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Patients and Methods: In a group of 20 patients undergoing chemoradiation for larynx organ preservation after diagnosis of laryngeal and hypopharyngeal carcinoma, (18)F-fluordeoxyglucose positron emission tomography ((18)F-FDG-PET) was performed before the start of therapy. After i.v. application of 240 MBq FDG, a dynamic PET in 3-D-mode was performed over 90 min (Siemens CTI ECAT EXACT HR(+)). Analysis was done visually and semiquantitatively (60-90 min p.i.) following iterative reconstruction. Additional (18)F-FDG-PET investigations were done and correlated with the clinical outcome in 16/20 patients at 3 months and in 14/20 patients at 6 months after the end of therapy., Results: In 17/20 patients (85%), the preclinical (18)F-FDG-PET correlated well with the histologically confirmed primary tumor. Three cases were false negatives. In one case this was due to an increased glucose value (203 mg%). After 3 months, 8/13 (62%) patients showed a positive correlation between clinical and PET results (sensitivity 100%, specificity 70%). After 6 months, 9/11 (82%) patients presented clinically normal PET results. PET results were false negative in one case (sensitivity 67%, specificity 88%)., Conclusion: The data of our trial slightly reduce the enthusiasm of early (18)F-FDG-PET detection of residual disease after chemoradiation in resectable laryngeal or hypopharyngeal cancer. Further trials should optimize the calculation integrating the exact quantification of glucose metabolism with the aim of improving sensitivity and specificity.

Zusammenfassung: Einleitung: Wir berichten über einen herausfordernden Fall von Autoimmunenzephalitis bei einem Patienten mit einem Thymom, das Titin- und Acetylcholinrezeptor-Antikörper enthielt. Trotz Thymektomie und aggressiver Erstlinien-Immuntherapie erlitt er mehrere Schübe. Letztendlich wurden GABAA-Rezeptor-Antikörper identifiziert. Falldarstellung: Dieser 40-jährige Mann wurde mit Kopfschmerzen, Schwäche, Diplopie, Hörverlust und Anfällen, die bis zum Status epilepticus reichten, vorstellig. Eine Magnetresonanztomografie (MRT) des Gehirns zeigte multifokale kortikale und subkortikale, in der T2/Fluid-Attenuated-Inversion-Recovery-Bildgebung hyperintensive Läsionen ohne Verbesserung. Bei anfänglichen neuronalen Antikörpertests wurden nur Acetylcholinrezeptor- und Titin-Antikörper identifiziert. Der Patient zeigte mehrere schwere Schübe trotz vollständiger Thymomresektion, intravenöser Gabe von Methylprednisolon mit Immunglobulinen oder Plasmapherese und Mycophenolat-Mofetil. Die Zweitlinien-Immuntherapie mit Rituximab linderte die Symptome und normalisierte die Elektroenzephalografie (EEG)- und MRT-Befunde nach der Identifizierung von Anti-GABAA-Rezeptor-Antikörpern durch die umfassenderen neuronalen Antikörpertests auf Autoimmunenzephalitis. [ABSTRACT FROM AUTHOR]

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ZusammenfassungHintergrundVorraussetzung für Indikation und Wahl des geeigneten operativen Verfahrens bei Patienten mit Õsophaguskarzinom ist ein genaues präoperatives Staging. Ziel der prospektiven Studie war es, zu klären, ob eine Positronenemissionstomographie mit 18F-Fluoro-Deoxyglukose (FDG-PET) die Genauigkeit des präoperativen Lymphknotendiagnostik gegenüber der Computertomographie (CT) erhöht und die Wahl des operativen Zugangs zur Õsophagusresektion beeinflusst.Patienten und Methodik58 Patienten, 46 Männer und 12 Frauen (Alter 61 Jahre im Mittel), erhielten bei histologisch gesichertem Õsophaguskarzinom im Rahmen des Stagings ein FDG-PET von Hals, Thorax und Abdomen sowie ein CT von Thorax und Abdomen. Sensitivität, Spezifität und Genauigkeit bei der Erkennung histologisch gesicherter Lymphknotenmetastasen mit FDG-PET und CT wurden berechnet.ErgebnisseBei größerer Spezifität der FDG-PET war die Genauigkeit des CT sowohl für die Erkennung abdominaler (73% vs. 59%) als auch thorakaler Lymphknotenmetastasen (73% vs. 63%) höher. Bei 23 Patienten wurde die Indikation zur transhiatalen und bei 16 Patienten zur transthorakalen Õsophagusresektion gestellt. FDG-PET bestimmte die Verfahrenswahl dabei nicht.SchlussfolgerungIn der vorliegenden Studie hat die FDG-PET die Genauigkeit des herkömmlichen Lymphknotenstagings (CT) bei Patienten mit Õsophaguskarzinom nicht erhöht. Für die Verfahrenswahl ergaben sich keine neuen Konsequenzen. Auch wegen der hohen Kosten wird die PET-Untersuchung hauptsächlich im Rahmen von Studien oder bei fraglichen CT-Befunden indiziert sein. Steigerung der Sensitivität durch tumoraffinere Radiopharmaka und optimierte Geräteauflösung kann bei dem prinzipiellen Vorteil der Ganzkörperuntersuchung durch die PET neue Indikationen schaffen. [ABSTRACT FROM AUTHOR]