1,721,190 research outputs found
Managing diagnosis and treatment paths. The case for adrenal tumour imaging
No full textThe recent and wide innovation in diagnostic imaging has provided the availability of multiple and different techniques to evaluate patients with hypersecreting or non-hypersecreting adrenal tumours, such as anatomic modalities, mainly represented by computed tomography (CT) and magnetic resonance (MR), or functional studies consisting of radionuclide molecular scans. Furthermore, advanced hybrid imaging, currently represented by combined positron emission tomography (PET) and CT (PET-CT), is attractive and reflects the diagnostic significance of morpho-functional integrated imaging which simultaneously offers information regarding the anatomic characteristics and metabolic features of adrenal tumours. Since the fundamental clinical issue in such patients is tumour characterization for correct treatment planning, it is crucial to establish the correct selection of imaging techniques as well as imaging protocols according to patient clinical scenario, patient safety and cost-effectiveness performance of selected diagnostic approach; therefore, the appropriate management of such imaging modalities is clinically recommended
Nuove frontiere della medicina nucleare: applicazioni terapeutiche in pazienti con feocromocitoma maligno.
No full textRadiopharmaceuticals to in vivo characterize adrenal incidentalomas: the integrated role of radionuclide and radiological techniques.
No full textTo illustrate the role of radiopharmaceuticals in characterizing non-hypersecreting adrenal masses, 56 patients with non-hypersecreting unilateral adrenal tumors detected on CT and/or MR underwent adrenal scintigraphy. Radionuclide studies (n=83) included nor-cholesterol (n=24), metaiodobenzylguanidine (MIBG) (n=23), deoxyglucose (FDG) (n=26) and somatostatin analogs (SAs) (n=10) scans. Histology (n=32) or biopsy (n=24) were obtained. Lesions were 19 adenomas, 4 cysts, 1 myelolipoma, 1 neurinoma, 2 ganglioneuromas, 5 pheochromocytomas, 4 pseudotumors, 6 carcinomas, 2 sarcomas, 1 fibro-histiocytoma and 11 metastases. For nor-cholesterol, sensitivity, specificity and accuracy were 100%, 71% and 92%, respectively; positive predictive value (PPV) was 89%, while negative predictive value (NPV) was 100%. For MIBG, sensitivity, specificity and accuracy were 100%, 94% and 96%, respectively; PPV was 83%, while NPV was 100%. For FDG, sensitivity, specificity and accuracy were 100%, 100% and 100%, respectively; PPV and NPV were 100%; furthermore, in 7 patients with malignant adrenal tumors, FDG imaging scan was able to reveal extra-adrenal tumor sites (n=29). For SAs, sensitivity, specificity and accuracy were 80%, 100% and 90%, respectively; PPV was 100%, while NPV was 83%. In non-hypersecreting adrenal masses, nuclear imaging using specific labeled radiopharmaceuticals such as nor-cholesterol, MIBG, FDG ans SAs may provide functional information for tissue characterization. Nor-cholesterol and MIBG scans are able to identify benign tumors such as adenoma and pheochromocytoma respectively, while FDG and Sas imaging allow the recognition of malignant adrenal lesions. Thus, adrenal scintigraphy is recommended for tumor diagnosis in non-hypersecreting adrenal masses and, hence, for appropriate treatment planning of such patients, particularly when CT and/or MR findings are uncertain as well as inconclusive for lesion characterization
Radiopharmaceuticals to in vivo characterize adrenal incidentalomas: the integrated role of radionuclide and radiological techniques.
No full textTo illustrate the role of radiopharmaceuticals in characterizing non-hypersecreting adrenal masses, 56 patients with non-hypersecreting unilateral adrenal tumors detected on CT and/or MR underwent adrenal scintigraphy. Radionuclide studies (n=83) included nor-cholesterol (n=24), metaiodobenzylguanidine (MIBG) (n=23), deoxyglucose (FDG) (n=26) and somatostatin analogs (SAs) (n=10) scans. Histology (n=32) or biopsy (n=24) were obtained. Lesions were 19 adenomas, 4 cysts, 1 myelolipoma, 1 neurinoma, 2 ganglioneuromas, 5 pheochromocytomas, 4 pseudotumors, 6 carcinomas, 2 sarcomas, 1 fibro-histiocytoma and 11 metastases. For nor-cholesterol, sensitivity, specificity and accuracy were 100%, 71% and 92%, respectively; positive predictive value (PPV) was 89%, while negative predictive value (NPV) was 100%. For MIBG, sensitivity, specificity and accuracy were 100%, 94% and 96%, respectively; PPV was 83%, while NPV was 100%. For FDG, sensitivity, specificity and accuracy were 100%, 100% and 100%, respectively; PPV and NPV were 100%; furthermore, in 7 patients with malignant adrenal tumors, FDG imaging scan was able to reveal extra-adrenal tumor sites (n=29). For SAs, sensitivity, specificity and accuracy were 80%, 100% and 90%, respectively; PPV was 100%, while NPV was 83%. In non-hypersecreting adrenal masses, nuclear imaging using specific labeled radiopharmaceuticals such as nor-cholesterol, MIBG, FDG ans SAs may provide functional information for tissue characterization. Nor-cholesterol and MIBG scans are able to identify benign tumors such as adenoma and pheochromocytoma respectively, while FDG and Sas imaging allow the recognition of malignant adrenal lesions. Thus, adrenal scintigraphy is recommended for tumor diagnosis in non-hypersecreting adrenal masses and, hence, for appropriate treatment planning of such patients, particularly when CT and/or MR findings are uncertain as well as inconclusive for lesion characterization
Radiopharmaceuticals to in vivo characterize adrenal incidentalomas: the integrated role of radionuclide and radiological techniques.
No full textTo illustrate the role of radiopharmaceuticals in characterizing non-hypersecreting adrenal masses, 56 patients with non-hypersecreting unilateral adrenal tumors detected on CT and/or MR underwent adrenal scintigraphy. Radionuclide studies (n=83) included nor-cholesterol (n=24), metaiodobenzylguanidine (MIBG) (n=23), deoxyglucose (FDG) (n=26) and somatostatin analogs (SAs) (n=10) scans. Histology (n=32) or biopsy (n=24) were obtained. Lesions were 19 adenomas, 4 cysts, 1 myelolipoma, 1 neurinoma, 2 ganglioneuromas, 5 pheochromocytomas, 4 pseudotumors, 6 carcinomas, 2 sarcomas, 1 fibro-histiocytoma and 11 metastases. For nor-cholesterol, sensitivity, specificity and accuracy were 100%, 71% and 92%, respectively; positive predictive value (PPV) was 89%, while negative predictive value (NPV) was 100%. For MIBG, sensitivity, specificity and accuracy were 100%, 94% and 96%, respectively; PPV was 83%, while NPV was 100%. For FDG, sensitivity, specificity and accuracy were 100%, 100% and 100%, respectively; PPV and NPV were 100%; furthermore, in 7 patients with malignant adrenal tumors, FDG imaging scan was able to reveal extra-adrenal tumor sites (n=29). For SAs, sensitivity, specificity and accuracy were 80%, 100% and 90%, respectively; PPV was 100%, while NPV was 83%. In non-hypersecreting adrenal masses, nuclear imaging using specific labeled radiopharmaceuticals such as nor-cholesterol, MIBG, FDG ans SAs may provide functional information for tissue characterization. Nor-cholesterol and MIBG scans are able to identify benign tumors such as adenoma and pheochromocytoma respectively, while FDG and Sas imaging allow the recognition of malignant adrenal lesions. Thus, adrenal scintigraphy is recommended for tumor diagnosis in non-hypersecreting adrenal masses and, hence, for appropriate treatment planning of such patients, particularly when CT and/or MR findings are uncertain as well as inconclusive for lesion characterization
I-131 nor-cholesterol nuclear imaging in patients with hypersecreting or non-hypersecreting adrenal adenomas.
No full textBackground. The aim of this study was to evaluate the diagnostic accuracy of nor-cholesterol radionuclide imaging in patients with adrenal tumors detected by CT or MR imaging studies. Methods. We studied 41 patients (18 M and 23 F, mean age 47±15 years) with hypersecreting (n=19) or non-hypersecreting (n=22) unilateral adrenal tumors. All patients underwent iodine-131 nor-cholesterol adrenal scintigraphy. Pathology examinations (n=26) or CT follow-up studies (n=15) were obtained. Adrenal lesions were represented by 34 adenomas, 2 cysts, 1 myelolipoma, 1 pheochromocytoma, 1 carcinoma and 2 metastases. Radionuclide studies were qualitatively evaluated and the corresponding results were classified as true-positive (TP), true-negative, false-positive (FP) and false-negative. Diagnostic sensitivity, specificity and accuracy as well as positive (PPV) and negative (NPV) predictive values were calculated. In addition, nor-cholesterol uptake was semi-quantitatively compared between hypersecreting and non-hypersecreting adenomas using a four-point scoring. Results. The diagnostic values of nor-cholesterol scintigraphy to identify adrenal adenomas were: sensitivity 100%, specificity 71%, accuracy 95%, PPV 94% and NPV 100%; of note, 2 FP cases were observed represented by a pheochromocytoma and a myelolipoma, while no FN findings occurred. A significantly (p=0.01) higher nor-cholesterol uptake was observed in hypersecreting (n=19) adenomas compared to non-hypersecreting (n=15) lesions; however, no significant difference in tumor size was found in this comparative analysis. Conclusion. In the large majority of cases, adrenal scintigraphy using nor-cholesterol was able to characterize specific lesions as cortical adenomas. These findings show relevant clinical impact particularly in patients with non-hypersecreting adenomas; in this setting, laboratory data are not helpful for lesions characterization, while radionuclide abnormalities allow tumor-type identification. However, rare as well as unusual findings of adrenal scintigraphy may be observed since nor-cholesterol uptake was also found in two non-adenoma tumors (a myelolipoma and a pheochromocytoma). Finally, the lower nor-cholesterol uptake of non-hypersecreting adenomas might suggest a normal hormone synthesis of these lesions and, thus, regular secretion
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