Primary intra and extradural solitary fibrous tumor/hemangiopericytoma of thoracic spine with paravertebral intrathoracic spread: Case report and review of the literature

Solitary fibrous tumors/hemangiopericytomas (SFTs/HPCs), constitute 1% of all CNS tumors. Spinal SFTs/HPCs are extremely rare. To date, few retrospective studies and case reports of primary spinal SFTs/HPCs have been published in the literature. We report clinical and radiological presentation, surgical treatment, and post-operative outcome at three years follow-up of a rare case of primary spinal intra and extradural SFT/HPC of thoracic spine with dumbbell shaped paravertebral intrathoracic spread and multidirectional erosion of the bone. A 73-year-old female presented with progressive lower limbs weakness and hypoesthesia below the rib cage. MRI showed an irregular isointense T5-T7 dumbbell shaped tumor. Tumor resection was successfully carried out through posterior and antero-lateral approach. Histological examination showed a grade II SFT/HPC. No local recurrence nor systemic metastases were observed at three years follow-up. A literature review has been performed to describe epidemiology, radiographic features, treatment, recurrence rate and mean disease-free survival of primary spinal SFTs/HPCs. No radiographic pathognomonic findings have been reported for these tumors. Differential diagnosis must be made with meningioma, schwannoma, chordoma, aggressive hemangioma, metastases, angiosarcoma. Surgical resection is the first choice of treatment, and total resection should be attempted whenever possible in all cases. Postsurgical radiotherapy does not change significantly recurrence rate after GTR, nonetheless it increases mean disease-free survival, especially in patients with extradural SFTs/HPCs. After subtotal resection, adjuvant radiotherapy is necessary to reduce progression of disease. The efficacy of chemotherapy has yet to be determined. Pathological degree and total surgical resection are the most important predictive factors of recurrence

Diagnostic Impact of Dual-Time PET/CT with 68Gallium-PSMA in Prostate Cancer and 68Gallium-DOTATOC in Neuroendocrine Tumors

Background: The timing of imaging for 68gallium (68Ga)-PSMA and 68Ga-DOTATOC are stated to be around 60 min post-injection (p.i.). In some lesions, late imaging (3–4 h p.i.) showed advantages. The aim of our evaluation was to demonstrate the relevance of an “early” late acquisition. Methods: We retrospectively evaluated 112 patients who underwent 68Ga-DOTATOC-PET/CT and 82 patients who underwent 68Ga-PSMA-PET/CT. The first scan was acquired 60 min (±15 min) after application. In cases of diagnostic ambiguity, a second scan was performed 30–60 min later. Pathological lesions were analyzed. Results: Almost half of all 68Ga-DOTATOC cases and about one-third of all 68Ga-PSMA examinations showed a change in findings due to the second acquisition. In total, 45.5% of neuroendocrine tumor (NET) patients and 66.7% of prostate cancer (PCa) patients showed relevant TNM classification changes. For 68Ga-PSMA, there were significant increases in sensitivity and specificity from 81.8% to 95.7% and from 66.7% to 100%, respectively. Statistically significant improvements in sensitivity (from 53.3% to 93.3%) and specificity (from 54.6% to 86.4%) were demonstrated for NET patients. Conclusion: Early second images can improve diagnostics with 68Ga-DOTATOC and 68Ga-PSMA PET/CT

La mediastinite discendente necrotizzante

La mediastinite discendente necrotizzante (DNM, Descending Necrotizing Mediastinitis) è la grave conseguenza di una infezione del distretto orofaringeo e cervicale che raggiunge il mediastino attraverso le fasce cervicali. Il ritardo nella diagnosi o la sottovalutazione del problema, insieme ad una non adeguata tecnica di drenaggio, possono avere conseguenze molto gravi con alti tassi di mortalità, anche oltre il 20%. In questo lavoro presentiamo l’esperienza di 9 casi clinici giunti alla nostra osservazione dal 2000 al 2006, cinque dei quali negli ultimi 2 anni. Scopo di questa pubblicazione è porre l’accento sulle differenze di approccio clinico e gestionale proposte dai vari autori che si sono occupati dell’argomento, sottolineando la multidisciplinaretà del trattamento di questa rara e gravissima affezione che richiede una stretta collaborazione tra chirurgo, rianimatore e infettivolog

PET Radiopharmaceuticals for Alzheimer’s Disease and Parkinson’s Disease Diagnosis, the Current and Future Landscape

Ironically, population aging which is considered a public health success has been accompanied by a myriad of new health challenges, which include neurodegenerative disorders (NDDs), the incidence of which increases proportionally to age. Among them, Alzheimer’s disease (AD) and Parkinson’s disease (PD) are the most common, with the misfolding and the aggregation of proteins being common and causal in the pathogenesis of both diseases. AD is characterized by the presence of hyperphosphorylated τ protein (tau), which is the main component of neurofibrillary tangles (NFTs), and senile plaques the main component of which is β-amyloid peptide aggregates (Aβ). The neuropathological hallmark of PD is α-synuclein aggregates (α-syn), which are present as insoluble fibrils, the primary structural component of Lewy body (LB) and neurites (LN). An increasing number of non-invasive PET examinations have been used for AD, to monitor the pathological progress (hallmarks) of disease. Notwithstanding, still the need for the development of novel detection tools for other proteinopathies still remains. This review, although not exhaustively, looks at the timeline of the development of existing tracers used in the imaging of Aβ and important moments that led to the development of these tracers

Diagnostic value of FDG-PET/CT in the diagnostic work-up of inflammation of unknown origin.

Introduction The present study aims to evaluate the clinical diagnostic value of FDG-PET/CT in patients with inflammation of unknown origin. Material and methods We retrospectively analyzed data of 130 patients who presented general inflammatory symptoms and/or elevated level of CRP and underwent FDG-PET/CT for the purpose of identifying unknown foci of inflammation. The accuracy of PET/CT findings was assessed against the standard of eventual clinical diagnosis e.g. results of pathology, microbiology or other imaging methods. Results In 99/130 patients (76 %) a final diagnosis was established, FDG-PET/CT showed a sensitivity and specificity of each 93 %. A decreased pseudocholinesterase is associated with a higher SUVmax value and with a higher CRP value whereas no significant relationship was found between elevated CRP values and the SUVmax, although higher CRP values are associated significantly with a true positive PET/CT result. Conclusion FDG-PET/CT is a highly sensitive, specific and accurate method for the detection of foci of inflammation of unknown origin. The combination of decreased pseudocholinesterase and increased CRP levels may be a useful tool to select patients for FDG PET/CT

Diagnostic Impact of Dual-Time PET/CT with ⁶⁸Gallium-PSMA in Prostate Cancer and ⁶⁸Gallium-DOTATOC in Neuroendocrine Tumors

Background: The timing of imaging for 68gallium (68Ga)-PSMA and 68Ga-DOTATOC are stated to be around 60 min post-injection (p.i.). In some lesions, late imaging (3–4 h p.i.) showed advantages. The aim of our evaluation was to demonstrate the relevance of an “early” late acquisition. Methods: We retrospectively evaluated 112 patients who underwent 68Ga-DOTATOC-PET/CT and 82 patients who underwent 68Ga-PSMA-PET/CT. The first scan was acquired 60 min (±15 min) after application. In cases of diagnostic ambiguity, a second scan was performed 30–60 min later. Pathological lesions were analyzed. Results: Almost half of all 68Ga-DOTATOC cases and about one-third of all 68Ga-PSMA examinations showed a change in findings due to the second acquisition. In total, 45.5% of neuroendocrine tumor (NET) patients and 66.7% of prostate cancer (PCa) patients showed relevant TNM classification changes. For 68Ga-PSMA, there were significant increases in sensitivity and specificity from 81.8% to 95.7% and from 66.7% to 100%, respectively. Statistically significant improvements in sensitivity (from 53.3% to 93.3%) and specificity (from 54.6% to 86.4%) were demonstrated for NET patients. Conclusion: Early second images can improve diagnostics with 68Ga-DOTATOC and 68Ga-PSMA PET/CT

Wertigkeit der PET/CT im Rahmen der Entzündungsherddiagnostik mit F-18-FDG

Introduction The present study aims to evaluate the clinical diagnostic value of FDG-PET/CT in patients with inflammation of unknown origin. Material and methods We retrospectively analyzed data of 130 patients who presented general inflammatory symptoms and/or elevated level of CRP and underwent FDG-PET/CT for the purpose of identifying unknown foci of inflammation. The accuracy of PET/CT findings was assessed against the standard of eventual clinical diagnosis e.g. results of pathology, microbiology or other imaging methods. Results In 99/130 patients (76 %) a final diagnosis was established, FDG-PET/CT showed a sensitivity and specificity of each 93 %. A decreased pseudocholinesterase is associated with a higher SUVmax value and with a higher CRP value whereas no significant relationship was found between elevated CRP values and the SUVmax, although higher CRP values are associated significantly with a true positive PET/CT result. Conclusion FDG-PET/CT is a highly sensitive, specific and accurate method for the detection of foci of inflammation of unknown origin. The combination of decreased pseudocholinesterase and increased CRP levels may be a useful tool to select patients for FDG PET/CT

Diesterified Derivatives of 5-Iodo-2′-Deoxyuridine as Cerebral Tumor Tracers

With the aim to develop beneficial tracers for cerebral tumors, we tested two novel 5-iodo-2′-deoxyuridine (IUdR) derivatives, diesterified at the deoxyribose residue. The substances were designed to enhance the uptake into brain tumor tissue and to prolong the availability in the organism. We synthesized carrier added 5-[125I]iodo-3′,5′-di-O-acetyl-2′-deoxyuridine (Ac2[125I]IUdR), 5-[125I]iodo-3′,5′-di-O-pivaloyl-2′-deoxyuridine (Piv2[125I]IUdR) and their respective precursor molecules for the first time. HPLC was used for purification and to determine the specific activities. The iodonucleoside tracer were tested for their stability against human thymidine phosphorylase. DNA integration of each tracer was determined in 2 glioma cell lines (Gl261, CRL2397) and in PC12 cells in vitro. In mice, we measured the relative biodistribution and the tracer uptake in grafted brain tumors. Ac2[125I]IUdR, Piv2[125I]IUdR and [125I]IUdR (control) were prepared with labeling yields of 31–47% and radiochemical purities of >99% (HPLC). Both diesterified iodonucleoside tracers showed a nearly 100% resistance against degradation by thymidine phosphorylase. Ac2[125I]IUdR and Piv2[125I]IUdR were specifically integrated into the DNA of all tested tumor cell lines but to a less extend than the control [125I]IUdR. In mice, 24 h after i.p. injection, brain radioactivity uptakes were in the following order Piv2[125I]IUdR>Ac2[125I]IUdR>[125I]IUdR. For Ac2[125I]IUdR we detected lower amounts of radioactivities in the thyroid and stomach, suggesting a higher stability toward deiodination. In mice bearing unilateral graft-induced brain tumors, the uptake ratios of tumor-bearing to healthy hemisphere were 51, 68 and 6 for [125I]IUdR, Ac2[125I]IUdR and Piv2[125I]IUdR, respectively. Esterifications of both deoxyribosyl hydroxyl groups of the tumor tracer IUdR lead to advantageous properties regarding uptake into brain tumor tissue and metabolic stability