ABSTRACT
BACKGROUND: Interpretation of abnormal foci with high tracer uptake may require morphological correlation. Fusion of functional images obtained by single photon emission computed tomography (SPECT) and anatomical images obtained by computed tomography (CT) or magnetic resonance (RM) allows an integrated comprehension of complementary information. AIM: To demonstrate that SPECT/CT fusion with external markers is useful in clinical practice to clarify the location and pathological meaning of questionable foci. MATERIAL AND METHODS: Thirty four pairs of images from separate equipments (31 SPECT/CT and 3 SPECT/RM) pertaining to 29 patients, were fused. Fifty one foci of abnormal tracer uptake of uncertain pathological meaning were analyzed. These were classified before and after the fusion as probably malignant or probably benign. RESULTS: Seventy percent of patients had a differentiated thyroid carcinoma. The fusion localized 100% of foci. Nine percent had a normal and 26% an abnormal anatomy. Before fusion 82% of foci were classified as potentially malignant. This figure changed to 59% after the fusion (p <0.01). Therefore the suspicion of malignancy was presumptively confirmed in 72% of foci and fusion results would have reached a 27% of incremental diagnostic value in 14 cases that changed of category (11 with differentiated thyroid carcinoma, one with colorectal cancer, one with a nasal Ewing sarcoma and one with a brain tumor). CONCLUSIONS: The fusion of SPECT and CT is useful in selected patients, specially those with differentiated thyroid carcinoma. The fusion of SPECT and RM is also feasible.
Subject(s)
Carcinoma/diagnosis , Magnetic Resonance Imaging/methods , Radiopharmaceuticals , Thyroid Neoplasms/diagnosis , Tomography, Emission-Computed, Single-Photon/methods , Tomography, X-Ray Computed/methods , Adolescent , Adult , Aged , Carcinoma/diagnostic imaging , Child , Child, Preschool , Female , Humans , Image Enhancement/methods , Iodine Radioisotopes , Male , Middle Aged , Retrospective Studies , Sensitivity and Specificity , Subtraction Technique , Technetium Tc 99m Medronate , Thyroid Neoplasms/diagnostic imagingABSTRACT
Background: Interpretation of abnormal foci with high tracer uptake may require morphological correlation. Fusion of functional images obtained by single photon emission computed tomography (SPECT) and anatomical images obtained by computed tomography (CT) or magnetic resonance (RM) allows an integrated comprehension of complementary information. Aim To demonstrate that SPECT/CT fusion with external markers is useful in clinical practice to clarify the location and pathological meaning of questionable foci. Material and methods: Thirty four pairs of images from separate equipments (31 SPECT/CT and 3 SPECT/RM) pertaining to 29 patients, were fused. Fifty one foci of abnormal tracer uptake of uncertain pathological meaning were analyzed. These were classified before and after the fusion as probably malignant or probably benign. Results: Seventy percent of patients had a differentiated thyroid carcinoma. The fusion localized 100 percent of foci. Nine percent had a normal and 26 percent an abnormal anatomy. Before fusion 82 percent of foci were classified as potentially malignant. This figure changed to 59 percent after the fusion (p <0.01). Therefore the suspicion of malignancy was presumptively confirmed in 72 percent of foci and fusion results would have reached a 27 percent of incremental diagnostic value in 14 cases that changed of category (11 with differentiated thyroid carcinoma, one with colorectal cancer, one with a nasalEwingsarcoma and one with a brain tumor). Conclusions: The fusion of SPECT and CT is useful in selected patients, specially those with differentiated thyroid carcinoma. The fusion of SPECT and RM is also feasible.
Subject(s)
Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Carcinoma/diagnosis , Magnetic Resonance Imaging/methods , Radiopharmaceuticals , Thyroid Neoplasms/diagnosis , Tomography, Emission-Computed, Single-Photon/methods , Tomography, X-Ray Computed/methods , Carcinoma , Carcinoma , Image Enhancement/methods , Iodine Radioisotopes , Retrospective Studies , Sensitivity and Specificity , Subtraction Technique , Thyroid Neoplasms , Thyroid NeoplasmsABSTRACT
Se presenta un estudio de linfonodo centinela y la experiencia inicial en el diagnóstico de micro metástasis linfática en melanoma maligno de piel, en un período de dos años. Se identificó en el pre operatorio el sitio del linfonodo centinela mediante albúmina marcada con Tc99 y, en el intra operatorio, con tinción vital con azul de isosulfán para seleccionar a los pacientes con micro metástasis que se pueden beneficiar con tratamiento quirúrgico linfático, descartar la cirugía ganglionar en los pacientes con linfonodo centinela negativo y reducir la morbilidad asociada al tratamiento quirúrgico. El criterio de inclusión incluyó pacientes con tumores Clark III o superior. Se incluyeron 6 pacientes; 2 Clark III, 3 Clark IV y un paciente Clark V. El diagnóstico de micro metástasis se realizó mediante tinción hematoxilina-eosina y estudio histoquímico de antígenos Melan A, S 100 y HMB 45. En dos pacientes Clark III y uno Clark IV, el estudio con H-E e inmunohistoquímica no identificó micro metástasis. Un paciente Clark IV no evidenció metástasis en el primer estudio con H-E; sin embargo, la inmunohistoquímica mostró micro metástasis con los tres marcadores tumorales. La revisión de las placas H-E confirmó el hallazgo. Un paciente con micro etapa IV y uno con micro etapa V mostraron metástasis a la tinción H_E y se confirmó la presencia de anticuerpos para los marcadores Melan A, S 100 y HMB 45. En este estudio el uso de Melan A, S 100 y HMB 45 mejoró la sensibilidad del diagnóstico histológico de metástasis linfáticas en un 20 por ciento y redujo a la mitad la indicación de disección ganglionar regional.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Sentinel Lymph Node Biopsy/methods , Melanoma , Melanoma/pathology , Antigens, Neoplasm/analysis , Rosaniline Dyes , Early Diagnosis , Immunohistochemistry , Biomarkers, Tumor/analysis , Melanoma/chemistry , Lymphatic Metastasis/pathology , Lymph Nodes , Lymph Nodes/pathology , Patient Selection , Prospective Studies , /analysisABSTRACT
Se presenta el caso de una escolar, de sexo femenino, de 12 años de edad, con un osteosarcoma convencional de pelvis estadio IV, que evoluciona en forma natural por 11 meses, con compromiso bilateral de las raíces sacras y que se manifiesta clínicamente como paraparesia, vejiga neurogénica y mielitis transversa. El estudio de imágenes tanto anatómico como funcional (TC de tórax y pelvis, RM de pelvis y cintigrama óseo), permitió su correcta estadificación y selección de quimioterapia paliativa. Se analiza el caso desde el punto de vista de las imágenes destacando el aporte de la medicina nuclear.
Subject(s)
Humans , Female , Child , Bone and Bones , Bone Neoplasms/diagnosis , Osteosarcoma , Lumbosacral Region , Lumbosacral Region , Tomography, Emission-Computed , Biopsy , Neoplasm Staging/methods , Magnetic Resonance Imaging , Nuclear Medicine , Bone Neoplasms/pathology , Pelvis , Pelvis , Radiography, ThoracicABSTRACT
Se estableció un protocolo de tratamiento kinésico basado en ejercicios de estabilización de columna lumbar, con el objetivo de disminuir la sintomatología y mejorar la funcionalidad en pacientes con Síndrome de Dolor lumbar crónico. El protocolo fue aplicado a una muestra de 10 pacientes entre 20 y 60 años de edad con el diagnóstico de Sd de Dolor Lumbar crónico. El tratamiento contó con 12 sesiones tres veces por semanas en días separados; en la primera y última se realizaron las evoluciones necesarias, para luego comparar los resultados antes y después del tratamiento a través de la T de student emparejada y el test de los signos para datos no paramétricos. Los resultados obtenidos en todos los parámetros evaluados fueron positivos concluyéndose que el protocolo propuesto cumplió con el objetivo planteado en su inicio
Subject(s)
Humans , Male , Adult , Female , Middle Aged , Clinical Protocols , Low Back Pain/therapy , Physical Therapy Modalities , Complementary Therapies , Exercise TherapyABSTRACT
BACKGROUND: The adverse effects of cocaine use mainly occur in the heart and central nervous system. AIM: To study the effects of cocaine base paste consumption on the cardiovascular system. SUBJECTS AND METHODS: Thirty five chronic cocaine base paste consumers, 26 male, aged 15 to 43 years old, were studied. A clinical assessment and a resting EKG were performed. Results were compared with those of 82 healthy controls. RESULTS: Sixty percent of cocaine consumers had EKG abnormalities, compared with 43% of controls. Forty one percent of cocaine users and 33% of controls had a prolonged QTc. Likewise, 36% of cocaine users and 46% of controls had an incomplete right bundle branch block. Among cocaine users, an active nodal rhythm, an ischemic and a QS anteroseptal image were observed. CONCLUSIONS: A slightly higher frequency of EKG abnormalities were observed in chronic cocaine users, when compared with healthy controls.
Subject(s)
Cardiovascular System/physiopathology , Cocaine-Related Disorders/physiopathology , Electrocardiography , Adolescent , Adult , Chile , Female , Humans , MaleABSTRACT
The adverse effects of cocaine use mainly occur in the heart and cebtral nervous system. To study the effects of cocaine base paste consumption on the cardiovascular system, 35 chronic cocaine base paste consumers, 26 males, aged 15 to 43 years old were studied. A clinical assessment and a resting EKG were performed. Results were compared with those of 82 healthy controls. Sixty percent of cocaine consumers had EKG abnormalities, compared with 43 percent of controls. Forty one percent of cocaine users and 33 percent of controls had a prolonged QTc. Likewise, 36 percent of cocaine users and 46 percent of controls had an incomplete right bundle branch block. Among cocaine users, an active nodal rhythm, an ischemic and a QS anteroseptal image were observed. A slightly higher frequency of EKG abnormalities were observed in chronic cocaine users, when compared with healthy controls