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Positron emission tomography-computed tomography in paraneoplastic neurologic disorders: systematic analysis and review McKeon A; Apiwattanakul M; Lachance DH; Lennon VA; Mandrekar JN; Boeve BF; Mullan B; Mokri B; Britton JW; Drubach DA; Pittock SJArch Neurol 2010[Mar]; 67 (3): 322-9OBJECTIVE: To evaluate the cancer detection rate of whole-body positron emission tomography-computed tomography (PET-CT) in a paraneoplastic neurologic context. DESIGN: Retrospective medical record review. SETTING: Mayo Clinic, Rochester, Minnesota. PATIENTS: Fifty-six consecutive patients with clinically suspected paraneoplastic neurologic disorders who underwent PET-CT after negative standard evaluations, including CT. MAIN OUTCOME MEASURE: Rate of cancer detection. RESULTS: Abnormalities suggestive of cancer were detected using PET-CT in 22 patients (39%); 10 patients (18%) had cancer confirmed histologically. Cancers detected (limited stage in 9 of 10 patients and extratruncal in 4) were as follows: 2 thyroid papillary cell carcinomas, 3 solitary lymph nodes with unknown primary (2 adenocarcinomas and 1 small cell carcinoma), 1 tonsil squamous cell carcinoma, 3 lung carcinomas (1 adenocarcinoma, 1 small cell, and 1 squamous cell), and 1 colon adenocarcinoma. Detection of a well-characterized neuronal nuclear or cytoplasmic paraneoplastic autoantibody was associated with a successful PET-CT-directed cancer search (P < .001). Detection of limited-stage cancer facilitated early initiation of oncologic treatments and immunotherapy; cancer remission was reported in 7 patients, and sustained improvements in neurologic symptoms were reported in 5 (median follow-up, 11 months; range, 2-48 months). Combined data from 2 previous studies using conventional PET alone (123 patients) revealed that 28% of patients had a PET abnormality suggestive of cancer and that 12% had a cancer diagnosis. CONCLUSION: In a paraneoplastic neurologic context, PET-CT improves the detection of cancers when other screening test results are negative, particularly in the setting of seropositivity for a neuronal nuclear or cytoplasmic autoantibody marker of cancer.|Adult[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Early Detection of Cancer/*methods[MESH]|Female[MESH]|Humans[MESH]|Male[MESH]|Medical Records[MESH]|Middle Aged[MESH]|Neoplasms/*diagnosis/therapy[MESH]|Paraneoplastic Syndromes, Nervous System/*diagnosis/therapy[MESH]|Positron-Emission Tomography/methods[MESH]|Retrospective Studies[MESH]|Tomography, X-Ray Computed/methods[MESH]|Treatment Outcome[MESH]|Whole Body Imaging[MESH] |
