RESUMEN
AIM: To evaluate the efficacy and clinical impact of the FDG-PET in the diagnosis of suspicion of recurrence of medullary thyroid cancer (MTC) in patients with elevated serum calcitonin and negative imaging test. MATERIAL AND METHODS: We performed a retrospective study of 31 consecutive cases from february 2001 to october 2007 of 17 women and 14 men, mean age 56.2 years (range: 26-88), with anatomical-pathology diagnosis of medullary thyroid cancer and suspicion of recurrence due to abnormal elevation of calcitonin and negative imaging tests. All of the patients underwent whole body FDG-PET scan with a dedicated PET or PET-CT 60 minutes after intravenous injection of 333-434 MBq of (18)F-FDG. Results were confirmed by pathology study in 45.2% of the patients and by clinical follow-up with a mean of 4 years (range: 16 m-8 years) RESULTS: Sensitivity was 88%, specificity 84.6%, positive predictive value 88%, negative predictive value 84.6% and diagnostic accuracy 87%. The results of the FDG PET modified the therapeutic strategy in 14 cases (45.2%). A comparison was made of the mean values of calcitonin using the Student's "t" test between positive PET studies for the disease and negative ones. No significant differences were found (P=.3). CONCLUSIONS: In patients with MTC and suspected recurrence with elevated calcitonin and negative imaging test, the FDG is the best test for the diagnosis of occult recurrence in MTC with elevated calcitonin and negative imaging techniques with elevated clinical impact. It facilitates the therapeutic management of the patients with MTC recurrence, and should be included in the diagnosis algorithm in these patients.
Asunto(s)
Biomarcadores de Tumor/sangre , Calcitonina/sangre , Carcinoma Medular/secundario , Fluorodesoxiglucosa F18 , Radiofármacos , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias Óseas/sangre , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/secundario , Carcinoma Medular/sangre , Carcinoma Medular/diagnóstico por imagen , Carcinoma Medular/cirugía , Progresión de la Enfermedad , Reacciones Falso Negativas , Reacciones Falso Positivas , Femenino , Humanos , Neoplasias Hepáticas/sangre , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/sangre , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/secundario , Metástasis Linfática/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Neoplasia Endocrina Múltiple Tipo 2a/diagnóstico por imagen , Neoplasia Endocrina Múltiple Tipo 2b/diagnóstico por imagen , Valor Predictivo de las Pruebas , Cintigrafía , Estudios Retrospectivos , Sensibilidad y Especificidad , Neoplasias de la Tiroides/sangre , Neoplasias de la Tiroides/cirugía , TiroidectomíaRESUMEN
AIMS: To evaluate the efficacy and clinical impact of Positron Emission Tomography with FDG (FDG-PET) in patients with suspected recurrent head and neck cancer or distant metastases. MATERIALS AND METHODS: Sixty patients (12 women and 48 men) with suspicion of recurrent head and neck cancer and ambiguous conventional imaging modalities. In all patients a whole body scan was performed with FDG-PET in fasting patients following i.v. administration of 370-444 MBq FDG. The results were confirmed by histology and clinical evolution (follow-up period > 12 months) and imaging test. RESULTS: Prevalence of recurrence was 66.6 %. FDG-PET was positive in 40/60 patients, with confirmation in 39 cases, and 18 were true negative (TN). We have found 2 false positive and 1 false negative. Overall sensitivity, specificity, PPV, NPV and accuracy were 97.5 %, 90 %, 95.12 %, 94.7 % and 95 %, respectively. FDG-PET changed the modality of treatment in 34 patients (clinical impact 56.6 %) CONCLUSIONS: FDG-PET has high clinical impact in patients with suspicion of recurrent head and neck cancer, and should be incorporated in the diagnostic protocols before making a therapy decision.
Asunto(s)
Fluorodesoxiglucosa F18 , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Recurrencia Local de Neoplasia/diagnóstico por imagen , Tomografía de Emisión de Positrones , Radiofármacos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Neoplasias de Cabeza y Cuello/patología , Humanos , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Estudios RetrospectivosRESUMEN
UNLABELLED: This study aimed to evaluate the role of Fluorine-18-fluorodeoxyglucose positron emission tomography (PET-FDG) in patients with elevated serum thyroglobulin (hTg) levels where thyroid cancer tissue does not concentrate radioiodine, rendering false-negative results on I-131 scanning. MATERIAL AND METHODS: Whole-body PET imaging using FDG was performed in 54 patients (37 female, 17 male) aged 17-88 years: 45 with papillary tumors and 9 with follicular tumors who were suspected of having recurrent thyroid carcinoma due to elevated thyroglobulin levels (hTg > 2 ng/ml) under thyroid-stimulating hormone (TSH > or = 30 microIU/ml) in whom the iodine scan was negative. All whole body scans were obtained with diagnostic doses (185 MBq). Whole body PET imaging was performed in fasting patients following i.v. administration of 370 MBq FDG while the patients were receiving full thyroid hormone replacement. Before PET, 99mTc methoxyisobutylisonitrile scintigraphy (99mTc-MIBI) was done in 14 patients and morphologic imaging in 26 by CT scan. RESULTS: Positive PET results confirmed the presence of hypermetabolic foci in 25/54 patients (46.29 %). Positive findings were found for PET-FDG in patients with hTg levels higher than 10 ng/ml receiving full thyroid hormone replacement. 99mTc-MIBI demonstrated lesions in 7/14 patients (50 %). PET-FDG and 99mTc-MIBI had congruent positive results in 4/7 patients. All the lesions found by CT were detected by PET-FDG, while recurrent disease was found in 12/21 patients with previous negative CT. CONCLUSIONS: These results suggest that PET-FDG seems to be a promising tool in the follow-up of thyroid cancer and should be considered in patients suffering from differentiated thyroid cancer with suspected recurrence and/or metastases by elevated thyroglobulin levels, and negative I-131 whole body scans. PET-FDG might be more useful at hTg levels > 10 ng/ml.
Asunto(s)
Fluorodesoxiglucosa F18 , Tomografía de Emisión de Positrones , Radiofármacos , Tiroglobulina/sangre , Neoplasias de la Tiroides/sangre , Neoplasias de la Tiroides/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Reacciones Falso Negativas , Femenino , Humanos , Radioisótopos de Yodo , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Recurrencia Local de Neoplasia/diagnóstico por imagen , Estudios RetrospectivosRESUMEN
We present the case of 15 day old female baby, with respiratory insufficiency, asphyxia and cyanosis when fed. She was diagnosed by ultrasound of intraauricular communication ostium secundum type. Passage of the contrast to the right respiratory tract but without localization of the fistula was observed in the esophagogastric contrast study. We performed esophageal scintigraphy that showed the passage of the isotope to both lungs, showing "H" type tracheoesophageal fistula. We review the bibliography on this special kind of disease.
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Fístula Traqueoesofágica/congénito , Fístula Traqueoesofágica/diagnóstico por imagen , Femenino , Humanos , Recién Nacido , Cintigrafía , Fístula Traqueoesofágica/clasificaciónAsunto(s)
Calcinosis/diagnóstico por imagen , Hipoparatiroidismo/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Radiofármacos , Medronato de Tecnecio Tc 99m/análogos & derivados , Calcinosis/etiología , Calcio/efectos adversos , Femenino , Bocio/cirugía , Humanos , Hipercalcemia/inducido químicamente , Hipercalcemia/complicaciones , Hipoparatiroidismo/etiología , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Cintigrafía , Tiroidectomía , Vitamina D/efectos adversosAsunto(s)
Dolor de Espalda/etiología , Vértebras Lumbares , Osteoblastoma/complicaciones , Osteoblastoma/diagnóstico por imagen , Neoplasias de la Columna Vertebral/complicaciones , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único , Adolescente , Femenino , HumanosRESUMEN
No disponible
Asunto(s)
Adolescente , Femenino , Humanos , Tomografía Computarizada de Emisión de Fotón Único , Vértebras Lumbares , Osteoblastoma , Dolor de Espalda , Neoplasias de la Columna VertebralAsunto(s)
Adenocarcinoma Folicular/diagnóstico por imagen , Adenocarcinoma Folicular/secundario , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/secundario , Pulmón/diagnóstico por imagen , Radiofármacos/farmacocinética , Pertecnetato de Sodio Tc 99m/farmacocinética , Glándula Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/diagnóstico por imagen , Adenocarcinoma Folicular/complicaciones , Femenino , Bocio/diagnóstico por imagen , Humanos , Hipertiroidismo/diagnóstico por imagen , Hipertiroidismo/etiología , Pulmón/metabolismo , Persona de Mediana Edad , Cintigrafía , Neoplasias de la Tiroides/complicacionesRESUMEN
No disponible