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array:24 [ "pii" => "S225380891200050X" "issn" => "22538089" "doi" => "10.1016/j.remnie.2012.05.003" "estado" => "S300" "fechaPublicacion" => "2012-05-01" "aid" => "302" "copyright" => "Elsevier España, S.L. and SEMNIM" "copyrightAnyo" => "2011" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Rev Esp Med Nucl Imagen Mol. 2012;31:124-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1466 "formatos" => array:2 [ "HTML" => 1207 "PDF" => 259 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0212698211001613" "issn" => "2253654X" "doi" => "10.1016/j.remn.2011.05.002" "estado" => "S300" "fechaPublicacion" => "2012-05-01" "aid" => "302" "copyright" => "Elsevier España, S.L. y SEMNIM" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Rev Esp Med Nucl Imagen Mol. 2012;31:124-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2606 "formatos" => array:2 [ "HTML" => 2205 "PDF" => 401 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "¿Resulta rentable un estudio selectivo cerebral con <span class="elsevierStyleSup">18</span>F-FDG-PET/TAC en los pacientes con cáncer microcítico de pulmón?" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "124" "paginaFinal" => "129" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Is a selective brain <span class="elsevierStyleSup">18</span>F-FDG PET/CT study profitable in patients with small cell lung cancer?" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2403 "Ancho" => 2485 "Tamanyo" => 447259 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Imágenes de la TAC, PET y la fusión de ambas en un paciente con cáncer microcítico de pulmón (A), estadio IV debido a lesiones en ambas glándulas suprarrenales (B). El paciente se encontraba asintomático neurológicamente y 15 días después de la realización del estudio PET/TAC comenzó con sintomatología (vómitos y cefalea). En el estudio selectivo cerebral (C) se aprecian varias lesiones tanto en la imagen morfológica como en la metabólica. Al menos dos de las lesiones mostraban hipometabolismo (flechas blancas) en el cerebelo derecho, evidenciándose otra lesión de carácter mixto, con área de hipometabolismo en la región anterior y aumento glucídico en la porción posterior, en el temporal izquierdo (flecha negra).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Palomar Muñoz, A.M. García Vicente, M.E. Bellón Guardia, B. González García, M.P. Talavera Rubio, J.P. Pilkington Woll, A. Núñez García, V.M. Poblete García, J.M. Cordero García, A. Soriano Castrejón" "autores" => array:10 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Palomar Muñoz" ] 1 => array:2 [ "nombre" => "A.M." "apellidos" => "García Vicente" ] 2 => array:2 [ "nombre" => "M.E." "apellidos" => "Bellón Guardia" ] 3 => array:2 [ "nombre" => "B." "apellidos" => "González García" ] 4 => array:2 [ "nombre" => "M.P." "apellidos" => "Talavera Rubio" ] 5 => array:2 [ "nombre" => "J.P." "apellidos" => "Pilkington Woll" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "Núñez García" ] 7 => array:2 [ "nombre" => "V.M." "apellidos" => "Poblete García" ] 8 => array:2 [ "nombre" => "J.M." "apellidos" => "Cordero García" ] 9 => array:2 [ "nombre" => "A." "apellidos" => "Soriano Castrejón" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S225380891200050X" "doi" => "10.1016/j.remnie.2012.05.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S225380891200050X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0212698211001613?idApp=UINPBA00004N" "url" => "/2253654X/0000003100000003/v1_201305061106/S0212698211001613/v1_201305061106/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2253808912000493" "issn" => "22538089" "doi" => "10.1016/j.remnie.2012.05.002" "estado" => "S300" "fechaPublicacion" => "2012-05-01" "aid" => "308" "copyright" => "Elsevier España, S.L. and SEMNIM" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Rev Esp Med Nucl Imagen Mol. 2012;31:130-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1486 "formatos" => array:2 [ "HTML" => 1200 "PDF" => 286 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Contribution of the portable gamma camera to detect the sentinel node in breast cancer during surgery" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "130" "paginaFinal" => "134" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Aportación de una gammacámara portátil en la localización intraoperatoria del ganglio centinela en el cáncer de mama" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2360 "Ancho" => 2370 "Tamanyo" => 270121 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">SPECT-CT image performed the day before surgery (a) showing two sentinel lymph nodes (red crosses). Intraoperative image in lateral projection (b) depicting a sentinel lymph node (red cross) and injection points (green arrow). Following removal of this node and a scan with negative gamma probe a new deposit (red cross) is observed in the intraoperative scintigraphy (c). After a new exhaustive search with the probe in the zone indicated in the image another lymph node was removed. A new image is made demonstrating no residual activity (d). The technique was negative for malignancy. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Cardona-Arboniés, J. Mucientes-Rasilla, A. Moreno Elola-Olaso, G. Salazar-Andía, A. Prieto-Soriano, J. Chicharo de Freitas, J.M. Román-Santamaría, J.L. Carreras-Delgado" "autores" => array:8 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Cardona-Arboniés" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Mucientes-Rasilla" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Moreno Elola-Olaso" ] 3 => array:2 [ "nombre" => "G." "apellidos" => "Salazar-Andía" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Prieto-Soriano" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Chicharo de Freitas" ] 6 => array:2 [ "nombre" => "J.M." "apellidos" => "Román-Santamaría" ] 7 => array:2 [ "nombre" => "J.L." "apellidos" => "Carreras-Delgado" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0212698211001777" "doi" => "10.1016/j.remn.2011.05.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0212698211001777?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808912000493?idApp=UINPBA00004N" "url" => "/22538089/0000003100000003/v1_201305061126/S2253808912000493/v1_201305061126/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2253808912000481" "issn" => "22538089" "doi" => "10.1016/j.remnie.2012.05.001" "estado" => "S300" "fechaPublicacion" => "2012-05-01" "aid" => "296" "copyright" => "Elsevier España, S.L. and SEMNIM" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Rev Esp Med Nucl Imagen Mol. 2012;31:117-23" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1363 "formatos" => array:2 [ "HTML" => 1074 "PDF" => 289 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Sentinel lymph node biopsy in patients with operable breast cancer treated with neoadjuvant chemotherapy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "117" "paginaFinal" => "123" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Biopsia del ganglio centinela en pacientes con cáncer de mama operable tratadas con quimioterapia neoadyuvante" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1576 "Ancho" => 1667 "Tamanyo" => 145042 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">CONSORT flow diagram of the patients.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Á.C. Rebollo-Aguirre, M. Gallego-Peinado, S. Menjón-Beltrán, J. García-García, E. Pastor-Pons, C.E. Chamorro-Santos, C. Ramos-Font, A. Salamanca-Ballesteros, J.M. Llamas-Elvira, N. Olea-Serrano" "autores" => array:10 [ 0 => array:2 [ "nombre" => "Á.C." "apellidos" => "Rebollo-Aguirre" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Gallego-Peinado" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Menjón-Beltrán" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "García-García" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "Pastor-Pons" ] 5 => array:2 [ "nombre" => "C.E." "apellidos" => "Chamorro-Santos" ] 6 => array:2 [ "nombre" => "C." "apellidos" => "Ramos-Font" ] 7 => array:2 [ "nombre" => "A." "apellidos" => "Salamanca-Ballesteros" ] 8 => array:2 [ "nombre" => "J.M." "apellidos" => "Llamas-Elvira" ] 9 => array:2 [ "nombre" => "N." "apellidos" => "Olea-Serrano" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0212698211001558" "doi" => "10.1016/j.remn.2011.04.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0212698211001558?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808912000481?idApp=UINPBA00004N" "url" => "/22538089/0000003100000003/v1_201305061126/S2253808912000481/v1_201305061126/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Is a selective brain <span class="elsevierStyleSup">18</span>F-FDG PET/CT study profitable in patients with small cell lung cancer?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "124" "paginaFinal" => "129" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Palomar Muñoz, A.M. García Vicente, M.E. Bellón Guardia, B. González García, M.P. Talavera Rubio, J.P. Pilkington Woll, A. Núñez García, V.M. Poblete García, J.M. Cordero García, A. Soriano Castrejón" "autores" => array:10 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Palomar Muñoz" "email" => array:1 [ 0 => "azaharap@sescam.jccm.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A.M." "apellidos" => "García Vicente" ] 2 => array:2 [ "nombre" => "M.E." "apellidos" => "Bellón Guardia" ] 3 => array:2 [ "nombre" => "B." "apellidos" => "González García" ] 4 => array:2 [ "nombre" => "M.P." "apellidos" => "Talavera Rubio" ] 5 => array:2 [ "nombre" => "J.P." "apellidos" => "Pilkington Woll" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "Núñez García" ] 7 => array:2 [ "nombre" => "V.M." "apellidos" => "Poblete García" ] 8 => array:2 [ "nombre" => "J.M." "apellidos" => "Cordero García" ] 9 => array:2 [ "nombre" => "A." "apellidos" => "Soriano Castrejón" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Medicina Nuclear, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Resulta rentable un estudio selectivo cerebral con <span class="elsevierStyleSup">18</span>F-FDG-PET/TAC en los pacientes con cáncer microcítico de pulmón?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1825 "Ancho" => 2422 "Tamanyo" => 428089 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">(A) Selective cerebral staging study (images of CT, PET and fusion PET/CT) in axial slices. No significant alterations were observed in the distribution of FDG nor were parenchymatous alterations found in the CT image. (B) Selective cerebral study in the same patient who remained neurologically asymptomatic five months after staging performed to evaluate response to the treatment showing a round-shaped lesion in the right parietal region in the CT image with hypometabolism in the PET image and the fusion PET/CT (arrows). Given the absence of neurological symptomatology, between the two PET/CT studies, no cerebral procedure was carried out (contrast CT or MRI).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In the last decades, lung cancer has become one of the neoplastic diseases with the highest incidence in our country (a little more than 23,000 new cases per year), only behind colorectal tumors in a general sense and prostate and breast cancer related to specific pathologies for males and females, respectively.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In addition, lung cancer presents a high mortality (approximately 20,000 individuals per year) with an ascending trend.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The frequency of metastasis in lung cancer is high, with the localization most often observed being the central nervous system.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The probability of the appearance of metastasis varies based on the stage of the disease at diagnosis, being 7.5% for patients in stage I, 18% in stage II and 24% for those in stage III. The histological type is the second most important factor in the development of metastasis, with cerebral metastasis at diagnosis in 15% of the patients with small cell lung carcinoma, rising up to 20% due to the introduction of magnetic resonance imaging (MRI).<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In the case of non small cell tumors the incidence of the appearance of metastasis is of approximately 40%,<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–8</span></a> with adenocarcinomas presenting a higher percentage of cerebral metastasis than the remaining histologies.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">According to EUROCARE-4<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> the one-year survival of patients with lung cancer is only 36.9%, decreasing to 12% at 5 years and further diminishing to 3–6 months after diagnosis in cases presenting cerebral metastasis.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">With respect to the staging of these patients the usefulness of positron emission tomography with <span class="elsevierStyleSup">18</span>F-FDG associated with computerized tomography (<span class="elsevierStyleSup">18</span>F-FDG PET/CT) is well known and is indicated in the staging and detection of metastasis, the diagnosis of recurrence and monitoring of response to treatment.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13–15</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In the specific case of the detection of cerebral lesions, MRI<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> shows the greatest profitability due to the lower sensitivity of <span class="elsevierStyleSup">18</span>F-FDG. Nonetheless, the protocol to follow in the detection of cerebral metastasis remains to be established since it varies according to the different groups.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,17–19</span></a> Some authors recommend cerebral MRI in patients who are candidates for curative treatment and not in an early stage,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> while others suggest both cerebral MRI and CT with contrast in patients with advanced stages despite being asymptomatic<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> or that they should be performed only in symptomatic cases or in those receiving chemoradiotherapy.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In view of the absence of consensus and the important clinical and prognostic implications involved in the detection of cerebral metastatic disease we decided to undertake a selective cerebral study with <span class="elsevierStyleSup">18</span>F-FDG-PET/CT in all the patients diagnosed with lung cancer. Due to the greater metastatic aggressiveness and worse prognosis of the patients with small cell cancer we evaluated the diagnostic performance achieved with selective cerebral PET/CT in neurologically asymptomatic patients. Likewise, we attempted to define the presence of any factor to predict the greater probability of cerebral disease with the aim of determining the group at risk to justify more exhaustive cerebral studies.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patients</span><p id="par0035" class="elsevierStylePara elsevierViewall">We retrospectively analyzed 300 patients referred to our department for suspicion of lung cancer from July 2008 to December 2009, excluding those with absence of histological confirmation or with a follow-up of less than 6 months. Of these 300 patients we only selected those histologically presenting small cell lung carcinoma in whom PET/CT was requested for staging prior to treatment and thus, the final sample included 21 patients (18 males and 3 females) with a mean age of 66.57 years (range: 45–83). All were asymptomatic from a neurological point of view. The mean follow-up was of 10.4 months (range: 3–19). <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the clinical characteristics of the patients.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">PET/CT methodology and image evaluation</span><p id="par0040" class="elsevierStylePara elsevierViewall">All the patients underwent <span class="elsevierStyleSup">18</span>F-FDGPET/CT study following the standard procedure<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> using hybrid equipment (Discovery DSTE 16, GE Healthcare). Initially a whole-body scan was performed (from the base of the cranium to the upper third of the lower extremities) with acquisition beginning with the transmission study with CT at low doses (120<span class="elsevierStyleHsp" style=""></span>keV, 80<span class="elsevierStyleHsp" style=""></span>mA) without intravenous contrast, followed by a tridimensional (3D) emission study at 3<span class="elsevierStyleHsp" style=""></span>min per bed. Posteriorly the patients were submitted to a selective cerebral 3D study with an acquisition time of 10<span class="elsevierStyleHsp" style=""></span>min per bed, also without intravenous contrast. The PET images were reconstructed using the CT images for enhancement correction and after the use of the iterative reconstruction algorithm. The images of the PET and CT studies and the fusion images of both techniques in axial, coronal and sagittal projection were independently evaluated by at least two experts in nuclear medicine.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The whole-body scans were classified based on the TNM classification<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> determining the change in stage induced by PET/CT in each case.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The selective cerebral studies were evaluated visually, confirming the metabolic alterations by measurement of the Standard Uptake Value of the area of the lesion and the contralateral side and correlating these with the morphologic image obtained.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> A positive cerebral study was considered with the presence of alterations (hypermetabolism or areas of reduction in metabolism) in the distribution of the radiotracer in the absence of known benign lesions (meningioma, arteriovenous malformation or previous infarction) in the CT. Negative cerebral studies were those with no alterations in the distribution of FDG in the cerebral parenchyma.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Final diagnosis</span><p id="par0055" class="elsevierStylePara elsevierViewall">The final diagnosis was achieved by cerebral MRI with or without intravenous contrast, CT with intravenous contrast or by clinical follow-up of at least 6 months. Patients with negative imaging studies or who were neurologically asymptomatic during the follow-up were classified as free of cerebral disease.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Statistical analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">Descriptive analysis of the patient data was performed using the Med Calc 11.3.1.0 program. The analyses of sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) and statistical precision in the diagnosis of cerebral metastasis were carried out with Epidat 3.1.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">Only five patients presented cerebral metastasis during follow-up. Of these three were correctly diagnosed with <span class="elsevierStyleSup">18</span>F-FDG-PET/CT. Two were classified as stage IV after the whole-body scan on the detection of metastasis in other localization and one of these went from stage III to stage IV after the cerebral study showed only metastatic disease at a cerebral level.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Two false negatives were observed; in both cases the cerebral metastases were diagnosed 5 months after the staging PET/CT study. One of the patients had been classified as stage III at the time of the PET/CT. In the other patient, who remained neurologically asymptomatic, cerebral metastases were diagnosed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) 5 months after the staging PET/CT study (stage IV for metastasis in the adrenal glands). After the reevaluation PET/CT study for assessment of response to treatment an area of hypometabolism was observed, with posterior confirmation of the lesion by MRI. Due to the absence of neurological manifestations in this case, no other diagnostic tests (cerebral CT with contrast or MRI) have been performed.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Of the three patients correctly classified after the selective cerebral PET/CT study only one showed a hypermetabolic lesion while the second presented two hypometabolic lesions and the third patient showed three hypometabolic lesions and one mixed lesion with areas of hypermetabolism and hypometabolism (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The characteristics of the cerebral lesions of each patient are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. The values of sensitivity, specificity, PPV, NPV and statistical precision with confidence intervals of 95% were 60% (14.6–94.73%), 100% (74.91–100%), 100% (29.24–100%) and 88.89% (65.29–98.62%), respectively. The statistical precision was 7%.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleSup">18</span>F-DG-PET/CT induced a change in staging with the detection of disseminated disease (stage IV) in 7 patients (33%). In one of these patients lesions were observed in the contralateral lung, four cases showed bone involvement, one presented involvement of the suprarenal glands and the last patient had the previously described cerebral involvement. Cerebral metastasis was found at the time of diagnosis in stage IV in 60% of the patients.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">The role of <span class="elsevierStyleSup">18</span>F-FDG-PET/CT in the staging of lung cancer is well established since, according to the different series, 30% of the cases<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26–30</span></a> show metastatic lesions not suspected by other imaging techniques similar to what occurred in 33% of our patients in whom the stage was modified. On the other hand, to evaluate cerebral lesions in these patients, the last guidelines of the National Comprehensive Cancer Network<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> do not recommend the use of <span class="elsevierStyleSup">18</span>F-FDG-PET since this radiotracer does not provide high diagnostic performance.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> Nonetheless, CT and MRI studies are recommended for early diagnosis since 30% of the patients with cerebral metastasis remain asymptomatic in the early stages. This allows the implementation of earlier treatment which carries a reduction in complications and morbidity, with prophylactic cranial radiation being recommended in some cases.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> Some groups<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> perform cerebral PET studies to confirm single cerebral lesions, considering that patients in stages IIIb or IV with a single metastasis may be candidates for curative rather than palliative treatment. On the other hand, other groups<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> complement the standard <span class="elsevierStyleSup">18</span>F-FDG-PET study with extension of a field in which the cerebral parenchyma is acquired since this does not produce significant radiologic overexposure or they perform late cerebral PET images to confirm the presence of cerebral lesions.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">35–38</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The detection of metastatic cerebral disease not suspected by PET/CT has a fundamental connotation in that it allows the implementation of early treatment. This practice may increase both the survival and the quality of life since patients with untreated cerebral metastasis have a very reduced survival (approximately one month after diagnosis).<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">It is important to note that the greatest incidence of cerebral lesions was found in patients with stage IV (60%) and thus, we suggest that cerebral studies should be performed in all patients presenting this stage.</p><p id="par0100" class="elsevierStylePara elsevierViewall">MRI is the technique with the greatest diagnostic performance in the detection of lesions of the central nervous system. Nonetheless, the different types of imaging may provide valuable information for the diagnosis of cerebral lesions.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> Therefore, despite the limitation of <span class="elsevierStyleSup">18</span>F-FDG-PET due to the high metabolism at the cortical level, the PET and CT image corregister aids in the interpretation of the PET findings. This corregistered image is particularly useful in hypometabolic lesions, providing a simple definition of its correspondence with areas of perilesional edema such as in the case of cerebral metastasis. Thus, in relation to the metabolic nature of the cerebral metastases, it is important to note that in our series we observed hypometabolism in most of the lesions detected. Indeed, two of the five patients with cerebral metastasis in our series presented a reduction in metabolic activity in the cerebral parenchyma in five lesions, coinciding with areas of edema shown in the localizing CT image, and one of the patients presented a mixed lesion (hypermetabolic and hypometabolic). Moreover, it should be underlined that many patholgies may appear with hypermetabolic areas,<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> leading to confusion in the interpretation in the absence of knowledge of previous neurological manifestations of the patient such as acute cerebral ischemia, meningioma or infectious diseases, among others.</p><p id="par0105" class="elsevierStylePara elsevierViewall">We are aware that our sample size was small. However, the values of sensitivity and specificity obtained (60% and 100%, respectively), the statistical precision of 7%, and the fact of not selecting the patients, led us to reassert the advantage provided by a protocol of cerebral PET/CT in small cell lung carcinoma for the early diagnosis of cerebral lesions, especially in advanced stages.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Another drawback to take into account is the acquisition of cerebral CT in a non-diagnostic protocol without intravenous contrast. The limited morphological evaluation of cerebral parenchyma did allow diagnosis of the 2 lesions not detected in the staging PET. Despite the lower sensitivity of CT compared with cerebral MRI, we believe that the administration of radiological contrast and the acquisition in the diagnostic protocol for CT may provide better resolution and definition of the lesions detected by PET or may even allow the diagnosis of small lesions without metabolic translation. Indeed, some authors have suggested that the administration of intravenous contrast in the PET/CT study, even at low doses and including a selective cerebral study, may be sufficient to improve the detection of cerebral metastases thereby reducing the radiation received by the patient.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">We consider that the absence of symptoms within the six months following the PET/CT study may be a sufficiently safe parameter for final clinical classification of patients without cerebral imaging studies since this disease, especially in advanced stages, evolves rapidly. Although contradictory, the cerebral PET detected disease during the post-treatment follow-up of one of the patients with initial negative PET five months later, with the patient remaining neurologically asymptomatic.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0120" class="elsevierStylePara elsevierViewall">Although <span class="elsevierStyleSup">18</span>F-FDG-PET/CT is not generally recommended in the diagnosis of cerebral metastasis, the use of a selective cerebral study together with the standard study in patients with small cell lung cancer, especially in cases with disseminated disease at other levels, allows more correct staging as well as the detection of unsuspected cerebral metastatic lesions with important prognostic and therapeutic implications. It should be considered that any alteration in the distribution of FDG in the cerebral parenchyma should lead to suspicion of the presence of malignant lesions in this area since the alterations observed in PET images often correspond with areas of cerebral edema and are, therefore, hypometabolic.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres120312" "titulo" => array:5 [ 0 => "Abstract" 1 => "Aim" 2 => "Material and methods" 3 => "Results" 4 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec107593" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres120311" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivo" 2 => "Material y métodos" 3 => "Resultados" 4 => "Conclusión" ] ] 3 => array:2 [ "identificador" => "xpalclavsec107592" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "PET/CT methodology and image evaluation" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Final diagnosis" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusion" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-02-24" "fechaAceptado" => "2011-05-03" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec107593" "palabras" => array:3 [ 0 => "PET/CT" 1 => "Small cell lung cancer" 2 => "Brain metastases" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec107592" "palabras" => array:3 [ 0 => "PET/TAC" 1 => "Cáncer de pulmón microcítico" 2 => "Metástasis cerebrales" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Aim</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate the diagnostic yield of a selective brain <span class="elsevierStyleSup">18</span>F-FDG PET/CT in neurologically asymptomatic patients with small cell lung cancer.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Twenty-one neurologically asymptomatic patients referred to our service between July 2008 and December 2009 for staging of small cell lung cancer were included in the study. All underwent a standard <span class="elsevierStyleSup">18</span>F-FDG PET/CT study followed by a selective brain PET/CT. The neurological findings were confirmed by CT scan with intravenous contrast, MRI or minimum clinical follow-up of 6 months.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The brain PET/CT was considered positive if any alteration was observed in the FDG distribution that was not related with previously known benign lesion in the CT image.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Brain metastases were detected in 5 of the 21 patients (23.8%), these being correctly classified in 3 of them by the selective brain PET/CT. The stage was upgraded in one of them with the selective brain study. Only one patient showed a hypermetabolic lesion in the PET images in relationship to the lesions observed in the CT images. Sensitivity, specificity, positive predictive value and negative predictive value were 60, 100, 100 and 88.89%, respectively.</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Hypometabolic areas in the cerebral parenchyma are frequently associated to metastatic lesions in patients with small cell lung cancer. The selective brain PET/CT in these patients allows correct staging and early treatment of unsuspected metastasis.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Evaluar la rentabilidad diagnóstica del estudio selectivo cerebral con <span class="elsevierStyleSup">18</span>F-FDG-PET/TAC en pacientes con cáncer microcítico de pulmón asintomáticos neurológicamente.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron en el estudio 21 pacientes derivados a nuestro servicio entre julio de 2008 y diciembre de 2009, para estadificación, con histología de carcinoma microcítico de pulmón y asintomáticos neurológicamente. A todos ellos se les realizó un estudio <span class="elsevierStyleSup">18</span>F-FDG-PET/TAC estándar y a continuación un estudio selectivo cerebral, y se confirmaron los hallazgos neurológicos mediante TAC con contraste intravenoso, RM o seguimiento clínico mínimo de 6 meses. Un estudio cerebral PET fue considerado positivo si mostraba cualquier alteración en la distribución de la FDG no relacionada con lesiones benignas previas en la TAC cerebral.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En 5 de los 21 pacientes (23,8%) se detectaron metástasis cerebrales, siendo correctamente diagnosticados mediante <span class="elsevierStyleSup">18</span>F-FDG-PET/TAC 3 de ellos. En uno de ellos la realización del estudio cerebral incrementó el estadio. Sólo uno de los pacientes mostró hipermetabolismo en la imagen PET en relación con las lesiones cerebrales evidenciadas en la imagen TAC. Se obtuvieron valores de sensibilidad, especificidad, valores predictivos positivo y negativo del 60, 100, 100 y 88,89%, respectivamente.</p> <span class="elsevierStyleSectionTitle">Conclusión</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Las áreas hipometabólicas en el parénquima cerebral con frecuencia se asocian a lesiones metastásicas en pacientes con cáncer microcítico de pulmón. La realización de un estudio selectivo cerebral PET/TAC en estos pacientes permite una correcta estadificación y el tratamiento precoz de las metástasis no sospechadas.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Palomar Muñoz A, et al. ¿Resulta rentable un estudio selectivo cerebral con <span class="elsevierStyleSup">18</span>F-FDG-PET/TAC en los pacientes con cáncer microcítico de pulmón? Rev Esp Med Nucl Imagen Mol. 2012;31:124–9.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1825 "Ancho" => 2422 "Tamanyo" => 428089 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">(A) Selective cerebral staging study (images of CT, PET and fusion PET/CT) in axial slices. No significant alterations were observed in the distribution of FDG nor were parenchymatous alterations found in the CT image. (B) Selective cerebral study in the same patient who remained neurologically asymptomatic five months after staging performed to evaluate response to the treatment showing a round-shaped lesion in the right parietal region in the CT image with hypometabolism in the PET image and the fusion PET/CT (arrows). Given the absence of neurological symptomatology, between the two PET/CT studies, no cerebral procedure was carried out (contrast CT or MRI).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2403 "Ancho" => 2480 "Tamanyo" => 475449 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Images of CT, PET and fusion PET/CT in a patient with small cell lung cancer (A), stage IV due to lesions in both adrenal glands (B). The patient was neurologically asymptomatic and 15 days after the PET/CT study began with symptomatology (vomiting and headache). The selective cerebral study (C) shows several lesions in both the morphologic and metabolic images. At least two of the lesions demonstrated hypometabolism (white arrows) in the right cerebellum, with another mixed lesion with an area of hypometabolism in the anterior region and increased glycidic activity in the posterior portion in the left temporal region (black arrow).</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Age range (years)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45–83 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Mean age (years)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.57 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Gender</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Males \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Females \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Staging by CT</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Stage II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Stage III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Stage IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Staging by PET/CT</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Stage II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Stage III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Stage IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Cerebral studies</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Normal PET \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pathological PET \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Patients with cerebral metastasis</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab208231.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Epidemiologic and clinico-pathologic characteristics of the patients: age range (years).</p>" ] ] 3 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Lesions according to PET/CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Lesions according to conventional imaging \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Two hypometabolic lesions in the cerebellous region and right temporal region. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Three lesions with perilesional edema, two of which were of approximately 17<span class="elsevierStyleHsp" style=""></span>mm in the cerebellous region and the right temporal region and one was of 7<span class="elsevierStyleHsp" style=""></span>mm in the right caudate nucleus. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Four lesions, three of which were hypometabolic in the right cerebellum and the ipsilateral temporal region and one mixed lesion in the left temporal region. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multiple lesions with edema of different sizes (from 1 to 2<span class="elsevierStyleHsp" style=""></span>cm) and localizations. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">One hypermetabolic lesion in right temporal region. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right temporal lesion with ring uptake after intravenous constrast of 30<span class="elsevierStyleHsp" style=""></span>mm. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal PET/CT cerebral staging \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right subcentimetric frontoparietal lesion \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal PET/CT cerebral staging.In the PET/CT of response to treatment we observed a hypometabolic lesion in the right parietal region. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right parietal lesion of around 20<span class="elsevierStyleHsp" style=""></span>mm confirmed by MRI. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab208232.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Characteristics and number of cerebral lesions in each of the patients in the selective cerebral PET/CT study and in the conventional imaging techniques performed posteriorly. 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