ABSTRACT
Llevamos a cabo un estudio retrospectivo para evaluar la exactitud, validez diagnóstica e impacto clínico de la 18F-FDG PET en el manejo de enfermedad metastásica y recurrente en pacientes con carcinoma de células renales (CCR) de nuestra base de datos. Se identificaron estudios 18F-FDG PET de 58 pacientes que cumplían con nuestros criterios de inclusión en el estudio. Se confirmaron los resultados con los hallazgos histopatológicos, seguimiento clínico (al menos 12 meses) y/o métodos convencionales de imagen (MCI).Se obtuvo una sensibilidad de 80,56%, especificidad 86,36%, exactitud dignóstica 58,7%, valor predictivo positivo 90,63%, y valor predictivo negativo 73.08%.El impacto clínico fue elevado en 25 casos (43%) y no hubo impacto en sólo 10 estudios (17,2%). Concluimos que la 18F-FDG PET es útil y que tiene elevado impacto clínico en el manejo de CCR metastático y recurrente. Basado en nuestros resultados, un estudio PET positivo fue de más ayuda al clínico que un estudio negativo en el manejo de estos pacientes(AU)
We performed a retrospective study to evaluate the accuracy, diagnostic validity, and clinical impact of 18F-FDG PET in the management of recurrent and metastatic disease in patients with Renal Cell Carcinoma (RCC) from our database. 18F-FDG PET studies were identified from 58 patients that matched our criteria for inclusion in the study. Results were confirmed with histopathological findings, clinical follow-up time (at least 12 months), and/ or conventional imaging methods (CIM).A sensitivity of 80.56%, specificity 86.36%, diagnostic accuracy 58.7%, positive predictive value 90.63%, and a negative predictive value of 73.08% were observed.The clinical impact was high in 25 cases (43%) and we found no impact in only 10 studies (17.2%). We concluded that 18F-FDG PET was useful and had a high clinical impact in the management of recurrent and metastatic RCC. From our data, it seemed that a positive PET study was more helpful to the physician than a negative study(AU)
Subject(s)
Humans , Fluorodeoxyglucose F18 , Positron-Emission Tomography/instrumentation , Positron-Emission Tomography/methods , Carcinoma, Renal Cell/diagnosis , Sensitivity and Specificity , Predictive Value of Tests , Carcinoma, Renal Cell , Retrospective StudiesABSTRACT
We performed a retrospective study to evaluate the accuracy, diagnostic validity, and clinical impact of (18)F-FDG PET in the management of recurrent and metastatic disease in patients with Renal Cell Carcinoma (RCC) from our database. (18)F-FDG PET studies were identified from 58 patients that matched our criteria for inclusion in the study. Results were confirmed with histopathological findings, clinical follow-up time (at least 12 months), and/ or conventional imaging methods (CIM). A sensitivity of 80.56%, specificity 86.36%, diagnostic accuracy 58.7%, positive predictive value 90.63%, and a negative predictive value of 73.08% were observed. The clinical impact was high in 25 cases (43%) and we found no impact in only 10 studies (17.2%). We concluded that (18)F-FDG PET was useful and had a high clinical impact in the management of recurrent and metastatic RCC. From our data, it seemed that a positive PET study was more helpful to the physician than a negative study.
Subject(s)
Carcinoma, Renal Cell/diagnostic imaging , Fluorine Radioisotopes , Fluorodeoxyglucose F18 , Kidney Neoplasms/diagnostic imaging , Positron-Emission Tomography , Radiopharmaceuticals , Bone Neoplasms/diagnostic imaging , Bone Neoplasms/secondary , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/secondary , Carcinoma, Renal Cell/secondary , Case Management , Decision Making , False Negative Reactions , False Positive Reactions , Follow-Up Studies , Humans , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/secondary , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/secondary , Lymphatic Metastasis/diagnostic imaging , Neoplasm Recurrence, Local/diagnostic imaging , Predictive Value of Tests , Retrospective Studies , Sensitivity and SpecificityABSTRACT
AIM: Renal cell carcinoma is the most frequent solid kidney tumor. At present, PET is not the imaging test of choice, the helical CT being the best method to assess these patients. The aim of the study was to perform a meta-analysis of the literature to evaluate the performance and accuracy of 18F-FDG PET in the detection of primary disease, recurrence and metastasis of renal cell carcinoma. MATERIALS AND METHODS: A systematic search was done of the available literature in primary and secondary databases published until October 2004 indexed in MEDLINE and CANCERLIT. Exclusion/inclusion criteria were applied. Their quality was evaluated using the Flynn criteria and joint estimators of sensitivity (S), specificity (Sp), likelihood ratios (LR), diagnostic odds ratio (DOR) and summary ROC (SROC) curve were obtained. The presence of the threshold effect was evaluated and the summary ROC (SROC) curve was calculated. RESULTS: Seven out of 46 studies fulfilled the inclusion criteria and were analyzed. Three studies evaluated the use of 18F-FDG PET in the differential diagnosis of renal masses. Two studies analyzed restaging and two analyzed the role of 18F-FDG PET in the detection of metastatic disease. All the selected studies were classified according to Flynn's criteria. We found the highest S in restaging with S 0.87 (95 % CI, 0.75-0.95) and in metastases detection with S 0.72 (95 % CI, 0.56-0.85) as well as the high Sp in differential diagnosis of renal masses. CONCLUSIONS: The results of this meta-analysis suggest that 18F-FDG PET can be useful in restaging and detection of metastatic disease, based on its acceptable S and Sp. However, the performance of 18F-FDG PET in the detection of primary disease is limited, but this may improve with the new PET/CT systems.
Subject(s)
Carcinoma, Renal Cell/diagnostic imaging , Fluorodeoxyglucose F18 , Kidney Neoplasms/diagnostic imaging , Positron-Emission Tomography , Radiopharmaceuticals , Humans , Reproducibility of ResultsABSTRACT
Objetivos. El adenocarcinoma de células renales es el tumor sólido renal más frecuente. La tomografía por emisión de positrones (PET) no constituye en el momento actual la prueba de imagen de elección, siendo la tomografía axial computarizada (TAC) el método más adecuado para la valoración de estos pacientes. El objetivo de este estudio es realizar una revisión sistemática, con la que resumir toda la evidencia existente hasta el momento sobre la eficacia y rendimiento diagnóstico de la PET con 18F-fluoro-deoxi-glucosa (FDG) en el diagnóstico de enfermedad primaria, recurrencia y metástasis del adenocarcinoma de células renales. Material y métodos. Para ello se realizó una búsqueda sistemática de la literatura disponible en bases de datos primarias y secundarias (MEDLINE y CANCERLIT), hasta octubre de 2004. Se aplicaron criterios de inclusión y exclusión. Se evaluó su calidad según criterios de Flynn y se obtuvieron los estimadores conjuntos de sensibilidad (S), especificidad (E), cocientes de probabilidad (CP), y odds ratio diagnóstica (ORD) con sus intervalos de confianza del 95 %. Se evaluó la presencia de efecto umbral y se calculó la curva ROC resumen (SROC). Resultados. De los 46 estudios encontrados se seleccionaron 7 según criterios de inclusión/exclusión. De ellos, tres hacían referencia a la PET en el diagnóstico de lesiones primarias, dos a la reestadificación y otros dos a la detección de metástasis. Los 7 estudios cumplían criterios de calidad de Flynn. El valor más alto de S lo encontramos en la reestadificación con S = 0,87 (IC 95 %, 0,75-0,95) y en la detección de metástasis con S = 0,72 (IC 95 %, 0,56-0,85), siendo la E más alta en el diagnóstico inicial E = 0,93 (IC 95 %, 0,86-0,97). Conclusiones. Los resultados de este meta-análisis sugieren que la PET-FDG es capaz de reestadificar y detectar lesiones metastásicas con una S y E aceptables, presentando limitaciones en el diagnóstico de tumores renales primarios. Este rendimiento diagnóstico quizá sea mejorable con la introducción de los nuevos equipos híbridos PET-TAC
Aim. Renal cell carcinoma is the most frequent solid kidney tumor. At present, PET is not the imaging test of choice, the helical CT being the best method to assess these patients. The aim of the study was to perform a meta-analysis of the literature to evaluate the performance and accuracy of 18F-FDG PET in the detection of primary disease, recurrence and metastasis of renal cell carcinoma. Materials and methods. A systematic search was done of the available literature in primary and secondary databases published until October 2004 indexed in MEDLINE and CANCERLIT. Exclusion/inclusion criteria were applied. Their quality was evaluated using the Flynn criteria and joint estimators of sensitivity (S), specificity (Sp), likelihood ratios (LR), diagnostic odds ratio (DOR) and summary ROC (SROC) curve were obtained. The presence of the threshold effect was evaluated and the summary ROC (SROC) curve was calculated. Results. Seven out of 46 studies fulfilled the inclusion criteria and were analyzed. Three studies evaluated the use of 18F-FDG PET in the differential diagnosis of renal masses. Two studies analyzed restaging and two analyzed the role of 18F-FDG PET in the detection of metastatic disease. All the selected studies were classified according to Flynn's criteria. We found the highest S in restaging with S 0.87 (95 % CI, 0.75-0.95) and in metastases detection with S 0.72 (95 % CI, 0.56-0.85) as well as the high Sp in differential diagnosis of renal masses. Conclusions. The results of this meta-analysis suggest that 18F-FDG PET can be useful in restaging and detection of metastatic disease, based on its acceptable S and Sp. However, the performance of 18F-FDG PET in the detection of primary disease is limited, but this may improve with the new PET/CT systems
Subject(s)
Humans , Tomography, Emission-Computed/methods , Carcinoma, Renal Cell , Kidney Neoplasms , Carcinoma, Renal Cell/diagnosis , Sensitivity and Specificity , Odds Ratio , Confidence Intervals , Kidney Neoplasms/diagnosisABSTRACT
OBJECTIVE: To present the case report of a patient with undifferentiated and diffuse signet-ring cell gastric carcinoma in which FDG-PET evidenced recurrent disease. MATERIALS AND METHODS: The patient was diagnosed of a stage III gastric carcinoma in 1994 and was treated with a subtotal gastrectomy. In February 2003, recurrent disease was detected in mediastinal and left supraclavicular lymph nodes. The patient was treated with chemotherapy and radiotherapy, reaching a complete response. After 6 months free of disease, he presented an elevation of the tumor markers with negative results in conventional imaging methods (upper digestive endoscopy, bone scintigraphy, and CT). An FDG-PET scan was performed to rule out recurrent disease. RESULTS: FDG-PET detected pathologic findings suggestive of malignant disease in right supraclavicular and mediastinal lymph nodes. These findings were confirmed by clinical follow-up and with another CT scan performed 4 months later. CONCLUSIONS: In this case report we stress the importance of early recurrence by FDG-PET in a non-intestinal gastric carcinoma. This is of interest given the greater difficulty to detect mucous secreting and/or producing carcinomas with the PET-FDG.
Subject(s)
Carcinoma, Signet Ring Cell/diagnostic imaging , Fluorodeoxyglucose F18 , Neoplasm Recurrence, Local/diagnostic imaging , Positron-Emission Tomography , Radiopharmaceuticals , Stomach Neoplasms/diagnostic imaging , Aged , Humans , MaleABSTRACT
Objetivo: Presentar la detección de una recurrencia secundaria a un carcinoma gástrico difuso, con células en anillo de sello e indiferenciado mediante PET-FDG. Material y métodos: Se trataba de un paciente con estadio III diagnosticado en 1994 y tratado con gastrectomía subtotal. En febrero del 2003 se diagnostica recurrencia mediastínica y supraclavicular izquierda, administrándose quimioterapia y radioterapia alcanzando respuesta completa. Tras 6 meses libre de enfermedad, presenta una elevación de marcadores tumorales con pruebas complementarias (endoscopia digestiva alta, gammagrafía ósea y TC) negativas, efectuándose PET-FDG para descartar recurrencia. Resultados: La PET-FDG identificó lesiones probablemente malignas en región supraclavicular derecha y en mediastino, confirmándose dichos hallazgos por seguimiento clínico y la realización de una TC 4 meses más tarde. Conclusiones: Destacamos la detección de recurrencia precoz por PET-FDG en un carcinoma no intestinal gástrico, circunstancia que creemos de interés dada la mayor dificultad de la PET-FDG en la detección de carcinomas productores y/o secretores de moco
Objective: To present the case report of a patient with undifferentiated and diffuse signet-ring cell gastric carcinoma in which FDG-PET evidenced recurrent disease. Materials and methods: The patient was diagnosed of a stage III gastric carcinoma in 1994 and was treated with a subtotal gastrectomy. In February 2003, recurrent disease was detected in mediastinal and left supraclavicular lymph nodes. The patient was treated with chemotherapy and radiotherapy, reaching a complete response. After 6 months free of disease, he presented an elevation of the tumor markers with negative results in conventional imaging methods (upper digestive endoscopy, bone scintigraphy, and CT). An FDG-PET scan was performed to rule out recurrent disease. Results: FDG-PET detected pathologic findings suggestive of malignant disease in right supraclavicular and mediastinal lymph nodes. These findings were confirmed by clinical follow-up and with another CT scan performed 4 months later. Conclusions: In this case report we stress the importance of early recurrence by FDG-PET in a non-intestinal gastric carcinoma. This is of interest given the greater difficulty to detect mucous secreting and/or producing carcinomas with the PET-FDG
Subject(s)
Male , Aged , Humans , Stomach Neoplasms/pathology , Stomach Neoplasms/surgery , Carcinoma, Signet Ring Cell/pathology , Neoplasm Metastasis/drug therapy , Neoplasm Metastasis , Recurrence , Tomography, Emission-ComputedABSTRACT
Objetivo: La detección de la recurrencia secundaria a cáncer de ovario es un problema de importancia notoria, pudiendo mediante un diagnóstico correcto ofrecer alternativas útiles en el manejo de las pacientes. El objetivo de este estudio ha sido valorar el impacto terapéutico de la PET-FDG en la recurrencia por cáncer de ovario. Material y métodos: Se han incluido 43 enfermas con cáncer de ovario en las que se efectuó el estudio PET-FDG ante la sospecha diagnóstica de recidiva. Los resultados de la PET-FDG se confirmaron por histopatología y seguimiento clínico mayor de 12 meses. Se ha comparado el impacto en el manejo de las pacientes basado en los métodos convencionales de imagen, con el plan de tratamiento considerando los hallazgos de la PET-FDG, clasificando el impacto de la PET-FDG como alto, medio, bajo o no impacto. Los cambios en el manejo terapéutico de las enfermas, han sido clasificados como intermodalidad o intramodalidad. Resultados: El estudio PET-FDG obtuvo un impacto alto en el manejo terapéutico de 28 pacientes (65,1 %), un impacto medio en 2 pacientes (4,6 %), un impacto bajo en 9 pacientes (20,9 %), y no tuvo impacto en 4 enfermas (9,3 %). La PET-FDG indujo un cambio intermodalidad en 27 pacientes (62,8 %); un cambio intramodalidad en 3 pacientes (7 %); y finalmente en 13 enfermas (30,2 %), no produjo ningún cambio en el tratamiento. Conclusiones: La PET-FDG proporciona una información adicional con respecto a los métodos diagnósticos de imagen convencional, permitiendo efectuar cambios en el manejo terapéutico en la mayoría de las enfermas
Aim: Recurrent ovarian cancer is a major problem and an accurate diagnosis can often change patients' management. This study aimed to assess the impact on management of FDG-PET in recurrent ovarian cancer. Material and methods: Forty-three patients in whom FDG-PET scan was performed due to suspected recurrent ovarian cancer were included. FDG-PET results were confirmed by histopathology and clinical follow-up of at least 12 months. To assess impact on management the treatment plan based on conventional imaging methods was compared with the treatment plan based on inclusion of PET findings, classifying FDG-PET impact on management as high, medium, low or no impact. Management changes, when present, were classified as intermodality or intramodality. Results: FDG-PET had a high impact on therapeutic management in 28 patients (65.1 %), medium impact in 2 patients (4.6 %), low impact in 9 patients (20.9 %), and no impact in 4 patients (9.3 %). FDG-PET induced an intermodality change in management in 27 patients (62,8 %); intramodality changes were induced in 3 patients (7 %). Finally, it produced no treatment changes in 13 patients (30.2 %). Conclusion: FDG-PET supplied additional information when compared to conventional diagnostic procedures and allowed adequate management changes in most patients
Subject(s)
Female , Adult , Aged , Humans , Tomography, Emission-Computed , Radiopharmaceuticals , Fluorodeoxyglucose F18 , Neoplasm Recurrence, Local , Ovarian Neoplasms , Ovarian Neoplasms/therapy , Retrospective StudiesABSTRACT
AIM: Recurrent ovarian cancer is a major problem and an accurate diagnosis can often change patients' management. This study aimed to assess the impact on management of FDG-PET in recurrent ovarian cancer. MATERIAL AND METHODS: Forty-three patients in whom FDG-PET scan was performed due to suspected recurrent ovarian cancer were included. FDG-PET results were confirmed by histopathology and clinical follow-up of at least 12 months. To assess impact on management the treatment plan based on conventional imaging methods was compared with the treatment plan based on inclusion of PET findings, classifying FDG-PET impact on management as high, medium, low or no impact. Management changes, when present, were classified as intermodality or intramodality. RESULTS: FDG-PET had a high impact on therapeutic management in 28 patients (65.1 %), medium impact in 2 patients (4.6 %), low impact in 9 patients (20.9 %), and no impact in 4 patients (9.3 %). FDG-PET induced an intermodality change in management in 27 patients (62,8 %); intramodality changes were induced in 3 patients (7 %). Finally, it produced no treatment changes in 13 patients (30.2 %). CONCLUSION: FDG-PET supplied additional information when compared to conventional diagnostic procedures and allowed adequate management changes in most patients.
Subject(s)
Fluorodeoxyglucose F18 , Neoplasm Recurrence, Local/diagnostic imaging , Ovarian Neoplasms/diagnostic imaging , Ovarian Neoplasms/therapy , Positron-Emission Tomography , Radiopharmaceuticals , Adult , Aged , Female , Humans , Middle Aged , Retrospective StudiesABSTRACT
We present the case of an 11 year-old Caucasian girl who presented chest pain of 12 weeks evolution, with no other symptoms and a negative physical examination. Lactate dehydrogenase levels were increased to 797 U/l, whereas beta-2-microglobulin (BM2) levels were normal. The thoracic CT showed a bulky mediastinal mass that occupied the pretracheal, paratracheal and right prevascular regions. The gallium scintigraphy showed high uptake in the mediastinic region; the bone scintigraphy was negative. Biopsy of the mediastinal mass revealed the presence of diffuse large B-cell non-Hodgkin's lymphoma. Treatment included 4 cycles of chemotherapy followed by 7 days of subcutaneous granulocyte colony-stimulating factor (G-CSF, Lenogastrim) at a dose of 5 mg/Kg/day. Following treatment, a CT scan was performed to evaluate response, finding a calcification of the mass without significant reduction of the overall size. Because CT was inconclusive in the assessment of response to therapy, a 18F-FDG PET scan was performed. The 18F-FDG PET scan did not show any pathological uptake in the mediastinum but revealed a splenic and bone marrow diffusely increased 18F-FDG uptake. The differential diagnosis included a secondary effect induced by G-CSF therapy as one of the main possibilities, but other possibilities such as a malignant infiltration by lymphoma could not be discarded. Therefore, a second 18F-FDG PET scan was performed 3 months later. This study showed no pathological findings, with a normal 18F-FDG uptake in the spleen and bone marrow. Thus, the benign and reactive nature of the splenic and bone marrow 18F-FDG increased uptake found in the previous study was confirmed. We consider that the stimulating effect that G-CSF therapy has on the spleen and bone marrow must be taken into account when performing a 18F-FDG PET scan, as it can be an important source of false-positive results.
Subject(s)
Bone Marrow/diagnostic imaging , Bone Marrow/metabolism , Fluorodeoxyglucose F18/metabolism , Granulocyte Colony-Stimulating Factor/adverse effects , Radiopharmaceuticals/metabolism , Spleen/diagnostic imaging , Spleen/metabolism , Tomography, Emission-Computed , Child , Female , HumansSubject(s)
Central Nervous System Diseases/diagnostic imaging , Central Nervous System/diagnostic imaging , Fluorodeoxyglucose F18 , Radiopharmaceuticals , Tomography, Emission-Computed , Dementia/diagnostic imaging , Epilepsy/diagnostic imaging , Humans , Mental Disorders/diagnostic imaging , Psychotic Disorders/diagnostic imaging , Substance-Related Disorders/diagnostic imagingABSTRACT
No disponible
Subject(s)
Humans , Tomography, Emission-Computed , Radiopharmaceuticals , Psychotic Disorders , Substance-Related Disorders , Mental Disorders , Central Nervous System Diseases , Central Nervous System , Dementia , Epilepsy , Fluorodeoxyglucose F18 , Fluorodeoxyglucose F18Subject(s)
Liver Neoplasms/diagnostic imaging , Liver Neoplasms/secondary , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/secondary , Neoplasms, Unknown Primary/diagnostic imaging , Rectal Neoplasms/diagnostic imaging , Aged , Aged, 80 and over , Fluorodeoxyglucose F18 , Humans , Male , Radiopharmaceuticals , Rectal Neoplasms/pathology , Tomography, Emission-ComputedABSTRACT
No disponible
Subject(s)
Humans , Positron-Emission Tomography/methods , Nuclear Medicine/methods , Neoplasms , Neuroimaging/methods , Diagnostic Imaging/methods , 50303 , Fee-for-Service PlansABSTRACT
Cerebral perfusion in a previously untreated patient with obsessive-compulsive disorder was studied qualitatively and semi-quantitatively with SPECT before, and during and 6 wk after treatment with clomipramine. The patient's symptoms disappeared while on medication and relapsed after drug withdrawal. At baseline, there was an increased perfusion ratio in the bilateral orbitofrontal, anterior cingular, frontotemporal and right caudate regions. These alterations disappeared during drug therapy. After treatment discontinuation and symptomatic relapse, the same pattern of hyperactivity was found. Semiquantitative measurements after treatment withdrawal showed a return to perfusion values similar to those observed before treatment in subcortical structures. In cortical areas, this level was not completely achieved. Subtraction SPECT images showed perfusion changes at the orbitofrontal, caudate and thalamic levels.
Subject(s)
Brain/diagnostic imaging , Cerebrovascular Circulation/physiology , Clomipramine/therapeutic use , Obsessive-Compulsive Disorder/diagnostic imaging , Obsessive-Compulsive Disorder/drug therapy , Selective Serotonin Reuptake Inhibitors/therapeutic use , Tomography, Emission-Computed, Single-Photon , Adult , Case-Control Studies , Female , Humans , Obsessive-Compulsive Disorder/physiopathology , Organotechnetium Compounds , Oximes , Technetium Tc 99m ExametazimeABSTRACT
To evaluate the clinical usefulness of immunoscintigraphy with OC 125 in ovarian carcinoma, we studied 25 patients suspected of having ovarian carcinoma or in follow-up after surgery. Fourteen patients were studied with 131I-OC 125 F(ab')2 and 11 with 111In-OC 125 F(ab')2. No differences were observed with the use of either radionuclide. Global diagnostic indexes obtained were S = 100%, Sp = 44,5% and A = 81%. The low specificity obtained was remarkable: 5 false positive results in two uterine myomas, one abscess, one follicular cyst and one granulation tissue scar. On the other hand, all lesions of ovarian carcinoma were detected. Analysis of the evolution of tumor/background (T/B) uptake ratios from the first to the second day of exploration revealed a tendency for the ratio to diminish significantly (greater than 15%) in false positive cases with the exception of the abscess while this did not happen in true positive cases, with the exception of a regional recurrence. Analysis of T/B ratio variations could contribute towards elevating the test's specificity.
