Aporte de la centellografía con trazadores tecneciados fosfatados al diagnóstico de amiloidosis cardíaca / Contribution of scintigraphy with technetium phosphated tracers to the diagnosis of cardiac amyloidosis / Contribuição da cintilografia com traçadores fosfatados com tecnécio para o diagnóstico de amiloidose cardíaca

Las amiloidosis son enfermedades causadas por el depósito patológico extracelular de un material proteico fibrilar e insoluble denominado amiloide, que puede estar vinculado a cadenas livianas (AL) o transtirretina (TTR). La amiloidosis cardíaca provoca una cardiomiopatía restrictiva de carácter progresivo caracterizada por falla cardíaca con función sistólica relativamente preservada, que se asocia a elevada mortalidad. Aunque el diagnóstico definitivo tradicionalmente se basa en la biopsia endomiocárdica, los avances en imagenología han mejorado su abordaje y la reciente introducción de terapias especificas permiten augurar cambios significativos en el pronóstico. El tratamiento difiere según el tipo de amiloide involucrado y su resultado depende de la instauración precoz de este, por lo cual resulta esencial un diagnóstico preciso y temprano. El centellograma cardíaco con fosfatos marcados (99mTc-PYP u otros), ampliamente disponible y de relativo bajo costo, se considera en la actualidad como una "biopsia molecular no invasiva" para el diagnóstico de la amiloidosis tipo ATTR, que debe ser usado en conjunto con la investigación de proteínas monoclonales en pacientes con sospecha clínica de la enfermedad.

Amyloidoses are diseases caused by the extracellular deposition of a fibrillar and insoluble protein material called amyloid, which can be linked either to light chains (AL) or transthyretin (TTR). Cardiac amyloidosis causes a progressive restrictive cardiomyopathy characterized by heart failure with relatively preserved systolic function, which is associated with high mortality. Although a definitive diagnosis is traditionally based on endomyocardial biopsy, advances in cardiac imaging have improved its approach, and the recent introduction of specific therapies predicts significant changes in prognosis. Since treatment differs according to the type of amyloid involved and the results depend on a prompt implementation, an accurate and early diagnosis is essential. Cardiac scintigraphy with labeled phosphates (99mTc-PYP or others), widely available and relatively inexpensive, is currently considered a "noninvasive molecular biopsy" for the diagnosis of ATTR type amyloidosis, which should be used in conjunction with investigation of monoclonal proteins in patients with clinical suspicion of the disease.

As amiloidoses são doenças causadas pela deposição patológica extracelular de um material proteico fibrilar e insolúvel, denominado amiloide, que pode estar ligado a cadeias leves (AL) ou transtirretina (TTR). A amiloidose cardíaca causa cardiomiopatia restritiva progressiva caracterizada por insuficiência cardíaca com função sistólica relativamente preservada, que está associada a alta mortalidade. Embora o diagnóstico definitivo seja tradicionalmente baseado na biópsia endomiocárdica, os avanços nos exames de imagem aprimoraram sua abordagem e a recente introdução de terapias específicas pode predizer mudanças significativas no prognóstico. O tratamento varia de acordo com o tipo de amiloide envolvida e seu resultado depende do início precoce, por isso um diagnóstico preciso e precoce é essencial. A cintilografia cardíaca com fosfatos marcados (99mTc-PYP ou outros), amplamente disponível e relativamente econômico, é atualmente considerada uma "biópsia molecular não invasiva" para o diagnóstico de amiloidose do tipo ATTR, que deve ser usada em conjunto com a investigação de proteínas monoclonais em pacientes com suspeita clínica da doença.

A dinâmica das infecções relacionadas à assistência à saúde utilizando a metodologia tracer e a modelagem por redes complexas / The route of healthcare-associated infections using tracer methodology and modeling by complex networks / La dinámica de las infecciones relacionadas con la asistencia a la salud utilizando la metodología tracer y el modelado por redes complejas

Justificativa e Objetivos: no Brasil, infecções de sítio cirúrgico (ISC) compreendem aproximadamente 15% das infecções relacionadas à assistência à saúde (IRAS). Este estudo avaliou a dinâmica das infecções por meio da metodologia tracer, alinhada à análise por redes complexas, utilizando o rastreamento de um paciente (caso) que foi submetido à cirurgia (cenário). Métodos: estudo de caso, de natureza observacional, abordagem descritiva, com avaliação transversal e retrospectiva, pelo rastreamento e análise do prontuário de um paciente submetido a procedimentos cirúrgicos, utilizando a metodologia tracer, sob a ótica das redes complexas, no Hospital das Clínicas, Universidade Federal de Pernambuco. Resultados: mulher, 65 anos, submetida à descompressão, artrodese e retirada de enxerto (doador) em ilíaco esquerdo. Readmitida com osteomielite do ilíaco esquerdo, evoluindo com piora do estado geral, seguido de óbito. O fator de prioridade (PFP) relacionado ao caso foi o procedimento cirúrgico para retirada do enxerto no ilíaco esquerdo pela clínica ortopédica. De acordo com o Manual Brasileiro de Acreditação Hospitalar, os padrões obrigatórios e aplicáveis, segundo o perfil do hospital, apresentam os seguintes percentuais de conformidade para o nível 1 (78,7%), nível 2(82,4%) e no nível 3 (51,7%). Utilizando as redes complexas e considerando que os profissionais são potenciais carreadores da disseminação das infecções aos suscetíveis e são preditores da propagação da ISC (cenário 2/hipótese 2), somado à falta de estrutura para higienização das mãos (cenário 3/hipótese 3), observou-se que há maior chance de ISC ter ocorrido nos setores da enfermaria e UTI. Conclusões: a provável propagação das IRAS está relacionada aos profissionais e à estrutura físico-funcional necessária para prestação da assistência segura.(AU)

Background and Objectives: surgical site infections (SSI) comprise approximately 15% of healthcare-associated infections (HAIs) in Brazil. This study assessed the route of infections using tracer methodology, aligned with analysis by complex networks, by tracing a patient (case) who underwent surgery (scenario). Methods: an observational and descriptive case study, with cross-sectional and retrospective assessment, by tracing and analyzing the medical records of a patient who underwent surgical procedures. Tracer methodology was used from the perspective of complex networks at Hospital das Clínicas, Universidade Federal de Pernambuco. Results: a woman, 65 years old, submitted to decompression, arthrodesis, and graft removal (donor) in the left iliac. Readmitted with left iliac osteomyelitis, worsening in general condition, followed by death. The priority factor (PFP) related to the case was the surgical procedure to remove the graft in the left iliac, by the orthopedic clinic. According to the Brazilian Manual of Hospital Accreditation, the mandatory and applicable standards according to hospital profile have the following percentages of conformity for level 1 (78.7%), level 2 (82.4%), and level 3 (51.7%). Using complex networks and considering that professionals are potential carriers of the spread of infections and are predictors of the spread of SSI (scenario 2/hypothesis 2) plus the lack of structure for hand hygiene (scenario 3/hypothesis 3), it was observed that there is a greater chance that SSI occurred in ward and ICU. Conclusions: the probable spread of HAIs is related to professionals and the physical-functional structure necessary to provide safe care.(AU)

Justificación y objetivos: en Brasil, la ocurrencia de infecciones en pacientes hospitalizados es aproximadamente 15%, y, por eso, la importancia de estudiar la dinámica de las infecciones hospitalarias. Este estudio evaluó la dinámica de las infecciones utilizando la metodología tracer, alineada con el análisis por redes complejas, a partir del rastreo de un paciente (caso) sometido a procedimientos quirúrgicos (escenario). Métodos: estudio de caso, de naturaleza observacional, abordaje descriptivo, con evaluación transversal y retrospectiva, a partir del rastreo individual utilizando la metodología tracer, a través del análisis de prontuario de un paciente sometido a procedimientos quirúrgicos en la Clínica de Ortopedia, Hospital das Clínicas, Universidade Federal de Pernambuco. Resultados: una mujer, 65 años, sometida a descompresión, artrodesis y retirada de injerto en ilíaco izquierdo. Leído con osteomielitis del ilíaco izquierdo, evolucionando con empeoramiento progresivo del estado general, seguido de muerte. El factor de prioridad (PFP) relacionado con el caso fue el procedimiento quirúrgico para la extracción del injerto en el ilíaco izquierdo, por la clínica ortopédica. Los porcentajes de conformidad en el nivel 1 correspondió al 78,7%, en el nivel 2 fue 82,4% y en el nivel 3, 51,7%. A partir del análisis por redes complejas, se observó que hay mayor probabilidad de que la diseminación de la infección esté relacionada con el conjunto de contactos, siendo los profesionales los potenciales portadores de las infecciones a los susceptibles, en los sectores de la enfermería y UTI, siendo éste el predictor de la propagación de la infección de sitio quirúrgico (Escenario 2/Hipótesis 2) y/o la falta de estructura para higienización de las manos (Escenario 3/Hipótesis 3). Conclusiones: las fuerzas que impulsan las infecciones hospitalarias están relacionadas a los cuidadores ya la estructura físico-funcional necesaria para el desarrollo de la asistencia a la salud.(AU)

Hiperinsulinismo congénito: caracterización de pacientes atendidos en un hospital universitario pediátrico en Colombia / Congenital hyperinsulinism: characterization of patients treated in a pediatric university hospital in Colombia

Resumen Introducción: El hiperinsulinismo congénito es una enfermedad del metabolismo de la glucosa, fundamental en la endocrinología pediátrica, ya que se refiere a la producción de mayor cantidad de insulina de la necesaria según la glucemia, lo cual produce hipoglucemias graves persistentes. Esta alteración puede tener importantes secuelas neurológicas debido al daño irreversible que se produce en la neurona por la exposición a la hipoglucemia por cortos periodos de tiempo. Su diagnóstico no es sencillo y requiere un alto índice de sospecha. El tratamiento se establece de manera secuencial, en varias etapas, observando la respuesta a cada uno de los posibles medicamentos empleados. En caso de que falle el manejo farmacológico, se requieren procedimientos quirúrgicos. Serie de casos: Se presentan siete casos de hiperinsulinismo congénito que fueron diagnosticados en los últimos 7 años en el Instituto Roosevelt en Bogotá, Colombia. En este país, el radiotrazador empleado usualmente durante la tomografía por emisión de positrones (PET/TC) no se encuentra disponible. Sin embargo, en uno de los casos descritos fue posible emplear otro radiotrazador alternativo que permitió un adecuado diagnóstico y un tratamiento quirúrgico exitoso. Conclusiones: El hiperinsulinismo congénito es una condición clínica compleja que amerita un correcto diagnóstico y un apropiado manejo, con el objetivo de evitar el daño neurológico que producen las hipoglucemias persistentes. Es posible emplear PET/TC con un radiotrazador adecuado para realizar un diagnóstico oportuno y proporcionar la mejor opción terapéutica disponible.

Abstract Background: Congenital hyperinsulinism is a disease of the glucose metabolism, relevant in pediatric endocrinology because of the elevated production of insulin according to blood glucose level, which leads to persistent severe hypoglycemia. This condition can produce important neurological sequelae in the patient due to the irreversible damage that occurs in the neuron caused by the exposure to hypoglycemia for short periods of time. Congenital hyperinsulinism diagnosis is not simple and it requires a high index of suspicion. The treatment should be established sequentially, in several steps, noticing the response to each possible medication used. If the pharmacological management fails, surgical procedures are required occasionally. Case series report: Seven cases of congenital hyperinsulinism diagnosed in the last seven years at the Instituto Roosevelt in Bogotá, Colombia are presented. In this country, the radiotracer used internationally during positron emission tomography/computed tomography (PET/CT) is not available. However, was possible to use an alternative radiotracer in one of the cases, which led to an adequate diagnosis and a successful surgical treatment. Conclusions: Congenital hyperinsulinism is a complex clinical condition, which requires proper diagnosis and treatment, with the aim of avoiding any neurological damage caused by persistent hypoglycemia. PET/CT can be used with an appropriate radiotracer for a timely diagnosis and to provide the best available therapeutic option.

Utilização de radiofármacos marcados com tecnécio 99m como potenciais marcadores na obtenção de imagens de perfusão miocárdica / Using technetium-99m-marked radiopharmaceuticals as potential markers in obtaining myocardial perfusion images

A Organização Mundial de Saúde (OMS) aponta as doenças cardiovasculares como a principal causa de morte no mundo, caracterizando um grave problema na saúde pública. Os três tipos de doenças que mais acarretam em óbito são: acidente vascular cerebral, seguido de infarto agudo do miocárdio e outras doenças isquêmicas do coração.Apesar dos avanços terapêuticos das últimas décadas, o infarto ainda apresenta altas taxas de mortalidade. Para as pessoas com doenças cardiovasculares ou com alto risco cardiovascular é fundamental o diagnóstico precoce da doença. A cintilografia de perfusão miocárdica é um método de investigação diagnóstica e prognóstico não invasivo de várias doenças cardiovasculares. Esse exame consiste na administração de um radiofármaco para obtenção de imagens de perfusão cardíaca. Dois traçadores marcados com Tecnécio-99m são amplamente utilizados na clínica, porém, esses dois radiofármacos não atendem aos requisitos de um agente de perfusão ideal, por sofrerem significativa excreção biliar, produzindo artefatos na imagem, o que pode inteferir um diagnóstico preciso, já que a qualidade é comprometida, e prolongando o tempo de obtenção da imagem após a administração do radiotraçador. Para superar essa lacuna, pesquisadores vêm estudando novos complexos catiônicos marcados com o Tecnécio. O objetivo desse artigo é fazer uma revisão, abordando a literatura sobre os radiofármacos que estão sendo estudados, suas vantagens e desvantagens sobre os traçadores já utilizados, e sobre sua potencial utilização na obtenção de imagem de perfusão cardíaca.

The World Health Organization (WHO) acknowledges cardiovascular diseases as the leading cause of death in the world, being regarded as a serious public health issue. The three types of diseases with the greatest mortality are: stroke, followed by acute myocardial infarction (AMI) and other ischemic heart diseases. Despite the therapeutic advances of the last decades, AMI still presents high mortality rates. Early diagnosis is essential for people with cardiovascular diseases or with a high cardiovascular risk. Myocardial perfusion scintigraphy is a method of diagnostic investigation and noninvasive prognosis of various cardiovascular diseases. This examination consists in the administration of a radiopharmaceutical drug to obtain images of cardiac perfusion. Two tracers labeled with Technetium-99m are widely used, however, these two radiopharmaceuticals do not meet the requirements of an ideal perfusion agent, because they have a high liver absorption, producing artifacts in the image, which can disrupt a precise diagnosis, since the quality is compromised, and prolonging the imaging time after administration of the radioisotope. To overcome this gap, researchers have been studying new cationic complexes marked with technetium. The objective of this article is to review the literature on the radiopharmaceuticals being studied, their advantages and disadvantages on the tracers already used, and their potential use in obtaining a cardiac perfusion image.

Aplicación de la Tomografía por emisión de positrones en el cáncer de próstata marcado con 68Ga-PSMA: Revisión y actualidad / Application of positron emission tomography in prostate cancer marked with 68Ga-PSMA: Review and update

Una de las características de cáncer de próstata es su baja afinidad a la absorción de glucólisis y glucosa. Esto se traduce la baja afinidad del 18F-FDG para la detección de los tumores de próstata por el PET/ CT. El antígeno prostático específico de membrana (PSMA) es una proteína transmembrana presente en todos los tejidos prostáticos. El incremento de la expresión de PSMA está presente en varios tumores, aunque su concentración es más elevada en el cáncer de próstata. Casi todos los adenocarcinomas de próstata muestran expresión de PSMA en la mayoría de las lesiones, tanto primarias como metastásicas. La expresión del PSMA en cáncer de próstata es más elevada que en otros tipos de cáncer, donde se ha descrito la presencia de PSMA. Se ha demostrado que el incremento de este antígeno se presenta principalmente en casi todos los adenocarcinomas de próstata tanto primario como metastásico con diferentes grados de desdiferenciados. La tomografía por emisión de positrones/tomografía computarizada (PET/TC) es una técnica de imagen no invasiva, reconocida para el estudio de diversos tumores malignos. La PET/CT marcada con 68Ga-PSMA o 18F-PSMA proporciona imágenes metabólicas semicuantitativas de las concentraciones anormales de este antígeno permitiendo una valoración más precisa del cáncer de próstata. En esta revisión describiremos la importancia de 68Ga-PSMA PET/CT en la valoración del cáncer de próstata.

One of the characteristics of prostate cancer is its low affinity to the absorption of glycolysis and glucose. This translates the low affinity of 18F-FDG for the detection of prostate tumors by PET/CT. Prostate-specific membrane antigen (PSMA) is a transmembrane protein present in all prostate tissues. The increase in the expression of PSMA is present in several tumors, although its concentration is higher in prostate cancer. Almost all prostate adenocarcinomas show PSMA expression in most lesions, both primary and metastatic. The expression of PSMA in prostate cancer is higher than in other types of cancer, where the presence of PSMA has been described. It has been shown that the increase of this antigen occurs mainly in almost all prostate adenocarcinomas, both primary and metastatic with different degrees of dedifferentiated. Positron emission tomography / computed tomography (PET/CT) is a noninvasive imaging technique, recognized for the study of various malignancies. PET/CT labeled with 68Ga-PSMA or 18F-PSMA provides semi quantitative metabolic images of abnormal concentrations of this antigen allowing a more accurate assessment of prostate cancer. In this review we will describe the importance of 68Ga-PSMA PET/CT in the evaluation of prostate cancer.

Importancia de los criterios (o escala) de Deauville, en la valoracion de respuesta temprana al tratamiento en linfomas con 18F-FDG PET/CT / Importance of the criteria (or scale) of Deauville, in the evaluation of early response to treatment in lymphomas with 18F-FDG PET/CT

Una de aplicaciones más importantes de la tomografía por emisión de positrones (PET/CT) usando 18 fluor desoxiglucosa (18F-FDG) en pacientes adultos y pediátricos con linfoma es para monitorizar el tratamiento. La PET/CT se usa hoy en día durante el tratamiento para evaluar la quimio sensibilidad y administrar la terapia adaptada a la respuesta al tratamiento, otro uso importante en este tipo de pacientes es valorar la remisión de la enfermedad, así como el pronóstico pre transplante1. Los Criterios de Deauville (CD) o escala de los 5 puntos es el resultado de varios años de investigaciones de la utilidad del 18F-FDG PET/CT (tomografía por emisión de positrones con 18 fluor desoxiglucosa) en linfomas, en estos análisis se determinó que el valor del SUV (Standardized Uptake Value) o valor estándarizado de captación variaba de un equipo a otro, además no siempre en el 18F-FDG PET/CT de control se podía realizar replicando las mismas condiciones en el paciente para que el resultado numérico del nivel de captación sea confiable y por lo tanto comparable, existen también diferentes formas de informar los resultados por lo tanto se buscaba un lenguaje único que permita la valoración, la comparación y que las conclusiones en el informe sean interpretables para todos2. En los pacientes con linfoma Hodgkin o No Hodking la 18F-FDG PET/CT es muy importante en su estadificación inicial, en la evaluación de la respuesta al tratamiento y en la identificación de recidivas. 18F-FDG PET/CT permite diferenciar tejido con actividad tumoral de masas necróticas o fibróticas residuales. Durante varios años se han realizado estudios que han confirmado la importancia de su papel en la valoración de recidivas, para la estadificación inicial y en la vigilancia de la respuesta después de los primeros ciclos de quimioterapia y al final del tratamiento. La evaluación temprana de la respuesta metabólica permite identificar de forma oportuna a los pacientes que no responden al tratamiento; en esos casos el cambio temprano a una terapia más adecuada así se puede evitar o disminuir la toxicidad innecesaria y mejorar la calidad de vida y supervivencia3. Es de especial importancia la 18F-FDG PET/CT de respuesta temprana al tratamiento o PET/CT "interin" (en Ingles), el cual se realiza después del tercer o cuarto ciclo de quimioterapia y en el cual la aplicación de la Escala de Deauville es fundamental.

One of the most important applications of positron emission tomography (PET/CT) using 18 fluor deoxyglucose (18F-FDG) in adult and pediatric patients with lymphoma is to monitor treatment. PET/CT is used today during treatment to assess chemo sensitivity and administer therapy adapted to the response to treatment. Another important use in this type of patients is to assess the remission of the disease as well as the pre-transplantation prognosis1. The Deauville Criteria (CD) or 5-point scale is the result of several years of investigations of the utility of 18F-FDG PET/CT (Positron Emission Tomography with 18 fluor deoxyglucose) in lymphomas. These analysis determined that the value of the SUV (Standardized Uptake Value) or standardized capture value varied from one device to another. Besides not always the 18F-FDG PET/CT control could be performed replicating the same conditions in the patient so that the numerical result at the level of recruitment is reliable and therefore comparable. There are also different ways of reporting the results. Therefore a common language that allows the assessment, comparison and that the conclusions reporting is necessary for all2. In patients with lymphoma Hodgkin's or non-Hodgkin's, 18F-FDG PET/CT is very important in its initial staging, in the evaluation of response to treatment and in the identification of recurrences. 18F-FDG PET/CT allows to differentiate tissue with tumor activity from residual necrotic or fibrotic masses. For several years, studies have been carried out that have confirmed its important role in assessing relapses, for initial staging and in the monitoring of the response after the first cycles of chemotherapy and at the end of treatment. The early evaluation of the metabolic response makes it possible to identify in a timely manner patients who do not respond to treatment; in such cases the opportune change to a more appropriate therapy can thus avoid or diminish the unnecessary toxicity and improve the quality of life and survival3. Special importance is 18F-FDG PET/CT for early response to treatment or PET/CT "interin", which is performed after the third or fourth cycle of chemotherapy and in which the application of the Deauville is fundamental.

Importancia del 18F-FDG PET/CT en patología no neoplásicas / Role of PET/CT with 18F-FDG in non-neoplastic pathology

En la actualidad el uso de las imágenes metabólicas en Medicina Nuclear con tecnología PET/ CT con diferentes radiotrazadores, en especial la 18F-FDG, se está extendiendo más allá del ámbito de la oncología, siendo las enfermedades inflamatorias e infecciosas de las que más interés están despertando. El PET/CT tiene la ventaja de poder detectar enfermedades incluso cuando no tienen una correlación en las imágenes morfológicas, permitiendo además localizar de manera precisa estas alteraciones. Entre las patologías más estudiadas se encuentran el estudio de fiebre de origen desconocido, enfermedades inflamatorias, enfermedades del tejido conectivo, vasculitis y también en el seguimiento y diagnóstico de algunas patologías infecciosas. En este artículo se hace una revisión de la aplicación y aporte de las imágenes PET/CT en diferentes patologías inflamatorias e infecciosas comparándolas con técnicas de imagen estructurales y de Medicina Nuclear convencional, haciendo énfasis en procesos inflamatorios e infecciosos articulares, prótesis en traumatología y prótesis vasculares complementando con casos clínicos.

At present, the use of metabolic images in Nuclear Medicine like PET/CT technology with different radiotracers, especially 18F-FDG, is extending beyond the field of oncology, with the inflammatory and infectious diseases being the most interesting. They are waking up PET/CT has the advantage of being able to detect diseases even when they do not have a correlation in morphological images, also locating these alterations accurately. Among the most studied pathologies are fever of unknown origin, inflammatory diseases, connective tissue diseases, vasculitis and also in the monitoring and diagnosis of some infectious diseases. In this article, a review of the application and contribution of PET/CT images in different inflammatory and infectious pathologies is made comparing them with structural imaging techniques and conventional Nuclear Medicine, speciallyd inflammatory and infectious joint processes, prostheses in traumatology and prostheses vascular and clinical cases.

Urología: Cáncer de Próstata Gleason 8 18F-FDG PET/CT / Urology: Prostate Cancer Gleason 8 18F-FDG PET/CT

El uso de la tomografía por emisión de positrones con fluordesoxiglucosa 18F-FDG-PET/CT en cáncer de próstata ha sido controversial, después de algunos trabajos científicos se ha visto que el uso de fluordesoxiglucosa (18F-FDG) es de gran utilidad tanto en el estadiaje pre tratamiento y en el seguimiento cuando el Gleason es mayor a 7, esto debido a que esa puntuación está en relación con el grado de des diferenciación y de agresividad, siendo de gran valor en estos pacientes pues la 18F-FDG-PET/CT es más accesible en la mayoría de países, además el 18F-FDG-PET/CT detecta de manera más confiable metástasis óseas y a distancia. Se presenta un caso de cáncer de próstata con Gleason 8 y 10 en donde se analiza la aplicación y aporte de las imágenes 18F-FDG-PET/CT permitiendo una estadificación más precisa, facilitando una adecuada elección terapéutica.

The use 18F-FDG-PET/CT in prostate cancer has been controversial, after some scientific work it has been seen that the use of (18F-FDG) is very useful both in the pre-treatment staging and in the follow-up when the Gleason is higher to 7, this is due to the fact that this score is related to the degree of differentiation and degree of aggressiveness, being of great value in these patients since PET/CT with 18FDG is more accessible in most countries, in addition 18F-FDG-PET/CT detects bone and distance metastases more reliably. A case of prostate cancer with Gleason 8 and 10 is presented, where the application and contribution of the 18F-FDG-PET/CT allowing a more precise staging, facilitating an adequate therapeutic choice.

Características de la imagen con 68Ga-PSMA PET/CT. Biodistribución normal y anormal / Image features with 68Ga-PSMA PET/CT. Normal and abnormal biodistribution

Un sistema de PET/CT integrado o multimodal es una combinación física de PET y CT que incluye adquisición secuencial de porciones de PET y CT. El paciente permanece en la misma posición durante los dos exámenes. Un examen 68Ga-PSMA PET/CT puede cubrir diversos rangos de imágenes coaxiales1. PSMA es una proteína transmembrana presente principalmente en todos los tejidos prostáticos. Este articulo tiene como objetivo ayudar a los médicos imagenólogos para clínicos, a reconocer las imágenes de 68Ga-PSMA PET/CT mostrar características propias y ofrecer conocimientos generales de su interpretación en el área de diagnósticos dirigido al cáncer de próstata.

Radiosynthesis and preliminary evaluation of 5-(11Cmethyloxy)-L-tryptophan as PET tumor imaging / 药学学报

The PET tracer 5-([11C]methyloxy)-L-tryptophan (5-(11)CMTP) was prepared by nucleophilic fluorination and alkylation reaction via a two-step procedure in order to develop specific tumor probe. The biodistribution and microPET imaging of 5-(11)CMTP were executed. The results unveiled that the overall radiochemical yield with no decay correction was (14.6 ±7.2) %, the radiochemical purity was more than 95% and high uptake and long retention time of 5-(11)CMTP in liver, kidney and blood were observed but low uptake in brain and muscle were found, furthermore, high uptake of 5-(11)CMTP in tumor tissue was observed. It seems that 5-(11)CMTP will be a potential amino acid tracer for tumors imaging with PET.

Tumor targeting efficacy of a novel PET radiotracer (1)8F-AlF-NOTA-PRGD2 in mice / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the tumor targeting efficacy of (18)F-AlF-NOTA-PRGD2, a novel radiotracer of Arginine-glycine-aspartic acid (RGD) peptides.</p><p><b>METHODS</b>(18)F-AlF-NOTA-PRGD2 was synthesized in one-step by conjugating NOTA-PRGD2 with (18)F-AlF at 100 degrees celsius;. The tumor targeting efficacy and in vivo biodistribution profile of (18)F-AlF-NOTA-PRGD2, following intravenous injection via the tail vein, were evaluated in a nude mouse model bearing subcutaneous U87MG glioblastoma xenograft by radioactivity biodistribution assessment, PET/CT and microPET/CT.</p><p><b>RESULTS</b>NOTA-PRGD2 was (18)F-fluorinated successfully in one-step with a yield of 17%-25% within 15-20 min. Radioactivity biodistribution study confirmed the tumor-targeting ability of (18)F-AlF-NOTA-PRGD2 in the tumor-bearing mice. At 1 and 2 h following injection, (18)F-AlF-NOTA-PRGD2 uptake in the tumor reached 4.14∓1.44 and 2.80∓1.18 % ID/g (t=1.910, P=0.070) with tumor/brain ratios of 2.95∓0.61 and 5.21∓2.62, respectively (t=-1.686, P=0.167). Both PET/CT and microPET/CT were capable of showing the radioactivity biodistribution of (18)F-AlF-NOTA-PRGD2 in the mouse model and clearly displayed the tumor, but microPET/CT showed a much better image quality.</p><p><b>CONCLUSION</b>(18)F-AlF-NOTA-PRGD2 prepared by one-step radiosynthesis can selectively target to the tumor, demonstrating its potential as a good radiotracer for tumor imaging.</p>

Inappropriate intracervical injection of radiotracer for sentinel lymph node mapping in a uterine cervix cancer patient: importance of lymphoscintigraphy and blue dye injection

Herein, we report a case of sentinel lymph node mapping in a uterine cervix cancer patient, referring to the nuclear medicine department of our institute. Lymphoscintigraphy images showed inappropriate intra-cervical injection of radiotracer. Blue dye technique was applied for sentinel lymph node mapping, using intra-cervical injection of methylene blue. Two blue/cold sentinel lymph nodes, with no pathological involvement, were intra-operatively identified, and the patient was spared pelvic lymph node dissection. The present case underscores the importance of lymphoscintigraphy imaging in sentinel lymph node mapping and demonstrates the added value of blue dye injection in selected patients. It is suggested that preoperative lymphoscintigraphy imaging be considered as an integral part of sentinel lymph node mapping in surgical oncology. Detailed results of lymphoscintigraphy images should be provided for surgeons prior to surgery, and in case the sentinel lymph nodes are not visualized, use of blue dye for sentinel node mapping should be encouraged

Variabilidade genética de Colletotrichum guaranicola usando marcadores AFLP / Variability of Colletotrichum guaranicola using AFLP markers

Foi detectada a variabilidade genética de vinte isolados de Colletotrichum guaranicola (Albuq.) provenientes de diferentes localidades produtoras de guaraná no Amazonas, utilizando-se marcadores moleculares AFLP. Foi possível separar os isolados em dois grupos. O coeficiente de variação genética entre os isolados foi de 0,0216 e a similaridade genética foi de 94,95 por cento, confirmando que os isolados pertencem à mesma espécie, no entanto, foi observada variabilidade intra-específica.

The genetic variability of twenty Colletotrichum guaranicola (Albuq.) isolates from different fields of guarana in Amazonas, was studied using molecular AFLP markers. The isolates were separated into two groups. The genetic variability coefficient was 0.0216 and the genetic similarity was 94.5 percent, confirming that the isolates belongs to the same species, however, an intra-specific variability was observed.

Experimental study of sentinel lymph node biopsy in larynx by using radioactive Nano tracer / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#Using radioactive Nano tracer at different sizes and doses in the Larynx of rabbits, to study the roles of them in the sentinel lymph node (SLN) biopsy in rabbits and to provide experimental evidences for the choices of ideal size and dose of radioactive Nano tracer of the sentinel lymph node biopsy in Laryngeal cancer patients.@*METHOD@#thirty rabbits were randomly divided into six groups with five rabbits in each group. After 50 nm--0.01 ml, 50 nm--0.02 ml, 80 nm--0.01 ml, 80 nm--0.02 ml,100 nm--0.01 ml, 100 nm--0.02 ml of 99mTc-sulfur Colloid were separately injected into the Larynx, the number of SLNs, the initial and strongest radioactive time of SLNs, and the lasting time of radioactivity was obtained.@*RESULT@#One to three SLNs were identified in one rabbit, so there were totally forty-five SLNs, which in the areas of II, III and IV. The group of 50 nm--0.02 ml had the largest number of SLNs and there were significant differences between the group of 50 nm-0.02 ml and 100 nm--0.01 ml. In the six groups, the group of 50 nm--0.02 ml was the earliest group of detecting the initial and strongest radioactivity of SLNs,which the time were 49.20 s and 178.60 s; the group of 100 nm--0.01 ml was the latest group of detecting the initial and strongest radioactivity of SLNs, which the time were 235.80 s and 311.20 s. Each group had radioactivity more than 30 minutes.@*CONCLUSION@#The group of 50 nm--0.02 ml was the best group, because it moved fast and had a higher rate of uptake in lymphangio. Moreover, the radioactivity time was more than 30 minutes. It was the ideal size and dose of SLN biopsy in larynx.

Experimental study of cervical lymph node in thyroid by using radioactive nano tracer / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Using radioactive nano tracer with different sizes (average diameter were 50, 80 and 100 nm) and dosages (0.01 and 0.02 ml) in the thyroids of rabbits, to study the drainage of thyroid to cervical lymph nodes (LNs) in rabbits and to provide experimental evidence for the choice of ideal sizes and dosages of radioactive Nano tracer for the sentinel lymph node biopsy (SLNB) in thyroid cancer patients.</p><p><b>METHODS</b>Thirty adult rabbits were randomly divided into six groups (50 nm - 0.01 ml, 50 nm - 0.02 ml, 80 nm - 0.01 ml, 80 nm - 0.02 ml, 100 nm - 0.01 ml, 100 nm - 0.02 ml of (99m)Tc-Sb(2)S(3)) with five rabbits in each group. A total of 60 sides of thyroids were included. The mean number of LNs with radioactivity, the initial, the strangest and the lasting time of radioactivity in LNs in each group were measured.</p><p><b>RESULTS</b>One to three LNs were identified in one side neck of rabbits, totally 86 LNs. Most of LNs with radioactivity existed in level VI, counting for 75.6% (65/86). (99m)Tc-Sb(2)S(3) with 50 nm particles was significantly better than that with 80 nm or 100 nm particles with regarding the initial and the strangest radioactive time of (99m)Tc-Sb(2)S(3) in LNs (P < 0.05). There were no significant difference in the mean number of LNs with radioactivity, the initial, the strangest and the lasting time of radioactivity between the dosages of 0.01 ml and 0.02 ml of (99m)Tc-Sb(2)S(3) with same size of particles (P > 0.05).</p><p><b>CONCLUSION</b>(99m)Tc-Sb(2)S(3) with 50 nm particles, in the dosage of 0.01 ml or 0.02 ml, could be good choice for SLNB of thyroid cancer.</p>

Localization of sentinel lymph node with radionuclide in clinically N0 laryngeal and hypopharyngeal cancers / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the characteristic of the radioactive lymph node with metastatic disease and to explore the method of the localization of sentinel lymph node (SLN) with radionuclide in N0 clinically laryngeal and hypopharyngeal cancer.</p><p><b>METHODS</b>Fourty-five patients with T1-T4 and clinically N0 laryngeal and hypopharyngeal cancer were recruited. For each patient a peritumoral submucosal injection of 99mTc-labeled sulfur colloid (99mTc-SC) was performed and lymph node mapping was performed by lymphoscintigraphy two hours afterward. The SLN was localized by a handheld gamma probe intraoperatively 10-12 hours after the injection. All hot lymph nodes accumulating activity were harvested and initially termed sentinel nodes. Selective neck dissections were performed for all patients. The specimen of SLN was sent to the pathologist for the following analysis: formal paraffin embedded section, consecutive section and immunohistochemistry assay. The results was compared to the remaining lymphadenectomy specimen. Resection of the primary tumour depended on the location and the T classification.</p><p><b>RESULTS</b>SLNs were identified in 41 of 45 patients with 51 necks, SLNs had occult metastases in 13 cases, 15 necks with SLN-positive of these 13 cases, there was one false negative case, they were found in non-SLNs of neck specimens. Each neck side was considered a single case. SLN identification rate was 92.7%, sensitivity was 93.7%, false-negative rate was 6.3%, and accuracy was 98.0%. In 11 (73.3%) of these SLN-positive necks, the SLN with the highest counts contained tumor; harvesting the first-three nodes with the highest radioactive counts, which could all patients with occult metastatic disease.</p><p><b>CONCLUSIONS</b>Excision of the first-three SLNs with the highest radioactive counts can accurately judge the presence or absence of the cervical lymph nodes metastases in patients with the clinically N0 laryngeal and hypopharyngeal cancer.</p>

Diffuse bilateral breast uptake on the myocardial perfusion SPECT of a nursing female

Bilateral diffuse intense breast uptake was noted in a 40 year old female who was evaluated with Tc-99m sestamibi [MIBI] myocardial perfusion scan for possible ischemia. She was breast feeding her 1.5 year old child. The intense uptake in the breasts was superimposed on the apical and anteroapical regions of the myocardium and caused interpretation problem. We recommend considering Tc-99m MIBI breast uptake during breast feeding as a possible cause of non-interpretable, superimposition of radiotracer on the myocardium in myocardial perfusion scan

(99m)Tc-YIGSR as a receptor tracer in imaging the Ehrlich ascites tumor-bearing mice as compared with (99m)Tc-MIBI / 华中科技大学学报（医学）（英德文版）

The validity of (99m)Tc-YIGSR, a novel receptor radio-tracer, in imaging the Ehrlich ascites tumor was evaluated. YIGSR, a pentapeptide of laminin, was labeled with (99m)Tc by using a bifunctional chelator S-Acetly-NH(3)-MAG(3). The MIBI was labeled with (99m)Tc by following the kit instruction. The mice of tumor group were intravenously injected 1-2 mCi of (99m)Tc-YIGSR or (99m)Tc-MIBI via caudal vein, immobilized and imaged under a Gamma camera. The same procedure was performed in mice of blockade group, in which the unlabeled YIGSR was previously injected to block the receptor-recognition sites, and inflammation group serving as control. The reverse-phase Sep-Pak C(18) chromatogram was found to have an essentially complete conjugation between YIGSR and S-Acetly-NH(3)-MAG(3). The conjugated YIGSR could be radio-labeled successfully with (99m)Tc at room temperature and neutral pH, with a radio-labeling yield of 62%. Without the chelator S-Acetly-NH(3)-MAG(3), the YIGSR was labeled with (99m)Tc at an efficiency of 4%. The imagological study revealed obvious tumor accumulation of (99m)Tc-YIGSR 15 min after the injection, and the uptake peaked after 3 h with a tumor-to-muscle ratio (T/M) of 11.36. The radio-tracer was slowly cleared up and resulted in a T/M of 3.01 at the 8th h after the injection. As for blocked group, the tumor uptake of radiotracer was significantly lower, with the highest T/M being 4.61 after 3 h and 0.89 after 8 h. The T/M was 3.72 at the 3rd h and 1.29 at the 8th h after the (99m)Tc-YIGSR injection in the inflammatory group. The T/M was significantly higher in tumor group than in inflammatory group or control group (P<0.001). In the 99mTc-MIBI group, the T/M was 1.40 at the 3rd h and 0.55 at the 8th h after the injection, which showed a significant difference as compared with (99m)Tc-YIGSR (P<0.001). It is concluded that YIGSR can be successfully radiolabelled by using S-Acetly-NH(3)-MAG(3). (99m)Tc-YIGSR has many advantages in tumor imaging, such as quick and clear visualization, high sensitivity and specificity, and satisfactory target/non-target ratio (N/NT). It promises to be tumor radio-tracer.

Tracing magnetically labeled mesenchymal stem cells transplanted into rat livers by MRI / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To trace magnetically labeled MSCs transplanted into the rat livers by magnetic resonance imaging (MRI).</p><p><b>METHODS</b>Feridex and DAPI labeled rat mesenchymal stem cells (MSCs) were injected via portal veins into carbon tetrachloride treated rats. MRI was performed with a clinical 1.5 T MRI machine immediately before the MSCs injection and at h 1, d 3, d 7, and d 14 after the injection, and then the signal-to-noise ratio (SNR) was measured. MRI findings were compared with the liver histopathologies after the slides were stained with fluorescence dye and Prussian blue.</p><p><b>RESULTS</b>The SNR for liver was 1.10+/-0.26 at hour 1, 8.18+/-1.55 at day 3, 11.08+/-1.30 at day 7, and 14.15+/-1.02 at day 14 respectively. Within 7 days after the MSCs transplantation, the SNRs of the livers were significantly lower than those before the transplantation (P less than 0.05). Histologically, the blue fluorescent particles under the fluorescence microscopy matched in distribution with the iron particles on the Prussian blue stained slides.</p><p><b>CONCLUSION</b>The magnetically labeled MSCs transplanted into livers give rise to an obvious signal decrease, and can be tracked with a 1.5 T clinical MRI machine for up to 7 days after MSCs transplantation.</p>