Noriega-Álvarez E, Moreno-Ballesteros A, Velasco Nuño M
… +6 more, Cordero García JM, Rosales Castillo JJ, Schmülling UV, López Rodríguez E, Rigabert Sánchez-Junco A, Rodríguez Alfonso B
The continued increase in demand for diagnosis and monitoring of infectious bone diseases, along with the introduction of new equipment, radiopharmaceuticals, and techniques for this purpose, has made it necessary to dyn...The continued increase in demand for diagnosis and monitoring of infectious bone diseases, along with the introduction of new equipment, radiopharmaceuticals, and techniques for this purpose, has made it necessary to dynamically update the existing protocols and recommendations. Therefore, the MSP-WG conducted a survey for spanish hospitals to complete and develop recommendations in the form of algorithms, in an attempt to combine existing scientific evidence with the reality of national clinical practice.
AIM: In this study, we aimed to evaluate the diagnostic performance of F-PSMA-1007 PET/CT compared to Ga-PSMA-11 PET/CT, which is more commonly used in routine practice, for detecting prostate cancer recurrence in prosta...AIM: In this study, we aimed to evaluate the diagnostic performance of F-PSMA-1007 PET/CT compared to Ga-PSMA-11 PET/CT, which is more commonly used in routine practice, for detecting prostate cancer recurrence in prostate cancer patients with biochemical recurrence. MATERIALS AND METHODS: Forty-one prostate cancer patients with biochemical recurrence were prospectively included in the study. Additionally, images from 46 patients in our institution's database, who had undergone Ga-PSMA-11 PET/CT imaging for biochemical recurrence, were retrospectively re-evaluated to compare the detection rates with those of F-PSMA-1007 PET/CT. SUVmax, total tumor PSMA, PSMA total tumor volume were calculated for local recurrence, lymph node metastasis, and organ metastasis. The diagnostic performances of the two imaging methods were then compared. RESULTS: The mean age, Gleason scores, ISUP scores, serum PSA levels at diagnosis and at the time of imaging, and PSA doubling times were similar across the F-PSMA-1007 and Ga-PSMA-11 groups. Pathological uptake was observed in the prostatic bed in 16 patients (39.0%), lymph nodes in 22 patients (46.3%), and bones in 11 patients (26.8%) with F-PSMA-1007 PET/CT. F-PSMA-1007 PET/CT showed statistically significant superiority over Ga-PSMA-11 PET/CT in detecting lymph node metastases (41.6% vs. 25.4%; P=.028). There was no significant difference between the two imaging protocols in the detection rates of local recurrence (P=.067) and bone metastasis (P=.580). CONCLUSION: Although the study included a small sample size, the results revealed that F-PSMA-1007 PET/CT had a higher detection rate than Ga-PSMA-11 PET/CT in patients with biochemically recurrent prostate carcinoma, particularly for lymph node metastases.
OBJECTIVE: To investigate the prognostic value of pretreatment 2-[F]-fluoro-2-deoxy-d-glucose (F-FDG) positron emission tomography/computed tomography (PET/CT) in patients with hepatic neuroendocrine tumors (HNET). METHO...OBJECTIVE: To investigate the prognostic value of pretreatment 2-[F]-fluoro-2-deoxy-d-glucose (F-FDG) positron emission tomography/computed tomography (PET/CT) in patients with hepatic neuroendocrine tumors (HNET). METHODS: In total, 41 patients were included in this study. PET-derived metabolic parameters, including maximum and mean standardized uptake values (SUV and SUV, respectively), metabolic tumor volume (MTV), and total lesion glycolysis (TLG), of the tumors were measured. Meanwhile, clinical data, including tumor pathological findings such as the Ki-67 index were also assessed. Progression-free survival (PFS) and overall survival (OS) were evaluated. Univariate and multivariate analyses were performed to predict the prognostic value of clinical variables and PET-derived metabolic parameters in HNET patients. Correlation between PET-derived metabolic parameters and Ki-67 was estimated. RESULTS: Univariate analyses revealed that among PET-derived metabolic parameters, SUV, SUV, and TLG were significant prognostic factors for OS (P < .05). Among clinical variables, the Ki-67 index and radical surgical resection were significant factors for both PFS and OS (P < .05). In multivariate analyses, only Ki-67 index was an independent prognostic factor for both PFS and OS (P < .05). Ki-67 index presented correlates with SUV and SUV (R = 0.566, P < .001, R = 0.493, P = .001, respectively). CONCLUSIONS: In patients with HNET, the Ki-67 index was an independent prognostic factor for both PFS and OS, while SUV, SUV, and TLG measured on pretreatment F-FDG PET/CT scans were prognostic factors for predicting OS. Ki-67 index also presented correlates with SUV and SUV. F-FDG-PET may be useful as quantitative predicting prognostic imaging biomarkers, especially in poorly differentiated HNET.
BACKGROUND AND OBJECTIVE: Thyrotoxicosis is a common clinical condition in endocrinology, with Graves' disease (GD) and subacute thyroiditis (SAT) as its predominant causes. These disorders often share overlapping clinic...BACKGROUND AND OBJECTIVE: Thyrotoxicosis is a common clinical condition in endocrinology, with Graves' disease (GD) and subacute thyroiditis (SAT) as its predominant causes. These disorders often share overlapping clinical and biochemical features, making differential diagnosis challenging. This study evaluates the diagnostic efficacy of the thyroid/background ratio (TBR) as a semiquantitative method for differentiating GD from SAT and compares multiple diagnostic parameters. MATERIALS AND METHODS: This was a retrospective analysis of 106 consecutive patients newly diagnosed with thyrotoxicosis. All participants underwent assessment of free tri-iodothyronine (fT3), free thyroxine (fT4), TSH, thyroid-stimulating immunoglobulin (TSI), Anti-TPO, Anti-Tg, CRP, erythrocyte sedimentation rate (ESR), 99mTc thyroid scintigraphy (TS), and ultrasonography (USG). TBR was calculated from TS. Each patient was followed for at least six months, with final diagnoses of GD or SAT made by an endocrinologist. RESULTS: Sixty-eight and 38 patients were diagnosed with GD and SAT, respectively. The analysis of thyroid-associated laboratory markers and inflammatory indices revealed characteristic differences between GD and SAT. Multivariable logistic regression analysis revealed three independent predictors of SAT: diminished TSI (OR = 0.04; P = .039), reduced fT3/fT4 ratio (OR = 0.05, P = .019), and lower TBR (OR = 0.20, P = .001). TSI demonstrated high diagnostic accuracy area under the curve (AUC): 0.923, optimal cut-off: ≤1.05 IU/L, sensitivity: 100%, specificity: 85.9%). The TBR yielded the highest AUC (0.990) in distinguishing GD from SAT (cut-off: ≤3.6 IU/L, sensitivity: 97.4%, specificity: 98.5%). According to USG findings, the cases showed two different patterns as diffuse thyroiditis pattern (DTP) and nodular thyroiditis pattern (NTP). On USG a DTP was more frequent in GD group than in SAT group (80.9% vs. 55.3%, P = .007). In both GD and SAT, demographic and clinical findings were similar between patients with DTP and patients with NTP. However, symptom duration, TSI, fT3, fT3/fT4 ratio, anti-TPO, thyroid ROI and TBR levels were higher in GD patients with DTP or NTP than in SAT patients with DTP or NTP. In contrast, background ROI, ESR and CRP levels were lower. Among patients with DTP, a TBR cut-off value of ≤3.7 yielded a sensitivity of 95.2% and a specificity of 98.2% in distinguishing SAT from GD. In this cohort, TBR demonstrated superior diagnostic performance compared to TSI. The optimal TBR threshold for differentiating SAT from GD among patients with NTP was <2.3, exhibiting 100% sensitivity and 100% specificity. However, the diagnostic performance was not significantly different from that of TSI. A positive thyroglossal duct activity finding was present only in GD, in 45.5% of the patients. CONCLUSION: The fT3/fT4 ratio demonstrates limited efficacy as a diagnostic tool for differentiating between GD and SAT. TSI exhibit high accuracy but, TBR demonstrated the highest diagnostic accuracy (AUC: 0.990) than other parameters in distinguishing SAT from GD. According to the subgroup analyses, the diagnostic accuracy of TBR in DTP cases was higher than TSI, while the diagnostic accuracy of TBR in NTP cases was found to be equivalent to TSI.
INTRODUCTION AND OBJECTIVES: Locoregional recurrence occurs in up to 28% of patients with papillary thyroid cancer (PTC). Several risk factors contribute to this metastatic process. The latest of them is perinodal infilt...INTRODUCTION AND OBJECTIVES: Locoregional recurrence occurs in up to 28% of patients with papillary thyroid cancer (PTC). Several risk factors contribute to this metastatic process. The latest of them is perinodal infiltration (PNI). PNI refers to the pathological extension of tumor cells through the lymph node (LN) capsule into the perinodal fibroadipose tissue. It has been accepted as a poor predictive variable. This study aimed to evaluate the prognostic significance of PNI in recurrence of PTC and identify predictive parameters associated with the recurrence in PNI (+) patients. MATERIAL AND METHODS: The study included 680 PTC patients with initial LN metastasis (ILNM). Study population was selected from them according to presence or absence of PNI. Eventually, 102 PNI (+) and 122 PNI (-) patients remained eligible for the study. Patients were statistically compared according to demographic, clinicopathologic features both between PNI (+) and PNI (-) groups and within the PNI (+) group over recurrence status. RESULTS: The recurrence rates were 40% and 15% in PNI (+) and PNI (-) patients, respectively (p < 0.001). The independent predictive factors associated with recurrence were central ILNM (p = 0.005), combined central and lateral ILNM (p = 0.003), ILNM > 5 (p = 0.023), stage III-IV (p = 0.025 and p < 0.001), tumor size (TS) (p < 0.001), ILNM size (p < 0.001), stimulated thyroglobulin (sTg) (p = 0.039). PNI (p = 0.05), central ILNM (p = 0.035) and TS (p = 0.027) remained prognostic variables after multivariate analysis. CONCLUSION: PNI positivity is a poor prognostic factor for PTC recurrence. PNI, especially with large TS and central ILNM, should be taken into account when planning RAI therapy in PTC patients.
Subcutaneous emphysema may occur iatrogenically, spontaneously, or post-traumatically as a result of free air passage under the skin from the respiratory tract or gastrointestinal tract. In this case, we present the typi...Subcutaneous emphysema may occur iatrogenically, spontaneously, or post-traumatically as a result of free air passage under the skin from the respiratory tract or gastrointestinal tract. In this case, we present the typical appearance of a case of massive subcutaneous emphysema observed on [18F]-FDG PET/CT for metabolic characterization due to a massive lesion in the lung and the images of complete resorption after seven months.
OBJECTIVES: Neuroblastoma often demonstrates high uptake of MIBG, which is used for imaging and therapy. This retrospective observational study aimed to assess the prognostic significance of modified Curie scores (mCS) a...OBJECTIVES: Neuroblastoma often demonstrates high uptake of MIBG, which is used for imaging and therapy. This retrospective observational study aimed to assess the prognostic significance of modified Curie scores (mCS) and SIOPEN scores (SS) derived from post-treatment I-MIBG scans in relapsed/refractory neuroblastoma. Additionally, the impact of SPECT-CT imaging on these scores was investigated as a secondary goal. MATERIAL AND METHODS: Pediatric patients with relapsed/refractory neuroblastoma, who underwent I-MIBG treatment, were included (n=35). mCS and SS were calculated from planar images of post-treatment I-MIBG scans. Patients were then categorized based on the cut-off values obtained from these scans, and survival analysis was conducted. To investigate the impact of SPECT-CT imaging on scores, mCS and SS were also calculated from both planar and SPECT-CT images of diagnostic I-MIBG scans separately. RESULTS: Patients with mCS>12 or SS>23 on post-treatment I-MIBG scans had significantly worse overall survival. mCS and SS from SPECT-CT were significantly higher than planar images in pre- and post-treatment diagnostic I-MIBG scans. SPECT-CT caused changes in mCS for 61% and SS for 55% of patients, predominantly in axial and appendicular skeleton regions. CONCLUSIONS: Both mCS and SS from post-treatment I-MIBG planar scans correlated significantly with overall survival in relapsed/refractory neuroblastoma. Patients with mCS>12 or SS>23 had poorer survival. SPECT-CT imaging influenced scores for a substantial portion of patients, emphasizing its value alongside planar imaging. Larger, comprehensive studies are warranted to validate these findings and refine prognostic cut-offs. Incorporating SPECT-CT in relevant body regions is recommended for improved disease assessment.
BACKGROUND: Prostate-Specific Membrane Antigen is overexpressed in primary and metastatic prostate cancer tissues. While PSMA PET agents have gained their role in the prostate cancer guidelines, Technetium-based PSMA age...BACKGROUND: Prostate-Specific Membrane Antigen is overexpressed in primary and metastatic prostate cancer tissues. While PSMA PET agents have gained their role in the prostate cancer guidelines, Technetium-based PSMA agents have left behind. Given the novelty of Tc-HYNIC-PSMA-11, we conducted this study to compare its detection rate in tracing skeletal metastases in comparison to bone scans and also compared the number of metastatic lesions which showed PSMA uptake in the diagnostic scan with those detected in post-treatment scans after radioligand therapy (RLT) with Lu-PSMA-617-617. METHODS: Bone and Tc-HYNIC-PSMA-11 scans with a maximum interval of 90 days were performed in thirty-nine patients with widespread bone metastases. If the PSMA scan was positive, patients were treated with Lu-PSMA-617 and post treatment scan was also obtained. For negative PSMA results, Ga-PSMA PET/CT was performed to compare its results with the bone scan. In patients with PSMA expression, detection of metastatic lesions in three consecutive whole-body scans in different regions were compared (Tc-HYNIC-PSMA-11 with bone and post treatment scans, separately). RESULTS: 37 (94.9%) showed adequate Tc-HYNIC-PSMA-11 uptake in the metastatic regions. Compared to bone scan, Tc-HYNIC-PSMA-11 showed additional lesions in 13 (35.1%) participants which were mostly located in the appendicular skeleton and pelvic bones. Inversely, the bone scan detected more lesions in 12 (32.4%) patients. Both scans in 12 (32.4%) patients showed the exact same results. Comparison between the Tc-HYNIC-PSMA-11 scan and Lu-PSMA-617 showed completely similar results in 29 (78.4%) patients; however, Lu-PSMA-617 detected more lesions in eight (21.6%) participants. CONCLUSION: The Tc-HYNIC-PSMA-11 scan demonstrates comparable results to bone scans in evaluating skeletal metastases in prostate cancer patients. It serves as a cost-effective modality for identifying suitable candidates for radioligand therapy, particularly beneficial in resource-limited countries.
INTRODUCTION AND OBJECTIVES: Although, oncocytic (Hurthle cell) carcinoma (OTC) resembles to follicular thyroid carcinoma (FTC), they are different tumors derived from thyroid follicular cells. OTC comprises 3-5% of all...INTRODUCTION AND OBJECTIVES: Although, oncocytic (Hurthle cell) carcinoma (OTC) resembles to follicular thyroid carcinoma (FTC), they are different tumors derived from thyroid follicular cells. OTC comprises 3-5% of all differentiated thyroid carcinomas and has more aggressive behaviour than FTC. Clinicians discuss about the treatment and prognosis of OTC. We evaluated its clinicopathological features and clinical course. MATERIAL AND METHODS: We examined and followed up 169 patients with OTC (126 minimally invasive, 43 widely invasive) and 837 patients with FTC (640 minimally invasive, 197 widely invasive). OTC and FTC were compared according to prognostic variables, recurrence rate (Rec) and outcome. The predictor factors impacting on recurrence in OTC were also determined. RESULTS: There were statistically significant differences between OTC and FTC in age, sex, capsule invasion (CI), tumor size (TS), total administered [131I]NaI dose (TID), stimulated thyroglobulin (sTg), Rec and stage (p<0.001, p=0.032, p<0.001, p<0.001, p=0.004, p=0.026, p=0.017, p=0.044, respectively). Age, CI, extrathyroidal extension (ETE), TS, initial lymph node metastasis (ILNM), sTg and stage (p=0.01, p=0.016, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, respectively) were the predictors for recurrence in OTC. Metastasis incidence was 19.5% for OTC and 12% for FTC. The cause of death was cancer in 25 patients with FTC (2.8%) and 11 patients with OTC (6.5%). CONCLUSION: The prognosis of minimally invasive OTC is quite favorable. However the prognosis of widely invasive OTC is unfavorable. RAI may be administered to these tumors, but it is in vain to insist on RAI after the first adjuvant therapy if it does not respond.
OBJECTIVES: This study aims to evaluate the diagnostic value of early static and delayed imaging in conjunction with standard 68Ga-PSMA-11 PET/CT scans to detect prostate malignant lesions in prostate cancer patients. ME...OBJECTIVES: This study aims to evaluate the diagnostic value of early static and delayed imaging in conjunction with standard 68Ga-PSMA-11 PET/CT scans to detect prostate malignant lesions in prostate cancer patients. METHODS: One hundred and thirty-eight prostate cancer patients underwent routine [68 Ga]Ga-PSMA-11 PET/CT imaging, 4-minute static acquisition post-injection, and delayed imaging 3 h post-injection. The imaging results were analysed for lesion count, type, localisation, and maximum standardised uptake values. RESULTS: 57.97% exhibited positive findings for pathologic prostatic lesions in the standard PET scans (SUV: 10.24). In contrast, early PET imaging detected lesions in 58.01% of patients (SUV of 5.86), while delayed scans revealed lesions suggestive of malignancy in 55.45% of patients (SUV of 12.79). The analysis demonstrated a statistically significant difference in SUV values across the time points (P < .001). Pathologic lymph nodes on images 60 min p.i. were revealed by an SUV max 60 min p.i.: 15.78; this number for the first 4 min and after 3 h were 7.36, 19.19, respectively. Metastatic bone lesions on WB were found in 38 patients, more than the ESI (n = 37) and DI (n = 24). In comparison, urinary bladder activity assessment was detectable with the WB imaging SUV 60 min 11.07. Even though the SUV max for ESI and DI were 6.95 and 31.97, respectively. In the statistical analysis, pathologic radiotracer uptake in tumour lesions was statistically higher in ESI and WB than in urinary bladder activity. CONCLUSIONS: The findings indicate that neither early [68 Ga]Ga-PSMA-11 PET/CT nor delayed imaging significantly enhanced the overall detection rate of malignant lesions in prostate cancer patients. However, the early 4-minute post-injection acquisition of PET images proved beneficial for distinguishing local bladder invasion more effectively.
OBJECTIVE: The aim of our study was to determine whether volumetric parameters measured from the primary lesion and metastatic lymph node (LN) using [F]FDG PET/CT imaging affect prognosis and survival in nasopharyngeal c...OBJECTIVE: The aim of our study was to determine whether volumetric parameters measured from the primary lesion and metastatic lymph node (LN) using [F]FDG PET/CT imaging affect prognosis and survival in nasopharyngeal cancer (NPC) patients. MATERIAL AND METHODS: Our study included 62 patients diagnosed with NPC who underwent [F]FDG PET/CT imaging for pre-treatment staging. SUVmax, SUVmean, MTV and TLG values were measured from the primary tumor and LN. Lymph node/primary tumor SUV ratio (NTR) was calculated. The relationships between volumetric parameters and overall survival (OS), locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS) and progression-free survival (PFS) were evaluated. RESULTS: LN SUVmax and LN SUVmean values were significantly higher in patients with distant metastases (p = 0.002 and p = 0.016, respectively). NTR values were significantly higher in patients with distant metastases (p = 0.047). The ideal LN SUVmax and SUVmean cut-off values for predicting distant metastasis in patients with LN metastasis were 16.45 and 6.5, respectively. There was a statistically significant difference between the DMFSs of the two groups when the NTR cut-off value was 0.8 (p = 0.047). Multivariate analysis showed that LN SUVmax, LN SUVmean and NTR were associated with DMFS (P = 0.003, 0.05 and 0.014, respectively), while primary tumor TLG and MTV values were associated with LRRFS (P = 0.035 and 0.03, respectively). CONCLUSION: In conclusion, we believe that LN SUVmax, SUVmean and NTR may be prognostic indicators for distant metastasis, and MTV and TLG for locoregional recurrence.
OBJECTIVE: This study evaluates the diagnostic importance of a new parameter consisting of the densitometric and metabolic properties of the lesion measured by 18F-FDG PET/CT in differentiating between benign and maligna...OBJECTIVE: This study evaluates the diagnostic importance of a new parameter consisting of the densitometric and metabolic properties of the lesion measured by 18F-FDG PET/CT in differentiating between benign and malignant adrenal lesions in cancer patients. MATERIAL AND METHODS: We evaluated PET/CT parameters of adrenal lesions of patients between 2017 and 2019. A new parameter, "Adrenal Dansitometabolic index (ADMI)," was investigated. Additionally, SUVmax, tumor-to-liver ratio (T/LR), Hounsfield Units (HU), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of adrenal lesions were analyzed. Logistic regression analyses were conducted to identify the most predictive parameter for malignant lesions. RESULTS: Two hundred and four adrenal lesions underwent PET/CT for tumor evaluation. Based on ROC analysis, ADMI > 9.5, a SUVmax > 4.15, a T/L SUVmax ratio > 1.7, an attenuation value > 21.75 HU, a TLG > 14.61 and a MTV > 4.5 were chosen as the optimal cut-off values for differentiating malignant from benign lesions. ADMI, SUVmax, and T/L ratio demonstrated similarly high diagnostic performance (AUC values: 0.993, 0.992 and 0.988 (P = .000), respectively). ADMI exhibited the highest sensitivity and negative predictive value. A multivariate logistic regression analysis revealed that both ADMI and T/L ratio serve as independent prognostic factors for malignancy (P = .001 and P = .003, respectively). CONCLUSION: ADMI, effectively distinguishes benign from malignant. This technique may facilitate investigations of the adrenal lesions to clinical outcomes but needs further large series studies.