Search

Determinar la contribución diagnóstica de la cuantificación absoluta del depósito miocárdico de 99mTc-DPD en pacientes con amiloidosis cardiaca por depósitos de transtiretina (ATTR). Se realizó SPECT/TC a 41 pacientes con resultado gammagráfico positivo para amiloidosis cardiaca ATTR. Se dividió a los pacientes en dos grupos (grados 2 y 3 de Perugini) y se calcularon los SUVmax a nivel del hueso y de ambos ventrículos y el porcentaje de dosis calculado en estas áreas. Se empleó la prueba t de Student para comparar resultados y se calculó el área bajo la curva (AUC) para evaluar la eficacia diferencial y establecer unos puntos de corte discriminatorios entre ambos grupos de pacientes. Se observaron diferencias estadísticamente significativas en todas las variables a estudio, a excepción del SUVmax hueso. Las diferencias con mayor potencia estadística se observaron en las variables SUVmax VD y el porcentaje de dosis en ambos ventrículos (p < 0,001). El punto de corte obtenido para la variable SUVmax VI fue de 8,620 (sensibilidad del 87,9% y especificidad del 100%; AUC: 0,966), mientras que el de la variable SUVmax VD fue de 6,195 (sensibilidad del 81,8% y especificidad del 100%; AUC: 0,955). La cuantificación absoluta de la captación miocárdica de 99mTc-DPD en las imágenes SPECT/TC de pacientes con sospecha de amiloidosis cardiaca por depósitos de transtiretina supone una nueva herramienta diagnóstica que permite una adecuada clasificación de los pacientes, acorde a la escala de gradación visual de Perugini. To determine the diagnostic contribution of the absolute quantification of the myocardial deposit of 99mTc-DPD in patients with cardiac amyloidosis due to transthyretin deposits (ATTR). SPECT/CT was performed on 41 patients with positive scintigraphic results for ATTR cardiac amyloidosis. The patients were divided into two groups (Perugini grades 2 and 3) and the SUVmax at the level of the bone and both ventricles and the percentage of dose calculated in these areas were calculated. Student's t -test was used to compare results and the area under the curve (AUC) was calculated to assess differential efficacy and establish discriminatory cut-off points between both groups of patients. Statistically significant differences were observed in all the study variables, with the exception of SUVmax bone. The differences with the greatest statistical power were observed in the variables SUVmax RV and the percentage of dose in both ventricles (P <.001). The cut-off point obtained for the variable SUVmax LV was 8.620 (sensitivity 87.9% and specificity 100%; AUC: 0.966), while that of the variable SUVmax RV was 6.195 (sensitivity 81.8% and specificity 100%; AUC: 0.955). The absolute quantification of myocardial uptake of 99mTc-DPD in the SPECT/CT images of patients with suspected cardiac amyloidosis due to transthyretin deposits represents a new diagnostic tool that allows an adequate classification of patients, according to the visual grading scale of Perugini. [ABSTRACT FROM AUTHOR]

La imagen de tomografía por emisión de positrones/tomografía computarizada con 18F-fluordesoxiglucosa (18F-FDG PET/TC) se considera una modalidad de imagen estándar en pacientes con carcinoma de pulmón de células no pequeñas. El objetivo de este estudio fue comparar la estadificación clínica (cTNM) realizada con 18F-FDG PET/TC y la estadificación quirúrgica (qTNM) en pacientes con carcinoma de células no pequeñas tratados con cirugía. Realizamos un análisis retrospectivo de 99 pacientes con carcinoma de células no pequeñas intervenidos quirúrgicamente a los que se realizó un estudio 18F-FDG PET/TC. Se realizaron medidas semicuantitativas en las lesiones primarias y los ganglios linfáticos mediastínicos. Los hallazgos de cTNM se compararon con la evaluación quirúrgica-patológica final. Los pacientes se dividieron en 2 grupos, qTNM posquirúrgico modificado y qTNM no modificado. Los pacientes en el grupo con cambio de qTNM se clasificaron adicionalmente como upstaged (US) y downstaged (DS) posquirúrgicos. Los resultados de los pacientes US se compararon con los resultados de los pacientes restantes, que consistían en qTNM sin cambios y DS, para evaluar el posible papel predictivo de los parámetros semicuantitativos en la estadificación postoperatoria. Para determinar la afectación mediastínica tumoral se obtuvieron valores de corte de los resultados semicuantitativos de captación de FDG en los ganglios linfáticos. Un valor p < 0,05 fue considerado estadísticamente significativo. Los pacientes tenían entre 40 y 82 años, con una edad media de 64,78 ± 8,7 años. Se observó un acuerdo de clasificación en 43 pacientes (43%), y en el 57% se observó modificación en la estadificación posquirúrgica. La concurrencia de cTNM y qTNM fue más destacada en la clasificación T1 y N0, con valores del 84% y 74%, respectivamente. La concurrencia más baja se observó en la clasificación N1 seguida de T4 y N2 (1%, 50% y 58%, respectivamente). El cambio en la estadificación T ocurrió en 20 de 56 pacientes (36%); el cambio en la estadificación N en 22 de 56 (39%) y el cambio en T y N en 14 pacientes (25%). La distribución de pacientes de US y DS en el grupo con cambio de cTNM fue de 43% (24 de 56) y 57% (32 de 56), respectivamente. Los resultados de las medidas semicuantitativas fueron significativamente más altos en los pacientes de US que los resultados del grupo compuesto por pacientes con DS y qTNM sin cambios, para todos los parámetros. El valor de corte calculado a partir de las captaciones mediastínicas fue más específico para metástasis en el MTV (volumen metabólico tumoral), con una sensibilidad aceptable (90% y 67%, respectivamente). La concordancia entre TNM y qTNM es mejor en la clasificación de la categoría T en comparación con la categoría N. Las medidas semicuantitativas en los tumores primarios pueden desempeñar un papel en la predicción del US posquirúrgico. El MTV en la región mediastínica puede tener un mayor valor que otros parámetros en la evaluación de la afectación ganglionar. 18F-Fluorine fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) imaging is considered the standard imaging modality for patients with non-small cell lung carcinoma. The aim of this study was to compare clinical staging (cTNM) performed with 18F-FDG PET/CT and surgical staging (sTNM) in patients with non-small cell carcinoma treated with surgery. We performed a retrospective analysis of 99 surgical patients with non-small cell carcinoma who underwent 18F-FDG PET/CT examination. Semiquantitative measures were calculated from the primary lesions and mediastinal lymph nodes. Findings of cTNM were compared with final surgical–pathological evaluation. Subjects were divided into two groups as postsurgical cTNM changed and cTNM unchanged. Patients in the cTNM changed group were further classified as postsurgical upstaged (US) and downstaged (DS). Results of the US patients were compared with the results of the remaining patients consisting of cTNM unchanged and DS to evaluate the predictable roles of semiquantitative parameters for postsurgical upstaging. To determine mediastinal tumoral involvement, cut-off values were obtained from calculated semiquantitative results of FDG uptakes in lymph nodes. A p value < 0.05 was considered statistically significant. Subjects were aged 40–82 years with a mean age of 64.78 ± 8.70 years. Classification agreement was observed in 43 patients (43%) and in 57%, postsurgical stage migration was seen. Concurrence of cTNM and sTNM was more pronounced in the T1 and N0 subsets which were 84% and 74%, respectively. The lowest concurrence was observed in N1 classification followed by T4 and N2 (1%, 50% and 58%, respectively). Change in T staging occurred in 20 of 56 (36%), in N staging 22 of 56 (39%) and change in T and N in 14 patients (25%). Distribution of US and DS patients in the cTNM changed group was 43% (24 of 56) and 57% (32 of 56), respectively. Results of semiquantitative measures were significantly higher in US patients than the results of the group consisting of DS patients and cTNM unchanged patients, for all parameters. Cut-off value calculated from mediastinal uptakes was most specific for metastases in MTV (metabolic tumor volume) with an acceptable sensitivity (90% and 67%, respectively). The concordance between cTNM and sTNM was better in staging T category compared to N stations. Semiquantitative measures of primary tumor may play a role in predicting postsurgical upstaging. Taking MTV into consideration in the mediastinal region may be more valuable than other parameters in the assessment of nodal involvement. [ABSTRACT FROM AUTHOR]

Resumen Las técnicas de valoración cualitativa han sido el estándar tradicional de valoración diagnóstica en los estudios PET con 18 F-FDG. Desde los inicios de la técnica se han buscado parámetros cuantitativos, más exactos y con mejor precisión diagnóstica, que puedan ofrecer información relevante en cuanto al comportamiento, agresividad o pronóstico de los tumores. Cada vez hay más estudios con evidencia de alta calidad sobre la utilidad de diferentes parámetros metabólicos distintos al SUV máximo, cuyo uso es controvertido, a pesar de ser ampliamente utilizado en la práctica clínica, y del que muchos médicos desconocen todavía su significado real. El objetivo de este trabajo ha sido revisar los conceptos clave de estos parámetros metabólicos que pueden ser relevantes en la práctica habitual durante los próximos años. Se ha visto que existe mayor evidencia en la valoración del metabolismo de una lesión de forma completa a través de parámetros volumétricos que reflejan de forma más adecuada la carga tumoral que presenta un paciente. Básicamente, estos parámetros calculan el volumen de tumor que cumple unas características determinadas. Para ello se ha utilizado un software , disponible en la mayor parte de las estaciones de trabajo y procesado de estudios PET, que ha permitido calcular estos volúmenes utilizando criterios más o menos complejos. Los métodos de segmentación más simples, basados en umbrales, están disponibles en la mayor parte de los equipos, son fáciles de calcular y han demostrado en muchos trabajos tener un importante significado pronóstico. Qualitative techniques have traditionally been the standard for the diagnostic assessment with 18 F-FDG PET studies. Since the introduction of the technique, quantitative parameters have been sought, more accurate and with better diagnostic precision, that may offer relevant information of the behavior, aggressiveness or prognosis of tumors. Nowadays, more and more studies with high quality evidence show the utility of other metabolic parameters different from the SUV maximum, which despite being widely used in clinical practice is controversial and many physicians still do not know its real meaning. The objective of this paper has been to review the key concepts of these metabolic parameters that could be relevant in normal practice in the future. It has been seen that there is more evidence in the complete evaluation of the metabolism of a lesion, through volumetric parameters that more adequately reflect the patient's tumor burden. Basically, these parameters calculate the volume of tumor that fulfills certain characteristics. A software available in the majority of the workstations has been used for this purpose and it has allowed to calculate these volumes using more or less complex criteria. The simplest threshold-based segmentation methods are available in most equipments, they are easy to calculate and they have been shown in many studies to have an important prognostic significance. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Medicina Nuclear e Imagen Molecular is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To determine the diagnostic contribution of the absolute quantification of the myocardial deposit of 99m Tc-DPD in patients with cardiac amyloidosis due to transthyretin deposits (ATTR)., Materials and Methods: SPECT/CT was performed in 41 patients with positive scintigraphic results for ATTR cardiac amyloidosis. The patients were divided into two groups (Perugini grades 2 and 3) and the SUVmax at the level of the bone and both ventricles and the percentage of dose calculated in these areas were calculated. The Student's t-test was used to compare results and the area under the curve (AUC) was calculated to assess differential efficacy and establish discriminatory cut-off points between both groups of patients., Results: Statistically significant differences were observed in all the study variables, with the exception of bone SUV max . The differences with the greatest statistical power were observed in the variables SUV maxRV and the percentage of dose in both ventricles (p < 0.001). The cut-off point obtained for the variable SUVm axLV was 8.620 (sensitivity 87.9% and specificity 100%; AUC 0.966), while that of the variable SUV maxRV was 6.195 (sensitivity 81.8% and specificity 100%; AUC 0.955)., Conclusions: The absolute quantification of myocardial uptake of 99m Tc-DPD in the SPECT/CT images of patients with suspected cardiac amyloidosis due to transthyretin deposits represents a new diagnostic tool that allows adequate classification of patients according to the Perugini visual grading scale., (Copyright © 2023 Sociedad Española de Medicina Nuclear e Imagen Molecular. Published by Elsevier España, S.L.U. All rights reserved.)

Copyright of Revista Española de Medicina Nuclear e Imagen Molecular is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Resumen La cirugía citorreductora radical seguida de quimioterapia intraperitoneal con hipertermia aumenta la supervivencia de los pacientes con carcinomatosis peritoneal. El Peritoneal Cancer Index cuantifica el tumor en el acto quirúrgico y permite planificar el tratamiento y establecer el pronóstico de la enfermedad. Se obtiene combinando la distribución del tumor en 13 regiones abdominopélvicas con el tamaño de la lesión más grande. La tomografía por emisión de positrones/tomografía computarizada con fluorodesoxiglucosa es la técnica de elección en la selección de los pacientes candidatos a cirugía citorreductora radical seguida de quimioterapia intraperitoneal con hipertermia debido a su mayor tasa de detección de la carcinomatosis y a que, además, permite el diagnóstico de enfermedad extraperitoneal. El Peritoneal Cancer Index simplificado (9 regiones definidas por 2 planos transversales y 2 sagitales) obtenido mediante tomografía por emisión de positrones/tomografía computarizada con fluorodesoxiglucosa permite su correlación con el acto quirúrgico, siendo su estandarización aconsejable. Radical cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy increases survival in patients with end-stage peritoneal carcinomatosis, and who are under palliative therapy. The Peritoneal Cancer Index enables the tumor burden to be quantified during surgery, as well as treatment planning and patient prognosis. It is obtained by combining the tumor spread in 13 abdominal and pelvic regions with the largest tumor size. Fluorodeoxyglucose positron emission tomography/computed tomography is the technique of choice for those patients selected to undergo radical cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy, due to its higher detection rate of carcinomatosis, and since it allows extra-peritoneal disease staging. The simplified Peritoneal Cancer Index (9 regions defined by 2 transverse and 2 sagittal planes) obtained by fluorodeoxyglucose positron emission tomography/computed tomography allows correlation with the surgical procedure, therefore its standardization is advisable. [ABSTRACT FROM AUTHOR]

The inclusion of 18 F-FDG PET as a biomarker in the diagnostic criteria of neurodegenerative diseases and its indication in the presurgical assessment for drug-resistant epilepsies allow to improve specificity of these diagnosis. The traditional interpretation of neurological PET studies has been performed qualitatively, although in the last decade, several quantitative evaluation methods have emerged. This technical development has become relevant in clinical practice, improving specificity, reproducibility and reducing the interrater reliability derived from visual analysis. In this article we update/review the main imaging processing techniques currently used. This may allow the Nuclear Medicine physician to know their advantages and disadvantages when including these procedures in daily clinical practice., (Copyright © 2020 Sociedad Española de Medicina Nuclear e Imagen Molecular. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: 18 F-Fluorine fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) imaging is considered the standard imaging modality for patients with non-small cell lung carcinoma. The aim of this study was to compare clinical staging (cTNM) performed with 18 F-FDG PET/CT and surgical staging (sTNM) in patients with non-small cell carcinoma treated with surgery., Material and Methods: We performed a retrospective analysis of 99 surgical patients with non-small cell carcinoma who underwent 18 F-FDG PET/CT examination. Semiquantitative measures were calculated from the primary lesions and mediastinal lymph nodes. Findings of cTNM were compared with final surgical-pathological evaluation. Subjects were divided into two groups as postsurgical cTNM changed and cTNM unchanged. Patients in the cTNM changed group were further classified as postsurgical upstaged (US) and downstaged (DS). Results of the US patients were compared with the results of the remaining patients consisting of cTNM unchanged and DS to evaluate the predictable roles of semiquantitative parameters for postsurgical upstaging. To determine mediastinal tumoral involvement, cut-off values were obtained from calculated semiquantitative results of FDG uptakes in lymph nodes. A p value<0.05 was considered statistically significant., Results: Subjects were aged 40-82 years with a mean age of 64.78±8.70 years. Classification agreement was observed in 43 patients (43%) and in 57%, postsurgical stage migration was seen. Concurrence of cTNM and sTNM was more pronounced in the T1 and N0 subsets which were 84% and 74%, respectively. The lowest concurrence was observed in N1 classification followed by T4 and N2 (1%, 50% and 58%, respectively). Change in T staging occurred in 20 of 56 (36%), in N staging 22 of 56 (39%) and change in T and N in 14 patients (25%). Distribution of US and DS patients in the cTNM changed group was 43% (24 of 56) and 57% (32 of 56), respectively. Results of semiquantitative measures were significantly higher in US patients than the results of the group consisting of DS patients and cTNM unchanged patients, for all parameters. Cut-off value calculated from mediastinal uptakes was most specific for metastases in MTV (metabolic tumor volume) with an acceptable sensitivity (90% and 67%, respectively)., Conclusions: The concordance between cTNM and sTNM was better in staging T category compared to N stations. Semiquantitative measures of primary tumor may play a role in predicting postsurgical upstaging. Taking MTV into consideration in the mediastinal region may be more valuable than other parameters in the assessment of nodal involvement., (Copyright © 2019. Publicado por Elsevier España, S.L.U.)

Qualitative techniques have traditionally been the standard for the diagnostic assessment with 18 F-FDG PET studies. Since the introduction of the technique, quantitative parameters have been sought, more accurate and with better diagnostic precision, that may offer relevant information of the behavior, aggressiveness or prognosis of tumors. Nowadays, more and more studies with high quality evidence show the utility of other metabolic parameters different from the SUV maximum, which despite being widely used in clinical practice is controversial and many physicians still do not know its real meaning. The objective of this paper has been to review the key concepts of these metabolic parameters that could be relevant in normal practice in the future. It has been seen that there is more evidence in the complete evaluation of the metabolism of a lesion, through volumetric parameters that more adequately reflect the patient's tumor burden. Basically, these parameters calculate the volume of tumor that fulfills certain characteristics. A software available in the majority of the workstations has been used for this purpose and it has allowed to calculate these volumes using more or less complex criteria. The simplest threshold-based segmentation methods are available in most equipments, they are easy to calculate and they have been shown in many studies to have an important prognostic significance., (Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.)

Objective: To test a software application for the quantification of metabolic heterogeneity and to evaluate its superiority in relation to visual interpretation. To investigate if a quantitative analysis adds information to the interpretation of 18 F-FDG-PET/CT., Material and Methods: The study analyzed 215 patients with a 18 F-FDG-PET/CT done for the initial staging of lung cancer between March 2011 and December 2015. The study included 57 (26.5%) women and 158 (73.5%) men, with ages ranging from 34 to 88 years (mean±SD: 67.23±10.04). There were 82 surgical stages (I, II, IIIA), and 133 non-surgical stages (IIIB, IV). The primary tumour was analyzed quantitatively by obtaining the following parameters: SUVmax, metabolic active tumour volume (MATV), total lesion glycolysis (TLG), and the entropy heterogeneity index (ET). Heterogeneity was assessed visually. Death dates and/or the follow-up time were registered, ranging from 0.70 to 67.60 months (mean±SD: 23.20±17.68)., Results: In multivariate analysis, ET emerged as a better predictor of survival than visual analysis of heterogeneity that was not statistically significant. The C-index determination demonstrated that all quantitative parameters were statistically-significant predictors of survival. Cut-offs were obtained in order to compare survival times. A multivariate analysis was performed. In the total population, the best predictor was the TNM stage, but MATV, ET, and male gender were statistically significant and independent predictors of survival. In stages without surgical indication, the best predictor was the TNM stage, but the MATV and male gender were statistically significant and independent predictors of survival. In the surgical stages, ET was the only statistically significant and independent predictor of survival., Conclusions: Quantification adds prognostic information to the visual analysis of 18 F-FDG-PET/CT., (Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.)

Radical cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy increases survival in patients with end-stage peritoneal carcinomatosis, and who are under palliative therapy. The Peritoneal Cancer Index enables the tumor burden to be quantified during surgery, as well as treatment planning and patient prognosis. It is obtained by combining the tumor spread in 13 abdominal and pelvic regions with the largest tumor size. Fluorodeoxyglucose positron emission tomography/computed tomography is the technique of choice for those patients selected to undergo radical cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy, due to its higher detection rate of carcinomatosis, and since it allows extra-peritoneal disease staging. The simplified Peritoneal Cancer Index (9 regions defined by 2 transverse and 2 sagittal planes) obtained by fluorodeoxyglucose positron emission tomography/computed tomography allows correlation with the surgical procedure, therefore its standardization is advisable., (Copyright © 2016 Elsevier España, S.L.U. y SEMNIM. All rights reserved.)