Chandra Shekhar Bal

Role of FDG-PET/CT in detection of recurrent disease in colorectal cancer.

BackgroundOne-third of patients with colorectal cancer (CRC) are likely to have a recurrence within the first 1–2 years. Conventional imaging modalities have limitations in detecting recurrent disease early. The purpose of this study was to assess the usefulness of fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in the detection of recurrence in patients with CRCs. MethodsOne hundred and eighty-three patients, who were earlier treated with surgery and/or chemotherapy/radiotherapy, underwent 269 PET/CT studies for the detection of recurrence. The final diagnosis was made on the basis of histological analysis or clinical and imaging follow-up. ResultsThe sensitivity, specificity, accuracy, positive predictive value, and negative predictive value in detecting recurrent CRC using 18F-FDG-PET/CT were 87, 90, 88, 93, and 80%, respectively. PET/CT was found to have limitations in detecting microscopic disease and small-sized lesions. The common cause of false-positive PET/CT results was infective and inflammatory pathology in our setup. ConclusionPET/CT showed high sensitivity, specificity, and accuracy for the detection of recurrent disease in patients, who were earlier treated for CRC. PET/CT can be considered as a useful diagnostic tool in these patients.

FDG PET/CT evaluation of treatment response in patients with recurrent colorectal cancer.

Aim: To evaluate the treatment response in patients with recurrent colorectal cancer (CRC) using FDG PET/CT. Materials and Methods: A total of 32 recurrent CRC patients (21 males, 11 females; mean age, 52.8 years) were included in this retrospective study. All patients underwent a baseline and follow-up FDG PET/CT scans after chemotherapy. Of 32 patients, 23 patients had follow-up carcinoembryonic antigen (CEA) levels. Results: On qualitative analysis of baseline and follow-up FDG PET/CT studies, there were 20 nonresponders and 12 were responders. On quantitative analysis, there were 19 nonresponders and 13 were responders. In responders, baseline and follow-up mean SUVmax were 11.8 ± 10.1 and 3.7 ± 4.1, respectively (significant decrease, P = 0.001). Among nonresponders, baseline and follow-up mean SUVmax were 8.1 ± 5.2 and 14.1 ± 9.0, respectively (significant increase, P = 0.003). There was no association between response and different factors like age, sex, diagnosis, extent of the lesions, and number of lesions. Conclusion: FDG PET/CT appears to be useful modality in evaluating chemotherapy response and can differentiate responders from nonresponders in recurrent CRC patients.

Bilateral primary renal lymphoma with orbital metastasis in a child

Primary renal lymphoma (PRL) is a rare condition and bilateral PRL even rarer. Most of these bilateral PRL have been reported in adults. We describe a 3‐year‐old male with bilateral primary renal B cell lymphoma with orbital metastases. We discuss the difficulties in diagnosis and management of this rare presentation of lymphoma. Pediatr Blood Cancer 2009;52:539–541.

Effect of enalapril on glomerular filtration rate and proteinuria in children with chronic kidney disease: A randomized controlled trial

ObjectiveTo evaluate the efficacy of enalapril treatment on decline in glomerular filtration rate and reduction in proteinuria in children with chronic kidney disease (CKD).DesignOpen-label, randomized controlled trial.SettingPediatric nephrology clinic at a tertiary-care referral hospital.InterventionChildren with GFR between 15–60 mL/min/1.73 m2 were randomized to receive either enalapril at 0.4 mg/kg /day or no enalapril for 1 year.Outcome measuresChange in GFR using 99mTc-DTPA and urine protein to creatinine ratio. Secondary outcomes included occurrence of composite outcome (30% decline in GFR or end stage renal disease) and systolic and diastolic blood pressure SDS during the study period.Results41 children were randomized into two groups; 20 received enalapril while 21 did not receive enalapril. During 1 year, GFR decline was not different in the two groups (regression coefficient (r) 0.40, 95% CI -4.29 to 5.09, P=0.86). The mean proteinuria reduction was 65% in the enalapril group, significantly higher than control group. The difference was significant even after adjustment for blood pressure was 198.5 (CI 97.5, 299.3; P<0.001). 3 (17.6%) patients in enalapril and 7 (36.8%) in nonenalapril group attained the composite outcome.ConclusionsEnalapril is effective in reducing proteinuria in children with CKD and might be renoprotective in proteinuric CKD.

Pulmonary alveolar microlithiasis: imaging characteristics of planar and SPECT/CT bone scan versus 18F-FDG and 18F-sodium fluoride PET/CT scanning

Pulmonary alveolar microlithiasis (PAM) is a very rare disease in which multiple microscopic calcium phosphate microliths are deposited within the alveoli of both lungs. A lung biopsy is considered to be definitive for final diagnosis; however, non-invasive imaging modalities such as chest X-ray, HRCT scan and 99mTc-MDP bone scan suggest the diagnosis in the vast majority of patients. Although 18F-FDG PET/CT has been tried to characterize the disease, 18F-sodium fluoride PET/CT as a ‘proof-of-principle’ was tried for the first time in a known case of PAM in order to characterize the lung lesions. Interestingly, we noted that 18F-sodium fluoride PET/CT is a superior modality in characterization and assessment of the extent of disease in PAM compared to all other non-invasive imaging modalities. Thus, we recommend that 18F-sodium fluoride PET/CT should be the investigation of choice in PAM.

Effect of basal ganglia calcification on its glucose metabolism and dopaminergic function in idiopathic hypoparathyroidism

The functional significance of basal ganglia calcification (BGC) in idiopathic hypoparathyroidism (IH) is not clear.