R. Formánek

Palacký University of Olomouc, Olmütz, Olomoucký, Czech Republic

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Publications (10)4.09 Total impact

  • K Vomackova · C Neoral · R Aujeský · R Vrba · M Stasek · M Myslivecek · R Formánek
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    ABSTRACT: RESULTS: The initial PET/CT examination performed in 349 patients correctly described the extent of the disease in accordance with the histologically confirmed diagnosis in virtually all patients. A false positive result was seen in only 5 patients (1.43%). When evaluating the effect of neoadjuvant therapy, the patients were divided into groups based on the findings of the follow-up PET/CT after neoadjuvant therapy and their overall survival was evaluated. A significant difference (p=0.0004) in survival was observed between the groups based on the different reactions to neoadjuvant therapy (CR (n=38), regression (n=89), stationary findings (n=10), progression (n=19)) without taking into account the following treatment the patient received after neoadjuvant therapy. Patients who had a better response to neoadjuvant therapy had better survival results. There was also a significant difference in survival between the group of patients who completed neoadjuvant therapy and underwent radical surgical resection (n=85) versus those patients who completed neoadjuvant therapy but did not undergo subsequent surgery (n=59). The operated group had a significantly higher overall survival (p=0.003). The longest mean survival, 38.6 months (median 29.0 months), was achieved by the group of patients who completed neoadjuvant therapy, showed a complete response on the follow-up PET/CT, and underwent surgical resection. However, a significant difference was not observed (p=0.587) between the groups who underwent surgical resection and whose follow-up PET/CT results differed (regression or stationary findings). To date, the number of cases in the individual groups is not great enough to consider the obtained results conclusive, and we will continue to include more patients into the study and continue with the analysis.
    No preview · Article · Jan 2015 · Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti
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    ABSTRACT: Abstract The significance of PET/CT in chronic lymphocytic leukemia (CLL) has not been systematically studied yet. This prospective study aimed at assessing the benefit of PET/CT in patients with newly diagnosed or relapsed CLL and Richter's transformation (RT). PET/CT examination was performed in twenty-three patients with newly diagnosed disease, thirteen with relapsed disease and eight with suspected or histopathologically confirmed RT. In all patients, maximum standardized uptake value (SUVmax) was calculated. The median SUVmax was 3.4 (range; 1.5 - 6.3) and 3.1 (range; 1.2 - 5.9) in newly diagnosed and relapsed patients, respectively. The median SUVmax of patients with suspected or confirmed RT reached 16.5 (range; 7.2 - 25.3), a value different from the previous groups (p < 0.001). (18)F-FDG PET/CT revealed inflammatory lesions in 7 patients (16%) and synchronous tumors in 2 newly diagnosed patients.(18)F-FDG PET/CT may be a beneficial imaging method when used in individuals with CLL and suspected RT.
    No preview · Article · May 2013 · Leukemia & lymphoma
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    ABSTRACT: Aim: To analyse sensitivity and specificity of SPECT and to assess the diagnostic potential of quantitative parameters of perfusion, left ventricular function and calcium score to identify high risk patients with multivessel coronary artery disease. Methods: 702 patients underwent stress gated SPECT study and then coronary angiography. We quantified% of ischemic myocardium, left ventricular ejection fraction, end-diastolic and end-systolic volumes and transient ischemic dilatation ratio. Results: Sensitivity and specificity of SPECT were 91 % (456/502) and 76 % (151/200), respectively, without significant difference between men and women. In quantitative analysis, % of ischemic myocardium rose with a number of diseased vessels: 11 % ± 11 %, 15 % ± 12 % and 19 % ± 14 % in patients with 1-, 2- and 3-vessel disease, respectively. We observed the sign of postischemic left ventricular stunning in 46%, 49 % a 63 % of patients with 1-, 2- and 3-vessel disease, respectively. In the subgroup of 81 patients with a dilated left ventricle, combining SPECT with calcium score (at a cutoff of 1 000) improved sensitivity from 80 % to 91 % and negative predictive value from 66 % to 81 % (p < 0.05), in association with not significant change in specificity and positive predictive value. Conclusions: Quantitative SPECT enables identification of high risk patients with a large ischemia and postischemic stunning with probable multivessel disease. In patients with a dilated left ventricle, the accuracy of SPECT has been improved by combination with calcium score.
    No preview · Article · Jan 2013 · Intervencni a Akutni Kardiologie
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    ABSTRACT: Integration of CT and nuclear cardiology methods have enabled noninvasive imaging of calcified and non-calcified plaques and assessing of its hemodynamic significance. CT angiography or myocardial perfusion imaging with SPECT are independent tests recommended in patients with intermediate pre-test likelihood of coronary artery disease. CT angiography would probably be convenient in low to moderate likelihood (< 50%), typically in younger patients, and when is normal, further tests are avoided. However, abnormal or equivocal findings have to be confirmed by SPECT. Thus, hybrid imaging is essential in many cases. Compared to CT angiography alone, the combination of SPECT/CT resulted in a significant increase in specificity and positive predictive value. In patients with probability of multivessel disease (diabetes mellitus, left ventricle dilatation, etc), the addition of calcium scoring or CT angiography can improve sensitivity of SPECT or PET. However, increase imaging costs and radiation doses associated with combination of more methods must be taken into consideration.
    No preview · Article · Jan 2012 · Intervencni a Akutni Kardiologie
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    ABSTRACT: Aim: The aim of this study was to investigate the prognostic value of coronary artery calcium (CAC) score in combination with cardiac stress sigle-photon emission tomography (SPECT) imaging in an asymptomatic population. Methods: One hundred twenty-eight consecutive asymptomatic patients (79 men, mean age 54±10 years, 25 with diabetes) underwent stress cardiac gated SPECT imaging and CT assessment of CAC score. Perfusion summed stress and difference score (SSS and SDS, resp.), the left ventricular ejection fraction (LVEF) and end-diastolic/end-systolic volumes (EDV/ESV) were automatically calculated using 4D-MSPECT. Cardiac event was defined as either cardiac death, nonfatal myocardial infarction (MI), or conditions requiring coronary revascularization. Results: During an average follow-up of 17±9 months, two patients had nonfatal MI, and revascularization was required in 8 patients. In the subgroup of 10 patients with cardiac events, the observed parameters was significantly worse than in patients without cardiac event concerning perfusion (SSS 10±12 vs. 1±0 and SDS 6±9 vs. 0±1, P<0.05), the left ventricular function (stress LVEF 56±12% vs. 68±9%, rest LVEF 56±7% vs. 66%±9, stress EDV/ESV 129 ml/59 ml vs. 98 ml/34 ml, P<0.05), and CAC score (588±1475 vs. 78±136, P<0.05). An annual cardiac event rate depended on the amount of CAC (2.5%, 6.1%, 11.1%, and 14.8% for CAC score 0-10, 11-100, 101-400, and >400, resp.). Moderate and high risk CAC score (101-400 and >400, resp.) was detected in 27 patients; however, no cardiac event was observed in 20 of them who had CAC ≥101 and simultaneously normal stress gated SPECT. Conclusion: CAC scoring combined with cardiac gated SPECT enables evaluation of prognosis in asymptomatic risk individuals.
    No preview · Article · Dec 2011 · Cor et vasa
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    ABSTRACT: To evaluate the ability of hybrid 18F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) to predict histopathological response and overall survival (OS) after preoperative neoadjuvant chemoradiotherapy (CRT) in patients with the esophageal carcinoma. 73 patients with locally advanced esophageal carcinoma were included in the study. All were treated with CRT and 34 subsequently underwent surgical resection of the esophagus. (18)F-FDG PET/CT was carried out prior to (PET/ CT1) and 6 weeks after (PET/CT2) completion of the CRT. PET/CT2-determined complete metabolic response (CMR) was achieved in 6 (17.6%) out of 34 operated patients, the metabolic response was incomplete (NCMR) in 28 (82.4%) patients. A histopathological complete response (CR) to CRT was discovered in 7 patients (20.6%). The median OS in operated patients was 17.1 months, 95% CI:12.9-23.3 months. In a group of 39 non-operated patients, CMR after neoadjuvant CRT was achieved in 12 patients (30.8%), while NCMR was found in 28 (82.4%). The median OS was 13.5 months in this group, 95% CI: 4.4-22.7 months. No statistically significant correlation was found between the (18)F-FDG metabolic response after the neoadjuvant CRT and histopathological response. Presently, the contribution of (18)F-FDG PET/CT as a marker of the potential result of CRT cannot be considered definite. Another study with a larger sample of patients and standardized algorithms for the examining protocols would be necessary for reaching definitive conclusions.
    No preview · Article · Nov 2011 · Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia
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    ABSTRACT: Aim. The majority of neuroendocrine tumors (NETs) exhibits an indolent growth pattern (well-differentiated tumors), but a substantial number may metastasize. The minority of NETs is aggressive and can have a highly malignant course. The aim of the study was to evaluate the reliability of contrast-enhanced 18F-FDG PET/CT in the staging of malignant NETs. Method. A total of 41 patients with verified or suspected NETs underwent contrast-enhanced 18F-FDG PET/CT. NETs were histologically verified in 29 patients (15 carcinoids, 8 neuroendocrine carcinomas, 2 medullary carcinomas, 2 Merkel cell carcinomas, 1 pheochromocytoma, 1 inzulinoma). 111In-pentetreotide or 123I-MIBG scintigraphies were performed in patients with absent or spurious accumulation of 18F-FDG. Results. 18F-FDG PET/CT did not reveal 18F-FDG uptake in 6 patients with histologically confirmed NETs (5/15 carcinoids, 1/8 neuroendocrine carcinomas) only. The NETs were detected using 111In-pentetreotide or 123I-MIBG scintigraphy in all 18F-FDG false negative patients. On the contrary, 18F-FDG PET/CT was more accurate than 111In-pentetreotide or 123I-MIBG scintigraphy in patients with high-grade neuroendocrine carcinomas and medullar thyroid carcinomas. Conclusion. Contrast enhanced 18F-FDG PET/CT identified malignant tissue in the majority of patients with malignant NETs, 18F-FDG PET/CT was an efficient diagnos-tic tool in patients with intermediate- and high-grade NETs. 18F-FDG PET/CT and 111In-pentetreotide scintigraphy are complementary examinations - functional imaging with both radiopharmaceuticals has a potential for a more comprehensive assessment of these tumors.
    No preview · Article · Jan 2011
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    ABSTRACT: Aim. To evaluate the reliability of contrast-enhanced 18F-FDG PET/CT in the preoperative evaluation of patients with pancreatic masses and in the assessment of the resectability of pancreatic cancer. Methods. A total of 106 patients with suspicion of pancreatic carcinomas or with diagnosed tumors underwent contrast-enhanced 18F-FDG PET/CT. Malignancy was subsequently confirmed in 72 patients. Intraoperative findings (42 malignancies in 67 surgeries), follow-up CT and clinical investigation were used as reference standards. Results. Contrast-enhanced 18F-FDG PET/CT correctly detected pancreatic carcinoma in 61 patients, 18F-FDG PET/CT findings were false negative in 11 patients, false positive in 5 patients (sensitivity 85%, specificity 85%, accuracy 85%). Reliability of N and M staging was evaluated in the subgroup of 67 patients which underwent surgical exploration. Lymph node involvement (16 patients) was correctly detected using 18F-FDG PET/CT in 8 patients, PET/CT was false negative in 8 patients and false positive 4 patients (sensitivity 50%, specificity 92%, accuracy 82%). 18F-FDG PET/CT correctly revealed distant metastases (22 patients) in 12 patients, was false negative in 10 patients and false positive in 1 patient (sensitivity 55%, specificity 98%, accuracy 84%). According to 18F-FDG PET/CT results, 19 patients with pancreatic carcinoma were judged to have non-operable disease. Conclusion. Contrast-enhanced multislice 18F-FDG PET/CT appears to be an attractive staging tool for pancreatic cancer, although the N and M sensitivity values are lower than levels of specificity. It could help to omit a non-indicated surgery in patients with advanced disease.
    No preview · Article · Nov 2010 · Ceska Radiologie
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    ABSTRACT: The aim of this study was to evaluate added value of coronary artery calcium score (CAC) measurement as an adjunct to cardiac gated SPECT for risk stratification in population of patients with diabetes mellitus (DM) and/or chronic renal failure on hemodialysis (CHRF-HD). Retrospective analysis of 67 patients, who were referred for stress gated myocardial perfusion SPECT and CAC. Characteristics of study population: 40 men, mean age 59 +/- 12 years, DM (n = 28), CHRF-HD (n = 22), DM and CHRF-HD simultaneously (n = 17). Perfusion summed stress and different scores (SSS, SDS), the left ventricle ejection fraction (LVEF) and enddiastolic/endsystolic volumes (EDV/ESV) were automatically calculated using 4D-MSPECT software. The hard cardiac event was defined as sudden cardiac death or myocardial infarction (MI); angina or other symptoms requiring coronary revascularization were also calculated. During the average period of 18 +/- 10 months, we registered 8 cardiac deaths, 4 nonfatal MI and 7 patients underwent revascularization. In the subgroup of 19 patients with cardiac events, the observed parameters were significantly worse concerning perfusion (SSS 9 +/- 11 vs 2 +/- 3 and SDS 6 +/- 9 vs 1 +/- 2, P < 0.05), the left ventricle function (stress LVEF 53% +/- 13% vs 59% +/- 13%, rest LVEF 55% +/- 14% vs 59% +/- 12%, stress EDV/ESV 144 ml/71 ml vs 128 ml/59 ml, P < 0.05), and CAC score (1 965 +/- 1 772 vs 387 +/- 740, P < 0.05) in comparison with patients without cardiac event. In patients without a reversible perfusion abnormality (SDS < 2), we observed lower annual hard event rate (8% vs 19.6%, P < 0.05) and revascularization procedures (4% vs 19.6%, P < 0.05) in comparison with patients with SDS > or = 2. In patients with or without reversible defects, we registered significantly higher annual hard event rate in the setting of post-stress worsening of the LVEF > 5% and/or severe CAC score > or = 709 (23.8% vs 1.9% in patients with SDS < 2, and 26.7% vs 9.5% in patients with SDS > or = 2, P < 0.05). The findings of highly elevated CAC score as well as the post-stress left ventricle stunning enable further risk stratification in patients with or without reversible perfusion abnormalities.
    No preview · Article · Nov 2010 · Vnitr̆ní lékar̆ství
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    ABSTRACT: Newer imaging modalities, such as 18F-FDG PET/CT and 99mTc-MIBI scintigraphy, have been recently introduced to assess the activity and extent of disease in patients with multiple myeloma (MM) and gammopathy of undetermined significance (MGUS). The aim of our study was to compare the impact of these imaging modalities in the evaluation of MM and MGUS patients. A total of 101 patients with MM (81 patients) and MGUS (20 patients) were enrolled in the study (21 newly diagnosed and 44 relapsed patients with symptomatic MM, 16 with asymptomatic MM and 20 with MGUS). All patients were without therapy and underwent 18F-FDG PET/CT and 99mTc-MIBI scintigraphy within a maximum interval of 14 days. The scans were classified as normal (N), diffuse (D), and focal or combined (F-FD) pattern. There was no significant difference in the detection of newly diagnosed MM and relapsed patients between the compared methods. 18F-FDG PET/CT performed better than 99mTc-MIBI scintigraphy in the detection of focal lesions (p < 0.039), whereas 99mTc-MIBI scintigraphy was superior in the visualization of diffuse disease (p = 0.042). 18F-FDG PET/CT visualised significantly more focal lesions than 99mTc-MIBI scintigraphy (p = 0.002), both generally in the cohort and when comparing the number of focal lesions per patient. Both the imaging modalities singly or in combination influenced the subsequent clinical management in 17% of patients. In our study, 18F-FDG PET/CT predicted asymptomatic MM and MGUS transformation into more aggressive forms with the necessity to start therapy more often than 99mTc-MIBI scintigraphy. 18F-FDG PET/CT appeared to be a better imaging technique than 99mTc-MIBI scintigraphy in the detection of focal lesions in patients with symptomatic MM. 99mTc-MIBI was superior in the visualization of diffuse disease. On the other hand, despite its limited capacity in detecting focal lesions, 99mTc-MIBI scintigraphy still remains the most rapid and inexpensive technique for whole-body evaluation and may be an alternative option when a PET/CT facility is not available.
    No preview · Article · Jan 2010 · Klinická onkologie: casopis Ceské a Slovenské onkologické spolecnosti