Lung cancer metastasis mimicking fingertip osteomyelitis: An 18F-fluorodeoxyglucose positron emission tomography-computed tomography study.

Lung cancer commonly metastasizes to ipsilateral and contralateral lungs, to mediastinal lymph nodes, to skeletal level, to brain, and to adrenal gland. It is indeed very rare to find skeletal metastases at the extremities, especially at the onset of the disease. We share the case of a 53-year-old man with dyspnea and pain at the level of the first finger of the left hand under antibiotic treatment for suspected osteomyelitis. 18F-fluorodeoxyglucose positron emission tomography-computed tomography showed the presence of a left lung lesion with multiple localizations at muscles and bones.

18F-Fluciclovine Positron Emission Tomography in Prostate Cancer: A Systematic Review and Diagnostic Meta-Analysis.

BACKGROUND: to explore the diagnostic accuracy of 18F-Fluciclovine positron-emission tomography (PET) in prostate cancer (PCa), considering both primary staging prior to radical therapy, biochemical recurrence, and advanced setting. METHODS: A systematic web search through Embase and Medline was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies performed from 2011 to 2020 were evaluated. The terms used were "PET" or "positron emission tomography" or "positron emission tomography/computed tomography" or "PET/CT" or "positron emission tomography-computed tomography" or "PET-CT" and "Fluciclovine" or "FACBC" and "prostatic neoplasms" or "prostate cancer" or "prostate carcinoma". Only studies reporting about true positive (TP), true negative (TN), false positive (FP) and false negative (FN) findings of 18F-fluciclovine PET were considered eligible. RESULTS: Fifteen out of 283 studies, and 697 patients, were included in the final analysis. The pooled sensitivity for 18F-Fluciclovine PET/CT for diagnosis of primary PCa was 0.83 (95% CI: 0.80-0.86), the specificity of 0.77 (95% CI: 0.74-0.80). The pooled sensitivity for preoperative LN staging was 0.57 (95% CI: 0.39-0.73) and specificity of 0.99 (95% CI: 0.94-1.00). The pooled sensitivity for the overall detection of recurrence in relapsed patients was 0.68 (95% CI: 0.63-0.73), and specificity of 0.68 (95% CI: 0.60-0.75). CONCLUSION: This meta-analysis showed promising results in term of sensitivity and specificity for 18F-Fluciclovine PET/CT to stage the primary lesion and in the assessment of nodal metastases, and for the detection of PCa locations in the recurrent setting. However, the limited number of studies and the broad heterogeneity in the selected cohorts and in different investigation protocols are limitation affecting the strength of these results.

The neural bases of discourse semantic and pragmatic deficits in patients with frontotemporal dementia and Alzheimer's disease.

Neuropsychological research on language has largely focused on how the brain processes single words and sentences whose meaning does not depend on the context or on the intentions of the speaker. Fewer studies have investigated the neurobiological bases of discourse semantics and pragmatics in patients and healthy individuals. We studied discourse semantic and pragmatic skills in patients with behavioral variant frontotemporal dementia (bvFTD) or Alzheimer's disease (AD) in comparison to healthy controls. Our goal was to assess whether and how the two patient groups differ in their cognitive and behavioral profiles, and whether these differences may be traced back to disease-specific patterns of neuronal hypometabolism. We combined PET imaging with standard neuropsychological assessment tools and a dedicated test battery designed to evaluate discourse semantics and pragmatics in patients with brain lesions or neurological disorders. We found that AD and bvFTD patients were both impaired compared to controls in discourse comprehension, but largely spared in single word comprehension. Importantly, we also found evidence for behavioral impairments specific to each disease, associated with different brain damage patterns. Compared to AD and controls, bvFTD patients had, behaviorally, more difficulty in evaluating whether certain inferences follow from discourse and in identifying humorous completions of stories; neurally, they had greater damage to medial and lateral regions of PFC. AD patients showed a different pattern of errors in a humor comprehension task than bvFTD patients and controls, and they showed greater posterior temporal and parietal cortical depletion. Both groups had comparable difficulties with understanding idioms and indirect requests. Finally, bvFTD-specific errors were correlated with the severity of hypometabolism in bvFTD. We discuss these results in light of previous research on the dementias as well as consequences for models of semantics and pragmatics in the brain.

Selective associative phonagnosia after right anterior temporal stroke.

We report the case of a 48 year old men who developed a selective impairment in famous voice recognition after ischemic stroke in right subcortical structures (lenticular nucleus and head of the caudate) and right anterior temporal lobe. He underwent fibrinolytic treatment. During the following days he progressively recovered and was discharged without neurological focal sign. Patent foramen ovale was found. When he got back to his house he noticed that he was unable to recognize the voice of his favoured singers and needed to ask who was the singer to his relatives. Neuropsychological examination revealed a selective impairment in famous voice recognition in the absence of alteration of voice perception, face perception and famous face recognition. All other neuropsychological domains were spared. In particular language, memory and executive functions were intact. Neuroimaging carried out by means of PET and MRI revealed two small ischemic lesions in the right subcortical region, involving lenticular and caudate nuclei and in the right temporal pole. To our knowledge, this is the first case described in literature of a patient showing a selective associative phonagnosia after right anterior temporal stroke. The present case helps to clarify the brain circuits underlying famous voice recognition and adds evidence in favour of a right hemisphere involvement in processing knowledge of familiar voices. These findings are discussed in relation to current models of brain organization of person-specific and general semantic knowledge.

Famous faces and voices: Differential profiles in early right and left semantic dementia and in Alzheimer's disease.

BACKGROUND: Famous face and voice recognition is reported to be impaired both in semantic dementia (SD) and in Alzheimer's Disease (AD), although more severely in the former. In AD a coexistence of perceptual impairment in face and voice processing has also been reported and this could contribute to the altered performance in complex semantic tasks. On the other hand, in SD both face and voice recognition disorders could be related to the prevalence of atrophy in the right temporal lobe (RTL). OBJECTIVE: The aim of the present study was twofold: (1) to investigate famous faces and voices recognition in SD and AD to verify if the two diseases show a differential pattern of impairment, resulting from disruption of different cognitive mechanisms; (2) to check if face and voice recognition disorders prevail in patients with atrophy mainly affecting the RTL. MATERIALS: To avoid the potential influence of primary perceptual problems in face and voice recognition, a pool of patients suffering from early SD and AD were administered a detailed set of tests exploring face and voice perception. Thirteen SD (8 with prevalence of right and 5 with prevalence of left temporal atrophy) and 25 CE patients, who did not show visual and auditory perceptual impairment, were finally selected and were administered an experimental battery exploring famous face and voice recognition and naming. Twelve SD patients underwent cerebral PET imaging and were classified in right and left SD according to the onset modality and to the prevalent decrease in FDG uptake in right or left temporal lobe respectively. Correlation of PET imaging and famous face and voice recognition was performed. RESULTS: Results showed a differential performance profile in the two diseases, because AD patients were significantly impaired in the naming tests, but showed preserved recognition, whereas SD patients were profoundly impaired both in naming and in recognition of famous faces and voices. Furthermore, face and voice recognition disorders prevailed in SD patients with RTL atrophy, who also showed a conceptual impairment on the Pyramids and Palm Trees test more important in the pictorial than in the verbal modality. Finally, in 12SD patients in whom PET was available, a strong correlation between FDG uptake and face-to-name and voice-to-name matching data was found in the right but not in the left temporal lobe. DISCUSSION: The data support the hypothesis of a different cognitive basis for impairment of face and voice recognition in the two dementias and suggest that the pattern of impairment in SD may be due to a loss of semantic representations, while a defect of semantic control, with impaired naming and preserved recognition might be hypothesized in AD. Furthermore, the correlation between face and voice recognition disorders and RTL damage are consistent with the hypothesis assuming that in the RTL person-specific knowledge may be mainly based upon non-verbal representations.