E Kresnik

Wernersville State Hospital, Wernersville, Pennsylvania, United States

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Publications (91)224.96 Total impact

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    ABSTRACT: Today's available therapeutic options in head and neck cancer patients have led to better treatment modalities tailored to the individually clinical staging of the patients towards a risk adapted tumour management. This, however, is only possible with an accurately pretherapeutic diagnostic regimen and closely posttherapeutic follow-up. These issues were discussed by nuclear medicine experts, otorhinolaryngologists, oral surgeons, radiologists, radio-oncologists and oncologists in a meeting that took place in Pörtschach, Austria, on 05 May 2006. The aim was to discuss the impact and indications of performing FDG PET/CT in patients with head and neck cancer and to outline possible future perspectives. FDG PET/CT is recommended for a better pretherapeutic staging in stage IV according to UICC and should be the method of choice in CUP with lymph node metastases. FDG PET/CT should be performed 3 - 4 months after radiation-/radiochemotherapy to diagnose viable tumour and to avoid false positive results. To evaluate the position and effectiveness of FDG PET/CT in therapy-monitoring further studies are needed. In case of radiation therapy FDG PET/CT allows a tailored treatment of patients with an accurate design of the target volume to reduce damage to the surrounding tissues. The interdisciplinary consensus reached by the experts is not intended to recommend standard guidelines in the management of head and neck cancer but to summarise and stress the impact of FDG PET/CT on the basis of the present literature and current clinical practise.
    No preview · Article · Mar 2009 · Laryngo-Rhino-Otologie
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    ABSTRACT: Patients with persistent elevated PSA and repeated negative prostate biopsy, that means having the prostate biopsied at multiple times, were investigated with 18F-choline PET/CT to delineate prostate cancer and guide renewed prostate biopsy. Twenty patients with elevated PSA and negative prostate biopsies underwent 18F-choline PET/CT. We performed an early examination of the pelvic region 3-5 min after application. After 30 minutes a whole body PET/CT examination was performed. Image analysis was performed visually and by semi-quantitative analysis calculating the maximum standardised uptake value (SUVmax). 18F-choline uptake was defined as focal, multifocal or inhomogeneous. After the 18F-choline PET/CT, all patients underwent a repeated prostate biopsy, and in the cases where a focal or multifocal uptake was found, the biopsy was guided by the result of the examination. Qualitative image analysis revealed focal 18F-choline uptake in 13 out of 20 patients. In five patients, prostate cancer was revealed by repeated aspiration biopsy. None of the patients with a multifocal or inhomogeneous 18F-choline uptake had a malignant neoplasm in the prostate. Semiquantitative analysis performed with SUVmax was not helpful in the discrimination of malignancy but showed high values also in benign prostate diseases, as well as in normal prostate tissue. The dual-phase protocol delivered no clear benefit in discriminating malignancy from benign alterations. The use of 18F-choline cannot be generally recommended for localising prostate cancer; however, in highly selected patients, we found useful additional information. In 25% of patients, 18F-choline PET/CT allowed the identification of neoplastic prostatic zones.
    No preview · Article · Jun 2008 · European journal of nuclear medicine and molecular imaging
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    ABSTRACT: Gaucher disease is the most prevalent inherited, lysosomal storage disease and is caused by deficient activity of the enzyme beta-glucocerebrosidase. Bone and bone marrow alterations are frequent in the most prevalent non-neuronopathic form of Gaucher disease. Imaging of bone manifestations in Gaucher disease is performed by a variety of imaging methods, conventional X-ray and MRI as the most frequently and most important ones. However, different modalities of scintigraphic imaging have also been used. This article gives an overview on scintigraphic imaging with respect to bone manifestations in Gaucher disease discussing the advantages and limitations of scintigraphic imaging in comparison to other imaging methods.
    No preview · Article · Feb 2008 · Nuklearmedizin
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    ABSTRACT: Thyroid hormone administration is associated with low bone density in some studies. The aim of the present study was to evaluate the influence L-thyroxine, in doses used to treat patients with a history of thyroid carcinoma, on serum cathepsin K and other markers of bone metabolism. Cathepsin K is thought to have a role in osteoclast mediated bone resorption. A group of male patients with differentiated thyroid cancer (DTC) on suppressive L-thyroxine therapy (DTC-group; n = 51; mean age 57 years; TSH < 0.1 mU/L) was selected as a model for hyperthyroidism. The results were compared to a group of healthy euthyroid men (control-group; n = 50; mean age 58 years; TSH 1.5 +/- 0.9 mU/L). In the DTC-group the median value of cathepsin K was 6.9 pmol/L, in the control group 4.8 pmol/L (p = 0.0052; highly significant [h.s.]). There was a significant negative correlation of cathepsin K with age (r = -0.279, p = 0.028). The analysis of various bone associated parameters revealed an increase of serum crosslaps in the DTC-group versus euthyroid controls (p = 0.03). A significant correlation could be found for cathepsin K and osteoprotegerin (p = 0.002). Cathepsin K is increased by a suppressive L-thyroxine therapy and decreases with increasing age. The increased cathepsin K levels seen in DTC-patients on suppressive L-thyroxine therapy are likely to contribute to accelerated bone degradation in these patients.
    No preview · Article · Feb 2008 · Thyroid
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    ABSTRACT: Head and neck cancers are rising in incidence. In the diagnosis of malignant head and neck cancer, conventional morphological imaging methods, i.e. ultrasonography, radiography, computerised tomography (CT) and magnetic resonance imaging (MR) play a routine role besides clinical investigation. Despite these diverse techniques, the primary tumour often cannot be found. Furthermore, for staging purposes as well as for the detection of tumour recurrence after chemotherapy and/or radiotherapy, morphological examination techniques such as CT and MR are of limited accuracy. Due to promising results in the literature, 18F-fluorodeoxyglucose-positron emission tomography has been playing an increasing role in the assessment of malignant head and neck cancer. The authors present a literature review as well as their own data in comparison to conventional imaging methods.
    No preview · Article · Jun 2007 · Imaging Decisions MRI
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    ABSTRACT: 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is a well-established method in the follow-up of patients with differentiated thyroid carcinoma (DTC), elevated thyroglobulin (Tg) and negative 131I scans. This retrospective clinical study was designed to evaluate the impact of computed tomography (CT) and that of FDG-PET in combined FDG-PET/CT examinations on the restaging of DTC patients. Forty-seven FDG-PET/CT scans of 33 patients with a history of DTC, elevated Tg levels and negative 131I uptake or additionally suspected 131I-negative lesions were studied. PET and CT images were analysed independently by an experienced nuclear medicine specialist and a radiologist. Afterwards a final consensus interpretation, the gold standard in our department, was provided for the fused PET/CT images and, if available, for supplementary investigations. Thirty-five investigations (74%) revealed pathological FDG-PET/CT findings. In summary, 25 local recurrences, 62 lymph node metastases and 122 organ metastases (41 lung, 60 bone, 21 other organs) were diagnosed. In 36 out of 47 examinations (77%), the original PET diagnoses were modified in the final consensus interpretation owing to the CT assessments. In 8 of the 35 pathological FDG-PET/CT examinations (23%), the final consensus interpretation of the PET/CT images led to an alteration in the treatment plan. PET/CT is a powerful fusion of two pre-existing imaging modalities, which not only improves the diagnostic value in restaging DTC patients with elevated Tg and negative 131I scan, but also provides accurate information regarding subsequent treatment options and may lead to a change in treatment management.
    No preview · Article · May 2007 · European journal of nuclear medicine and molecular imaging
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    ABSTRACT: The AIM of this study was to determine the additional value of SPECT/CT in sentinel node scintigraphy in breast cancer. Furthermore, it was our question to determine, whether the low-dose computed tomography component (LD-CT) can be used for axillary lymph node staging of clinically negative patients. 51 patients with invasive breast cancer <3 cm in diameter were included in our prospective investigation. SPECT/CT was performed on a dedicated scanner 30 minutes after subareolar injection of (99m)Tc-Nanocoll. Axillary staging with CT(LD) was performed using standard CT-criteria. SLN were allocated to an axillary level using SPECT alone and SPECT/CT. Additionally, the number of SLN on CT(LD) corresponding to the scintigraphic hot node was notified for each patient and compared to the number of SLN found with the gamma probe. In 45/51 evaluable patients SLN could be localised in level I in 43 patients and in level II in two patients (all positive) using SPECT-CT, whereas a clear allocation could not be obtained by SPECT alone. The number of SLN was discrepant between SPECT and CT(LD) in 13/45 patients. The number of SLN detected with the gamma probe (n = 68) not significantly differed from the number of SLN detected by CT(LD) (n = 65) but was significantly higher than with SPECT (n = 51). CT(LD) yielded a sensitivity of 35.7%, a specificity of 83.9%, a positive predictive value (PPT) of 50%, a negative predictive value (NPV) of 74.3% and a diagnostic accuracy of 68.9% for axillary staging with CT(LD). The additional information of SPECT/CT allows a more accurate characterization of the SN concerning size, depth and anatomical location. CT(LD) when performed during (99m)Tc-Nanocoll sentinel-SPECT/CT is not suitable for axillary staging in breast cancer patients with clinical negative axilla due to its low sensitivity and moderate specificity. Therefore, it does not influence the decision for SNB or ALND. The limited resolution of SPECT leads to an underestimation of the number of SLN compared to CT(LD) and the gamma probe.
    No preview · Article · Jan 2007 · Nuklearmedizin
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    ABSTRACT: The aim of our study was to determine whether treatment with a long-acting somatostatin-receptor analogue is effective in patients with (131)I-negative but somatostatin-receptor-positive metastases from dedifferentiated and anaplastic thyroid cancer. Twelve patients were screened for the study. All of them showed progressive disease confirmed by radiologic evaluation, increasing serum thyroglobulin (Tg), and negative diagnostic or posttherapeutic (131)I whole-body scans (WBS). Eight of 12 patients (4 males and 4 females; age range, 57-89 years; 1 papillary thyroid cancer; 4 poorly differentiated follicular thyroid cancer; 1 follicular and anaplastic thyroid cancer; 2 anaplastic thyroid cancer) showed positive somatosatin-receptor expression in Tc-99m depreotide WBS/SPECT (Tc-99m Dep.WBS). Initially, in all patients fluorine-18 2-fluoro-2- D-glucose-positron emission tomography-computed tomography ((18)F-FDG-PET-CT), Tc-99m Dep.WBS, and Tg measurements were performed. In the case of positive receptor scintigraphy, patients were treated with 20mg Sandostatin LAR (Novartis Pharmaceuticals, Basel, Switzerland) once per month intramuscularly over a period of 6 months followed by repeated (18)F-FDG-PET-CT, Tc-99m Dep.WBS, and Tg measurement to determine metabolic activity and tumor size. In case of tumor progression, the dose was increased to 30mg of Sandostatin LAR once per month. Only 3 patients were able to undergo long-term treatment. Two patients were treated with octreotide long-acting release (LAR) for 1 year and 1 patient for 1(1/2) years. All patients showed progressive disease during the treatment: an increase of serum Tg on one hand and an increase in the number of lesions and extent in tumor size visible on FDG-PET-CT and Tc-99m Dep.WBS on the other. During the treatment there was no change in receptor expression, nevertheless, clear tumor progression under therapy with a somatostatin analogue was visible in FDG-PET-CT and in Tc-99m Dep.WBS. Our data demonstrate that all of our patients treated with a somatostatin analogue showed clinical progression and that our attempt to achieve a stabilization of the disease failed.
    No preview · Article · Dec 2006 · Thyroid
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    ABSTRACT: In addition to standard methods such as serum thyroglobulin, neck ultrasonography and I-131-whole body scintigraphy F-18-FDG PET is of great value for localizing iodine negative metastases in the follow up of differentiated thyroid cancer. The early use of F-18-FDG is indicated in case of elevated thyroglobulin but negative post therapeutic I-131-scintigraphy, as well as in cases of markedly elevated thyroglobulin but only faint uptake in the I-131-whole body scan. F-18-FDG PET cannot substitute I-131-whole-body scintigraphy but can provide additional information in most cases. Using a combination of F-18-FDG PET and I-131 whole body scintigraphy most of the metastases from differentiated thyroid cancer can be localized. With the increasing use of F-18-FDG it was able to demonstrate, that in the past conventional methods often underestimated the extend of the disease. In contrast to conventional nuclear medicine methods the advantages of F-18-FDG PET are higher sensitivity and the much better spatial resultion. Elevated F-18-FDG-uptake within metastases mostly demonstrates low differentiation of tumor cells and therefore bad prognosis. In contrast well differentiated metastases accumulate iodine but no F-18-FDG. The early use of F-18-FDG PET may influence the therapeutic strategy such as using retinoic acid for redifferentiation, surgery of single metastases and additional use of external radiotherapy.
    No preview · Article · Oct 2006 · Chirurgische Praxis
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    ABSTRACT: Suppressive thyroid hormone therapy is generally a lifelong treatment for patients with differentiated thyroid cancer (DTC). However, long-standing thyrotropin (TSH) suppression is a risk factor for osteoporosis. Osteoprotegerin (OPG) and receptor activator of nuclear factor kappaB ligand (RANKL) are central regulators of bone turnover. The aim was to analyze the effects of a suppressive thyroid hormone therapy in males with DTC on the OPG/RANKL system and on bone metabolism. The OPG and soluble RANKL (sRANKL) were determined in 40 men (mean age, 53.2 years) with DTC on suppressive thyroid hormone therapy (TSH; 0.053 +/- 0.037 mU L(-1), duration 5.7 +/- 4.4 years) and 120 healthy controls matched for age. The markers of bone metabolism were C-terminal telopeptide of type I collagen in serum (sCTx) and osteocalcin (OC). The control group had OPG values (mean +/- SD) of 1.9 +/- 1.0 pmol L(-1) and sRANKL values of 0.40 +/- 0.62 pmol L(-1). In patients with DTC, results for OPG were 3.03 +/- 1.04 pmol L(-1) (P < 0.05) and for sRANKL were 0.13 +/- 0.16 pmol L(-1) (P < 0.05). The control group presented values for sCTx of 2669 +/- 1132 pmol L(-1) and for OC of 17.89 +/- 6.5 ng mL(-1). Patients with DTC on suppressive thyroid hormone therapy had increased sCTx values of 3810 +/- 2020 pmol L(-1) (P = 0.03) but comparable OC values of 19.21 +/- 7.67 ng mL(-1) (NS). Suppressive thyroid hormone therapy in men with DTC increased bone degradation and induced significant changes in the OPG/RANKL system. These changes include, besides the risk of osteoporosis, possible negative effects on the vascular function and an increased risk of cardiovascular disease.
    No preview · Article · Sep 2006 · European Journal of Clinical Investigation
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    ABSTRACT: Non-small-cell lung cancer represents frequently as a solitary pulmonary nodule (SPN), occasionally found by routine examination. Non-invasive examinations like CT or X-ray provide exact anatomical and morphological information, but often fail to discriminate between benign and malignant with the consequence of further invasive diagnostic procedures. Positron emission tomography using F-18 fluorodeoxy-glucose renders the possibility of exact characterization of these SPN by its high negative predictive value, which leads to a reduction in unnecessary surgical interventions and associated morbidity. Furthermore, PET allows a more exact assessment of lymph node involvement and distant metastasis and gives prognostic information. Also in the follow - up of bronchogenic carcinoma, F-18 FDG plays an incremental role.
    No preview · Article · Aug 2006
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    ABSTRACT: Inflammatory bowel disease (IBD) requires a complex diagnostic workup. In contrast to endoscopy and cross-sectional imaging methods, scintigraphy enables a complete survey of the whole small and large bowel intestinal tract with a single noninvasive examination. For detection of IBD, 80% to 90% sensitivity and 92% to 100% specificity can be found for conventional scintigraphy. A new imaging method like fluorine-18 (F-18) fluorodeoxyglucose PET has been shown to be useful in tumor diagnostics. A major problem in PET is the limited anatomic information and nonspecific tracer uptake within the colon, however, which may lead to false-positive results. New imaging methods like combined PET/CT can help to solve the problem, because physiologic tracer uptake can be easily distinguished from pathologic lesions as a result of the anatomic detail provided by CT.
    No preview · Article · Apr 2006 · PET Clinics
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    ABSTRACT: In addition to standard methods such as serum thyroglobulin, neck ultrasonography and I-131-whole body scintigraphy F-18-FDG PET is of great value for localizing iodine negative metastases in the follow up of differentiated thyroid cancer. The early use of F-18-FDG is indicated in case of elevated thyroglobulin but negative post therapeutic I-131-scintigraphy, as well as in cases of markedly elevated thyroglobulin but only faint uptake in the I-131-whole body scan. F-18-FDG PET cannot substitute I-131-whole-body scintigraphy but can provide additional information in most cases. Using a combination of F-18-FDG PET and I-131 whole body scintigraphy most of the metastases from differentiated thyroid cancer can be localized. With the increasing use of F-18-FDG it was able to demonstrate, that in the past conventional methods often underestimated the extend of the disease. In contrast to conventional nuclear medicine methods the advantages of F-18-FDG PET are higher sensitivity and the much better spatial resultion. Elevated F-18-FDG-uptake within metastases mostly demonstrates low differentiation of tumor cells and therefore bad prognosis. In contrast well differentiated metastases accumulate iodine but no F-18-FDG. The early use of F-18-FDG PET may influence the therapeutic strategy such as using retinoic acid for redifferentiation, surgery of single metastases and additional use of external radiotherapy.
    No preview · Article · Sep 2005 · Tagliche Praxis
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    ABSTRACT: In addition to standard methods such as serum thyroglobulin, neck ultrasonography and I-131-whole body scintigraphy F-18-FDG PET is of great value for localizing iodine negative metastases in the follow up of differentiated thyroid cancer. The early use of F-18-FDG is indicated in case of elevated thyroglobulin but negative post therapeutic I-131-scintigraphy, as well as in cases of markedly elevated thyroglobulin but only faint uptake in the I-131-whole body scan. F-18-FDG PET cannot substitute I-131-whole-body scintigraphy but can provide additional information in most cases. Using a combination of F-18-FDG PET and I-131 whole body scintigraphy most of the metastases from differentiated thyroid cancer can be localized. With the increasing use of F-18-FDG it was able to demonstrate, that in the past conventional methods often underestimated the extend of the disease. In contrast to conventional nuclear medicine methods the advantages of F-18-FDG PET are higher sensitivity and the much better spatial resultion. Elevated F-18-FDG-uptake within metastases mostly demonstrates low differentiation of tumor cells and therefore bad prognosis. In contrast well differentiated metastases accumulate iodine but no F-18-FDG. The early use of F-18-FDG PET may influence the therapeutic strategy such as using retinoic acid for redifferentiation, surgery of single metastases and additional use of external radiotherapy.
    No preview · Article · Dec 2004 · Internistische Praxis
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    ABSTRACT: The aim of the study was to investigate the current thyroid carcinoma (TC) incidence in Carinthia, a former iodine-deficient, goiter-endemic region in Austria with approximately 550,000 inhabitants from 1984 to 2001. Using age-cohort analysis we analyzed the TC incidence under the impact of two regional risk factors: the contamination of Austrian soils by the radioactive fallout in from Chernobyl 1986 and the increased iodination of table salt in a general program of goiter prophylaxis begun in 1991. To evaluate the characteristics of TC incidence, we compared the results of the periods 1984-1989, 1990-1995, and 1996-2001. A total of 734 TC cases were diagnosed. Papillary, follicular, medullary, oxyphilic, and anaplastic TC accounted for 76%, 18%, 3%, 1%, and 2%, respectively. The female to male ratio was 3:1. The annual incidence rate increased by 8.05% in females and 11.6% in males. TC cases younger than 40 years of age accounted for 22.6%, with a rate increase of 18% per year in young males, the female-to-male ratio decreased from 8.3, 6.1, 2.7 younger than 40 in the compared periods. Along with a further increase in papillary TC incidence and papillary thyroid carcinoma (PTC) follicular thyroid carcinoma (FTC) ratio in the adult population, the ratio tended to decrease in the younger than 40-year-old population. T4 class TC and loco-regional lymph node involvement increased significantly. The observed changes in TC incidence, particularly in the young population, as in adults, could be linked to the abovementioned risk factors involved in the initiation and early growth of TC, and iodine may play a role in stimulating overall thyroid activity.
    No preview · Article · May 2004 · Thyroid
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    ABSTRACT: The occurrence of head and neck cancer is increasing. In diagnosis of malignant head and neck cancer beside clinical investigation, conventional morphological imaging methods, i.e. ultrasonography, radiography, computed tomography and magnetic resonance imaging (MRI), have a routine role. Despite these diverse techniques, the primary tumor often cannot be found. Furthermore, for staging purposes as well as for the detection of tumour recurrence after chemotherapy and/or radiotherapy, morphological examination techniques such as CT and MRI are of limited accuracy. Due to promising results in the literature, 18F-FDG-PET has been playing an increasing role in the assessment of malignant head and neck cancer. The authors present a literature review as well as own data in comparison to conventional imaging methods.
    No preview · Article · Dec 2003 · Tagliche Praxis
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    ABSTRACT: F-18-FDG-PET represents a new method in nuclear medicine. Beside its use in cardiology and neurology, the main indication for this method is oncology. The principle of this method in oncology is the fact that malignant tumors, their recurrences and metastases demonstrate an elevated glucose metabolism compared to normal tissue. The glucose analogue deoxyglucose, labeled with the positron emitter fluorine-18, is able to represent this high glucose metabolism, which can be imaged using PET. It is not only possible to differentiate benign from malignant tumors in most cases, but also to differentiate viable tumor tissue from scar or fibrosclerosis after treatment (surgery, chemotherapy, radiation therapy). Clinical experience and studies in many thousand patients demonstrate that F-18-FDG-PET is highly recommended for the following indications: probability of malignancy in solitary pulmonary nodule including staging of lung cancer, early detection of colorectal recurrence, diagnosis and staging of pancreatic cancer, restaging of malignant melanoma, follow up of thyroid cancer, staging and restaging of head and neck cancer, and staging and restaging of lymphoma. Additional indications may be breast cancer and germ cell tumors. This review deals with the principle of PET and the clinical impact of the most important indication for oncology.
    No preview · Article · Sep 2003
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    ABSTRACT: The occurrence of head and neck cancer is increasing. In diagnosis of malignant head and neck cancer beside clinical investigation, conventional morphological imaging methods, i.e. ultrasonography, radiography, computed tomography and magnetic resonance imaging (MRI), have a routine role. Despite these diverse techniques, the primary tumor often cannot be found. Furthermore, for staging purposes as well as for the detection of tumour recurrence after chemotherapy and/or radiotherapy, morphological examination techniques such as CT and MRI are of limited accuracy. Due to promising results in the literature, 18F-FDG- PET has been playing an increasing role in the assessment of malignant head and neck cancer. The authors present a literature review as well as own data in comparison to conventional imaging methods.
    No preview · Article · Jun 2003 · Internistische Praxis
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    ABSTRACT: To evaluate the role of F-18-fluorodeoxyglucose positron-emission tomography (F-18 FDG PET) in the follow-up of breast carcinoma in case of clinical suspicion of local recurrence or distant metastases and/or tumor marker increase in correlation to conventional imaging. Retrospective analysis of the results of F-18 FDG PET (ECAT ART(R), Siemens CTI MS) of 62 patients (age 58.5 +/- 12.8) with surgically resected breast carcinoma (time interval after surgery, 86 +/- 82 months, mean follow-up 24 +/- 12.6 months). Patient- and lesion-based comparison with conventional imaging (CI) including mammography (MG), ultrasonography (US), computerized tomography (CT), magnetic resonance imaging (MRI), radiography (XR) and bone scintigraphy (BS). Furthermore, we evaluated the influence on tumor stage and therapeutic strategy. A visual qualitative evaluation of lesions was performed. On a patient base, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for detecting local recurrence or distant metastases were calculated to be 97%, 82%, 87%, 96% and 90% compared with 84%, 60%, 73%, 75% and 74% with CI. On a lesion base, significantly more lymph node (84 vs. 23, P < 0.05) and fewer bone metastases (61 vs. 97, P < 0.05) could be detected by using F-18 FDG PET compared with CI. Sclerotic bone lesions were predominantly detected by BS. On the other hand, there were several patients with more FDG positive bone lesions and also mixed FDG positive/Tc-99m methylenediphosphonate (MDP) negative and FDG negative/Tc-99m MDP positive metastases. In case of normal tumor markers, sensitivity, specificity, PPV, NPV and accuracy for detecting local recurrence or distant metastases were calculated to be 100%, 85.0%, 78.6%, 100% and 90.3% for FDG PET and 80%, 50%, 50%, 80% and 61.5% for CI. An upstaging could be observed in 9.7% (6/62) and downstaging in 12.9% (8/62), leading to a change in therapeutic regimen in 13 patients (21%). F-18 FDG PET demonstrates apparent advantages in the diagnosis of metastases in patients with breast carcinoma, compared with conventional imaging on a patient base. On a lesion base, significantly more lymph node and less bone metastases can be detected by using F-18 FDG PET compared with conventional imaging, including bone scintigraphy. In patients with clinical suspicion but negative tumor marker profile, too, F-18 FDG PET seems to be a reliable imaging tool for detection of tumor recurrence or metastases. Considering the high predictive value of F-18 FDG PET, tumor stage and therapeutic strategy will be reconsidered in several patients.
    No preview · Article · Jun 2003 · Investigative Radiology
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    ABSTRACT: Patients with differentiated thyroid carcinoma (DTC) must receive suppressive levothyroxine (LT(4)) therapy for the rest of their lives. The literature, however, presents conflicting results on how this affects bone metabolism. The aim of this study was to assess the influence of the estrogen status and LT(4) therapy, in particular LT(4) dosage in micrograms per kilograms (microg/kg), on bone metabolism in female patients with DTC. Three markers of bone metabolism (C-terminal telopeptide of type I collagen in serum [SCTx]; N-terminal telopeptide of type I collagen in urine [U-NTx]; and osteocalcin [OC]) were investigated in four groups: group REF (healthy premenopausal female controls), group DTC-ES (premenopausal women with DTC and normal estrogen levels), group DTC-ED (postmenopausal women with DTC and estrogen deficiency), and group DTC-HRT (postmenopausal women with DTC undergoing hormone replacement therapy [HRT]). All patients with DTC were on a well-adjusted suppressive LT(4) therapy with TSH levels 0.1 mU/L or less. In group DTC-ES bone turnover was comparable to group REF, whereas in group DTC-ED, all three markers were significantly increased as compared to groups REF and DTC-ES. In group DTC-HRT, the HRT normalized U-NTx and OC. However, in this group S-CTx was not completely normalized by HRT in all patients, although also significantly lowered compared to group DTC-ED. The analysis of LT(4 )dosage per kilogram showed that premenopausal DTC-patients had increased markers of bone metabolism if LT(4) dosage exceeded 2.6 microg/kg. Estrogen-deficient patients with DTC, however, had a much lower critical LT(4) dosage, above which increased markers of bone metabolism were seen. A well-adjusted suppressive LT(4) therapy of less than 2.6 microg/kg and normal estrogen levels do not seem to increase bone metabolism in estrogen-sufficient patients with DTC. The normalization of an estrogen deficiency by HRT or other antiresorptive therapies and minimal suppressive dosages of LT(4) are attempts to optimize the care of patients with DTC. In postmenopausal patients with DTC and patients with DTC who require LT(4) dosages in excess of 2.6 microg/kg, the information provided by markers of bone metabolism may help to prevent bone damage.
    No preview · Article · May 2003 · Thyroid

Publication Stats

2k Citations
224.96 Total Impact Points

Institutions

  • 2002-2008
    • Wernersville State Hospital
      Wernersville, Pennsylvania, United States
    • St. Vincent Hospital
      Green Bay, Wisconsin, United States
  • 2003
    • Alpen-Adria-Universität Klagenfurt
      • Institute of Mathematics
      Celovec, Carinthia, Austria
  • 1999-2002
    • Klinikum-Klagenfurt am Wörthersee
      Celovec, Carinthia, Austria