ABSTRACT
OBJECTIVE: Use of the routine field of view for whole-body (18)F-FDG PET/CT can lead to underestimation of the true extent of the disease because metastasis outside the typical base of skull to upper thigh field of view can be missed. The purpose of this study was to evaluate the incremental added value of true whole-body as opposed to this limited whole-body PET/CT of cancer patients. MATERIALS AND METHODS: True whole-body FDG PET/CT, from the top of the skull to the bottom of the feet, was performed on 500 consecutively registered patients. A log was kept of cases of suspected malignancy outside the typical limited whole-body field of view. Suspected lesions in the brain, skull, and extremities were verified by correlation with surgical pathologic or clinical follow-up findings. RESULTS: Fifty-nine of 500 patients had PET/CT findings suggestive of malignancy outside the limited whole-body field of view. Thirty-one of those patients had known or suspected malignancy outside the limited whole-body field of view at the time of the true whole-body study. Among the other 28 patients, follow-up data were not available for two, six had false-positive findings, and new cancerous involvement was confirmed in 20. Detection of malignancy outside the limited whole-body field of view resulted in a change in management in 65% and in staging in 55% of the 20 cases. CONCLUSION: Our study showed that 20 of 500 (4.0%) of patients had previously unsuspected malignancy outside the typical limited whole-body field of view. Detection of such malignancy resulted in a change in management in 13 of 500 cases (2.6%). We propose that adopting a true whole-body field of view in the imaging of cancer patients may lead to more accurate staging and restaging than achieved with the routinely used limited whole-body field of view.
Subject(s)
Neoplasms/diagnostic imaging , Positron-Emission Tomography/methods , Tomography, X-Ray Computed/methods , Whole Body Imaging , Aged , Female , Fluorodeoxyglucose F18 , Humans , Male , Middle Aged , Radiopharmaceuticals , Retrospective StudiesABSTRACT
BACKGROUND: The aim of this retrospective study was to report the prevalence and patterns of soft tissue (ST) metastasis detected with true whole-body (TWB) F-18 FDG PET/CT acquired from the top of the skull through the bottom of the feet and to compare such findings to that of the typically acquired skull-base to upper-thigh, thus limited whole-body (LWB) field of view (FOV). METHODS: TWB FDG-PET/CT scans were performed in 500 consecutive cancer patients. Suspected ST metastasis was verified by correlation with surgical pathology, other imaging modalities, or clinical follow-up. RESULTS: Nine out of 500 patients (1.8 %) had ST metastasis with a prevalence of 4/41 (9.8%) for melanoma, 2/60 (3.3%) for lung carcinoma, 2/88 (2.3%) for lymphoma and 1/13 (77%) for esophageal cancer. Those nine patients had a total of 41 ST lesions: 22 lesions within and 19 outside of LWB FOV. Of those 41 lesions, 19 (46%) were subcutaneous and 22 (54%) were muscular lesions. The presence of ST metastasis neither changed the staging nor the treatment in any of these patients. However, the ST lesions provided a biopsy site in 4 of the 9 patients (44%). Seven out of nine studied patients died of their disease within 1-22 months after ST metastasis was diagnosed. CONCLUSION: The detection of ST metastasis may have prognostic implications, provide more accessible biopsy sites and help avoid invasive procedures. A LWB scanning may underestimate the true extent of ST metastasis since a significant percentage of ST metastasis (46%) occurred outside the typical LWB FOV.
Subject(s)
Soft Tissue Neoplasms/secondary , Tomography, Emission-Computed , Tomography, X-Ray Computed , Adult , Aged , Biopsy , Female , Fluorodeoxyglucose F18 , Humans , Image Interpretation, Computer-Assisted , Male , Middle Aged , Neoplasm Metastasis/diagnostic imaging , Prevalence , Prognosis , Radiopharmaceuticals , Retrospective Studies , Soft Tissue Neoplasms/diagnostic imaging , Soft Tissue Neoplasms/epidemiology , Whole Body ImagingABSTRACT
Patients with an autoimmune disease have a propensity for development of a second autoimmune disease. We report the first instance of a patient with both idiopathic thrombotic thrombocytopenic purpura (TTP) and Graves disease. The TTP remitted with a combination of plasmapheresis and prednisone. Methimazole led to sustained remission of the hyperthyroid state within 6 weeks. Although hyperthyroidism may induce immune imbalance causing autoimmunity, it is unclear if this influenced the development of TTP in our patient and if treatment of hyperthyroidism alone could have resulted in the cure of both diseases.
Subject(s)
Graves Disease/complications , Purpura, Thrombotic Thrombocytopenic/complications , Female , Graves Disease/diagnosis , Graves Disease/therapy , Humans , Middle Aged , Plasmapheresis , Purpura, Thrombotic Thrombocytopenic/diagnosis , Purpura, Thrombotic Thrombocytopenic/therapySubject(s)
Antibodies, Monoclonal/therapeutic use , Antibodies, Neoplasm/therapeutic use , Antineoplastic Agents/therapeutic use , Leukemia, Prolymphocytic/drug therapy , Alemtuzumab , Antibodies, Monoclonal, Humanized , B-Lymphocytes/pathology , Combined Modality Therapy , Humans , Leukemia, Prolymphocytic/pathology , Leukemia, Prolymphocytic/surgery , Male , Middle Aged , Peripheral Blood Stem Cell Transplantation , Remission Induction , Transplantation, AutologousSubject(s)
Chromosomes, Human, Pair 11/genetics , Chromosomes, Human, Pair 13/genetics , Gene Expression Regulation, Leukemic/genetics , Leukemia, Lymphocytic, Chronic, B-Cell/genetics , ZAP-70 Protein-Tyrosine Kinase/genetics , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cytogenetic Analysis , Disease Progression , Follow-Up Studies , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis , Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy , Male , Middle Aged , Neoplasm Staging , Prognosis , Treatment Outcome , ZAP-70 Protein-Tyrosine Kinase/biosynthesisABSTRACT
Procarbazine hydrochloride is an oral alkylating agent with activity against lymphoma. It is most commonly used in the treatment of Hodgkin's disease. The use of procarbazine-containing chemotherapeutic regimens in non-Hodgkin's lymphoma fell out of favor with the advent of CHOP. We report two patients with relapsed and/or refractory follicular lymphoma that achieved a complete and durable remission with a prolonged course of daily procarbazine.
