OBJECTIVES: To perform a systematic review and meta-analysis of the prognostic value of post-treatment 18F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET) in uterine cervical cancer patients treated with radiotherapy (RT) with or without chemotherapy. METHODS: PubMed and Embase databases were searched up to July 22, 2018, for studies which evaluated the response outcomes of ¹⁸F-FDG PET following RT, and their prognostic significance in uterine cervical cancer was assessed with overall survival (OS) or progression-free survival (PFS) as endpoints. Hazard ratios (HRs) were meta-analytically pooled using the random-effects model. RESULTS: Eleven studies with 12 patient cohorts including 1,104 patients were included. For a quantitative synthesis of OS, 7 cohorts were included. Two cohorts which reported disease-specific survival instead of OS were also included with flexibility. Pooled HR of complete metabolic response (CMR) compared to partial metabolic response (PMR) was 0.19 (95% confidence interval [CI]=0.11–0.31). Pooled HR of CMR compared to progressive metabolic disease (PMD) was more evident at 0.07 (95% CI=0.04–0.12), and that of CMR compared to both PMR and PMD was 0.20 (95% CI=0.12–0.34). Quantitative synthesis for PFS was performed with a total of 8 cohorts. Pooled HR of CMR was 0.17 (95% CI=0.10–0.29) compared to PMR, 0.02 (95% CI=0.01–0.06) compared to PMD and 0.12 (95% CI=0.07–0.19) compared to both PMR and PMD. CONCLUSION: Response results of post-RT ¹⁸F-FDG PET were significant prognostic factors in patients with uterine cervical cancer, and ¹⁸F-FDG PET could be a reasonable follow-up imaging modality.
Cohort Studies ; Disease-Free Survival ; Drug Therapy ; Electrons ; Follow-Up Studies ; Humans ; Metabolic Diseases ; Pliability ; Positron-Emission Tomography ; Radiotherapy ; Uterine Cervical Neoplasms

OBJECTIVE: We describe a systematic review and meta-analysis of the performance of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for detecting metastasis in ovarian cancer. METHODS: MEDLINE and Embase were searched for diagnostic accuracy studies that used 18F-FDG PET or PET/CT for pre-treatment staging, using surgical findings as the reference standard. Sensitivities and specificities were pooled and plotted in a hierarchic summary receiver operating characteristic plot. Potential causes of heterogeneity were explored through sensitivity analyses. RESULTS: Eight studies with 594 patients were included. The overall pooled sensitivity and specificity for metastasis were 0.72 (95% confidence interval [CI]=0.61–0.81) and 0.93 (95% CI=0.85–0.97), respectively. There was considerable heterogeneity in sensitivity (I2=97.57%) and specificity (I2=96.74%). In sensitivity analyses, studies that used laparotomy as the reference standard showed significantly higher sensitivity and specificity (0.77; 95% CI=0.67–0.87 and 0.96; 95% CI=0.92–0.99, respectively) than those including diagnostic laparoscopy (0.62; 95% CI=0.46–0.77 and 0.84; 95% CI=0.69–0.99, respectively). Higher specificity was shown in studies that confirmed surgical findings by pathologic evaluation (0.95; 95% CI=0.90–0.99) than in a study without pathologic confirmation (0.69; 95% CI=0.24–1.00). Studies with a lower prevalence of the FDG-avid subtype showed higher specificity (0.97; 95% CI=0.94–1.00) than those with a greater prevalence (0.89; 95% CI=0.80–0.97). CONCLUSION: Pre-treatment 18F-FDG PET/CT shows moderate sensitivity and high specificity for detecting metastasis in ovarian cancer. With its low false-positive rate, it can help select surgical approaches or alternative treatment options.
Electrons* ; Fluorodeoxyglucose F18 ; Humans ; Laparoscopy ; Laparotomy ; Neoplasm Metastasis* ; Ovarian Neoplasms* ; Population Characteristics ; Positron-Emission Tomography ; Positron-Emission Tomography and Computed Tomography ; Prevalence ; ROC Curve ; Sensitivity and Specificity

Dementia pugilistica (DP) or chronic traumatic encephalopathy (CTE) is a neurodegenerative disease or dementia that may affect amateur or professional boxers as well as athletes in other sports who suffer concussions. The condition is thought to affect around 15% to 20% of professional boxers and caused by repeated concussive or subconcussive blows. CTE was in the past referred to as dementia pugilistica, which reflected the prevailing notion that this condition was restricted to boxers. Recent research, however, has demonstrated neuropathological evidence of CTE in retired American football players, a professional wrestler, a professional hockey player and a soccer player, as well as in nonathletes. It is probable that many individuals are susceptible to CTE, including those who experience falls, motor vehicle accidents, assaults, epileptic seizures, or military combat, and that repeated mild closed head trauma of diverse origin is capable of instigating the neurodegenerative cascade leading to CTE. We report a 62-year old man suspicious of dementia pugilistica with clinical features of frontotemporal dementia and parkinsonism.
Athletes ; Brain Injury, Chronic ; Dementia ; Epilepsy ; Football ; Frontotemporal Dementia ; Head Injuries, Closed ; Hockey ; Humans ; Military Personnel ; Motor Vehicles ; Neurodegenerative Diseases ; Parkinsonian Disorders ; Soccer ; Sports

Objective: The purpose was to review the diagnostic performance of the length of tumor capsular contact (LCC) on magnetic resonance imaging (MRI) for detecting prostate cancer extraprostatic extension (EPE). Materials and Methods: PubMed and EMBASE databases were searched up to March 24, 2019. We included diagnostic accuracy studies that evaluated LCC on MRI for EPE detection using radical prostatectomy specimen histopathology as the reference standard. Quality of studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Sensitivity and specificity were pooled and graphically presented using hierarchical summary receiver operating characteristic (HSROC) plots. Meta-regression and subgroup analyses were conducted to explore heterogeneity. Results: Thirteen articles with 2136 patients were included. Study quality was generally good. Summary sensitivity and specificity were 0.79 (95% confidence interval [CI] 0.73–0.83) and 0.67 (95% CI 0.60–0.74), respectively. Area under the HSROC was 0.81 (95% CI 0.77–0.84). Substantial heterogeneity was present among the included studies according to Cochran’s Q-test (p < 0.01) and Higgins I2 (62% and 86% for sensitivity and specificity, respectively). In terms of heterogeneity, measurement method (curvilinear vs. linear), prevalence of Gleason score ≥ 7, MRI readers’ experience, and endorectal coils were significant factors (p ≤ 0.01), whereas method to determine the LCC threshold, cutoff value, magnet strength, and publication year were not (p = 0.14–0.93). Diagnostic test accuracy estimates were comparable across all assessed MRI sequences. Conclusion Greater LCC on MRI is associated with a higher probability of prostate cancer EPE. Due to heterogeneity among the studies, further investigation is needed to establish the optimal cutoff value for each clinical setting.

Chronic thromboembolic pulmonary hypertension (CTEPH), which is classified as a group 4 pulmonary hypertension (PH), is a life-threatening complication of acute pulmonary embolism (PE). With the introduction of multidisciplinary approaches and innovative treatment strategies for CTEPH, it is currently regarded not as a fatal disease, but as a curable form of PH.Ventilation/perfusion (V/Q) scan is the preferred imaging method for screening for CTEPH, with superior sensitivity to CT pulmonary angiography. The findings and interpretations of V/Q scan in CTEPH may differ from those observed in acute PE. The use of V/Q scan in combination with SPECT or SPECT/CT is becoming more popular than planar scan alone.Comprehensive understanding of the role of V/Q scan in CTEPH will assist in providing early diagnosis, proper therapeutic decision making, and improved prognosis. This review outlines the current roles and potential clinical applications of V/Q scan in the diagnosis and evaluation of CTEPH.

Chronic thromboembolic pulmonary hypertension (CTEPH), which is classified as a group 4 pulmonary hypertension (PH), is a life-threatening complication of acute pulmonary embolism (PE). With the introduction of multidisciplinary approaches and innovative treatment strategies for CTEPH, it is currently regarded not as a fatal disease, but as a curable form of PH.Ventilation/perfusion (V/Q) scan is the preferred imaging method for screening for CTEPH, with superior sensitivity to CT pulmonary angiography. The findings and interpretations of V/Q scan in CTEPH may differ from those observed in acute PE. The use of V/Q scan in combination with SPECT or SPECT/CT is becoming more popular than planar scan alone.Comprehensive understanding of the role of V/Q scan in CTEPH will assist in providing early diagnosis, proper therapeutic decision making, and improved prognosis. This review outlines the current roles and potential clinical applications of V/Q scan in the diagnosis and evaluation of CTEPH.

Chronic thromboembolic pulmonary hypertension (CTEPH), which is classified as a group 4 pulmonary hypertension (PH), is a life-threatening complication of acute pulmonary embolism (PE). With the introduction of multidisciplinary approaches and innovative treatment strategies for CTEPH, it is currently regarded not as a fatal disease, but as a curable form of PH.Ventilation/perfusion (V/Q) scan is the preferred imaging method for screening for CTEPH, with superior sensitivity to CT pulmonary angiography. The findings and interpretations of V/Q scan in CTEPH may differ from those observed in acute PE. The use of V/Q scan in combination with SPECT or SPECT/CT is becoming more popular than planar scan alone.Comprehensive understanding of the role of V/Q scan in CTEPH will assist in providing early diagnosis, proper therapeutic decision making, and improved prognosis. This review outlines the current roles and potential clinical applications of V/Q scan in the diagnosis and evaluation of CTEPH.

Chronic thromboembolic pulmonary hypertension (CTEPH), which is classified as a group 4 pulmonary hypertension (PH), is a life-threatening complication of acute pulmonary embolism (PE). With the introduction of multidisciplinary approaches and innovative treatment strategies for CTEPH, it is currently regarded not as a fatal disease, but as a curable form of PH.Ventilation/perfusion (V/Q) scan is the preferred imaging method for screening for CTEPH, with superior sensitivity to CT pulmonary angiography. The findings and interpretations of V/Q scan in CTEPH may differ from those observed in acute PE. The use of V/Q scan in combination with SPECT or SPECT/CT is becoming more popular than planar scan alone.Comprehensive understanding of the role of V/Q scan in CTEPH will assist in providing early diagnosis, proper therapeutic decision making, and improved prognosis. This review outlines the current roles and potential clinical applications of V/Q scan in the diagnosis and evaluation of CTEPH.

Chronic thromboembolic pulmonary hypertension (CTEPH), which is classified as a group 4 pulmonary hypertension (PH), is a life-threatening complication of acute pulmonary embolism (PE). With the introduction of multidisciplinary approaches and innovative treatment strategies for CTEPH, it is currently regarded not as a fatal disease, but as a curable form of PH.Ventilation/perfusion (V/Q) scan is the preferred imaging method for screening for CTEPH, with superior sensitivity to CT pulmonary angiography. The findings and interpretations of V/Q scan in CTEPH may differ from those observed in acute PE. The use of V/Q scan in combination with SPECT or SPECT/CT is becoming more popular than planar scan alone.Comprehensive understanding of the role of V/Q scan in CTEPH will assist in providing early diagnosis, proper therapeutic decision making, and improved prognosis. This review outlines the current roles and potential clinical applications of V/Q scan in the diagnosis and evaluation of CTEPH.