Role of 18F-FDG PET/CT in diagnosing peritoneal carcinomatosis in the restaging of patient with ovarian cancer as compared to contrast enhanced CT and tumor marker Ca-125 / Papel del 18F-FDG PET/CT en el diagnóstico de carcinomatosis peritoneal en la reclasificación de los pacientes con cáncer de ovario en comparación con el TC con contraste y con el marcador tumoral Ca-125

Objectives. To investigate the role of whole-body fluorine-18-2-deoxy-2-fluoro- d -glucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the identification of peritoneal carcinomatosis in patients with ovarian cancer (OC). Material and methods. Seventy-nine patients with histologically proven stages III-IV OC who underwent 18F-FDG PET/CT were studied retrospectively. We considered group A as 51 patients who also underwent computed-tomography with contrast-enhancement (CECT), and group B as 35 patients who had also been tested for biomarker Ca-125. Sensitivity, specificity, accuracy, positive predictive values (PPV) and negative predictive values (NPV) of 18F-FDG PET/CT as compared to CECT and to Ca-125 were evaluated. Results. 18F-FDG PET/CT’ sensitivity, specificity, accuracy, PPV and NPV for all 79 patients were: 85%, 92.31%, 88.61%, 91.89% and 85.71%, respectively. 18F-FDG PET/CT sensitivity in group A was 78.6%, while it was 53.6% for CECT. 18F-FDG PET/CT specificity, calculated in the same group, was 91.3%, while that of CECT was 60.9% (statistically significant difference, McNemar 4, P = 0.039). Accuracy was 84.3% and 56.9%, respectively. 18F-FDG PET/CT’ sensitivity in group B was 86.4%, while that of Ca-125 was 81.8% (no statistical difference, McNemar 0, P = 1). 18F-FDG PET/CT specificity in group B was 84.6% while that of Ca-125 was 38.5% (clear but not statistically significant difference, McNemar 3.12, P = 0.070). Accuracy calculated in the same group was 85.7% for 18F-FDG PET/CT and 65.7% for Ca-125. Conclusion. 18F-FDG PET/CT is a useful diagnostic tool when peritoneal biopsy cannot be performed and it can better select those who are candidates for adjuvant chemotherapy (AU)

Objetivos. Investigar el papel de flúor-18-2-desoxi-2-fluoro-D-glucosa tomografía por emisión de positrones/tomografía computarizada (18F-FDG PET/CT) en la identificación de la carcinomatosis peritoneal en pacientes con cáncer de ovario (CO). Material y métodos. Setenta y nueva pacientes con CO en estadio III-IV que se sometieron a 18F-FDG PET/CT fueron estudiadas retrospectivamente. Consideramos el grupo A de 51 pacientes que también realizaron la tomografía computarizada con contraste (CECT) y el grupo B de 35 pacientes que tenían cuantificación del Ca-125. Se evaluó sensibilidad, especificidad, exactitud, valor predictivo positivo (VPP) y valores predictivos negativos (VPN) de 18F-FDG PET/CT en comparación con CECT y Ca-125.Resultados. La sensibilidad, especificidad, exactitud, VPP y VPN de 18F-FDG PET/CT en los 79 pacientes fueron: 85, 92,31, 88,61, 91,89 y 85,71% respectivamente. La sensibilidad de 18F-FDG PET/CT en el grupo A fue de 78,6% y de 53,6% por CECT. La especificidad de 18F-FDG PET/CT en el mismo grupo fue de 91,3%, mientras la de CECT del 60,9% (diferencia estadísticamente significativa, McNemar = 4, P = 0,039); la exactitud fue respectivamente de 84,3 y 56,9%. La sensibilidad de la 18F-FDG PET/CT en el grupo B fue de 86,4%, mientras que la del Ca-125 fue de 81,8% (sin diferencia estadística, McNemar = 0, P = 1). La especificidad 18F-FDG PET/CT en el grupo B fue de 84,6%, mientras que la del Ca-125 fue de 38,5% (diferencia evidente, no estadísticamente significativa, McNemar = 3,12, P = 0,070). La exactitud en el mismo grupo fue 85,7% para el 18F-FDG PET/CT y 65,7% para Ca-125. Conclusión. La 18F-FDG PET/CT es un instrumento de diagnóstico útil cuando la biopsia peritoneal no se puede realizar y puede seleccionar de manera mejor las candidatas a quimioterapia adyuvante (AU)

Role of 18F-FDG PET/CT in diagnosing peritoneal carcinomatosis in the restaging of patient with ovarian cancer as compared to contrast enhanced CT and tumor marker Ca-125.

OBJECTIVES: To investigate the role of whole-body fluorine-18-2-deoxy-2-fluoro-d-glucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) in the identification of peritoneal carcinomatosis in patients with ovarian cancer (OC). MATERIAL AND METHODS: Seventy-nine patients with histologically proven stages III-IV OC who underwent (18)F-FDG PET/CT were studied retrospectively. We considered group A as 51 patients who also underwent computed-tomography with contrast-enhancement (CECT), and group B as 35 patients who had also been tested for biomarker Ca-125. Sensitivity, specificity, accuracy, positive predictive values (PPV) and negative predictive values (NPV) of (18)F-FDG PET/CT as compared to CECT and to Ca-125 were evaluated. RESULTS: (18)F-FDG PET/CT' sensitivity, specificity, accuracy, PPV and NPV for all 79 patients were: 85%, 92.31%, 88.61%, 91.89% and 85.71%, respectively. (18)F-FDG PET/CT sensitivity in group A was 78.6%, while it was 53.6% for CECT. (18)F-FDG PET/CT specificity, calculated in the same group, was 91.3%, while that of CECT was 60.9% (statistically significant difference, McNemar 4, P=0.039). Accuracy was 84.3% and 56.9%, respectively. (18)F-FDG PET/CT' sensitivity in group B was 86.4%, while that of Ca-125 was 81.8% (no statistical difference, McNemar 0, P=1). (18)F-FDG PET/CT specificity in group B was 84.6% while that of Ca-125 was 38.5% (clear but not statistically significant difference, McNemar 3.12, P=0.070). Accuracy calculated in the same group was 85.7% for (18)F-FDG PET/CT and 65.7% for Ca-125. CONCLUSION: (18)F-FDG PET/CT is a useful diagnostic tool when peritoneal biopsy cannot be performed and it can better select those who are candidates for adjuvant chemotherapy.

18F-FDG Positron Emission Tomography/Computed Tomography in the Diagnosis and Post-Therapeutic Treatment in a Patient with an Early Stage of Retroperitoneal Fibrosis.

UNLABELLED: Here, we report an experience about 18F-FDG-PET/CT in a patient with an early stage of Idiopathic Retroperitoneal Fibrosis (IRF). At the diagnosis Contrast Enhanced Computed Tomography (CE-CT) revealed periaortic solid tissue in the infrarenal section and locoregional lymph nodes; findings were interpreted as lymphomatous tissue. 18F-FDG-PET/CT showed elevated 18F-FDG uptake in the periaortic tissue but no uptake was detected in lymph nodes. The histologic examination showed recent-onset IRF. The patient began corticosteroid therapy. Nearly at the end of the therapy, CE-CT showed the enlargement of the fibrous tissue and 18F-FDG-PET/CT showed an increased 18F-FDG uptake in the aforesaid lesion and another area of uptake in the aortic wall. 18F-FDG-PET/CT can play an important role in the diagnosis of patients with an initial clinical suspicion of retroperitoneal fibrosis and in their management. Then the patient began a therapy with methotrexate and after six months we performed an 18F-FDG-PET/CT which didn't show 18F-FDG uptake. CONFLICT OF INTEREST: None declared.

Radio-guided sentinel lymph node identification by lymphoscintigraphy fused with an anatomical vector profile: clinical applications.

OBJECTIVE: To develop a method to fuse lymphoscintigraphic images with an adaptable anatomical vector profile and to evaluate its role in the clinical practice. METHODS: We used Adobe Illustrator CS6 to create different vector profiles, we fused those profiles, using Adobe Photoshop CS6, with lymphoscintigraphic images of the patient. We processed 197 lymphoscintigraphies performed in patients with cutaneous melanomas, breast cancer or delayed lymph drainage. RESULTS: Our models can be adapted to every patient attitude or position and contain different levels of anatomical details ranging from external body profiles to the internal anatomical structures like bones, muscles, vessels, and lymph nodes. If needed, more new anatomical details can be added and embedded in the profile without redrawing them, saving a lot of time. Details can also be easily hidden, allowing the physician to view only relevant information and structures. Fusion times are about 85 s. The diagnostic confidence of the observers increased significantly. The validation process showed a slight shift (mean 4.9 mm). CONCLUSIONS: We have created a new, practical, inexpensive digital technique based on commercial software for fusing lymphoscintigraphic images with built-in anatomical reference profiles. It is easily reproducible and does not alter the original scintigraphic image. Our method allows a more meaningful interpretation of lymphoscintigraphies, an easier recognition of the anatomical site and better lymph node dissection planning.

Whole-body MR-DWIBS vs. [18F]-FDG-PET/CT in the study of malignant tumors: a retrospective study.

PURPOSE: Our aim was to assess the overall diagnostic accuracy of magnetic resonance diffusion-weighted whole-body imaging with background signal suppression (MR-DWIBS) compared with ([(18)F]-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT), considered the reference standard of whole-body tumour imaging modalities, in a series of consecutive patients with malignant tumour. MATERIALS AND METHODS: Thirty-eight patients diagnosed with a malignant tumour over a 4-month period were enrolled in this retrospective, observational study. PET/CT and MR-DWIBS images were reviewed in double-blind manner by a nuclear medicine physician and radiologists with 4 years experience. Lesion size, standard uptake value (SUV) and apparent diffusion coefficient (ADC) were measured and calculated for each lesion. RESULTS: The qualitative analysis of MR-DWIBS and [(18)F]-FDG-PET/CT showed that two patients were negative at both techniques. MR-DWIBS was positive in 36 patients, 34 of whom were positive and two negative at [(18)F]-FDG-PET/CT, respectively. Two hundred and fifty-five lesions were identified by MR-DWIBS and 184 by [(18)F]-FDG-PET/CT, which was a significative discordance. Correlation between SUV and ADC of lesions positive at both techniques was not statistically significant. The mean difference between lesion size in [(18)F]-FDG-PET/CT and MR-DWIBS was not statistically significant. No correlation was found between glucose metabolism and water motion. CONCLUSIONS: MR-DWIBS may be used to evaluate localisation of parenchymal neoplasms but is less efficacious in characterising lymph-node and skeletal lesions. [(18)F]-FDG-PET/CT remains the best whole-body technique to identify lymph-node and skeletal lesions, but its limitation is identifying tumours with low glucose metabolism as in mucinous neoplasms. MR-DWIBS evaluation must be integrated with morphological images to increase MR diagnostic accuracy.

[A program of combined ECG and VCG automatic diagnosis. Note I. The atriogram]. / Su di un programma di diagnostica automatica combinata in ECG e VCG. Nota I. L'atriogramma

In this paper a new computer aided ECG and VCG data handling is analized. It is based on an optimum estimation of dipole moment, which is used as the main diagnosis parameter. Already known diagnostical methods (available in present literature) are compared with this new technique. The available diagnostical range has been increased widely. The sensitivity of such a program is being analyzed both for normal and abnormal cases.