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CONTEXT: Exercise reduces adiposity, but its influence on bone marrow fat fraction (BMFF) is unknown; nor is it known whether a reduction in liver fat content mediates this reduction. OBJECTIVES: (i) To determine whether incorporating exercise into a lifestyle program reduces the lumbar spine (LS)-BMFF, and (ii), to investigate whether changes in liver fat mediate any such effect. DESIGN: Ancillary analysis of a two-arm, parallel, non-randomized clinical trial. SETTING: Primary care centres in Vitoria-Gasteiz (Spain). PARTICIPANTS: A total of 116 children with overweight/obesity were assigned to a 22-week family-based lifestyle program (control group [n=57]) or the same program plus an exercise intervention (exercise group [n=59]. INTERVENTIONS: The compared interventions consisted of a family-based lifestyle program (two 90-minute sessions/month) and the same program plus supervised exercise (three 90-minute sessions/week). MAIN OUTCOMES AND MEASURES: The primary outcome examined was the change in LS-BMFF between baseline and 22 weeks, as estimated by MRI. The effect of changes in hepatic fat on LS-BMFF were also recorded. RESULTS: Mean weight loss difference between groups was 1.4±0.5 kg favour of the exercise group. Only the children in the exercise group experienced a reduction in LS-BMFF (effect size [Cohen d] -0.42, CI: -0.86, -0.01). Importantly, 40.9% of the reductions in LS-BMFF were mediated by changes in percentage hepatic fat (indirect effect: ß=-0.104, 95%CI=-0.213, -0.019). The impact of changes in hepatic fat on LS-BMFF was independent of weight loss. CONCLUSIONS AND RELEVANCE: The addition of exercise to a family-based lifestyle program designed to reduce cardiometabolic risk improves bone health by reducing LS-BMFF in children with overweight or obesity. This beneficial effect on bone marrow appears to be mediated by reductions in liver fat.
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CONTEXT: Hepatic steatosis is associated with decreased bone mineral density (BMD). Bone marrow fat fraction (BMFF) could play a role in this relationship in children with obesity. OBJECTIVE: The objectives of this work were (i) to examine the relationship between the lumbar spine (LS) BMFF and BMD, and (ii) to explore the mediating role of LS-BMFF on the relationship between percentage hepatic fat with LS-BMD in preadolescent children with overweight/obesity. METHODS: Hepatic fat and LS-BMFF (magnetic resonance imaging) and areal LS-BMD (LS-aBMD, dual-energy x-ray absorptiometry) were measured in 106 children (aged 10.6 ± 1.1 years, 53.8% girls) with overweight/obesity. RESULTS: LS-BMFF was inversely associated with LS-aBMD (r = -0.313; P = .001) and directly related with percentage hepatic fat (r = 0.276; P = .005). LS-BMFF was significantly greater in children with than without hepatic steatosis (P = .003; Cohen's d: 0.61; 95% CI, -0.21 to 1.0), while no significant difference was seen between children with overweight and those with obesity (P = .604; Cohen's d: 0.16; 95% CI, -0.21-0.55). Mediating analysis indicated that LS-BMFF is an important mediator (50%) in the association of hepatic fat with lower LS-aBMD (indirect effect: ß = -.076; 95% CI, -0.143 to -0.015). CONCLUSION: These findings suggest that hepatic steatosis, rather than overall excess adiposity, is associated with greater bone marrow adipose tissue in preadolescent children with overweight/obesity, which in turn, is related to lower BMD. Hepatic steatosis could be a potential biomarker of osteoporosis risk, and a therapeutic target for interventions that aim to reduce not only hepatic steatosis, but for those designed to improve bone health in such children.
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Densidad Ósea , Hígado Graso , Femenino , Niño , Humanos , Masculino , Sobrepeso/complicaciones , Sobrepeso/patología , Médula Ósea/diagnóstico por imagen , Médula Ósea/patología , Obesidad/patología , Tejido Adiposo/diagnóstico por imagen , Tejido Adiposo/patología , Absorciometría de Fotón , Hígado Graso/diagnóstico por imagen , Hígado Graso/patología , Vértebras LumbaresRESUMEN
OBJECTIVES: Fat depots localization has a critical role in the metabolic health status of adults. Nevertheless, whether that is also the case in children remains under-studied. Therefore, the aims of this study were: (i) to examine the differences between metabolically healthy (MHO) and unhealthy (MUO) overweight/obesity phenotypes on specific abdominal fat depots, and (ii) to further explore whether cardiorespiratory fitness plays a major role in the differences between metabolic phenotypes among children with overweight/obesity. METHODS: A total of 114 children with overweight/obesity (10.6 ± 1.1 years, 62 girls) were included. Children were classified as MHO (n = 68) or MUO. visceral (VAT), abdominal subcutaneous (ASAT), intermuscular abdominal (IMAAT), psoas, hepatic, pancreatic, and lumbar bone marrow adipose tissues were measured by magnetic resonance imaging. Cardiorespiratory fitness was assessed using the 20 m shuttle run test. RESULTS: MHO children had lower VAT and ASAT contents and psoas fat fraction compared to MUO children (difference = 12.4%-25.8%, all p < 0.035). MUO-unfit had more VAT and ASAT content than those MUO-fit and MHO-fit (difference = 34.8%-45.3%, all p < 0.044). MUO-unfit shows also greater IMAAT fat fraction than those MUO-fit and MHO-fit peers (difference = 16.4%-13.9% respectively, all p ≤ 0.001). In addition, MHO-unfit presented higher IMAAT fat fraction than MHO-fit (difference = 13.4%, p < 0.001). MUO-unfit presented higher psoas fat fraction than MHO-fit (difference = 29.1%, p = 0.008). CONCLUSIONS: VAT together with ASAT and psoas fat fraction, were lower in MHO than in MUO children. Further, we also observed that being fit, regardless of metabolic phenotype, has a protective role over the specific abdominal fat depots among children with overweight/obesity.
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Capacidad Cardiovascular , Síndrome Metabólico , Humanos , Sobrepeso , Obesidad/metabolismo , Estado de Salud , Grasa Abdominal/diagnóstico por imagen , Grasa Abdominal/metabolismo , Fenotipo , Síndrome Metabólico/metabolismo , Factores de Riesgo , Índice de Masa CorporalRESUMEN
OBJECTIVE: In adults, there is evidence that improvement of metabolic-associated fatty liver disease (MAFLD) depends on the reduction of myosteatosis. In children, in whom the prevalence of MAFLD is alarming, this muscle-liver crosstalk has not been tested. Therefore, we aimed to explore whether the effects of a multicomponent intervention on hepatic fat is mediated by changes in intermuscular abdominal adipose tissue (IMAAT) in children with overweight/obesity. RESEARCH DESIGN AND METHODS: A total of 116 children with overweight/obesity were allocated to a 22-week family-based lifestyle and psychoeducational intervention (control group, n = 57) or the same intervention plus supervised exercise (exercise group, n = 59). Hepatic fat percentage and IMAAT were acquired by MRI at baseline and at the end of the intervention. RESULTS: Changes in IMAAT explained 20.7% of the improvements in hepatic steatosis (P < 0.05). Only children who meaningfully reduced their IMAAT (i.e., responders) had improved hepatic steatosis at the end of the intervention (within-group analysis: responders -20% [P = 0.005] vs. nonresponders -1.5% [P = 0.803]). Between-group analysis showed greater reductions in favor of IMAAT responders compared with nonresponders (18.3% vs. 0.6%, P = 0.018), regardless of overall abdominal fat loss. CONCLUSIONS: The reduction of IMAAT plays a relevant role in the improvement of hepatic steatosis after a multicomponent intervention in children with overweight/obesity. Indeed, only children who achieved a meaningful reduction in IMAAT at the end of the intervention had a reduced percentage of hepatic fat independent of abdominal fat loss. Our findings suggest that abdominal muscle fat infiltration could be a therapeutic target for the treatment of MAFLD in childhood.
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Hígado Graso , Sobrepeso , Grasa Abdominal , Tejido Adiposo , Adulto , Niño , Hígado Graso/complicaciones , Hígado Graso/terapia , Humanos , Estilo de Vida , Obesidad/complicaciones , Sobrepeso/complicaciones , Sobrepeso/terapiaRESUMEN
OBJECTIVES: To examine the relationship between physical fitness and physical activity (PA) with specific abdominal fat depots and their potential implications for cardiometabolic risk and insulin resistance (IR) in children with overweight/obesity. MATERIALS AND METHODS: A total of 116 children with overweight/obesity (10.7 ± 1.1 year, 54% girls) participated in the study. Abdominal visceral (VAT), subcutaneous (ASAT), and intermuscular abdominal adipose tissue (IMAAT) were assessed by magnetic resonance imaging. The cardiometabolic risk (MetS) score and the insulin resistance homeostasis model assessment (HOMA-IR) were calculated. Health-related physical fitness components (treadmill test, and 20 m shuttle run, handgrip, standing broad jump and 4 × 10 m tests) were evaluated, and PA was measured (accelerometry). Children were categorized as fit or unfit for each specific fitness test, and as active or inactive. RESULTS: Higher VAT, ASAT, and IMAAT were associated with higher MetS score and HOMA-IR (all p < 0.02). A better performance in all fitness tests and total and vigorous PA were strongly associated with lower VAT (all p < 0.04), ASAT (all p < 0.005), and IMAAT (all p < 0.005). Fit or active children had lower VAT, ASAT, and IMAAT (all p < 0.03) than their unfit or inactive counterparts. CONCLUSION: These results reinforce the importance of having adequate fitness and PA levels to reduce abdominal fat accumulation in children. Given that VAT, ASAT, and IMAAT are associated with higher risk of developing cardiovascular diseases and type 2 diabetes, the improvement of physical fitness by the promotion of PA should be goals of lifestyle interventions for improving health in children with overweight/obesity.
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Diabetes Mellitus Tipo 2 , Sobrepeso , Grasa Abdominal , Niño , Ejercicio Físico , Femenino , Fuerza de la Mano , Humanos , Masculino , ObesidadRESUMEN
Healthy lifestyle education programs are recommended for obesity prevention and treatment. However, there is no previous information on the effects of these programs on the reduction of hepatic fat percentage. The aims were (i) to examine the effectiveness of a 22-week family-based lifestyle education program on dietary habits, and (ii) to explore the associations of changes in dietary intake with percent hepatic fat reduction and adiposity in children with overweight/obesity. A total of 81 children with overweight/obesity (aged 10.6 ± 1.1 years, 53.1% girls) and their parents attended a 22-week family based healthy lifestyle and psychoeducational program accompanied with (intensive group) or without (control) an exercise program. Hepatic fat (magnetic resonance imaging), adiposity (dual energy X-ray absorptiometry) and dietary habits (two non-consecutive 24 h-recalls) were assessed before and after the intervention. Energy (p < 0.01) fat (p < 0.01) and added sugar (p < 0.03) intake were significantly reduced in both groups at the end of the program, while, in addition, carbohydrates intake (p < 0.04) was reduced exclusively in the control group, and simple sugar (p < 0.05) and cholesterol (p < 0.03) intake was reduced in the exercise group. Fruit (p < 0.03) and low-fat/skimmed dairy consumption (p < 0.02), the adherence to the Mediterranean Diet Quality Index for children and teenagers (KIDMED, p < 0.01) and breakfast quality index (p < 0.03) were significantly higher in both control and intervention groups after the intervention. Moreover, participants in the exercise group increased the adherence to the Dietary Approaches to Stop Hypertension (DASH) diet (p < 0.001), whereas the ratio of evening-morning energy intake was significantly lower exclusively in the control group after the program (p < 0.02). Changes in energy intake were significantly associated with changes in fat mass index (FMI) in the exercise group, whereas changes in sugar-sweetened beverages (SSB) consumption was associated with percent hepatic fat reduction (p < 0.05) in the control group. A 22-week family-based healthy lifestyle program seems to be effective on improving diet quality and health in children with overweight/obesity and these should focus on SSB avoidance and physical activity.
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Terapia Familiar/métodos , Estilo de Vida , Educación del Paciente como Asunto/métodos , Obesidad Infantil/terapia , Programas de Reducción de Peso/métodos , Tejido Adiposo/patología , Adiposidad , Terapia Conductista/métodos , Biomarcadores/análisis , Índice de Masa Corporal , Niño , Conducta Alimentaria , Femenino , Humanos , Hígado/patología , Masculino , Obesidad Infantil/patología , Resultado del TratamientoRESUMEN
BACKGROUND: Non-alcoholic fatty liver disease is the most common liver disease in childhood and is related to insulin resistance and cardiometabolic risk factors. Evidence supporting the association of fitness and physical activity with hepatic fat, liver enzymes, or triglyceride-to-high-density lipoprotein ratio is scarce in children. OBJECTIVE: To analyze the associations of physical fitness and physical activity (PA) with percentage hepatic fat, liver enzymes, insulin resistance, and cardiometabolic risk in children with overweight/obesity. SUBJECTS: A total of 115 children (10.6 ± 1.1 years; 54% girls) with overweight/obesity of the EFIGRO study (ClinicalTrials.gov: NCT02258126) were included in the analyses. METHODS: Cardiorespiratory fitness (CRF), musculoskeletal fitness and speed-agility were measured by the Alpha-fitness tests, and PA by wGT3X-BT accelerometers. Percentage hepatic fat was assessed by magnetic resonance imaging. Alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), aspartate aminotransferase (AST), insulin, glucose, triglycerides (TG), and high-density lipoprotein (HDL) levels were obtained from fasting blood samples. The homeostasis model assessment insulin resistance (HOMA-IR) and AST/ALT and TG/HDL ratios were calculated. RESULTS: Higher CRF was associated with lower percentage hepatic fat (ß = -0.266, P = .01) and GGT (ß = -0.315, P < .01), and higher AST/ALT ratio (ß = 0.306, P < .01). CRF-fit children have lower GGT levels (15 ± 1 vs 17 ± 1 U/L, CRF-fit vs CRF-unfit children, P = .02), HOMA-IR (2.2 ± 0.1 vs 2.9 ± 0.1, P < .01) and TG/HDL ratio (1.4 ± 0.1 vs 1.9 ± 0.1, P = .01) and higher AST/ALT ratio (1.3 ± 0.0 vs 1.2 ± 0.0, P = .03), than CRF-unfit children. CONCLUSIONS: These findings emphasize the importance of considering the improvement of CRF as a target of programs for preventing hepatic steatosis, type 2 diabetes and cardiovascular diseases in children with overweight.
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Capacidad Cardiovascular/fisiología , Ejercicio Físico/fisiología , Enfermedad del Hígado Graso no Alcohólico/etiología , Obesidad Infantil/complicaciones , Obesidad Infantil/metabolismo , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Glucemia/análisis , Glucemia/metabolismo , Niño , Estudios Transversales , Terapia por Ejercicio , Femenino , Humanos , Resistencia a la Insulina/fisiología , Hígado/enzimología , Masculino , Enfermedad del Hígado Graso no Alcohólico/metabolismo , Enfermedad del Hígado Graso no Alcohólico/terapia , Sobrepeso/complicaciones , Sobrepeso/metabolismo , Sobrepeso/terapia , Obesidad Infantil/terapia , Aptitud Física/fisiología , Factores de Riesgo , gamma-Glutamiltransferasa/sangreRESUMEN
OBJECTIVES: To examine the influence of non-alcoholic fatty liver disease (NAFLD) and hepatic fat content on bone mineral density (BMD), and to investigate whether the relationship between NAFLD and BMD is independent of lifestyle factors related to BMD. METHODS: Hepatic fat content (magnetic resonance imaging), BMD, lean mass index, total and abdominal fat mass (dual-energy-X-ray absorptiometry), moderate to vigorous physical activity (MVPA) (accelerometry), and calcium and vitamin D intake (two 24 h recalls) were measured in 115 children with overweight/obesity aged 10.6 ± 1.1 years old. RESULTS: Children with NAFLD had lower BMD than children without NAFLD regardless of sex, puberty stage, lean mass index, fat mass, MVPA, and calcium and vitamin D intake (0.89 ± 0.01 vs. 0.93 ± 0.01 g/cm2 for NAFLD and non-NAFLD, respectively, P < 0.01). Higher hepatic fat content was significantly associated with lower BMD regardless of confounders (adjusted P < 0.05). CONCLUSIONS: Findings of the current study suggest that hepatic fat accumulation is associated with decreased BMD independently of adiposity, and regardless of those lifestyle factors closely related to bone mineral accrual in children. These results may have implication in the clinical management of children with overweight/obesity given the high prevalence of pediatric NAFLD.
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Tejido Adiposo/patología , Densidad Ósea , Hígado/patología , Obesidad/patología , Sobrepeso/patología , Calcio/administración & dosificación , Niño , Ejercicio Físico , Femenino , Humanos , Masculino , Vitamina D/administración & dosificaciónRESUMEN
BACKGROUND: The global pandemic of obesity has led to an increased risk for prediabetes and type-2 diabetes (T2D). The aims of the current project are: (1) to evaluate the effect of a 22-week family based intervention program, including supervised exercise, on insulin resistance syndrome (IRS) risk in children with a high risk of developing T2D and (2) to identify the profile of microRNA in circulating exosomes and in peripheral blood mononuclear cells in children with a high risk of developing T2D and its response to a multidisciplinary intervention program including exercise. METHODS: A total of 84 children, aged 8-12 years, with a high risk of T2D will be included and randomly assigned to control (N = 42) or intervention (N = 42) groups. The control group will receive a family based lifestyle education and psycho-educational program (2 days/month), while the intervention group will attend the same lifestyle education and psycho-educational program plus the exercise program (3 days/week, 90 min per session including warm-up, moderate to vigorous aerobic activities, and strength exercises). The following measurements will be evaluated at baseline prior to randomization and after the intervention: fasting insulin, glucose and hemoglobin A1c; body composition (dual-energy X-ray absorptiometry); ectopic fat (magnetic resonance imaging); microRNA expression in circulating exosomes and in peripheral blood mononuclear cells (MiSeq; Illumina); cardiorespiratory fitness (cardiopulmonary exercise testing); dietary habits and physical activity (accelerometry). DISCUSSION: Prevention and identification of children with a high risk of developing T2D could help to improve their cardiovascular health and to reduce the comorbidities associated with obesity. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03027726 . Registered on 16 January 2017.
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Diabetes Mellitus Tipo 2/prevención & control , Terapia por Ejercicio/métodos , Terapia Familiar/métodos , Obesidad Infantil/terapia , Factores de Edad , Biomarcadores/sangre , Glucemia/metabolismo , Composición Corporal , Niño , Conducta Infantil , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/etiología , Femenino , Hemoglobina Glucada/metabolismo , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Estado de Salud , Humanos , Insulina/sangre , Masculino , Educación del Paciente como Asunto , Obesidad Infantil/sangre , Obesidad Infantil/complicaciones , Obesidad Infantil/diagnóstico , Proyectos de Investigación , Factores de Riesgo , Conducta de Reducción del Riesgo , España , Factores de Tiempo , Resultado del Tratamiento , Pérdida de PesoRESUMEN
OBJECTIVES: To compare staging correctness between contrast-enhanced FDG PET/ceCT and 64-slice multi-detector-row CT (ceCT64) for initial staging and response evaluation at the end of treatment (EOT) in patients with Hodgkin lymphoma, diffuse large B cell lymphoma (DLBCL), and follicular lymphoma. METHODS: This prospective study compared initial staging and response evaluation at EOT. One hundred eighty-one patients were randomly assigned to either ceCT64 or FDG PET/ceCT. A nuclear medicine physician and a radiologist read FDG PET/ceCT scans independently and achieved post hoc consensus, whereas another independent radiologist interpreted ceCT64 separately. The reference standard included all clinical information, all tests, and follow-up. Ethics committees of the participating centers approved the study, and all participants provided written consent. RESULTS: Ninety-one patients were randomized to ceCT64 and 90 to FDG PET/ceCT; 72 had Hodgkin lymphoma, 72 had DLBCL, and 37 had follicular lymphoma. There was excellent correlation between the reference standard and initial staging for both FDG PET/ceCT (κ = 0.96) and ceCT64 (κ = 0.84), although evaluation of the response at EOT was excellent only for FDG PET/ceCT (κ = 0.91). CONCLUSIONS: Our study demonstrated satisfactory agreement between FDG PET/ceCT (κ = 0.96) and ceCT64 (κ = 0.84) in initial staging compared with the reference standard (P = 0.16). Response evaluation at EOT with FDG PET/ceCT (κ = 0.91) was superior compared with ceCT64 (κ = 0.307) (P < 0.001).
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Medios de Contraste , Fluorodesoxiglucosa F18 , Linfoma/diagnóstico por imagen , Linfoma/terapia , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Adulto , Anciano , Femenino , Humanos , Linfoma/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Tomografía Computarizada por Tomografía de Emisión de Positrones/instrumentación , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Introducción. La reflexión sobre los recursos literarios puede mejorar su aplicación como herramienta de aprendizaje para profesionales de la salud, tanto en contextos transversales como específicos de especialidad. Proponemos una novedosa clasificación de los recursos literarios, desde una perspectiva médica, con el objetivo de facilitar su aplicación en la ense-ñanza y aprendizaje de dermatología. Materiales y métodos. Análisis cualitativo de múltiples textos literarios y selección de aquellos textos que incluían referencias a una enfermedad cutánea frecuente (acné), que se seleccionó como paradigma. Resultados. Se realizó una clasificación basada en cinco grupos: autobiografía de la enfermedad cutánea, el escritor en la descripción de la enfermedad cutánea de otros, la enfermedad cutánea como recurso estilístico en la literatura, el médico como escritor: recursos estilísticos en la descripción médica de la enfermedad, y literatura médica relacionada con los textos seleccionados. Conclusiones. Los recursos literarios, desde una perspectiva médica, se pueden clasificar en cinco grupos; esta clasificación puede facilitar su aplicación docente y su integración como recurso didáctico en la enseñanza especializada de la dermatología y en la enseñanza médica en general. (AU)
Introduction. To classify literary texts from a medical perspective facilitates their application in the teaching and learning of medicine and dermatology. Materials and methods. Qualitative analysis of multiple literary texts and selection of those texts that contain references to a common skin disease (acne), which was selected as a paradigm. Results. A classification was carried out of the literary texts analyzed, based on five groups: autobiography of the skin disease; the writer describing skin disease in others; skin disease as a stylistic device in literature; the physician as writer: stylistic devices in the medical description of the disease; and medical texts related to selected literary texts. Conclusions. The literary texts, from a medical perspective, can be classified into five groups; this classification facilitates their implementation as a didactic resource in medical education and specialised dermatology teaching (AU)
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Humanos , Dermatología/educación , Acceso a la Información , Medicina en la Literatura , Educación Médica/métodos , Personajes , Autobiografías como Asunto , Síntomas CaracterológicosRESUMEN
Accurate diagnosis and staging are essential for an optimal management of cancer patients. Positron emision tomography with 2-deoxy-2-fluorine-18-fluoro-D-glucose ((18)FDG-PET) and, more recently, (18)FDG-PET/computed tomography ((18)FDG-PET/CT) have emerged as powerful imaging tools in oncology, because of the valuable functional information they provide. The combined acquisition of PET and CT has synergistic advantages over its isolated constituents and minimizes their limitations. It decreases examination times by 25%-40%, leads to a higher patient throughput and unificates two imaging procedures in a single session. There is evidence that (18)FDG-PET/CT is a more accurate test than either of its components for the evaluation of various tumors. It is a particularly valuable tool for detection of recurrence, especially in asymptomatic patients with rising tumor markers and those with negative or equivocal findings on conventional imaging tests. Yet, there are some limitations and areas of uncertainty, mainly regarding the lack of specificity of the (18)FDG uptake and the variable (18)FDG avidity of some cancers. This article reviews the advantages, limitations and main applications of (18)FDG-PET/CT in oncology, with especial emphasis on lung cancer, colorectal cancer, lymphomas, melanoma and head and neck cancers.
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An accurate initial staging of patients with non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) is critical for the selection of an appropriate treatment. Computed tomography (CT) remains the standard imaging technique, although it is based on anatomic criteria. Positron emission tomography (PET) with 2-deoxy-2-[fluorine-18]fluoro-d-glucose (FDG) provides useful functional information but requires anatomical correlation to localise lesions accurately. We have prospectively compared the accuracy of combined PET/CT with that of CT and PET alone at initial staging in lymphoma patients. Forty-seven newly diagnosed patients were evaluated. PET/CT was superior compared with CT and PET in nodal evaluation and detection of extranodal disease. Using a staging algorithm with PET/CT resulted in the disease stage being increased in 11 of 47 patients (10 NHL and 1 HL) (McNemar test P = 0.012). Therefore, a different treatment strategy based on PET/CT findings was suggested for seven patients (14.8%). PET/CT markedly improves accuracy in the diagnostic work-up of patients with lymphoma.
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Linfoma/diagnóstico por imagen , Tomografía de Emisión de Positrones/métodos , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Algoritmos , Médula Ósea/patología , Femenino , Fluorodesoxiglucosa F18 , Enfermedad de Hodgkin/diagnóstico por imagen , Enfermedad de Hodgkin/tratamiento farmacológico , Humanos , Linfoma/tratamiento farmacológico , Linfoma no Hodgkin/diagnóstico por imagen , Linfoma no Hodgkin/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Prospectivos , Radiofármacos , Resultado del TratamientoRESUMEN
UNLABELLED: PET/CT combines functional and morphologic data and increases diagnostic accuracy in a variety of malignancies. This study prospectively compares the agreement between contrast-enhanced full-dose PET/CT and unenhanced low-dose PET/CT in lesion detection and initial staging of Hodgkin's disease and non-Hodgkin's lymphoma. METHODS: Forty-seven biopsy-proven lymphoma patients underwent a 18F-FDG PET/CT study that included unenhanced low-dose CT and enhanced full-dose CT for initial staging. Patients who had undergone previous diagnostic CT for initial staging were excluded. For every patient, each modality of PET/CT images was evaluated by either of 2 pairs of readers, with each pair comprising 1 experienced radiologist and 1 experienced nuclear physician. While evaluating one of the 2 types of PET/CT, the readers were unaware of the results of the other type. Lesion detection, number of sites affected in each anatomic region, and disease stage were assessed. Agreement between techniques was determined by the kappa-statistic, and discordances were studied by the McNemar test. Clinical, analytic, histopathologic, diagnostic CT, and PET data; data from other imaging techniques; and follow-up data constituted the reference standard. RESULTS: For region-based analysis, no significant differences were found between unenhanced low-dose PET/CT and contrast-enhanced full-dose PET/CT, although full-dose PET/CT showed fewer indeterminate findings and a higher number of extranodal sites affected than did low-dose PET/CT. Agreement between the 2 types of PET/CT was almost perfect for disease stage (kappa = 0.92; P < 0.001). CONCLUSION: Our study showed a good correlation between unenhanced low-dose PET/CT and contrast-enhanced full-dose PET/CT for lymph node and extranodal disease in lymphomas, suggesting that unenhanced low-dose PET/CT might suffice in most patients as the only imaging technique for the initial staging of lymphomas, reserving diagnostic CT for selected cases.
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Enfermedad de Hodgkin/diagnóstico , Linfoma no Hodgkin/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Medios de Contraste , Femenino , Fluorodesoxiglucosa F18 , Enfermedad de Hodgkin/diagnóstico por imagen , Humanos , Linfoma no Hodgkin/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Tomografía de Emisión de Positrones , Estudios Prospectivos , Dosis de Radiación , Radiografía Abdominal , Esclerosis , Tomografía Computarizada por Rayos XRESUMEN
The incidence of Hodgkin's disease (HD) and Non-Hodgkin's lymphoma (NHL) is around 8% of all malignancies. Fortunately, HD and NHL are among the few malignancies that are potentially curable with current existing treatment modalities, even in advanced or recurrent disease. Accurate staging, early therapy monitoring, and posttreatment evaluation of lymphomas are important for optimum management of these patients. We reviewed the imaging findings of patients with histologically proved lymphoma who underwent staging positron emission tomography/computed tomography (PET/CT), early monitoring therapy PET/CT (after 3 cycles of chemotherapy), and posttreatment PET/CT. PET/CT imaging findings are shown. Utility of PET/CT in recognizing false-positive and false-negative cases of CT and PET alone is addressed. Pitfalls and diagnostic difficulties are analyzed. PET/CT is a new imaging technology that improves the evaluation of lymphoma. This review will help the reader to better understand the imaging findings and applications of PET/CT in the management of lymphoma.
Asunto(s)
Enfermedad de Hodgkin/diagnóstico por imagen , Linfoma no Hodgkin/diagnóstico por imagen , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Artefactos , Enfermedad de Hodgkin/terapia , Humanos , Linfoma no Hodgkin/terapia , Sensibilidad y EspecificidadRESUMEN
The aim of this study was to determine the correlation between the measurement of transverse diameter of the proximal neck on computed tomographic angiography (CTA) and graduated catheter aortography in patients who are candidates for endovascular graft placement in order to replace, if both measurements are equivalent, aortography for CTA alone. Preoperative dual-slice CTA and graduated catheter aortography were performed in 35 consecutive patients with infrarenal aortic aneurysm within 10 days. Transverse proximal neck diameters were measured on a true axial section on CTA reconstructions and on aortographic images, always 6 mm distal from the most inferior main renal artery. Mean, median, and standard deviation were obtained and the measurements correlated for each patient using Pearson's correlation and linear regression analysis. A significant difference in proximal neck transverse diameter measurements was found between graduated catheter aortography and CTA in all cases. CTA values were a mean of 1.74 mm higher than aortography values. Pearson's correlation indicates a strong correlation between both techniques, and a regression equation determines the predictive value of aortography on the basis of CTA values. Estimation of the transverse diameter of the proximal neck on aortography on the basis of that obtained on CTA allows us to affirm that CTA could be used as the sole method for the preoperative selection of appropriate endograft size in patients with infrarenal aortic aneurysm.