This case report presents a patient diagnosed with small intestine adenocarcinoma associated with Crohn´s disease. Intestinal cancer is a feared and rare complication of idiopathic bowel diseases. The most important factors for dysplasia include extensive involvement of the intestine and a long-term inflammatory process.
- Klíčová slova
- Crohn´s disease, small intestine adenocarcinoma,
- MeSH
- adenokarcinom * komplikace diagnostické zobrazování MeSH
- Crohnova nemoc * komplikace diagnóza MeSH
- lidé MeSH
- střevní nádory * komplikace chirurgie MeSH
- tenké střevo patologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Background and Objectives: The treatment of gastroesophageal junction (GEJ) adenocarcinoma consists of either perioperative chemotherapy or preoperative chemoradiotherapy. Radiotherapy (RT) in the neoadjuvant setting is associated with a higher probability of resections with negative margins (R0) and better tumor regression rate, which might be enhanced by incrementing RT dose with potential impact on treatment results. This virtual planning study demonstrates the feasibility of increasing the dose to GEJ tumor and involved nodes using PET/CT imaging. Materials and Methods: 16 patients from the chemoradiotherapy arm of the phase II GastroPET study were treated by a prescribed dose of 45.0 Gray (Gy) in 25 fractions. PET/CT was performed before treatment. The prescribed dose was virtually boosted on PET/CT-positive areas to 54.0 Gy by 9 Gy in 5 fractions. Dose-volume histograms (DVH) were compared, and normal tissue complication (NTCP) modeling was performed for both dose schedules. Results: DVHs were exceeded in mean heart dose in one case for 45.0 Gy and two cases for 54.0 Gy, peritoneal space volume criterion V45Gy < 195 ccm in three cases for 54.0 Gy and V15Gy < 825 ccm in one case for both dose schedules. The left lung volume of 25 Gy isodose exceeded 10% in most cases for both schedules. The NTCP values for the heart, spine, liver, kidneys and intestines were zero for both schemes. An increase in NTCP value was for lungs (median 3.15% vs. 4.05% for 25 × 1.8 Gy and 25 + 5 × 1.8 Gy, respectively, p = 0.013) and peritoneal space (median values for 25 × 1.8 Gy and 25 + 5 × 1.8 Gy were 3.3% and 14.25%, respectively, p < 0.001). Conclusion: Boosting PET/CT-positive areas in RT of GEJ tumors is feasible, but prospective trials are needed.
- Klíčová slova
- PET/CT, gastroesophageal junction cancer, neoadjuvant chemoradiotherapy, radiotherapy,
- MeSH
- adenokarcinom * diagnostické zobrazování terapie MeSH
- chemoradioterapie MeSH
- gastroezofageální junkce diagnostické zobrazování MeSH
- lidé MeSH
- PET/CT * MeSH
- plánování radioterapie pomocí počítače MeSH
- prospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Preoperative chemoradiotherapy (CRT) and perioperative chemotherapy (CHMT) are a standard of care for distal esophageal and gastroesophageal junction adenocarcinomas. PET/CT using 18F-fluorodeoxyglucose (18F-FDG-PET/CT) is one of the basic staging examinations with a certain prognostic significance and has recently been studied for the possibility of showing prognostic or predictive results suitable for the individualization of treatment strategy. PURPOSE: The aim of this review is to map the role of 18-FDG-PET/CT in predicting the response to CHMT and CRT, which could be a starting point for personalized treatment. CONTENT: The change in metabolic activity in the maximum standardized uptake value is most often used to quantify the treatment response; total lesion glycolysis is a volumetric parameter. A method for standardizing measurements was offered in the PERCIST system. Several studies have been published showing that the decrease in metabolic activity after chemotherapy correlates with a surrogate measure of the treatment outcome, which is the degree of tumor regression in the resected tissue, but also with survival or time to progression. The cut-off value separating sensitive and resistant tumors varied from 33 to 78%, the measurement took place either at the end of neoadjuvant treatment or „early“, about 2 weeks after the first cycle of CHMT. However, this value has not yet been validated and the parameters of sensitivity, specificity and negative and positive predictive values for the prediction of treatment outcome fluctuated significantly. In the case of preoperative CRT, PET/CT could not predict the complete response to the treatment with satisfactory accuracy. Studies using early metabolic response to change the treatment strategies in non-responders have not yet shown whether changing the treatment in patients without an early metabolic response to CHMT will improve survival. In the case of randomization, a standard arm with a continuation of the original CHMT was never used. CONCLUSION: Evaluation of an early PET-based response has the potential to modify the treatment in patients who have not demonstrated an early response to CHMT. However, this is not an approach suitable for routine practice outside of clinical trials. So far, it seems possible to use an early metabolic response for small, exploratory studies evaluating new agents and their combinations in the preoperative treatment of localized esophageal cancer or gastroesophageal junction cancer.
- Klíčová slova
- esophageal adenocarcinoma, gastroesophageal junction adenocarcinoma, personalized therapy, positron emission tomography-computed tomography (PET/CT),
- MeSH
- adenokarcinom diagnostické zobrazování terapie MeSH
- chemoradioterapie MeSH
- fluorodeoxyglukosa F18 * MeSH
- gastroezofageální junkce diagnostické zobrazování patologie MeSH
- lidé MeSH
- nádory jícnu diagnostické zobrazování terapie MeSH
- PET/CT * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- fluorodeoxyglukosa F18 * MeSH
We illustrate the development of NaDyF4-NaGdF4 core-shell nanoparticles (NPs) for targeting prostate cancer cells using a preclinical 9.4 T magnetic resonance imaging (MRI) of live animals. The NPs composed of paramagnetic Dy3+ and Gd3+ (T2- and T1-contrast agents, respectively) demonstrate proton relaxivities of r1 = 20.2 mM-1 s-1 and r2 = 32.3 mM-1 s-1 at clinical 3 T and r1 = 9.4 mM-1 s-1 and r2 = 144.7 mM-1 s-1 at preclinical 9.4 T. The corresponding relaxivity values per NP are r1 = 19.4 × 105 mMNP-1 s-1 and r2 = 33.0 × 105 mMNP-1 s-1 at 3 T and r1 = 9.0 × 105 mMNP-1 s-1 and r2 = 147.0 × 105 mMNP-1 s-1 at 9.4 T. In vivo active targeting of human prostate tumors grown in nude mice revealed docking of anti-prostate-specific membrane antigen (PSMA) antibody-tagged NPs at tumor sites post-24 h of their intravenous injection. On the other hand, in vivo passive targeting showed preferential accumulation of NPs at tumor sites only within 2 h of their injection, ascribed to the enhanced permeation and retention effect of the tumor. A biodistribution study employing the harvested organs of mice, post-24 h injection of NPs, quantified active targeting as nearly twice as efficient as passive targeting. These outcomes provide potential opportunities for noninvasive diagnosis using NaDyF4-NaGdF4 core-shell NPs for target-specific MRI.
- Klíčová slova
- EPR, MRI, anti-PSMA, dysprosium, gadolinium, nanoparticle, paramagnetic, relaxivity,
- MeSH
- adenokarcinom diagnostické zobrazování MeSH
- glutamátkarboxypeptidasa II imunologie MeSH
- magnetická rezonanční tomografie metody MeSH
- membránové glykoproteiny imunologie MeSH
- myši nahé MeSH
- myši MeSH
- nádory prostaty diagnostické zobrazování MeSH
- nanočástice chemie MeSH
- zvířata MeSH
- Check Tag
- mužské pohlaví MeSH
- myši MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- glutamátkarboxypeptidasa II MeSH
- membránové glykoproteiny MeSH
- PSMA protein, mouse MeSH Prohlížeč
We prospectively investigated whether metabolic response assessed by 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (PET/CT) early in the course of neoadjuvant chemotherapy is predictive of survival in patients with adenocarcinoma of the esophagus and esophagogastric junction. PET/CT was performed before and in the third week after the initiation of the first cycle of neoadjuvant chemotherapy, which consisted of epirubicin, cisplatin, and 5-fluorouracil or capecitabine. The metabolic response was defined as a relative decrease in the peak standardized uptake value (SUL) of the tumor by ≥35% or total lesion glycolysis (TLG) by ≥66%. The associations of metabolic response with overall survival (OS) and disease-free survival (DFS) were investigated using Kaplan-Meier curves and multivariable Cox regression analysis. Among 126 recruited patients, the early metabolic response was assessed in 107 patients (90 of them underwent surgical resection). The five-year OS and DFS rates of all patients were 28% and 27%, respectively. No difference was found in OS (p=0.10 for SUL, p=0.08 for TLG) or DFS (p=0.50 for SUL, p=0.20 for TLG) between metabolic responders and non-responders. Post hoc analysis of the patients with a follow-up PET/CT within 16 days showed that metabolic response reflected by SUL predicted OS (p=0.03). We concluded that metabolic response assessed by PET/CT after the first cycle of neoadjuvant chemotherapy does not predict survival in patients with adenocarcinoma of the esophagus and esophagogastric junction. However, proper timing of the follow-up PET/CT may affect the prognostic ability of the early metabolic response.
- MeSH
- adenokarcinom * diagnostické zobrazování farmakoterapie chirurgie MeSH
- fluorodeoxyglukosa F18 * MeSH
- gastroezofageální junkce diagnostické zobrazování MeSH
- lidé MeSH
- neoadjuvantní terapie MeSH
- PET/CT MeSH
- prognóza MeSH
- radiofarmaka MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- fluorodeoxyglukosa F18 * MeSH
- radiofarmaka MeSH
Pancreatic carcinoma is an aggressive tumor with a grim prognosis. Accurate staging is essential for indicating surgery in patients with borderline resectable tumors. This paper examines the correlation between pre-operation characteristics of tumors found on CT, infiltration of individual resection margins as confirmed by a pathologist, and the survival of patients with resectable pancreatic head ductal adenocarcinoma. This prospective cohort study involved patients operated on for pancreatic head adenocarcinoma, which was clearly resectable based on the staging CT and intraoperative observation between 2011-2014. Only patients without postoperative complications who underwent adjuvant chemotherapy were analyzed. Seventy-nine patients were assessed, of which 16 (20.3%) had R0 resection and 63 (79.7%) had R1 resection. Patients with R1 results had up to 2.7 times higher risk of death than patients with R0 resection. We found a trend towards shorter survival associated with a closer relationship of the tumor to the superior mesenteric vein/portal vein (SMV/PV) wall in the pre-operation CT examination. Patients with a tumor interface between the vein wall of up to 180 ° circumference had up to 1.97 times higher risk of death than patients without (p=0.131). The results of our work confirmed that in our center, even surgically treated, clearly resectable pancreatic head tumors still have a high occurrence of positive surgical margins (R1 resection) and that tumors with R1 resection had statistically significantly reduced survival compared to R0 resection. A trend for shorter overall survival was found after tumor resection depending on the increasing interface between the tumor and the SMV/PV wall, but this result was not statistically significant.
- MeSH
- adenokarcinom * diagnostické zobrazování chirurgie MeSH
- lidé MeSH
- míra přežití MeSH
- nádory slinivky břišní * diagnostické zobrazování chirurgie MeSH
- pankreatoduodenektomie * MeSH
- počítačová rentgenová tomografie MeSH
- prospektivní studie MeSH
- resekční okraje MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Celiac disease is an immune mediated entheropathy triggered by gluten in genetically predisposed individuals. Patients with celiac disease are at a higher risk of gastrointestinal malignancies. Diagnosis at an advance stage is one of the factors of an unfavorable prognosis of these complications. Our patient is a woman who was diagnosed with celiac disease at 53 years of age. After two years on a gluten-free diet she developed sideropenic anemia. No source of bleeding was found on the esophagogastroduodenoscopy or colonoscopy. Video capsule endoscopy revealed exulcerated bleeding stenosis in the jejunum, in front of which the capsule lodged. There were no signs of infiltration on simultaneous CT enterography. The patient was operated on and the infiltration of the jejunum was resected. The specimen was evaluated by a histopathologist as a moderately differentiated adenocarcinoma. Due to the risk factors, the patient received adjuvant chemotherapy. The knowledge of the malignant complications of celiac disease, their risk factors and the possibilities of modern enteroscopic methods could help in the early diagnosis and improvement of the prognosis of these diseases. Due to a lack of data and an absence of guidelines, treatment of a small bowel adenocarcinoma is based on an expert agreement and guidelines for colon cancer. Surgical treatment is the only potentially curative option. For stage II with risk factors and stage III adjuvant chemotherapy should be considered.
- Klíčová slova
- Adenocarcinoma, Celiac disease, small bowel, surgery, video capsule endoscopy,
- MeSH
- adenokarcinom * diagnostické zobrazování MeSH
- celiakie * komplikace MeSH
- kapslová endoskopie * MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory duodena * MeSH
- tenké střevo diagnostické zobrazování MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
Pancreatic cancer is the seventh leading cause of cancer deaths worldwide and is associated with a poor survival rate. The vast majority of pancreatic cancers are inoperable at the time of diagnosis. In the absence of metastatic disease, operability depends on the extent of local disease; in particular, the presence or absence of vascular and lymph node involvement. Adequate staging is vital in deciding an appropriate treatment plan. Cross sectional imaging including CT, MRI and PET-CT are commonly used for staging. However, EUS is a useful adjunct for accurate loco-regional staging in addition to allowing diagnostic tissue samples to be obtained. Emerging EUS-guided therapeutic techniques have opened up new horizons in the management of pancreatic malignancy. EUS guidance can be used for coeliac plexus neurolysis in patients with intractable pain and fiducial placement in directing stereotactic radiotherapy. The majority of patients with cancer of the pancreatic head present with biliary obstruction. ERCP can be used to drain the obstructed biliary system with plastic or metal stents and offers an opportunity to confirm the diagnosis by obtaining brush cytology and forceps biopsy specimens. EUS-guided choledocho-duodenostomy or hepatico-gastrostomy is increasingly being employed for draining the biliary system if ERCP is unsuccessful.
- Klíčová slova
- ERCP, endoscopic ultrasound, pancreatic adenocarcinoma,
- MeSH
- adenokarcinom * diagnostické zobrazování epidemiologie terapie MeSH
- cholangiopankreatografie endoskopická retrográdní * MeSH
- endosonografie * MeSH
- lidé MeSH
- nádory slinivky břišní * diagnostické zobrazování epidemiologie terapie MeSH
- paliativní péče metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Geografické názvy
- Spojené království epidemiologie MeSH
PURPOSE: The main aim of the study was to compare the diagnostic performance of Prostate Imaging Reporting and Data System (PI-RADS) versions 1 and 2 for detection of prostate carcinoma (PCa) and clinically significant prostate carcinoma (CSPCa). The second aim was to evaluate the potential benefit of adding the apparent diffusion coefficient (ADC) and prostate specific antigen (PSA) density to the standard evaluation protocol. METHODS: A total of 167 consecutive patients with elevated PSA underwent magnetic resonance imaging. The images were evaluated prospectively using both versions of the PI-RADS and the results compared with 12-core template biopsy and magnetic resonance/transrectal ultrasound fusion biopsy. Receiver-operating characteristic (ROC) curves were compared for each scoring system using DeLong\'s test. The area under the curve (AUC) was calculated for ADC and PSA density for lesions scored 4. RESULTS: PI-RADS V2 had high discriminative ability for PCa prediction with an AUC of 0.824 (95% CI 0.763 to 0.885), compared to an AUC of 0.724 (95% CI 0.654 to 0.794) for PI-RADS V1 (p = 0.0335). ADC demonstrated a higher discriminative ability with an AUC of 0.702 (95% CI 0.548 to 0.856) in CSPCa prediction. Using the obtained ADC threshold of 828x10^-6 mm^2/s improved specificity to 86.73% with a sensitivity of 60.38%. CONCLUSION: PI-RADS version 2 exhibited significantly higher discriminative ability for PCa and CSPCa detection compared to PI-RADS version 1. Using the ADC can improve the tumor predictability of PI-RADS version 2 in lesions scored 4.
- MeSH
- adenokarcinom diagnóza diagnostické zobrazování patologie MeSH
- biopsie MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- nádory prostaty diagnóza diagnostické zobrazování patologie MeSH
- prospektivní studie MeSH
- prostata diagnostické zobrazování patologie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ultrasonografie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
AIM: To evaluate our own experience with 18F- fluoromethylcholine-(FCH)-positron-emission tomography combined with magnetic resonance imaging (PET/MRI) in restaging of patients with prostatic carcinoma and elevated serum prostate-specific antigen (PSA) level. PATIENTS AND METHODS: The analysis was performed on a sample of 100 male patients who underwent 18F-FCH-PET/MRI, with a mean age of 63.2 years (range=47-78 years). The imaging was performed using an integrated PET/MRI hybrid system after intravenous application of 18F-FCH at a dose of 1.25 MBq/kg. The number and sites of pathological accumulation of FCH related to local recurrence, nodal spread and skeletal metastases were compared to corresponding MRI findings; furthermore, the relation of PSA level and presence of FCH accumulation in tumorous tissue was assessed; finally we correlated the findings of different sites of metastatic involvement. RESULTS: In patients with a PSA level up to 2 ng/ml, accumulation in tumorous tissue of local recurrence or metastases was found in 83.33% in cases of biochemical relapse, and in patients with PSA level above 5 ng/ml in 100% of cases. In general, we found any finding explained rise of PSA level in 94% of patients. CONCLUSION: 18F-FCH-PET/MRI using an integrated system with 1,25 MBq/kg dosing of FCH is a valuable tool in evaluation of restaging in patients with prostatic carcinoma, with high detection rate even in those with a low serum PSA level.
- Klíčová slova
- PET/MRI, PSA, Prostatic carcinoma, fluoromethylcholine, restaging,
- MeSH
- adenokarcinom diagnostické zobrazování patologie MeSH
- cholin analogy a deriváty MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- multimodální zobrazování metody MeSH
- nádory prostaty diagnostické zobrazování patologie MeSH
- pozitronová emisní tomografie metody MeSH
- prostatický specifický antigen MeSH
- radiofarmaka MeSH
- radioizotopy fluoru MeSH
- senioři MeSH
- staging nádorů metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- cholin MeSH
- fluorocholine MeSH Prohlížeč
- prostatický specifický antigen MeSH
- radiofarmaka MeSH
- radioizotopy fluoru MeSH
