ABSTRACT
Background: PET/CT (Positron Emission Tomography/Computed Tomography) is widely used in nodal and metastatic staging of lung cancer patients. Aim: To analyze PET/CT detection of metastatic disease in patients with lung cancer. Material and Methods: We reviewed retrospectively F18Fluorodeoxyglucose PET/CT scans performed between December 2008 and December 2013. We selected 143 patients aged 30 to 92 years (63% males) with confirmed lung cancer referred for staging, with no previous treatment. We reviewed whole body PET/CT and brain magnetic resonance images. SUVmax (Standardized Uptake Value maximum) of primary pulmonary lesion, hilar/mediastinal nodes, and distant metastases were calculated. Results: Histological types encountered were adenocarcinoma in 55%, squamous-cell in 15%, small-cell in 8%, large-cell in 6% and adeno-squamous in 2%. In 22 cases (15%) histology was not available. Nodal involvement was observed in 60% of patients (44% hilar and 48% mediastinal). Skip metastases (mediastinal involvement without hilum involvement) were encountered in 17% of cases, and were significantly more common among high uptake lung tumors (p < 0.01). Best SUVmax cut-off for node involvement was 4.4 for hilum and 4.0 for mediastinum (sensibility: 86.4%, specificity: 99.8%). Sixty six patients (46.2%) showed distant metastases on PET/CT. The most common metastases were osseous in 22%, adrenal in 16%, hepatic in14%, pulmonary in 14% and cerebral in 12%. PET/CT detected a second unexpected synchronic cancer in eight patients (6%). Conclusions: PET/CT is accurate for nodal staging using an uptake index as SUVmax. Distant metastases are common, especially in bone, adrenal glands and liver.
Subject(s)
Adult , Female , Humans , Infant, Newborn , Pregnancy , Health Planning Guidelines , Pregnancy Complications/ethnology , Pregnancy Outcome/ethnology , Weight Gain , Body Mass Index , Infant, Small for Gestational Age , Parity , Risk Factors , SmokingSubject(s)
Humans , Adult , Female , Young Adult , May-Thurner Syndrome/diagnosis , Tomography, X-Ray Computed , UltrasonographyABSTRACT
Background: Perianal fistula (PF) may be present in 40 percent of patients with Crohn´s Disease (CD). Due to its complexity, its management should be multidisciplinary. Purpose: To describe clinical treatment in patients with CD and PF in our institution. Materials and Methods: This is a descriptive retroprospective study, using a registry of CD patients. We selected patients with PF and further characterized those patients that received their treatment at Clínica las Condes (CLC). Results: From a total of 74 patients with CD in the registry, 23 (31 percent) had PF, 61 percent male, median of 7 years of disease and half with colonic extension. Twelve patients were treated in CLC, from these, seven had concomitant proctitis. Optimal diagnostic study (magnetic resonance imaging/endorectal ultrasound plus examination under anesthetic) was performed in eleven (92 percent) patients. Ten (83 percent) patients received an optimal treatment (drainage and installation of a loose seton + start or optimization of medical therapy). Complete clinical response was achieved in more than half of the patients under optimal treatment within the first 6 months. Six (50 percent) patients had one or more recurrences of PF with similar study and management in a median of 13 months. With a median follow-up of 29 months, eight out of 12 patients had complete clinical response. There was one patient with unfavorable course who required a proctectomy and terminal diversion. Conclusion: Treatment of PF in CD is complex and in our population, the first-line treatment includes the installation of a loose seton and medical therapy to achieve clinical response even though fistulous tracts may persist.
Introducción: La fístula perianal (FP) puede presentarse hasta en 40 por ciento de los pacientes con Enfermedad de Crohn (EC). Dada su complejidad el tratamiento debe ser multidisciplinario. Objetivo: Describir el tratamiento de los pacientes portadores de EC con FP. Métodos: Estudio descriptivo, utilizando un registro de pacientes con EC. Se seleccionaron los pacientes con FP y se caracterizaron aquellos que recibieron el tratamiento en Clínica Las Condes (CLC). Resultados: De un total de 74 pacientes con EC, 23 (31 por ciento) presentaban FP asociada, 61 por ciento de sexo masculino, mediana de duración de enfermedad 7 años y la mitad con extensión colónica. Doce pacientes fueron tratados en CLC, de ellos, siete presentaban proctitis al momento de la FP. En 11 (92 por ciento) pacientes se realizó un estudio diagnóstico óptimo (resonancia magnética/ endosonografía transrrectal y exploración bajo anestesia). Diez (83 por ciento) pacientes recibieron tratamiento óptimo biasociado (drenaje e instalación de sedal no cortante + inicio u optimización de terapia médica). Siete pacientes con tratamiento óptimo presentaron mejoría clínica completa dentro de los primeros 6 meses. Seis (50 por ciento) pacientes presentaron una o más recurrencia de FP con estudio y manejo similar en una mediana de 13 meses. Con una mediana de seguimiento de 29 meses, ocho de los 12 pacientes obtuvieron mejoría clínica completa. Una paciente evolucionó desfavorablemente, requiriendo proctectomía y ostomía terminal. Conclusión: El manejo del FP en EC es complejo, en nuestra población el tratamiento biasociado (sedal + fármacos) fue de elección para lograr una mejoría clínica aun cuando persistieron los trayectos fistulosos.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Crohn Disease/complications , Rectal Fistula/etiology , Rectal Fistula/therapy , Antibodies, Monoclonal/therapeutic use , Azathioprine/therapeutic use , Biological Therapy , Combined Modality Therapy , Anal Canal/pathology , Drainage/methods , Crohn Disease/therapy , Follow-Up Studies , Retrospective Studies , Treatment OutcomeABSTRACT
The intrahepatic air, in particular gas within the portal venous or within biliary system, exhibits typical morphological patterns clearly seen on CT studies. Nevertheless, this gas can also be found in the periportal space, a little-known extension of the subperitoneal space, showing intrahepatic distribution patterns similar to those described above, but with completely different pathological and diagnostic implications. This fact led us to characterize this sign and its findings on CT scans, along with its main differential diagnoses.
El gas intrahepático, en particular el ubicado en relación con la vía biliar y la porta, tiene patrones morfológicos característicos especialmente evidentes en los estudios por tomografía computada. El aire,sin embargo, no solamente puede encontrarse en estos lugares, sino que también puede ubicarse en el espacio periportal; una extensión poco conocida del espacio subperitoneal, con patrones de distribución intrahepáticos similares a los ya descritos, pero con implicancias patológicas y diagnósticas completamente diferentes. Por estas razones se decide caracterizar este signo y sus hallazgos en TAC, así como sus principales diagnósticos diferenciales.