Prognostic value of myocardial perfusion scintigraphy in diabetic patients and without coronary lesion. / Valor pronóstico de la gammagrafía de perfusión miocárdica en pacientes diabéticos sin lesiones coronarias.

OBJECTIVE: To determine the prognostic value of myocardial perfusion scintigraphy-gated SPECT in patients with diabetes mellitus and without obstructive coronary artery disease. MATERIALS AND METHODS: This retrospective study included consecutive patients undergoing adenosine stress-rest myocardial perfusion imaging (MPI) by 99mTc-tetrofosmin between 2009 and 2011. The patients had diabetes mellitus and coronary angiography without significant coronary lesions. In total, 37 diabetic patients (female/male: 20/17; mean age: 65.2 (range: 40-78). 29 non-diabetic patients were included wich are matched with the group of diabetic patients with positive MPI. The group of non-diabetic patients had scintigraphy with myocardial ischemia and without angiographic lesions. A 36-month clinical follow-up was performed, and major cardiac events were recorded. RESULTS: In 78.3% (29/37) of diabetic patients the scintigraphic study showed myocardial ischemia, while it was negative in the 21.7%. The cardiac event rate in both groups was 6%. In diabetics with a myocardial perfusion study with myocardial ischemia, there were 3 major cardiac events. In diabetic patients with negative study had no cardiac event. In the non-diabetic control group the cardiac events rate was 3.4% (1/29). CONCLUSION: In diabetic patients without obstructive coronary disease, myocardial perfusion study can be predictor of cardiac events. A negative study can be an indicator of a better cardiovascular prognosis.

Tumor miofibroblástico de maxilar superior. Estadificación inicial y evaluación de la respuesta al tratamiento con PET/TC con 18F-FDG / Upper maxilla myofibroblastic tumour. Initial staging and treatment response evaluation with 18F-FDG PET/CT

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Carcinoma epidermoide primario de tiroides. Valoración inicial y control evolutivo mediante 18F-FDG PET/TC / Primary squamous cell carcinoma of the thyroid. Initial assessment and follow-up using 18F-FDG PET/CT

El carcinoma epidermoide primario de tiroides es una neoplasia muy poco frecuente, con comportamiento agresivo, de mal pronóstico, con pobre respuesta al tratamiento quimioterápico y radioterápico, y cuyo tratamiento de elección es la cirugía. Suele presentarse al diagnóstico como enfermedad extendida, como una tumefacción cervical que causa la mayoría de sus síntomas por invasión o metástasis locales. Su diagnóstico requiere excluir infiltración desde un tumor adyacente, afectación metastásica a distancia desde otro carcinoma epidermoide primario y realizar estudio inmunohistoquímico, el cual refleje el patrón característico de expresión de citoqueratinas. Presentamos el caso de un paciente de 53 años con antecedentes oncológicos de hepatocarcinoma, en el que durante el seguimiento se detecta una lesión cervical, caracterizada como hipermetabólica al realizar el estudio de extensión mediante tomografía por emisión de positrones con 18F-FDG (18F-FDG PET/TC). También presentamos el control evolutivo de dicha lesión mediante esta técnica y la utilidad de esta última (AU)

Squamous cell carcinoma of thyroid is an uncommon, very aggressive neoplasm, having a poor prognosis and poor response to chemotherapy and radiotherapy. Surgery is the initial treatment of choice, although it often presents as a widespread disease at the time of diagnosis, usually with cervical swelling that causes most of the symptoms due to local infiltration or metastasis. Local infiltration from adjacent tumour and metastatic disease needs to be excluded from other primary epidermoid carcinomas, in order to make a correct diagnosis. This also requires the typical cytokeratin pattern seen in histological studies. The case is presented of a 53 year-old man with a medical history of hepatocarcinoma, with a cervical hypermetabolic lesion detected in an 18F-FDG PET/CT performed to exclude widespread disease. The follow-up of this lesion with this technique and its usefulness is also described (AU)

Primary squamous cell carcinoma of the thyroid. Initial assessment and follow-up using 18F-FDG PET/CT. / Carcinoma epidermoide primario de tiroides. Valoración inicial y control evolutivo mediante 18F-FDG PET/TC.

Squamous cell carcinoma of thyroid is an uncommon, very aggressive neoplasm, having a poor prognosis and poor response to chemotherapy and radiotherapy. Surgery is the initial treatment of choice, although it often presents as a widespread disease at the time of diagnosis, usually with cervical swelling that causes most of the symptoms due to local infiltration or metastasis. Local infiltration from adjacent tumour and metastatic disease needs to be excluded from other primary epidermoid carcinomas, in order to make a correct diagnosis. This also requires the typical cytokeratin pattern seen in histological studies. The case is presented of a 53 year-old man with a medical history of hepatocarcinoma, with a cervical hypermetabolic lesion detected in an 18F-FDG PET/CT performed to exclude widespread disease. The follow-up of this lesion with this technique and its usefulness is also described.

Efectividad e impacto clínico de la PET- 18F-FDG en el diagnóstico de segundos tumores primarios insospechados / Effectivity and clinical impact of 18F-FDG-PET in the diagnosis of unsuspected second primary tumors

Objetivo. Evaluar la capacidad e impacto clínico de la PET-18F-FDG en el diagnóstico de segundos tumores primarios malignos inesperados. Material y métodos. Estudio retrospectivo transversal descriptivo de 1.984 exploraciones PET-18F-FDG consecutivas realizadas entre marzo de 2004 y marzo de 2005, identificándose aquellos estudios en los que se había informado de la presencia de lesiones hipermetabólicas, no sospechadas ni detectadas previamente y que pudiesen ser sugestivas de segundos tumores primarios. Se obtuvo un diagnóstico histopatológico o mediante seguimiento clínico-radiológico durante un período de tiempo superior a un año. Resultados. Se detectaron 62 hallazgos sugestivos de incidentalomas en 58 pacientes (3,1%). Los motivos de indicación en este grupo de pacientes fueron diversos siendo los más frecuentes el diagnóstico diferencial de benignidad vs malignidad de nódulos pulmonares solitarios. Un 43,5% de las lesiones no tuvieron seguimiento. Se confirmó la existencia de 35 lesiones, bien mediante estudio anatomopatológico (21 lesiones, 13 incidentalomas, la incidencia en nuestra población fue del 0,65%) o por seguimiento clínico-radiológico (14 lesiones, ninguna de ellas correspondió a segundos tumores primarios). El impacto clínico total fue el hallazgo de 14 lesiones no esperadas en 12 pacientes. Conclusiones. La presencia de incidentalomas en la PET-18F-FDG es relativamente frecuente. Estas lesiones deben ser objeto de seguimiento clínico para su diagnóstico exacto. En un alto porcentaje se corresponden con segundos tumores primarios inesperados en fase incipiente y, por lo tanto, susceptibles de tratamiento curativo o que pueden modificar la planificación del tratamiento del tumor ya conocido(AU)

Objective. This study has aimed to determine the capacity and clinical impact of the 18F-FDG-PET to detect previously unsuspected second primary tumors. Material and Methods. This is a retrospective cross-sectional study of 1984 consecutive scans performed between March 2004 and March 2005, identifying those studies that had reported the presence of hypermetabolic lesions, that had not been previously suspected or detected and that could be suggestive of second primary tumors. Diagnosis was made histopathologically or by clinical and radiological follow-up for a period exceeding one year. Results. 62 findings suggestive of second primary tumors were detected in 58 patients (3.1%). The reasons for the study for this group of patients were diverse, the most common being the differential diagnosis of solitary pulmonary nodules. A total of 43.5% of lesions were not followed-up. We confirmed the existence of 35 lesions, either by pathology study (21 lesions, 13 second primary tumors, the incidence in our population was 0.65%) or clinical and radiological follow-up (14 lesions, none of which corresponded to second primary tumors). The total clinical impact was the discovery of unexpected 14 lesions in 12 patients. Conclusion. The presence of second primary tumors on 18F-FDG-PET is relatively common. These lesions should be monitored clinically for accurate diagnosis. In a high percentage, they correspond to unexpected second primary tumors in an early stage and therefore amenable to curative treatment or for which tumor treatment planning may be modified(AU)

[Effectivity and clinical impact of (18)F-FDG-PET in the diagnosis of unsuspected second primary tumors]. / Efectividad e impacto clínico de la PET-(18)F-FDG en el diagnóstico de segundos tumores primarios insospechados.

OBJECTIVE: This study has aimed to determine the capacity and clinical impact of the (18)F-FDG-PET to detect previously unsuspected second primary tumors. MATERIAL AND METHODS: This is a retrospective cross-sectional study of 1984 consecutive scans performed between March 2004 and March 2005, identifying those studies that had reported the presence of hypermetabolic lesions, that had not been previously suspected or detected and that could be suggestive of second primary tumors. Diagnosis was made histopathologically or by clinical and radiological follow-up for a period exceeding one year. RESULTS: 62 findings suggestive of second primary tumors were detected in 58 patients (3.1%). The reasons for the study for this group of patients were diverse, the most common being the differential diagnosis of solitary pulmonary nodules. A total of 43.5% of lesions were not followed-up. We confirmed the existence of 35 lesions, either by pathology study (21 lesions, 13 second primary tumors, the incidence in our population was 0.65%) or clinical and radiological follow-up (14 lesions, none of which corresponded to second primary tumors). The total clinical impact was the discovery of unexpected 14 lesions in 12 patients. CONCLUSION: The presence of second primary tumors on (18)F-FDG-PET is relatively common. These lesions should be monitored clinically for accurate diagnosis. In a high percentage, they correspond to unexpected second primary tumors in an early stage and therefore amenable to curative treatment or for which tumor treatment planning may be modified.

Adenocarcinoma de colon y carcinoma faríngeo detectados incidentalmente mediante 18F-FDG PET en paciente diagnosticado de cáncer de pulmón / A colon adenocarcinoma and a pharyngeal carcinoma incidentally detected by means of 18F-FDG PET in a patient diagnosed of lung cancer

No es infrecuente el hallazgo de dos o más tumores en un mismo paciente, usualmente sobre la base de factores etiológicos comunes o del empleo de radioterapia y/o quimioterapia. Este hecho acontece con cierta frecuencia en el caso del cáncer de pulmón. En este sentido, la tomografía por emisión de positrones con 18F-FDG (PET-FDG) es un método ampliamente utilizado en el manejo diagnóstico y terapéutico de pacientes oncológicos, y con especial utilidad en pacientes con nódulo pulmonar solitario, carcinoma broncogénico, cáncer de cabeza y cuello, cáncer colorrectal, tumor de origen desconocido, linfomas, etc. Asimismo, ha demostrado su capacidad para detectar segundos o terceros tumores primarios no sospechados previamente.Presentamos un caso clínico que muestra cómo se detectaron, de manera incidental, dos cánceres sincrónicos en un paciente de 73 años diagnosticado de cáncer de pulmón y remitido para estudio PET-FDG(AU)

It is not uncommon to find two or more tumors in the same patient, usually based on similar etiologic factors or the use of radiotherapy and/or chemotherapy. This occurs quite often in the case of lung cancer. In this sense, the positron emission tomography with 18F-FDG (FDG-PET) is widely used for the diagnosis and treatment of cancer patients. It is also especially useful in patients with solitary pulmonary nodule, bronchogenic carcinoma, head and neck cancer, colon cancer, tumors of unknown origin, lymphomas, etc. Its capacity to detect previously unsuspected second or third primary tumors has also been demonstrated.We report a clinical case showing how two synchronous cancers were incidentally detected in a 73-year old patient diagnosed with lung cancer and referred for (FDG-PET) study(AU)

[A colon adenocarcinoma and a pharyngeal carcinoma incidentally detected by means of (18)F-FDG PET in a patient diagnosed of lung cancer]. / Adenocarcinoma de colon y carcinoma faríngeo detectados incidentalmente mediante (18)F-FDG PET en paciente diagnosticado de cáncer de pulmón.

It is not uncommon to find two or more tumors in the same patient, usually based on similar etiologic factors or the use of radiotherapy and/or chemotherapy. This occurs quite often in the case of lung cancer. In this sense, the positron emission tomography with (18)F-FDG (FDG-PET) is widely used for the diagnosis and treatment of cancer patients. It is also especially useful in patients with solitary pulmonary nodule, bronchogenic carcinoma, head and neck cancer, colon cancer, tumors of unknown origin, lymphomas, etc. Its capacity to detect previously unsuspected second or third primary tumors has also been demonstrated. We report a clinical case showing how two synchronous cancers were incidentally detected in a 73-year old patient diagnosed with lung cancer and referred for (FDG-PET) study.

Validación del renograma con estímulo diurético inmediato / Validation of the renogram with immediate diuretic stimulus

Objetivo El objetivo de este estudio es determinar la fiabilidad diagnóstica del renograma con estímulo diurético a la vez que la administración de la dosis comparando dos grupos de 59 pacientes cada uno (F0 y F+10) para identificar a aquellos pacientes susceptibles de ser tratados con cirugía. Material y métodos Estudio retrospectivo de dos grupos de 59 pacientes cada uno a los que se les efectuó renograma con estímulo diurético (furosemida) por sospecha de obstrucción ureteropiélica o ureterovesical, utilizando 99mTc-mercaptoacetylglicina. En el primero se aplicó el estímulo diurético a los 600 s de la administración de la dosis del radiotrazador (F+10). En el segundo se efectuó simultáneamente a la administración de la dosis (F0). Para la interpretación se valoró el análisis visual de las imágenes, los parámetros de las curvas y el porcentaje de eliminación tras modificación con la gravedad y micción. Se realizó análisis estadístico de los datos. Resultados El renograma F+10 muestra una sensibilidad del 96,7%, especificidad del 96,1%, valor predictivo positivo del 90,6% y valor predictivo negativo del 98,6%. El renograma F0 muestra una sensibilidad del 95,2%, especificidad del 98,9%, valor predictivo positivo del 95,2% y valor predictivo negativo del 98,9%. Conclusión La realización de renograma mediante la administración de estímulo diurético al mismo tiempo que la administración del radiofármaco es un método útil y cómodo en pacientes de edad pediátrica, y no supone una merma significativa en los parámetros de eficacia de la prueba en la selección de pacientes para intervención quirúrgica(AU)

Objective The aim of this study is to determine the diagnostic reliability of the renogram with diuretic stimulus simultaneously at the administration of the dose, comparing two groups of 59 patients each one (F0 and F+10), to select patients for surgery. Material and Methods This is an retrospective study about two groups of 59 patients to whom the diuretic renogram was carried out by stimulus (furosemide), by suspicion of ureteropelvic or vesicoureteral obstruction, using 99mTc-Mercaptoacetylglicine. In the first one, the study was conducted applying the diuretic stimulus 600 seconds after the administration of the dose of the radiotracer (F+10). In the second one it was carried out simultaneously to the administration (F0). For the interpretation there was used the visual analysis, the parameters of the curves and the percentage of elimination after modification by the severity and micturition. Statistical analysis of the information was made. Results The F+10 renogram shows a sensitivity of 96,7%, specificity of 96,1%, positive predictive value of 90,6%, and a negative predictive value of 98,6%. The F0 renogram shows a sensitivity of 95,2%, specificity of 98,9%, positive predictive value of 95,2%, and a negative predictive value of 98,9%. Conclusion The performance of renogram by means of the administration of diuretic stimulus at the same time as the administration of the radiotracer is a useful and comfortable method in paediatric patients, not supposing a significant wastage in the parameters of efficiency of the test in the patients selection for surgery(AU)

[Validation of the renogram with immediate diuretic stimulus]. / Validación del renograma con estímulo diurético inmediato.

OBJECTIVE: The aim of this study is to determine the diagnostic reliability of the renogram with diuretic stimulus simultaneously at the administration of the dose, comparing two groups of 59 patients each one (F0 and F+10), to select patients for surgery. MATERIAL AND METHODS: This is an retrospective study about two groups of 59 patients to whom the diuretic renogram was carried out by stimulus (furosemide), by suspicion of ureteropelvic or vesicoureteral obstruction, using (99m)Tc-Mercaptoacetylglicine. In the first one, the study was conducted applying the diuretic stimulus 600 seconds after the administration of the dose of the radiotracer (F+10). In the second one it was carried out simultaneously to the administration (F0). For the interpretation there was used the visual analysis, the parameters of the curves and the percentage of elimination after modification by the severity and micturition. Statistical analysis of the information was made. RESULTS: The F+10 renogram shows a sensitivity of 96,7%, specificity of 96,1%, positive predictive value of 90,6%, and a negative predictive value of 98,6%. The F0 renogram shows a sensitivity of 95,2%, specificity of 98,9%, positive predictive value of 95,2%, and a negative predictive value of 98,9%. CONCLUSION: The performance of renogram by means of the administration of diuretic stimulus at the same time as the administration of the radiotracer is a useful and comfortable method in paediatric patients, not supposing a significant wastage in the parameters of efficiency of the test in the patients selection for surgery.