The objective of this study was to investigate whether metabolic tumor volume (MTV) by positron emission tomography (PET) can be a potential prognostic tool when compared with Ann Arbor stage, in stages II and III nodal diffuse large B cell lymphoma (DLBCL). We evaluated 169 patients with nodal stages II and III DLBCL who underwent measurements with PET prior to rituximab combined with cyclophosphamide, adriamycin, vincristine, and prednisone (R-CHOP). Cutoff point of MTV was measured using the receiver operating characteristic (ROC) curve. During a median period of 36 months, stage II was 59.2% and III was 40.8%. Using the ROC curve, the MTV of 220 cm3 was the cutoff value. The low MTV group (<220 cm3) had longer progression-free survival (PFS) and overall survival (OS), compared with the high MTV group (≥220 cm3) (p < 0.001, p < 0.001). Stage II patients had longer survival than those in stage III (PFS, p = 0.011; OS, p = 0.001). The high MTV group had lower PFS and OS patterns, regardless of stage, compared with the low MTV group (p < 0.001, p < 0.001). Multivariate analysis revealed an association of the high MTV group with lower PFS and OS (PFS, hazard ratio (HR) = 5.300, p < 0.001; OS, HR = 7.009, p < 0.001), but not stage III (PFS, p = 0.187; OS, p = 0.054). Assessment of MTV by PET had more potential predictive power than Ann Arbor stage in the patients that received R-CHOP.

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Background and Aims: This study evaluated the prognostic value of 18F-fluorodeoxyglucose positron emission tomography with integrated computed tomography (18F-FDG PET/CT) performed before and after concurrent chemoradiotherapy (CCRT) in esophageal cancer. Methods: We analyzed the prognosis of 50 non-metastatic squamous cell esophageal cancer (T1-4N0-2) patients who underwent CCRT with curative intent at Inje University Busan Paik Hospital and Haeundae Paik Hospital from 2009 to 2019. Median total radiation dose was 54 Gy (range 34-66 Gy). Our aim was to investigate the relationship between PET/CT values and prognosis. The primary end point was progression-free survival (PFS). Results: The median follow-up period was 9.9 months (range 1.7-85.7). Median baseline maximum standard uptake value (SUVmax) was 14.2 (range 3.2-27.7). After treatment, 29 patients (58%) showed disease progression. The 3-year PFS and overall survival (OS) were 24.2% and 54.5%, respectively. PFS was significantly lower ( P = 0.015) when SUVmax of initial PET/CT exceeded 10 (n = 22). However, OS did not reach a significant difference based on maximum SUV ( P = 0.282). Small metabolic tumor volume (≤14.1) was related with good PFS ( P = 0.002) and OS ( P = 0.001). Small total lesion of glycolysis (≤107.3) also had a significant good prognostic effect on PFS ( P = 0.009) and OS ( P = 0.025). In a subgroup analysis of 18 patients with follow-up PET/CT, the patients with SUV max ≤3.5 in follow-up PET/CT showed longer PFS ( P = 0.028) than those with a maximum SUV >3.5. Conclusion: Maximum SUV of PET/CT is useful in predicting prognosis of esophageal cancer patients treated with CCRT. Efforts to find more effective treatments for patients at high risk of progression are still warranted.

Neurosyphilis (NS) is an infection of the central nervous system, caused by the invasion of Treponema pallidum, which can occur in any stage of syphilis, particularly in the late stages of the disease. 1 NS presents with various clinical features, such as mimicking early onset Alzheimer's disease (AD), mild frontotemporal dementia (FTD) or primary psychiatric disease (PPD). 1-3 Brain magnetic resonance imaging (B-MRI) features seen in NS vary, and are usually presented as cerebral infarction, sulci widening, global/hippocampal predominant atrophy, white matter lesions, or meningitis. 4-7 Recently, diffuse temporoparietal hypometabolism and spared thalamic metabolism, in fluorodeoxy-glucose-positron emission tomography (FDG-PET), have been reported as new findings in NS. 3 In the current case report, the authors describe a patient with NS, who exhibited varied and complex clinical symptoms. B-MRI showed severe atrophy, involving bilateral medial temporal lobes (MTL), and abnormalities were detected in FDG-PET scan. CASE REPORTA 49-year-old male patient was hospitalized with a history of psychiatric manifestations since 10 months, personality changes, and progressive cognitive impairments. The patient had a history of exhibiting depressive behavior and at times anger, for about 10 months before admission. He also displayed the habit of repeating words and frequently mentioning past episodes. Sometimes, during conversations, the patient interrupted inappropriately or spoke on irrelevant subjects.Approximately 7-month before hospitalization, the patient experienced delusion and insomnia. He believed he was a genius with an IQ of 190. Occasionally,The clinical features and brain magnetic resonance image (B-MRI) findings in neurosyphilis (NS) are highly varied. Cortical atrophy, especially involving the medial temporal lobes (MTL), is a remarkable radiographic feature, reported in B-MRI scans, in cases of NS presenting with severe cognitive impairments. The observed MTL atrophy is similar to the atrophy seen in neurodegenerative disorders such as Alzheimer's disease (AD) or frontotemporal dementia (FTD). A fluorodeoxy-glucose-positron emission tomography (FDG-PET), used for the diagnosis of AD, commonly reveals global cortical hypometabolism, sparing basal ganglia and thalamus, in NS. We report a case of NS, with complex symptoms and bilateral MTL atrophy. FDG-PET imaging showed bilateral thalamic and right visual cortical glucose reduction, as well as diffuse cortical hypometabolism. This type of FDG-PET pattern is a new finding in the field of NS. FIG. 2. Fluorodeoxy-glucose-positron emission tomography. (A) Hypometabolism observed in bilateral frontal, parietal, and temporal lobes (more prominent on the right) (black arrows), and thalamus (white arrows). (B) Statistical parametric mapping analysis showing the hypometabolism in bilateral frontal, parietal, and temporal lobes, compared with age-matched controls. A B 176 http://www.j-nn.org