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Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography in Assessing Retroperitoneal Fibrosis: A Literature Review
Giorgio Treglia,Maria Vittoria Mattoli,Francesco Bertagna
International Journal of Molecular Imaging , 2012, DOI: 10.1155/2012/484052
Abstract: Background and Purpose. Several studies have evaluated the role of fluorine-18-fluorodeoxyglucose positron emission tomography and positron emission tomography/computed tomography (FDG-PET and PET/CT) in diagnosing and assessing disease activity in patients with retroperitoneal fibrosis (RF). The aim of our paper is to perform a literature review on this topic. Methods. Scientific articles that evaluated the usefulness of FDG-PET and PET/CT in patients with RF were searched and discussed. Results. Eleven studies were found, and the main findings of these articles were described. Conclusion. FDG-PET and PET/CT are useful functional imaging methods for assessing patients with RF both in the diagnosis and in the treatment response evaluation. Moreover, further studies are needed to substantiate the role of FDG-PET and PET/CT in patients with RF. 1. Introduction Retroperitoneal fibrosis (RF) is a chronic inflammatory disease, characterized by the presence of retroperitoneal inflammatory tissue, typically surrounding abdominal aorta and/or iliac arteries, and often leading to the involvement of adjacent structures, more frequently the ureters and inferior vena cava [1–7]. RF is a complex clinical entity still incompletely defined and with unclear etiology. Idiopathic RF (even reported as Ormond’s disease) represents two thirds of all cases of RF. A true idiopathic form is present in any cases of RF in which no potential etiologic condition may be identified. The pathogenesis of the idiopathic RF appears today to be related to IgG4 autoimmune mechanisms “hyper-IgG4 disease”. Otherwise, RF in the presence of aortic atheromatous inflammation (atheromatous aortitis) has been included, more than twenty years ago, among the secondary forms, since this condition appears to be elicited by antigen-acting oxidized-LDL and/or ceroid, that are present within the atheromatous plaque. Etiology of other secondary RF refers to medications (drug-induced RF), infections, traumas, surgery, radiation therapy, and malignancies [1–7]. Clinical presentation of RF is usually characterized by constitutional symptoms and back or abdominal pain. Because of the presence of increased serum inflammatory markers levels and positive autoantibodies, and the frequent association with autoimmune diseases (such as Riedel’s thyroiditis, sarcoidosis, inflammatory aneurysm, and autoimmune pancreatitis), some authors suspected that RF may result from autoimmune mechanisms [7] or, even, be considered as distinct autoimmune diseases [3, 8–11]. A frequent complication of RF is unilateral or bilateral
123I-MIBG Scintigraphy as a Powerful Tool to Plan an Implantable Cardioverter Defibrillator and to Assess Cardiac Resynchronization Therapy in Heart Failure Patients
Antonella Stefanelli,Giorgio Treglia,Alessandro Giordano
International Journal of Molecular Imaging , 2012, DOI: 10.1155/2012/690468
Abstract: Iodine-123-metaiodobenzylguanidine (123I-MIBG) scintigraphy is a nuclear medicine technique which describes the functional status of the cardiac sympathetic nervous system. It is well known that an autonomic dysfunction is present in heart failure setting as a neuronal uptake of norepinephrine is impaired in the failing myocardium. Reduction in sympathetic nervous function in the heart, measured by reduced myocardial uptake of 123I-MIBG, is an indicator of poor prognosis for heart failure patients. The aim of this paper was to investigate the role of 123I-MIBG scintigraphy in evaluating the need of implantable cardioverter defibrillator (ICD) and the response to cardiac resynchronization therapy (CRT) in heart failure patients. For this purpose scientific literature data on these topics were reviewed. Based on literature data, 123I-MIBG scintigraphy seems to be a useful tool to assess which patients may benefit most from an ICD implantation to reduce the risk of ventricular arrhythmia or sudden cardiac death. Furthermore, 123I-MIBG scintigraphy seems to predict which patients will response to CRT with an improvement in left ventricular function. 1. Introduction Heart failure (HF) is characterized by alterations in myocardial sympathetic nerve activity; an increased sympathetic response is initially favorable by serving as compensation for decreased cardiac output, but as HF progresses, this response leads to deleterious neurohormonal and myocardial structural changes that worsen the condition and increase the likelihood of arrhythmias and cardiac death [1]. Myocardial innervation imaging with iodine 123 metaiodobenzylguanidine (123I-MIBG) scintigraphy provides a noninvasive tool for the investigation of cardiac sympathetic innervation; this technique can also demonstrate drug-induced changes in cardiac adrenergic activity [2]. Radiolabeled MIBG is considered an established sympathetic neuron-imaging agent useful to study the organs richly innervated by the sympathetic nervous system. MIBG is an analog of guanethidine and is taken up by the postganglionic presynaptic nerve endings of the adrenergic nervous system [3–6]. After depolarization, MIBG is released into the synaptic cleft like norepinephrine but is not metabolized. Labeling MIBG with 123I allows the visualization of adrenergic innervation in vivo; 123I-MIBG scintigraphy not only displays the presence of noradrenergic innervation but also its functional capability [3–6]. About the scintigraphic procedure, planar images of the thorax are acquired 15 minutes (early image) and 4 hours (delayed
The Role of Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography in Evaluating the Response to Treatment in Patients with Multiple Myeloma
Carmelo Caldarella,Giorgio Treglia,Maria Antonietta Isgrò,Ivan Treglia,Alessandro Giordano
International Journal of Molecular Imaging , 2012, DOI: 10.1155/2012/175803
Abstract: Background and Aim. Fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) is well recognized as a powerful diagnostic tool in the initial staging of patients with multiple myeloma (MM). The aim of this paper is to perform a systematic review about the usefulness of FDG-PET or PET/CT in evaluating the response to treatment in patients with MM. Methods. The scientific literature about the role of FDG-PET or PET/CT in evaluating the response to treatment in patients affected by MM was systematically reviewed. Results. Ten studies about the role of FDG-PET or PET/CT in evaluating treatment response in MM were retrieved and discussed. Conclusions. FDG-PET or PET/CT seems to be helpful in assessing the response to treatment in patients with MM and in the evaluation of possible sites of recurrent or progressive disease. 1. Introduction Multiple myeloma (MM) is the second most common haematological malignancy. It accounts for <1% of all cancers and primarily affects older people, with a median age at diagnosis of about 65–70 years. The characteristic haematological alteration is monoclonal proliferation of plasma cells in bone marrow; in most cases, excessive production of monoclonal immunoglobulins can be observed and detected in serum and/or urine. Bone is involved in more than 80% of patients at the time of diagnosis, in most cases with evidence of osteolytic lesions; resulting pain, spinal cord compression, and hypercalcemia have a major impact on life quality [1–3]. The extension of bone marrow and extramedullary involvement should be carefully evaluated to establish prognosis and clinical management [4]. Currently, whole-body X-ray scan is the most commonly used diagnostic tool in the evaluation of bone involvement in patients with MM, due to the rare occurrence of extraosseous sites. Additional information could be provided by computed tomography (CT) and magnetic resonance imaging (MRI), while conventional bone scintigraphy is affected by low sensitivity because of inadequate osteoblastic activity in MM lesions [1–3]. Molecular imaging modalities such as Fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) or FDG-PET/CT have emerged in the recent years as useful methods in the initial staging and treatment planning of patients affected by MM. FDG is a glucose analogue which is taken up by human cells by means transmembrane glucose transporters (GLUTs) and then phosphorylated to FDG-6-phosphate. Differently from normal glucose, it is not further metabolized to pyruvate and accumulates into the cytosol. The amount of
The Role of Fluorine-18-fluorodeoxyglucose Positron Emission Tomography in Assessing the Response to Neoadjuvant Treatment in Patients with Osteosarcoma
Carmelo Caldarella,Marco Salsano,Maria Antonietta Isgrò,Giorgio Treglia
International Journal of Molecular Imaging , 2012, DOI: 10.1155/2012/870301
Abstract: Aim. The objective of this study is to systematically review the role of positron emission tomography (PET) and PET/computed tomography (PET/CT) with fluorine-18-fluorodeoxyglucose (FDG) in assessing the response to neoadjuvant treatment in patients with osteosarcoma (OS). Methods. A comprehensive literature search of published studies through March 2012 in PubMed/MEDLINE, Embase, and Scopus databases regarding whole-body FDG-PET and FDG-PET/CT in patients with OS was performed. Results. Twenty-two studies have investigated the role of FDG-PET and FDG-PET/CT in the evaluation of response to neoadjuvant treatment with either chemotherapy or radiation therapy in patients with OS. The main findings of these studies are presented. Conclusion. FDG-PET or PET/CT seems to be sensitive and reliable diagnostic tools in the assessment of metabolic response to treatment in patients with OS, after baseline PET evaluation has been performed in advance. However, false positive findings due to inflammation in sites of tumoral response should be considered. 1. Introduction Osteosarcoma (OS) is the most common primary malignant bone tumour in children and adolescents, with a peak of incidence at the age of 15–19 years [1]. OS is a tumour derived from primitive mesenchymal cells, originated from bone and rarely from soft tissue [2]. Although OS can occur in any bone, it is most common in the metaphyses of long bones: distal femur, proximal tibia, proximal humerus, and around the knee [3–5]. OS has a high tendency to metastatic spread: 80% of all metastases arise in the lungs (20% of them at initial diagnosis) but metastases can also develop in bone and rarely in lymph nodes [6–9]. The 5-year survival rate for OS patients with metastases is 20% compared to 65% for patients with localised disease [10]. Usually, the treatment scheme for patients with OS is comprised of preoperative chemotherapy, surgical removal of all detectable tumour sites, and/or local treatment, followed by postoperative chemotherapy. The prognosis for patients with metastatic disease or recurrent disease remains poor [11, 12]. In order to correctly evaluate patients with OS in staging and restaging, a variety of diagnostic imaging modalities may be used, such as radiography, computed tomography (CT), magnetic resonance imaging (MRI), and traditional nuclear medicine techniques (bone scintigraphy). Fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) has been successfully used to evaluate different malignant tumours, such as musculoskeletal tumours [13]. Tumour cells have a metabolic
PET Imaging in Recurrent Medullary Thyroid Carcinoma
Giorgio Treglia,Vittoria Rufini,Massimo Salvatori,Alessandro Giordano,Luca Giovanella
International Journal of Molecular Imaging , 2012, DOI: 10.1155/2012/324686
Abstract: Purpose. To perform an overview about the role of positron emission tomography (PET) or PET/computed tomography (PET/CT) using different radiopharmaceuticals in recurrent medullary thyroid carcinoma (MTC) based on biochemical findings (increased tumor marker levels after primary surgery). Methods. A comprehensive literature search of studies published in PubMed/MEDLINE, Scopus, and Embase databases through February 2012 regarding PET or PET/CT in patients with recurrent MTC was performed. Results. Twenty-nine studies comprising 714 patients with suspected recurrent MTC were retrieved. Twenty-seven articles evaluated the role of fluorine-18-fluorodeoxyglucose (FDG) PET or PET/CT in recurrent MTC with conflicting results. Diagnostic accuracy of FDG-PET and PET/CT increased in MTC patients with higher calcitonin and carcinoembryonic antigen values, suggesting that these imaging methods could be very useful in patients with more advanced and aggressive disease. Eight articles evaluated the role of fluorine-18-dihydroxyphenylalanine (FDOPA) PET or PET/CT in recurrent MTC reporting promising results. Overall, FDOPA seems to be superior but complementary compared to FDG in detecting recurrent MTC. Few studies evaluating other PET tracers are also discussed. Conclusions. PET radiopharmaceuticals reflect different metabolic pathways in MTC. FDOPA seems to be the most useful PET tracer in detecting recurrent MTC based on rising levels of tumor markers. FDG may complement FDOPA in patients with more aggressive MTC. 1. Introduction Medullary thyroid carcinoma (MTC) is a slow-growing neuroendocrine tumor originating from parafollicular C cells. MTC accounts for approximately 5% of thyroid carcinomas, occurring in either sporadic (75% of cases) or familial forms (25% of cases). This tumor is frequently aggressive; most frequent sites of metastatic disease are cervical and mediastinal lymph nodes, lungs, liver, and bone. The main treatment for MTC is surgical resection that is the only strategy for potential cure; in patients with metastatic disease therapeutic options are limited as this tumor does not concentrate radioiodine and shows poor response to chemotherapy and radiation therapy [1]. Also targeted therapy with vandetanib seems to show promising results in the treatment of patients with metastatic/recurrent MTC [1]. Serum calcitonin represents the most sensitive and accurate tumor marker in the postoperative management and surveillance of MTC. In about one third of patients with MTC lesions also carcinoembryonic antigen (CEA) levels may be increased and this
Usefulness of MIBG scintigraphy in idiopathic REM sleep behavior disorder: a systematic review
Giorgio Treglia, Fabrizio Cocciolillo, Antonella Stefanelli, et al
Research and Reports in Nuclear Medicine , 2011, DOI: http://dx.doi.org/10.2147/RRNM.S16143
Abstract: efulness of MIBG scintigraphy in idiopathic REM sleep behavior disorder: a systematic review Review (2634) Total Article Views Authors: Giorgio Treglia, Fabrizio Cocciolillo, Antonella Stefanelli, et al Published Date January 2011 Volume 2011:1 Pages 1 - 7 DOI: http://dx.doi.org/10.2147/RRNM.S16143 Giorgio Treglia1, Fabrizio Cocciolillo1, Antonella Stefanelli1, Ernesto Cason2, Alessandro Giordano1 1Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, Italy; 2Unit of Nuclear Medicine, Maggiore Hospital, Bologna, Italy Background and purpose: It has been widely demonstrated that Parkinson's disease (PD) and dementia with Lewy bodies (DLB) share one clinicopathological entity; Lewy body disease (LBD) has thus become a general term for these diseases. LBD presents an impairment of adrenergic function and consequently an abnormal myocardial metaiodobenzylguanidine (MIBG) innervation imaging. Like PD and DLB, other Lewy body disorders, including pure autonomic failure and idiopathic rapid eye movement sleep behavior disorder (RBD), have been reported to develop cardiac sympathetic denervation. This study is designed to systematically review whether iodine-123-MIBG scintigraphy in patients with RBD demonstrates reduced myocardial uptake thereby suggesting cardiac sympathetic denervation, a typical finding of LBD, in these patients. Methods: A comprehensive computer literature search of studies published through December 2010 regarding MIBG scintigraphy in patients with RBD was performed in PubMed/Medline and EMBASE databases. Only studies in which MIBG scintigraphy was performed in more than two patients with RBD were selected. Results: Ultimately, six studies comprising a total of 139 patients with RBD were identified and discussed. Conclusions: RBD usually show a markedly reduced cardiac MIBG uptake, consistent with a sympathetic denervation, a typical finding of a LBD.
18F-FDG PET Imaging in the Evaluation of Treatment Response to New Chemotherapies beyond Imatinib for Patients with Gastrointestinal Stromal Tumors
Antonella Stefanelli,Giorgio Treglia,Paoletta Mirk,Barbara Muoio,Alessandro Giordano
ISRN Gastroenterology , 2011, DOI: 10.5402/2011/824892
Abstract: Aim. 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) is a powerful tool for staging and defining “good responders” to chemotherapy in tumor setting. Gastrointestinal stromal tumors (GISTs) are sarcoma involving gastrointestinal tract and may require a chemotherapy including imatinib, a tyrosine kinase inhibitor agent. Some GIST patients become refractory to imatinib; therefore, other tyrosine kinase inhibitors or concomitant chemotherapy may be considered for treatment. The aim of this paper is to assess if 18F-FDG PET imaging is a useful tool to evaluate treatment response to new chemotherapies beyond imatinib for GIST patients. Methods. We performed a review of the literature about the role of 18F-FDG PET in the evaluation of treatment response to new chemotherapies beyond imatinib for GIST patients. Results and Conclusions. 18F-FDG PET seems to be able to assess therapy response earlier than computed tomography (CT) imaging in imatinib refractory GIST patients treated with other agents. However, a dual modality PET-CT imaging is recommendable to achieve a better detection of all lesions. 1. Introduction Gastrointestinal stromal tumors (GISTs) are 0.1–3.0% of all cancers involving gastrointestinal tract and account for 6% of all sarcomas [1]. GISTs usually occur in middle-aged and older patients and are often asymptomatic when <5?cm in their longest dimension; GISTs become symptomatic when they grow >5?cm of diameter [2]. Patients affected by GISTs are frequently symptomatic for gastrointestinal bleeding, anemia, abdominal pain, dyspepsia, or an abdominal mass. Most common localizations of GISTs are stomach (70%), followed by the small intestine (20%), large intestine (5%), and esophagus (<5%) [3]. GISTs are benign in 70% of cases, but 30% are malignant and most common metastatic localizations occur in liver and peritoneum. Other metastatic sites include the lungs, pleura, retroperitoneum, bone, and subcutaneous tissues [1]. Prognostic factors have been proposed as tumor size <5?cm, ability to perform a complete initial resection of the tumor, and tumor grade and site; however, prediction of benign or malignant behavior of a GIST remains difficult to establish [4], for example, intestinal tumors seem to be more malignant than gastric tumors [5, 6]. Beyond the prognostic stratification, surgical resection remains the mainstay of treatment in resectable tumors, whereas recurrent and metastatic GISTs are poor responders to chemotherapy and irradiation. The origin of GIST cells is probably related not to smooth muscle cells but to cells
Technological Use Behaviors, Internet Addiction and Personality among Italian University Students  [PDF]
Eugenia Treglia, Rosella Tomassoni
Psychology (PSYCH) , 2018, DOI: 10.4236/psych.2018.93029
Abstract: Aims of this study are to evaluate the technological use behaviors among university students and the relationship between the type of use/abuse of internet and some personality characteristics. The sample consists of 435 Italian university students. The Multidimensional Personality Profile (MPP) test and the Questionnaire about the Internet use, abuse and addiction (UADI), have been administered online but in the experimenter’s presence. The use of the Internet in our sample is mainly not a problematical one. Significant correlations were found between Self regulation and Dissociation (r = -0.36) and between Machiavellism/cynism and Escape (r = 0.36), Dissociation (r = 0.33) and Experimentation (r = 0.34). The results of the correlations suggest that the more people are able to set purposes, monitor actions, organise and deal with matters with order and method (Self-Regulation), the less they will tend to have dissociative experiences connected to the use of Internet (Dissociation). A high level of cynicism correspond a high tendency to use Internet to escape from reality, a high tendency to dissociation and to aggressive/transgressive behaviours online. In conclusion it is necessary to consider the complex psychological dynamics in the relationship between the subject and the technological tool.
Comparison between 18F-Fluorodeoxyglucose Positron Emission Tomography and Sentinel Lymph Node Biopsy for Regional Lymph Nodal Staging in Patients with Melanoma: A Review of the Literature
Paoletta Mirk,Giorgio Treglia,Marco Salsano,Pietro Basile,Alessandro Giordano,Lorenzo Bonomo
Radiology Research and Practice , 2011, DOI: 10.1155/2011/912504
Abstract: Aim. to compare 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET) to sentinel lymph node biopsy (SLNB) for regional lymph nodal staging in patients with melanoma. Methods. We performed a literature review discussing original articles which compared FDG-PET to SLNB for regional lymph nodal staging in patients with melanoma. Results and Conclusions. There is consensus in the literature that FDG-PET cannot replace SLNB for regional lymph nodal staging in patients with melanoma. 1. Introduction 18F The usefulness of imaging studies in patients with melanoma generally depends on the stage of the tumour. In patients with early-stage disease, surgery is often curative with little role for comprehensive imaging in this patient population [1]. Regional lymph nodes are the most frequent site of metastatic disease. In many patients with primary cutaneous melanoma and clinically negative regional lymph nodes, surgical staging of the regional nodal basins at risk is performed using intraoperative lymphatic mapping and sentinel lymph node biopsy (SLNB). Regional nodal basins at risk (sentinel lymph nodes (SLN)) are typically identified by preoperative lymphoscintigraphy (LS) using intradermal injection of technetium-labelled sulphur colloid around the primary melanoma [2, 3]. Positron emission tomography with 18F-Fluorodeoxyglucose (FDG-PET) is a functional noninvasive imaging method extensively investigated in patients with melanoma [3]. We searched in the literature for relevant published articles which compared FDG-PET to SLNB for regional lymph nodal staging in patients with melanoma in order to assess if FDG-PET could substitute SLNB in this setting. 2. Comparison between FDG-PET and SLNB for Regional Lymph Nodal Staging in Patients with Melanoma: Literature Data The first study on this topic was published in 1999 by Wagner et al. [4], who compared FDG-PET imaging of regional lymph node basins to SLNB, in patients with American Joint Committee on Cancer (AJCC) stages I, II, and III melanoma. Seventy patients with cutaneous melanoma with Breslow thickness greater than 1?mm (AJCC T2-4N0M0) or localized regional cutaneous recurrence (TxN2bM0) underwent whole-body FDG-PET followed by SLNB. Eighty-nine lymph node basins were evaluated by FDG-PET and SLNB. Eighteen patients (25.7%) had lymph nodal metastases at the time of FDG-PET imaging: 17 proved by SLNB (24.3%) and one by follow-up examination (1.4%). Median tumour volume in positive SLN was 4.3?mm3 (range: 0.07–523?mm3). Sensitivity of SLNB for detection of occult regional lymph node metastases was
Usefulness of Whole-Body Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography in Patients with Neurofibromatosis Type 1: A Systematic Review
Giorgio Treglia,Silvia Taralli,Francesco Bertagna,Marco Salsano,Barbara Muoio,Pierluigi Novellis,Maria Letizia Vita,Fabio Maggi,Alessandro Giordano
Radiology Research and Practice , 2012, DOI: 10.1155/2012/431029
Abstract: Aim. To systematically review the role of positron emission tomography (PET) with fluorine-18-fluorodeoxyglucose (FDG) in patients with neurofibromatosis type 1 (NF1). Methods. A comprehensive literature search of published studies regarding FDG-PET and PET/CT in patients with NF1 was performed. No beginning date limit and language restriction were used; the search was updated until December 2011. Only those studies or subsets in studies including whole-body FDG-PET or PET/CT scans performed in patients with NF1 were included. Results. We identified 12 studies including 352 NF1 patients. Qualitative evaluation was performed in about half of the studies and semiquantitative analysis, mainly based on different values of SUV cutoff, in the others. Most of the studies evaluated the role of FDG-PET for differentiating benign from malignant peripheral nerve sheath tumors (MPNSTs). Malignant lesions were detected with a sensitivity ranging between 100% and 89%, but with lower specificity, ranging between 100% and 72%. Moreover, FDG-PET seems to be an important imaging modality for predicting the progression to MPNST and the outcome in patients with MPNST. Two studies evaluated the role of FDG-PET in pediatric patients with NF1. Conclusions. FDG-PET and PET/CT are useful methods to identify malignant change in neurogenic tumors in NF1 and to discriminate malignant from benign neurogenic lesions. 1. Introduction Neurofibromatosis type 1 (NF1) is an autosomal dominant disease with an incidence of 1 in 2,500 to 1 in 3,000 subjects. Neurofibroma, a benign peripheral nerve sheath tumor, is the most common tumor in NF1 patients and may manifest as focal nodular, cutaneous or subcutaneous lesion, intraforaminal spinal nerve root tumor, or plexiform neurofibroma (PNF). Patients with NF1 have an increased risk of developing malignant peripheral nerve sheath tumors (MPNSTs) with a life-time risk of 8–12% [1–6]. MPNSTs usually arise from preexisting benign PNF, metastasize widely, and frequently have a poor prognosis. Therefore, differentiating between benign and malignant tumors in patients with NF1 has important prognostic and therapeutic implications, but can be difficult, especially in individuals who have multiple benign tumors. Optimal management is dependent on early and accurate histological grading and staging of the disease, but MPNSTs are often difficult to detect and may metastasize to many different sites. Pain, rapid increase in size of a neurofibroma, and the development of neurological deficit are clinical indicators of malignancy, but may also be features
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