Revista Espa?ola de Medicina Nuclear (English Edition)最新文献

Objective

To compare the bone scintigraphy (BS) findings and PET/CT scintigraphy with FDG (FDG PET/CT) in the detection of bone metastases in lung cancer.

Material and methods

We studied 32 patients with lung cancer who underwent FDG PET/CT and BS in a period of 15.9 ± 18.6 days. The results of both techniques were compared with the histology, where available, radiological structural techniques and the clinical follow-up. In 30 patients, a definitive diagnosis was reached with the scintigraphic findings. No final diagnosis was obtained in 2 patients.

Results

BS was positive in 25/30 patients (83.3%) and negative in 5 patients. FDG PET/CT was positive in 21/30 patients (70%) and negative in 9. The BS and the FDG PET/CT were positive in 19/30 patients (63.3%) for the detection of bone metastases. In 6/19, both techniques showed the same number of bone lesions. In 10/19, FDG PET/CT showed a greater number of bone metastases than BS. In 3/19 patients, BS showed more lesions than FDG PET/CT and in 2/30 patients (6.6%), the BS was normal and the FDG PET/CT showed bone lesions which were confirmed as metastasis. In 6/30 patients (20%), the FDG PET/CT was negative and the BS was positive. BS and FDG PET/CT scan were normal in 3/30 patients (10%).

Conclusions

In patients with lung cancer, FDG PET/CT scan detected more metastatic bone lesions than BS. It also identified bone metastasis in negative BS. In our experience, when the BS was positive and the FDG PET/CT scan was negative, the lesions observed were mostly related with degenerative bone conditions and bone fractures. In the clinical practice, the FDG PET/CT and BS have a complementary role for the assessment of bone status in lung cancer patients.

Objectives

The aim of this study was to analyze how the myocardial perfusion gated-SPECT (Single Photon Emission Computed Tomography) influences the practice of a coronary angiography in patients with ischemic cardiomyopathy (IM).

Patients and methods

A total of 120 consecutive patients (mean age: 64.9 ± 11.5 years, 25 female) with IM (left ventricular ejection fraction ≤40%) and without previous coronary angiography were evaluated by myocardial perfusion gated-SPECT (96 stress-rest and 24 only at rest). The ventricular ejection fraction (EF) was obtained at rest by gated-SPECT in all patients. The ischemic origin of the systolic dysfunction was established by means of coronary angiography in 64 patients and by previous myocardial infarction in the rest. Gated-SPECT results of these 64 patients were compared with those of 56 patients in whom coronary angiography had not been indicated.

Result

Scintigraphic myocardial ischemia (HR: 5.2; CI 95%: 2.68 to 10.35) in patients who were able to perform the stress-rest test) and who had severely impaired EF (<30%) (HR: 0.9; CI 95%: 0.89 to 0.99) were the best independent predictors of coronary angiography. On the contrary, scintigraphic criteria of viability were not a determinant, from the statistical point of view, of coronary angiography in this series.

Conclusions

In patients with IM, demonstration of ischemia and severe reduction of the EF, but not detection of viable myocardium, prompted the performance of coronary angiography.

Aim

The aim of this study was to evaluate the role of ^99mTc-MIBI parathyroid scintigraphy and radioguided parathyroidectomy on the diagnosis and treatment of primary hyperparathyroidism (PHP) due to ectopic adenomas.

Methods

We reviewed 105 consecutive patients who underwent radioguided parathyroidectomy due to adenomas between March 2004 and December 2008. Of this group we studied 20 patients (19%) with ectopic adenomas. All patients had biochemical evidence of PHP, a positive parathyroid scintigraphy, radioguided detection with histolopathological confirmation of adenoma and at least 1 year-follow up. The parathyroid scintigraphy consisted on dual-phase planar and tomographic images (SPECT or SPECT/CT). During the parathyroidectomy, intraoperative PTH determinations (0, 7, 15 and 30 min after the parathyroidectomy) were done. The follow up consisted on blood examinations of PTH, calcium, phosphorus and vitamin D and assessment of renal function.

Results

Parathyroid scintigraphy detected all adenomas. Scintigraphic and surgical findings were coincident in 18 cases (90%). The final adenoma localization was paraesophagic in 9 patients, cervicothymic in 5, posterior cervicomediastinal in 4, anterior mediastinal in 1 and parathymic in 1. The parathyroidectomy consisted on 12 minimally invasive surgeries, 2 unilateral cervicotomies, 4 bilateral cervicotomies and 2 sternotomies. No case of persistent or recurrent PHP was observed during the follow up.

Conclusions

Parathyroid scintigraphy (SPECT/CT) and radioguided surgery are effective methods on the localization and treatment of PHP due to ectopic adenomas. In our study the radioguided parathyroidectomy was successful in all cases and there was no evidence of persistent or recurrent hyperparathyroidism on the follow up.

The use of deep (intratumoral, peritumoral) and superficial (subdermal, subareolar) administration is recognized as valid in sentinel lymph node biopsy for breast cancer. Herein, we are presenting a clinical case in which a personalized methodology was a determining factor in axillary staging.

Initially, the radiotracer was injected intratumorally guided by ultrasound. The ultrasound scan identified a previously unknown axillary lymphadenopathy, with focal cortical thickening, this being a non-specific ultrasound finding, but with possibility of biopsy.

The lymphoscintigraphy did not show uptake in the mentioned node, hence, a second subareolar dose was administered. On this occasion, the lymphoscintigraphy detected drainage to the sentinel node, which was the only one positive for micrometastases

Aim

To evaluate the utility of ^18FFDG-PET for patients diagnosed of differentiated thyroid carcinoma who present risk of disease and invaluable levels of thyroglobulin (Tg) by the presence of antibodies antithyroglobulin (AbTg).

Material and methods

Retrospective study of 7 women of 40 years old and histological diagnosis of differentiated thyroid cancer (7 papillary tumours) that were sent to our department for the accomplishment of ^18FFDG-PET study because of suspicion of disease, due to ¹³¹I negative and high levels of AbTg, between the year 2002 and 2007. 11 PET scans were obtained after the intravenous injection of 370–434 MBq of ^18FFDG in normoglycemia conditions and previous administration of muscle relaxant, hydration and diuretic. The results of ^18FFDG-PET scans were confirmed by pathologic examination or clinical outcome and radiographic examination for more than 24 months.

Results

The prevalence of recurrence in our population was 57.14%. All patients presented levels of Tg lower than 3 ng/dl and AbTg superior to 200 UI/ml. Three patients had precedent thyroiditis. Out of 11 scans performed 3 of them were negative and 8 cases were found positive. It ruled out the existence of disease in three patients and localized the presence of recurrence in 4 patients.

Conclusion

18F-FDG-PET is a useful diagnostic tool for the detection of recurrence as well as to rule out the existence of disease with a high accuracy, in patients with differentiated thyroid carcinoma with ¹³¹ I whole body scan negative but with pathological elevation of antithyroglobulin antibodies.

We present the case of a 60-year old male with a follicular pattern of multifocal invasive papillary thyroid carcinoma who had undergone total thyroidectomy. During post-surgical follow-up with I-131 scan, a I-131 deposit was observed in the upper left hemiabdomen. Due to suspicion that it could be a metastasis, an ultrasound and CT scan were performed, with the subsequent diagnosis of a left simple serous renal cyst. Once confirmed, drainage was performed under ultrasound control, obtaining I-131 in the analysis of its content.

Sarcoidosis of bone lesions are rare, with an overall incidence of 3–9% of the cases. When they do occur, they are more frequent in the small bones of hands and feet than in long bones, spine or skull. We report a case of a male patient with sarcoidosis with multiple enlarged lymph nodes, skin and bone lesions, and the scintigraphic findings.