Article
Revista Española de Medicina Nuclear e Imagen Molecular (English Edition)
array:24 [ "pii" => "S2253808913001468" "issn" => "22538089" "doi" => "10.1016/j.remnie.2013.11.005" "estado" => "S300" "fechaPublicacion" => "2014-01-01" "aid" => "526" "copyright" => "Elsevier España, S.L. and SEMNIM" "copyrightAnyo" => "2013" "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Rev Esp Med Nucl Imagen Mol. 2014;33:43-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2254 "formatos" => array:2 [ "HTML" => 1477 "PDF" => 777 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S2253654X13001297" "issn" => "2253654X" "doi" => "10.1016/j.remn.2013.07.005" "estado" => "S300" "fechaPublicacion" => "2014-01-01" "aid" => "526" "copyright" => "Elsevier España, S.L. y SEMNIM" "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Rev Esp Med Nucl Imagen Mol. 2014;33:43-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3544 "formatos" => array:3 [ "EPUB" => 11 "HTML" => 2413 "PDF" => 1120 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Colaboración especial</span>" "titulo" => "<span class="elsevierStyleSup">18</span>F-FDG-PET-TC en sarcomas de partes blandas: ¿cuándo?" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "43" "paginaFinal" => "49" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "<span class="elsevierStyleSup">18</span>F-FDG-PET-CT in soft tissue sarcomas: When to image?" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1615 "Ancho" => 1625 "Tamanyo" => 264684 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Diferencias en el comportamiento metabólico de 2 tipos de sarcomas. La figura 1.a. corresponde a un liposarcoma retroperitoneal bien diferenciado que muestra una escasa o nula afinidad por la <span class="elsevierStyleSup">18</span>F-FDG. La figura 1.b. corresponde histológicamente a un carcinosarcoma de endometrio pobremente diferenciado de alto grado. La lesión alcanza un SUVmax 29.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "B. Rodríguez-Alfonso, J. Mucientes Rasilla, M. Mitjavila Casanovas, J. Cardona Arboniés, R. Cubedo" "autores" => array:5 [ 0 => array:2 [ "nombre" => "B." "apellidos" => "Rodríguez-Alfonso" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Mucientes Rasilla" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Mitjavila Casanovas" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Cardona Arboniés" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Cubedo" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2253808913001468" "doi" => "10.1016/j.remnie.2013.11.005" "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/S2253808913001468?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X13001297?idApp=UINPBA00004N" "url" => "/2253654X/0000003300000001/v2_201403140106/S2253654X13001297/v2_201403140106/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2253808913001420" "issn" => "22538089" "doi" => "10.1016/j.remnie.2013.11.001" "estado" => "S300" "fechaPublicacion" => "2014-01-01" "aid" => "111" "copyright" => "Elsevier España, S.L. and SEMNIM" "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Rev Esp Med Nucl Imagen Mol. 2014;33:50-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 947 "formatos" => array:2 [ "HTML" => 636 "PDF" => 311 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting images</span>" "titulo" => "Neurolymphomatosis as initial manifestation of recurrence in lymphoma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "50" "paginaFinal" => "51" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Neurolinfomatosis como manifestación inicial de recidiva en linfoma" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 365 "Ancho" => 1505 "Tamanyo" => 79044 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Axial <span class="elsevierStyleSup">18</span>F-FDG/PET-CT images showing an increase in the <span class="elsevierStyleSup">18</span>F-FDG uptake in the right brachial plexus suggestive of lymphomatous infiltration.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Ramírez Ocaña, A.L. Gutiérrez Cardo, L. González Díaz, K. Hurst, M. Espeso de Haro" "autores" => array:5 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Ramírez Ocaña" ] 1 => array:2 [ "nombre" => "A.L." "apellidos" => "Gutiérrez Cardo" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "González Díaz" ] 3 => array:2 [ "nombre" => "K." "apellidos" => "Hurst" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Espeso de Haro" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X13000164" "doi" => "10.1016/j.remn.2013.02.003" "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/S2253654X13000164?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808913001420?idApp=UINPBA00004N" "url" => "/22538089/0000003300000001/v1_201402040008/S2253808913001420/v1_201402040008/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2253808913001523" "issn" => "22538089" "doi" => "10.1016/j.remnie.2013.12.005" "estado" => "S300" "fechaPublicacion" => "2014-01-01" "aid" => "122" "copyright" => "Elsevier España, S.L. and SEMNIM" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "crp" "cita" => "Rev Esp Med Nucl Imagen Mol. 2014;33:39-42" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 795 "formatos" => array:2 [ "HTML" => 578 "PDF" => 217 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical note</span>" "titulo" => "Neurolymphomatosis as a late relapse of non-Hodgkin's lymphoma detected by <span class="elsevierStyleSup">18</span>F-FDG PET/CT: A case report" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "39" "paginaFinal" => "42" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Neurolinfomatosis como recaída de un linfoma no Hodgkin detectada con <span class="elsevierStyleSup">18</span>F-FDG PET/TAC: a propósito de un caso" ] ] "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" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1462 "Ancho" => 2170 "Tamanyo" => 293689 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Coronal T1-weighted (A), coronal (B) and axial fat-suppression (C) contrast–enhanced T1-weighted and axial T2-weighted images of MR examination (3<span class="elsevierStyleHsp" style=""></span>T). Red arrows show the thickening of right S1 nerve root (a) with pathological contrast enhancement (b, c), which has heterogeneous signal intensity on the T2-weighted image (d). Blue arrows show the normal left S1 nerve root which has contrast enhancement in the level of ganglion (c), but not elsewhere (b).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "K. Kajáry, Z. Molnár, I. Mikó, P. Barsi, Z. Lengyel, S. Szakáll" "autores" => array:6 [ 0 => array:2 [ "nombre" => "K." "apellidos" => "Kajáry" ] 1 => array:2 [ "nombre" => "Z." "apellidos" => "Molnár" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Mikó" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Barsi" ] 4 => array:2 [ "nombre" => "Z." "apellidos" => "Lengyel" ] 5 => array:3 [ "nombre" => "S." "apellidos" => "Szakáll" "sufijo" => "Jr" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2253654X13000437" "doi" => "10.1016/j.remn.2013.03.004" "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/S2253654X13000437?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808913001523?idApp=UINPBA00004N" "url" => "/22538089/0000003300000001/v1_201402040008/S2253808913001523/v1_201402040008/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Special collaboration</span>" "titulo" => "<span class="elsevierStyleSup">18</span>F-FDG–PET–CT in soft tissue sarcomas: When to image?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "43" "paginaFinal" => "49" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "B. Rodríguez-Alfonso, J. Mucientes Rasilla, M. Mitjavila Casanovas, J. Cardona Arboniés, R. Cubedo" "autores" => array:5 [ 0 => array:4 [ "nombre" => "B." "apellidos" => "Rodríguez-Alfonso" "email" => array:1 [ 0 => "brodrigueza@salud.madrid.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Mucientes Rasilla" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Mitjavila Casanovas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Cardona Arboniés" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "R." "apellidos" => "Cubedo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Oncología Médica, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "<span class="elsevierStyleSup">18</span>F-FDG-PET-TC en sarcomas de partes blandas: ¿cuándo?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 455 "Ancho" => 1400 "Tamanyo" => 81192 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Study performed for suspicion of recurrence of well-differentiated leiomyosarcoma. A soft tissue lesion is observed in the mesothelium in contact with the adjacent loop of the jejunum. A moderate increase in pathological uptake of <span class="elsevierStyleSup">18</span>F-FDG can be seen. Histologically was a well-differentiated leiomyosarcoma with a Ki 67 of 15%.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Soft tissue sarcomas (STS) are an infrequent group of tumors originating in cells derived from the embryonary mesoderm, representing less than 1% of solid malignant tumors in adults and being the cause of approximately 2% of cancer-related mortality. According to data of the Spanish Society of Medical Oncology it is estimated that 2 cases/100,000 inhabitants are diagnosed in Spain per year with a maximum peak of presentation in adults from 40 to 60 years of age.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The incidence in the pediatric population younger than 20 years is of 11 cases/100,000 inhabitants, representing 7.4% of the total neoplasms diagnosed.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In addition, STS are a heterogeneous group of tumors. According to data from the WHO there are more than 50 histological types of these tumors (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) which are fundamentally classified based on their line of differentiation (adipose tissue, fibroblastic-myofibroblastic tissue, fibrohistiocytic, smooth muscle, skeletal muscle, vascular, osteochondral and uncertain differentiation) and depending on their aggressivity (benign, intermediate and malignant). The most frequent types are the malignant fibrohistiocytoma, liposarcoma, leiomyosarcoma, synovial sarcoma and malignant tumor of the peripheral nerve sheath. The most frequent type in pediatric patients is rhabdomyosarcoma (40%) and fibrosarcoma (30%). These tumors represent a diagnostic and therapeutic challenge since each tumor presents its own particular clinical, prognostic and therapeutic characteristics.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Approximately 75% of STS are localized in the extremities, especially in the muscle, with 10% in the thoracic wall and another 10% in the retroperitoneum. Retroperitoneal STS usually have a larger size (mean diameter of 9<span class="elsevierStyleHsp" style=""></span>cm) because symptoms manifest later.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The prognosis is related to different factors, the most important being the size and depth of the lesion at diagnosis, tumor grade and the histologic subtype, the age of the patient, the involvement of surgical margins and the stage. The overall 5-year survival of adults with STS is of approximately 50% and significantly diminishes in the presence of metastasis or local recurrence.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The 5-year survival in the pediatric population is of 71% for all the types of STS.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The treatment of STS is based on surgery which has the objective of complete tumor resection. Depending on the grade and margin excision, the need for radiotherapy (pre- or post-operative) or brachytherapy is assessed. Adjuvant chemotherapy is not recommended as standard treatment but it is an option to consider in patients with high-grade STS greater than 5<span class="elsevierStyleHsp" style=""></span>cm in size and of deep localization. Chemotherapy (anthracyclines and oxazaphosphorins) is the treatment of choice in advanced disease together with the target treatments under development in the last years.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">PET–CT with <span class="elsevierStyleSup">18</span>F-FDG may be used with good results for predicting prognosis, for (re)-staging and in the evaluation of response to treatment in patients with STS.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Nonetheless, the role of this imaging technique is not clearly consolidated since neither guidelines nor consensus protocols are available.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The present collaboration aims to review the indications with the greatest evidence of the benefit of the use of PET as well as of the fields under investigation and future development.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Initial diagnosis of soft tissue sarcomas</span><p id="par0040" class="elsevierStylePara elsevierViewall">There is a wide variation in the metabolic behavior of STS due to the histologic heterogeneity, the different levels of lesion aggressivity and the tumor grade. In general <span class="elsevierStyleSup">18</span>F-FDG–PET shows acceptable sensitivity (S) and specificity (Sp) in the initial diagnosis of these tumors. With the aim of estimating the diagnostic yield of <span class="elsevierStyleSup">18</span>F-FDG–PET in soft tissue lesions, Loannidis et al. performed a meta-analysis of 15 studies including a total of 416 patients and 441 lesions (227 malignant and 214 benign). Data demonstrated a diagnostic accuracy (DP) of 82.7% (S: 0.92; Sp: 0.73) for the visual analysis and 80.8% (S: 0.79; Sp: 0.82) for the semiquantitative analysis applying a standardized uptake value (SUV) threshold of 2.0. Significant differences were found in the metabolic behavior of the intermediate or high-grade malignant lesions and the low-grade or benign lesions; however, no differences were found between these 2 last groups.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In addition, there was important overlapping in the behavior of the different lesions from a metabolic point of view. Thus, PET did not replace the histologic analysis in any case (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Despite PET not substituting histology it may be useful in relation to guiding biopsy. According to data of the consensus meeting of the Spanish Research Group in Sarcoma (GEIS), an excisional biopsy is performed in 50% of tumors greater than 5<span class="elsevierStyleHsp" style=""></span>cm and this may cause contamination of the tumor bed and condition the resection of affected margins, thereby increasing the risk of local recurrence and mortality by the tumor.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> This same group proposes that tumors greater than 5<span class="elsevierStyleHsp" style=""></span>cm in size, those of recent growth or fixed, or of deep localization should be referred to a center with expertise in sarcomas prior to performing a biopsy. The presence of pain associated with any of these 3 criteria supports the presumption of malignancy. The level of <span class="elsevierStyleSup">18</span>F-FDG uptake has been significantly correlated with overexpression of the GLUT-1 receptors, p53 (overexpressed by up to 49% in grades II and III STS) and Ki-67, translating greater cellular proliferation in the tumor.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Taking this into consideration, a high level of tumor uptake in a PET study prior to invasive manuevers may be another “sign of alarm”.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In addition, PET differentiates the areas of necrosis, hemorrhage, cystic degeneration or lesser cellular component of the most hypercellular areas within the lesion, which are usually those showing a greater SUV, thereby allowing biopsy of the zones of greatest yield and minimizing distorsions which could secondarily be generated in the tissue.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> This is especially important in large sized masses such as liposarcomas in which areas of greater histological grade may be found and which are usually responsible for therapeutic failure, or in patients with type 1 neurofibromatosis in which malignant tumors of the peripheral nerve sheath may be identified early and with a high sensitivity.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In parallel, in the initial assessment of an STS, PET provides additional prognostic information. The relationship between tumor grade and the glycolytic phenotype of the lesion is clinically relevant since an association has been demonstrated between tumor grade and overall and disease-free survival. Moreover, the poor outcome of STS in general makes it important to identify as many prognostic factors as possible to establish adequate therapeutic strategies and follow up schedules adapted to the risk. In a study including 102 patients with 12 different STS subtypes, Benz et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> analyzed the relationship between the SUVmax of the lesion and the histological grade established according to the system of the National Federation of Centers in the Fight Against Cancer [Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC)] (grades I, II and III) and following the binary system proposed by Deyrup and Weiss (high/low grade). The authors observed a statistically significant difference between the SUVmax of grades I, II and III sarcomas as well as between the high and low grade sarcomas with SUVmax cut-offs of 6.6 and 5.2, respectively, and with a greater correlation on application of the binary system which also involved less complexity. Nonetheless, in the histological types which usually behave as lesions with low or moderate affinity to <span class="elsevierStyleSup">18</span>F-FDG, the discriminative capacity of the SUV is lower. As mentioned previously, SUV or visual analysis of the uptake of a lesion is a useful method for non-invasive preoperative assessment of the aggressivity of resectable STS which may influence therapeutic decisions post surgery<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> since the level of uptake is positively and statistically significantly associated with the mitotic index. Moreover, it has been correlated with the presence of tumor necrosis.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Both are factors of worse prognosis which may indicate that lesions with a high level of uptake benefit from more aggressive treatment protocols and closer follow up. The level of uptake by the sarcomas has therefore been suggested as a prognostic factor which is also correlated with tumor grade, disease-free survival, local control and overall survival.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Lastly, not only is lesion uptake of prognostic value but rather the heterogeneous distribution of <span class="elsevierStyleSup">18</span>F-FDG in the interior of the tumor volume suggests the presence of multiple cellular populations with a different rate of growth, vascularization, necrosis, extracellular matrix and fluids, thereby implying a more aggressive behavior.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The evaluation of the grade and prognosis using the additional information provided by <span class="elsevierStyleSup">18</span>F-FDG–PET in STS is probably of greater importance in cases with interobserver discrepancies in the pathological diagnosis or in STS which cannot be adequately classified only on the basis of histopathological assessment in histologies considered as “not gradable” such as epithelioid sarcoma, clear cell sarcoma, alveolar sarcoma or angiosarcoma.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Staging and restaging</span><p id="par0070" class="elsevierStylePara elsevierViewall">The utility of PET–CT in the initial staging and restaging of recurrences of different tumors is clearly established in lung cancer, esophageal cancer, locally advanced breast cancer and colorectal cancer.</p><p id="par0075" class="elsevierStylePara elsevierViewall">One of the advantages of <span class="elsevierStyleSup">18</span>F-FDG–PET–CT studies in tumor staging is that this technique is able to evaluate the different structures of the organism in a single study including the limbs and a scanning time usually ranging of 25–50<span class="elsevierStyleHsp" style=""></span>min. Another advantage is that <span class="elsevierStyleSup">18</span>F-FDG–PET–CT is based on metabolic alterations which take place during tumor transformation of the cell and thus, it may detect tumor lesions even before anatomical changes are produced. This is of special importance in the evaluation of lymph node of non-pathological size according to the radiologic criteria and in the detection of incipient bone disease. Likewise, the capacity of <span class="elsevierStyleSup">18</span>F-FDG–CT to demonstrate metabolic alterations makes this technique more sensitive in the detection of recurrence in distorted tissues or in those with fibrosis due to previous surgery or radiotherapy in which the yield of the basically morphologic imaging techniques is lower.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Despite these advantages, the performance of <span class="elsevierStyleSup">18</span>F-FDG–PET–CT in the staging of STS compared to the commonly used imaging techniques is not clearly established. The articles to date include heterogeneous series grouping STS and bone sarcoma and small sample sizes.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The fundamental pathway of the production of metastasis in STS is hematogenic with special affinity for the pulmonary territory, with pulmonary metastases constituting 75% of all metastases. The risk of metastasis is correlated with the size of the primary tumor, the grade, localization and the histologic subtype. Some subtypes such as myxoid liposarcoma or round cell sarcomas are more likely to develop retroperitoneal and bone metastasis.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Lymph node metastases are rare, being found in less than 5% of the cases, except in some tumors such as epithelioid sarcoma, synovial sarcoma rhabdomyosarcoma, angiosarcoma and clear cell sarcoma.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The staging system most commonly used in STS is the AJCC.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> The latest edition establishes 3 tumor grades and reclassified N1 disease as stage III. In the evaluation of the T the size of the primary tumor is taken into account (T1, T2), but it is also important to determine superficial invasion of the fascia (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Adequate assessment of the invasion of planes and the relationship of the tumor with adjacent neurovascular structures requires a technique with high anatomical resolution and, thus, MR or CT studies with intravenous contrast are fundamentally used.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">As mentioned above, lymph node involvement in STS is not frequent. Data from the references reviewed include retrospective series and, in most cases, involving rhabdomyosarcomas or mixed series also including bone sarcomas. In these studies the S of PET for the detection of lymph node disease was greater than that of conventional imaging techniques (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). In a prospective multicenter study Volker et al.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> compared the results of PET–CT and CT in the initial staging of sarcomas in a pediatric population which included 12 rhabdomyosarcomas and obtained a greater S, Sp and diagnostic accuracy with PET for the detection of lymph node and bone disease and a greater diagnostic S and Sp for CT in the detection of pulmonary involvement. According to the authors the best results were achieved in the joint analysis of the two studies. In a series of 13 pediatric patients with rhabdomyosarcoma, Ricard et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> found similar results. The PET–CT detected a greater number of adenopathies (19 vs. 12) and bone lesions (11 vs. 3) than morphologic imaging techniques (CT) in the initial staging of these tumors. However, both PET and the CT component of PET–CT demonstrated limitations in the detection of subcentimetric pulmonary nodules. The results of the PET–CT in their study led to modification of the treatment in 2 patients (15%). The fundamental contribution of PET–CT in the evaluation of lymph node disease particularly lays in its high negative predictive value which ranges from 92 to 100% as shown in the study by FuglØ.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> The most usual causes of false negative (FN) results in the detection of lymph node disease are small sized lesions (<4–5<span class="elsevierStyleHsp" style=""></span>mm) or in those with microscopic disease, lesions derived from histologic subtypes with mild <span class="elsevierStyleSup">18</span>F-FDG uptake (the most common being desmoid tumors, chondrosarcomas, sarcoma of the peripheral nerve or liposarcomas) and lesions near areas of physiological uptake. The usual cause of false positive (FP) results is inflammatory disease, normally due to recent surgery, thereby making it important to take into account the history of the patient and attempting to separate both events insofar as possible.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">With regard to metastatic disease (M), the most frequent localization of metastasis is the lung parenchyma. One of the limitations of <span class="elsevierStyleSup">18</span>F-FDG–PET is its limited S in the detection of subcentimetric pulmonary nodules (50–86.5%).<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> In many centers this limitation is being minimized with the use of PET–CT equipment. The development of combined PET–CT protocols associating CT on inspiration in cases in which this is considered necessary allows correct evaluation of the pulmonary parenchyma without the need for duplicating studies. The heterogeneous metabolic behavior of sarcomas should also be taken into account, with some histological subtypes showing lesser uptake as well as the variation in uptake due to tumor grade. In a study by Fortes et al. data of the S of PET–CT were collected in the evaluation of 154 metastatic pulmonary nodules including 18 derived from STS (leiomyosarcoma, synovial sarcoma and fibrosarcoma). The global S obtained was 67.5%, while this value fell to 44.4% for the group of sarcomas. None of the pulmonary nodules derived from synovial sarcoma or fibrosarcoma showed significant uptake.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Thus, a suspicious pulmonary nodule in CT that does not demonstrate pathological uptake in PET should not be ruled out as a tumor, especially in the absence of visualization of the primary tumor which allows knowledge of the affinity of the same by <span class="elsevierStyleSup">18</span>F-FDG (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). In the detection of bone metastasis PET–CT has demonstrated its superiority over bone scintigraphy with respect to S and especially with regard to Sp, reducing the number of uncertain results.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> While bone scintigraphy with 99mTc-diphosphonate detects the osteoblastic reaction in bone, <span class="elsevierStyleSup">18</span>F-FDG–PET detects the presence of tumor cells, thereby allowing it to visualized intramedullar lesions as well as lesions of lythic nature. The CT component of PET–CT allows the identification of blastic lesions which, despite not showing significant uptake, may indicate the need for a complementary scintigraphic study. If the PET–CT study does not show pathologic findings, it is improbable that these will appear in the bone scintigraphy. With regard to morphologic imaging techniques, the S and Sp of the capacity of PET–CT to detect bone metastasis is similar to that of MR, with both being superior to CT and bone scintigraphy as reported in a meta-analysis published by Yang et al.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> who analyzed the capacity of the usual imaging techniques used in the detection of bone metastasis in a total of 67 articles. The values of S in PET and MR did not show statistically significant differences, and both were superior to CT and bone scintigraphy. With respect to the Sp, PET, MR and CT showed similar results, being superior to those of bone scintigraphy. Nonetheless, on analysis by lesions, PET showed a higher Sp than the remaining techniques.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Few studies have evaluated the real impact of incorporating PET–CT in the initial staging of sarcomas. Tateishi et al.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> analyzed a series of 117 adult patients with bone sarcomas and STS (48 patients). The combined use of PET–CT and CT modified the staging with changes in treatment in 14% of the patients, particularly reducing the stage and contributing to ruling out surgery in 13% of the patients. Similar results were reported in a posterior studied by Eugene et al.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> who included a larger series of patients with rhabdomyosarcoma. They found an impact in the management of 13% based on PET–CT findings. Nonetheless, on excluding bone sarcoma and rhabdomyosarcomas, the impact of PET–CT on management was not as high. In a retrospective study Roberge et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> analyzed an acceptably homogeneous series of 109 patients with STS localized in the extremities or the thoracic wall with an intermediate or high grade (89%) with the most frequent histologic types being leiomyosarcoma (17%), liposarcoma (17%) and fibrosarcoma (16%) and most being of stage T2b (64%). The authors analyzed the yield of PET–CT in the initial staging of these tumors in comparison with conventional staging (MR of primary tumor and CT of thorax). The values of S and Sp of the PET–CT were 52 and 96%, respectively with 9% of FN due to the presence of pulmonary metastasis. According to the authors, in this group of selected patients the pretest probability of disease is around 20% and considering that 75% of metastatic lesions are pulmonary, the performance of PET–CT over conventional staging is low, with a change in treatment management in 4.5% of the patients. Although the number of patients was small, earlier, more aggressive treatment of the lesions observed in PET seemed to benefit patients.</p><p id="par0110" class="elsevierStylePara elsevierViewall">To date, the indication of PET–CT in the initial staging of STS has not been clearly established, but taking the results of the literature into account its use seems recommendable in sarcomas with a greater trend to bone or retroperitoneal involvement such as in myxoid liposarcoma, round cell sarcoma or leiomyosarcoma, or in those with a greater probability of lymphatic involvement such as epithelioid sarcoma, synovial sinovial, rhabdomyosarcoma, angiosarcoma and clear cell sarcoma. It is probably this type of tumor, and, in general, high grade tumors (grade III and more uncertainly grade II), those greater than 3<span class="elsevierStyleHsp" style=""></span>cm in size and of deep localization which would most benefit from more complete staging maneuvers.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Detection of recurrence</span><p id="par0115" class="elsevierStylePara elsevierViewall">The series published on the utility of PET–CT for the detection of recurrence in patients with sarcoma are small but point to the elevated S with this technique (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28–34</span></a> The utility of PET–CT in this framework is influenced by the same factors as those in initial staging (high grade tumors expressing avidity by <span class="elsevierStyleSup">18</span>F-FDG are those showing a greater benefit with the use of the technique).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">False positive results usually occur as a consequence of inflammatory changes and thus, knowledge of the treatments applied and the time since the completion of these treatments is required. On the other hand, most FN occurs in the pulmonary parenchyma. In treated sarcoma patients with pulmonary nodules without significant pathological uptake close at least follow up should be considered, especially in the absence of a basal PET showing the avidity of the tumor type of the patient by <span class="elsevierStyleSup">18</span>F-FDG.</p><p id="par0125" class="elsevierStylePara elsevierViewall">In general, with the data available to date, the use of PET as a follow up tool has not been standardized in patients with sarcoma. Nonetheless, some scenarios could probably show more evident benefits such as in patients with non-conclusive findings in the morphologic images, those with important fibrosis or changes in scarring in the area treated in order to assess local recurrences and patients with resectable pulmonary metastases or, in general, candidates for surgical rescue resection to exclude metastasis in other localizations (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Evaluation of response to treatment</span><p id="par0130" class="elsevierStylePara elsevierViewall">Sarcomas are complex processes with a wide range of vascularization, cellular proliferation rate, cellular viability, inflammation and oxygenation and thus, there is also a wide variability in the response to treatment. The cellular necrosis fraction achieved translates the histological response to treatment.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Histological response to chemotherapy or neoadjuvant chemotherapy in STS has shown a strong correlation with prognosis.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> However, only 20–30% of these patients demonstrate significant response to presurgical therapy.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> Taking into account the costs, the toxicity and the low rate of response to neoadjuvant treatment, it is necessary to have tools which can adequately and rapidly classify patients as responder or non-responder. This differentiation may influence the management of these patients, avoiding unnecessary therapies and bringing forward surgical treatment in non-responder patients.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Response may be overestimated in this type of tumors due to the presence of necrosis in the primary tumor. In addition, the globally accepted response evaluation criteria in solid tumors (RECIST), which are based on fundamentally morphologic data, have very limited utility in this group of tumors. On one hand, it is difficult to measure lesions localized in the bone, intestine or peritoneal carcinomatosis. On the other hand, the reduction in tumor volume after treatment may be slow, even null, due to the presence of necrosis or fibrosis as well as myxoid, bone or cartilaginous material of the tumor and to the more cytostatic than cytolytic effect that some of the drugs used in the treatment of sarcomas have, increasing the survival despite the disease remaining morphologically stable. Some STS may even grow because of tumor edema or hemorrhage.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> Thus, morphologic imaging techniques such as CT and MR are not able to adequately establish parameters allowing the prediction of tumor behavior<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> or survival.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSup">18</span>F-FDG–PET–CT is a standard tool for the assessment of the therapeutic response of many solid tumors. Metabolic imaging provides an alternative method for the evaluation of the effects of treatment. Many studies have demonstrated that a reduction in metabolic activity precedes changes in size.</p><p id="par0150" class="elsevierStylePara elsevierViewall">In STS a reduction of metabolic activity may precisely assess the response to chemotherapy<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> and is correlated with survival.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> Early changes in the SUVmax are an independent predictor factor of survival. It has recently been demonstrated that a reduction in the uptake of <span class="elsevierStyleSup">18</span>F-FDG in STS with treatment is adequately correlated with histologic response at both the end of treatment and after the first cycle.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> A reduction of more than 40% leads to a lower risk of recurrence and death related to the sarcoma. A reduction of between 30 and 60% in the percentage of SUV has been proposed to differentiate responder patients from non-responder patients. A SUVmax less than 2.5 after chemotherapy is associated with a greater disease-free survival independently of the initial stage.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> However, patients classified as non-responder have a 90% probability of recurrence at 4 years.</p><p id="par0155" class="elsevierStylePara elsevierViewall">Nonetheless, studies published up to now have usually had a reduced sample size, have used different parameters to evaluate the response to treatment and, on occasions, have included several histologic types, making it difficult to extrapolate the results to clinical practice. Although greater scientific evidence is needed, it seems that a reduction in the SUV may be a substitute of the prognosis and thus, is an important tool for the management of patients with STS. This evaluation which cannot be made with morphologic imaging techniques could represent a change in the therapeutic management of STS, bringing forward surgery in non-responder patients and may, in the future, make new protocols in responder patients possible.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="par0160" class="elsevierStylePara elsevierViewall">In the initial study of soft tissue masses, PET does not substitute the histologic analysis of the tumor but does contribute to the evaluation of benignity/malignancy and thus, could direct the subsequent diagnostic maneuvers such as biopsy toward specific zones of the tumor with a greater diagnostic yield and avoiding unadvisable procedures such as incomplete surgery.</p><p id="par0165" class="elsevierStylePara elsevierViewall">The level of uptake of the primary tumor as well as the distribution of <span class="elsevierStyleSup">18</span>F-FDG within has prognostic implications making these factors subrogate markers in the classification of tumor risk, allowing the selection of patients who will benefit from more aggressive treatment or closer follow up protocols.</p><p id="par0170" class="elsevierStylePara elsevierViewall">PET–CT with <span class="elsevierStyleSup">18</span>F-FDG improves the initial staging and restaging of patients with intermediate and high grade sarcoma and also adds an estimation of the prognosis based on not only the metabolic behavior but also the stage.</p><p id="par0175" class="elsevierStylePara elsevierViewall">PET is a useful tool in the early identification of patients who will respond to treatment and the level of decrease in the uptake of the lesion shows a correlation in both histologic response and overall and disease-free survival.</p></span><span id="sec1020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect1045">Conflict of interest</span><p id="par2115" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Initial diagnosis of soft tissue sarcomas" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Staging and restaging" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Detection of recurrence" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Evaluation of response to treatment" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 6 => array:2 [ "identificador" => "sec1020" "titulo" => "Conflict of interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rodríguez-Alfonso B, Mucientes Rasilla J, Mitjavila Casanovas M, Cardona Arboniés J, Cubedo R. <span class="elsevierStyleSup">18</span>F-FDG-PET-TC en sarcomas de partes blandas: ¿cuándo? Rev Esp Med Nucl Imagen Mol. 2014;33:43–49.</p>" ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 969 "Ancho" => 975 "Tamanyo" => 145984 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Differences in the metabolic behavior of 2 types of sarcomas. (a) Well-differentiated retroperitoneal liposarcoma showing scarce or null <span class="elsevierStyleSup">18</span>F-FDG uptake. (b) Histologically demonstrated poorly differentiated high grade endometrial carcinosarcoma. The lesion achieved a SUVmax of 29.</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" => 928 "Ancho" => 975 "Tamanyo" => 133727 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Ability of PET–CT to localize lymph nodes suspicious of malignancy which are unspecific in the morphological imaging studies. A pathological uptake is observed in a left inguinal adenopathy in a patient attended for a classical high grade epithelioid sarcoma of the spinobulbous muscle.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 965 "Ancho" => 975 "Tamanyo" => 103536 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Different behavior of the metastatic pulmonary nodules in STS. (a) Absence of pathological uptake in a pulmonary nodule in the lower left lobe in a patient with an intermediate grade chondrosarcoma of the thoracic wall. On the other hand, (b) shows a pathological increase uptake in a pulmonary nodule of the upper left lobe in a patient with high grade inguinal round cell liposarcoma. In both cases, surgery confirmed the metastatic origin of the nodules.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 455 "Ancho" => 1400 "Tamanyo" => 81192 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Study performed for suspicion of recurrence of well-differentiated leiomyosarcoma. A soft tissue lesion is observed in the mesothelium in contact with the adjacent loop of the jejunum. A moderate increase in pathological uptake of <span class="elsevierStyleSup">18</span>F-FDG can be seen. Histologically was a well-differentiated leiomyosarcoma with a Ki 67 of 15%.</p>" ] ] 4 => 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">Adipocytic tumors \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">Dedifferentiated liposarcomasRound cell myxoid liposarcomaPleomorphic liposarcoma \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">Esclerosing epithelioid fibrosarcoma \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">FibrosarcomaFibroblastic or myofibroblastic tumorsLow grade mixofibrosarcomaLow grade fibromyxoid sarcoma \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">Fibrohistiocytic tumors \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">Undifferentiated pleomorphic sarcomaor malignant fibrous histiocytoma \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">Smooth muscle tumors \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">Leiomyosarcoma \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">Skeletal muscle tumors \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">Rhabdomyosarcoma (embryonary, alveolar and pleomorphic) \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">Vascular tumors \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">Hemangio epithelioid endotheliomaAngiosarcoma \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">Peripheral nerve tumors \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">Malignant tumors of the peripheral nerve sheath \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">Chondro-osseous tumors \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">Extra-skeletal chondrosarcomasExtra-skeletal osteosarcoma \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">Tumors of uncertain differentiation \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">Synovial sarcomaEpithelioid sarcomaSoft tissue alveolar sarcomaClear cell sarcomaPrimitive neuroectodermic tumor (PNET) or Extra-skeletal Ewing tumorSmall round cell desmoplastic tumorUndifferentiated sarcoma; sarcoma no otherwise specified (NOP) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab455107.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Histologic types of soft tissue sarcomas.</p>" ] ] 5 => 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=""><tbody title="tbody"><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="elsevierStyleBold">Primary tumor</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><span class="elsevierStyleItalic">TX</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">Primary tumor cannot be assessed \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><span class="elsevierStyleItalic">T0</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">No evidence of primary tumor \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><span class="elsevierStyleItalic">T1</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">Tumor not greater than 5<span class="elsevierStyleHsp" style=""></span>cm in greatest diameter \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">T1a superficial tumor \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">T1b deep tumor \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><span class="elsevierStyleItalic">T2</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">Tumor greater than 5<span class="elsevierStyleHsp" style=""></span>cm in greatest diameter \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">T2a superficial tumor \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">T2b deep tumor \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="elsevierStyleBold">Regional lymph nodes</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><span class="elsevierStyleItalic">NX</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">Regional lymph nodes cannot be assessed \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><span class="elsevierStyleItalic">N0</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">No regional lymph nodes metastasis \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><span class="elsevierStyleItalic">N1</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">Regional lymph nodes metastasis \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="elsevierStyleBold">Distant metastasis</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><span class="elsevierStyleItalic">M0</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">No distant metastasis \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><span class="elsevierStyleItalic">M1</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">Distant metastasis \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="elsevierStyleBold">Staging</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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Stage IA</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><span class="elsevierStyleHsp" style=""></span>T1a N0 M0 low grade \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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><span class="elsevierStyleHsp" style=""></span>T1b N0 M0 low grade \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Stage IB</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><span class="elsevierStyleHsp" style=""></span>T2a N0 M0 low grade \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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><span class="elsevierStyleHsp" style=""></span>T2b N0 M0 low grade \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Stage IIA</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><span class="elsevierStyleHsp" style=""></span>T1a N0 M0 low grade \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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><span class="elsevierStyleHsp" style=""></span>T1b N0 M0 high grade \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Stage IIB</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><span class="elsevierStyleHsp" style=""></span>T2a N0 M0 high grade \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Stage III</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><span class="elsevierStyleHsp" style=""></span>T2b N0 M0 high grade \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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><span class="elsevierStyleHsp" style=""></span>Any T, N1, M0. Any grade \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Stage IV</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><span class="elsevierStyleHsp" style=""></span>Any T, Any N, M1. Any grade \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab455106.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">TNM classification.</p>" ] ] 6 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Sp, specificity; Ac, accuracy; FN, false negative; M, distant metastasis; OS, osteosarcoma; R, retrospective; S, sensitivity; STS, soft tissue sarcoma; TP, true positive.</p>" "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">Author \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">Design \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">Tumor \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"><span class="elsevierStyleItalic">N</span> \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">S PET \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">S 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">Sp PET \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">Sp 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">Ac PET \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">Ac 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">Remarks \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Charest<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> \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">R \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">OS, STB \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">212 \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">88.1 \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">NE \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">NE \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">NE \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">NE \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">NE \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Al-Ibraheem<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> \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">R \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">OS, STB \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 \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">94 \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">78 \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">92 \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">67 \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">93 \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">73 \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">Greater yield PET in soft tissue and bone lesions \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">Sharma<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> \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">R \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">Uterine sarcomas \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \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">85.7 \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">57.4 \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">100 \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">87.5 \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">93.3 \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">73.3 \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">P no significant \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">Kao<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> \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">R \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">Uterine leiomyosarcomas \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \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">100 \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">100 \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">NE \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">NE \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">NE \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 FN PET but TP PET–CT (breast and lung nodules detected on CT) \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">Sung<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> \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">R \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">Uterine sarcomas \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="char" 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><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">Extrapelvic 100Intrapelvic 66.7 \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">Extrapelvic 42.9Intrapelvic 100 \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Additional results of S PET vs. CT in extrapelvic disease \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">Arush<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> \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">R \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">Pediatric sarcomas \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \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">Local 100M 77 \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Local 92M 83 \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Local 95M 79 \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Agreement with CT or MR 57.9% \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">Nicolli<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> \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">R \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">Retroperitorneal sarcomas \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \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">66.7 \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">58.3 \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">100 \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">50 \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab455105.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Utility of PET–CT for the detection of recurrences.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:43 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Garcia del Muro X. 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The Revista Española de Medicina Nuclear e Imagen Molecular (Spanish Journal of Nuclear Medicine and Molecular Imaging), was founded in 1982, and is the official journal of the Spanish Society of Nuclear Medicine and Molecular Imaging, which has more than 700 members. The Journal, which publishes 6 regular issues per year, has the promotion of research and continuing education in all fields of Nuclear Medicine as its main aim. For this, its principal sections are Originals, Clinical Notes, Images of Interest, and Special Collaboration articles. The works may be submitted in Spanish or English and are subjected to a peer review process. In 2009, it became the leading Spanish journal in the field of Medical Imaging on having an Impact Factor , awarded by the Journal Citation Reports.
Science Citation Index Expander, Medline, IME, Bibliomed, EMBASE/Excerpta Medica, Healthstar, Cancerlit, Toxine, Inside Conferences, Scopus
See moreThe Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.
© Clarivate Analytics, Journal Citation Reports 2022
SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.
See moreSNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.
See moreRevista Española de Medicina Nuclear e Imagen Molecular (English Edition)
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