ABSTRACT
Objetivo Evaluar la captación metabólica de diferentes signos tomográficos observados en pacientes con hallazgos estructurales incidentales sugestivos de neumonía por COVID-19 mediante PET/TC con 18F-FDG. Material y métodos Se analizaron retrospectivamente 596 estudios PET/TC realizados desde el 21 de febrero de 2020 hasta el 17 de abril de 2020. Tras excluir 37 exploraciones (trazadores PET diferentes a la 18F-FDG y estudios cerebrales), se evaluó la actividad metabólica de varios cambios estructurales integrados en la puntuación CO-RADS mediante el SUVmáx de estudios multimodales con 18F-FDG. Resultados Se incluyeron 43 pacientes r COVID-19 en la 18F-FDG PET/TC (edad media: 68±12,3 años, 22 varones). Los valores de SUVmáx fueron mayores en los pacientes con categorías CO-RADS 5-6 respecto a los de categorías CO-RADS inferiores (6,1±3,0 vs. 3,6±2,1, p=0,004). En los pacientes con CO-RADS 5-6, las opacidades en vidrio deslustrado, la bilateralidad y las consolidaciones mostraron valores de SUVmáx más elevados (valores de la p de 0,01, 0,02 y 0,01, respectivamente). La distribución parcheada y el patrón crazy paving también se asociaron a valores de SUVmáx más elevados (valores de p de 0,002 y 0,01). Tras el análisis multivariable, el SUVmáx se asoció significativamente con un diagnóstico estructural positivo de neumonía por COVID-19 (odds ratio=0,63, intervalo de confianza del 95%=0,41-0,90; p=0,02). La curva ROC del modelo de regresión destinado a confirmar o descartar el diagnóstico estructural de neumonía por COVID-19 mostró un AUC de 0,77 (error estándar=0,072; p=0,003). Conclusiones En aquellos pacientes remitidos a 18F-FDG PET/TC por indicaciones oncológicas y no oncológicas estándar (43/559; 7,7%) durante la pandemia, la obtención de imágenes multimodales es una herramienta útil durante la detección incidental de neumonía (AU)
Purpose To evaluate the metabolic uptake of different tomographic signs observed in patients with incidental structural findings suggestive of COVID-19 pneumonia through 18F-FDG PET/CT. Material and methods We retrospectively analyzed 596 PET/CT studies performed from February 21, 2020 to April 17, 2020. After excluding 37 scans (non-18F-FDG PET tracers and brain studies), we analyzed the metabolic activity of several structural changes integrated in the CO-RADS score using the SUVmax of multimodal studies with 18F-FDG. Results Forty-three patients with 18F-FDG PET/CT findings suggestive of COVID-19 pneumonia were included (mean age: 68±12.3 years, 22 male). SUVmax values were higher in patients with CO-RADS categories 56 than in those with lower CO-RADS categories (6.1±3.0 vs. 3.6±2.1, p=0.004). In patients with CO-RADS 56, ground-glass opacities, bilaterality and consolidations exhibited higher SUVmax values (p-values of 0.01, 0.02 and 0.01, respectively). Patchy distribution and crazy paving pattern were also associated with higher SUVmax (p-values of 0.002 and 0.01). After multivariate analysis, SUVmax was significantly associated with a positive structural diagnosis of COVID-19 pneumonia (odds ratio=0.63, 95% confidence interval=0.410.90; p=0.02). The ROC curve of the regression model intended to confirm or rule out the structural diagnosis of COVID-19 pneumonia showed an AUC of 0.77 (standard error=0.072, p=0.003). Conclusions In those patients referred for standard oncologic and non-oncologic indications (43/559; 7.7%) during pandemic, imaging with 18F-FDG PET/CT is a useful tool during incidental detection of COVID-19 pneumonia. Several CT findings characteristic of COVID-19 pneumonia, specifically those included in diagnostic CO-RADS scores (56), were associated with higher SUVmax values (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Lung/diagnostic imaging , Lung/physiopathology , /diagnostic imaging , /pathology , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/physiopathology , Multimodal Imaging , Positron Emission Tomography Computed Tomography , Incidental FindingsABSTRACT
PURPOSE: To evaluate the metabolic uptake of different tomographic signs observed in patients with incidental structural findings suggestive of COVID-19 pneumonia through 18F-FDG PET/CT. MATERIALS AND METHODS: We retrospectively analyzed 596 PET/CT studies performed from February 21, 2020 to April 17, 2020. After excluding 37 scans (non-18F-FDG PET tracers and brain studies), we analyzed the metabolic activity of several structural changes integrated in the CO-RADS score using the SUVmax of multimodal studies with 18F-FDG. RESULTS: Forty-three patients with 18F-FDG PET/CT findings suggestive of COVID-19 pneumonia were included (mean age: 68±12.3 years, 22 male). SUVmax values were higher in patients with CO-RADS categories 5-6 than in those with lower CO-RADS categories (6.1±3.0 vs. 3.6±2.1, p=0.004). In patients with CO-RADS 5-6, ground-glass opacities, bilaterality and consolidations exhibited higher SUVmax values (p-values of 0.01, 0.02 and 0.01, respectively). Patchy distribution and crazy paving pattern were also associated with higher SUVmax (p-values of 0.002 and 0.01). After multivariate analysis, SUVmax was significantly associated with a positive structural diagnosis of COVID-19 pneumonia (odds ratio=0.63, 95% confidence interval=0.41-0.90; p=0.02). The ROC curve of the regression model intended to confirm or rule out the structural diagnosis of COVID-19 pneumonia showed an AUC of 0.77 (standard error=0.072, p=0.003). CONCLUSIONS: In those patients referred for standard oncologic and non-oncologic indications (43/559; 7.7%) during pandemic, imaging with 18F-FDG PET/CT is a useful tool during incidental detection of COVID-19 pneumonia. Several CT findings characteristic of COVID-19 pneumonia, specifically those included in diagnostic CO-RADS scores (5-6), were associated with higher SUVmax values.
Subject(s)
COVID-19 , Positron Emission Tomography Computed Tomography , Humans , Male , Middle Aged , Aged , Aged, 80 and over , Fluorodeoxyglucose F18 , Pandemics , Retrospective Studies , COVID-19/diagnostic imaging , Lung/diagnostic imagingABSTRACT
No disponible
Subject(s)
Humans , Fluorodeoxyglucose F18 , Tomography, Emission-Computed , Radiopharmaceuticals , Tomography, X-Ray Computed/methods , Abdomen , Head , Neck , ThoraxABSTRACT
We present the cases of two oncology patients: a male with Hodgkin's disease after completion of chemotherapy, and a woman recently diagnosed of melanoma, who underwent positron emission tomography/computed tomography (PET/CT) with 18F-FDG for therapeutic monitoring and initial staging, respectively. In both cases, hypermetabolic foci of 18F-FDG in lung parenchyma were found, without morphologic abnormalities in CT. These findings would have been consistent with lung pathology in the absence of any anatomic correlation. Combined PET/CT interpretation was of lung microembolisms probably originated at the injection site.
Subject(s)
Endothelium, Vascular/injuries , Fluorine Radioisotopes/administration & dosage , Fluorodeoxyglucose F18/administration & dosage , Hodgkin Disease/diagnostic imaging , Injections, Intravenous/adverse effects , Lung Neoplasms/diagnostic imaging , Melanoma/diagnostic imaging , Positron-Emission Tomography , Pulmonary Embolism/diagnostic imaging , Radiopharmaceuticals/adverse effects , Adult , Diagnosis, Differential , Female , Humans , Iatrogenic Disease , Lung Neoplasms/secondary , Male , Melanoma/secondary , Middle Aged , Pulmonary Embolism/etiologyABSTRACT
Presentamos los casos de dos pacientes oncológicos: varón con enfermedad de Hodgkin tras finalizar tratamiento quimioterápico y mujer recién diagnosticada de melanoma coroideo, a los que se realiza tomografía por emisión de positrones/tomografía computarizada (PET/TC) con 18F-fluorodesoxiglucosa ( 18F-FDG) para monitorización terapéutica y estudio de extensión inicial, respectivamente. En ambos casos se encuentran focos hipermetabólicos de 18F-FDG en parénquima pulmonar, sin concordancia morfológica en la TC. Estos hallazgos hubieran sugerido patología pulmonar en caso de no disponer de estudio anatómico conjunto. La interpretación de la PET/TC fue de microembolismos pulmonares probablemente originados en el punto de inyección
We present the cases of two oncology patients: a male with Hodgkin's disease after completion of chemotherapy, and a woman recently diagnosed of melanoma, who underwent positron emission tomography/computed tomography (PET/CT) with 18F-FDG for therapeutic monitoring and initial staging, respectively. In both cases, hypermetabolic foci of 18F-FDG in lung parenchyma were found, without morphologic abnormalities in CT. These findings would have been consistent with lung pathology in the absence of any anatomic correlation. Combined PET/CT interpretation was of lung microembolisms probably originated at the injection site
Subject(s)
Male , Adult , Middle Aged , Humans , Tomography, Emission-Computed/methods , Iatrogenic Disease , Injections, Intravenous/adverse effects , Pulmonary Embolism/etiology , Pulmonary Embolism , Fluorodeoxyglucose F18 , MicrocirculationABSTRACT
This is a retrospective study carried out in a group of 30 patients with differentiated thyroid cancer (age at diagnosis equal to or less than twenty years old). The aim of the study is to evaluate outcome after 131I therapy. Patients were classified into three groups on the basis of initial surgery, pathology and scintigraphic results: group I (thyroid extent), group II (locoregional extent), and group III (distant metastatic disease). Clinical parameters, 131I scans, serum thyroglobulin determinations and 131I therapeutic administered doses were evaluated in the follow-up. Some other complementary techniques such as chest X-ray and pulmonary function tests are also described. Scintigraphic absence of thyroid tissue has been observed in 83% of the cases; high thyroglobulin level is still detectable in 34% of the patients as a single evidence of disease, and 21% remain without any abnormal clinical, scintigraphic or analytical findings. Total doses administered have increased in groups I, II and III respectively, and have also been inversely proportional to the extension of lymph node surgery. At present, all the patients are alive and in good general condition. According to the results obtained, we conclude that children and young adults with DTC should undergo periodical 131I therapeutic doses in case of positive scans (once total thyroidectomy has been realized, with or without lymph node resection depending on the extension of disease). In our experience, the use of radioiodine is effective and safe in the follow-up of children and youngs with DTC.
Subject(s)
Adenocarcinoma, Follicular/radiotherapy , Carcinoma, Papillary/radiotherapy , Iodine Radioisotopes/therapeutic use , Radiopharmaceuticals/therapeutic use , Thyroid Neoplasms/radiotherapy , Adenocarcinoma, Follicular/diagnostic imaging , Adenocarcinoma, Follicular/surgery , Adenoma, Oxyphilic/diagnostic imaging , Adenoma, Oxyphilic/radiotherapy , Adenoma, Oxyphilic/surgery , Adolescent , Biomarkers, Tumor/blood , Carcinoma, Papillary/diagnostic imaging , Carcinoma, Papillary/surgery , Cell Differentiation , Child , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Lymph Node Excision , Male , Neoplasm Invasiveness , Neoplasm Metastasis , Radionuclide Imaging , Radiotherapy, Adjuvant , Retrospective Studies , Thyroglobulin/blood , Thyroid Neoplasms/diagnostic imaging , Thyroid Neoplasms/surgery , Thyroidectomy , Treatment OutcomeABSTRACT
Este es un estudio retrospectivo realizado en un grupo de treinta pacientes con carcinoma diferenciado de tiroides (edad al dignóstico igual o menor a veinte años), que tiene como objetivo valorar la respuesta al tratamiento con radioyodo. Los pacientes fueron clasificados en tres grupos según los resultados quirúrgicos, anatomopatológicos y gammagráficos iniciales: grupo I (enfermedad limitada al tiroides), grupo II (enfermedad locorregional), grupo III (afectación metastásica a distancia). En el seguimiento se evaluaron parámetros clínicos, resultados de rastreos gammagráficos con Iodo-131, determinaciones de tiroglobulina sérica y dosis terapeúticas de radioyodo administradas. También se describen otras técnicas complementarias como la radiología de tórax y las pruebas de función respiratoria. Hemos observado una negativización gammagráfica en el 83 por ciento de los casos; un 34 por ciento presenta niveles de tiroglobulina elevados como único hallazgo sugestivo de existencia de enfermedad y un 21 por ciento no presenta hallazgos clínicos, analíticos o gammagráficos patológicos. Las dosis totales de radioyodo administradas han sido crecientes en los grupos I, II y III respectivamente, e inversamente proporcionales a la extensión de la limpieza ganglionar efectuada. En la actualidad todos los pacientes están vivos y presentan un buen estado general.De acuerdo con los resultados obtenidos, concluímos que el manejo adecuado del CDT en este grupo de edad debe incluir rastreos gammagráficos periódicos con 131I y dosis terapeúticas de 131I en caso de rastreos positivos (una vez realizada la tiroidectomía total, con o sin limpieza ganglionar dependiendo de la extensión de la enfermedad). Según nuestra experiencia, el empleo de radioiodo es eficaz y seguro en el seguimiento de niños y jóvenes con CDT. (AU)
