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Yoshiharu Miura - One of the best experts on this subject based on the ideXlab platform.

  • intramedullary Spinal Cord Metastasis from breast cancer mimicking delayed radiation myelopathy detection with 18 f fdg pet ct
    Nuclear Medicine and Molecular Imaging, 2016
    Co-Authors: Terufumi Kawamoto, Satoshi Kaito, Toshinari Yamashita, Yoshiharu Miura
    Abstract:

    We present the case of a 53-year-old woman with breast cancer who developed vertebral body metastases at the 7-10th thoracic vertebrae (Th7-10) and started radiotherapy in April 2011. Radiotherapy was administered in 15 fractions of 2.5 Gy each to the vertebral bodies. Total dose to the tumor was 37.5 Gy. She gradually developed severe paresthesia and numbness of the lower extremities, and sensory deficit below the Th7 level was revealed in July 2013. Laboratory tests, which included cerebroSpinal fluid analysis, were unremarkable. Magnetic resonance imaging (MRI) of the Spinal Cord demonstrated an intramedullary enhanced lesion extending at the Th7-8 level on gadolinium-enhanced images (Fig. 1a). T2-weighted images showed an oval hyperintense signal area and edema (Fig. 1b). Suspected diagnoses acCording to MRI were intramedullary Spinal Cord Metastasis (ISCM) or delayed radiation myelopathy (DRM). Subsequent F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) (injected dose, 267.7 MBq; serum glucose level, 103 mg/dl; time between injection and acquisition: 60 min [early], 120 min [delayed]) showed focal uptake at the Th7 to Th8 level of the Spinal Cord (maximum standardized uptake value [SUVmax]: 2.76, early; 3.60, delayed) on early (Fig. 1c) and delayed (Fig. 1d) slices. The avid lesion had fusiform morphology. Delayed FFDG PET-CT showed a 30.4 % increment of SUVmax (retention index was 30.4 %) that suggested malignancy; therefore we suspected ISCM. She received steroid pulse therapy for discrimination from DRM, but it was not effective and neurological findings were getting worse. Follow-up MRI showed expansion of the intramedullary lesion and new appearance of the vertebral body Metastasis at Th3 on gadolinium-enhanced images in April 2014 (Fig. 1e). On the basis of her clinical and radiological findings, ISCM was diagnosed. The results of such studies showed that most of the SUV values in malignant lesions were increased in the delayed scan and for most benign lesions these delayed values decreased [1]. In F-FDG PET/CT images, ISCM showed pathological FDG uptake, but, on the other hand, DRM showed no pathological FDG uptake [2, 3]. In conclusion, F-FDG PET/CT has an important role to play in the diagnosis of ISCM and the differentiation from DRM. * Yoshiharu Miura ymiura@cick.jp

Terufumi Kawamoto - One of the best experts on this subject based on the ideXlab platform.

  • intramedullary Spinal Cord Metastasis from breast cancer mimicking delayed radiation myelopathy detection with 18 f fdg pet ct
    Nuclear Medicine and Molecular Imaging, 2016
    Co-Authors: Terufumi Kawamoto, Satoshi Kaito, Toshinari Yamashita, Yoshiharu Miura
    Abstract:

    We present the case of a 53-year-old woman with breast cancer who developed vertebral body metastases at the 7-10th thoracic vertebrae (Th7-10) and started radiotherapy in April 2011. Radiotherapy was administered in 15 fractions of 2.5 Gy each to the vertebral bodies. Total dose to the tumor was 37.5 Gy. She gradually developed severe paresthesia and numbness of the lower extremities, and sensory deficit below the Th7 level was revealed in July 2013. Laboratory tests, which included cerebroSpinal fluid analysis, were unremarkable. Magnetic resonance imaging (MRI) of the Spinal Cord demonstrated an intramedullary enhanced lesion extending at the Th7-8 level on gadolinium-enhanced images (Fig. 1a). T2-weighted images showed an oval hyperintense signal area and edema (Fig. 1b). Suspected diagnoses acCording to MRI were intramedullary Spinal Cord Metastasis (ISCM) or delayed radiation myelopathy (DRM). Subsequent F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) (injected dose, 267.7 MBq; serum glucose level, 103 mg/dl; time between injection and acquisition: 60 min [early], 120 min [delayed]) showed focal uptake at the Th7 to Th8 level of the Spinal Cord (maximum standardized uptake value [SUVmax]: 2.76, early; 3.60, delayed) on early (Fig. 1c) and delayed (Fig. 1d) slices. The avid lesion had fusiform morphology. Delayed FFDG PET-CT showed a 30.4 % increment of SUVmax (retention index was 30.4 %) that suggested malignancy; therefore we suspected ISCM. She received steroid pulse therapy for discrimination from DRM, but it was not effective and neurological findings were getting worse. Follow-up MRI showed expansion of the intramedullary lesion and new appearance of the vertebral body Metastasis at Th3 on gadolinium-enhanced images in April 2014 (Fig. 1e). On the basis of her clinical and radiological findings, ISCM was diagnosed. The results of such studies showed that most of the SUV values in malignant lesions were increased in the delayed scan and for most benign lesions these delayed values decreased [1]. In F-FDG PET/CT images, ISCM showed pathological FDG uptake, but, on the other hand, DRM showed no pathological FDG uptake [2, 3]. In conclusion, F-FDG PET/CT has an important role to play in the diagnosis of ISCM and the differentiation from DRM. * Yoshiharu Miura ymiura@cick.jp

Satoshi Kaito - One of the best experts on this subject based on the ideXlab platform.

  • intramedullary Spinal Cord Metastasis from breast cancer mimicking delayed radiation myelopathy detection with 18 f fdg pet ct
    Nuclear Medicine and Molecular Imaging, 2016
    Co-Authors: Terufumi Kawamoto, Satoshi Kaito, Toshinari Yamashita, Yoshiharu Miura
    Abstract:

    We present the case of a 53-year-old woman with breast cancer who developed vertebral body metastases at the 7-10th thoracic vertebrae (Th7-10) and started radiotherapy in April 2011. Radiotherapy was administered in 15 fractions of 2.5 Gy each to the vertebral bodies. Total dose to the tumor was 37.5 Gy. She gradually developed severe paresthesia and numbness of the lower extremities, and sensory deficit below the Th7 level was revealed in July 2013. Laboratory tests, which included cerebroSpinal fluid analysis, were unremarkable. Magnetic resonance imaging (MRI) of the Spinal Cord demonstrated an intramedullary enhanced lesion extending at the Th7-8 level on gadolinium-enhanced images (Fig. 1a). T2-weighted images showed an oval hyperintense signal area and edema (Fig. 1b). Suspected diagnoses acCording to MRI were intramedullary Spinal Cord Metastasis (ISCM) or delayed radiation myelopathy (DRM). Subsequent F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) (injected dose, 267.7 MBq; serum glucose level, 103 mg/dl; time between injection and acquisition: 60 min [early], 120 min [delayed]) showed focal uptake at the Th7 to Th8 level of the Spinal Cord (maximum standardized uptake value [SUVmax]: 2.76, early; 3.60, delayed) on early (Fig. 1c) and delayed (Fig. 1d) slices. The avid lesion had fusiform morphology. Delayed FFDG PET-CT showed a 30.4 % increment of SUVmax (retention index was 30.4 %) that suggested malignancy; therefore we suspected ISCM. She received steroid pulse therapy for discrimination from DRM, but it was not effective and neurological findings were getting worse. Follow-up MRI showed expansion of the intramedullary lesion and new appearance of the vertebral body Metastasis at Th3 on gadolinium-enhanced images in April 2014 (Fig. 1e). On the basis of her clinical and radiological findings, ISCM was diagnosed. The results of such studies showed that most of the SUV values in malignant lesions were increased in the delayed scan and for most benign lesions these delayed values decreased [1]. In F-FDG PET/CT images, ISCM showed pathological FDG uptake, but, on the other hand, DRM showed no pathological FDG uptake [2, 3]. In conclusion, F-FDG PET/CT has an important role to play in the diagnosis of ISCM and the differentiation from DRM. * Yoshiharu Miura ymiura@cick.jp

Toshinari Yamashita - One of the best experts on this subject based on the ideXlab platform.

  • intramedullary Spinal Cord Metastasis from breast cancer mimicking delayed radiation myelopathy detection with 18 f fdg pet ct
    Nuclear Medicine and Molecular Imaging, 2016
    Co-Authors: Terufumi Kawamoto, Satoshi Kaito, Toshinari Yamashita, Yoshiharu Miura
    Abstract:

    We present the case of a 53-year-old woman with breast cancer who developed vertebral body metastases at the 7-10th thoracic vertebrae (Th7-10) and started radiotherapy in April 2011. Radiotherapy was administered in 15 fractions of 2.5 Gy each to the vertebral bodies. Total dose to the tumor was 37.5 Gy. She gradually developed severe paresthesia and numbness of the lower extremities, and sensory deficit below the Th7 level was revealed in July 2013. Laboratory tests, which included cerebroSpinal fluid analysis, were unremarkable. Magnetic resonance imaging (MRI) of the Spinal Cord demonstrated an intramedullary enhanced lesion extending at the Th7-8 level on gadolinium-enhanced images (Fig. 1a). T2-weighted images showed an oval hyperintense signal area and edema (Fig. 1b). Suspected diagnoses acCording to MRI were intramedullary Spinal Cord Metastasis (ISCM) or delayed radiation myelopathy (DRM). Subsequent F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) (injected dose, 267.7 MBq; serum glucose level, 103 mg/dl; time between injection and acquisition: 60 min [early], 120 min [delayed]) showed focal uptake at the Th7 to Th8 level of the Spinal Cord (maximum standardized uptake value [SUVmax]: 2.76, early; 3.60, delayed) on early (Fig. 1c) and delayed (Fig. 1d) slices. The avid lesion had fusiform morphology. Delayed FFDG PET-CT showed a 30.4 % increment of SUVmax (retention index was 30.4 %) that suggested malignancy; therefore we suspected ISCM. She received steroid pulse therapy for discrimination from DRM, but it was not effective and neurological findings were getting worse. Follow-up MRI showed expansion of the intramedullary lesion and new appearance of the vertebral body Metastasis at Th3 on gadolinium-enhanced images in April 2014 (Fig. 1e). On the basis of her clinical and radiological findings, ISCM was diagnosed. The results of such studies showed that most of the SUV values in malignant lesions were increased in the delayed scan and for most benign lesions these delayed values decreased [1]. In F-FDG PET/CT images, ISCM showed pathological FDG uptake, but, on the other hand, DRM showed no pathological FDG uptake [2, 3]. In conclusion, F-FDG PET/CT has an important role to play in the diagnosis of ISCM and the differentiation from DRM. * Yoshiharu Miura ymiura@cick.jp

Mohit Chawla - One of the best experts on this subject based on the ideXlab platform.

  • symptom management in patients with lung cancer diagnosis and management of lung cancer 3rd ed american college of chest physicians evidence based clinical practice guidelines
    Chest, 2013
    Co-Authors: Michael Simoff, Brian E Lally, Mark Slade, Wendy G Goldberg, Pyng Lee, Gaetane Michaud, Momen M Wahidi, Mohit Chawla
    Abstract:

    Background Many patients with lung cancer will develop symptoms related to their disease process or the treatment they are receiving. These symptoms can be as debilitating as the disease progression itself. To many physicians these problems can be the most difficult to manage. Methods A detailed review of the literature using strict methodologic review of article quality was used in the development of this article. MEDLINE literature reviews, in addition to Cochrane reviews and other databases, were used for this review. The resulting article lists were then reviewed by experts in each area for quality and finally interpreted for content. Results We have developed recommendations for the management of many of the symptom complexes that patients with lung cancer may experience: pain, dyspnea, airway obstruction, cough, bone Metastasis, brain Metastasis, Spinal Cord Metastasis, superior vena cava syndrome, hemoptysis, tracheoesophageal fistula, pleural effusions, venous thromboembolic disease, depression, fatigue, anorexia, and insomnia. Some areas, such as dyspnea, are covered in considerable detail in previously created high-quality evidence-based guidelines and are identified as excellent sources of reference. The goal of this guideline is to provide the reader recommendations based on evidence supported by scientific study. Conclusions Improved understanding and recognition of cancer-related symptoms can improve management strategies, patient compliance, and quality of life for all patients with lung cancer.