Christine Z. Dickinson

Patterns of abnormal FDG uptake by various histological types of non-small cell lung cancer at initial staging by PET

Abstract. The aim of this study was to identify useful patterns of abnormal fluorine-18 fluorodeoxyglucose (FDG) uptake by different types of non-small cell (NSC) lung cancer and to assess their clinical implications. One hundred and three sequential patients with newly diagnosed, pathology-proven NSC lung cancer were included. FDG positron emission tomography (PET) images were acquired using a dedicated PET scanner. There were 35 squamous cell carcinomas (SQC), 17 large cell cancers (LGC), 38 adenocarcinomas (ADC), 1 bronchioloalveolar carcinoma (BAC) and 12 non-classified NSC cancers. PET images were categorized into detectable patterns of necrotic center in the primary tumor, satellite lesions (T4), hilar lymph nodes (N1), and N2, N3, and M1 lesions by visual interpretation of PET images for SQC, LGC, and ADC (n=90; BAC and non-classified NSC cancers were excluded). The PET lesions were correlated with surgical pathology and with CT findings in inoperable cases. Necrosis was more commonly present in the primary tumors of LGC (53%) and SQC (43%) than in those of ADC (26%) (P<0.0001 and <0.01, respectively). The frequencies of nodal uptake in ADC, SQC and LGC were similar (71%, 60%, and 59%, respectively). However, M1 lesions were present significantly more often in LGC (41%) and ADC (34%) than in SQC (3%) (both P<0.0001). Significantly more surgically inoperable cases were found by PET (T4, N3, M1) in ADC (50%) and LGC (41%) than in SQC (26%) (P<0.001 and <0.02, respectively). Our results suggest a wide variation of PET findings for different types of NSC lung cancer. Identification of these patterns is useful in clinical PET interpretation, in that knowledge of the most probable association between the PET patterns and the histological types will facilitate initial staging and planning of management.

Adductor Insertion Avulsion Syndrome

A 51-year-old woman with a history of chronic thigh muscular exertion was examined for pain on the medial aspect of the thighs. A bone scan showed symmetric focal radiotracer uptake at the medial cortex of both proximal femoral shafts. SPECT localized the focal activity to the cortical surface of the femoral shafts. Findings of magnetic resonance imaging (MRI) were unremarkable and hot spots on the bone scan were localized to the anterior end of both adductor brevis muscle insertions. Plain radiographs of the femurs, which showed bilateral periosteal reactions along the medial proximal femoral shafts, further confirmed the diagnosis of thigh splints at the insertion of the adductor brevis.

Clinical outcome of patients evaluated with emergency centre myocardial perfusion SPET for unexplained chest pain

SummaryThe clinical outcome of 68 patients with unexplained chest pain triaged with emergency centre (EC) SPET myocardial perfusion imaging (MPI) was assessed at 9 month follow-up. Based on clinical presentation and EC-MPI, 63% (43/68) of patients were discharged from the EC; 84% (36/43) of these patients reported no further symptoms at follow-up. There were no adverse clinical events in patients with totally normal EC-MPI.

959-105 Emergency Center Tc99m-sestamibi SPECT Imaging for Unexplained Chest Pain: Cost Savings and Outcome Analysis

Emergent myocardial perfusion imaging (MPI) has been shown to be accurate in diagnosis of acute MI. We assessed the financial and pt outcome implications of such imaging. Method 50 pts presenting to emergency center (EC) with unexplained chest pain received resting Tc99m-sestamibi SPECT MPI as part of their EC evaluation with a gamma camera dedicated to this purpose. If resting scan was nl, adenosine stress imaging was performed in EC at cardiologists (MD) discretion. Influence of MPI was determined by MD questionnaire completd immediately before and after MPI results were made available. Cost savings analysis was based on pre- vs post-MPI management strategy and historical analysis of costs. 45 pts were followed avg 9 months post MPI. Results MPI altered pt management in 34/50 pts (68%). 29 pts were sent home rather than admitted based on EC MPI. 9/21 admitted pts were sent to lower intensity beds. Total cost savings was

Sarcoidosis with musculocutaneous involvement.

88,533 (

Low bone mineral density predicts significant coronary artery disease at cardiac catheterization

1771/pt).35 pts were asymptomatic on follow-up, 8 had recurrent chest pain and 6 had at least 1 EC visit for chest pain. No pt with nl MPI had a major cardiac event or revascularization on follow-up. Conclusion The use of acute EC SPECT MPI is a cost effective means of assigning pts to a low risk group that may be followed safely on an outpatient basis.

Usefulness of Bone Mineral Density to Predict Significant Coronary Artery Disease

The authors report an uncommon case of musculocutaneous sarcoidosis in a 46-year-old man with hilar lymph node uptake and widespread extrapulmonary uptake. The muscular uptake in the forearm was localized predominantly in the extensor muscles. The patient had widespread cutaneous lesions, which surgical biopsy showed to be diagnostic of sarcoidosis.

Cost-effectiveness of myocardial perfusion imaging with SPECT in the emergency department evaluation of patients with unexplained chest pain.

to test the hypothesis that subjects with TAO have a greater degree of tobacco dependence than do control subjects with coronary atherosclerosis (CAD). Methods: Subjects with TAO (n = 218, confirmed by angiography, biopsy, or noninvasive arterial testing) or CAD (n=343, diagnosed by coronary angiography) were mailed a standardized questionnaire regarding tobacco use, to which 103 and 273 responded, raspectively. Degree of tobacco dependence in each group was ascertained by several methods, including the Fagerstrtim Test for Nicotine Dependence Questionnaire. Resuks: The TAO group was younger at Index date (year of first diagnosis for TAO patients, year of PTCA for CAD patients) (TAO 37.6e9.0 vs CAD 43.3+4.9 yrs, P<.OOOl), but the groups did not differ in age at first tobacco exposure (TAO 16.7k3.1 vs CAD 17.3k4.2 yrs, p=.67), current tobacco use at time of survey (TAO 54% vs CAD 46%, p=.17). or Fagerstrbm score (TAO 4.7t2.3 vs CAD 5.1~2.3, p=.24). Kaplan Meier curves showed no significant difference in time lo stopping tobacco use after first diagnosis (p=.798). TAO subjects smoked fewer cigarettes per day than CAD subjects (TAO 22.3*10.7 vs CAD 27.7k15.3 cigarettes/day, p=.OO3). However, among current smokers (n=l53). the groups did not seem lo differ in number of cigarettes/day (19.6+7.9 vs. 22.5+11 .l, p=.20). Individuals in the TAO group appeared to be more likely to have made a serious attempt to quit smoking than those in the CAD group (TAO 97%% vs CAD 90%, p=O.O5). Conclusions: In contrast to case reports of extreme tobacco dependence in the TAO population, the degree of tobacco dependence in subjects with TAO is similar to matched subjects with CAD.