Comment on: Teaching Neuroimages: Hypometabolism of the primary motor cortex in primary lateral sclerosis: The stripe sign.

Commenting on “Teaching NeuroImages: Hypometabolism of the primary motor cortex in primary lateral sclerosis: The stripe sign,” Dr. Turner proposes that when primary lateral sclerosis (PLS) symptoms start in the upper extremity, the disease invariably progresses to amyotrophic lateral sclerosis

Ischemia and Infarction in STEMI Patients With Multivessel Disease : Insights From the CvLPRIT Nuclear Substudy

The CvLPRIT (Complete versus Lesion-only PRimary PCI Trial) trial was undertaken in 7 UK centers (1,2). Patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary stenoses were randomized to primary percutaneous coronary intervention (PPCI) to the infarct-related artery (IRA) only, or complete revascularization. At 12-month follow-up, the rate of the combined primary endpoint (all-cause mortality, recurrent MI, heart failure, ischemia-driven revascularization) was lower after complete revascularization. All surviving patients were asked to undergo myocardial perfusion scintigraphy (MPS) 6 to 8 weeks post-admission. It was expected that this a priori nuclear substudy would provide mechanistic insights into the outcome of the main trial, and help to define the clinical role of MPS in the PPCI era

The Impact of 18F-FDG PET CT Prior to Chemoradiotherapy for Stage III/IV Head and Neck Squamous Cell Carcinoma

Introduction. To determine the value of a FDG-PET-CT scan in patients with locally advanced head and neck squamous cell carcinoma (HNSCC) prior to chemoradiotherapy. Materials and Methods. Consecutive patients with stage III or IV HNSCC who had undergone a staging FDG-PET-CT scan prior to chemoradiotherapy between August 2008 and April 2011 were included. Clinical details and conventional imaging (CT and/or MRI) were, retrospectively, reviewed, a TNM stage was assigned, and levels of cervical lymph node involvement were documented. This process was repeated with the addition of FDG-PET-CT. Radiotherapy plans were reviewed for patients with an alteration identified on TNM staging and/or nodal level identification with FDG-PET-CT and potential alterations in radiotherapy planning were documented. Results. 55 patients were included in the analysis. FDG-PET-CT altered the TNM stage in 17/55 (31%) of patients, upstaging disease in 11 (20%) and downstaging in 6 (11%); distant metastases were identified by FDG-PET-CT in 1 (2%) patient. FDG-PET-CT altered the lymph node levels identified in 22 patients (40%), upclassifying disease in 16 (29%) and downclassifying in 6 (11%). Radiotherapy plans were judged retrospectively to have been altered by FDG-PET-CT in 10 patients (18%). Conclusions. The use of FDG-PET-CT potentially impacts upon both treatment decisions and radiotherapy planning

F-18 FDG PET/CT Imaging of Follicular Dendritic Cell Sarcoma of the Mediastinum

A 52-year-old female smoker presenting with unexplained weight loss underwent CT and FDG PET/CT imaging, which demonstrated an extremely hypermetabolic mediastinal mass with calcification, necrosis, and features of local invasiveness. Mediastinoscopy and biopsy were followed by successful surgical resection of an encapsulated mass showing the typical histologic features of follicular dendritic cell sarcoma (FDCS). FDCS of the mediastinum is a rare neoplasm arising from accessory cells of the immune system. Integrated FDG PET/CT of mediastinal FDCS highlights the importance of histologic assessment of mediastinal tumors that may seem unresectable on initial imaging.</p