Utilidade da PET/CT, (18F-FDG), no estudo do linfoma Hodgkin e linfoma não Hodgkin

Os linfomas são tumores estabelecidos a nível do sistema linfático. Devido à sua heterogeneidade classificam-se como Linfoma Hodgkin (LH) e Linfoma não Hodgkin (LNH), apresentando diferente prognóstico e seguimento quimioterapêutico. Actualmente, a Photon Emission Tomography/Computed Tomography (PET/CT, do acrónimo inglês) é considerada “imagem” de excelência no estudo desta patologia. Neste contexto, é objectivo deste artigo verificar a utilidade da técnica PET/CT e correlacionar o valor de Standard Uptake Value (SUV), obtido pela PET, com o estadio histológico do linfoma e com a resposta ao tratamento quimioterapêutico. Metodologia - Analisaram-se retrospectivamente 356 estudos respeitantes a 231 pacientes, aos quais se realizou uma PET/CT para estadiamento, estudo de massa ou avaliação da resposta ao tratamento. Após a administração de uma actividade média de 18F-FDG de 288,6 MBq, foram adquiridas imagens numa PET/CT GE Discovery ST. Os resultados obtidos foram comparados com os dados clínicos dos pacientes. Resultados - Foram encontradas diferenças significativas entre a idade Vs tipo de linfoma. Não foram encontradas diferenças significativas entre: valor de SUVmáx ganglionar, lesões extra-ganglionares e seu valor de SUV relativamente ao tipo de linfoma. Comprovou-se a influência da PET/CT na alteração do estadio do linfoma e atitude terapêutica. Em última análise, obtiveram-se respectivamente os seguintes valores de sensibilidade, especificidade e exactidão: 98%, 79% e 88%. Conclusões - Os resultados obtidos permitem verificar a importância da imagem PET/CT no estadiamento, monitorização e alteração da atitude terapêutica dos LH e LNH.

Utilidade do PET/CT na caracterização do nódulo solitário pulmonar

Introdução – O cancro de pulmão/traqueia e brônquios é a principal causa de morte por neoplasia na União Europeia. A técnica de duas aquisições de imagem em tempos diferentes no Positron Emission Tomography/Computed Tomography (PET/CT) tem sido referenciada em alguns artigos como uma mais-valia no diagnóstico do cancro do pulmão. O objectivo deste estudo consiste em avaliar a eficiência diagnóstica do PET/CT com a aquisição das duas imagens em tempos diferentes na caracterização do nódulo solitário pulmonar (NSP), tendo em conta a histologia e o tamanho do nódulo. Metodologia – Foram analisados 115 NSP, num total de 110 pacientes, dos quais 65 nódulos eram malignos. Adquiriram-se duas imagens, a primeira a um tempo médio de 52 minutos e a segunda a um tempo médio de 125 minutos após administração do 18F-2-fluoro-2-deoxi-D-glucose (18F-FDG). Para a análise das imagens obteve-se o standard uptake value máximo (SUVmax) e a percentagem de variação dos SUVmax (%variação). Resultados – A %variação apresenta valores de eficiência diagnóstica superiores à análise dos SUVmax em separado. Existem também diferenças significativas na histologia e no SUVmax, registando-se um aumento do SUVmax2 comparativamente ao SUVmax1 nas patologias malignas. Conclusão – A técnica da aquisição de duas imagens em tempos diferentes mostrou ser mais eficaz na caracterização do NSP do que a análise de apenas uma imagem.

Evaluation of the respiratory motion effect in small animal PET images with GATE Monte Carlo simulations

The rapid growth in genetics and molecular biology combined with the development of techniques for genetically engineering small animals has led to increased interest in in vivo small animal imaging. Small animal imaging has been applied frequently to the imaging of small animals (mice and rats), which are ubiquitous in modeling human diseases and testing treatments. The use of PET in small animals allows the use of subjects as their own control, reducing the interanimal variability. This allows performing longitudinal studies on the same animal and improves the accuracy of biological models. However, small animal PET still suffers from several limitations. The amounts of radiotracers needed, limited scanner sensitivity, image resolution and image quantification issues, all could clearly benefit from additional research. Because nuclear medicine imaging deals with radioactive decay, the emission of radiation energy through photons and particles alongside with the detection of these quanta and particles in different materials make Monte Carlo method an important simulation tool in both nuclear medicine research and clinical practice. In order to optimize the quantitative use of PET in clinical practice, data- and image-processing methods are also a field of intense interest and development. The evaluation of such methods often relies on the use of simulated data and images since these offer control of the ground truth. Monte Carlo simulations are widely used for PET simulation since they take into account all the random processes involved in PET imaging, from the emission of the positron to the detection of the photons by the detectors. Simulation techniques have become an importance and indispensable complement to a wide range of problems that could not be addressed by experimental or analytical approaches.

Otimização do co-registo metabolismo-morfologia em estudos de PET/CT com 18F-DG de nódulos pulmonares: comparação de dois protocolos - 4D vs CT lento

Mestrado em Medicina Nuclear - Área de especialização: Tomografia por Emissão de Positrões.

Criticality of colloids with distinct interaction patches: The limits of linear chains, hyperbranched polymers, and dimers

We use a simple model of associating fluids which consists of spherical particles having a hard-core repulsion, complemented by three short-ranged attractive sites on the surface (sticky spots). Two of the spots are of type A and one is of type B; the bonding interactions between each pair of spots have strengths epsilon(AA), epsilon(BB), and epsilon(AB). The theory is applied over the whole range of bonding strengths and the results are interpreted in terms of the equilibrium cluster structures of the phases. In addition to our numerical results, we derive asymptotic expansions for the free energy in the limits for which there is no liquid-vapor critical point: linear chains (epsilon(AA)not equal 0, epsilon(AB)=epsilon(BB)=0), hyperbranched polymers (epsilon(AB)not equal 0, epsilon(AA)=epsilon(BB)=0), and dimers (epsilon(BB)not equal 0, epsilon(AA)=epsilon(AB)=0). These expansions also allow us to calculate the structure of the critical fluid by perturbing around the above limits, yielding three different types of condensation: of linear chains (AA clusters connected by a few AB or BB bonds); of hyperbranched polymers (AB clusters connected by AA bonds); or of dimers (BB clusters connected by AA bonds). Interestingly, there is no critical point when epsilon(AA) vanishes despite the fact that AA bonds alone cannot drive condensation.

Relatório de estágio de natureza profissional em PET/CT: Clinical Imaging Sciences Centre, Sussex

Mestrado em Medicina Nuclear - Ramo de especialização: Tomografia por Emissão de Positrões

Avaliação da viabilidade miocárdica pós-enfarte: Gated-SPECT versus Gated-PET

Mestrado em Medicina Nuclear - Ramo de especialização: Tomografia por Emissão de Positrões

PET/TC no planeamento em radioterapia

A delimitação precisa é crucial na RT. TC: informação anatómica, pobre na definição do envolvimento ganglionar; alguns tumores são praticamente invisíveis (p.e., esófago, fígado, baço e glândulas salivares), mapa de densidades electrónicas essencial para o cálculo. 18F-FDG PET: 1) mapeamento metabólico que permite alterar volumes alvo: BTV, elimina incertezas no GTV; 2) vantagens: estadiamento tumoral, predição da resposta tumoral, avaliação da resposta tumoral, detecção precoce da doença recorrente. PET/TC: maior precisão, menor variabilidade inter e intra-observador, menor erro no reposicionamento, adaptação à RT, ainda em Investigação Clínica.

PET/CT com 18-fluor-fluorodeoxiglucose no seguimento do melanoma maligno cutâneo

Introdução – O melanoma maligno cutâneo (MMC) é considerado uma das mais letais neoplasias e no seu seguimento recorre-se, para além dos exames clínicos e da análise de marcadores tumorais, a diversos métodos imagiológicos, como é o exame Tomografia por Emissão de Positrões/Tomografia Computorizada (PET/CT, do acrónimo inglês Positron Emission Tomography/Computed Tomography) com 18fluor-fluorodeoxiglucose (18F-FDG). O presente estudo tem como objetivo avaliar a utilidade da PET/CT relativamente à análise da extensão e à suspeita de recidiva do MMC, comparando os achados imagiológicos com os descritos em estudos CT. Metodologia – Estudo retrospetivo de 62 estudos PET/CT realizados em 50 pacientes diagnosticados com MMC. Excluiu-se um estudo cujo resultado era duvidoso (nódulo pulmonar). As informações relativas aos resultados dos estudos anatomopatológicos e dos exames imagiológicos foram obtidas através da história clínica e dos relatórios médicos dos estudos CT e PET/CT. Foi criada uma base de dados com os dados recolhidos através do software Excel e foi efetuada uma análise estatística descritiva. Resultados – Dos estudos PET/CT analisados, 31 foram considerados verdadeiros positivos (VP), 28 verdadeiros negativos (VN), um falso positivo (FP) e um falso negativo (FN). A sensibilidade, especificidade, o valor preditivo positivo (VPP), o valor preditivo negativo (VPN) e a exatidão da PET/CT para o estadiamento e avaliação de suspeita de recidiva no MMC são, respetivamente, 96,9%, 96,6%, 96,9%, 96,6% e 96,7%. Dos resultados da CT considerados na análise estatística, 14 corresponderam a VP, 12 a VN, três a FP e cinco a FN. A sensibilidade, especificidade, o VPP e o VPN e a exatidão da CT para o estadiamento e avaliação de suspeita de recidiva no MMC são, respetivamente, 73,7%, 80,0%, 82,4%, 70,6% e 76,5%. Comparativamente aos resultados CT, a PET/CT permitiu uma mudança na atitude terapêutica em 23% dos estudos. Conclusão – A PET/CT é um exame útil na avaliação do MMC, caracterizando-se por uma maior acuidade diagnóstica no estadiamento e na avaliação de suspeita de recidiva do MMC comparativamente à CT isoladamente.

Cooperative effects in the detection of a nitroaliphatic liquid explosive and na explosive taggant in the vapor phase by calix[4]arene-based carbazole-containing conjugated polymers

Two fluorescent molecular receptor based conjugated polymers were used in the detection of a nitroaliphatic liquid explosive (nitromethane) and an explosive taggant (2,3-dimethyl-2,3-dinitrobutane) in the vapor phase. Results have shown that thin films of both polymers display remarkably high sensitivity and selectivity toward these analytes. Very fast, reproducible, and reversible responses were found. The unique behavior of these supramolecular host systems is ascribed to cooperativity effects developed between the calix[4] arene hosts and the phenylene ethynylene-carbazolylene main chains. The calix[4]-arene hosts create a plethora of host-guest binding sites along the polymer backbone, either in their bowl-shaped cavities or between the outer walls of the cavity, to direct guests to the area of the transduction centers (main chain) at which favorable photoinduced electron transfer to the guest molecules occurs and leads to the observed fluorescence quenching. The high tridimensional porous nature of the polymers imparted by the bis-calixarene moieties concomitantly allows fast diffusion of guest molecules into the polymer thin films.

Calix[4]arene-carbazole-containing polymers: synthesis and properties

New highly fluorescent calix[4]arene-containing phenylene-alt-ethynylene-3,6- and 2,7-carbazolylene polymers (CALIX-PPE-CBZs) have been synthesized for the first time and their photophysical properties evaluated. Both polymers were obtained in good isolated yields (70-84%), having M-w ranging from 7660-26,700 g mol(-1). It was found that the diethynyl substitution (3,6- or 2,7-) pattern on the carbazole monomers markedly influences the degree of polymerization. The amorphous yellow polymers are freely soluble in several nonprotic organic solvents and have excellent film forming abilities. TG/DSC analysis evidences similar thermal behaviors for both polymers despite their quite different molecular weight distributions and main-chain connectivities (T-g, in the range 83-95 degrees C and decomposition onsets around 270 degrees C). The different conjugation lengths attained by the two polymers dictates much of their photophysical properties. Thus, whereas the fully conjugated CALIX-PPE-2,7-CBZ has its emission maximum at 430 nm (E-g = 2.84 eV; Phi(F) = 0.62, CHCl3), the 3,6-linked counterpart (CALIX-PPE-3,6-CBZ) fluoresces at 403 nm with a significant lower quantum yield (E-g = 3.06 eV; Phi(F) = 0.31, CHCl3). The optical properties of both polymers are predominantly governed by the intrachain electronic properties of the conjugated backbones owing to the presence of calix[4]arenes along the polymer chain which disfavor significant interchain interactions, either in fluid- or solid-state.

Substituted P-Phenylene Ethynylene trimers as fluorescent sensors for nitroaromatic explosives

New sensory materials based on p-phenylene ethynylene trimers integrating calix[4]arene receptors (CALIX-PET) and tert-butylphenol (TBP-PET) moieties have been synthesized and their sensitivity and selectivity for the detection of nitroaromatic compounds (NACs) such as nitrobenzene (NB), 2,4-dinitrotoluene (2,4-DNT), 2,4,6-trinitrotoluene (TNT) and picric acid (PA) investigated in fluid phase and solid-state. It was found that both fluorophores displayed high sensitivities toward NACs detection in solution as evaluated by the Stern-Volmer formalism. For all the tested explosives, the ratio of fluorescence intensities (F-0/F) is a linear function of the quencher concentration only after appropriate correction of fluorescence quenching data for inner-filter effects. The quenching efficiencies for CALIX-PET and TBP-PET follow the order PA >> TNT > DNT > NB, which correlate well with the quenchers electron affinities as evaluated from their LUMOs energies thereby suggesting a photoinduced electron transfer as the dominant mechanism of fluorescence quenching. The selectivity of these sensors was checked against exemplar interferents possessing differentiated electronic properties (benzoic acid, 2,4-dichlorophenol and benzoquinone) and reduced quenching activity was detected. The quenching efficiencies and response times of the two fluorophores in the solid-state toward NB, 2,4-DNT and TNT vapors were evaluated through steady-state fluorescence quenching experiments with the materials dispersed in polymeric matrices or as neat films. The most significant fluorescence quenching responses were achieved for drop-casted films of TBP-PET upon exposure to nitroaromatics.

Radiopharmaceuticals for myocardial perfusion imaging: SPECT & PET

Myocardial perfusion imaging (MPI) is used on a daily basis to access coronary blood flow in patients that are suspected or have known Coronary Artery Disease (CAD). A Single Photon Emission Computed Tomography (SPECT) or and Positron Emission Tomography (PET) scan are used to access regional blood flow quantification either at rest or stress, the imaging acquisition is connected to an Electrocardiogram (ECG) and it is able to determine and quantify other myocardial parameters like myocardial wall thickness and wall motion. PET is not used so broadly due to its high procedure cost, the proximity with cyclotron, where are produced the majority of radiopharmaceuticals used in PET, due to their shor thalf-life. This work is intended to carry out a review of the tests relating to radiopharmaceuticals that are used in clinical practice in SPECT or PET for assessment of myocardial perfusion, also focusing very promising radiopharmaceuticals that are under investigation or in clinical trials with great potential for conventional nuclear medicine or PET, proceeding to a comparative analysis of both techniques and respective radiopharmaceuticals used.

PET/CT e PET/RM

Individualmente nenhuma modalidade imagiológica oferece em simultâneo uma elevada resolução espacial e temporal, aliado a uma boa resolução de contraste e sensibilidade. No entanto, combinações de diferentes modalidades podem aproximar-se deste ideal, permitindo a integração de diferentes sistemas num sistema de imagem única. Um dos marcos históricos da medicina nuclear ocorreu com o aparecimento dos sistemas de Tomografia por Emissão de Positrões/Tomografia Computorizada (PET/CT) que permitem obter, em simultâneo, informações funcionais e anatómicas sobre as alterações metabólicas e estruturais que ocorrem em situações de doença.

Performing PET/CT studies: do they create anxiety?

Introduction: Anxiety is a common problem in primary care and specialty medical settings. Treating an anxious patient takes more time and adds stress to staff. Unrecognised anxiety may lead to exam repetition, image artifacts and hinder the scan performance. Reducing patient anxiety at the onset is probably the most useful means of minimizing artifactual FDG uptake, both fat brown and skeletal muscle uptake, as well patient movement and claustrophobia. The aim of the study was to examine the effects of information giving on the anxiety levels of patients who are to undergo a PET/CT and whether the patient experience is enhanced with the creation of a guideline. Methodology: Two hundred and thirty two patients were given two questionnaires before and after the procedure to determine their prior knowledge, concerns, expectations and experiences about the study. Verbal information was given by one of the technologists after the completion of the first questionnaire. Results: Our results show that the main causes of anxiety in patients who are having a PET/CT is the fear of the procedure itself, and fear of the results. The patients who suffered from greater anxiety were those who were scanned during the initial stage of a disease. No significant differences were found between the anxiety levels pre procedural and post procedural. Findings with regard to satisfaction show us that the amount of information given before the procedure does not change the anxiety levels and therefore, does not influence patient satisfaction. Conclusions: The performance of a PET/CT scan is an important and statistically generator of anxiety. PET/CT patients are often poorly informed and present with a range of anxieties that may ultimately affect examination quality. The creation of a guideline may reduce the stress of not knowing what will happen, the anxiety created and may increase their satisfaction in the experience of having a PET/CT scan.