18F-choline PET/MRI on initial staging of prostate cancer. Impact on therapy approach. / La PET/RM con 18F-colina en el diagnóstico inicial del cáncer de próstata. Impacto en la estrategia terapéutica.

AIM: Evaluate the therapy impact of initial staging in patients diagnosed with prostate cancer by 18 F-choline PET/MRI hybrid technique. MATERIAL: A prospective study which included 31 patients diagnosed with prostate cancer; Gleason > 7; mean PSA 13.6 ng/mL (range 6.3-20.6). PET/MRI studies were acquired simultaneously with hybrid equipment (SIGNA.3T, GE) following intravenous injection of 185 ± 18.5MBq of 18F-choline: - Early/prostate imaging: PET emission + multiparametric MR: DIXON-T1-T2-diffusion-gadolinium. - Late/whole-body imaging: PET emission + MR: DIXON-T1-T2-diffusion-STIR sequences. Images were visually evaluated. SUV & ADC & textures were also calculated. Treatment selection was based upon Oncology Committee consensus decision. RESULTS: Procedure was well tolerated in all patients, and no artifacts were reported. MRI was superior in T staging in eight patients (25.8%) (Likert: 2-3), whereas PET increased MRI sensitivity in three patients (9.7%) (PIRADS: 3). PROSTATE LESION LOCATION: Peripheral 91.4%, transitional 8.6%. SUVmax threshold: 2.95: sensitivity 92.9%, specificity 66.7%. No correlation SUV vs. ADC. Better distinction between stage T2 vs. T3 using the DiscrLin model with NG = 16 (AUC 0.7767 ± 0.3386). PET was superior to T2 in textures analysis (0.588 vs. 0.412). Seventeen patients (54.8%) were staged ≥ T3, with surgical treatment being contraindicated. Fifteen patients (48.4%) presented with extra-prostatic disease: 8/31 oligometastatic and 7/31 multiple metastasis. Therapy approach following PET/MRI was: radical treatment in 24/31 patients (77.4%), 14 radical prostatectomy and 10 MRI-guided radiotherapy; systemic treatment in 7/31 patients (22.6%). CONCLUSION: 18F-choline PET/MRI had a complementary role for the T staging, with a high detection rate for NM infiltration. PET/MRI findings allowed patients to be directed either to prostatectomy or MRI-guided radiotherapy, and thus avoiding radicaltreatment in 22.6% of patients.

Impacto de la tecnología híbrida PET/RM con 18F-colina en la estrategia terapéutica de los pacientes con cáncer de próstata tratados con prostatectomía que presentan elevación del antígeno prostático específico inferior a 1 ng/ml / Value of 18F-Choline PET/MRI hybrid technique on the therapeutic approach for patients with prostate cancer treated with prostatectomy and rising prostate specific antigen levels below 1 ng/ml

OBJETIVO: Evaluar la tasa de detección de la PET/RM con 18F-colina y los cambios en el manejo terapéutico de los pacientes con cáncer de próstata tratados con prostatectomía que presentan elevación del PSA <1 ng/ml. MÉTODO: Estudio prospectivo de los 36 primeros pacientes con cáncer de próstata tratados con prostatectomía, con elevación de PSA<1 ng/ml, a los que hemos realizado una PET/RM con 18F-colina. Tras la administración de 185±10% MBq de 18F-colina se ha adquirido un estudio en dos fases: 1) precoz prostática (inmediatamente tras la administración del trazador): emisión PET/RM multiparamétrica. 2) Estudio una hora postinyección de cuerpo completo: emisión PET/RM: T1, T2, STIR, difusión. El comité oncológico ha decidido la estrategia terapéutica de los pacientes según los hallazgos de la PET/RM con 18F-colina. RESULTADOS: De los 36 pacientes, 20 (55,6%) han mostrado positividad del estudio PET/RM con 18F-colina: en 8 (22,2%) lecho de prostatectomía, en 7 (19,4%) adenopatías infradiafragmáticas, en 4 (11,1%) recidiva local y adenopatías infradiafragmáticas, en 1 (2,8%) una metástasis ósea. De los 36 pacientes, en 16 (44,4%) el estudio PET/RM con 18F-colina ha sido negativo. Los hallazgos de la PET/RM con 18F-colina han condicionado la estrategia terapéutica: en 15 pacientes (41,6%) enfermedad oligometastásica tratada con radioterapia guiada por la imagen, en 5 (13,9%) enfermedad multimetastásica tratada con privación androgénica, en 16 (44,4%) negativo en vigilancia activa. CONCLUSIÓN: La técnica híbrida PET/RM con 18F-colina ha demostrado una elevada tasa de detección de la recidiva en los pacientes tratados con prostatectomía que presentan PSA <1 ng/ml, permitiendo una estrategia terapéutica personalizada según los hallazgos de la exploración

OBJECTIVE: To assess the detection rate of 18F-Choline PET/MRI and subsequent changes in therapy approach for patients with prostate cancer treated by prostatectomy and with rising levels of PSA <1 ng/ml. METHODS: Prospective study with our first 36 patients with prostatectomy for prostate cancer and rising levels of PSA, who were referred for an 18F-Choline PET/MRI study. A dual-phase study was acquired after intravenous administration of 185±10% MBq of 18F-Choline: 1) early imaging (immediately after tracer administration) of prostate area (emission PET/Multiparametric MRI). 2) whole-body imaging 1 h after tracer injection (emission PET/MRI: T1, T2, STIR, diffusion). The therapy approach for patients was decided upon the Oncology Committee consensus based on 18F-Choline PET/MRI findings. RESULTS: Twenty out of 36 patients (55.6%) were positive for the 18F-Choline PET/MRI study: 8 (22.2%) within the prostatectomy bed, 7 (19.4%) with infradiaphragmatic lymph nodes, 4 (11.1%) with local recurrence and infradiaphragmatic lymph nodes, and 1 (2.8%) with bone metastasis. Sixteen out of the 36 patients (44.4%) were negative for the 18F-Choline PET/MRI study. 18F-Choline PET/MRI findings had an impact on the therapy approach to follow: 15 patients (41.6%) showed oligometastatic disease which was treated by imaging-guided radiotherapy, 5 (13.9%) with multiple metastatic disease were treated by androgen deprivation therapy, 16 (44.4%) negative were under active surveillance. CONCLUSION: Hybrid 18F-Choline PET/MRI procedure showed a high detection rate for recurrence in prostate cancer patients treated with prostatectomy and rising PSA levels <1 ng/ml, and 18F-Choline PET/MRI findings resulted in a better tailored therapy approach delivered to our patients

Estandarización de los protocolos de adquisición mediante PET/TC con 18F-Colina en el cáncer de próstata / Standardization of acquisition protocols using PET/CT with 18F-Choline in prostate cancer

INTRODUCCIÓN: Estandarizar los protocolos de adquisición de 18F-Colina PET/TC, que permitan evitar la interferencia urinaria, evaluar el mejor tiempo del estudio de cuerpo completo y valorar si la «doble fase» permite la diferenciación entre lesiones benignas frente a malignas. MÉTODO: Estudio prospectivo que incluye 100 pacientes con cáncer de próstata: 31 estadificación y 69 recidiva bioquímica (32 posprostatectomía y 37 posradioterapia). Adquisición pélvica inmediatamente tras inyección de 18F-Colina y estudio de cuerpo completo, 1 y 2h p.i. Cálculo de media SUVmáx por territorios en todos los estudios secuenciales. Análisis de medias (χ2) y porcentaje de cambio del SUV (2/1h; 1h/0min). Patrón de dinámica metabólica: acumulativo frente a aclaramiento. Seguimiento tras tratamiento en todos los pacientes y de forma dirigida, cuando éticamente es posible. RESULTADOS: Cincuenta y tres focos prostáticos, en ninguna de las imágenes precoces actividad urinaria: Patrón acumulativo en 42, porcentaje de aumento: 0min/1h: +16,7% (X20,94); 1/2h: +10,0% (X20,83). Patrón aclaramiento en 11, porcentaje de reducción: 0min/1h: 21,4% (X20,91); 1/2h: −7,7% (X20,85), correspondiendo en 7 a estadificación y 4 a posradioterapia. Todos los focos infradiafragmáticos (n: 24) mostraron dinámica acumulativa, porcentaje de aumento: +9,1% (χ20,97), todas ellas visibles en el primer estudio. De los 12 focos supradiafragmáticos, 8 mostraron aclaramiento, porcentaje de reducción: −13,0% (χ2 0,95). Los otros 4 dinámica acumulativa, porcentaje de aumento: +13,0% (χ2 0,96), siendo valorados invasivamente. Todos los focos óseos (n: 18) mostraron dinámica acumulativa, porcentaje de aumento: +17,1% (χ20,95), todas ellas visibles en el estudio 1h. CONCLUSIONES: En la valoración prostática la mejor técnica doble fase es 0min/1h. En la diferenciación de adenopatías supradiafragmáticas es aconsejable la técnica de doble fase: 1/2h. Para la infiltración infradiafragmática y ósea, ante hallazgos dudosos, las imágenes 2h aumentan la confianza diagnóstica

AIM: To standardize acquisition protocols for 18F-Choline PET/CT to prevent from urine interference, to determine the best time point for the whole-body study, and to assess whether "dual point" acquisition allows for differentiating malignant vs. benign lesions. METHODS: One hundred consecutive patients with prostate cancer were prospectively studied. Immediately after 18F-Choline injection, a pelvis study was acquired, and a whole-body was subsequently obtained 1 and 2 hours p.i. Mean SUVmax was obtained in regions and for every sequential imaging. Mean analysis (χ2) and SUV percentage change (2/1 hours; 1 hours/0 min) were obtained. Metabolic pattern dynamics were assessed: accumulative vs. clearance. Patient follow-up after therapy and directed classification whenever ethically possible were performed. RESULTS: Fifty-three prostate foci, without disturbing urinary activity was ever found on early images. Accumulative pattern in 42, with percentage increase was: 0 min/1 hour: +16.7% (χ20.94); 1/2 hours: +10,0% (χ2 0.83). Clearance pattern in 11, with percentage decrease: 0 min/1 hour: −21.4% (χ20.91): −7.7% (χ20.85), corresponding in 7 to initial staging and in 4 post-radiotherapy biochemical recurrence. Every infradiaphragmatic uptake (n: 24) showed accumulative pattern, with percentage increase of +9.1% (χ20.97), all of them depicted on early imaging. As for 12 supradiaphragmantic uptake, 8 of them showed clearance pattern with percentage decrease: −13.0% (χ20.95). Accumulative pattern showed in 4 of them with percentage increase +13.0% (χ2 0.96), thus being assessed as invasive/malignant. Every bone uptake (n: 18) showed accumulative pattern, with percentage increase: +17.1% (χ20.95), all of them depicted on 1 hour imaging. CONCLUSIONS: As for prostate assessment is concerned, dual point at 0 min/1 hour proved to be the best procedure. As for supradiaphragmatic lymph-nodes detection, dual point with 1/2 hours performed best. As for infradiaphragmatic and bone involvement, as well as for inconclusive findings, the 2 hour imaging increased our diagnostic confidence

Standardization of acquisition protocols using PET/CT with 18F-Choline in prostate cancer. / Estandarización de los protocolos de adquisición mediante PET/TC con 18F-Colina en el cáncer de próstata.

AIM: To standardize acquisition protocols for 18F-Choline PET/CT to prevent from urine interference, to determine the best time point for the whole-body study, and to assess whether "dual point" acquisition allows for differentiating malignant vs. benign lesions. METHODS: One hundred consecutive patients with prostate cancer were prospectively studied. Immediately after 18F-Choline injection, a pelvis study was acquired, and a whole-body was subsequently obtained 1 and 2 hours p.i. Mean SUVmax was obtained in regions and for every sequential imaging. Mean analysis (χ2) and SUV percentage change (2/1 hours; 1 hours/0 min) were obtained. Metabolic pattern dynamics were assessed: accumulative vs. clearance. Patient follow-up after therapy and directed classification whenever ethically possible were performed. RESULTS: Fifty-three prostate foci, without disturbing urinary activity was ever found on early images. Accumulative pattern in 42, with percentage increase was: 0 min/1 hour: +16.7% (χ20.94); 1/2 hours: +10,0% (χ2 0.83). Clearance pattern in 11, with percentage decrease: 0 min/1 hour: -21.4% (χ20.91): -7.7% (χ20.85), corresponding in 7 to initial staging and in 4 post-radiotherapy biochemical recurrence. Every infradiaphragmatic uptake (n: 24) showed accumulative pattern, with percentage increase of +9.1% (χ20.97), all of them depicted on early imaging. As for 12 supradiaphragmantic uptake, 8 of them showed clearance pattern with percentage decrease: -13.0% (χ20.95). Accumulative pattern showed in 4 of them with percentage increase +13.0% (χ2 0.96), thus being assessed as invasive/malignant. Every bone uptake (n: 18) showed accumulative pattern, with percentage increase: +17.1% (χ20.95), all of them depicted on 1 hour imaging. CONCLUSIONS: As for prostate assessment is concerned, dual point at 0 min/1 hour proved to be the best procedure. As for supradiaphragmatic lymph-nodes detection, dual point with 1/2 hours performed best. As for infradiaphragmatic and bone involvement, as well as for inconclusive findings, the 2 hour imaging increased our diagnostic confidence.

Value of 18F-Choline PET/MRI hybrid technique on the therapeutic approach for patients with prostate cancer treated with prostatectomy and rising prostate specific antigen levels below 1 ng/ml. / Impacto de la tecnología híbrida PET/RM con 18F-colina en la estrategia terapéutica de los pacientes con cáncer de próstata tratados con prostatectomía que presentan elevación del antígeno prostático específico inferior a 1 ng/ml.

OBJECTIVE: To assess the detection rate of 18F-Choline PET/MRI and subsequent changes in therapy approach for patients with prostate cancer treated by prostatectomy and with rising levels of PSA <1 ng/ml. METHODS: Prospective study with our first 36 patients with prostatectomy for prostate cancer and rising levels of PSA, who were referred for an 18F-Choline PET/MRI study. A dual-phase study was acquired after intravenous administration of 185±10% MBq of 18F-Choline: 1) early imaging (immediately after tracer administration) of prostate area (emission PET/Multiparametric MRI). 2) whole-body imaging 1 h after tracer injection (emission PET/MRI: T1, T2, STIR, diffusion). The therapy approach for patients was decided upon the Oncology Committee consensus based on 18F-Choline PET/MRI findings. RESULTS: Twenty out of 36 patients (55.6%) were positive for the 18F-Choline PET/MRI study: 8 (22.2%) within the prostatectomy bed, 7 (19.4%) with infradiaphragmatic lymph nodes, 4 (11.1%) with local recurrence and infradiaphragmatic lymph nodes, and 1 (2.8%) with bone metastasis. Sixteen out of the 36 patients (44.4%) were negative for the 18F-Choline PET/MRI study. 18F-Choline PET/MRI findings had an impact on the therapy approach to follow: 15 patients (41.6%) showed oligometastatic disease which was treated by imaging-guided radiotherapy, 5 (13.9%) with multiple metastatic disease were treated by androgen deprivation therapy, 16 (44.4%) negative were under active surveillance. CONCLUSION: Hybrid 18F-Choline PET/MRI procedure showed a high detection rate for recurrence in prostate cancer patients treated with prostatectomy and rising PSA levels <1 ng/ml, and 18F-Choline PET/MRI findings resulted in a better tailored therapy approach delivered to our patients.

Estudio de pacientes con síndrome febril prolongado con 18F-FDG PET-TC / Study of patients with prolonged fever with 18F-FDG PET/CT

Objetivo. Revisar el resultado de la tomografía por emisión de positrones (PET)-tomografía computarizada (TC) con flúor-18-fluorodesoxiglucosa (18F-FDG) en pacientes con fiebre de origen desconocido de más de 7 días de evolución. Material y métodos. Estudio observacional descriptivo retrospectivo de 93 estudios de PET-TC con 18F-FDG solicitados para detectar el foco causante de la fiebre en tres centros de medicina nuclear entre octubre de 2006 y febrero de 2014. Un especialista en medicina nuclear y un radiólogo revisaron las imágenes buscando focos de captación patológica. Las discrepancias se resolvieron con la opinión de un nuevo especialista. El resultado de la 18F-FDG PET-TC se comprobó clínica y/o anatomopatológicamente. Resultados. En la PET-TC se observaron captaciones anómalas de la 18F-FDG que podían justificar la causa de la fiebre en 52 de los 93 estudios (56%). La causa se confirmó en 50 de estos 52 estudios. De las 50 causas de fiebre diagnosticadas, la infección (54%) fue la más frecuente, seguida de la enfermedad inflamatoria no infecciosa (28%) y la enfermedad tumoral (18%). Conclusión. La PET-TC con 18F-FDG es útil para diagnosticar la causa del síndrome febril prolongado, por lo que puede ser práctico emplearla en una etapa más precoz del proceso diagnóstico (AU)

Objective. To review the findings on 18F-FDG PET-CT in patients with fever of unknown origin lasting more than 7 days. Material and methods. This retrospective descriptive observational study included 93 18F-FDG PET-CT studies to detect a fever-causing focus done at three nuclear medicine centers from October 2006 through February 2014. A nuclear medicine specialist and a radiologist reviewed the images for foci of pathological uptake; another specialist's opinion resolved discrepancies. The findings on 18F-FDG PET-CT studies were checked against clinical and/or histological findings. Results. Abnormal 18F-FDG uptake on PET-CT that could explain the cause of the fever was found in 52 (56%) of the 93 studies, and the cause of the fever was confirmed in 50 of these 52 studies. In the 50 cases in which the cause of the fever was confirmed, infection was the most common cause (54%), followed by noninfectious inflammatory disease (28%) and tumors (18%). Conclusion. 18F-FDG PET-CT is useful in diagnosing the cause of prolonged febrile illness, so it might be practical to use it earlier in the diagnostic process (AU)

[Study of patients with prolonged fever with (18)F-FDG PET/CT]. / Estudio de pacientes con síndrome febril prolongado con 18F-FDG PET-TC.

OBJECTIVE: To review the findings on (18)F-FDG PET-CT in patients with fever of unknown origin lasting more than 7 days. MATERIAL AND METHODS: This retrospective descriptive observational study included 93 (18)F-FDG PET-CT studies to detect a fever-causing focus done at three nuclear medicine centers from October 2006 through February 2014. A nuclear medicine specialist and a radiologist reviewed the images for foci of pathological uptake; another specialist's opinion resolved discrepancies. The findings on (18)F-FDG PET-CT studies were checked against clinical and/or histological findings. RESULTS: Abnormal (18)F-FDG uptake on PET-CT that could explain the cause of the fever was found in 52 (56%) of the 93 studies, and the cause of the fever was confirmed in 50 of these 52 studies. In the 50 cases in which the cause of the fever was confirmed, infection was the most common cause (54%), followed by noninfectious inflammatory disease (28%) and tumors (18%). CONCLUSION: (18)F-FDG PET-CT is useful in diagnosing the cause of prolonged febrile illness, so it might be practical to use it earlier in the diagnostic process.

Diagnóstico y seguimiento del mieloma extraóseo mediante tomografía por emisión de positrones/tomografía computarizada con 18F-fluorodeoxiglucosa / Diagnosis and follow-up with 18F-fluorodeoxiglucose positron emission tomography/computed tomography of extraosseous myeloma

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Resultados de la autoevalución en la biopsia del ganglio centinela. Aplicación de los criterios de la Sociedad Española de Senología y Patología Mamaria a la experiencia de diez años del Hospital Universitario Mútua de Terrassa / No disponible

Objetivo: Evaluar la calidad de la biopsia del ganglio centinela en nuestro centro. Material y métodos: Se incluyeron de forma consecutiva y prospectiva 460 pacientes diagnosticadas de carcinoma infiltrante de mama en el Hospital Universitario Mútua de Terrassa. Se analizaron los resultados de la prestación de acuerdo con los estándares de calidad del la Sociedad Española de Senología y Patología Mamaria (SESPM). Resultados: Hemos objetivado una mejoría en el 20% de los estándares, independientemente si se producía o no un cambio de nivel. La autoevaluación continuada nos ha permitido mejorar estándares tan importantes como es la eficacia técnica de detección en un 8%, el número de reconversiones a linfadenectomías diferidas en un 3%. La tasa de ganglios extra- axilares se ha incrementado un 5%, así como la tasa de micrometástasis o células tumorales aisladas ha pasado del 9 al 11%. Conclusiones: La autoevaluación continuada nos permite mejorar nuestra práctica clínica diaria y utilizando los estándares de calidad podemos homogenizar todas las series(AU)

Objective: To assess procedural quality of sentinel node biopsy in our centre. Material and method: 460 consecutive patients with invasive breast cancer were prospectively included in our SN Data Base, at the University Hospital Mútua Terrassa. Results from SND biopsy were analysed according to the quality standards set by the Sociedad Española de Senología y Patología Mamaria (SESPM). Results: We have been able to show improvement in up to 20% of the standards, regardless of quality level changes. Continued self-evalution of our results has allowed for improvements in such important standards as the SN detection rate (8%), or conversion rate to axillary lymph-node dissection after definitive SN histology (3%). Extra-axillary SN rate has increased (5%), and also the rate of SN micrometastases or isolated cancer cells has increased form 9 to 22%. Conclusions: Continued self-evaluation using the SESPM standards resulted in significant opportunity for improvement in our daily clinical practice(AU)

[Utility of inspiratory diagnostic CT scan after CT/PET study in the detection of pulmonary nodules]. / Utilidad de la TC diagnóstica inspiratoria tras la realización del estudio PET/TC en la detección de nódulos pulmonares.

We present the case of a 57-year old woman diagnosed of papillary thyroid carcinoma and treated with thyroidectomy followed by radioiodine (I-131) on two occasions. Follow-up radioiodine scan showed disease in right cervical region, confirmed by fine needle aspiration (FNA) and treated with lymphadenectomy. Due to thyroglobulin elevation, I-131 scan negative and inconclusive cervical ultrasonography/CT scan, we conducted a CT/PET study that confirmed cervical disease. An additional CT scan that was performed on maximum-inspiration showed four micro-nodules, one of which was not detected by the CT scan on shallow breathing (CT/PET). Post-treatment (I-131) scan confirmed uptake in these localizations. Good fusion between PET and CT images that avoids the errors of attenuation correction, especially in the lung bases, is necessary for correct image interpretation of the CT/PET study. Shallow breathing is necessary in order to obtain optimal image fusion with the CT/PET study, although this is not the best to evaluate pulmonary parenchyma in which an additional inspiratory CT scan improves detection of the pulmonary nodules.

Utilidad de la TC diagnóstica inspiratoria tras la realización del estudio PET/TC en la detección de nódulos pulmonares / Presentamos el caso de una mujer de 57 años diagnosticada de carcinoma papilar de tiroides, tratada con tiroidectomía y radioyodo en dos ocasiones. Un rastreo de control muestra captación cervical derecha, confirmada por punción aspiración con aguja fina, tratada con linfadenectomía. Ante la elevación de tiroglobulina, el rastreo negativo y la ecografía/TC cervical inespecífica se realiza un estudio tomográfico por emisión de positrones/tomográfico computarizado (PET/TC) que confirma infiltración del lecho cervical. Adicionalmente se le realiza una TC en máxima inspiración que muestra cuatro micronódulos, uno de ellos no detectado por la TC del estudio PET/TC. El rastreo posterapéutico (I-131) confirma captación en estas localizaciones. Para la correcta interpretación de las imágenes PET/TC se necesita una fusión óptima de la PET y la TC, que minimice errores de corrección de atenuación, especialmente en las bases pulmonares. La fusión más óptima se consigue en respiración suave, aunque no es la más adecuada para la evaluación del parénquima pulmonar, para la que es necesaria realizar una segunda TC en máxima inspiración

Presentamos el caso de una mujer de 57 años diagnosticada de carcinoma papilar de tiroides, tratada con tiroidectomía y radioyodo en dos ocasiones. Un rastreo de control muestra captación cervical derecha, confirmada por punción aspiración con aguja fina, tratada con linfadenectomía. Ante la elevación de tiroglobulina, el rastreo negativo y la ecografía/TC cervical inespecífica se realiza un estudio tomográfico por emisión de positrones/tomográfico computarizado (PET/TC) que confirma infiltración del lecho cervical. Adicionalmente se le realiza una TC en máxima inspiración que muestra cuatro micronódulos, uno de ellos no detectado por la TC del estudio PET/TC. El rastreo posterapéutico (I-131) confirma captación en estas localizaciones. Para la correcta interpretación de las imágenes PET/TC se necesita una fusión óptima de la PET y la TC, que minimice errores de corrección de atenuación, especialmente en las bases pulmonares. La fusión más óptima se consigue en respiración suave, aunque no es la más adecuada para la evaluación del parénquima pulmonar, para la que es necesaria realizar una segunda TC en máxima inspiración

We present the case of a 57-year old woman diagnosed of papillary thyroid carcinoma and treated with thyroidectomy followed by radioiodine (I-131) on two occasions. Follow-up radioiodine scan showed disease in right cervical region, confirmed by fine needle aspiration (FNA) and treated with lymphadenectomy. Due to thyroglobulin elevation, I-131 scan negative and inconclusive cervical ultrasonography/CT scan, we conducted a CT/PET study that confirmed cervical disease. An additional CT scan that was performed on maximum-inspiration showed four micro-nodules, one of which was not detected by the CT scan on shallow breathing (CT/PET). Post-treatment (I-131) scan confirmed uptake in these localizations. Good fusion between PET and CT images that avoids the errors of attenuation correction, especially in the lung bases, is necessary for correct image interpretation of the CT/PET study. Shallow breathing is necessary in order to obtain optimal image fusion with the CT/PET study, although this is not the best to evaluate pulmonary parenchyma in which an additional inspiratory CT scan improves detection of the pulmonary nodules

Evaluation of Aution Max AX-4280 automated urine test-strip analyser.

Aution Max AX-4280, an automated urine test-strip analyser, was evaluated in three centres. Method comparison, imprecision, carry-over, linearity, detection limit and drift studies were performed for glucose, protein, blood and leukocytes using Uriflet S 9UB strips. These strips enable measurement of pH, glucose, protein, blood, leukocytes, ketones, bilirubin, urobilinogen and nitrite. Specific gravity is determined by the refractive index method. Within-run and between-day imprecision, assessed using pooled urines and quality control materials, were good. No drift over 24 h or sample carry-over was observed. Method comparison with quantitative methods for glucose, protein and specific gravity yielded good correlations. Ascorbate negatively interfered with haemoglobin, glucose and nitrite measurements. Acetylsalicylic acid lowered pH, the effect being greatest when protein was absent. During the assessment period no malfunction or breakdown was reported. The Aution Max is easy to use and needs minimal maintenance.

Stress and rest myocardial SPET quantification with 201Tl and 99Tcm-tetrofosmin: a comparison.

99Tcm-tetrofosmin is a new myocardial perfusion agent that has excellent physical and pharmacokinetic characteristics for performing tomographic myocardial perfusion studies. The aim of this study was to compare the behaviour of 99Tcm-tetrofosmin and 201Tl in the assessment of ischaemia and viability in patients with previous myocardial infarction. Twenty consecutive patients who had suffered infarction and been referred for assessment of ischaemia and myocardial viability were enrolled into the study. Each patient underwent two stress tests performed no more than 10 days apart, one with a 201Tl exercise-reinjection-redistribution method and one with a 99Tcm-tetrofosmin short protocol (exercise-rest). The results were quantified using polar maps to represent images for stress, rest and reversibility. The post-stress images showed there was a slight tendency to overestimate defect size with 99Tcm-tetrofosmin in the lateral region (P < 0.006). We found no significant differences between the two tracers when comparing reversibility. The same defect size at rest were obtained when the maps for 201Tl with uptake of 50% were compared with those for 99Tcm-tetrofosmin with uptake of 45%. Agreement between the two agents for assessment of viability was 93%. We conclude that the quantitative assessment of myocardial ischaemia and uptake of 99Tcm-tetrofosmin at rest are comparable to those obtained with 201Tl in patients who have suffered myocardial infarction.

[ST segment elevation during exercise test and perfusion scintigraphy in patients without infarction]. / Elevación del segmento ST en la prueba de esfuerzo y gammagrafía de perfusión en pacientes sin infarto.

BACKGROUND: The features of perfusion scintigraphy in patients who show exercise-induced ST-segment elevation in the absence of previous infarction have been assessed in only a few reports. Therefore, we have evaluated our experience in a wide review of exercise 201-thallium scintigraphies. METHODS: 16,620 exercise 201-thallium scintigraphies, carried out between 1986 and 1993, have been retrospectively reviewed. Fourteen patients (0.8/1000) without previous infarction who were evaluated for chest pain showed ST-segment elevation. In all patients coronary arteriography was also available. RESULTS: Five patients were free from significant coronary artery stenoses, 6 had one-vessel disease, 2 had two-vessel disease, and the remaining patient had three-vessel disease. In 8 patients ST-segment elevation (up to 3-24 mm) was inferior, in 5 anterior and in 1 lateral. The radionuclide was injected during ST-segment elevation in 10 cases and before such elevation (which developed in the postexercise phase) in 4. In 3 out of these 4, which had angiographically normal coronary arteries, the scintigraphy was negative. In all cases where thallium-201 was injected during ST elevation, severe perfusion defects were detected corresponding to the localization of ST elevation. In the 4 patients with critical coronary stenoses, thallium-201 redistribution after 3 hours was partial. CONCLUSIONS: In patients without previous infarction and with exercise-induced ST-segment elevation, very severe perfusion defects are detected when the radionuclide has been injected during the crisis. Thallium-201 redistribution after 3 hours was not total in patients with fixed critical stenoses. When radionuclide injection preceded the crisis, the result of the scintigraphy was in agreement with the coronary anatomy.