ABSTRACT
PURPOSE OF REVIEW: Multiple myeloma is a common hematological malignancy arising in the bone marrow. Bone lesions were initially depicted with conventional radiography, although recently F-FDG PET/CT and MRI are recognized as having a clear role in the initial workup and in the evaluation of therapy response. RECENT FINDINGS: Tumor development produces osteolysis and expansive lesions. Although tumor burden and extent are key prognostic factors, different cancer hallmarks can also be evaluated in vivo through noninvasive imaging. SUMMARY: This imaging-based virtual biopsy approach might be useful to define several relevant prognostic markers, such as angiogenesis, cellularity, metabolic trapping and bone morphology and elasticity, both before and during treatment, to predict tumor behavior and the early effect of therapy.
Subject(s)
Bone Marrow , Multiple Myeloma/diagnosis , Bone Marrow/diagnostic imaging , Bone Marrow/pathology , Fluorodeoxyglucose F18 , Humans , Magnetic Resonance Imaging/methods , Multiple Myeloma/pathology , Positron-Emission Tomography/methods , Radiopharmaceuticals , Tomography, X-Ray Computed/methodsABSTRACT
BACKGROUND: An alteration of the autonomic nervous system has been described in heart failure (HF). The aim of this study was to assess, compare and relate the impairment of both arms of the autonomic nervous systems, the sympathetic and parasympathetic (SNS and PNS) in a same group of patients. METHODS: We analyzed 23 patients with advanced HF (NYHA III-IV/IV and IV/IV) and EF<35% who were on the waiting list for heart transplantation. We assessed the SNS by determining cardiac uptake of (123)I metaiodobenzylguanidine, and analyzed the heart mediastinum rate (HMR) and the myocardial washout rate (WR). The PNS was assessed by 24-hour Holter ECG recording and subsequent analyses of heart rate turbulence (HRT) in which turbulence onset (TO) and turbulence slope (TS) were determined. RESULTS: In the study of the SNS, HMR values were 1.32 ± 0.12, and WR 0.36 ± 0.1. Higher creatinine levels were associated with a lower WR (r=-0.604; p=0.02). In the study of the SNP, TO was higher the lower the LVEF (r=-0.410; p=0.052), and age was associated with a lower TS (r=-0.4; p=0.059). In the study of the relationships between the SNS and PNS, HMR was correlated in a nearly significant manner with TO (r=-0.399; p=0.059) and WR with TS (r=-0.447; p=0.033). CONCLUSIONS: In stable patients with advanced HF (NYHA III-IV and IV/IV), a significant and parallel impairment occurs in both arms of the autonomic nervous system. This could have prognostic implications and would help to prioritize patients on the waiting list for heart transplantation.
