परमाणु चिकित्सा एवं विकिरण चिकित्सा

Objectives: Conduct a systematic review and meta-analysis to assess the diagnostic performance of 18Ffluorodeoxyglucose positron emission tomography (18F-FDG PET) or PET-computed tomography (PET-CT) in multiple myeloma (MM). Methods: A comprehensive literature search about studies that published till July 2015 was performed. Methodological quality of each study was assessed. The meta-regression and subgroup analysis was applied to assess the heterogeneity of between-study. A meta-analysis was used to state sensitivity, specificity, diagnostic odds ratio (DOR), area under the curve (AUC), summary receiver operating characteristic (SROC) curve and Ǫ* indexes with statistical software. Results: Eleven studies met the inclusion criteria in this meta-analysis, which comprise a total of 492 patients. The pooled sensitivity and specificity of 18F-FDG PET or PET-CT in multiple myeloma were 0.870 (95% CI, 0.825-0.907), 0.937 (95% CI, 0.892-0.967), and the AUC and the Ǫ* index were 0.9332, 0.869, respectively. The pooled sensitivity and specificity of PET in multiple myeloma were 0.94495% CI, 0.887-0.977) and 0.990 (95% CI, 0.947-1.000), and the AUC and the Ǫ* index were 0.98, 0.95, respectively. The pooled sensitivity and specificity for PET-CT in multiple myeloma were 0.813 (95% CI, 0.743-0.870) and 0.875 (95% CI, 0.787-0.936), and the AUC and the Ǫ* index were 0.88, 0.82, respectively. The funnel plots suggested the publication bias may exist. Conclusions: The whole-body 18F-FDG PET or PET-CT were imaging methods with high accuracy in differential diagnosis of multiple myeloma patients.

Background: We reported the high correlation between cavity-to-myocardial (C/M) count ratio at stress and rest thallium SPECT, and stress-rest EF calculated by MUGA test, this was confirmed by others. This correlation was explained partially by the functional mass. On the other hand, two important prognostic parameters should be considered before any revascularization technique: (1) Identification of viable myocardium and its amount, (2) Prediction of EF improvement post revascularization. Aim of the study: Correlating EF (C/M) on RD and RI image (EFRD & EFRI) image to actual EF (prevascularization EF1) and 1 year post revascularization EF2. Patients and methods: 78 patients with CAD (68 males and 10 females with mean age of 54.2+9 years) had been subjected to: (1) St-RD-RI thallium SPECT with assessment of reversible or fixed perfusion defects and calculation of C/M and consequently the EFC/M at the three settings. (2) Assessment of EF by MUGA at rest pre and 1 year post revascularization EF1 & EF2 respectively. These patients had been subjected to revascularization either by PTCA and stent (23/78 i.e., 29.5%) or by CABG (55/78, i.e., 70.5%). Results: Out of the 1560 myocardial segments (20 segments × 78 patients), 780 (50%) segments had abnormal resting wall motion. 441/780 (56.5%) of these segments were either of normal thallium uptake or with reversible perfusion defects while the rest (43.5%) showed fixed defects. 233/441 (52.8%) of those normal uptake or reversible segments showed recovery of wall motion post revascularization (PRV) while only 29/339 (15.1%) showed similar improvements. EFRI was found higher than EFRD in 44/78 of patients, no change in 23/78 patients and worsened in 11/78 patients with total agreements of 63/78 (80.8%) with EF2. On the other hand, EFRD was matched with EF1 in 64/78 of patients. 30/64 (46.9%) showed higher EF2, 23/64 (35.9%) showed similar EF2 while 11/64 (17.2%) showed lower EF2. The rest of cases 14/78 showed mismatch between EFRD and EF1 with higher values of EFRD. These patients still had higher values of EFRI and EF2 than EFRD. Conclusion: (1) Mismatch between EFRD and EF1 is an indication of presence of stunning myocardium and of good prognosis. (2) EFRI can be used to predict EF2 and so helps on selecting patients who can benefit from revascularization.

Purpose: To assess the efficacy and safety of reirradiation in head and neck cancer and potential prognostic factors associated. Material and methods: Cohort study of patients treated with curative reirradiation for recurrence or second primary tumor. The analysis of RR is obtained prospectively from the database available at both centers. Statistical analysis was performed using the R Commander 2.0 software. Results: Between 2006 and 2013, 40 patients with head and neck carcinoma were reirradiated. The mean dose was 66.39 Gy. 35% of patients showed acute toxicity grade 3 or higher and 20.5% showed chronic toxicity grade 2 or higher. The median follow-up was 11 months. The overall survival at 2 years was 41%; disease free survival and locoregional control at 1 year was 35.9% and 41.1% respectively. The time between treatments and disease-free interval to death and local recurrence were statistically significant (p < 0.05); and the first treatment scheme to distant metastases.

Accurate definition of the lumpectomy cavity (LC) is essential for both partial breast and electron boost planning and delivery. The goal of this study is to evaluate CT, 3DUS and clips in the daily target localization of the LC. Twenty whole breast radiation patients, including 10 with clips, underwent two sets of treatment planning CTs (CT1, CT2) with co-registered 3DUS (US1, US2), separated by approximately 6 weeks. The cavities were independently outlined on each CT and 3DUS dataset. Of the 20 patients, 18 had visible cavities. The shifts in cavity position were calculated from CT, 3DUS and clips. The PTV margins required to be added to the CT1 cavity volume in order to fully encompass the CT2 cavity were calculated without and with shifts according to 3DUS or clips. The median cavity displacement ranged from 0.0-3.0 mm with a maximum of up to 17.9 mm. The cavity displacements were not significantly different when calculated based on 3DUS, CT, or clips (p > 0.05). The average PTV margin required to encompass the CT2 cavity was 6.3 mm without shifts, 4.3 mm with 3DUS shifts and 5.2 mm with clip-based shifts. The differences in the margin between no shift and 3DUS or clip-guided shift were found to be significant, while differences between 3DUS and clip-based shifts were not (p > 0.7). With no shift, the mean CT2 volume that lied outside the CT1 was 3.2 cc compared to 2.4 cc (p < 0.03) with 3DUS and 2.8 cc (p < 0.05) with clip-based shift. The volume difference between the shifting methods was not significant (p > 0.9). Without adjusting for the changes in the cavity shape and location, a portion of the volume will be undertreated unless the margins are increased. 3DUS may offer an easily implemented solution to localizing the LC without requiring additional ionizing radiation.