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Luo ZH, Lu PX, Qi WL, Liao FX, Jin AF, Zen QY. Role of 18F-FDG PET/CT in the diagnosis and management of patients with Langerhans cell histiocytosis. Quant Imaging Med Surg 2022; 12:3351-3363. [PMID: 35655814 PMCID: PMC9131337 DOI: 10.21037/qims-21-823] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/04/2022] [Indexed: 03/19/2024]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is an inflammatory myeloid neoplasm that can involve multisystem organs. Positron emission tomography/computed tomography (PET/CT) has been widely used in tumor staging and efficacy evaluation. However, at present, there are few 18F-fluorodeoxyglucose (FDG) PET/CT studies on LCH. This study aimed to explore the possible role of 18F-FDG PET/CT in the diagnosis and management of patients with LCH. METHODS 18F-FDG PET/CT images of 22 Chinese patients diagnosed with LCH on biopsy or surgery histopathology between January 2011 and December 2020 were retrospectively analyzed. The incidence of LCH in each system was assessed by a PET/CT scan. The imaging characteristics were analyzed semiquantitatively and qualitatively. The discrepancies between PET/CT and conventional imaging modalities were recorded. Evaluations of curative effect according to RECIST1.1 and PERCIST1.0 were compared using Fisher's exact chi-squared test, and P values <0.05 were considered significant. RESULTS Eight (36.4%) of the 22 patients presented with single system involvement (4 isolated site involvement, 4 multiple site involvement), and 14 (63.6%) presented with multiple system involvement. Twenty-one (95.5%) patients had hypermetabolic lesions. Musculoskeletal, lymphatic, respiratory, liver, skin-soft tissue and thyroid involvement were seen in 14 (63.6%), 13 (59.1%), 5 (22.7%), 4 (18.2%), 5 (22.7%) and 1 (4.5%) patient, respectively. Cranial and facial bones were the most common sites of musculoskeletal involvement. Ten patients underwent PET/CT follow-up, and there was no significant difference in curative effect evaluations according to RECIST1.1 and PERCIST1.0. However, among the complete remission cases assessed by RECIST1.1, three were partial metabolic responses assessed by PERCIST1.0, while among the partial response cases assessed by RECIST1.1, one was metabolic progressive disease assessed by PERCIST1.0. CONCLUSIONS 18F-FDG PET/CT is an imaging modality option for the diagnosis and assessment of the curative effect of LCH.
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Affiliation(s)
- Zhe-Huang Luo
- PET/CT Center, Jiangxi Provincial People’s Hospital, Nanchang, China
| | - Pu-Xuan Lu
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Wan-Lin Qi
- PET/CT Center, Jiangxi Provincial People’s Hospital, Nanchang, China
| | - Feng-Xiang Liao
- PET/CT Center, Jiangxi Provincial People’s Hospital, Nanchang, China
| | - Ai-Fang Jin
- PET/CT Center, Jiangxi Provincial People’s Hospital, Nanchang, China
| | - Qing-Yun Zen
- PET/CT Center, Jiangxi Provincial People’s Hospital, Nanchang, China
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Lizal F, Elcner J, Jedelsky J, Maly M, Jicha M, Farkas Á, Belka M, Rehak Z, Adam J, Brinek A, Laznovsky J, Zikmund T, Kaiser J. The effect of oral and nasal breathing on the deposition of inhaled particles in upper and tracheobronchial airways. JOURNAL OF AEROSOL SCIENCE 2020; 150:105649. [PMID: 32904428 PMCID: PMC7455204 DOI: 10.1016/j.jaerosci.2020.105649] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/05/2020] [Accepted: 08/13/2020] [Indexed: 05/21/2023]
Abstract
The inhalation route has a substantial influence on the fate of inhaled particles. An outbreak of infectious diseases such as COVID-19, influenza or tuberculosis depends on the site of deposition of the inhaled pathogens. But the knowledge of respiratory deposition is important also for occupational safety or targeted delivery of inhaled pharmaceuticals. Simulations utilizing computational fluid dynamics are becoming available to a wide spectrum of users and they can undoubtedly bring detailed predictions of regional deposition of particles. However, if those simulations are to be trusted, they must be validated by experimental data. This article presents simulations and experiments performed on a geometry of airways which is available to other users and thus those results can be used for intercomparison between different research groups. In particular, three hypotheses were tested. First: Oral breathing and combined breathing are equivalent in terms of particle deposition in TB airways, as the pressure resistance of the nasal cavity is so high that the inhaled aerosol flows mostly through the oral cavity in both cases. Second: The influence of the inhalation route (nasal, oral or combined) on the regional distribution of the deposited particles downstream of the trachea is negligible. Third: Simulations can accurately and credibly predict deposition hotspots. The maximum spatial resolution of predicted deposition achievable by current methods was searched for. The simulations were performed using large-eddy simulation, the flow measurements were done by laser Doppler anemometry and the deposition has been measured by positron emission tomography in a realistic replica of human airways. Limitations and sources of uncertainties of the experimental methods were identified. The results confirmed that the high-pressure resistance of the nasal cavity leads to practically identical velocity profiles, even above the glottis for the mouth, and combined mouth and nose breathing. The distribution of deposited particles downstream of the trachea was not influenced by the inhalation route. The carina of the first bifurcation was not among the main deposition hotspots regardless of the inhalation route or flow rate. On the other hand, the deposition hotspots were identified by both CFD and experiments in the second bifurcation in both lungs, and to a lesser extent also in both the third bifurcations in the left lung.
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Affiliation(s)
- Frantisek Lizal
- Brno University of Technology, Faculty of Mechanical Engineering, Energy Institute, Technicka 2896/2, Brno, 616 69, Czech Republic
| | - Jakub Elcner
- Brno University of Technology, Faculty of Mechanical Engineering, Energy Institute, Technicka 2896/2, Brno, 616 69, Czech Republic
| | - Jan Jedelsky
- Brno University of Technology, Faculty of Mechanical Engineering, Energy Institute, Technicka 2896/2, Brno, 616 69, Czech Republic
| | - Milan Maly
- Brno University of Technology, Faculty of Mechanical Engineering, Energy Institute, Technicka 2896/2, Brno, 616 69, Czech Republic
| | - Miroslav Jicha
- Brno University of Technology, Faculty of Mechanical Engineering, Energy Institute, Technicka 2896/2, Brno, 616 69, Czech Republic
| | - Árpád Farkas
- Brno University of Technology, Faculty of Mechanical Engineering, Energy Institute, Technicka 2896/2, Brno, 616 69, Czech Republic
- Centre for Energy Research, Konkoly-Thege Miklós u. 29-33, 1121, Budapest, Hungary
| | - Miloslav Belka
- Brno University of Technology, Faculty of Mechanical Engineering, Energy Institute, Technicka 2896/2, Brno, 616 69, Czech Republic
| | - Zdenek Rehak
- Masaryk Memorial Cancer Institute, Zluty kopec 7, Brno, 602 00, Czech Republic
| | - Jan Adam
- Masaryk Memorial Cancer Institute, Zluty kopec 7, Brno, 602 00, Czech Republic
- ÚJV Řež, a.s., Hlavni 130, Husinec-Rez, Rez 250 68, Czech Republic
| | - Adam Brinek
- CEITEC - Central European Institute of Technology, Brno University of Technology, Purkynova 123, Brno, 612 00, Czech Republic
| | - Jakub Laznovsky
- CEITEC - Central European Institute of Technology, Brno University of Technology, Purkynova 123, Brno, 612 00, Czech Republic
| | - Tomas Zikmund
- CEITEC - Central European Institute of Technology, Brno University of Technology, Purkynova 123, Brno, 612 00, Czech Republic
| | - Jozef Kaiser
- CEITEC - Central European Institute of Technology, Brno University of Technology, Purkynova 123, Brno, 612 00, Czech Republic
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Karamouzos V, Prokakis C, Kosmopoulou F, Karanikolas E, Kalogeropoulou C, Aretha D, Panagiotopoulos N, Koletsis E, Velissaris D. Simultaneous Bilateral Spontaneous Pneumothorax in an Adult Patient With Pulmonary Langerhans Cell Histiocytosis: A Case Report. J Investig Med High Impact Case Rep 2018; 6:2324709618792945. [PMID: 30094268 PMCID: PMC6080074 DOI: 10.1177/2324709618792945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/01/2018] [Accepted: 07/12/2018] [Indexed: 11/17/2022] Open
Abstract
We report a case of a young female with known history of pulmonary Langerhans
cell histiocytosis who was initially presented in the emergency department of a
university hospital with respiratory distress. Clinical assessment and
diagnostic workup revealed left hemithorax subcutaneous emphysema, bilateral
pneumothorax, and atelectasis in both lower lung lobes. The patient was treated
with bilateral staged thoracoscopic bullectomy and mechanical abrasion of the
parietal pleura combined with chemical pleurodesis with talc. A new occurrence
of right-sided pneumothorax was noticed 3 days after surgery, which was treated
with chest tube insertion and chemical pleurodesis. The aforementioned surgical
approach resulted in complete lung expansion and the patient’s full recovery. A
review of pulmonary Langerhans cell histiocytosis and treatment options in cases
of pneumothorax due to lung histiocytosis is also presented in this report.
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Song H, Lee D, Park SY, An YS, Yoon JK, Lee SJ. Single Pulmonary Langerhans Cell Histiocytosis Mimicking Metastasis in Lung Cancer: Imaging with (18)F-FDG PET/CT. Nucl Med Mol Imaging 2015; 49:243-5. [PMID: 26279700 DOI: 10.1007/s13139-015-0326-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 02/10/2015] [Accepted: 02/12/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Heesung Song
- Department of Nuclear Medicine, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Dakeun Lee
- Departments of Pathology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Seong Yong Park
- Thoracic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Young-Sil An
- Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, 443-380 Republic of Korea
| | - Joon-Kee Yoon
- Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, 443-380 Republic of Korea
| | - Su Jin Lee
- Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, 443-380 Republic of Korea
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Aburto M, Capelastegui A. [Pulmonary Langerhans' cell histiocytosis in adults: an unknown old disease]. Med Clin (Barc) 2014; 143:444-5. [PMID: 24747024 DOI: 10.1016/j.medcli.2014.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 02/06/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Myriam Aburto
- Servicio de Neumología, Hospital de Galdakao-Usansolo, Galdakao, Bizkaia, España
| | - Alberto Capelastegui
- Servicio de Neumología, Hospital de Galdakao-Usansolo, Galdakao, Bizkaia, España.
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Mueller WP, Melzer HI, Schmid I, Coppenrath E, Bartenstein P, Pfluger T. The diagnostic value of 18F-FDG PET and MRI in paediatric histiocytosis. Eur J Nucl Med Mol Imaging 2012; 40:356-63. [PMID: 23096080 DOI: 10.1007/s00259-012-2278-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 10/04/2012] [Indexed: 12/19/2022]
Abstract
PURPOSE To analyse the diagnostic value of (18)F-FDG PET and MRI for the evaluation of active lesions in paediatric Langerhans cell histiocytosis. METHODS We compared 21 (18)F-FDG PET scans with 21 MRI scans (mean time interval 17 days) in 15 patients (11 male, 4 female, age range 4 months to 19 years) with biopsy-proven histiocytosis. Primary criteria for the lesion-based analysis were signs of vital histiocyte infiltrates (bone marrow oedema and contrast enhancement for MRI; SUV greater than the mean SUV of the right liver lobe for PET). PET and MR images were analysed separately and side-by-side. The results were validated by biopsy or follow-up scans after more than 6 months. RESULTS Of 53 lesions evaluated, 13 were confirmed by histology and 40 on follow-up investigations. The sensitivity and specificity of PET were 67 % and 76 % and of MRI were 81 % and 47 %, respectively. MRI showed seven false-positive bone lesions after successful chemotherapy. PET showed five false-negative small bone lesions, one false-negative lesion of the skull and three false-negative findings for intracerebral involvement. PET showed one false-positive lesion in the lymphoid tissue of the head and neck region and two false-positive bone lesions after treatment. Combined PET/MR analysis decreased the number of false-negative findings on primary staging, whereas no advantage over PET alone was seen in terms of false-positive or false-negative results on follow-up. CONCLUSION Our retrospective analysis suggests a pivotal role of (18)F-FDG PET in lesion follow-up due to a lower number of false-positive findings after chemotherapy. MRI showed a higher sensitivity and is indispensable for primary staging, evaluation of brain involvement and biopsy planning. Combined MRI/PET analysis improved sensitivity by decreasing the false-negative rate during primary staging indicating a future role of simultaneous whole-body PET/MRI for primary investigation of paediatric histiocytosis.
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Affiliation(s)
- Wolfgang Peter Mueller
- Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Marchioninistraße 15, 81377, Munich, Germany.
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