ABSTRACT
objetivo Analizar la literatura disponible sobre el valor pronóstico de los parámetros metabólicos de la 18F-FDG PET/TC preoperatoria y su utilidad en la estratificación de riesgo en pacientes con cáncer de endometrio (CE). Material y métodos En búsquedas de Pubmed se utilizó «(endometr* OR uter*) AND (PET OR FDG)» como palabras clave desde enero-2000 hasta junio-2020. Se revisaron referencias en los artículos incluidos buscando posibles publicaciones no incluidas en la primera búsqueda. Se incluyeron los estudios que evaluaron el valor pronóstico de la 18F-FDG PET/TC preoperatoria y su papel para la estratificación del riesgo en pacientes con CE. Los artículos no originales (revisiones, editoriales, cartas, casos legales, entrevistas, informes de casos, etc.) no fueron incluidos. Resultados Veintiséis estudios (1.918 pacientes) fueron elegidos según los criterios de inclusión en esta revisión. Se incluyeron 13 estudios (939 pacientes) relacionados con el papel pronóstico de la 18F-FDG PET/TC preoperatoria y 14 estudios (1.036 pacientes) relacionados con su papel en la estratificación de riesgo. Parámetros como SUVmáx, volumen tumoral metabólico (VTM) y glicólisis total de lesión (GTL) del tumor primario fueron analizados. Conclusiones El SUVmáx preoperatorio es útil para realizar diagnósticos no invasivos y decidir la estrategia terapéutica adecuada, ya que podría utilizarse como marcador pronóstico independiente de recurrencia y supervivencia en el CE. Además, tanto VTM como GTL preoperatorios podrían ser factores pronósticos independientes para predecir recurrencia y supervivencia, pero, aun no existe suficiente evidencia científica. La utilidad del SUVmáx para la estratificación del riesgo es limitada (no existe literatura suficiente acerca de que la 18F-FDG PET/TC pueda sustituir la estadificación quirúrgica), aunque el VTM y la GTL sí que son más precisos y tienen un valioso papel en la estratificación del riesgo del CE (AU)
Objective To analyse the available literature on the prognostic value of preoperative 18F-FDG PET/CT metabolic parameters and their usefulness in risk stratification in patients with endometrial cancer (EC). Material and methods Pubmed searches used «(endometr* OR uter*) AND (PET OR FDG)» as keywords from January-2000 to June-2020. References in included articles were checked for possible publications not included in the first search. Studies evaluating the prognostic value of preoperative 18F-FDG PET/CT and its role for risk stratification in patients with EC were included. Non-original articles (reviews, editorials, letters, legal cases, interviews, case reports, etc.) were not included. Results Twenty-six studies (1918 patients) were selected according to the inclusion criteria in this review. Thirteen studies (939 patients) related to the prognostic role of preoperative 18F-FDG PET/CT and 14 studies (1036 patients) related to its role in risk stratification were included. Parameters such as SUVmax, metabolic tumour volume (MTV) and total lesion glycolysis (TLG) of the primary tumour were analysed. Conclusions Preoperative SUVmax is useful for non-invasive diagnosis and for deciding the appropriate therapeutic strategy, as it could be used as an independent prognostic marker for recurrence and survival in EC. In addition, both preoperative VTM and GTL could be independent prognostic factors for predicting recurrence and survival, but there is still insufficient scientific evidence. The usefulness of SUVmax for risk stratification is limited (there is insufficient literature that 18F-FDG PET/CT can replace surgical staging), although VTM and GTL are more accurate and have a valuable role in risk stratification of EC. However, larger multicentre studies with adequate follow-up time are needed to confirm these findings (AU)
Subject(s)
Humans , Female , Endometrial Neoplasms/diagnostic imaging , Endometrial Neoplasms/surgery , Fluorodeoxyglucose F18 , Positron Emission Tomography Computed Tomography , Risk Assessment , Surgical Clearance , PrognosisABSTRACT
Objetivo: Como hay poca literatura sobre el tema, nos propusimos comparar la utilidad diagnóstica del análisis semicuantitativo versus el análisis visual en la escintigrafía de glóbulos blancos etiquetados (WBCS) para la infección osteoarticular. Se evaluaron protocolos de uno y dos días, en particular en los dispositivos ortopédicos.Material y métodos: Estudio prospectivo de 79 pacientes consecutivos con sospecha de infección osteoarticular. En todos los pacientes, la SCBM se realizó a los 30 min, 4 h, 8 h y 24 h. Las imágenes se analizaron agrupándolas en dos protocolos: protocolo de un día (los expertos evaluaron imágenes planas de 30 min, 4 h y 8 h) y protocolo de dos días (los expertos evaluaron imágenes planas de 30 min, 4 h y 24 h). Las imágenes planas se interpretaron cualitativa y semicuantitativamente y también se compararon agrupando a los pacientes con y sin dispositivos ortopédicos. Para determinar qué valor de corte de la variación porcentual podía predecir la infección osteoarticular, se calcularon múltiples valores de corte en ambos protocolos a partir del índice de Youden. Tres lectores ciegos analizaron las imágenes.Resultados: Comparando el diagnóstico final, el análisis visual del protocolo de un día proporcionó mejores resultados con una sensibilidad del 95,5%, una especificidad del 93% y una precisión diagnóstica del 93,7% (p < 0,01) que el protocolo de dos días con valores del 86,4%, 94,7% y 92,4%, respectivamente (p < 0,01). Para el análisis semicuantitativo, el protocolo de un día también obtuvo mejores resultados con una sensibilidad del 72,7%, una especificidad del 78,9% y una precisión del 77,2% (p < 0,01) que el protocolo de dos días (sin resultados significativos; p = 0,14), especialmente en el grupo de pacientes con aparatos ortopédicos (sensibilidad del 100%, especificidad del 79,5% y precisión del 82,7%; p < 0,01)
Objective: As scarce literature on the topic is available, we aimed to compare diagnostic utility of semi-quantitative versus visual analysis in labelled white blood cell scintigraphy (WBCS) for osteoarticular infection. One-day and two-day protocols were assessed, particularly in orthopaedic devices.Material and methods: Prospective study of 79 consecutive patients with suspected osteoarticular infection. In all patients, WBCS were performed at 30min, 4h, 8h and 24h. Images were analysed by grouping in two protocols: one-day-protocol (experts evaluated 30min, 4h and 8h planar images) and two-day-protocol (experts evaluated 30min, 4h and 24h planar images). Planar images were interpreted qualitative and semiquantitatively and also were compared grouping patients with and without orthopaedic devices. To find which cut-off value of the percentage variation could predict of osteoarticular infection, multiple cut-off values were calculated in both protocols from the Youden index. Three blinded readers analysed the images.Results: Comparing final diagnosis visual analysis of the one-day-protocol provided better results with sensitivity of 95.5%, specificity of 93% and diagnostic accuracy of 93.7% (P<.01) than the two-day-protocol with values of 86.4%, 94.7% and 92.4%, respectively (P<.01). For semi-quantitative analysis, the one-day-protocol also obtained better results with sensitivity of 72.7%, specificity of 78.9% and accuracy of 77.2% (P<.01) than two-day-protocol (no significant results; P=.14), especially in the group of patients with orthopaedic devices (sensitivity of 100%, specificity of 79.5% and accuracy of 82.7%; P<.01).Conclusions: Most accurate approach in the diagnosis of osteoarticular infection corresponded to visual analysis in one-day-protocol that showed greater sensitivity and specificity than semi-quantitative analysis. Semi-quantitative analysis only could be useful when visual analysis is doubtful
Subject(s)
Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Leukocytes , Bone Diseases, Infectious/diagnostic imaging , Sensitivity and Specificity , Predictive Value of Tests , Clinical ProtocolsABSTRACT
OBJECTIVE: As scarce literature on the topic is available, we aimed to compare diagnostic utility of semi-quantitative versus visual analysis in labelled white blood cell scintigraphy (WBCS) for osteoarticular infection. One-day and two-day protocols were assessed, particularly in orthopaedic devices. MATERIAL AND METHODS: Prospective study of 79 consecutive patients with suspected osteoarticular infection. In all patients, WBCS were performed at 30min, 4h, 8h and 24h. Images were analysed by grouping in two protocols: one-day-protocol (experts evaluated 30min, 4h and 8h planar images) and two-day-protocol (experts evaluated 30min, 4h and 24h planar images). Planar images were interpreted qualitative and semiquantitatively and also were compared grouping patients with and without orthopaedic devices. To find which cut-off value of the percentage variation could predict of osteoarticular infection, multiple cut-off values were calculated in both protocols from the Youden index. Three blinded readers analysed the images. RESULTS: Comparing final diagnosis visual analysis of the one-day-protocol provided better results with sensitivity of 95.5%, specificity of 93% and diagnostic accuracy of 93.7% (P<.01) than the two-day-protocol with values of 86.4%, 94.7% and 92.4%, respectively (P<.01). For semi-quantitative analysis, the one-day-protocol also obtained better results with sensitivity of 72.7%, specificity of 78.9% and accuracy of 77.2% (P<.01) than two-day-protocol (no significant results; P=.14), especially in the group of patients with orthopaedic devices (sensitivity of 100%, specificity of 79.5% and accuracy of 82.7%; P<.01). CONCLUSIONS: Most accurate approach in the diagnosis of osteoarticular infection corresponded to visual analysis in one-day-protocol that showed greater sensitivity and specificity than semi-quantitative analysis. Semi-quantitative analysis only could be useful when visual analysis is doubtful. In patients with joint prostheses, an increase in percentage variation above 9% obtained maximum sensitivity and negative predictive value.
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AIM: To analyze the relationship between measurements of global heterogeneity, obtained from 18F-FDG PET/CT, with biological variables, and their predictive and prognostic role in patients with locally advanced breast cancer (LABC). MATERIAL AND METHODS: 68 patients from a multicenter and prospective study, with LABC and a baseline 18F-FDG PET/CT were included. Immunohistochemical profile [estrogen receptors (ER) and progesterone receptors (PR), expression of the HER-2 oncogene, Ki-67 proliferation index and tumor histological grade], response to neoadjuvant chemotherapy (NC), overall survival (OS) and disease-free survival (DFS) were obtained as clinical variables. Three-dimensional segmentation of the lesions, providing SUV, volumetric [metabolic tumor volume (MTV) and total lesion glycolysis (TLG)] and global heterogeneity variables [coefficient of variation (COV) and SUVmean/SUVmax ratio], as well as sphericity was performed. The correlation between the results obtained with the immunohistochemical profile, the response to NC and survival was also analyzed. RESULTS: Of the patients included, 62 received NC. Only 18 responded. 13 patients relapsed and 11 died during follow-up. ER negative tumors had a lower COV (p=0.018) as well as those with high Ki-67 (p=0.001) and high risk phenotype (p=0.033) compared to the rest. No PET variable showed association with the response to NC nor OS. There was an inverse relationship between sphericity with DFS (p=0.041), so, for every tenth that sphericity increases, the risk of recurrence decreases by 37%. CONCLUSIONS: Breast tumors in our LABC dataset behaved as homogeneous and spherical lesions. Larger volumes were associated with a lower sphericity. Global heterogeneity variables and sphericity do not seem to have a predictive role in response to NC nor in OS. More spherical tumors with less variation in gray intensity between voxels showed a lower risk of recurrence.
Subject(s)
Breast Neoplasms/diagnostic imaging , Fluorodeoxyglucose F18 , Positron Emission Tomography Computed Tomography , Radiopharmaceuticals , Breast Neoplasms/pathology , Female , Humans , Immunohistochemistry , Neoplasm Staging , Positron Emission Tomography Computed Tomography/methods , Predictive Value of Tests , PrognosisABSTRACT
AIM: To investigate the usefulness of metabolic variables using 18F-FDG PET/CT in the prediction of neoadjuvant chemotherapy (NC) response and the prognosis in locally advanced breast cancer (LABC). MATERIAL AND METHODS: Prospective study including 67 patients with LABC, NC indication and a baseline 18F-FDG PET/CT. After breast tumor segmentation, SUV variables (SUVmax, SUVmean and SUVpeak) and volume-based variables, such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG), were obtained. Tumors were grouped into molecular phenotypes, and classified as responders or non-responders after completion of NC. Disease-free status (DFs), disease-free survival (DFS), and overall survival (OS) were assessed. A univariate and multivariate analysis was performed to study the potential of all variables to predict DFs, DFS, and OS. RESULTS: Fourteen patients were classified as responders. Median±SD of DFS and OS was 43±15 and 46±13 months, respectively. SUV and TLG showed a significant correlation (p<0.005) with the histological response, with higher values in responders compared to non-responders. MTV and TLG showed a significant association with DFs (p=0.015 and p=0.038 respectively). Median, mean and SD of MTV and TLG for patients with DFs were: 8.90, 13.73, 15.10 and 33.78, and 90.54 and 144.64, respectively. Median, mean and SD of MTV and TLG for patients with non-DFs were: 16.72, 29.70 and 31.09 and 90.89, 210.98 and 382.80, respectively. No significant relationships were observed with SUV variables and DFs. Volume-based variables were significantly associated with OS and DFS, although in multivariate analysis only MTV was related to OS. No SUV variables showed an association with the prognosis. CONCLUSION: Volume-based metabolic variables obtained with 18F-FDG PET/CT, unlike SUV based variables, were good predictors of both neoadjuvant chemotherapy response and prognosis.
Subject(s)
Breast Neoplasms/diagnostic imaging , Fluorine Radioisotopes/analysis , Fluorodeoxyglucose F18/analysis , Neoadjuvant Therapy , Positron Emission Tomography Computed Tomography/methods , Radiopharmaceuticals/analysis , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/drug therapy , Breast Neoplasms/metabolism , Breast Neoplasms/surgery , Combined Modality Therapy , Disease-Free Survival , Female , Glycolysis , Humans , Kaplan-Meier Estimate , Lymphatic Metastasis/diagnostic imaging , Mastectomy , Middle Aged , Prognosis , Proportional Hazards Models , Prospective Studies , Tumor BurdenABSTRACT
OBJECTIVE: A retrospective study, using a prospective database, was conducted on patients treated with surgery in order to analyze the prognosis between two groups: NSCLC (non-small cell lung cancer) patients with occult N2 disease and patients with single station N2 disease observed on pre-operative integrated PET/CT scan. METHODS: A total of 772 patients underwent surgical treatment for lung cancer from January 2007 to December 2014. All of them had an integrated PET/CT scan in the pre-operative work-up and a pulmonary resection plus mediastinal lymphadenectomy were performed in all cases. In the selected cases, no one received induction treatment. All patients from both groups had N2 disease after examination of the histopathology specimen. Clinical and pathological characteristics, disease free survival, and overall survival, were analyzed in both groups. RESULTS: A total of 34 cases presented occult N2 disease, whereas 11 cases showed single station N2 disease on pre-operative PET/CT scan. Mean disease free survival and mean overall survival for occult N2 disease compared to single-station N2 disease on PET/CT scan was 36.0 months (95% CI: 24.9-47.1) and 38.9 months (95% CI: 20.6-57.1), p=.586; and 52.3 months (95% CI: 38.9-65.7) and 38.2 months (95% CI: 21.9-54.5), p=.349, respectively. CONCLUSION: The prognosis of patients with single-station N2 disease on PET/CT scan treated by surgical resection and mediastinal lymphadenectomy as first line treatment was similar to those with occult N2 disease. More studies are needed to support our findings.
Subject(s)
Carcinoma, Non-Small-Cell Lung/diagnostic imaging , Carcinoma, Non-Small-Cell Lung/pathology , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/pathology , Positron Emission Tomography Computed Tomography , Adult , Aged , Aged, 80 and over , Carcinoma, Non-Small-Cell Lung/mortality , Carcinoma, Non-Small-Cell Lung/surgery , Female , Humans , Lung Neoplasms/mortality , Lung Neoplasms/surgery , Male , Middle Aged , Neoplasm Staging , Prognosis , Prospective Studies , Survival RateABSTRACT
OBJECTIVES: To study 18F-Choline PET/CT in the diagnosis and biopsy guide of prostate cancer (pCa) in patients with persistently high prostate-specific antigen (PSA) and previous negative prostate biopsy. To compare the clinical risk factors and metabolic variables as predictors of malignancy. METHODS: Patients with persistently elevated PSA in serum (total PSA >4ng/mL) and at least a previous negative or inconclusive biopsy were consecutively referred for a whole body 18F-Choline PET/CT. Patient age, PSA level, PSA doubling time (PSAdt) and PSA velocity (PSAvel) were obtained. PET images were visually (positive or negative) and semiquantitatively (SUVmax) reviewed. 18F-Choline uptake prostate patterns were defined as focal, multifocal, homogeneous or heterogeneous. Histology on biopsy using transrectal ultrasound-guided approach was the gold standard. Sensitivity (Se), specificity (Sp) and accuracy (Ac) of PET/CT for diagnosis of pCa were evaluated using per-patient and per-prostate lobe analysis. Receiver-operating-characteristic (ROC) curve analysis was used to assess the value of SUVmax to diagnose pCa. Correlation between PET/CT and biopsy results per-prostate lobe was assessed using the Chi-square test. Univariate and multivariate logistic regression analysis were applied to compare clinical risk factors and metabolic variables as predictors of malignancy. RESULTS: Thirty-six out of 43 patients with histologic confirmation were included. In 11 (30.5%) patients, pCa was diagnosed (Gleason score from 4 to 9). The mean values of patient age, PSA level, PSAdt and PSAvel were: 65.5 years, 15.6ng/ml, 28.1 months and 8.5ng/mL per year, respectively. Thirty-three patients had a positive PET/CT; 18 had a focal pattern, 7 multifocal, 4 homogeneous and 4 heterogeneous. Se, Sp and Ac of PET/CT were of 100%, 12% and 38% in the patient based analysis, and 87%, 29% and 14% in the prostate lobe based analysis, respectively. The ROC curve analysis of SUVmax showed an AUC of 0.568 (p=0.52). On a lobe analysis, poor agreement was observed between PET/CT findings and biopsy results (p=0.097). In the univariate/multivariate analysis, none of clinical and metabolic variables were statistically significant as predictor of pCa. CONCLUSION: Choline PET/CT is a suitable procedure for the detection of pCa in highly selected patients, however, a high rate of false positive should be expected.
Subject(s)
Adenocarcinoma/diagnostic imaging , Biopsy, Needle/methods , Image-Guided Biopsy/methods , Positron Emission Tomography Computed Tomography , Prostate-Specific Antigen/blood , Prostatic Neoplasms/diagnostic imaging , Whole Body Imaging , Adenocarcinoma/blood , Adenocarcinoma/pathology , Aged , Choline , False Positive Reactions , Fluorine Radioisotopes , Humans , Male , Middle Aged , Prospective Studies , Prostatic Neoplasms/blood , Prostatic Neoplasms/pathology , Prostatitis/diagnostic imaging , Sensitivity and SpecificityABSTRACT
OBJECTIVE: To investigate the relationship between maximum standardised uptake value (SUVmax) of ovarian lesions and histopathology subtypes, and their involvement in the response and prognosis of patients with epithelial ovarian carcinoma (EOC). MATERIAL AND METHODS: A retrospective analysis of 31 patients with EOC and 18F-FDG-PET/CT before treatment, including an assessment of the SUVmax of ovarian lesion. Histopathological diagnosis and follow-up was performed. A study was made on the relationship between the SUVmax and histological type (type I and II) and tumour stage, as well as the role of various parameters (SUVmax, histology, stage) on the patient outcomes (complete response [CR], overall survival [OS], disease-free survival [DFS], and disease-free [DF] status, at 12 and 24 months). RESULTS: The medium SUVmax in type I lesions was lower than in type II (6.3 and 9.3, respectively; P=.03). A 7.1 cut-off was set for SUVmax in order to identify type II EOC (sensitivity: 77.8%, specificity: 69.2%; AUC=0.748; P=.02). No significant relationship was found between tumour stage and SUVmax. CR was more common in early stages; relative risk (RR) of 1.64; P=.003, as well as in type I tumours and a lower SUVmax. Tumour stage was decisive in DFS (P=.04), LE24m (0.07) and OS (P=.08). Longer DFS and a higher percentage of DF 24m were observed in type I tumours (RR: 1.32; P=.26). CONCLUSIONS: SUVmax was related to EOC histology, so could predict the response and prognosis of these patients. No association was found between glycolytic activity of the primary tumor with the response and prognosis.
Subject(s)
Neoplasms, Glandular and Epithelial/diagnostic imaging , Ovarian Neoplasms/diagnostic imaging , Positron Emission Tomography Computed Tomography , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Ovarian Epithelial , Combined Modality Therapy , Disease-Free Survival , Female , Fluorine Radioisotopes , Fluorodeoxyglucose F18 , Follow-Up Studies , Humans , Kaplan-Meier Estimate , Middle Aged , Models, Biological , Neoadjuvant Therapy , Neoplasms, Glandular and Epithelial/etiology , Neoplasms, Glandular and Epithelial/pathology , Neoplasms, Glandular and Epithelial/therapy , Ovarian Neoplasms/etiology , Ovarian Neoplasms/pathology , Ovarian Neoplasms/therapy , Ovariectomy , Prognosis , Radiopharmaceuticals , Retrospective StudiesSubject(s)
Adjuvants, Immunologic/therapeutic use , BCG Vaccine/therapeutic use , Carcinoma, Transitional Cell/therapy , Fever of Unknown Origin/etiology , Neoplasm Recurrence, Local/therapy , Positron Emission Tomography Computed Tomography , Tuberculosis/complications , Urinary Bladder Neoplasms/therapy , Fever of Unknown Origin/diagnostic imaging , Fluorodeoxyglucose F18 , Humans , Male , Radiopharmaceuticals , Tuberculosis/diagnostic imagingABSTRACT
OBJECTIVE: F-18 fluorodeoxyglucose integrated PET-CT scan is commonly used in the work-up of lung cancer to improve preoperative disease stage. The aim of the study was to analyze the ratio between SUVmax of N1 lymph nodes and primary lung cancer to establish prediction of mediastinal disease (N2) in patients operated on non-small cell lung cancer. MATERIAL AND METHOD: This is a retrospective study of a prospective database. Patients operated on non-small cell lung cancer (NSCLC) with N1 disease by PET-CT scan were included. None of them had previous induction treatment, but they underwent standard surgical resection plus systematic lymphadenectomy. RESULTS: There were 51 patients with FDG-PET-CT scan N1 disease. 44 (86.3%) patients were male with a mean age of 64.1±10.8 years. Type of resection: pneumonectomy=4 (7.9%), lobectomy/bilobectomy=44 (86.2%), segmentectomy=3 (5.9%). HISTOLOGY: adenocarcinoma=26 (51.0%), squamous=23 (45.1%), adenosquamous=2 (3.9%). Lymph nodes after surgical resection: N0=21 (41.2%), N1=12 (23.5%), N2=18 (35.3%). Mean ratio of the SUVmax of N1 lymph node to the SUVmax of the primary lung tumor (SUVmax N1/T ratio) was 0.60 (range 0.08-2.80). ROC curve analysis to obtain the optimal cut-off value of SUVmax N1/T ratio to predict N2 disease was performed. At multivariate analysis, we found that a ratio of 0.46 or greater was an independent predictor factor of N2 mediastinal lymph node metastases with a sensitivity and specificity of 77.8% and 69.7%, respectively. CONCLUSIONS: SUVmax N1/T ratio in NSCLC patients correlates with mediastinal lymph node metastasis (N2 disease) after surgical resection. When SUVmax N1/T ratio on integrated PET-CT scan is equal or superior to 0.46, special attention should be paid on higher probability of N2 disease.
Subject(s)
Carcinoma, Non-Small-Cell Lung/diagnostic imaging , Fluorodeoxyglucose F18 , Lymph Nodes/diagnostic imaging , Radiopharmaceuticals , Aged , Carcinoma, Non-Small-Cell Lung/surgery , Female , Humans , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Staging , Pneumonectomy/methods , Positron Emission Tomography Computed Tomography , Prospective Studies , Retrospective StudiesABSTRACT
(99m)Tc-tetrofosmin single photon emission computed tomography ((99m)Tc-tetrofosmin SPECT) has an important role in the assessment of coronary artery disease. Despite being its main indication, this study does not only evaluate myocardial perfusion, but much more. Moreover, during the SPECT acquisition, the field area covered includes many important organs of the thorax and abdomen, so extracardiac abnormalities can be observed. The correct etiologic diagnosis of them is only possible if we understand how (99m)Tc-tetrofosmin works and make a comprehensive investigation of the clinical history of the patient.
Subject(s)
Artifacts , Bile Reflux/diagnostic imaging , Gastroplasty , Medical History Taking , Myocardial Perfusion Imaging , Organophosphorus Compounds/pharmacokinetics , Organotechnetium Compounds/pharmacokinetics , Postoperative Complications/diagnostic imaging , Radiopharmaceuticals/pharmacokinetics , Single Photon Emission Computed Tomography Computed Tomography , Aged , Carcinoma, Squamous Cell/diagnostic imaging , Carcinoma, Squamous Cell/secondary , Carcinoma, Squamous Cell/surgery , Chest Pain/etiology , Esophageal Neoplasms/surgery , Esophagectomy , False Positive Reactions , Gastrointestinal Contents , Humans , Male , Neoplasm Recurrence, Local/diagnostic imaging , Neoplasm Recurrence, Local/surgery , Positron Emission Tomography Computed Tomography , Tissue DistributionABSTRACT
This article details the high technology equipment in Spain obtained through a survey sent to the three main provider companies of equipment installed in Spain. The geographical distribution of high technology by Autonomous Communities and its antiquity have been analyzed.
Subject(s)
Nuclear Medicine/instrumentation , Positron-Emission Tomography/instrumentation , Tomography, Emission-Computed, Single-Photon/instrumentation , Gamma Cameras/supply & distribution , Positron Emission Tomography Computed Tomography/instrumentation , SpainSubject(s)
Adenocarcinoma/diagnostic imaging , Adenocarcinoma/secondary , Colonic Neoplasms/pathology , Fluorine Radioisotopes , Fluorodeoxyglucose F18 , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/secondary , Multimodal Imaging/methods , Positron-Emission Tomography/methods , Radiopharmaceuticals , Tomography, X-Ray Computed/methods , Adenocarcinoma/drug therapy , Adenocarcinoma/surgery , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Colectomy , Colonic Neoplasms/drug therapy , Colonic Neoplasms/surgery , Combined Modality Therapy , Female , Humans , Neoadjuvant TherapyABSTRACT
OBJECTIVE: To describe the process of implementing a quality management system according to UNE-EN-ISO 9001:2008 standard in a Nuclear Medicine Department. MATERIAL AND METHOD: In February 2008, the committee on internal quality of the Department was established, naming a responsible physician. The general operating plan was drawn up, following the requirements established by the ISO 9001:2008 standard. It defined the scope of the standard, defining, preparing and transcribing the various activities of our Department. Four training sessions were carried out. RESULTS: A total of nine general and two specific procedures were documented in which all the activities performed in our Department were included. Personnel records of each worker were created, including their profiles and training plan. A record of the equipment and service providers was created, as well as issues with the latter. Satisfaction surveys were obtained from external (patients) and internal customers (faculty applicants). Targets for improvement and activity markers were established. Two audits were performed to complete the process, one internal and one external. The Department was accredited in April 2010. CONCLUSION: The quality accreditation process is a tool that requires reflection on how we do things and how they can be improved. It makes it possible to measure what we do, to analyze and introduce improvement measures, and therefore, to achieve a higher level of quality in the service we provide our customers. The involvement of the Department workers with a commitment to team performance was essential.
Subject(s)
Hospital Departments/standards , Nuclear Medicine , Total Quality ManagementABSTRACT
The (18)F-choline PET-CT (FCH) has better performance in the assessment of patients with prostate cancer than (18)F-FDG. However, similarly, it is also not a tumor specific radiotracer. We present four (18)F-FCH PET-CT scans in which false positive findings were correctly assessed after evaluation with CT, clinical parameters and/or histological analysis.
Subject(s)
Choline/analogs & derivatives , Fluorine Radioisotopes , Multimodal Imaging , Positron-Emission Tomography/methods , Prostatic Neoplasms/diagnosis , Tomography, X-Ray Computed/methods , False Positive Reactions , Humans , MaleABSTRACT
AIM: To analyze the costs of Fever of Unknown Origin (FUO) prior to the PET-CT study. To determine the effectiveness of PET-CT in the diagnosis of FUO. A proposal of diagnostic algorithm. MATERIAL AND METHODS: A retrospective study was performed that included 20 patients who had been studied between January 2007 and January 2011, with a mean age of 57.75 years and FUO diagnosis. All underwent a PET-CT study with (18)F-FDG. Individual and mean costs of FUO in these patients were assessed, including hospitalization days and complementary tests prior to the PET-CT study. The effectiveness of the PET-CT study in the diagnosis of FUO was analyzed. Costs of the FUO process were determined, including those of the PET-CT study, and if it had been done earlier in the diagnostic process. RESULTS: Mean hospital stay per patient until the PET-CT study was 28 days. The cost per hospitalization day was 342 . Average cost per patient in complementary tests was 1395 . Total cost of the FUO process until the PET-CT study was around 11167 per patient. The PET-CT study showed a 78% sensitivity, 83% specificity, 92% PPV and 62% NPV. If PET-CT had been performed earlier in the FUO process, assuming the same effectiveness, 5471 per patient would have been saved. CONCLUSION: The PET-CT study could be cost-effective in the FUO process if used at an early stage, helping to establish an early diagnosis, reducing hospitalization days due to diagnostic purposes and the repetition of unnecessary tests.
