postoperative cardiac events (4.7%) in the patients with abnormal MPI results and none in the patients with normal MPI results (P = 0.001). These major events consisted of 3 deaths, 2 acute MIs, 1 non-Q-wave MI, and 3 cases of CHF. Four of these patients had only scarring on their MPI studies, 3 had ischemia, and 2 had scarring and ischemia. CONCLUSION: Normal MPI results have a high negative predictive value for perioperative cardiac events in cancer patients. Abnormal MPI results, whether demonstrating scarring or ischemia, should prompt appropriate perioperative management in patients with cancer to minimize major cardiac events.

Asunto(s)

Cicatriz/diagnóstico por imagen , Circulación Coronaria , Isquemia Miocárdica/diagnóstico por imagen , Neoplasias/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/fisiopatología , Neoplasias/cirugía , Cintigrafía , Medición de Riesgo