ABSTRACT
OBJECTIVES@#This study aimed to determine the value of clinical prognostic factors and semiquantitative metabolic parameters from initial staging fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) in non-Hodgkin lymphoma (NHL) patients treated with stem cell transplantation (SCT).@*METHODS@#A total of 39 malignant lymphoma patients who underwent initial staging F-18 FDG PET/CT were enrolled in this study. SUVmax, MTV_wb, and TLG_wb were measured during the initial staging PET/CT. Receiver operating characteristic curve (ROC) analysis was adopted to dichotomize continuous variables. Log-rank test and Cox proportional hazard regression analysis were used to evaluate disease-free survival (DFS) rate.@*RESULTS@#Among the 39 patients with malignant lymphoma, 17 (43.6%) had a relapse. For several clinical factors such as age, ECOG performance score, AMC/ALC score, stages, and revised International Prognostic Index score, differences between the two dichotomized groups were statistically insignificant. In univariate analysis, DFS estimates were 71.0 ± 7.8 months and 18.0 ± 5.9 months in high-SUVmax and low-SUVmax group, respectively (P < 0.01). For MTV_wb, DFS estimates were 46.6 ± 12.4 months and 69.1 ± 8.5 months in high-MTV_wb and low-MTV_wb group, respectively (P = 0.12). For TLG_wb, DFS estimates were 65.3 ± 7.5 months and 13.7 ± 8.6 months in high-TLG_wb and low-TLG_wb group, respectively (P = 0.02). In Cox proportional hazard regression analysis, only MTV_wb showed statistical significance (HR 3.01, 95% CI 1.04−8.74, P = 0.04).@*CONCLUSION@#In NHL patients treated with SCT, the MTV_wb of initial staging F-18 FDG PET/CTwas an independent prognostic factor.
ABSTRACT
OBJECTIVES: This study aimed to determine the value of clinical prognostic factors and semiquantitative metabolic parameters from initial staging fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) in non-Hodgkin lymphoma (NHL) patients treated with stem cell transplantation (SCT).METHODS: A total of 39 malignant lymphoma patients who underwent initial staging F-18 FDG PET/CT were enrolled in this study. SUVmax, MTV_wb, and TLG_wb were measured during the initial staging PET/CT. Receiver operating characteristic curve (ROC) analysis was adopted to dichotomize continuous variables. Log-rank test and Cox proportional hazard regression analysis were used to evaluate disease-free survival (DFS) rate.RESULTS: Among the 39 patients with malignant lymphoma, 17 (43.6%) had a relapse. For several clinical factors such as age, ECOG performance score, AMC/ALC score, stages, and revised International Prognostic Index score, differences between the two dichotomized groups were statistically insignificant. In univariate analysis, DFS estimates were 71.0 ± 7.8 months and 18.0 ± 5.9 months in high-SUVmax and low-SUVmax group, respectively (P < 0.01). For MTV_wb, DFS estimates were 46.6 ± 12.4 months and 69.1 ± 8.5 months in high-MTV_wb and low-MTV_wb group, respectively (P = 0.12). For TLG_wb, DFS estimates were 65.3 ± 7.5 months and 13.7 ± 8.6 months in high-TLG_wb and low-TLG_wb group, respectively (P = 0.02). In Cox proportional hazard regression analysis, only MTV_wb showed statistical significance (HR 3.01, 95% CI 1.04−8.74, P = 0.04).CONCLUSION: In NHL patients treated with SCT, the MTV_wb of initial staging F-18 FDG PET/CTwas an independent prognostic factor.
Subject(s)
Humans , Disease-Free Survival , Electrons , Lymphoma , Lymphoma, Non-Hodgkin , Positron Emission Tomography Computed Tomography , Prognosis , Recurrence , ROC Curve , Stem Cell Transplantation , Stem CellsABSTRACT
PURPOSE: This study aimed to investigate the relationship between the SUVmax of primary breast cancer lesions and the molecular subtypes based on the recommendations of the St. Gallen consensus meeting 2013.METHODS: Clinical records of patients who underwent F-18 FDG PET/CT for initial staging of invasive ductal carcinoma (IDC) of SUVmax was correlated with the molecular subtypes defined by the St. Gallen Consensus Meeting 2013, i.e., luminal A-like (LA), luminal B-like HER2 negative (LBHER2−), luminal Blike HER2 positive (LBHER2+), HER2 positive (HER2+), and triple negative (TN), and with the clinicohistopathologic characteristics.RESULTS: The molecular subtype was LA in 38 patients, LBHER2− in 72, LBHER2+ in 21, HER2+ in 30, and TN in 22. The mean SUVmax in the LA, LBHER2−, LBHER2+, HER2+, and TN groups were 4.5 ± 2.3, 7.2 ± 4.9, 7.2 ± 4.3, 10.2 ± 5.5, and 8.8 ± 7.1, respectively. Although SUVmax differed significantly among these subtypes (p < 0.001), the values showed a wide overlap. Optimal cut-off SUVmax to differentiate LA from LBHER2−, LBHER2+, HER2+ and TN were 5.9, 5.8, 7.5, and 10.2 respectively, with area under curve (AUC) of 0.648, 0.709, 0.833, and 0.697 respectively. The cut-off value of 5.9 yielded the highest accuracy for differentiation between the LA and non-LA subtypes, with sensitivity, specificity, and AUC of 79.4 %, 57.9 %, and 0.704 respectively.CONCLUSION: The SUVmax showed a significant correlation with the molecular subtype. Although SUVmax measurements could be used along with immunohistochemical analysis for differentiating between molecular subtypes, its application to individual patients may be limited due to the wide overlaps in SUVmax.
Subject(s)
Humans , Area Under Curve , Breast Neoplasms , Breast , Carcinoma, Ductal , Consensus , Glucose , Metabolism , Phenobarbital , Positron Emission Tomography Computed Tomography , Sensitivity and SpecificityABSTRACT
No abstract available.
Subject(s)
Humans , Thyroid Gland , Thyroid Neoplasms , Thyroid NoduleABSTRACT
No abstract available.
Subject(s)
Humans , Thyroid Gland , Thyroid Neoplasms , Thyroid NoduleABSTRACT
Objective: The aim of the present study was to evaluate cortical hypometabolism of the F-18- fluorodeoxyglucose positron emission tomography (FDG-PET) based on a diagnostic cutoff point of the mini-mental state examination (MMSE) in de novo PD.Methods: We recruited 24 PD patients and 15 healthy controls to analyze FDG-PET. We divided the patients into two groups by the diagnostic cutoff point of MMSE for diagnosing dementia, with scores of>25 vs. 25. Compared to healthy controls, patients with a MMSE> 25 and 25 and < 25 was found in the right inferior parietal lobule. Conclusions: In the comparison by cutoff point of MMSE (25/24), hypometabolism in the right inferior parietal lobule suggests that the posterior cortical deficit is the main region ofde novo PD with cognitive impairment. Hypometabolism of right inferior parietal lobule is related to the damage of cerebral networkin de novo PD.
Subject(s)
Parkinson DiseaseABSTRACT
Gastrocolic fistula is a fistulous communication between the stomach and the colon. It is a passage between the gastric epithelium and the colonic epithelium. This uncommon complication is caused by benign and malignant diseases of the stomach or the colon. Its clinical manifestations include weight loss, diarrhea and fecal vomiting; occasionally, anemia, poor oral intake, fatigue and dizziness; and very rarely, gastrointestinal bleeding. In this paper, an unusual case of gastrocolic fistula accompanied by hematochezia, which was revealed to have been caused by colon cancer invasion, is described.
Subject(s)
Anemia , Colon , Colonic Neoplasms , Diarrhea , Epithelium , Fatigue , Fistula , Gastrointestinal Hemorrhage , Hemorrhage , Intestinal Fistula , Stomach , Weight LossABSTRACT
Behcet's disease (BD) is a multi-systemic inflammatory disease of unknown origin that affects nearly all organs. Recent reports of BD with myelodysplastic syndrome (MDS) often note an association with gastrointestinal involvement and trisomy 8. We herein report on a case of a 51-year-old man who had refractory schizophrenia and developed gastrointestinal BD and MDS with trisomy 8 and 9. He visited our hospital due to fever and abdominal pain. Multiple ulcerations in the colorectum were observed on colonoscopy, and he was diagnosed with intestinal BD. During the treatment of intestinal BD, anemia and thrombocytopenia developed. His bone marrow study revealed myelodysplastic syndrome (refractory anemia with ringed sideroblast) with trisomy 8 and trisomy 9. We report a rare case of intestinal BD accompanied by schizophrenia and myelodysplastic syndrome with trisomy 8 and 9.
Subject(s)
Humans , Middle Aged , Abdominal Pain , Anemia , Bone Marrow , Colonoscopy , Fever , Myelodysplastic Syndromes , Schizophrenia , Thrombocytopenia , Trisomy , UlcerABSTRACT
BACKGROUND: The autonomic nervous system plays a central role in the maintenance of hemodynamic stability. Cardiac autonomic dysfunction may result in serious complications, such as sudden cardiac death. Heart rate variability (HRV) is sigificantly reduced in patients undergoing chronic hemodialysis (HD). The aim of this study was to evaluate the effect of on-line hemodiafiltration (OL-HDF) on the autonomic nervous system in chronic HD patients. METHODS: Forty chronic HD patients were prospectively studied. The participants were divided into conventional HD and OL-HDF groups. They received regular high-flux HD or OL-HDF for 4-hour sessions, three times a week. Time-and frequency-domain measures of the 24-hour HRV were analyzed during the interdialytic period prior to postdilution OL-HDF and every 6 months for 24 months. The 7-year survival was also evaluated. RESULTS: Among the 40 participants, 15 patients in the HD group and 11 patients in the OL-HDF group completed the study. There was no difference in the baseline characteristics. After 24 months of treatment, beta2-microglobulin concentration decreased (from 33.4 +/- 15.2 mg/dL to 28.4 +/- 6.2 mg/dL, P = 0.02) in the OL-HDF group, while there was no change in the HD group In the HRV analysis, the frequency-domain HRV parameters increased significantly compared with baseline in the OL-HDF group [natural logarithmic high frequency (lnHF), 3.15 +/- 3.36 ms2 vs. 4.42 +/- 3.81 ms2; ln low frequency (LF), 3.56 +/- 3.17 ms2 vs. 4.78 +/- 3.99 ms2; ln very low frequency (VLF), 4.90 +/- 4.62 ms2 vs. 6.38 +/- 5.54 ms2; LF/HF ratio, 1.4 +/- 0.4 vs. 2.5 +/- 0.1]. The survival rate was similar between the groups. CONCLUSION: This study shows that OL-HDF improved autonomic nervous system dysfunction in chronic HD patients.
Subject(s)
Humans , Autonomic Nervous System , Death, Sudden, Cardiac , Heart Rate , Heart , Hemodiafiltration , Hemodynamics , Kidney Failure, Chronic , Prospective Studies , Renal Dialysis , Survival RateABSTRACT
Osteochondroma is a common bone tumor but a rare tumor in the rib. It is often asymptomatic and observed incidentally. This is a case report of a 49-year-old woman with an osteochondroma mimicking a mediastinal mass in hereditary multiple exostoses. The chest X-ray and computed tomography (CT) scans revealed the bony density feature of the mass. Surgical excision confirmed that the lesion was an osteochondroma.
Subject(s)
Female , Humans , Middle Aged , Exostoses, Multiple Hereditary , Osteochondroma , Ribs , ThoraxABSTRACT
PURPOSE: The aim of the study was to introduce our experience of establish task-based learning outcomes for core clinical clerkships. METHODS: We first define our educational goal and objectives of the clinical clerkship curriculum according to knowledge, cognitive function and skill, and attitude. We selected clinical presentations and related diseases with expert panels and allocated them to core clinical departments. We classified doctor's tasks into 6 categories: history taking, physical examination, diagnostic plan, therapeutic plan, acute and emergent management, and prevention and patient education. We described learning outcomes by task using behavioral terms. RESULTS: We established goals and objectives for students to achieve clinical competency on a primary care level. We selected 75 clinical presentations and described 377 learning outcomes. CONCLUSION: Our process can benefit medical schools that offer outcome-based medical education, especially for clinical clerkships. To drive effective clerkships, a supportive system including assessment and faculty development should be implemented.
Subject(s)
Humans , Clinical Clerkship , Curriculum , Education, Medical , Learning , Patient Education as Topic , Physical Examination , Primary Health Care , Schools, MedicalABSTRACT
Metastasis to the temporal bone is uncommon. In some cases, metastasis may be the first evidence of malignant dissemination, but more frequently, the diagnosis is unsuspected, possibly because ear symptoms are overshadowed by those deriving from the primary tumor. It is not until they have symptoms like hearing loss, otalgia, facial nerve paralysis, periauricular swelling, otorrhea, or even an aural mass that patients usually undergo treatment at the late stage of the disease course. Tumors of the breast, lung, and kidney are the most common sources of temporal bone metastasis. Although axial bone and cranial metastases are common in patients with prostatic carcinoma, temporal bone involvement is extremely rare. We report a case of metastatic prostatic adenocarcinoma in the temporal bone which was diagnosed with delay.
Subject(s)
Humans , Adenocarcinoma , Breast , Delayed Diagnosis , Ear , Earache , Facial Nerve , Facial Paralysis , Hearing Loss , Kidney , Lung , Neoplasm Metastasis , Paralysis , Prostate , Temporal BoneABSTRACT
A 56 years old woman referred to our hospital with dysphagia and epigastric soreness. Gastroendoscopy revealed huge submucosal tumor with ulceration extending from distal esophagus to lesser curvature of stomach. Subsequent computed tomography (CT) demonstrated soft tissue mass encircling distal esophagus, and 18F-FDG PET/CT demonstrated intense 18F-FDG accumulation in it. Finally this case was diagnosed as esophageal leiomyoma based on pathologic evaluation of the surgical specimen.
Subject(s)
Female , Humans , Deglutition Disorders , Esophagus , Fluorodeoxyglucose F18 , Leiomyoma , Stomach , UlcerABSTRACT
PURPOSE: Gated myocardial perfusion SPECT provides not only myocardial perfusion status but also various functional parameters of left ventricle. We compared left ventricular ejection fraction, end-diastolic volume, LV mass by cardiac SPECT using Quantitative Gated SPECT (QGS), 4D-MSPECT software and standard 2D-echocardiography. MATERIALS AND METHODS: One hundred fourteen patients (male 51, female 63; 29-85 years old, mean 61.3+/-13.3 years old) with normal perfusion status on Tc-99m tetrofosmin gated myocardial perfusion SPECT were analyzed retrospectively. Ejection fraction (LVEF), End-diastolic volume (LVED), LV mass (LVM) were calculated using QGS, 4D-MSPECT, and LVEF, LVM using 2D-echocardiography. Statistical analysis including Bland-Altman plot was performed using MedCalc(R) (MedCalc software, Mariakerke, Belgium). RESULTS: The correlation of LVEF between methods was good: 0.95/0.96 (stress/rest) between QGS and 4D-MSPECT, 0.79 between QGS and echocardiography, 0.79 between 4D-MSPECT and echocardiography (p<0.001). Using Bland-Altman plot, the 95% confidence interval of agreement between QGS and 4D-MSPECT ranged from -12.7% to 7.3% / from -12.2% to 6.5% (stress/rest). The agreement between QGS and echocardiography, 4D-MSPECT and echocardiography ranged from -17.4% to 24.0%, and -14.8% to 27.0% respectively. The correlation of LVM between methods was also good: 0.95 between QGS and 4D-MSPECT, 0.76 between QGS and echocardiography, 0.73 between 4D-MSPECT and echocardiography (p<0.001). The 95% confidence interval of agreement between QGS and 4D-MSPECT ranged from -33.8 g to 14.1 g (stress/rest). The 95% confidence interval of agreement between QGS and echocardiography, 4D-MSPECT and echocardiography ranged from -148.7 g to 21.8. g, and -142.8 g to 35.5 g, respectively. CONCLUSION: There was a good correlation for LVEF, LVED, LVM among methods (QGS, 4D-MSPECT, echocardiography), but the variance between methods was big. Therefore, the functional parameters by each method cannot be used interchangeably.
Subject(s)
Female , Humans , Echocardiography , Heart Ventricles , Perfusion , Retrospective Studies , Stroke Volume , Tomography, Emission-Computed, Single-PhotonABSTRACT
Well-differentiated thyroid cancer is the most common endocrine malignancy with an increasing incidence. Most patients with well-differentiated thyroid caner have a favorable prognosis with high survival rate. While surgery and radioiodine therapy is sufficient treatment for the majority of patients with differentiated thyroid cancer, a minority of these patients experiences progressive, life-threatening growth and metastatic spread of the disease. Because there is no prospective controlled study to evaluate the differences of management of thyroid cancer, it is hard to choose the best treatment option. And there are still lots of controversies about the management of this disease, such as surgical extent, proper use of radioiodine for remnant ablation and therapy, use of rhTSH instead of withdrawal of thyroid hormone, long-term follow-up strategy, thyroglobulin as a tumor marker, etc. In this review, recent data related to these conflicting issues and recent advances in diagnosis, radioiodine therapy and long-term monitoring of well-differentiated thyroid cancer are summarized.
Subject(s)
Humans , Carcinoma, Papillary , Diagnosis , Follow-Up Studies , Incidence , Prognosis , Survival Rate , Thyroglobulin , Thyroid Gland , Thyroid Neoplasms , Thyrotropin AlfaABSTRACT
Hypoxia (decreased tissue oxygen tension) is a component of many diseases such as tumors, cerebrovascular diseases and ischemic heart diseases. Although hypoxia can be secondary to a low inspired pO2 or a variety of lung disorders, the most common cause is ischemia due to an oxygen demand greater than the local oxygen supply. In the heart tissue, hypoxia is often observed in persistent low-flow states, such as hibernating myocardium. Direct "hot spot" imaging of myocardial tissue hypoxia is potentially of great clinical importance because it may provide a means of identifying dysfunctional chronically ischemic but viable hibernating myocardium. A series of radiopharmaceuticals that incorporate nitroimidazole moieties have been synthesized to detect decreased local tissue pO2. In contrast to agents that localize in proportion to perfusion, these agents concentrate in hypoxic tissue. However, the ideal agents are not developed yet and the progress is very slow. Furthermore, the research focus is on tumor hypoxia nowadays. This review introduces the myocardial hypoxia imaging with summarizing the development of radiopharmaceuticals.
Subject(s)
Hypoxia , Heart , Ischemia , Lung , Myocardial Ischemia , Myocardium , Oxygen , Perfusion , RadiopharmaceuticalsABSTRACT
PURPOSE: The sodium-iodide symporter (NIS) expression is an important factor in determining the sensitivity of radioiodine therapy in well-differentiated thyroid cancers. Several previous studies for the expression of NIS in thyroid tissues show diverse results. To investigate whether there is difference between methods in determining the expression of NIS in thyroid tissues of patients with thyroid nodules, we measured the expression of NIS using two different methods (RT-PCR and immunoshistochemical staining) and compared the results. MATERIALS AND METHODS: We measured the expression of NIS by reverse transcriptase-polymerase chain reaction (RT-PCR) and also by immunohistochemical staining using anti-NIS antibody in thyroid cancers and other benign thyroid diseases. We compared the results of each method. We included 19 papillary carcinomas, 1 follicular carcinoma, 1 medullary carcinoma, 4 adenomas and 7 nodular hyperplasias. RESULTS: By RT-PCR analysis, 10 of 19 papillary carcinomas expressed NIS, but 1 follicular cancer didn't express NIS. By immunohistochemical staining, 15 of 19 papaillary carcinomas express NIS, but 1 follicular cancer didn't express NIS. There was a significant correlation between the semiquantitative results of RT-PCR and immunohistochemical staining of NIS expression. (p< 0.01) CONCLUSION: Our data demonstrated that the expression of NIS in thyroid cancers and other benign diseases investigated by RT-PCR and immunohistochemical staining correlated well each other. However, by immunohistochemical staining, more NIS expression was found.
Subject(s)
Humans , Adenoma , Carcinoma, Medullary , Carcinoma, Papillary , Hyperplasia , Ion Transport , Thyroid Diseases , Thyroid Gland , Thyroid NoduleABSTRACT
BACKGROUND/AIMS: Liver scintigraphy is a useful tool in evaluating the chronic liver disease, even though it is less sensitive to detect a mass lesion in the liver than ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI). We evaluate the clinical usefulness of liver scintigraphy in patients with liver cirrhosis by comparing with the clinical and biochemical indices. METHODS: Liver scintigraphy was taken beginning 20 minutes after the intravenous injection of 370 MBq of Tc-99m phytate. Images were obtained in multiple views with a gamma camera (Basicam(R), Siemens). The size of the liver, left lobe enlargement, inhomogeneity of radioactivity, the size of the spleen, the extrahepatic uptake were evaluated on liver scintigraphy. The compared clinical indices were serum albumin level, serum bilirubin level, INR (international normalized ratio) for prothrombin time, the presence of hepatic coma, and esophageal varix. RESULTS: Forty four patients (M:F=24:20) were included. The extrahepatic uptake such as bone marrow and splenic uptake was positively correlated with the level of serum bilirubin and negatively correlated with the level of serum albumin. The size of the spleen, inhomogenous liver uptake, hypertrophy of left lobe was positively correlated with the degree of esophageal varix. The size of the liver was negatively correlated with that of esophageal varix. CONCLUSION: We suggest that scintigraphic findings in liver scintigraphy could be used in the evaluation of patients with liver cirrhosis not only to diagnose cirrhosis but also to know the severity of cirrhosis.
Subject(s)
Humans , Bilirubin , Bone Marrow , Esophageal and Gastric Varices , Fibrosis , Gamma Cameras , Hepatic Encephalopathy , Hypertrophy , Injections, Intravenous , International Normalized Ratio , Liver Cirrhosis , Liver Diseases , Liver , Magnetic Resonance Imaging , Phytic Acid , Prothrombin Time , Radioactivity , Radionuclide Imaging , Serum Albumin , Spleen , UltrasonographyABSTRACT
PURPOSE: We compared the first postoperative diagnostic and post-therapy scans of patients who received therapeutic doses of I-131, to investigate the difference in clinical outcomes between patients with concordant findings of diagnostic and post-therapy scans and patients with discrepant (more lesions in post-therapy scan) findings. MATERIALS AND METHODS: The first postoperative diagnostic and post-therapy radioiodine scans of one hundred forty three patients with well differentiated thyroid carcinoma were reviewed. Diagnostic scans were obtained following ingestion of 185 MBq of I-131 and post-therapy scans were obtained after therapeutic dose of 3.7~9.3 GBq of I-131. Successful ablation was defined as no radioiodine uptake on diagnostic radioiodine scan and normal range of serum thyroglobulin level (<10 ng/ml) during serum TSH elevation. RESULTS: Discrepant scan findings were noted in 25 (17.5%) patients. Twenty-two patients (15.4%) showed more lesions in post-therapy scan and 3 patients (2.1%) showed stunning effect. Nine (64.3%) of 14 patients with distant metastasis revealed metastatic lesion(s) only on post-therapy scan. Stunning effect was considered as sublethal damage in 1 patient and treatment by a diagnostic dose in 2 patients. Ablation was achieved in 52.4% (75/143) of all patients. Ablation rate and mean cumulative radioiodine dose were not different statistically between concordant and discrepant groups. CONCLUSION: There were 17.5% difference between diagnostic and post-therapy scan findings when using 185 MBq of I-131 as a diagnostic dose. However, 64.3% of distant metastases were revealed only on post-therapy scan. Ablation rate and mean cumulative radioiodine dose were not different statistically between concordant and discrepant groups. The stunning effect was considered as not only sublethal damage but also treatment by a small diagnostic dose of radioiodine.