Hepatobiliary Scintigraphy to Evaluate Biliary Complications of Pediatric Liver Transplantation: An Account of an Experience.

INTRODUCTION: Hepatobiliary scintigraphy (HS) is a noninvasive imaging technique whose use in the follow-up of liver transplantation has not been duly documented. The main objective of this study is to describe the experience of using this technique to detect biliary complications in pediatric patients following liver transplantation. MATERIALS AND METHODS: A retrospective, observational, and descriptive study involving 86 pediatric patients who had undergone liver transplantation between 2013 and 2018. Of the 86, 31 had undergone at least one HS during their postoperative period. RESULTS: A total of 45 studies were performed on 31 patients (36% of the patients undergoing transplantation during that time period). Patient ages ranged from 5 to 204 months (mean = 50 months). A total of 22 transplants (71%) were from living donors and 9 (29%) were from cadaveric donors. Of the 45 studies, 22 were positive for biliary complications, and all of them had an impact on clinical decision-making. The remaining 23 studies were negative. Of these 23, 19 continued under medical treatment and the other four underwent an additional intervention with positive surgical outcomes in all cases. All scintigraphy studies revealed hepatocellular dysfunction and cholestasis. CONCLUSION: The HS is a useful, noninvasive, and diagnostic procedure for the early diagnosis of biliary complications that may impact the evolution of disease in liver transplant patients. It allows the treating physician to make a more informed decision regarding expectant management, surgical management, or a less invasive course of action for transplantation complications.

Cambios esperables en el estudio isotópico de laperfusión miocárdica en los pacientes con enfermedadde Chagas y arterias coronarias epicárdicas normales / Suspected changes in isotopic study of myocardial perfusion in patients with Chagas disease and normal epicardial coronary arteries

Resumen La enfermedad de Chagas es una entidad parasitaria ocasionada por el Tripanosoma cruzi muy prevalente en América, especialmente en América Latina. Su fase indeterminada dura entre 10 a 30 años, período en el que los pacientes no presentan síntomas y pueden emigrar a cualquier parte del mundo. La consecuencia más relevante es la cardiopatía chagásica con diferentes manifestaciones. En muchas ocasiones la manifestación inicial de la cardiopatía es la insuficiencia cardiaca sobre un corazón dilatado lo que en ocasiones hace indispensable descartar un componente isquémico. La gammagrafía de perfusión miocárdica es una herramienta muy útil para el estudio de la cardiopatía isquémica, su alta sensibilidad permite observar defectos de perfusión diversos incluso en ausencia de la enfermedad aterosclerótica coronaria. Presentamos el caso de un paciente con dolor torácico y enfermedad de Chagas con diversos defectos de perfusión de origen microvascular en la gammagrafía de perfusión miocárdica con evidencia de las arterias coronarias epicárdicas sanas.

Abstract Chagas disease is a parasitic entity caused by Tripanosoma cruzi with a high prevalence in America, mostly in Latin America. Its indeterminate phase lasts between 10 and 30 years. Within this period patients do not show symptoms and can migrate to anywhere in the world. The most relevant consequence is chagasic cardiomyopathy with different manifestations. Many times the initial sign of this cardiomyopathy is cardiac insufficiency in a dilated heart, which on occasion makes it imperative to rule out an ischemic component. Myocardial perfusión scintigraphies are a useful tool to study myocardial ischemia, their high sensitivity allows to observe diverse perfusion defects, even in the absence of atherosclerotic coronary disease. This study presents the case of a male patient with chest pain and Chagas disease showing multiple perfusion defects of microvascular origin in the myocardial perfusion scintigraphy, evidencing healthy epicardial coronary arteries.

Phase analysis for the assessment of left ventricular dyssynchrony by Gated Myocardial Perfusion SPECT. Importance of clinical and technical parameters / Análisis de fase para la valoración del sincronismo mecánico del ventrículo izquierdo mediante Gated-SPECT de perfusión miocárdica. Importancia de los parámetros clínicos y técnicos

Abstract Introduction: Phase analysis (PA) of the left ventricle is a new tool in nuclear cardiology studies used to assess left ventricular mechanical timing based on different clinical applications. However, the use of this tool is relatively unknown. Objective: To expose the feasibility of the new PA tool in myocardial perfusion (Gated-SPECT) to assess left ventricle mechanical timing, and to verify the differences between values depending on clinical and technical conditions. Materials and methods: The study included consecutive patients evaluated by Gated-SPECT. The main variables were different depending on clinical and technical conditions. PA was assessed using the PHASE tool of the QPS-QGS program (Cedars-Sinai Medical Center, Los Angeles, USA). The following parameters were obtained: histogram bandwith (HB), standard deviation (SD) and entropy (E). A descriptive and analytical analysis of means and/or medians was performed using parametric or non-parametric tests. Statistical significance was p <0.05. IBM-SPSS V21® was used. Results: 300 patients were included in this study with a mean age of 65±12.7. No differences were found in relation to the study phase (stress-rest) [HB (p=0.4), SD (p=0.6), E (p=0.8)], stress type [HB (p=0.38), SD (p=0.8), E (p=0.06), E (p=0.06)], dose used [HB (p=0.19), SD (p=0.05), E (p=0.06)], gamma camera [HB (p=0.02), SD (p=0.06), E (p=0.08)], or history of coronary heart disease [HB (p=0.44), SD (p=0.18), E (p=0.17)]. Furthermore, differences in conduction disorders were observed [HB (p=0.001), SD (p=0.02), E (p=0.001)], ejection fraction < or >35% (p=0.001), E (p=0.001)] normal or necrosis study [HB (p=0.001), SD (p=0.001), E (p=0.001)], and gender [HB (p=0.002), SD (p=0.006), E (p=0.005)]. Conclusions: The new PA tool of nuclear medicine is feasible in our context. The type of stress, the administered dose, the study phase or the gamma camera used did not affect the parameters. However, gender, interventricular conduction disorders, necrosis and systolic dysfunction did have an impact on them.

Resumen Introducción. El análisis de fase (AF) del ventrículo izquierdo es una herramienta de reciente introducción en los estudios de cardiología nuclear, que permite valorar el sincronismo mecánico de la contracción del ventrículo izquierdo con diferentes aplicaciones clínicas, si bien es poco conocida. Objetivo. Mostrar la factibilidad de la nueva herramienta AF por perfusión miocárdica (Gated-SPECT) para valorar el sincronismo mecánico del ventrículo izquierdo y verificar diferencias entre sus valores, según situaciones clínicas y condiciones técnicas. Materiales y métodos. En el estudio participaron pacientes consecutivos con Gated-SPECT. Las variables principales fueron diferentes condiciones clínicas y técnicas. La valoración del AF se realizó mediante la herramienta FASE del programa cardiodedicado (QPS-QGS, Cedars-Sinai Medical Center, Los Angeles, USA). Se obtuvieron los siguientes parámetros: ancho del histograma (AH), desviación estandar de la fase (DE) y entropía (E). Se realizó análisis descriptivo y analítico de medias o medianas a través de test paramétricos o no paramétircos. El límite de significancia estadísitca fue p<0.05. Se utilizó IBM-SPSS V21®. Resultados. Con un total de 300 pacientes y una media de edad de 65±12.7, en el análisis del AF no existieron diferencias según la fase del estudio (estrés-reposo) [AH (p=0.4), DE (p=0.6), E (p=0.7)], tipo de estrés [AH (p=0.38), DE (p=0.8), E (p=0.84)], dosis utilizada [AH(p=0.19), DE (p=0.05), E (p=0.06)], gammacámara [AH (p=0.02), DE (p=0.06), E (p=0.08)] ni entre antecedente de enfermedad coronaria [AH (p=0.44), DE (p=0.18), E (p=0.17)]. Hubo diferencias según trastornos de conducción [AH (p=0.001), DE (p=0.02), E (p=0.001)], fracción de eyección < o >35% [AH (p=0.001), DE (p=0.001), E (p=0.001)], estudio normal o con necrosis [AH (p=0.001), DE (p=0.001), E (p=0.001)] y género [AH (p=0.002), DE (p=0.006), E (p=0.005)]. Conclusiones. El uso de la nueva herramienta del AF de medicina nuclear es factible. Sus parámetros no se afectaron por el tipo de estrés producido, dosis administrada o fase del estudio por la gammacámara empleada. Por su parte, sí fueron afectados por género, trastornos de conducción interventricular, necrosis y disfunción sistólica.

Un caso de carcinoma de tiroides de células de Hürthle. Abordando la incertidumbre del papel del Yodo I-131 / A case of Hürthle Cell Thyroid Carcinoma. Dealing with the Uncertainty of the Role of Iodinel-131 / Um caso de carcinoma de tireoides de células de Hürthle. Abordando a incerteza do papel do Iodo I-131

Objetivo: el fin de este artículo es dar a conocer la experiencia del manejo multidisciplinario de un caso documentado de carcinoma de células de Hürthle en el que se encontró captación con I-131 y por lo tanto opción terapéutica con el mismo. Presentación de caso: se trata de una paciente en la sexta década de la vida, diagnosticada inicialmente con bocio difuso quien fue manejada con terapia de sustitución hormonal con análogos de tiroxina sin respuesta satisfactoria, por lo que se realizó biopsia tiroidea, cuyo resultado reportó neoplasia de células de Hürthle de comportamiento inespecífico. Se realizó tiroidectomía oncológica y linfadenectomía. Se realizó revisión de placas de patología y se llegó a un diagnóstico definitivo de carcinoma de Hürthle. Se llevó el caso a junta multidisciplinaria y se decide terapia con I-131 pero este proceso llevó a que la terapia se realizara de forma tardía; aun así se evidencia en el rastreo postratamiento, captación en adenopatía cervical. Finalmente, presentó recaída pulmonar 12 meses después. Este tipo de tumor es un desafío para los médicos tratantes por la incertidumbre en su historia natural, en su tratamiento y en la utilidad del I-131, esta última es muy debatida debido a su alta tendencia a la desdiferenciación y al bajo porcentaje de los mismos que presentan captación del radiofármaco. Es incierto si la paciente de este caso se hubiese podido beneficiar de una terapia ablativa con I-131 más temprana disminuyendo el riesgo de recaída luego de haberse documentado avidez tumoral por el mismo

Objetive: The objective is to present a case with successful I-131 uptake in a patient with Hürthle cell carcinoma. Case presentation: A 60 years old female patient with diagnosed goiter, that was treated with thyroid hormone analogues that didn't decreased the growth of the mass; due to that, it was biopsied. The report of the pathology reported a Hürthle cell neoplasm with indeterminate behavior, lately oncologic thyroidectomy and lymphadenectomy were performed, from which the pathology plates were revised showing a definitive diagnosis of Hurthle cell carcinoma. The case was reviewed in a medical board where I-131 therapy was suggested. In the postheraphy scan performed, there was evidence of I-131 uptake in the neck and in an adenopathy. Twelve months later, there was evidence of pulmonary relapse. Is an uncertainty to know if the patient in this case would have been able to benefit from an early ablative therapy with I-131 decreasing the risk of relapse after having documented tumor avidity for it. The Hürthle thyroid carcinoma is rare, and its natural history is still controversial because it's challenging diagnosis, treatment and monitoring. Because there is no definitive agree about his integral approach despite it has been considered differentiated thyroid cancer even therapy with I-131 is still debated

Objetivo: O fim deste artigo é dar a conhecer a experiência do manejo multidisciplinar de um caso documentado de carcinoma de células de Hürthle no qual encontrou-se captação com I-131 e pelo tanto opção terapêutica com o mesmo. Presentación de caso: Trata-se de uma paciente na sexta década da vida, diagnosticada inicialmente com bócio difuso que foi tratada com terapia de substituição hormonal com análogos de tiroxina sem resposta satisfatória, pelo que se realizou biopsia tireóidea, cujo resultado reportou neoplasia de células de Hürthle de comportamento inespecífico. Realizou-se tireoidectomia oncológica e linfadenectomia. Realizou-se revisão de placas de patologia e chegou-se a um diagnóstico definitivo de carcinoma de Hürthle. Levouse o caso à junta multidisciplinar e decide-se terapia com I-131 mas este processo levou a que a terapia se realizara de forma tardia; ainda assim evidencia-se no rastreamento pós-tratamento captação em adenopatia cervical. Finalmente, apresentou recaída pulmonar 12 meses depois. Este tipo de tumor pe um desafio para os médicos tratantes pela incerteza na sua história natural, no seu tratamento e na utilidade do I-131, esta útlima é muito debatida devido à sua alta tendência à desdiferenciação e à baixa percentagem dos mesmos que apesentam captação do radiofármaco. É incerto se a paciente deste caso se tivesse conseguido beneficiar de uma terapia ablativa com I-131 mais temporã diminuindo o risco de recaída após ter-se documentado avidez tumoral pelo mesmo

Terapia con [ 177 Lu - Dota0 - Tyr 3 ]-Octreotate ( 177 Lu-Dotatate) en pacientes con tumores avanzados de origen neuroendocrino: experiencia inicial y resultados preliminares / Therapy with [ 177 Lu - Dota0 - Tyr 3 ]-Octreotate ( 177 Lu-Dotatate) in Patients with Advanced Neuroendocrine Tumors: Initial Experience and Preliminary Results / Terapia com [ 177 Lu - Dota0 - Tyr 3 ]-Octreotate ( 177 Lu-Dotatate) em Pacientes com Tumores Avançados de Origem Neuroendócrino: Experiência Inicial e Resultados Preliminares

Resumen Objetivo: Mostrar la experiencia inicial y los resultados preliminares de la terapia con [177Lu -Dota0 - Tyr3] - Octreotate (177Lu-Dotatate) en pacientes tratados en la Fundación Cardioinfantil - Instituto de Cardiología (FCI-IC) debido a que la experiencia derivada de esta práctica en países latinoamericanos es poco conocida. Materiales y métodos: Se realizó un análisis descriptivo y retrospectivo en pacientes a los que se les realizó terapia con 177Lu-Dotatate con al menos una dosis y un año de seguimiento. Se incluyeron 8 pacientes (4 mujeres y 4 hombres) de edad media: 57 años (50-63). Se administraron 24 dosis en total, 3 dosis en promedio por paciente, 187 GBq totales y 23,5 GBq dosis/paciente. Se valoró la respuesta al tratamiento y la presencia de efectos adversos. Resultados: El tiempo medio de seguimiento fue de 46 meses (26-72 meses). 5/8 pacientes tenían diagnóstico de tumores neuroendocrinos (TNE) de origen pancreático, 2/8 de origen gástrico y 1/8 de yeyuno. 7/8 pacientes tenían compromiso metastásico; 1/8, a pesar de no tener afectación metastásica, fue considerado irresecable. 7/8 pacientes presentaron síntomas posterapia leves y 1/8 eventos adversos serios. 2/8 pacientes tuvieron respuesta parcial, 4/8 enfermedad estable y 2/8 respuesta completa. Sin embargo, al final del seguimiento un paciente que tuvo respuesta completa presentó recaída y otro, respuesta parcial con posterior progresión y muerte. Conclusiones: En la institución, la terapia con 177Lu-Dotatate ha sido segura y eficaz en pacientes con TNE como alternativa terapéutica con adecuados niveles de respuesta y control de la enfermedad con eventos adversos leves, esperables y eventos serios mínimos autolimitados.

Abstract Objective: To Show the initial experience and preliminary results of therapy with [177Lu -Dota0 - Tyr3] - Octreotate (177 Lu-Dotatate) in patients with neuroendocrine tumors (NET) treated in our institution, because the experience gained from this practice in Latin American countries is poorly known. Materials and methods: A descriptive and retrospective analysis in patients who have undergone therapy with 177 Lu-Dotatate with at least one dose and at least one year of follow-up was performed. 8 patients (4 women and 4 men) with a mean age of 57 years (50-63) were included. A total of 24 doses were given, an average of 3 doses per patient. A total of 187 GBq were administered, equivalent to 23.5 GBq / patient. Response to therapy and the presence of adverse short and long term effects were assessed. Results: The average follow-up time was 46 months (26-72 months). 5/8 patients were diagnosed with pancreatic net, 2/8 of gastric origin and 1/8 of small bowel origin. 7/8 patients had metastatic involvement and 1/8 patient despite not having metastasis was considered unresectable. 6/8 patients had mild post-therapy symptoms and 1/8 serious adverse events. 2/8 patients had partial response, 4/8 stable disease and 2/8 had a complete response. At the end of follow-up, however, one patient who had a complete response presented with recurrence and one with partial response showed progression and death. Conclusions: In our experience, therapy with 177 Lu-Dotatate was safe and effective in patients with net as an alternative therapy with appropriate levels of response and disease control and with mild expected adverse events and self-limiting minimum serious events.

Resumo Objetivo: Mostrar a experiência inicial e os resultados preliminares da terapia com [177Lu - Dota0 - Tyr3] -Octreotate (177Lu-Dotatate) em pacientes tratados na nossa instituição, devido a que a experiência derivada desta prática em países latino-americanos é pouco conhecida. Materiais e métodos: Se realizou uma análise descritiva e retrospectiva em pacientes aos que se lhes tem realizado terapia com 177Lu-Dotatate com ao menos uma dose e ao menos um ano de seguimento. Incluíram-se 8 pacientes, idade média de 57 anos (50-63). Administraram-se: 24 doses em total, 3 doses em média por paciente, 187 GBq totais administrados e 23.5 GBq doses/paciente. Valorou-se a resposta ao tratamento e a presença de efeitos adversos. Resultados: O tempo médio de seguimento foi de 45 meses (26-72 meses). 5/8 tinham diagnóstico de TNE de origem pancreática, 2/8 de origem gástrica e 1/8 de jejuno. 7/8 pacientes tinham compromisso metastático e 1/8 paciente apesar de não ter afetação metastática foi considerado irressecável. 6/8 pacientes apresentaram sintomas pós-terapia leves e 1/8 eventos adversos sérios. 2/8 pacientes tiveram resposta parcial, 4/4 doença estável e 2/8 resposta completa. No entanto, no final do seguimento um paciente que teve resposta completa apresentou recaída e outro resposta parcial com posterior progressão e morte. Conclusões: no nosso meio a terapia com 177Lu-Dotatate tem sido segura e eficaz em pacientes com TNE como alternativa terapêutica com adequados níveis de resposta e controle da doença com eventos adversos leves esperáveis e eventos sérios mínimos autolimitados.

Análisis de fase mediante "Gated-SPECT" de perfusión miocárdica para valorar el sincronismo mecánico del ventrículo / Phase analysis to measure left ventricular dyssynchrony by Gated-SPECT myocardial perfusion imaging showed by two different software

Resumen Introducción y objetivos: El análisis de fase mediante Gated-SPECT de perfusión miocárdica (GS-PMI) es una nueva herramienta para medir la asincronía ventricular izquierda con importantes aplicaciones clínicas futuras en resincronización e insuficiencia cardiaca. Se puede medir mediante dos programas (ECTb o QGS C-S). El objetivo es demostrar su factibilidad y verificar si existen diferencias entre ambos. Metodología: Estudio analítico, observacional y retrospectivo en pacientes con GS-PMI normales. Los parámetros obtenidos fueron: la desviación estándar de la fase (DE) y el ancho de banda de histograma (AH). La evaluación de la diferencia entre los grupos se realizó usando pruebas para muestras independientes después de analizar la distribución de datos. Nivel de significación p<0,05. Se utilizó SPSS IBM V.21®. Resultados: Total pacientes: 193 (104 hombres). Edad media: 64 años (24-89).61/193 procesados con QGS C-S y 132/193 con ECTb. Postestrés: la media de la DE fue 6º±3,7º, con mediana de 5º y rango intercuartílico (IR):3.6º. La media de AH fue 22,7º±10º, con mediana de 18º y IR:11.5º. Postreposo: la media de la DE fue 5,76º±4,82º y la mediana 4,5º con IR: 3.1º. La media de AH fue 21.67º± 14.06º y la mediana 18º, IR:12º. Entre ambos programas se encontraron diferencias significativas en la DE en postestrés (p=0,001) y postreposo (p=0,019), sin diferencias en el AH postestrés (p=0,31) y postreposo (p=0,18). Conclusión: Realizar el análisis fase de análisis por GS-PMI es factible. Sin embargo, la DE mostró diferencias significativas entre los dos programas. Aunque los valores mostrados podrían ser utilizados como valores normales, se recomienda que estos se obtengan y utilicen para cada programa por separado.

Abstract Introduction and objectives:Phase analysis by Gated-SPECT myocardial perfusion imaging (G-MPI) is a new tool to measure left ventricular dyssynchrony with important clinical applications in near future (heart failure and resynchronization) and can be measured by two software (ECTb o QGS C-S). The aim is to show its feasibility and verify whether there is difference between the programs. Methodology: Analytical observational and retrospective study in patients with normal G-MPI. The parameters were the phase standard deviation (SD) and the histogram bandwidth (HB) in post-stress and rest tests. Assessment of the difference between groups was performed using tests for independent samples after analyze the distribution of data. The significance level (p) was 0,05 and the software used was SPSS IBM V.21® Results: Total:193 patients (104 men).64 years old ± (24-89).61/193 processed with QGS C-S and 132/193 with ECTb. Post-stress tests: mean of the SD was 6º±3.7º,the median was 5º,interquartile range (IR):3.6º.The mean of HB was 22.7º±10º and the median was 18º IR:11.5º. Post-rest tests: mean of the SD was 5.76º±4.82º and median was 4.5º IR: 3.1º.The overall mean of HB was 21.67º±14.06º and median was 18º IR: 12º. Between the data from both software, significant differences were found in SD in post-stress(p=0.001)and post-rest tests(p=0.019)and no significant differences were found in HB in post-stress(p= 0.31)or post-rest tests(p=0.18). Conclusion: Phase analysis by G-MPI is feasible. However SD showed significant differences between the two groups. Although the values showed could be used as normal values, it is recommended that these have to be obtained and used for each software separately.

Feasibility and performance of an adaptive contrast-oriented FDG PET/CT quantification technique for global disease assessment of malignant pleural mesothelioma and a brief review of the literature.

OBJECTIVE: Treatment of malignant pleural mesothelioma (MPM) remains very challenging. Assessment of response to treatment is necessary for modifying treatment and using new drugs. Global disease assessment (GDA) by implementing image processing methods to extract more information out of positron emission tomography (PET) images may provide reliable information. In this study we show the feasibility of this method of semi-quantification in patients with mesothelioma, and compare it with the conventional methods. We also present a review of the literature about this topic. METHODS: Nineteen subjects with histologically proven MPM who had undergone fluoride-18-fluorodeoxyglucose PET/computed tomography ((18)F-FDG PET/CT) before and after treatment were included in this study. An adaptive contrast-oriented thresholding algorithm was used for the image analysis and semi-quantification. Metabolic tumor volume (MTV), maximum and mean standardized uptake volume (SUVmax, SUVmean) and total lesion glycolysis (TLG) were calculated for each region of interest. The global tumor glycolysis (GTG) was obtained by summing up all TLG. Treatment response was assessed by the European Organisation for Research and Treatment of Cancer (EORTC) criteria and the changes of GTG. Agreement between global disease assessment and conventional method was also determined. RESULTS: In patients with progressive disease based on EORTC criteria, GTG showed an increase of 150.7 but in patients with stable or partial response, GTG showed a decrease of 433.1. The SUVmax of patients before treatment was 5.95 (SD: 2.93) and after the treatment it increased to 6.38 (SD: 3.19). Overall concordance of conventional method with GDA method was 57%. Concordance of progression of disease based on conventional method was 44%, stable disease was 85% and partial response was 33%. Discordance was 55%, 14% and 66%. CONCLUSIONS: Adaptive contrast-oriented thresholding algorithm is a promising method to quantify the whole tumor glycolysis in patients with mesothelioma. We are able to assess the total metabolic lesion volume, lesion glycolysis, SUVmax, tumor SUVmean and GTG for this particular tumor. Also we were able to demonstrate the potential use of this technique in the monitoring of treatment response. More studies comparing this technique with conventional and other global disease assessment methods are needed in order to clarify its role in the assessment of treatment response and prognosis of these patients.

Role of 18F-FDG-PET/CT in the management of marginal zone B cell lymphoma.

The use of PET in patients with marginal zone B cell lymphoma (MZL) is controversial because of variability of fluorodeoxyglucose (FDG) avidity. We analyzed 40 PET/CT in 25 consecutive patients to compare its performance with CT at staging and as a first-line response assessment. Sensitivity of PET/CT and CT was 96 and 76%. Mean standard uptake value was 6.1, 6.9 and 3.4 (p = 0.3) in nodal, extranodal and splenic subtypes, respectively. Of 17 patients (extranodal: n = 9; nodal: n = 6; splenic subtype: n = 2) with both imaging tests available at diagnosis, 8 (47%) had more involved areas with PET/CT than with CT, 75% of which were extranodal lesions. PET/CT resulted in upstaging of five patients although treatment of only two of them was changed. Responses of 15 patients with post-treatment PET/CT were the following: 9 negative and 6 positive of which 3 were isolated residual lesions. Progression was documented in two of these three patients. Response was also assessed by CT in 11 patients. Discrepancies were found in three: Two were in complete remission by CT while PET/CT detected localized residual disease; another patient was in partial remission by CT, whereas PET/CT showed only one positive lesion. Two of these three patients relapsed. Patients with negative post-treatment PET/CT did not relapse. With a median follow-up of 50 months (10-152 months), 3-year overall survival was 100 and 80% for patients with negative and positive post-treatment PET/CT (p = 0.2). Three-year disease-free survival was 86%; the negative predictive value (NPV) was 100%, and the positive predictive value (PPV) was 83.3%. Although a larger number of patients will be required to further confirm these data, we can conclude that PET/CT is a useful imaging tool for both staging and response assessment in patients with nodal and extranodal MZL as a result of its high sensitivity, NPV and PPV.

Role of 18F-FDG-PET/CT in the management of Burkitt lymphoma.

UNLABELLED: Burkitt lymphoma (BL) is highly FDG-avid even though its usefulness in the management of these patients is still controversial. AIM: We analyzed the role of positron emission tomography/computerized tomography (PET/CT) in staging newly diagnosed patients with BL and evaluating disease after first-line chemotherapy. METHODS: Fifty-two PET/CTs were performed in 32 patients (20 at diagnosis, 27 after treatment, five to monitor residual disease). Involved areas were retrospectively compared with those observed in contrast-enhanced CT. RESULTS: Discrepancies were found in 64.7% of patients for whom results of both tests at diagnosis were available (n = 17), most of them involving extranodal sites. Regarding response assessment, discrepancies were observed in 38% of patients with both tests (5/13): residual masses detected by CT with negative PET/CT. Of 27 patients with post-treatment PET/CT, 22 were in complete remission whereas one true-positive and four false-positive lesions (two nodal and two extranodal) were detected. With a median follow-up of 27 months, 22 patients with negative PET/CT did not relapse. Thus, negative predictive value (NPV) was 100%. With respect to positive predictive value (PPV), one of five patients with positive assays after treatment died due to progression while the remaining four had false-positive lesions. Nevertheless, for these four patients, mean SUVmax at nodal sites was 4.1 vs. 14.9 at diagnosis, while mean SUVmax at extranodal sites was 3.8 vs. 12.1. Thus, with a cutoff value for SUVmax < 66% of that observed at diagnosis, PPV was also 100%. CONCLUSION: More accurate staging can be achieved using PET/CT. NPV reaches 100%, and using a ΔSUV < 66%, a high PPV is also observed.

[SPECT/CT with 99mTc-HMPAO in progressive encephalitis mediated by anti-GAD antibodies]. / SPECT/TC con 99mTc-HMPAO en la encefalitis progresiva mediada por anticuerpos anti-GAD.

TITLE: SPECT/TC con 99mTc-HMPAO en la encefalitis progresiva mediada por anticuerpos anti-GAD.

Quantitative assessment of global hepatic glycolysis in patients with cirrhosis and normal controls using 18F-FDG-PET/CT: a pilot study.

OBJECTIVE: To compare differences in global measures of hepatic metabolism between control subjects and subjects with cirrhosis. MATERIALS AND METHODS: FDG-PET/CT scans of 33 subjects either without or with cirrhosis were analyzed retrospectively and classified as follows: group 1 includes subjects without cirrhosis or extrahepatic malignancy (1a) (n=11) and subjects without cirrhosis but with history of extrahepatic malignancy (1b) (n=10); group 2 includes subjects with cirrhosis and history of extrahepatic malignancy (n=12). Subjects with focal hepatic lesions, prior hepatic surgery, co-existing liver pathology, or who received chemotherapy or radiation therapy within the last 6 months were excluded. The hepatic volumes, hepatic mean standardized uptake value (SUVmean), and global hepatic glycolysis (GHG) were compared between groups. RESULTS: Subjects with cirrhosis showed a lower average hepatic SUVmean as compared to non-cirrhotic patients (1.55±0.29 for group 2 versus 1.81±0.23 for group 1; p value=0.009) and lower average values for GHG (2238.29±903.60 for group 2 versus 2974.67±829.16 for group 1; p value=0.024). No differences were noted between the non-cirrhotic subgroups (i.e., between the groups 1a and 1b) without and with associated extrahepatic malignancy, respectively. CONCLUSIONS: We hypothesize that presence of fibrosis, reduction of active inflammation, and decreased hepatic metabolism and function are potential causes of the lower FDG uptake in cirrhotic livers. Our results also indicate that extrahepatic cancer status does not influence FDG uptake in the non-cirrhotic liver in subjects without hepatic metastases.

Clinical features and 123I-FP-CIT SPECT imaging in vascular parkinsonism and Parkinson's disease.

OBJECTIVES: To analyse the differences in the clinical features and characteristics of (123)I-labelled 2ß-carbomethoxy-3ß-(4-iodophenyl)-N-(3-fluoropropyl) nortropane ((123)I-FP-CIT) single photon emission CT (SPECT) imaging among patients with vascular parkinsonism (VP) and Parkinson's disease (PD). METHODS: We performed a case-control study to compare clinical features and qualitative and semi-quantitative analyses of (123)I-FP-CIT SPECT images between 106 patients with VP and 280 patients with PD. A case series study was used to search for clinical features related to SPECT or neuroimaging findings among patients with VP. RESULTS: Patients with VP had a higher age at symptom onset and lower disease duration than patients with PD. The most frequent symptom at onset was gait disorder in VP and tremor in PD. Gait disorder, postural instability and falls were more frequent in VP. Rest and mixed tremor were more prevalent in PD. Of the patients who received levodopa treatment in the VP group, only about half had a good response. Qualitatively (123)I-FP-CIT SPECT images were normal in 32.5% of patients with VP and abnormal in all patients with PD. The use of different visual score patterns showed higher ability to differentiate VP from PD. Semi-quantitative analysis showed significantly higher uptake in the striatum, caudate and putamen in VP. The asymmetry index was higher in patients with PD. Among patients with VP, falls were the only clinical feature that demonstrated a correlation with the SPECT visual pattern. CONCLUSION: Our data contribute to the confirmation that VP and PD are two different clinical entities. Neurological signs, response to treatment and qualitative and semi-quantitative (123)I-FP-CIT SPECT analyses may help to make the diagnosis.