Usefulness of 18-fluorodeoxyglucose positron emission tomography in the evaluation of tumor cardiac thrombus from renal cell carcinoma

García, J.R.; Simó, Marc; Huguet, Marina; Ysamat, M.; Lomeña, Francisco

doi:10.1007/s12094-006-0169-7

Cited by 24 publications

(12 citation statements)

References 5 publications

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“…However, 18 F-FDG uptake is observed in a variety of benign and malignant conditions such as inflammation or tumors (31), thus reducing its specificity. Moreover, special caution should be used in the interpretation of 18 F-FDG uptake in the cardiac region, because of the high number of possible causes other than IE for a positive finding: recent thrombi (32), soft atherosclerotic plaques (33), vasculitis (34), primary and metastatic cardiac tumors (35,36), or simply a postsurgical inflammatory reaction (37). In clinical routine, focal areas of 18 F-FDG uptake at the heart in the absence of IE are quite commonly observed (Paola A. Erba, unpublished data, 2011; Fig.…”

Section: Discussionmentioning

confidence: 99%

Added Value of ^99mTc-HMPAO–Labeled Leukocyte SPECT/CT in the Characterization and Management of Patients with Infectious Endocarditis

Erba¹,

Conti²,

Lazzeri³

et al. 2012

J Nucl Med

208

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The clinical performance of the Duke Endocarditis Service criteria to establish the diagnosis of infectious endocarditis (IE) can be improved through functional imaging procedures such as radiolabeled leukocytes ( 99m Tc-hexamethylpropyleneamine oxime [HMPAO]-labeled white blood cells [WBC]). Methods: We assessed the value of 99m Tc-HMPAO-WBC scintigraphy including SPECT/CT acquisitions in a series of 131 consecutive patients with suspected IE. Patients with permanent cardiac devices were excluded. 99m Tc-HMPAO-WBC scintigraphy results were correlated with transthoracic or transesophageal echocardiography, blood cultures, and the Duke criteria. Results: Scintigraphy was true-positive in 46 of 51 and false-negative in 5 of 51 cases (90% sensitivity, 94% negative predictive value, and 100% specificity and positive predictive value). No false-positive results were found, even in patients with early IE evaluated within the first 2 mo from the surgical procedure. In 24 of 51 patients with IE, we also found extracardiac uptake, indicating septic embolism in 21 of 24. Despite the fact that septic embolism was found in 11 of 18 cases of Duke-definite IE, most of the added value from the 99m Tc-HMPAO-WBC scan for decision making was seen in patients in whom the Duke criteria yielded possible IE. The scan was particularly valuable in patients with negative or difficult-to-interpret echocardiographic findings because it correctly classified 11 of 88 of these patients as having IE. Furthermore, 3 patients were falsely positive at echocardiography but correctly negative at 99m Tc-HMPAO-WBC scintigraphy: these patients had marantic vegetations. Conclusion: Our results demonstrate the ability of 99m Tc-HMPAO-WBC scintigraphy to reduce the rate of misdiagnosed cases of IE when combined with standard diagnostic tests in several situations: when clinical suspicion is high but echocardiographic findings are inconclusive; when there is a need for differential diagnosis between septic and sterile vegetations detected at echocardiography; when echocardiographic, laboratory, and clinical data are contradictory; and when valve involvement (especially of a prosthetic valve) needs to be excluded during febrile episodes, sepsis, or postsurgical infections.

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Section: Discussionmentioning

confidence: 99%

Added Value of ^99mTc-HMPAO–Labeled Leukocyte SPECT/CT in the Characterization and Management of Patients with Infectious Endocarditis

Erba¹,

Conti²,

Lazzeri³

et al. 2012

J Nucl Med

208

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“…Coronary occlusion or compression from tumor masses can lead to myocardial infarction, heart failure, and death [12]. A typical clinical pattern of cardiac ccRCC disease progression is characterized by a worsening performance status, exacerbation of cardiac symptoms, including tamponade, arrhythmia, obstruction, or dilated cardiomyopathy, representing one of the terminal events as in the case of the reported patient [30]. Coronary occlusion or compression from tumor masses may also lead to myocardial infarction and death [12].…”

Section: Discussionmentioning

confidence: 99%

“…Also necrosis, extra-cardiac spread, and pericardial effusion may be identified with cardiac MRI [31]. Transthoracic echocardiography, transesophageal echocardiography, and PET-CT may also be used to diagnose cardiac metastases [20,30]. The capability of PET for absolute quantification in general and for blood flow quantification in particular is a substantial advantage.…”

Section: Discussionmentioning

confidence: 99%

Renal cell carcinoma with intramyocardial metastases

et al. 2014

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BackgroundCardiac metastases from renal cell carcinoma without vena caval involvement are extremely rare with a limited number of cases reported in the worldwide literature until now. Nevertheless, this rare location of metastasis may significantly influence patient treatment and prognosis. Cooperation between oncology, cardiology, and urology teams are indispensable in cases of patients suffering from intramyocardial tumors. For these individuals, treatment guidelines based on large-scale studies are unavailable and only case/case series analysis may provide clinicians with decision assistance.Case presentationIn this paper, we report a case of a 50-year-old Caucasian male diagnosed with a 10.2 × 10.3 × 10.0 cm lower pole left renal mass in January 2002. He was subsequently treated with immunochemotherapy, tyrosine kinase inhibitors (TKIs), and mTOR inhibitors (mTORIs) - that is sunitinib, everolimus, and sorafenib. In March 2012, contrast-enhancing tumors in the left myocardium (∅22 mm) and in the interventricular septum (∅26 mm) were seen on CT. Cardiology testing was conducted and the patient was treated with pazopanib with a profound response. Overall survival since the clear cell renal cell carcinoma (ccRCC) diagnosis was 11 years 2 months and since diagnosis of multiple heart metastases was 1 year.ConclusionsCardiac metastases present a unique disease course in renal cell carcinoma. Cardiac metastases may remain asymptomatic, as in the case of this patient at the time of diagnosis. The most common cardiac presentation of renal cell carcinoma is hypertension, but other cardiac presentations include shortness of breath, cough, and arrhythmias. Targeted systemic therapy with tyrosine kinase inhibitors may be useful for this group of patients, but necrosis in the myocardium can result in tamponade and death. Regular cardiac magnetic resonance imaging scans are required for treatment monitoring.

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“…In the evaluation of distant metastases from RCC, FDG PET in not a sensitive imaging modality and may not adequately characterize small metastatic lesion 14. FDG study might demonstrate tumor invasion of the right renal vein and infra-hepatic inferior vena cava 15–17…”

Section: Discussionmentioning

confidence: 99%

Photon-deficient Mass on FDG-PET Scan in Renal Cell Carcinoma: A Case Report

Shih

Mitchell

et al. 2008

Clinical Medicine: Case Reports

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F-18 Fluorodeoxyglucose Positron Emission Tomography imaging (F-18 FDG PET) detects malignancies depending on the uptake profi le of glycolysis of tumors; however, the role of FDG PET is limited in the evaluation of primary renal malignancy because of low FDG uptake by renal cell carcinoma and also because normal urinary excretion of FDG seen in the images. A patient with renal cell carcinoma whose FDG PET imaging study incidentally shows a photon-defi cient mass in the upper pole of the right kidney is present here. The diagnosis is also validated by the histopathological fi ndings of tumor necrosis, hemorrhage, and scars.

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Usefulness of 18-fluorodeoxyglucose positron emission tomography in the evaluation of tumor cardiac thrombus from renal cell carcinoma

Abstract: Whole-body FDG PET in RCC patients could help to diagnose cardiac metastasis, and allows the possibility of therapeutic surgery, due to the thrombus significance of heart involvement.

Cited by 24 publications

References 5 publications

Added Value of ^99mTc-HMPAO–Labeled Leukocyte SPECT/CT in the Characterization and Management of Patients with Infectious Endocarditis

Added Value of ^99mTc-HMPAO–Labeled Leukocyte SPECT/CT in the Characterization and Management of Patients with Infectious Endocarditis

Renal cell carcinoma with intramyocardial metastases

Photon-deficient Mass on FDG-PET Scan in Renal Cell Carcinoma: A Case Report

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Usefulness of 18-fluorodeoxyglucose positron emission tomography in the evaluation of tumor cardiac thrombus from renal cell carcinoma

Abstract: Whole-body FDG PET in RCC patients could help to diagnose cardiac metastasis, and allows the possibility of therapeutic surgery, due to the thrombus significance of heart involvement.

Cited by 24 publications

References 5 publications

Added Value of 99mTc-HMPAO–Labeled Leukocyte SPECT/CT in the Characterization and Management of Patients with Infectious Endocarditis

Added Value of 99mTc-HMPAO–Labeled Leukocyte SPECT/CT in the Characterization and Management of Patients with Infectious Endocarditis

Renal cell carcinoma with intramyocardial metastases

Photon-deficient Mass on FDG-PET Scan in Renal Cell Carcinoma: A Case Report

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Product

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Added Value of ^99mTc-HMPAO–Labeled Leukocyte SPECT/CT in the Characterization and Management of Patients with Infectious Endocarditis

Added Value of ^99mTc-HMPAO–Labeled Leukocyte SPECT/CT in the Characterization and Management of Patients with Infectious Endocarditis