ABSTRACT
Aim/Introduction: To analyze the relationship (negative correlation) between the health care delay related with the Covid-19 pandemic and the cases detected of bone scans with multiple bone metastases coinciding with the oncological diagnosis. Material(s) and Method(s): 5849 full-body bone scans with 99mTc-HMDP performed during the periods of March 2018 -February 2020 (2910 cases) and March 2020 -February 2022 (2939 cases), which were evaluated as tumor extension studies. The official commence of the Covid-19 pandemic in Spain (March 2020) was chosen as the temporary time dividing line.In each period, the number of bone scans that presented multiple bone metastases was assessed, and the demographic and clinical characteristics of the patients were compared, searching for statistically significant differences. Result(s): In the pre-Covid19 period, 62 patients (2.13%) with multiple bone metastases were detected (average age 69.7 years;58% men). The tumors with the highest frequency of these findings were prostate cancer (38.8%) and breast cancer (27.4%).In the Covid-19 pandemic period, 70 patients (2.38%) had multiple bone metastases (average age 68.3 years;77.1% men). Prostate cancer was the tumor with the highest frequency of multiple bone metastases (55.7%).The findings have not shown a significant increase in the incidence of bone metastatic disease between these two periods (p=0.259);although, there are statistically significant differences regarding the characteristics of patients with multiple bone metastases at diagnosis, detecting in the pandemic period a higher number of cases in men (p=0.0088) and in patients with prostate cancer (p=0.0237). Conclusion(s): The health care delay caused by the pandemic has not been associated with a significant increase in the number of cancer patients with multiple bone metastases at diagnosis;although, in our health area, early diagnosis for male with cancer does seem to have been delayed, especially in those with prostate cancer.
ABSTRACT
Aim/Introduction: Chronic thromboembolic pulmonary hypertension (CTEPH) is a difficult entity to diagnose due to its association with other etiologies causing pulmonary hypertension (PHT), mainly cardiological disease. Our aim is to analyse the value of pulmonary perfusion SPECT/CT in the presence of suspected CTEPH and to evaluate its impact on the diagnosis and subsequent therapeutic approach. Material(s) and Method(s): Retrospective series of 108 patients with suspected CTEPH who were performed a lung perfusion SPECT/CT in the presence of perfusion defects on planar images between March 2020-April 2022. Variables such as age, sex, scintigraphic result, other radiological findings, correlation with catheterisation and CT angiography, type of PHT (according to Dana Point Consensus Classification of Pulmonary Hypertension, California 2008) and therapy of choice after scintigraphy were analysed. Result(s): Mean age: 69 +/- 12 years (25-90). 54% women. In 55 patients(51%) CTEPH was ruled out by SPECT/CT(-), although other radiological findings were observed (13% chronic parenchymal pathology/post-COVID-19 infection, 7% cardiomegaly, 5% pleural effusion, 4% infiltrates consistent with COVID-19 infection,2% pulmonary nodule suspicious of malignancy). 6 of the 18 patients with catheterisation(33%) had a pulmonary capillary pressure(PCP) suspicious for CTEPH(<=15mmHg), which was ruled out after negative scintigraphy. In the 53(49%) confirmed CTEPH by SPECT/ CT(+), 28 with other radiological findings(36% chronic pulmonary pathology/post-COVID-19,11% pulmonary nodule suspicious of malignancy,11% infiltrates consistent with COVID-19 infection). 10 of 15 patients(67%) with CT angiography(-). 55% of the patients with catheterisation(11/20) presented with a PCP not suspicious of CTEPH(>=15mmHg), and were finally diagnosed with CTEPH after positive SPECT. In patients without CTEPH after SPECT(-), PHT was classified into the following types:37 with PHT type-II/left heart disease(6 candidates for valve replacement),9 type-III/pulmonary disease and/or hypoxaemia, 5 mixed type-II+III, 2 type-I (1 portal hypertension in cirrhotic patient and 1 scleroderma), 2 type-V (1 obstruction of tumour origin and 1 chronic renal failure). of the patients who were confirmed to have CTEPH, 19(36%) had purely embolic PHT(type-IV), with 5 being candidates for endacterectomy/ angioplasty, and the remaining 34(64%) had mixed PHT(24 type-II+IV, 5 type-III+IV, 5 type-II+III+IV), with 35% being candidates for surgery. Conclusion(s): Lung perfusion SPECT/CT imaging is a very useful test for the classification of pulmonary hypertension leading to better therapeutic management of these patients. The greatest efficiency is seen with a negative result as the embolic origin is excluded with excellent reliability, thus avoiding more aggressive and/or difficult-to-manage therapies. In addition, low-dose CT provides additional information of great clinical relevance.