Clinical nuclear medicine
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Clinical nuclear medicine · Apr 2016
Case Reports18F-FDG PET/CT of Primary Mediastinal Hepatoid Adenocarcinoma.
Hepatoid adenocarcinoma is a rare extrahepatic tumor that shows clinicopathologic and morphologic similarities to hepatocellular carcinoma. An FDG PET/CT imaging of primary mediastinal hepatoid adenocarcinoma in a 43-year-old man who had an elevated serum alpha-fetoprotein level was reported in this case. The patient's mediastinal lesion had avid FDG uptake. Hepatoid adenocarcinoma should be considered among the differential diagnoses when an FDG-avid extrahepatic mass is seen in patients with increased alpha-fetoprotein.
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Clinical nuclear medicine · Mar 2016
Case ReportsIsolated Calcaneal Metastasis: An Unusual Presentation of Lung Carcinoma as Heel Pain.
A 63-year-old woman initially presented with progressive left foot pain for 3 months, not responding to conservative management. MRI of the left foot showed a suspicious lesion in calcaneus. An open biopsy was consistent with metastatic lung adenocarcinoma. ⋯ CT scan of the chest revealed a soft tissue mass in the superior aspect of the right lower lobe. Staging FDG PET/CT showed hypermetabolic right lung mass and left calcaneus lesion. She received chemotherapy and local radiation to the left calcaneus metastatic lesion.
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Clinical nuclear medicine · Mar 2016
Case Reports"Cold" Spondylodiscitis on 18F-FDG PET/CT in a Patient With Myelofibrosis.
A 74-year-old man was evaluated by bone scan for possible rib fractures, which revealed a diffuse skeletal uptake secondary to myelofibrosis and focal midthoracic uptake. Chest CT and F-FDG PET/CT demonstrated pathological vertebral fractures of the midthoracic spine, which appeared as a cold defect on PET comparing to intense marrow uptake related to myelofibrosis and a lung nodule with a low uptake, later biopsy-proven as non-small cell lung carcinoma (NSCLC). ⋯ Biopsies did not reveal malignant cells. Final diagnosis was spondylodiscitis and a stage I NSCLC.
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Clinical nuclear medicine · Feb 2016
Case Reports18F-FDG PET/CT Reveals Disease Remission in a Patient With Ipilimumab-Refractory Advanced Melanoma Treated With Pembrolizumab.
Pembrolizumab is an anti-programmed cell death receptor 1 (anti-PD-1) antibody, recently approved for the treatment of ipilimumab-refractory metastatic melanoma. We report on a 49-year-old patient with unresectable metastatic melanoma initially treated with 4 cycles of ipilimumab. Because of demonstration of progressive disease on PET/CT, the patient was enrolled into a clinical trial of pembrolizumab. After completion of 4 cycles of pembrolizumab, the follow-up PET/CT scans performed early after and 7 months after the end of treatment exhibited complete disease remission, reflecting the potential role of the modality in treatment response evaluation of melanoma patients receiving anti-PD-1 therapy.
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Clinical nuclear medicine · Feb 2016
Quality and Safety in Health Care, Part VII: Lower Costs and Higher Quality.
The Institute of Medicine report entitled The Health Care Imperative: Lowering Costs and Improving Outcomes discussed numerous ways to decrease costs in the health care system without decreasing quality. The use of evidence-based medicine, eliminating wasteful spending such as needlessly high administrative costs, having more preventive services, having a better reimbursement system that emphasized quality, developing a less fragmented and more efficient medical delivery system, having more transparency for patients on the outcomes of different providers, having greater health care literacy for patients, and eliminating fraud were some of the recommendations. The total savings from eliminating unnecessary health care costs was estimated to be over 3 quarters of a trillion dollars each year.