ПЭТ-КТ с 11С-метионином в диагностике анапластических астроцитом и анапластических олигодендроглиом

The aim of this study was to evaluate average 11C-methionine uptake for grade II (anaplastic) gliomas in a large cohort, as well as relations between MRI and PET characteristics and their unfluence on overall and progression-free survival.Materials and methods. The study was based upon 78 patients with supratentorial tumors, among them 48 with anaplastic astrocytoma (AA) and 30 with anaplastic oligodendroglioma (AO). ALL patients underwent PET-CT with 11C-methionine and MRI study (Т1, Т2, Т2-FLAIR, DWI и 3D Т1+Gd regimes). Tumor removal was performed in 71 cases, stereotactic biopsy in 8 patients. Tumor specimen were assessed by neuropatomorphologists and IDH1-status and 1p/19q co-deletion were evaluated.Study results. AA IDH− tumors demonstrated statistically significant bigger metabolic volume and radiotracer uptake comparing with AA IDH+. Moreover, AA IDH − characterized by higher fractional MET uptake. The smallest tumors (by MRI) were AOs, meanwhile their fractional contrast enhancement was higher than for AAs. AOs were also known as tumors with minimal difference between MRI and PET-CT volume. MET uptake decreased in a row АА IDH− – АОД – AA IDH+, but the difference has not reached statistical significance. For wild-type AAs metabolic volume correlated with OS and PFS, meanwhile for IDH-mutant AAs tumor volume (measured by MRI) correlated only with PFS.Conclusion. Present study based on the largest cohort of patients with anaplastic gliomas who underwent both MRI and PET with 11C-methionine. It turned out, that unlike grade II oligodendogliomas, AOs do not always demonstrate higher than their astrocytic counterparts MET uptake levels.Цель исследования: определение усредненных показателей индекса накопления (ИН) радиофармпрепарата (РФП) (11С-метионина) в группе глиом Grade III на большом клиническом материале, а также изучение взаимосвязи показателей МРТ- и ПЭТ-исследований и значений ИН РФП с показателями общей и безрецидивной выживаемости.Материал и методы. В исследуемую группу вошло 78 пациентов, из них с диагнозом анапластическая астроцитома (АА) 48 (61,5%) пациентов и анапластическая олигодендроглиома (АОД) 30 (38,5%) пациентов; во всех случаях супратенториальной локализации. Всем пациентам выполнена ПЭТ-КТ с 11С-метионином по стандартной методике, а также МРТ в режимах Т1, Т2, Т2-FLAIR, DWI и 3D Т1+Gd. В 71 случае выполнено удаление опухоли, в 8 – верификация гистологического диагноза путем стереотаксической биопсии. Все опухоли подверглись молекулярно-генетическому анализу, в том числе с исследованием мутации IDH1 и ко-делеции 1p/19q.Результаты исследования. Метаболический объем опухоли и величина ИН РФП были статистически значимо выше в группе IDH-негативных АА, нежели в группе IDH-позитивных АА; кроме того, АА дикого типа продемонстрировали более высокие значения долевого накопления РФП. Наименьший общий объем опухоли по МРТ продемонстрировали АОД, при этом долевой объем контрастирования этих опухолей был значительно выше, чем в общей группе астроцитарных опухолей; для АОД характерно минимальное отличие общего объема опухоли от метаболического. Значения ИН РФП уменьшается в ряду АА IDH− – АОД – AA IDH+, однако эти различия не достигли статистически значимых величин. В группе IDH-негативных АА объем метаболически активной ткани по данным ПЭТ демонстрировал слабоотрицательную зависимость с общей и безрецидивной выживаемостью, а объем опухоли в группе IDH-мутантных АА коррелировад только с безрецидивной выживаемостью.Заключение. Настоящая работа на крупнейшем клиническом материале анализирует соотношения результатов МРТ и ПЭТ-КТ с 11С-метионином в группе глиом Grade III. На основании полученных данных удалось продемонстрировать неоднозначность зависимости значений ИН РФП в группе анапластических глиом от наличия олигодендрокомпонента в гистоструктуре опухоли, где, в отличие от глиом Grade II, не получено значимых отличий в уровне метаболической активности астроцитарных и олигодендроглиом, обе группы демонстрировали большой разброс показателей

Application of biological markers of kidney injury for prognosis of long-term adverse outcomes in patients with ST-segment elevation myocardial infarction

Objective: To study the prognostic significance of serum NGAL (sNGAL) and cystatin C in the acute phase of ST-segment elevation myocardial infarction (STEMI) in the late disease period. Material and Methods: 357 patients with STEMI, admitted to hospital within 24 h of symptom onset, were included in the study. Serum creatinine levels with the calculation of glomerular filtration rate (GFR) using the MDRD as well as levels of sNGAL and cystatin C were measured on day 1 and 12–14. Results: All patients were divided into 2 groups according to their estimated GFR: with and without renal dysfunction (RD), defined as a decrease of GFR < 60 ml/min/1.73 m2. Within 3 years of follow-up, the composite endpoint (CEP) were assessed (CEP – death + non-fatal cardiovascular events). The ROC curve analysis was used to determine the thresholds for every biomarker, involved in the CEP development: NGAL (≥ 1.25 ng / ml) and cystatin C (≥ 1.9 mg / l). On day 12–14 of hospitalization elevated NGAL ≥ 1.25 ng / mL was associated with a 3-fold increased risk for adverse cardio vascular events in a 3-year follow up after STEMI; whereas, elevated cystatin C ≥ 1.9 mg/l – with a 2-fold increased risk for the CEP, and signs of RD, found in patients before the discharge from the hospital, – with a 1.5-fold increased cardiovascular risk. The model considering an increase of NGAL over 1.25 ng / l has the highest prognostic value, while the models based on the levels of cystatin C and GFR are of equal prognostic value. Conclusion: The most promising issue in the prognosis of long-term adverse outcomes in patients with STEMI may be considered the assessment of RD using new biomarkers such as sNGAL

CLINICAL AND PREDICTIVE VALUE OF SERUM INTERLEUKINE-18 IN ST ELEVATION MYOCARDIAL INFARCTION

Aim. To assess clinical and predictive value of serum IL-18 in ST elevation myocardial infarction.Material and methods. Totally, 132 patients included, hospitalized to Kemerovo cardiovascular dispensary due to STEMI with &lt;24 hours pain onset. Assessment of IL-18 concentration (pg/ml) was done on 12th day of care.Results. Mean concentration of IL-18 in all patients was 244,02 (172,13-315,91) pg/ml, that was 3,5 times higher than reference range. Correlation analysis showed relation of IL-18 levels with total cholesterol, with low density lipoproteides, left ventricle ejection fraction, glomerular filtration rate (GFR) by CKD-EPI: r=0,18 (р=0,040), r=0,24 (р=0,008), r=-0,19 (р=0,029), r=-0,18 (р=0,039), resp. Median concentration of IL-18 in multifocal atherosclerosis (MFA) patients was 214,75 (129,20-362,35) pg/ml vs. 140,40 (97,80-292,80) pg/ml in non-MFA patients (р=0,010). In those patients without any significant progression of BCA lesion, baseline concentration of IL-18 was 271,0 (128,3-358,4) mg/ml, but in patients with the increase of stenosis grade more than 30% and/or appearance of novel plaques the level of IL-18 was 119,35 (94,61-188,95) pg/ml.Conclusion. In prediction of early (in-hospital) and long-term (3-year) stages of myocardial infarction there was no any clinical and predictive value of IL-18. Concentration of serum IL-18 did not relate to kidney diseases in STEMI patients, but correlates negatively with GFR defined by CKD-EPI. There was significant role of IL-18 in forming of multifocal atherosclerosis. High concentrations of IL-18 at 12th day of hospitalization were related to the increase of total cholesterol and LDL, and with the decrease of contractility of the left ventricle myocardium. In STEMI with MFA there is increase of IL-18 1,5 times. At the same time significant progression of atherosclerotic lesion during one year was found in patients with lower baseline IL-18 level, which requires further studies of the IL-18 role in atherogenesi