Bilateral alien hand syndrome in cerebrovascular disease: CT, MR, CT angiography, and 99mTc-HMPAO-SPECT findings.

We report a 65-year-old man with a right cerebral infarction that occurred 15 years ago and a residual left hemiparesis that began with progressive contralateral hemiparesis. During the hospitalization, the patient developed a bilateral alien hand syndrome. Urgent CT, MR, CT angiography, and brain perfusion SPECT were performed that revealed an old right cerebral infarction and a new ischemic lesion in left parietal lobe and adjacent brain territories.

Indicaciones de la tomografía por emisión de positrones y la gammagrafía ósea en la estadificación del cáncer de pulmón / Indications for positron emission tomography and bone gammagraphy in staging lung cancer

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Adrenal metastasis of breast cancer with involvement of the inferior vena cava.

Tumour thrombosis of the inferior cava vein is usually associated with primary renal cell cancer. To our knowledge, this is the first case reported of adrenal metastasis of breast cancer extending into the inferior vena cava. There are few references in the literature documenting this extension with positron emission tomography (PET) and enhanced computed tomography (CT). The authors focus on the role of combined PET-CT imaging in the accurate detection of malignant thrombus.

Radioguided surgery in brain tumors with thallium-201.

RATIONALE: Malignant astrocytomas show thallium uptake with a high target-to-background ratio, allowing the use of radioguided surgery. METHOD: We report on 6 patients (3 men) diagnosed with malignant astrocytoma. All patients signed informed consent documents. Previous thallium-201 SPECT was performed, showing uptake in tumors. In the operating room we injected 37 MBq (1 mCi) of thallium-201 at the same time the craniotomy was performed. With the gamma probe we confirmed the tumor uptake, and a biopsy sample was taken. After conventional tumor resection, we scanned the surgical bed with the gamma probe. All areas of abnormal uptake were evaluated by the surgeon and, if possible, removed. RESULTS: In all patients the biopsy confirmed a high-grade astrocytoma. In all cases we found residual uptake in the surgical bed that was confirmed as residual tumor by pathologic examination. In 3 cases it was not possible to remove all the sites of pathologic uptake because critical areas were involved. In the other 3 patients, only background activity was found after the procedure. CONCLUSION: Radioguided surgery in brain tumors with thallium-201 is a complex technique and expertise in radioguided surgery and neuroimaging is needed, but we think that it is promising.

Aportación de la tomografía por emisión de positrones a la detección y estadificación del cáncer de mama / Contribution of positron emission tomography to the detection and staging of breast cancer

Introducción. La tomografía por emisión de positrones con 18F-fluorodeoxiglucosa (PET-FDG) es una técnica de diagnóstico por la imagen con numerosas aplicaciones en el campo de la oncología. En el cáncer de mama, concretamente, una de sus indicaciones más prometedoras es la estadificación no invasiva, tanto de la afección ganglionar como a distancia, lo cual tendría importantes repercusiones pronósticas y terapéuticas. Material y método. Se ha realizado una revisión de la bibliografía disponible sobre la utilidad de la PETFDG en la detección y estadificación del cáncer de mama. Se incluyen los resultados de la experiencia propia en nuestro centro. Resultados. La PET-FDG tiene especial interés para la detección de tumores en mamas densas, para la determinación de lesiones múltiples y para las mamas protésicas. En la estadificación ganglionar, la PET-FDG presenta una baja sensibilidad, por lo que no puede sustituir el estudio histológico y del ganglio centinela, pero es más exacta que otros métodos no invasivos y es especialmente útil en la valoración de la cadena mamaria interna. En la estadificación a distancia, la PET-FDG puede reemplazar y optimizar otros métodos de imagen habituales, sobre todo en casos de afección locorregional avanzada, elevación de marcadores tumorales y en la caracterización de hallazgos dudosos en la imagen anatómica o gammagráfica. Conclusiones. La PET-FDG tiene un importante impacto en el estudio de extensión del cáncer de mama, y complementa e incluso sustituye la información aportada por otras técnicas diagnósticas; asimismo, modifica el estadio tumoral en un elevado número de pacientes (AU)

Introduction. 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET) is a diagnostic imaging tool with multiple applications in oncology. One of the more promising applications in breast cancer is noninvasive lymph node staging and detection of distant metastases, which may provide useful information about prognosis and treatment response. Material and method. Published studies on FDGPET applications in breast cancer detection and staging were reviewed. We also present our own experience in patients referred for preoperative staging of breast cancer. Results. FDG-PET is very useful in evaluating dense breasts, multicentric disease and breast prostheses. The sensitivity of FDG-PET for nodal staging is low, and consequently it cannot replace either sentinel lymph node biopsy or histologic examination. However, it is more accurate than another noninvasive techniques and is very useful in internal mammary node chain evaluation. FDG-PET can improve and maybe replace conventional imaging in detecting metastatic disease, especially in high risk patients with locoregionally advanced recurrent breast cancer or increased serum tumor markers, and helps to characterize unclear findings of anatomic imaging techniques or scintigraphy. Conclusions. FDG-PET is useful in breast cancer staging. It complements and even improves information from other diagnostic techniques and changes therapeutic management in a high proportion of patients (AU)

[Contribution of positron emission tomography to the detection and staging of breast cancer]. / Aportación de la tomografía por emisión de positrones a la detección y estadificación del cáncer de mama.

INTRODUCTION: 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is a diagnostic imaging tool with multiple applications in oncology. One of the more promising applications in breast cancer is noninvasive lymph node staging and detection of distant metastases, which may provide useful information about prognosis and treatment response. MATERIAL AND METHOD: Published studies on FDG-PET applications in breast cancer detection and staging were reviewed. We also present our own experience in patients referred for preoperative staging of breast cancer. RESULTS: FDG-PET is very useful in evaluating dense breasts, multicentric disease and breast prostheses. The sensitivity of FDG-PET for nodal staging is low, and consequently it cannot replace either sentinel lymph node biopsy or histologic examination. However, it is more accurate than another noninvasive techniques and is very useful in internal mammary node chain evaluation. FDG-PET can improve and maybe replace conventional imaging in detecting metastatic disease, especially in high risk patients with locoregionally advanced recurrent breast cancer or increased serum tumor markers, and helps to characterize unclear findings of anatomic imaging techniques or scintigraphy. CONCLUSIONS: FDG-PET is useful in breast cancer staging. It complements and even improves information from other diagnostic techniques and changes therapeutic management in a high proportion of patients.