We here aim to provide a comprehensive and critical review of the literature concerning the clinical applications of positron emission tomography/computed tomography (PET/CT) with radiolabeled choline in patients with prostate cancer (PCa). We will initially briefly summarize the historical context that brought to the synthesis of [C]choline, which occurred exactly 20 years ago. We have arbitrarily grouped the clinical studies in three different periods, according to the year in which they were published and according to their relation with their applications in urology, radiotherapy and oncology. Studies at initial staging and, more extensively, studies in patients with biochemical failure, as well as factors predicting positive PET/CT will be reviewed. The capability of PET/CT with radiolabeled choline to provide prognostic information on PCa-specific survival will also be examined. The last sections will be devoted to the use of radiolabeled choline for monitoring the response to androgen deprivation therapy, radiotherapy, and chemotherapy. The accuracy and the limits of the technique will be discussed according to the information available from standard validation processes, including biopsy or histology. The clinical impact of the technique will be discussed on the basis of changes induced in the management of patients and in the evaluation of the response to therapy. Current indications to PET/CT, as officially endorsed by guidelines, or as routinely performed in the clinical practice will be illustrated. Emphasis will be made on methodological factors that might have influenced the results of the studies or their interpretation. Finally, we will briefly highlight the potential role of positron emission tomography/magnetic resonance and of new radiotracers for PCa imaging.
In this group of patients with type 2 diabetes, microalbuminuria was the only predictor of silent ischaemia on MPS. Assessment of microalbuminuria should be routinely considered among the first risk stratification steps for CAD in patients with type 2 diabetes, even though severe ischaemia on MPS is a major predictor of cardiac event-free survival.
Differentiated thyroid cancer (DTC) is a common endocrine tumor with increasing incidence and excellent prognosis. The therapy of thyroid cancer consists of thyroidectomy, thyroid hormone treatment and, depending on pathological stage, adjuvant radioactive iodine ablation (RIA). Because of the excellent outcome of DTC and the potential cancerous effect of iodine-131, in the last years there has been a huge number of articles addressing the issue of the incidence of second tumors in DTC patients. We will make a short critical review of some of these articles focusing on results reporting and interpretation. Methodological factors that may affect the obtained results will be highlighted for the benefit of the reader so that the risk associated to iodine-131 exposure will be balanced to the risk associated to other risk factors, including enhanced medical surveillance, shared genetic variability and environment factors and proper methodological study design. The review is finally a call to physicians involved in the therapy of these patients, primarily nuclear medicine physicians, endocrinologists and surgeons, to join their complimentary skill for the therapy of these patients.
Neuropathological and clinical evidence indicates that the clinical expression of Alzheimer's disease (AD) occurs as neuropathology exceeds the brain reserve capacity. The brain or cognitive reserve (BCR) hypothesis states that high premorbid intelligence, education, and an active and stimulating lifestyle provide reserve capacity, which acts as a buffer against the cognitive deficits due to accumulating neuropathology. Neuroimaging studies that assessed the BCR hypothesis are critically reviewed with emphasis on study design and statistical analysis. Many studies were performed in the last two decades owing to the increasing availability of positron emission tomography (PET) and PET/computed tomography scanners and to the synthesis of new radiopharmaceuticals, including tracers for amyloid and tau proteins. Studies with different tracers provided complementary consistent results supporting the BCR hypothesis. Many studies were appropriately designed with a measure of reserve, a measure of brain anatomy/function/neuropathology, and a measure of cognitive functions that are necessary. Most of the early studies were performed with PET and [ 18F]fluorodeoxyglucose, and occasionally with [ 15O]water, reporting a significant association between higher occupation/education and lower glucose metabolism (blood flow) in associative temporo‐parietal cortex in patients with AD and also in patients with MCI, after correcting for the degree in the cognitive impairment. On the contrary, performances on several neuropsychological tests increased with increasing education for participants with elevated [ 11C]PiB uptake. Studies with the tracers specific for tau protein showed that patients with AD with elevated tau deposits had higher cognitive performances compared with patients with similar levels of tau deposits. BCR in AD is also associated with a preserved cholinergic function. The BCR hypothesis has been validated with methodologically sound study designs and sophisticated neuroimaging techniques using different radiotracers and providing an explanation for neuropathological and clinical observations on patients with AD.
3 boys and 1 girl with a true precocious puberty have been studied. Neuroradiologic investigation and surgery allowed us to diagnose an astrocytoma of the anterior part of the third ventricle, involving the chiasm; an optic-chiasm glioma and a hydrocephalus secondary to aqueductal stenosis in the presence of neurofibromatosis; a third ventricle arachnoid cyst; a postinfectious hydrocephalus. We present endocrinological data, in particular on the hypothalamo-pituitary function in these patients, before and after surgery.
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