Whole-body diffusion-weighted magnetic resonance imaging versus FDG-PET/CT for initial lymphoma staging: systematic review on diagnostic test accuracy studies / Ressonância magnética de corpo total com difusão comparada à FDG-PET/CT no estadiamento inicial do linfoma: revisão sistemática de estudos de acurácia diagnóstica

CONTEXT AND OBJECTIVE: Positron emission tomography with [18]F-fluoro-2-deoxyglucose (FDG-PET/CT) has been advocated as the method of choice for lymphoma staging, since it enables whole-body analysis with high sensitivity for detection of affected areas and because it combines capacities for anatomical and functional assessment. With technological advances, magnetic resonance imaging (MRI) has emerged as an alternative to FDG-PET/CT. This systematic review with meta-analysis aimed to compare whole-body diffusion-weighted MRI (WB-MRI) with FDG-PET/CT for lymphoma staging. DESIGN AND SETTING: Systematic review on diagnostic test accuracy studies conducted at a public university. METHODS: The Medline, Scopus, Embase and Lilacs databases were searched for studies published up to September 2013 that compared WB-MRI and FDG-PET/CT for lymphoma staging. The reference lists of included studies were checked for any relevant additional citations. RESULTS: Six studies that evaluated the initial lymphoma staging in 116 patients were included. WB-MRI and FDG-PET/CT agreed in 90.5% of the cases (κ = 0.871; P < 0.0001). In most of the studies, when there was disagreement between the methods, WB-MRI overstaged in relation to FDG-PET/CT. The sensitivity of WB-MRI and FDG-PET/CT, in comparison with the clinical-radiological standard, ranged from 59 to 100% and from 63 to 100% respectively. CONCLUSION: WB-MRI is a highly sensitive method for initial lymphoma staging. It has excellent agreement with FDG-PET/CT and is a great alternative for managing lymphoma patients, without using ionizing radiation or an intravenous contrast agent. .

CONTEXTO E OBJETIVO: A tomografia por emissão de pósitrons com 2-[18F]-fluoro-2-deoxi-D-glicose (FDG-PET/CT) tem sido defendida como método de escolha para o estadiamento do linfoma por realizar o estudo do corpo inteiro com boa sensibilidade para detecção das áreas acometidas e por combinar as capacidades de avaliação anatômica e funcional. Com os avanços tecnológicos, a ressonância magnética tem se apresentando como alternativa à FDG-PET/CT. Esta revisão sistemática com metanálise visa comparar a ressonância magnética de corpo inteiro (WB-MRI) com difusão com a FDG-PET/CT no estadiamento do linfoma. TIPO DE ESTUDO E LOCAL: Revisão sistemática de estudos de acurácia diagnóstica conduzida em universidade pública. MÉTODOS: Foi conduzida uma busca nos bancos de dados Medline, Embase, Scopus e Lilacs por estudos publicados até setembro de 2013 comparando a WB-MRI com a FDG-PET/CT no estadiamento do linfoma. As referências bibliográficas dos estudos incluídos foram checadas com a finalidade de encontrar citações adicionais relevantes. RESULTADOS: Foram incluídos seis estudos que avaliaram o estadiamento inicial do linfoma de 116 pacientes. A WB-MRI e a FDG-PET/CT concordaram em 90,5% dos casos (κ = 0,871; P < 0,0001). Na maioria dos estudos, quando houve discordância, a WB-MRI estabeleceu estadiamento superior à FDG-PET/CT. A sensibilidade da WB-MRI e da FDG-PET/CT, em relação ao padrão clínico-radiológico, variou de 59% a 100% e de 63% a 100%, respectivamente. CONCLUSÃO: A WB-MRI apresenta alta sensibilidade no estadiamento inicial do linfoma, excelente concordância com a FDG-PET/CT e representa uma ótima alternativa no manejo de pacientes com linfoma, sem utilizar radiação ionizante ou meio de contraste intravenoso. .

Chronic myeloid leukemia as a secondary malignancy after diffuse large B-cell lymphoma

No abstract available.

Comparação preliminar entre ultrassonografia quantitativa de falanges e densitometria óssea na avaliação da massa óssea em adolescentes / Preliminary comparision between phalangeal quantitative ultrassonography and bone densitometry for bone mass evaluation in adolescents

OBJETIVO: Avaliar associação entre ultrassonografia quantitativa de falanges da mão (QUS) e a densitometria por absorção de raio-X de dupla energia (DXA) e desses com os históricos alimentar e de fraturas. SUJEITOS E MÉTODOS: Após dois anos de acompanhamento de 270 escolares, 10 com massa óssea por QUS abaixo de -2 DP foram incluídos no estudo e avaliados com DXA. RESULTADOS: A massa óssea por DXA de L1-L4 variou de -2,8 a -1,1 DP e de corpo inteiro -2,9 e -1,2. Três estudantes apresentaram fraturas. Baixa ingestão de cálcio foi observada nos 10 casos, de fósforo em 6 e de vitamina D em 8. Não houve diferença entre os casos com massa abaixo de -2 DP nos três métodos de avaliação. Não foi observada associação entre as fraturas e o histórico alimentar, nem com os valores de massa óssea. CONCLUSÃO: Neste pequeno grupo de adolescentes houve associação entre QUS e DXA, porém sem associação entre essas avaliações e as fraturas e a ingestão de cálcio, fósforo e vitamina D.

OBJECTIVE: To evaluate the association between quantitative ultrasonography at hand phalanges (QUS) and dual energy X-ray absorptiometry (DXA), and between these methods with food intake and history of bone fractures. SUBJECTS AND METHODS:After two years of follow up of 270 schoolchildren, 10 of them, who showed bone mass below - 2 SD in QUS, were included in the present study. Laboratory results and DXA data were analyzed. RESULTS: Bone mass evaluated by DXA at L1-L4 ranged from -2.8 to -1.1 SDS, and whole body bone mass, from -2.9 to -1.2 SDS. Three children had history of non-pathological bone fractures. Dietary assessment showed low intake of calcium in 10 cases, of phosphorus in 6, and of vitamin D in 8 cases. There were no differences among the cases of bone mass below-2 SD in any of the three used methods. There was no association between history of bone fractures and food intake, and between these evaluations and bone mass. CONCLUSION: In this small group of schoolchildren there was an association between the methods QUS and DXA. However, there was no association between bone mass and the history of bone fractures, or calcium, phosphorus and vitamin D intake.

Incidental finding of ovarian teratoma on post-therapy scan for papillary thyroid cancer and impact of SPECT/CT imaging / Achado incidental de teratoma ovariano em uma avaliação pós-tratamento para carcinoma papilar de tiroide e impacto da tomografia computadorizada por emissão de fóton único

A 41-year old woman post thyroidectomy and neck dissection is presented in this case. She initially presented goiter and an enlarged cervical lymph node. She had no family history of cancer or radiation therapy. She had total thyroidectomy and found to have papillary thyroid cancer (T4N1M0). Histopathology report revealed multifocal classical papillary thyroid carcinoma with lympho-vascular invasion, extra-thyroidal extension, and positive lymph nodes. She was treated with 6.5 Gigabecquerel (GBq) of 131Iodine. Whole-body scan showed uptake in the neck and large focus in the left lower abdomen. Single-photon emission computed tomography SPECT/CT demonstrated a round shaped mass in the left pelvis. Pathology revealed cystic teratoma with benign thyroid tissue (struma ovarii), and no malignancy. Two months later, she had the second treatment with 5.5 GBq 131Iodine. Her follow-up stimulated and non-stimulated thyroglobulin levels were significantly lower, and there was no abnormal uptake in the follow-up scan.

Este é o caso de uma mulher de 41 anos de idade, com pós-tireoidectomia e dissecção da área do pescoço. Ela inicialmente apresentou bócio e um linfonodo cervical aumentado. Não tinha histórico familiar de câncer ou tratamento com radiação. Ela foi submetida a uma tiroidectomia total e se observou um carcinoma papilar de tiroide (T4N1M0). Os achados histopatológicos revelaram carcinoma papilar multifocal clássico com invasão linfovascular, extensão extratiroideana e linfonodos positivos. Ela foi tratada com 6.5 Gigabecquerel (GBq) de Iodo131. A tomografia de corpo inteiro mostrou captação na área do pescoço e um grande foco no abdômen inferior esquerdo. A tomografia computadorizada por emissão de fóton único SPECT/CT demonstrou uma massa arredondada na pelve esquerda. A análise patológica revelou um teratoma cístico com tecido tiroideano benigno (struma ovarii) e nenhuma malignidade. Dois meses depois, ela foi submetida a um segundo tratamento com 5.5 GBq de Iodo131. O acompanhamento dos níveis de tireoglobulina estimulada e não estimulada foi significativamente mais baixo e não houve captação anormal na tomografia seguinte.

The Role of Whole-Body FDG PET/CT, Tc 99m MDP Bone Scintigraphy, and Serum Alkaline Phosphatase in Detecting Bone Metastasis in Patients with Newly Diagnosed Lung Cancer

Bone scan (BS) and serum alkaline phosphatase (ALP) concentration are used to detect bone metastasis in malignancy, although whole-body fluoro-D-glucose positron emission tomography computed tomography (FDG PET/CT) is being used increasingly. But BS is still used for the detection of metastatic bone lesion. So we compared the usefulness of PET/CT, BS, and serum ALP in detecting bone metastases in patients with newly diagnosed lung cancer. The medical record database was queried to identify all patients with a new diagnosis of lung cancer between January 2004 and December 2005, who had a PET/CT, BS, and serum ALP before treatment. We retrospectively reviewed all patients' records and radiological reports. One hundred eighty-two patients met the inclusion criteria. Bone metastases were confirmed in 30 patients. The sensitivity values were 93.3% for PET/CT, 93.3% for BS, 26.7% for serum ALP concentration, and 26.7% for BS complemented with serum ALP concentration. The respective specificity values were 94.1%, 44.1%, 94.1%, and 97.3%. The kappa statistic suggested a poor agreement among the three modalities. FDG PET/CT and BS had similar sensitivity, but PET/CT had better specificity and accuracy than BS. PET/CT is more useful than BS for evaluating bone metastasis. However, in the advanced stage, because of its high specificity, BS complemented with serum ALP is a cost-effective modality to avoid having to use PET/CT.

Utilización de RNM de cuerpo completo como complemento de PET-FDG de cuerpo completo: a propósito de un caso / Whole-body magnetic resonance like complement of imaging whole-body FDG-PET: case report

Exponemos el caso de una mujer de 55 años, con antecedentes de melanoma en cara interna de pierna izquierda, años atrás. Tras golpe en dicha zona, aparece nodulación que se biopsia e identifica como metástasis de melanoma. Para valorar la extensión de la enfermedad, se realiza PET-FDG, donde se identifican tres hallazgos patológicos; dos de ellos sugestivos de malignidad y un tercero de posible origen osteoarticular. Para su exacta localización y complementar imágenes PET-FDG, se realiza RNM de cuerpo completo. Sus hallazgos son coincidentes con los del estudio PET, permitiéndonos determinar que el foco hipermetabólico PET, probablemente osteoarticular, no se corresponde con alteración articular alguna, sino en porción inferior del tejido infra-rotuliano. Resaltamos la importancia de complementar la PET-FDG con RNM de cuerpo completo frente a complementar con TAC, cuando las localizaciones de focos patológicos PET se sitúen en zonas donde la RNM presente mayor sensibilidad que la TAC.

We present a case of 55 years old woman with antecedents of left leg melanoma, several years ago. After a strike in that area, a node appeared; this one was biopsed and identified as melanoma metastasis. To value the bodily extension of the disease, a PET-FDG was performed. There were three pathologic findings; two were suggestive of malignancy and the third one had a possible ostheoarticular origin. In order to have an exact localization of the lesions and to complement PET-FDG images, a whole body MRI was performed. Its findings coincide with PET findings, allowing determine that the hypermetabolic focus from PET, probably ostheoarticular, doesn´t correspond with articular alteration, but it was in lower infrapatellar tissue. We emphasize the importance of PET-FDG complement with whole-body MRI in front of to complement with CT, when the pathologic focus localizations in PET are in areas where MRI presents upper sensibility than CT.