Maurizio Zompatori

The value of 18F-FDG PET/CT after autologous stem cell transplantation (ASCT) in patients affected by multiple myeloma (MM): Experience with 77 patients

Aim The objective of this study was to analyze the prognostic value of 18F-FDG PET/CT after therapy in patients with multiple myeloma (MM). Patients and Methods One hundred seven patients prospectively recruited with MM had FDG PET/CT at staging 3 months after therapy (autologous stem cell transplantation) and every 6 to 12 months during the follow-up (mean 41 months). Patients were divided into group 1 (relapsed) and group 2 (nonrelapsed). In group 1, PET results and SUVmax were compared to the time to relapse (TTR). In group 2, the presence of PET finding changes during follow-up was analyzed to identify typical patterns of disease behavior (ie, late responders or stabilized disease). Patients with a negative PET at staging were excluded from further evaluation. Results Forty-seven out of 107 (44%) patients relapsed: 10 were excluded because of a negative PET at staging. In group 1, 22 patients had a negative posttherapy PET (59%, mean TTR = 27.6 months) and 15 had a positive posttherapy PET (41%, mean TTR = 18 months). There was a significant difference between the TTR of the two subgroups (t test P = 0.05). In patients with a positive posttherapy PET, the SUVmax was inversely correlated to the TTR (correlation coefficient = −0.7; P < 0.01). Sixty out of 107 (56%) patients did not relapse. Twenty patients were excluded because of a negative PET at staging. In group 2, 27 patients had a negative posttherapy PET (68%) and 13 had a positive posttherapy PET (32%). None of nonrelapsed patients showed a progressive increase in SUVmax during the follow-up. There was no significant difference between relapsed and nonrelapsed patients in terms of SUVmax at posttherapy PET/CT (t test P = 0.7). Conclusion In our series of MM patients, a negative posttherapy PET was predictive for nonrelapse or a long disease-free survival. In contrast, a persistent significantly increased SUVmax after therapy was correlated to a short TTR.

18F-FDG PET/CT for the Assessment of Disease Extension and Activity in Patients With Sarcoidosis: Results of a Preliminary Prospective Study

Purpose This study aimed to prospectively investigate 18F-FDG PET/CT role for the assessment of sarcoidosis activity and extension in comparison with thoracic high-resolution CT (HRCT) and to evaluate the potential clinical impact of PET/CT findings. Secondary aim was to investigate the changes in cardiac FDG uptake related to the specific preparation before PET/CT. Methods We prospectively enrolled biopsy proven sarcoidosis patients consecutively referred for 18F-FDG PET/CT since January 2010. PET/CT was performed after a fat meal followed by 12-hour fasting and compared with thoracic HRCT results obtained in supine position and clinical follow-up. The impact on the clinical management was recorded. Patterns of cardiac FDG uptake of the study group were compared with a historical population in which PET/CT was performed following standard preparation. Results A total of 28 patients were enrolled, and 35 PET/CT scans were reviewed. On a scan basis, PET/CT was concordant with HRCT in 16 (45.7%), detecting active disease in 10/16 and no signs of activity in 4/16. PET/CT data had a direct impact on management in 4/16. In 19 (54.3%) discordant scans, PET/CT finding was positive in 14 and negative in 5. PET/CT findings influenced the clinical management in 18/19 cases. Considering all scans, PET/CT information influenced the clinical management of 22 (63%) of 35. Our data suggest that cardiac FDG uptake may vary regardless of the preparation before PET/CT. Conclusions 18F-FDG PET/CT was useful to assess sarcoidosis activity and extension and provided valuable information for the clinical management in a single-step examination. Additional data are needed to better ascertain the optimal patient preparation before image acquisition to improve sensitivity of heart lesions.

Airway malacia in chronic obstructive pulmonary disease: prevalence, morphology and relationship with emphysema, bronchiectasis and bronchial wall thickening

The aim of this study was to determine the prevalence of airway malacia and its relationship with ancillary morphologic features in patients with chronic obstructive pulmonary disease (COPD). A retrospective review was performed of a consecutive series of patients with COPD who were imaged with inspiratory and dynamic expiratory multidetector computed tomography (MDCT). Airway malacia was defined as ≥50% expiratory reduction of the airway lumen. Both distribution and morphology of airway malacia were assessed. The extent of emphysema, extent of bronchiectasis and severity of bronchial wall thickness were quantified. The final study cohort was comprised of 71 patients. Airway malacia was seen in 38 of 71 patients (53%), and such proportion was roughly maintained in each stage of COPD severity. Almost all tracheomalacia cases (23/25, 92%) were characterised by an expiratory anterior bowing of the posterior membranous wall. Both emphysema and bronchiectasis extent did not differ between patients with and without airway malacia (p > 0.05). Bronchial wall thickness severity was significantly higher in patients with airway malacia and correlated with the degree of maximal bronchial collapse (p < 0.05). In conclusion, we demonstrated a strong association between airway malacia and COPD, disclosing a significant relationship with bronchial wall thickening.

68Ga-DOTANOC PET/CT Allows Somatostatin Receptor Imaging in Idiopathic Pulmonary Fibrosis: Preliminary Results

Interstitial lung diseases include different clinical entities with variable prognoses. Idiopathic pulmonary fibrosis (IPF), the most common, presents the most severe outcome (death within 3–5 y), whereas nonspecific interstitial pneumonia (NSIP) shows a more indolent progression. Preclinical evidence of somatostatin receptor (SSTR) expression on fibroblasts in vitro and in lung fibrosis murine models, coupled with the longer survival of mice with fibrotic lungs treated with agents blocking SSTR, supports the hypothesis of imaging fibroblast activity in vivo by visualization of SSTR with 68Ga-DOTANOC PET/CT. The aim of this study was to evaluate 68Ga-DOTANOC PET/CT in patients with IPF and NSIP. Methods: Seven IPF patients and 7 NSIP patients were included in the study. 68Ga-DOTANOC PET/CT and high-resolution CT (HRCT) were performed in all cases by following a standard procedure. PET/CT results were compared with disease sites and extent on HRCT. Results: In IPF, 68Ga-DOTANOC uptake was peripheral, subpleural, and directly correlated with pathologic areas on HRCT (subpleural/reticular fibrosis, honeycombing). NSIP patients showed fainter tracer uptake, whereas corresponding HRCT showed areas of ground-glass opacity and rare fibrotic changes. Only IPF patients showed a linear correlation between maximal SUV and disease extent quantified both automatically (Q) (IPF: P = 0.002, R = 0.93) and using the visual score (Spearman ρ = 0.46, P = 0.0001). Q directly correlated with percentage carbon monoxide diffusing capacity in IPF (P = 0.03, R = 0.79) and NSIP (P = 0.05, R = 0.94), whereas maximal SUV did not present any correlation with percentage carbon monoxide diffusing capacity. Conclusion: Our preliminary data show that 68Ga-DOTANOC PET/CT demonstrates SSTR overexpression in IPF patients; this may prove interesting for the evaluation of novel treatments with somatostatin analogs.

Post-ARDS pulmonary fibrosis in patients with H1N1 pneumonia: role of follow-up CT.

PurposeOur aim was to evaluate the evolution of 20 patients with H1N1 pneumonia, focusing our attention on patients with severe clinical and radiological findings who developed post-acute respiratory distress syndrome (post-ARDS) pulmonary fibrosis.Materials and methodsTwenty adult patients (nine women and 11 men; mean age 43.5±16.4 years) with a diagnosis of H1N1 infection confirmed by pharyngeal swab came to our attention from September to November 2009 and were followed up until September 2010. All patients were hospitalised in consideration of the severity of clinical findings, and all underwent chest X-ray. Twelve of them underwent at least one computed tomography (CT) scan of the chest.ResultsIn 75% of cases (15/20), there was complete resolution of the clinical and radiological findings. Twenty-five percent of patients (5/20) developed acute respiratory distress syndrome (ARDS), which progressed to predominantly peripheral pulmonary fibrosis in 10% (2/20; one died and one had late-onset pulmonary fibrosis, documented on day 68). Moreover, in one patient with a CT diagnosis of pulmonary fibrosis, we observed progressive regression of radiological findings over 4 months of follow-up.ConclusionsIn patients with H1N1 pneumonia, post-ARDS pulmonary fibrosis is not a rare complication. Therefore, a CT scan should be performed in all patients with severe clinical findings. Our study demonstrated that in these patients, fibrosis could present a different spatial distribution and a different temporal trend, with delayed late onset; moreover, in one case, the signs of interstitial lung disease partially regressed over time. Therefore, CT should be considered not only in the diagnostic stage, but also during the follow-up.RiassuntoObiettivoScopo del presente lavoro è quello di effettuare una valutazione evolutiva in 20 pazienti con polmonite da H1N1, focalizzando l’attenzione sui casi con severo decorso clinico-radiologico e sulle sequele polmonari post-acute respiratory distress syndrome (ARDS).Materiali e metodiVenti pazienti adulti, di cui 9 donne e 11 uomini, con età media di 43,5±16,4 anni e con diagnosi di influenza suina H1N1 confermata mediante tampone faringeo sono giunti alla nostra osservazione tra settembre e novembre 2009 e sono stati valutati evolutivamente fino a settembre 2010. Tutti i pazienti, in considerazione della severità del quadro clinico, sono stati sottoposti a regime di ricovero ed hanno eseguito almeno una radiografia del torace; 12 di essi hanno eseguito inoltre almeno una tomografia computerizzata (TC) del torace.RisultatiNel 75% dei casi (15/20) la sintomatologia e le alterazioni a carico del parenchima polmonare sono regredite dopo terapia in assenza di significativi esiti parenchimali. Nel restante 25% (5/20), il ricovero è stato gravato da complicanze respiratorie fino ad un quadro conclamato di ARDS, con evoluzione in interstiziopatia prevalentemente periferica in 2 pazienti, di cui uno poi deceduto ed uno con sviluppo tardivo di fibrosi polmonare documentata in 68a giornata. Si segnala infine un caso in cui si è verificata comparsa di segni compatibili con interstiziopatia polmonare che sono andati incontro a graduale regressione nei controlli a quattro mesi.ConclusioniPoiché l’evoluzione in interstiziopatia polmonare dell’ARDS da H1N1 rappresenta una complicanza di non rara osservazione, il monitoraggio evolutivo dei pazienti con presentazioni cliniche particolarmente severe non può esimersi dall’impiego dell’indagine TC. Il nostro studio ha documentato che la interstiziopatia conseguente alla polmonite virale con ARDS può presentare non solo una distribuzione spaziale peculiare, ma anche un inconsueto andamento temporale, con insorgenza tardiva; inoltre, in un singolo caso si è documentata una parziale e graduale riduzione nel tempo dei segni di interstiziopatia. Questa osservazione può giustificare ulteriormente, l’impiego della TC non solo in acuto ma soprattutto nel monitoraggio tardivo di questi pazienti.

Extensive right pulmonary artery dissection in a young patient with chronic pulmonary hypertension

A 28-year-old man with chronic pulmonary artery hypertension (PAH) underwent a cardiac CT scan for pulmonary artery (PA) and coronary artery (CA) evaluation due to sporadic dyspnoea and atypical chest discomfort. No acute clinical symptoms were present. Multidetector CT (MDCT) scan showed enlargement of the PA with slight displacement of the left main/proximal tract of the anterior descending CA without any coronary compression. However, the most important and unexpected finding was the presence of an extensive intimal flap inside …

Congenital cystic adenomatoid malformation of the lung associated with bronchial atresia involving a different lobe in an adult patient: a case report

IntroductionCongenital cystic adenomatoid malformation of the lung is an uncommon cause of respiratory distress in neonates and babies. The disorder is usually diagnosed in the neonatal period and the first two years of life. This anomaly has been described in association with bronchopulmonary sequestration, extralobar intra-abdominal sequestration or bronchial atresia in live and stillborn babies. It is rarely encountered in adults, in whom the diagnosis is made incidentally from mass lesion features seen on chest radiographs. The oldest patients recorded with this malformation have been about 35 years old, and only 10% of primary diagnoses are made after the first year of life. Delayed diagnosis can be related to infection or serendipitous discovery.Case presentationWe describe the radiological findings of a 34-year-old Caucasian woman with a clinical history of recurrent pneumonia, intermittent anterior pleuritic chest pain and haemoptysis. Congenital cystic adenomatoid malformation of the lung associated with bronchial atresia involving a different lobe was discovered.ConclusionAlthough rare in adults, congenital cystic adenomatoid malformation should be suspected in adult patients who suffer from recurrent or persistent non-productive coughs. The discovery of an association of congenital cystic adenomatoid malformation with bronchial atresia in adulthood is rare but possible, even in different lobes.

Three-dimensional analysis of pulmonary nodules: variability of semiautomated volume measurements between different versions of the same software

PurposeThis study was done to evaluate the variability of semiautomated volume measurements of solid pulmonary nodules between two different versions of the same volumetric software.Materials and methodsThe volumes of 100 solid intraparenchymal nodules (mean volume 88.10 mm3; range 7.36–595.25 mm3) studied with the same multidetector computed tomography (MDCT) protocol were determined using two different versions of the same volumetric software (LungCARE 2006G and LungCARE 2007S). The 2006G version is based on a single-segmentation algorithm, whereas the newer version features two algorithms: SmallSizeNodule and AllSizeNodule. The results obtained with the 2006G version were compared with those of the 2007S version with the SmallSizeNodule algorithm, as recommended by the user manual. In addition, we compared the volumetric measurements obtained by the two different algorithms of the 2007S version.ResultsThe 2006G version and the 2007S version with the SmallSizeNodule algorithm agreed in only two of 100 cases and showed a mean variability of 1.66% (range 0%–8.78%). A more significant volumetric discrepancy was observed between the two different algorithms of the 2007S version, with the AllSizeNodule algorithm providing on average larger volumes (mean variability 71.08%; range 6.02%–218.80%) than SmallSizeNodule. Volume discrepancies were more pronounced in the subgroups of smaller nodules in all comparisons.ConclusionsThere is variability also in the results provided by different versions of the same volumetric software, and this may affect the calculation of the nodule-doubling time. Computer-aided assessment of the growth of lung nodules should always be performed using the same version of volumetric software and the same segmentation algorithm.RiassuntoObiettivoScopo del nostro studio è stato valutare la variabilità delle misurazioni volumetriche di noduli polmonari solidi dovuta all’utilizzo di diverse versioni dello stesso software di volumetria.Materiali e metodiI volumi di 100 noduli polmonari solidi intraparenchimali (volume medio di 88,10 mm3; range 7,36–595,25 mm3) sottoposti a tomografia computerizzata (TC) multidetettore con lo stesso protocollo d’esame sono stati misurati con 2 versioni diverse dello stesso software di volumetria (LungCARE 2006G e LungCARE 2007S). La versione 2006G presenta un unico algoritmo di segmentazione mentre la versione 2007S è dotata di 2 algoritmi chiamati SmallSizeNodule e AllSizeNodule. I risultati della versione 2006G sono stati confrontati con quelli della versione 2007S ottenuti con l’algoritmo SmallSizeNodule come consigliato dal manuale del software. Sono stati inoltre confrontati tra loro i risultati delle volumetrie ottenute con i diversi algoritmi della versione 2007S.RisultatiLa versione 2006G e la versione 2007S con algoritmo SmallSizeNodule hanno dato un risultato sovrapponibile solo in 2 casi su 100 ed hanno esibito una variabilità volumetrica media dell’1.66% (range 0%–8,78%). Una discrepanza volumetrica assai maggiore è stata osservata tra i 2 diversi algoritmi di segmentazione della versione 2007S in cui l’algoritmo AllSizeNodule ha fornito volumi mediamente superiori del 71,08% (range 6,02%–218,80%) rispetto all’algoritmo SmallSizeNodule. L’entità delle discrepanze volumetriche è risultata maggiore nei sottogruppi di noduli di minori dimensioni in tutte le comparazioni eseguite.ConclusioniAnche tra diverse versioni dello stesso software di analisi volumetrica esiste una variabilità di risultati che può influenzare il calcolo del tempo di raddoppiamento dei noduli. La valutazione computerizzata del tasso di crescita di un nodulo polmonare andrebbe eseguita utilizzando nei vari controlli sempre la stessa versione del software di volumetria ed il medesimo algoritmo di segmentazione.