Fusión de datos multimodales de neurociencias generados en estudios EEG-fMRI, un análisis temático / Fusion of Multimodal Neuroscience Data Generated in EEG-fMRI Studies, a Thematic Analysis

La actividad cerebral tiene múltiples atributos, entre ellos los eléctricos, metabólicos, hemodinámicos y hormonales. Los métodos modernos para estudiar las funciones cerebrales como el PET (Tomografía por Emisión de Positrones), fMRI (Imagen de Resonancia Magnética Funcional) y MEG (Magnetoencefalograma) son ampliamente utilizados por los científicos. Sin embargo, el EEG es una herramienta utilizada para la investigación y diagnóstico debido a su bajo costo, simplicidad de uso, movilidad y la posibilidad de monitoreo a largo tiempo de adquisición. Para detectar e interpretar las características relevantes de estas señales, se describe cada proceso por su escala temporal (EEG) y espacial (fMRI). La presente investigación se enfoca en realizar una revisión bibliográfica sobre la integración de datos multimodales EEG-fMRI que propicie valorar su importancia para el desarrollo de algoritmos de fusión y su uso en el contexto cubano. Para ello se analizaron documentos con altos índices de citas en la literatura, donde se destacan autores precursores de los temas en análisis. Los estudios multimodales EEG-fMRI generan múltiples datos temporales y espaciales con alto valor para la medicina basada en evidencia. La integración de los mismos provee un valor agregado en la búsqueda de nuevos métodos diagnósticos, aplicando minería de datos, Deep learning y algoritmos de fusión. En este trabajo se pone de relieve la existencia de baja resolución temporal de fMRI y por otro lado la baja resolución espacial de EEG, por lo que la integración de ambos estudios aumentaría la calidad de su información(AU)

Brain activity has multiple attributes, including electrical, metabolic, hemodynamic, and hormonal. Modern methods for studying brain functions such as PET (Positron Emission Tomography), fMRI (Functional Magnetic Resonance Imaging), and MEG (Magnetoencephalogram) are widely used by scientists. However, the EEG is a tool used for research and diagnosis due to its low cost, simplicity of use, mobility and the possibility of long-term monitoring of acquisition. To detect and interpret the relevant characteristics of these signals, each process is described by its temporal (EEG) and spatial (fMRI) scale. The present research focuses on conducting a bibliographic review on the integration of multimodal EEG-fMRI data that favors assessing its importance for the development of fusion algorithms and their use in the Cuban context. For this, documents with high rates of citations in the literature were analyzed, where precursor authors of the topics under analysis stand out. Multimodal EEG-fMRI studies generate multiple temporal and spatial data with high value for evidence-based medicine. Their integration provides added value in the search for new diagnostic methods, applying data mining, Deep learning and fusion algorithms. This work highlights the existence of low temporal resolution of fMRI and, on the other hand, the low spatial resolution of EEG, so the integration of both studies would increase the quality of their information(AU)

Linfoma cardíaco primário: o papel da multimodalidade de imagem na abordagem diagnóstica / Primary cardiac lymphoma: role of imaging multimodality in diagnosis

Massas intracardíacas constituem um desafio diagnóstico, já que os sintomas são comuns a patologias cardiovasculares ou não. Métodos ­ invasivos ou não ­ possibilitam o diagnóstico diferencial e a confirmação histológica, propiciando tratamento adequado. Para melhor compreender a importância da multimodalidade em imagem e a abordagem nos tumores cardíacos , relatamos o caso de um lifoma cardíaco primário, em que a abordagem multidisciplinar permitiu o rápido diagnóstico e seu tratamento, inclusive das intercorrências, com resposta inicial promissora, a despeito da evolução fatal durante a pandemia por SARS-CoV-2.(AU)

Intracardiac masses are a diagnostic challenge since their symptoms can be common to cardiovascular pathologies. Some methods, whether invasive or not, enable differential diagnosis, histological confirmation, and adequate treatment. To better understand the importance of imaging multimodality and the approach to managing cardiac tumors, we investigated a case of a primary cardiac lymphoma in which the multidisciplinary approach allowed rapid diagnosis and treatment, including of intercurrences, with a promising initial response despite fatal progression due to severe acute respiratory syndrome coronavirus 2 infection. (AU)

The correlation between metabolic parameters in (18)F-FDG PET-CT and solid and micropapillary histological subtypes in lung adenocarcinoma / 中华肿瘤杂志

Objective: Solid and micropapillary pattern are highly invasive histologic subtypes in lung adenocarcinoma and are associated with poor prognosis while the biopsy sample is not enough for the accurate histological diagnosis. This study aims to assess the correlation and predictive efficacy between metabolic parameters in (18)F-fluorodeoxy glucose positron emission tomography/computed tomography ((18)F-FDG PET-CT), including the maximum SUV (SUV(max)), metabolic tumor volume (MTV), total lesion glycolysis (TLG) and solid and micropapillary histological subtypes in lung adenocarcinoma. Methods: A total of 145 resected lung adenocarcinomas were included. The clinical data and preoperative (18)F-FDG PET-CT data were retrospectively analyzed. Mann-Whitney U test was used for the comparison of the metabolic parameters between solid and micropapillary subtype group and other subtypes group. Receiver operating characteristic (ROC) curve and areas under curve (AUC) were used for evaluating the prediction efficacy of metabolic parameters for solid or micropapillary patterns. Univariate and multivariate analyses were conducted to determine the prediction factors of the presence of solid or micropapillary subtypes. Results: Median SUV(max) and TLG in solid and papillary predominant subtypes group (15.07 and 34.98, respectively) were significantly higher than those in other subtypes predominant group (6.03 and 10.16, respectively, P<0.05). ROC curve revealed that SUV(max) and TLG had good efficacy for prediction of solid and micropapillary predominant subtypes [AUC=0.811(95% CI: 0.715~0.907) and 0.725(95% CI: 0.610~0.840), P<0.05]. Median SUV(max) and TLG in lung adenocarcinoma with the solid or micropapillary patterns (11.58 and 22.81, respectively) were significantly higher than those in tumors without solid and micropapillary patterns (4.27 and 6.33, respectively, P<0.05). ROC curve revealed that SUV(max) and TLG had good efficacy for predicting the presence of solid or micropapillary patterns [AUC=0.757(95% CI: 0.679~0.834) and 0.681(95% CI: 0.595~0.768), P<0.005]. Multivariate logistic analysis showed that the clinical stage (Stage Ⅲ-Ⅳ), SUV(max) ≥10.27 and TLG≥7.12 were the independent predictive factors of the presence of solid or micropapillary patterns (P<0.05). Conclusions: Preoperative SUV(max) and TLG of lung adenocarcinoma have good prediction efficacy for the presence of solid or micropapillary patterns, especially for the solid and micropapillary predominant subtypes and are independent factors of the presence of solid or micropapillary patterns.

Atrial myxoma in a patient with patent foramen ovale: evaluation with multimodal imaging. Case report / Mixoma auricular en un paciente con foramen oval permeable: evaluación con imágenes multimodales. Reporte de un caso

Abstract: Primary cardiac tumors in adults are rare and mostly benign, approximately 75%, being the myxoma the most frequent in half of that percentage. One-fourth of the primary cardiac tumors are malignant and 95% of the cases are sarcomas. Metastases are more frequent than primary tumors. Cardiac surgery is indicated specially in benign masses and therapies such as chemotherapy and/or radiotherapy should be reserved for unresectable or metastatic malignancies. Hence the importance of a diagnostic approach, which leads to the best therapeutic conduct and in many cases, a multimodal image approach is necessary, as it is exposed in our case.(AU)

Resumen: Los tumores cardiacos primarios en adultos son raros y en su mayoría benignos, aproximadamente el 75%, siendo el mixoma el más frecuente en la mitad de ese porcentaje. Un cuarto de los tumores cardiacos primarios son malignos y el 95% de los casos son sarcomas. Las metástasis son más frecuentes que los tumores primarios. La cirugía cardiaca está indicada especialmente en masas benignas y las terapias como la quimioterapia y/o la radioterapia deben reservarse para tumores malignos o metástasis irresecables. De ahí la importancia de un enfoque de diagnóstico, que conduzca a la mejor conducta terapéutica y, en muchos casos, es necesario un enfoque de imagen multimodal, como está expuesto en nuestro caso.(AU)

Positron emission tomography/magnetic resonance imaging (PET/MRI): An update and initial experience at HC-FMUSP / Tomografia por emissão de pósitrons/ressonância magnética (PET/RM): atualização e experiência inicial do HC-FMUSP

Summary The new technology of PET/MRI is a prototype of hybrid imaging, allowing for the combination of molecular data from PET scanning and morphofunctional information derived from MRI scanning. Recent advances regarding the technical aspects of this device, especially after the development of MRI-compatible silicon photomultipliers of PET, permitted an increase in the diagnostic performance of PET/MRI translated into dose reduction and higher imaging quality. Among several clinical applications, PET/MRI gains ground initially in oncology, where MRI per se plays an essential role in the assessment of primary tumors (which is limited in the case of PET/CT), including prostate, rectal and gynecological tumors. On the other hand, the evaluation of the lungs remains an enigma although new MRI sequences are being designed to overcome this. More clinical indications of PET/MRI are seen in the fields of neurology, cardiology and inflammatory processes, and the use of PET/MRI also opens perspectives for pediatric populations as it involves very low radiation exposure. Our review aimed to highlight the current indications of PET/MRI and discuss the challenges and perspectives of PET/MRI at HC-FMUSP.

Resumo A nova tecnologia PET/RM é o protótipo de diagnóstico por imagem híbrido e permite combinar dados moleculares obtidos da tomografia PET e informações morfofuncionais derivadas da ressonância magnética. Avanços recentes relativos a aspectos técnicos desse dispositivo, principalmente após o desenvolvimento de fotomultiplicadores de silício compatíveis com RM, permitiram uma melhora do desempenho diagnóstico da PET/RM traduzida em redução da dose e qualidade superior das imagens. Entre diversas aplicações clínicas, a PET/RM ganha espaço inicialmente no campo da oncologia, onde a RM tem papel essencial na avaliação de tumores primários (limitado no caso da PET/TC), incluindo tumores de próstata, reto e ginecológicos. Por outro lado, a avaliação dos pulmões ainda é um enigma, a despeito de novas sequências de RM que estão sendo criadas para tentar resolver essa questão. Outras indicações clínicas da PET/RM são encontradas no âmbito da neurologia, cardiologia e de processos inflamatórios, nos quais a técnica também abre perspectivas para pacientes pediátricos, já que envolve uma exposição baixíssima à radiação. Nossa revisão teve como objetivo destacar as indicações atuais da PET/RM e discutir os desafios e perspectivas da aplicação dessa técnica no Hospital das Clínicas da FMUSP.

PET/MRI: a novel hybrid imaging technique. Major clinical indications and preliminary experience in Brazil / PET/RM: um novo método de imagem híbrida. Principais indicações clínicas e experiência preliminar no Brasil

ABSTRACT In recent years, medical imaging with hybrid techniques has widely accepted and employed in clinical routine. PET/MRI offers significant advantages, including excellent contrast and resolution and reduced ionizing radiation, as compared to well-established PET/CT. Therefore, PET/MRI is a promising modality for oncologic imaging of some regions, such as brain, head and neck, liver and pelvis. This article set out to analyze clinical conditions that could benefit from PET/MRI imaging based on our caseload. The potential of PET/MRI to become the imaging modality of choice for assessment of neurologic and oncologic conditions associated with soft tissues is highlighted. Clinical aspects of PET/MRI and its application to clinical cases are illustrated with examples extracted from the authors’ preliminary experience.

RESUMO Nos últimos anos, imagens médicas com tecnologias híbridas tornaram-se amplamente aceitas e utilizadas na prática clínica. O PET/RM possui vantagens importantes, incluindo excelentes contrastes e resolução, e menor radiação ionizante, em comparação ao PET/TC. Por isto, é uma modalidade promissora para exames de imagem de pacientes oncológicos, para avaliar o cérebro, cabeça e pescoço, o fígado e a pelve. O objetivo deste artigo foi analisar as situações clínicas que se beneficiariam de exames de PET/RM a partir de uma casuística. Destacamos o potencial desta técnica se tornar o método de imagem de escolha para doenças neurológicas e oncológicas que envolvam partes moles. Os aspectos clínicos de PET/RM e sua aplicação aos casos clínicos são ilustrados com exemplos da experiência inicial dos autores.

Relationship between Preoperative 18F-Fluorodeoxyglucose Uptake and Epidermal Growth Factor Receptor Status in Primary Colorectal Cancer

PURPOSE: Both 18F-fluorodeoxyglucose (18F-FDG) uptake and epidermal growth factor receptor (EGFR) status are prognostic variables of colorectal cancer (CRC). The aim of this study was to investigate a possible association between 18F-FDG uptake on preoperative positron emission tomography/computed tomography (PET/CT) and EGFR status in primary CRC. MATERIALS AND METHODS: Records of 132 patients (66 men and 66 women; mean age=67.1+/-11.1 years) who underwent 18F-FDG PET/CT for CRC staging and subsequent bowel resection were reviewed. In primary lesions, 18F-FDG uptake was semiquantitatively evaluated in terms of maximum standardized uptake value (SUVmax), and EGFR status was determined by immunohistochemistry. Associations of clinicopathological parameters and EGFR status were analyzed by Pearson's chi-square test, multiple logistic regression, and receiver operating characteristic curves. RESULTS: Eighty-six patients (65.2%) showed EGFR expression. SUVmax was significantly lower in EGFR-negative tumors than in EGFR-expressing tumors (10.0+/-4.2 vs. 12.1+/-2.1; p=0.012). It was the only significant parameter correlated with EGFR expression (odds ratio=2.457; relative risk=2.013; p=0.038). At the SUVmax threshold of 7.5, the sensitivity and specificity for predicting EGFR expression were 84.9% and 40.4%, respectively (area under the curve=0.624; p=0.019). CONCLUSION: Preoperative 18F-FDG uptake is slightly correlated with EGFR status in primary CRC. Preoperative SUVmax of 18F-FDG may have a limited role in predicting EGFR expression in such tumors because of its poor specificity.

Efficacy of levofloxacin, amoxicillin and a proton pump inhibitor in the eradication of Helicobacter pylori in Brazilian patients with peptic ulcers

OBJECTIVES: The eradication of Helicobacter (H.) pylori allows peptic ulcers in patients infected with the bacteria to be cured. Treatment with the classic triple regimen (proton pump inhibitor, amoxicillin and clarithromycin) has shown decreased efficacy due to increased bacterial resistance to clarithromycin. In our country, the eradication rate by intention to treat with this regimen is 83%. In Brazil, a commercially available regimen for bacterial eradication that uses levofloxacin and amoxicillin with lansoprazole is available; however, its efficacy is not known. Considering that such a treatment may be an alternative to the classic regimen, we aimed to verify its efficacy in H. pylori eradication. METHODS: Patients with peptic ulcer disease infected with H. pylori who had not received prior treatment were treated with the following regimen: 30 mg lansoprazole bid, 1,000 mg amoxicillin bid and 500 mg levofloxacin, once a day for 7 days. RESULTS: A total of 66 patients were evaluated. The patients’ mean age was 52 years, and women comprised 55% of the sample. Duodenal ulcers were present in 50% of cases, and gastric ulcers were present in 30%. The eradication rate was 74% per protocol and 73% by intention to treat. Adverse effects were reported by 49 patients (74%) and were mild to moderate, with a prevalence of diarrhea complaints. CONCLUSIONS: Triple therapy comprising lansoprazole, amoxicillin and levofloxacin for 7 days for the eradication of H. pylori in Brazilian peptic ulcer patients showed a lower efficacy than that of the classic triple regimen. .

Takayasu arteritis and antiphospholipid antibody syndrome in an elderly woman

No abstract available.

Treatment Response Evaluation of Breast Cancer after Neoadjuvant Chemotherapy and Usefulness of the Imaging Parameters of MRI and PET/CT

This study was aimed to evaluate the ability of imaging parameters measured on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), diffusion-weighted MRI (DWI) and positron emission tomography/computed tomography (PET/CT) to serve as response markers in breast cancer after neoadjuvant chemotherapy (NAC). In 20 patients with breast cancer, DCE-MRI and DWI using a 3 T scanner and PET/CT were performed before and after NAC. DCE-MRI was analyzed using an automatic computer-aided detection program (MR-CAD). The response imaging parameters were compared with the pathologic response. The areas under the curve (AUCs) for DCE-MRI using MR-CAD analysis, DWI and PET/CT were 0.77, 0.59 and 0.76, respectively. The combination of all parameters measured by MR-CAD showed the highest diagnostic performance and accuracy (AUC = 0.77, accuracy = 90%). The combined use of the parameters of PET/CT with DCE-MRI or DWI showed a trend toward improved specificity and negative predictive value (100%, 100%, accuracy = 87.5%). The use of DCE-MRI using MR-CAD parameters indicated better diagnostic performance in predicting the final pathological response compared with DWI and PET/CT, although no statistically significant difference was observed. The combined use of PET/CT with DCE-MRI or DWI may improve the specificity for predicting a pathological response.

Multimodality Imaging of Heart Valve Disease / Técnicas de Imagem Multimodal para Valvopatia Multimodality

Unidentified heart valve disease is associated with a significant morbidity and mortality. It has therefore become important to accurately identify, assess and monitor patients with this condition in order that appropriate and timely intervention can occur. Although echocardiography has emerged as the predominant imaging modality for this purpose, recent advances in cardiac magnetic resonance and cardiac computed tomography indicate that they may have an important contribution to make. The current review describes the assessment of regurgitant and stenotic heart valves by multimodality imaging (echocardiography, cardiac computed tomography and cardiac magnetic resonance) and discusses their relative strengths and weaknesses.

Doenças valvares cardíacas não identificadas são associadas com significativas taxas de morbidade e mortalidade. Dessa forma, é importante que os pacientes com essa condição sejam corretamente identificados, investigados e monitorizados para que a apropriada intervenção seja feita a tempo. Contudo, a modalidade ecocardiográfica surgiu predominantemente com esta finalidade, recentes avanços em ressonância magnética cárdica e tomografia computadorizada cardíaca indicam que provavelmente ambos tenham importante contribuição. A atual revisão descreve a avaliação das válvulas cardíacas regurgitantes e estenosadas através de multimodalidade (diversos tipos) de imagens (ecocardiografia, tomografia computorizada cardíaca e ressonância magnética cardíaca), promovendo a discussão de seus pontos positivos e negativos.

Análise dos custos do procedimento PET-TC com 18 F-FDG na perspectiva do SUS provedor: estudo em uma unidade pública de saúde do Rio de Janeiro, Brasil / Cost analysis of 18 F-FDG PET-CT from the perspective of the Brazilian Unified National Health System as healthcare provider: a study in a public healthcare center in Rio de Janeiro, Brazil / Análisis de costes del procedimiento PET-TC con 18 F-FDG desde la perspectiva del SUS proveedor: estudio en una unidad pública de salud de Río de Janeiro, Brasil

A tomografia de emissão de pósitrons (PET) é de uso recente no Brasil e há necessidade de se estimar os custos do procedimento, de forma a subsidiar estudos de avaliação econômica sobre a tecnologia. O trabalho analisou o processo de produção da PET-TC utilizando 18 F-FDG e estimou seus custos na perspectiva de um provedor público de serviços de saúde. Utilizou- se a técnica de microcustos, com identificação, quantificação e valoração de todos os insumos consumidos na produção do procedimento. As estimativas de custo consideraram a observação de 85 exames realizados no Instituto Nacional de Câncer, de março/julho de 2012. O caso de referência considerou pacientes oncológicos adultos, volume de produção de 5 exames/dia e uso de uma dose de 18 F-FDG por paciente. Os custos unitários do procedimento foram de R$ 3.150,30, na perspectiva salarial da carreira de Ciência & Tecnologia, e de R$ 2.927,19 na do Ministério da Saúde. O elemento de maior impacto nos custos correspondeu ao volume diário de produção dos exames. Foram explorados elementos que podem impactar no custo do exame nas instituições públicas de saúde.

Positron emission tomography (PET) has been introduced recently in Brazil and requires costs analysis to support economic evaluation studies on its use. The current study analyzed the use of 18 F-FDG PET-CT and estimated its costs from the perspective of a public healthcare provider. The micro-costing technique was used, identifying, quantifying, and valuing all the inputs used to perform the procedure. Cost estimates considered 85 tests performed at the Brazilian National Cancer Institute from March to June 2012. Reference cases were defined as adult cancer patients, output of five tests per day, and one dose of 18 F-FDG per patient. Unit cost for the procedure was BRL 3,150.30 based on career wages under the Ministry of Science and Technology and BRL 2,927.19 based on Ministry of Health career wages. The factor with the heaviest cost impact was daily output of tests. Other factors that could impact the test’s cost in public healthcare institutions were also examined.

La tomografía por emisión de positrones (PET) es de uso reciente en Brasil y es necesario estimar sus costes, con el fin de subsidiar estudios de evaluación económica sobre esta tecnología. El trabajo examina el proceso de producción de PET-TC con 18F-FDG y se estimaron sus costes desde la perspectiva de un prestador público de servicios de salud. Se empleó la técnica de microcostes, con la identificación, cuantificación y valoración de los insumos consumidos en la producción del procedimiento. Las estimaciones consideran la observación de 85 exámenes entre marzo y julio de 2012. El “caso base” considera pacientes adultos de cáncer, con una producción de 5 exámenes/día y el uso de una dosis de 18F-FDG por paciente. Los costes unitarios del procedimiento fueron, respectivamente, R$ 3.150.30 y R$ 2.927.19, desde la perspectiva del Ministerio de Ciencia y Tecnología y del Ministerio de Salud. El volumen diario de producción fue el elemento de mayor impacto en los costes. Además, se analizaron los factores que pueden repercutir en el coste del examen en instituciones de salud pública.

The Value of SPECT/CT in Localizing Pain Site and Prediction of Treatment Response in Patients with Chronic Low Back Pain

In many circumstances, causing sites of low back pain (LBP) cannot be determined only by anatomical imaging. Combined functional and morphological imaging such as bone scan with single-photon emission computed tomography/computed tomography (SPECT/CT) may be helpful in identifying active lesions. The purpose of this study was to evaluate the usefulness of bone SPECT/CT in localizing the pain site and the treatment of chronic LBP. One hundred seventy-five patients suffering from chronic LBP who underwent SPECT/CT were included, retrospectively. All of the patients received multiple general treatments according to the symptoms, and some of them underwent additional target-specific treatment based on SPECT/CT. Numerical rating scale (NRS) pain score was used to assess the pain intensity. Of 175 patients, 127 showed good response to the given therapies, while the rest did not. Overall, 79.4% of patients with definite active lesions showed good response. Patients with mild active or no lesions on SPECT/CT had relatively lower response rate of 63.0%. Good response was observed by the treatment with the guidance of active lesions identified on SPECT/CT. SPECT/CT could be useful in identifying active lesions in patients with chronic LBP and guiding the clinicians to use adequate treatment.

Von Hippel-Lindau Syndrome: Demonstration of Entire Disease Spectrum with 68Ga-DOTANOC PET-CT

Von Hippel-Lindau (VHL) syndrome is a rare neoplastic disorder characterized by central nervous system (CNS) and visceral tumors. We here present 68Ga-labelled [1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetraacetic acid]-1-Nal3-Octreotide positron emission tomography computed tomography findings in a 52 year old female with VHL syndrome, demonstrating both CNS and visceral tumors.

Hot-Clot Artifacts in the Lung Parenchyma on F-18 Fluorodeoxyglucose Positron Emission Tomography/CT due to Faulty Injection Techniques: Two Case Reports

F-18-fluorodeoxyglucose (FDG) positron emission tomography/CT is an important whole-body imaging tool in the oncology and widely utilized to stage and restage various malignancies. The findings of significant focal accumulation of FDG in the lung parenchyma in the absence of corresponding CT abnormalities are related to the lung microembolism and known as hot-clot artifacts. Herein we present two cases with focal FDG uptake in the lung parenchyma with no structural lesions on the CT scan and discuss the possible mechanisms.