This work presents the key aspects of the sentinel lymph node biopsy (SLNB) procedure in breast cancer, based on the protocol used at Hospital Clínic de Barcelona. The aim is to facilitate its generalization in other hospital settings and training environments, promoting the standardization of the technique. It is also intended to serve as a useful resource for resident physicians and other medical trainees.
Introduction: Transarterial radioembolization (TARE) using holmium-166 (¹⁶⁶Ho) microspheres is a treatment for unresectable primary and secondary liver malignancies. The pre-therapeutic simulation procedure using a scout dose is critical to predict microsphere distribution and exclude extrahepatic leakage. This single-center observational study aimed to evaluate the dosimetric agreement between ¹⁶⁶Ho-scout and ¹⁶⁶Ho-therapy, and to correlate tumor-absorbed dose with treatment response at both tumor and patient levels.
Methods: Prospective, observational study included patients with BCLC 2022 stage A/B hepatocellular carcinoma or oligometastatic liver disease undergoing ¹⁶⁶Ho-TARE were included. Voxel-based dosimetry was performed using Q-suite. Contrast-enhanced CT was acquired 3 months post-treatment. Treatment response was assessed by RECIST/mRECIST criteria.
Results: Twenty patients underwent the pre-treatment procedure; 18 proceeded to therapy. No significant differences were observed between scout and therapy procedures in whole-liver (P = .331) and tumor doses (P = .063), indicating reliable pre-therapeutic evaluation. Fourteen patients with 16 treated lesions were included in the dose-response analysis (median volume: 22,1 [10,5-80,3] mL; dose: 22,1 [10,5-80,3] Gy). The objective tumor response rate at 3 months was 94%. However, no significant differences were found in absorbed dose metrics (P = .315) or dose-volume histogram values (D50, D70, D85) between responsive and non-responsive (NR) lesions. Patient-level analysis showed a 29% progression rate, with NR patients more likely to have secondary liver tumors (P = .011).
Conclusion: This study including a Portuguese cohort treated with ¹⁶⁶Ho-TARE showed a high tumor response rate. However, the limited sample size reduces the robustness of the conclusions. Further data from ongoing follow-up are awaited.
Objective: To establish a renal tubular uptake rate (RTUR) model based on renal dynamic imaging (RDI) for detecting early tubular injury and to explore its clinical application value.
Materials and methods: RDI data collected from August 2020 to June 2025 were analyzed. A total of 292 eligible cases (441 kidneys) were included. Participants were categorized into: - Control group: 56 cases (112 kidneys) - Renal insufficiency group: 93 cases (186 kidneys) - Fully compensated group: 62 cases (62 kidneys) - Partially compensated group: 35 cases (35 kidneys) - Decompensated group: 46 cases (46 kidneys).
Rtur calculation formula: RTUR = (Ascent slope of renal scintigraphy/Total injected radioactive drug activity) × 105 × 100%.
Analysis content: Distribution of RTUR values across five groups; correlation between GFR and RTUR in 441 kidneys. Differences in RTUR between the control group and other four groups; diagnostic efficacy and clinical value of RTUR.
Results: Compared with the control group, significant differences in RTUR were observed in the renal insufficiency group, fully compensated group, and decompensated group (P < .01). GFR in 441 kidneys showed a strong positive correlation with RTUR (r = 0.739, P < .001). ROC analysis indicated that RTUR ≤ 5.225% identified renal insufficiency (sensitivity 77.7%, specificity 70.4%), while RTUR ≥ 9.135% diagnosed complete renal compensation with 82.3% sensitivity.
Conclusion: The RTUR model enables stable quantitative assessment of renal tubular reabsorption rate, facilitating diagnosis of renal insufficiency and complete renal compensation. It holds promise as a novel quantitative indicator for evaluating tubular function. Renal GFR exhibits a strong correlation with RTUR.
Objective: This study aims to compare differential renal function (DRF) results obtained from Tc-99m DTPA and Tc-99m DMSA scintigraphy in children with urinary tract infection (UTI) combined with varying degrees of hydronephrosis. We evaluate the diagnostic performance of both methods and provide recommendations for selecting individualized imaging strategies based on specific case characteristics.
Methods: A retrospective analysis was conducted on 57 children with UTI combined with ipsilateral hydronephrosis. Clinical data collected included gender, age, urinary ultrasound findings, and results from renal dynamic and static scintigraphy. Hydronephrosis was classified by ultrasound into mild (<15 mm), moderate (15-30 mm), and severe (>30 mm). The kidney volume ratio between the affected and unaffected sides was calculated. DRF percentages for each kidney were separately obtained from both scintigraphy methods, and the deviation in DRF of the affected kidney was calculated. Based on the degree of deviation, results were categorized as normal (<5%), differing (5%-10%), or significantly different (>10%). The non-parametric Mann-Whitney U test was used to compare DRF values between Tc-99m DMSA and Tc-99m DTPA. Spearman correlation analysis assessed the relationship between hydronephrosis and DRF deviation. Receiver operating characteristic (ROC) curves were used to determine diagnostic thresholds and assess the predictive value of renal pelvic and calyceal dilation for DRF deviations.
Results: Among the 57 children, the median DRF of the affected kidney was 50.84% (IQR: 43.24,55.00) by Tc-99m DMSA and45% (IQR: 35.35, 47.95) by Tc-99m DTPA, with the difference being statistically significant (Z = -4.074, p < 0.000). Of these, 34 children had a DRF deviation > 5%, and 16 had a deviation >10%. Positive correlations were observed between DRF deviation and renal pelvic dilation (r = 0.299, p = 0.024), calyceal dilation (r = 0.235, p = 0.078), and kidney volume ratio (r = 4.416, p = 0.001). A renal pelvic dilation >13.5 mm or calyceal dilation >8.8 mm predicted DRF deviations >5% with a sensitivity of 73.5% and 79.4%, respctively. For deviations >10%, a calyceal dilation long axis >23.2 mm yielded a diagnostic specificity of 100%.
Conclusion: Tc-99m DMSA-derived DRF may be affected by the degree of hydronephrosis. In children with UTI combined with hydronephrosis, significant differences in DRF assessment exist between Tc-99m DMSA and Tc-99m DTPA. When renal pelvic dilation exceeds 13.5 mm or calyceal diameter reaches 23.2 mm, Tc-99m DMSA may overestimate renal function. In such cases, Tc-99m DTPA should be considered for more accurate functional evaluation.
Objective: To assess the diagnostic feasibility of transperineal biopsy guided by fusion of PET/MRI with [18F]F-PSMA-1007 and real-time transrectal ultrasound (BP PET/MR PSMA + TRUS) in patients with PIRADS 3 lesions. To analyze imaging biomarkers and radiomic features for differentiating between patients with negative biopsy, clinically non-significant prostate cancer (cnsPCa), and clinically significant prostate cancer (csPCa).
Methods: A prospective study was conducted in 20 patients with PIRADS 3 lesions and PSA ≥ 4 ng/mL, with no concurrent suspicious lesions. All patients underwent a PET/MRI with [18F]F-PSMA-1007, followed by targeted biopsy using real-time ultrasound fusion. Diagnostic accuracy for prostate cancer (PCa) and the proportion of csPCa and cnsPCa diagnoses were calculated. Imaging biomarkers and machine learning models based on radiomic features were analyzed.
Results: The technique was feasible in 100% of cases. The overall detection rate of PCa was 80%, with 100% sensitivity and 36% specificity for csPCa. SUVpeak was the only biomarker that showed significant differences between patients with negative histology and PCa (AUC 0.81; sensitivity 75%; specificity 80%; cutoff value 3.5). No biomarker successfully differentiated between csPCa and cnsPCa. Both supervised classification models demonstrated high diagnostic performance (AUC > 0.95): Multimodal regression performed slightly better for binary classification (negative vs. PCa). Random Forest outperformed in three-class classification (negative vs. cnsPCa vs. csPCa).
Conclusions: BP PET/MRI PSMA + TRUS is a feasible, safe, and potentially superior technique compared to MRI-only targeted biopsy, especially in PIRADS 3 lesions. Radiomic analysis improves discriminative ability over conventional imaging biomarkers, particularly for distinguishing between cnsPCa and csPCa.
Objective: To assess the diagnostic impact of using automatic segmentation and quantitative analysis of lung perfusion SPECT/CT in the evaluation of pulmonary reperfusion in patients undergoing follow-up for pulmonary thromboembolism (PTE).
Materials and methods: A prospective study was conducted from October 2021 to October 2024. We included 132 patients with PTE diagnosed by lung perfusion scintigraphy with SPECT/CT, who underwent a follow-up scan at 6 months. Reperfusion was assessed visually and quantitatively. Three grades were visually established: no reperfusion, partial reperfusion, and complete reperfusion. For quantitative analysis, automatic segmentation was performed, obtaining volumes and total counts in the baseline and follow-up SPECT/CT scans. Two parameters were established for comparison: the relative decrease in defect volume (RDV) and the relative increase in total perfused volume counts (RIC). Reperfusion was classified as: no reperfusion, partial reperfusion (minor and major), and complete reperfusion. The scintigraphic results were correlated with demographic variables, extension and size of the PTE and other complementary diagnostic tools (pulmonary function tests and echocardiogram).
Results: 82 patients were women (mean age 70 ± 16 years) and 50 were men (64 ± 15 years). Comparing the agreement between visual and quantitative analysis (weighted Cohen's Kappa index), a slight, but non-statistically significant, agreement was demonstrated between evaluators (κ = 0.04; p = 0.464). Pearson's assessment revealed a very high and positive assessment between RDV and RIC (r = 0.77; p < 0.001). Patients with abnormal complementary diagnostics tools at follow-up were not more likely to have residual thrombosis (p > 0.05 in the visual and quantitative analyses). The remaining variables also did not show statistical significance in the persistence of PTE.
Conclusions: In the assessment of post-PTE pulmonary reperfusion, quantitative analysis of lung perfusion SPECT/CT is superior to visual analysis. Furthermore, it suggests that it is a particularly useful tool in patients in whom visual analysis does not show improvement, as it could prevent unnecessary and prolonged treatment if reperfusion is observed through quantification.
Objective: The three treatment modalities for patients with hyperthyroidism are antithyroid drugs (ATDs), surgery, and radioactive iodine (RAI) therapy. The study aims to determine the predictors of a response to RAI in patients with hyperthyroidism.
Materials and methods: We retrospectively assessed 914 patients who received RAI for the treatment of hyperthyroidism between January 2000 and December 2023, with a follow-up of at least 6 months after the first dose.
Results: Hypothyroidism was ultimately achieved in 62.9% of the patients. Multiple variables are possible predictors in univariable logistic regression analysis. However, only shorter duration of ATD therapy (odds ratio 0.996; 95% confidence interval [CI], 0.093-0.999; P = .003, multivariable logistic regression analysis) and a diagnosis of Graves' disease (GD) (odds ratio 1.803; 95% confidence interval [CI], 1.042-3.141; P = .035, multivariable logistic regression analysis) are the independent predictors of post-treatment hypothyroidism, with decreasing age also being a late-response independent predictor of hypothyroidism 24 months after the treatment (odds ratio 0.983; 95% confidence interval [CI], 0.968-0.998; P = .028, multivariable logistic regression analysis). The median time to hypothyroidism was 10.0 ± 0.7 months (Kaplan-Meier method), with a statistically significant difference in hypothyroidism-free survival (HFS) between patients with GD on one side and solitary toxic adenoma (STA) and toxic multinodular goiter (TMG) on the other (P < .001, log-rank test).
Conclusions: GD and a shorter duration of previous ATD therapy are independent predictors of post-therapeutic hypothyroidism in patients treated for hyperthyroidism with RAI, with younger age also being an independent predictor of a late response.
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