ABSTRACT
Multimodality can be defined as a technique that brings together information obtained simultaneously from different imaging techniques in a single exploration to one patient. It encompasses joint assistance, teaching and investigation of Radiology and Nuclear Medicine in some of its techniques. It arose at the beginning of the XXI century with the development of equipment such as SPECT-CT, PET-CT and PET-MRI, able to achieve a better attenuation correction and to obtain fused images known as "corregistrated images". With the emergence of this equipment the need arises to consider new ways for the management of Radiology and Nuclear Medicine Departments, establishing diagnostic imaging Units combining both specialties. Similarly, the training of future specialists in these fields needs a specific training program in these new health technologies.
Subject(s)
Magnetic Resonance Imaging/methods , Multimodal Imaging/methods , Positron-Emission Tomography , Tomography, Emission-Computed, Single-Photon/methods , Tomography, X-Ray Computed/methods , HumansABSTRACT
Objetivo: Valorar las modificaciones en el tratamiento inducidas por la tomografía por emisión de positrones con 18F-desoxiglucosa (PET-FDG) en pacientes con sospecha de enfermedad residual o recurrente de cáncer diferenciado de tiroides (CDT) con tiroglobulina (Tg) elevada y rastreo corporal total (RCT) con 131I negativo. Pacientes y método: Se analizó de forma retrospectiva a un grupo de 50 pacientes (35 mujeres y 15 varones) tratados de CDT, a los que se hizo estudio PET-FDG (51 exploraciones) por elevación de Tg con RCT con 131I negativo. La comprobación de resultados se hizo según la anatomía patológica, respuesta al tratamiento o seguimiento clínico. Valoraron el impacto los médicos, que indicaron cómo influyó esta técnica en las decisiones terapéuticas, y se clasificó como alto, moderado, bajo o sin impacto, según los criterios de Hicks modificados. Resultados: La PET-FDG tuvo alto impacto en 18 (35,3%) pacientes, en los que se modificó la estrategia terapéutica; en 2 (3,9%) el impacto fue moderado, ya que no se aplicó tratamiento pero el resultado negativo de la PET-FDG evitó la realización de otros métodos diagnósticos; en 18 (35,3%), el impacto fue bajo, ya que no modificó el tratamiento; en 13 (25,5%) no tuvo impacto, pues no se tuvo en cuenta a la hora de decidir el tratamiento. Conclusiones: La PET-FDG resulta una técnica diagnóstica útil para la toma de decisiones terapéuticas en pacientes con sospecha de enfermedad residual o recurrente de CDT que presentan Tg elevada y RCT con 131I negativo (AU)
Objective: To assess FDG-PET-induced treatment modifications in patients with suspected recurrent or residual differentiated thyroid cancer (DTC) with elevated thyroglobulin (Tg) and negative 131I whole body scan (WBS). Patients and method: Fifty-one FDG-PET studies due to elevated Tg with negative WBS were retrospectively analyzed in 50 patients treated for DTC (35 women and 15 men). The results were verified by pathological analysis, treatment response or clinical follow-up. The impact of FDG-PET was assessed by asking the physicians to indicate how this technique had affected their therapeutic decisions and the influence was classified as high, moderate, low or nil according to Hicks' modified criteria. Results: The impact of FDG-PET was high in 18 patients (35.3%), in whom the therapeutic strategy was modified. A moderate impact was found in 2 patients (3.9%) since no treatment was applied; however, in these patients, negative FDG-PET results obviated the need for other diagnostic methods. Impact was low in 18 patients (35.3%) as treatment was not modified, and was null in 13 (25.5%) since this technique was not considered when therapeutic decisions were made. Conclusions: FDG-PET is a useful diagnostic technique for therapeutic decision-making in patients with suspected residual or recurrent DTC, elevated Tg and negative 131I-WBS (AU)
