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OBJECTIVE: The main aim of this study was to retrospectively evaluate the clinical data and outcomes of a cohort of 492 hospitalized patients who underwent fluorine-18-fluorodeoxyglucose (F-FDG)-PET/CT analysis at the nuclear medicine unit of 'Policlinico Tor Vergata' in Rome during the years 2017 and 2018 with particular emphasis for patients affected by pulmonary diseases. METHODS: Anamnestic data (age and gender), main pathologic conditions, results of F-FDG-PET/CT examination, appropriateness of the request, and medical records of 492 consecutive hospitalized patients who underwent F-FDG-PET/CT analysis (55.38 ± 3.78 years; range 33-81 years) from January 2017 to December 2018 were obtained. RESULTS: Considering all examinations, positive results were observed in 66.9% of cases whereas it was not possible to perform a diagnosis in 12.7% of cases (doubt results). About 20-fold increase in the percentage of doubt results was observed in F-FDG-PET/CT analysis with no appropriateness as compared to those with double appropriateness (both the request and clinical). Noteworthy, our data showed a 95% higher concordance between the positive results of the F-FDG-PET/CT examination and the histologic diagnosis. Conversely, the concordance between the analysis of the bronchoalveolar lavages and the PET analysis was very low. CONCLUSION: Data here reported showed the high accuracy of the F-FDG-PET/CT performed in our department, mainly for pulmonary diseases, also highlighting the importance of continuously updating the selection criteria for patients who need PET examinations.
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Tomografía Computarizada por Tomografía de Emisión de PositronesRESUMEN
[This corrects the article DOI: 10.1155/2018/9840962.].
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The main aim of this study was to investigate the putative association among the presence of prostate cancer cells, defined as prostate osteoblast-like cells (POLCs), and showing the expression of typical morphological and molecular characteristics of osteoblasts, the development of bone metastasis within 5 years of diagnosis, and the uptake of 18F-choline evaluated by PET/CT analysis. To this end, prostate biopsies (n = 110) were collected comprising 44 benign lesions and 66 malignant lesions. Malignant lesions were further subdivided into two groups: biopsies from patients that had clinical evidence of bone metastasis (BM+, n = 23) and biopsies from patients that did not have clinical evidence of bone metastasis within 5 years (BM-, n = 43). Paraffin serial sections were obtained from each specimen to perform histological classifications and immunohistochemical (IHC) analysis. Small fragments of tissue were used to perform ultrastructural and microanalytical investigations. IHC demonstrated the expression of markers of epithelial-to-mesenchymal transition (VIM), bone mineralization, and osteoblastic differentiation (BMP-2, PTX-3, RUNX2, RANKL, and VDR) in prostate lesions characterized by the presence of calcium-phosphate microcalcifications and high metastatic potential. Ultrastructural studies revealed the presence of prostate cancer cells with osteoblast phenotype close to microcalcifications. Noteworthy, PET/CT analysis showed higher uptake of 18F-choline in BM+ lesions with high positivity (≥300/500 cells) for RUNX2 and/or RANKL immunostaining. Although these data require further investigations about the molecular mechanisms of POLCs generation and role in bone metastasis, our study can open new and interesting prospective in the management of prostate cancer patients. The presence of POLCs along with prostate microcalcifications may become negative prognostic markers of the occurrence of bone metastases.
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Neoplasias Óseas/secundario , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Neoplasias de la Próstata/patología , Neoplasias Óseas/diagnóstico por imagen , Calcificación Fisiológica , Calcinosis , Diferenciación Celular , Forma de la Célula , Colina , Transición Epitelial-Mesenquimal , Radioisótopos de Flúor , Humanos , Masculino , Persona de Mediana Edad , Osteoblastos/ultraestructura , PronósticoRESUMEN
The present study was aimed to investigate the relationships between thyroid stimulating hormone (TSH), freeT3 (fT3) and freeT4 (fT4) and brain glucose consumption as detectable by means of 2-deoxy-2-(F-18) fluoro-D-glucose (F-18 FDG) Positron Emission Tomography/Computed Tomography (PET/CT) in a selected population with Alzheimer disease (AD). We evaluated 87 subjects (37 males and 50 females, mean age 70 (±6) years old) with AD. All of them were subjected to TSH, fT3 and fT4 assay and to cerebrospinal fluid amyloid (Aß1-42) and tau [phosphorylated-tau (p-tau) and total-tau (t-tau)] assay prior PET/CT examination. Values for TSH, fT3 and fT4 were in the normal range. The relationships were evaluated by means of statistical parametric mapping (SPM8) using age, sex, MMSE, scholarship and CSF values of amyloid and tau as covariates. We found a significant positive correlation between TSH values and cortical glucose consumption in a wide portion of the anterior cingulate cortex bilaterally (BA32) and left frontal lobe (BA25) (p FWE-corr <0.001; p FDRcorr <0.000; cluster extent 66950). No significant relationships were found between cortical F-18 FDG uptake and T3 and T4 serum levels. The results of our study suggest that a cortical dysfunction in anterior cingulate and frontal lobes may affect serum values of TSH in AD patients.
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Enfermedad de Alzheimer/metabolismo , Encéfalo/metabolismo , Fluorodesoxiglucosa F18/metabolismo , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Tirotropina/metabolismo , Tiroxina/metabolismo , Triyodotironina/metabolismo , Anciano , Enfermedad de Alzheimer/diagnóstico por imagen , Enfermedad de Alzheimer/patología , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Estudios de Casos y Controles , Femenino , Glucosa/metabolismo , Humanos , Masculino , RadiofármacosRESUMEN
PURPOSE: To investigate the performance of (18)F-fluorocholine ((18)F-FCH) PET/CT in relation to the prostate-specific antigen (PSA) kinetic indexes, PSA doubling time (PSAdt) and PSA velocity (PSAve), in detecting recurrent prostate cancer (PC) in a selected population of patients treated with radical prostatectomy and with PSA ≤2 ng/ml. METHODS: The study group comprised 79 patients (mean age 70 ± 7 years, range 58 - 77 years) who had been treated with radical surgery 30 to 90 months previously and with biochemical failure (defined as a measurable serum PSA level) who were evaluated with (18)F-FCH PET/CT. In order to establish the optimal threshold for PSAdt and PSAve, the diagnostic performance of PSA, PSAdt and PSAve were compared by receiver operating characteristic analysis. RESULTS: In the population examined, PSA (mean ± SD) was 1.37 ± 0.44 ng/ml (range 0.21 - 2 ng/ml) before PET/CT examination, PSAdt was 10.04 ± 16.67 months and PSAve was 2.75 ± 3.11 ng/ml per year. (18)F-FCH PET/CT was positive in 44 patients (55 %). PSAve and PSAdt were significantly different between patients with a positive and a negative (18)F-FCH PET/CT scan. Thresholds of 6 months for PSAdt and 1 ng/ml per year for PSAve were selected. For PSAdt ≤6 months the detection rate (DR) was 65 %, and for PSAve >1 ng/ml per year the DR was 67 %. PSA values were not significantly different between patients with a positive and a negative PET/CT scan. CONCLUSION: The results of our study suggest that (18)F-FCH PET/CT could be considered for the evaluation of patients with biochemical recurrence of PC and with low PSA levels. Fast PSA kinetics could be useful in the selection of these patients.
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Colina/análogos & derivados , Selección de Paciente , Tomografía Computarizada por Tomografía de Emisión de Positrones , Antígeno Prostático Específico/metabolismo , Prostatectomía , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/cirugía , Anciano , Humanos , Procesamiento de Imagen Asistido por Computador , Cinética , Masculino , Persona de Mediana Edad , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/metabolismoRESUMEN
AIM: To investigate the diagnostic performance of early acquisition compared to late imaging for the detection of local recurrence of prostate cancer by means of ¹8F-FCH PET/CT. MATERIALS AND METHODS: 99 patients with radical prostatectomy (mean PSA 3.9 ± 5.03) were subjected to early dynamic PET/CT acquisition of the pelvis and a whole body PET/CT in the same exam session. None of the patients examined was subjected to radiotherapy for local or distant recurrence. All the subjects were taken off hormonal therapy. RESULTS: 58 subjects did not show local recurrence in both early and late acquisition, 22 were positive in both modalities, 10 showed a positive early and a negative late acquisition while 9 showed a negative early and a positive late acquisition (Cohen's k = 0.558). When the results of imaging modalities were considered separately, sensitivity, specificity, positive predictive value and negative predictive value resulted: 78.9, 96.7, 93.8 and 88.1 % for early acquisition and 73.7, 95.1, 90.3 and 85.3 % for late acquisition, respectively. When the results of early and late acquisition were considered together, results were 97.4, 93.4, 90.2 and 98.3 %, respectively. CONCLUSIONS: The combination of early acquisition with late acquisition lead to an increase of the diagnostic accuracy of ¹8F-FCH PET/CT for the diagnosis of local recurrence in prostate cancer.
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Colina/análogos & derivados , Recurrencia Local de Neoplasia/diagnóstico por imagen , Tomografía de Emisión de Positrones/métodos , Prostatectomía , Neoplasias de la Próstata/cirugía , Tomografía Computarizada por Rayos X/métodos , Anciano , Humanos , Masculino , Imagen Multimodal , Antígeno Prostático Específico/metabolismo , Neoplasias de la Próstata/metabolismo , Neoplasias de la Próstata/patología , Estudios Retrospectivos , Factores de TiempoRESUMEN
AIM: We evaluated somatostatin receptor scintigraphy (SRS) with (111)In-pentetreotide incremental value in pulmonary carcinoid (PC) diagnosis compared to contrast enhanced Computed Tomography (ceCT). PATIENTS AND METHODS: We enrolled 81 patients with ascertained PC, 39 at initial staging and 42 in follow-up; the primary tumor had already been excised in 68 cases. Single Photon emission Computed Tomography (SPECT) images were reconstructed with the iterative method and fused with non-enhanced Computed tomography (CT) images. RESULTS: Primary PC or metastatic lesions were ascertained in 55/81 patients and SPECT/CT was positive in 50/55 cases, while ceCT was positive in 44/55. Comparing SPECT/CT with ceCT results, we found a sensitivity of 96 vs. 87.5%, and specificity of 92% vs. 97% for the detection of primary lesion or recurrent disease. A total of 198 lesions were ascertained at SPECT/CT, while 161 at ceCT, with values of sensitivity and specificity of 85.5% and 84.6% for SRS and 75.2% and 90.5% respectively. CONCLUSION: (111)In-Pentetreotide SPECT/CT proved to be more sensitive and accurate than ceCT, thus enhancing its role in evaluating patients with PC.
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Tumor Carcinoide/diagnóstico , Radioisótopos de Indio , Neoplasias Pulmonares/diagnóstico , Somatostatina/análogos & derivados , Anciano , Femenino , Humanos , Neoplasias Pulmonares/metabolismo , Masculino , Tumores Neuroendocrinos/diagnóstico , Tumores Neuroendocrinos/metabolismo , Radiofármacos , Receptores de Somatostatina/metabolismo , Sensibilidad y Especificidad , Tomografía Computarizada de Emisión de Fotón Único/métodos , Tomografía Computarizada por Rayos X/métodosRESUMEN
The aim of the present study was to investigate brain glucose metabolism in patients with Hodgkin disease (HD) after diagnosis and during chemotherapy treatment. Following the administration of first-line doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) chemotherapy, 74 HD patients underwent 18F-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography (PET)/computed tomography brain scans, both baseline (PET0) and interim (PET2) at the Department of Biomedicine and Prevention, University of Rome Tor Vergata (Rome, Italy). Fifty-seven patients were further evaluated 15±6 days after four additional cycles (PET6). Furthermore, a control group (CG) of 40 chemotherapy-naïve subjects was enrolled. Differences in brain 18F-FDG uptake between the CG, PET0, PET2 and PET6 scans were analyzed using statistical parametric mapping. Compared with the PET0 and CG scans, the PET2 scan demonstrated a higher metabolic activity in Brodmann area (BA) 39, and a metabolic reduction in BA 11 bilaterally and in left BA 32. All of these changes disappeared at PET6. The results of the present study indicate that ABVD chemotherapy has a limited impact on brain metabolism.
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OBJECTIVE: The aim of our study was to evaluate the accuracy of F-18 choline positron emission tomography/computed tomography (PET/CT) in assessing the presence of extraprostatic disease during staging of prostate cancer, in relation to prostate-specific antigen (PSA) and PSA density, a PSA derivative that is useful for improving risk stratification in prostate cancer patients. METHODS: F-18 choline PET/CT was performed in 45 patients for early staging of biopsy-proven prostate cancer. None of the examined patients had received therapy before the examination. In all of them a transrectal ultrasonography had been performed earlier to calculate the prostate volume and PSA density. The mean PSA value was 25.5 (±38.1) ng/ml, whereas the mean PSA density was 0.70 (±0.88). RESULTS: Results of F-18 choline PET/CT were related to PSA and PSA density. PET/CT was positive for extraprostatic disease in 18/45 patients (40%) (mean PSA and PSA density were, respectively, 44.08 ng/ml and 1.08); PET/CT was negative for extraprostatic disease in 27/45 patients (60%) (mean PSA and PSA density were, respectively, 13.12 ng/ml and 0.4). PET/CT was positive in 13/18 patients (72%) with a PSA cutoff value greater than or equal to 18 ng/ml and in 5/21 (24%) with a PSA value less than 18 ng/ml (P=0.0017). PET/CT was positive in 16/18 patients (89%) with PSA density greater than or equal to 0.31 and in 2/18 (11%) with PSA density lower than 0.31 (P=0.0234). CONCLUSION: The possibility of detecting extraprostatic disease of prostate cancer with F-18 choline PET/CT is related to PSA and PSA density. In particular, F-18 choline PET/CT should be recommended only in patients with a PSA value of at least 18 ng/ml, whereas a PSA density of at least 0.31 ng/ml is more probably associated with distant metastases.
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Colina/análogos & derivados , Selección de Paciente , Tomografía de Emisión de Positrones , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/patología , Tomografía Computarizada por Rayos X , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana Edad , Imagen Multimodal , Estadificación de Neoplasias , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/diagnóstico por imagenRESUMEN
AIM: The aim of our study was to investigate the relationship between myocardial sympathetic degeneration and nigrostriatal impairment in patients affected by Parkinson's disease (PD) by means of (123)I-metaiodobenzylguanidine ((123)I MIBG) scintigraphy and N-(3-fluoropropyl)-2ß-carbomethoxy-3ß-(4-[(123)I]iodophenyl)nortropane ((123)I FP-CIT) scintigraphy. PATIENTS AND METHODS: The study involved 37 patients with clinical diagnosis of PD (22 males and 15 females, mean age 62 years (±10), evaluated with (123)I FP-CIT single photon emission computed tomography (SPECT) followed by (123)I MIBG scintigraphy within 20 (±3) days. Early and delayed anterior chest images were acquired and the heart/mediastinum ratio (H/M ratio) was calculated. Furthermore, the population has been divided on the basis of the main clinical pattern to investigate the possible role of a tremor-dominant or an akinetic-dominant phenotype in this comparison. RESULTS: In PD population, there were no statistical relationships between early and delayed (123)I MIBG cardiac and (123)I FP-CIT striatal uptake in contralateral caudate (P > 0.05) and in contralateral putamen (P > 0.05) to the side mainly affected; no statistically significant relationships have been found at any level when considering ipsilateral striatum. We did not find statistically significant relationships when considering the single PD phenotypes. CONCLUSIONS: The results of our study suggest that cardiac sympathetic system and nigrostriatal system are differently affected in PD. In particular, the sympathetic neurodegeneration rate is not related to nigrostriatal degeneration rate and vice versa in our series as detectable scintigraphically.
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Enfermedades del Sistema Nervioso Autónomo/complicaciones , Enfermedades del Sistema Nervioso Autónomo/diagnóstico por imagen , Cuerpo Estriado/diagnóstico por imagen , Corazón/diagnóstico por imagen , Corazón/inervación , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/diagnóstico por imagen , Sustancia Negra/diagnóstico por imagen , Simpatectomía/efectos adversos , Cuerpo Estriado/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cintigrafía , Sustancia Negra/patologíaRESUMEN
OBJECTIVE: The aim of the study was to investigate the effect of chemotherapy treatment with ABVD on brain glucose metabolism in patients with Hodgkin's disease (HD). METHODS: A total of 49 patients (23 men, 26 women; mean age 32±9 years) diagnosed with HD were included in the study. All of them underwent a baseline (PET0) and an interim (PET2) 2-deoxy-2-[(18)F]fluoro-D-glucose ((18)F-FDG) PET/computed tomography (CT) brain scan. All patients were treated after PET0 with two cycles of ABVD consisting of doxorubicin (adriamycin), bleomycin, vinblastine, and dacarbazine for 2 months. Thirty-five patients were evaluated further 15±6 days after four additional cycles (PET6). Differences in brain (18)F-FDG uptake were analyzed by statistical parametric mapping (SPM2). RESULTS: Compared with PET0, PET2 showed a significantly higher metabolic activity in the right angular gyrus (Brodmann area 39) and a significant metabolic reduction in Brodmann areas 10, 11, and 32 bilaterally. All these changes disappeared at PET6. CONCLUSION: Our results support the conclusion of a very limited impact of ABVD chemotherapy on brain metabolism in patients with HD.
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Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Encéfalo/efectos de los fármacos , Encéfalo/metabolismo , Glucosa/metabolismo , Enfermedad de Hodgkin/tratamiento farmacológico , Enfermedad de Hodgkin/metabolismo , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Transporte Biológico/efectos de los fármacos , Bleomicina/efectos adversos , Bleomicina/uso terapéutico , Encéfalo/diagnóstico por imagen , Dacarbazina/efectos adversos , Dacarbazina/uso terapéutico , Doxorrubicina/efectos adversos , Doxorrubicina/uso terapéutico , Femenino , Fluorodesoxiglucosa F18/metabolismo , Enfermedad de Hodgkin/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Imagen Multimodal , Tomografía de Emisión de Positrones , Factores de Tiempo , Tomografía Computarizada por Rayos X , Vinblastina/efectos adversos , Vinblastina/uso terapéuticoRESUMEN
PURPOSE: To evaluate the accuracy of contrast-enhanced (18)F-choline PET/CT in restaging patients with prostate cancer after radical prostatectomy in relation to PSA, PSA velocity (PSAve) and PSA doubling time (PSAdt). METHODS: PET/CT was performed in 49 patients (age range 58-87 years) with rising PSA (mean 4.13 ng/ml) who were divided in four groups according to PSA level: ≤1 ng/ml, 1 to ≤2 ng/ml, 2 to ≤4 ng/ml, and >4 ng/ml. PSAve and PSAdt were measured. PET and CT scans were interpreted separately and then together. RESULTS: PET/CT diagnosed relapse in 33 of the 49 patients (67%). The detection rates were 20%, 55%, 80% and 87% in the PSA groups ≤1, 1 to ≤2, 2 to ≤4 and >4 ng/ml, respectively. PET/CT was positive in 7 of 18 patients (38.9%) with a PSA ≤2 ng/ml, and in 26 of 31 (83.9%) with a PSA >2 ng/ml. PET/CT was positive in 7 of 25 patients (84%) with PSAdt ≤6 months, and in 12 of 24 patients (50%) with PSAdt >6 months, and was positive in 26 of 30 patients (86%) with a PSAve >2 ng/ml per year, and in 7 of 19 patients (36.8%) with PSAve ≤2 ng/ml per year. PET alone was positive in 31 of 49 patients (63.3%), and of these 31 patients, CT was negative in 14 but diagnosed bone lesions in 2 patients in whom PET alone was negative. CT with the administration of intravenous contrast medium did not provide any further information. CONCLUSION: Detection rate of (18)F-choline imaging is closely related to PSA and PSA kinetics. In particular, (18)F-choline PET/CT is recommended in patients with PSA >2 ng/ml, PSAdt ≤6 months and PSAve >2 ng/ml per year. CT is useful for detecting bone metastases that are not (18)F-choline-avid. The use of intravenous contrast agent seems unnecessary.
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Colina/análogos & derivados , Medios de Contraste , Imagen Multimodal , Tomografía de Emisión de Positrones , Antígeno Prostático Específico/sangre , Prostatectomía , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Anciano , Anciano de 80 o más Años , Humanos , Cinética , Masculino , Persona de Mediana Edad , Neoplasias de la Próstata/cirugía , Estudios Retrospectivos , Imagen de Cuerpo EnteroRESUMEN
OBJECTIVES: 18F-choline positron emission tomography (PET)/computed tomography (CT) is an integral part in restaging of patients with prostate cancer (PC). The aim of this study was to describe the whole-body physiologic distribution of 18F-choline and to discuss some abnormal sites of uptake not related to PC we observed. MATERIALS AND METHODS: Eighty consecutive patients submitted to 18F-choline PET/CT imaging for primary staging or biochemical recurrence (prostate specific antigen rising) after treatment of PC was considered. Whole-body PET/CT was acquired approximately 40 min after 18F-choline injection. RESULTS: We observed physiological 18F-choline uptake in liver, pancreas, spleen, salivary and lachrymal glands and also, owing to renal excretion, in urinary tract. Other sites of less intense tracer uptake were bone marrow and intestines. We found abnormal and unexpected PET findings in 15 patients (18.7%), not owing to PC localizations. The majority of these findings were owing to inflammation (12 of 15); a case of low grade lymphoma was detected; two patients showed focal brain uptake of 18F-choline and were subsequently submitted to magnetic resonance: in one a meningioma and in the other a low-grade brain tumour were diagnosed. CONCLUSION: Accurate knowledge of the biodistribution of 18F-choline is essential for the correct interpretation of PET/CT imaging. CT enables differentiation of physiological bowel activity and 18F-choline excretion in the ureters. In our series, 18F-choline uptake in benign pathological conditions mainly included sites of inflammation; nevertheless, accumulation in tumour deposits not because PC cannot be excluded, particularly in the brain, where correlative imaging with magnetic resonance is of the utmost importance.