Revista espanola de medicina nuclear e imagen molecular最新文献

Aim: To assess the correlation between the result of the PET/CT study with [¹⁸F]FDG and the histological outcome in patients with esophageal cancer undergoing chemoradiotherapy and subsequent surgery.

Material and methods: 41 patients (35 men) diagnosed with esophageal cancer during a 10-year interval were retrospectively evaluated. PERCIST criteria and SULpeak (ΔSULpeak) variation between pre- and post-treatment PET/CT studies were used. After neoadjuvant treatment and subsequent surgery, histological response and patient survival were determined, correlating the findings with the result of the metabolic study. Different parameters related to patient and tumors lesion characteristics were compared with respect to histologic response. ROC curves and the Kaplan-Meier method were applied for the analysis of prognostic factors and survival curves.

Results: The mean follow-up was 34.9 months, with 21 relapses-progressions and 25 deaths. Significant differences were demonstrated between histologic responses regarding PERCIST criteria and ΔSULpeak. Both showed adequate sensitivity and moderate specificity in relation to their histological correlation. No significant differences were found with respect to other parameters studied. Survival analysis showed significantly different progression-free survival curves for the ΔSULpeak and histologic outcome.

Conclusion: PERCIST criteria and ΔSULpeak differentiated between patients with and without histological response. ΔSULpeak and histological results proved to be prognostic factors. The results could help to personalize treatment and, together with other determinations, allow an active surveillance approach could be contemplated.

Objective: To evaluate the correlation between response assessment measured by PET/CT with [¹⁸F] F-fluorocholine (Choline PET/CT) and serum levels of PSA in patients with prostate cancer under antiandrogenic treatment.

Methodology: A retrospective study included patients with CRPC and CSPC treated with enzalutamide, abiraterone, or apalutamide between June 2018 and July 2021, who underwent baseline and a follow-up Choline PET/CT. The difference in maximum SUVmax (ΔSUV) between both studies and the PSA value before and at follow-up were recorded. The response to treatment was compared by PSA vs. PET, assessing their association, agreement, and correlation.

Results: Thirty patients were included (median age 74 years, range 68-78), 12 with CSPC and 18 with CRPC; 22 had nodal disease, and 15 had active bone disease. The average time between pre-treatment and follow-up PET/CT was 11 months (range 3.5-23). Patients with extra-nodal metastatic disease at the beginning of treatment showed a higher correlation between PSA and ΔSUV (OR 4.375). In patients with bone disease at the start of treatment, 80% were classified as non-responders on PET response assessment, while only 40% were non-responders by PSA. The correlation between PET and PSA was mild (Kendall's tau_b 0.26), and the classification into Responders/Non-responders had only slight agreement (Cohen's kappa 0.30).

Conclusion: Choline PET/CT shows low concordance with the PSA values obtained during the follow-up of response to anti-androgen therapy, especially in patients with bone involvement.

Objective: To assess the clinical value of [¹⁸F]F-PSMA negative PET/CT, in patients diagnosed with prostate cancer treated with prostatectomy with elevated PSA less than 1 ng/mL, on the outcome of salvage radiotherapy.

Method: We prospectively included 98 patients diagnosed with prostate cancer treated with prostatectomy with biochemical recurrence [mean PSA 0.51 ng/mL (range 0.17-1.0 ng/mL)] who were referred for an [¹⁸F]F-PSMA -PET/CT study. The [¹⁸F]F-PSMA -PET/CT scan was negative in 53/98 patients (54.09%). Differences were analysed between those patients who were or were not candidates for pelvic salvage radiotherapy (PSRT) decided upon multidisciplinary committee and patient consent, with a minimum follow-up time for 1 year. Response to treatment was defined as a 50% reduction in PSA levels. Recurrence was ascertained upon clinical, analytical and imaging follow-up outcomes.

Results: 54.7% (29/53) of the patients with a negative [¹⁸F]F-PSMA -PET/CT underwent PSRT. Of these, 93.1% (27/29) patients demonstrated response to treatment (PSMA false negatives). The remaining two patients showed fluctuating PSA levels without detecting disease on the [¹⁸F]F-PSMA -PET/CT follow-up study. 45.3% (24/53) of patients with negative [¹⁸F]F-PSMA -PET/CT did not undergo PSRT. Of these, progressive PSA elevation was observed in 62.5% (15/24) (PSMA false negatives), localising recurrence on the [¹⁸F]F-PSMA -PET/CT follow-up study in 4 patients. The remaining 9 patients (37.5%) showed fluctuating PSA levels without detecting disease on the [¹⁸F]F-PSMA -PET/CT follow-up study. Our series confirmed 42 (42.85%) [¹⁸F]F-PSMA -PET/CT false negatives cases.

Conclusion: Patients diagnosed with prostate cancer with post-prostatectomy biochemical recurrence and a negative [¹⁸F]F-PSMA -PET/CT study are likely to benefit from pelvic salvage radiotherapy, with response seen in 93.1% of our cases.

[¹⁸F]FDG PET/TC is an emerging tool in the evaluation of inflammatory arthropathies, characterised by their insidious course and clinical overlap. It allows detection of subclinical inflammation, assessment of systemic involvement and quantification of metabolic parameters useful in early diagnosis and therapeutic monitoring. In rheumatoid arthritis, it correlates with clinical indices (Disease Activity Score), serological markers (CRP, anti-citrullinated protein antibodies) and ultrasound findings, and facilitates the identification of complications such as cardiovascular and pulmonary involvement. In spondyloarthritis, its ability to identify enthesitis and peripheral synovitis is promising, although less studied. In addition, [¹⁸F]FDG PET/TC evaluates the response to biological treatments, helping to optimise therapeutic decisions. However, its implementation faces challenges such as lack of standardised indications, incidental findings and technical artefacts. Although not routinely recommended, its usefulness in specific settings underlines the need for further studies to consolidate its role in the management of these diseases. In this manuscript, we present a brief review providing general and practical information about the role of [¹⁸F]FDG PET/TC in inflammatory osteoarticular pathology, while "Role and applications of [¹⁸F]FDG PET/CT in the assessment of osteoarticular infection and inflammation - Part I" has addressed its role in infectious osteoarticular disease.

Purpose: This study aimed to evaluate the reliability and readability of responses generated by two popular AI-chatbots, 'ChatGPT-4.0' and 'Google Gemini', to potential patient questions about PET/CT scans.

Materials and methods: Thirty potential questions for each of [¹⁸F]FDG and [⁶⁸Ga]Ga-DOTA-SSTR PET/CT, and twenty-nine potential questions for [⁶⁸Ga]Ga-PSMA PET/CT were asked separately to ChatGPT-4 and Gemini in May 2024. The responses were evaluated for reliability and readability using the modified DISCERN (mDISCERN) scale, Flesch Reading Ease (FRE), Gunning Fog Index (GFI), and Flesch-Kincaid Reading Grade Level (FKRGL). The inter-rater reliability of mDISCERN scores provided by three raters (ChatGPT-4, Gemini, and a nuclear medicine physician) for the responses was assessed.

Results: The median [min-max] mDISCERN scores reviewed by the physician for responses about FDG, PSMA and DOTA PET/CT scans were 3.5 [2-4], 3 [3-4], 3 [3-4] for ChatPT-4 and 4 [2-5], 4 [2-5], 3.5 [3-5] for Gemini, respectively. The mDISCERN scores assessed using ChatGPT-4 for answers about FDG, PSMA, and DOTA-SSTR PET/CT scans were 3.5 [3-5], 3 [3-4], 3 [2-3] for ChatGPT-4, and 4 [3-5], 4 [3-5], 4 [3-5] for Gemini, respectively. The mDISCERN scores evaluated using Gemini for responses FDG, PSMA, and DOTA-SSTR PET/CTs were 3 [2-4], 2 [2-4], 3 [2-4] for ChatGPT-4, and 3 [2-5], 3 [1-5], 3 [2-5] for Gemini, respectively. The inter-rater reliability correlation coefficient of mDISCERN scores for ChatGPT-4 responses about FDG, PSMA, and DOTA-SSTR PET/CT scans were 0.629 (95% CI = 0,32-0,812), 0.707 (95% CI = 0.458-0.853) and 0.738 (95% CI = 0.519-0.866), respectively (p < 0.001). The correlation coefficient of mDISCERN scores for Gemini responses about FDG, PSMA, and DOTA-SSTR PET/CT scans were 0.824 (95% CI = 0.677-0.910), 0.881 (95% CI = 0.78-0.94) and 0.847 (95% CI = 0.719-0.922), respectively (p < 0.001). The mDISCERN scores assessed by ChatGPT-4, Gemini, and the physician showed that the chatbots' responses about all PET/CT scans had moderate to good statistical agreement according to the inter-rater reliability correlation coefficient (p < 0,001). There was a statistically significant difference in all readability scores (FKRGL, GFI, and FRE) of ChatGPT-4 and Gemini responses about PET/CT scans (p < 0,001). Gemini responses were shorter and had better readability scores than ChatGPT-4 responses.

Conclusion: There was an acceptable level of agreement between raters for the mDISCERN score, indicating agreement with the overall reliability of the responses. However, the information provided by AI-chatbots cannot be easily read by the public.

Objective: Describe our experience in treatment with Phosphorus-32P for refractory Philadelphia negative chronic myeloproliferative syndromes or with side effects to the usual treatment, its complications and risk of leukemic transformation.

Material and methods: Retrospective descriptive study including 17 patients with a diagnosis of Philadelphia-negative chronic myeloproliferative syndrome treated with Phosphorus-32P in our hospital from January 1985 to March 2017. Indications, response to treatment, as well as early and late complications have been analyzed.

Results: Of the 17 patients treated with 32P (11 men, 6 women; mean age 79,8 years), 6 patients had Polycythemia Vera and 11 Essential Thrombocytosis. A single dose was administered in 9 of the subjects, the rest required two or more doses due to inadequate hematological response and/or relapse. The total dose range of Phosphorus-32P administered was 116-951MBq (median: 236MBq). In 14 patients treated with Phosphorus-32P, complete or partial response was achieved in hematimetry. In 11 patients, the response was complete, established as a platelet count <400.000/mm³ in those diagnosed with Essential Thrombocythemia and a hematocrit <45% in cases of Polycythemia Vera. The median follow-up of patients from the date of the first treatment of Phosphorus-32P until study completion or death was 37 months (range: 5-230 months). Regarding early complications, 2 cases of anemia requiring blood transfusion were observed, and 1 case of mild thrombocytopenia. No leukemic transformation was identified.

Conclusions: In our experience, treatment with Phosphorus-32P has been a useful therapeutic option in Philadelphia-negative chronic myeloproliferative syndromes in elderly patients who showed poor tolerance and/or resistance to first-line treatment. No leukemic transformation was identified.

Background and objectives: To assess the feasibility of performing selective parathyroidectomy without intraoperative parathyroid hormone (PTHio) determination when first-line preoperative localization tests (ultrasonography and [^99mTc]Tc-MIBI) are negative and/or discordant, and second-line [¹⁸F]F-Colina PET-CT, is positive.

Materials and methods: Retrospective cohort study, including patients with negative or discordant ultrasound and MIBI scans and positive [¹⁸F]F-Colina PET-CT, who underwent selective parathyroidectomy between 2019 and 2022. Groups were compared based on PTHio determination. Study variables were: gender, mean age, biochemical cure assessed by PTH value (pg/mL) and corrected calcium by albumin (mg/dL) at 6 months post-surgery follow-up, and histopathological analysis.

Results: The final sample included 42 patients. At 6 months post-surgery, in the PTHio group (20 patients), PTH values were 64.50 pg/mL and calcium 9.30 pg/mL, with 19 adenomas and 1 hyperplasia found. In the non-PTHio group (22 patients), PTH values were 61 pg/mL and calcium 9.37 pg/mL, with 22 adenomas found. No statistically significant differences were found between both groups.

Conclusions: Based on the results obtained in our patient cohort, selective parathyroidectomy could be considered with negative or discordant first-line tests and positive [¹⁸F]F-Colina PET-CT, without intraoperative PTH determination.