[The clinical relevance of FDG-PET imaging in severe traumatic brain injuries]. / Relevancia clínica de la FDG-PET en los traumatismos craneoencefálicos graves.

AIM: To evaluate the usefulness of positron emission tomography (PET) as a predictor of long-term disability after a severe traumatic brain injury (TBI). PATIENTS AND METHODS: Fifty-six patients who had sustained a severe TBI were assessed with a broad battery of cognitive and functional scales at baseline and 6-months after inclusion in a multidisciplinary rehabilitation program. All patients underwent a FDG-PET at baseline. A physician blind to clinical data performed a semiquantitative analysis (normal vs altered) of functional neuroimaging (PET), including four cortical and three subcortical areas. The total number of lesions (cortical, subcortical and total) was correlated to the intensity of the TBI and to clinical data at admission and at follow-up. RESULTS: All patients showed changes in cerebral metabolism, being the thalamus the area most frequently affected. The degree of cerebral hypometabolism showed a significant correlation with TBI severity, functional disability, global outcome and cognitive impairment not only at baseline but also at follow-up. CONCLUSIONS: According to our results, FDG-PET may be a useful tool when studying brain dysfunction after severe TBI. FDG-PET findings correlate with the TBI severity, and with the level of patients' disability, as well as with the degree of memory and intelligence impairment. However, clinical variables related to the severity of the TBI, still are the best predictors of functional outcome after TBI.

Relevancia clínica de la FDG-PET en los traumatismos craneoencefálicos graves / The clinical relevance of FDG-PET imaging in severe traumatic brain injuries

Resumen. Objetivo. Demostrar la utilidad de la tomografía por emisión de positrones (PET) como predictor de la discapacidad a largo plazo tras un traumatismo craneoencefálico (TCE). Pacientes y métodos. Se evaluó neuropsicológica y funcionalmente a 56 pacientes que habían sufrido un TCE grave al inicio y aproximadamente seis meses después de su inclusión en un programa de rehabilitación multidisciplinar. A todos los pacientes se les realizó una tomografía por emisión de positrones con fluordeoxiglucosa al inicio del tratamiento. De forma ciega, se determinó la presencia o ausencia de alteraciones en cuatro áreas corticales y tres subcorticales, y se determinaron tres índices cualitativos de metabolismo cerebral (cortical, subcortical y total). Los índices de metabolismo se correlacionaron con las variables relacionadas con la gravedad del traumatismo, y con la situación cognitiva y funcional de los pacientes en el momento de realizar la PET y al finalizar el programa de rehabilitación. Resultados. Todos los pacientes mostraron alteraciones en el metabolismo cerebral, y el tálamo fue el área más frecuentemente afectada. La intensidad del hipometabolismo cerebral se correlacionó significativamente con la gravedad del TCE y con la alteración cognitiva y funcional tanto al inicio como al final del tratamiento. Conclusiones. Las técnicas de neuroimagen funcional presentan una excelente sensibilidad para detectar alteraciones tras un TCE, además de ofrecer una buena correlación anatomoclínica. No obstante, las variables relacionadas con la gravedad del TCE, siguen siendo las mejores predictoras de la discapacidad resultante tras un TCE (AU)

Summary. Aim. To evaluate the usefulness of positron emission tomography (PET) as a predictor of long-term disability after a severe traumatic brain injury (TBI). Patients and methods. Fifty-six patients who had sustained a severe TBI were assessed with a broad battery of cognitive and functional scales at baseline and 6-months after inclusion in a multidisciplinary rehabilitation program. All patients underwent a FDG-PET at baseline. A physician blind to clinical data performed a semiquantitative analysis (normal vs altered) of functional neuroimaging (PET), including four cortical and three subcortical areas. The total number of lesions (cortical, subcortical and total) was correlated to the intensity of the TBI and to clinical data at admission and at follow-up. Results. All patients showed changes in cerebral metabolism, being the thalamus the area most frequently affected. The degree of cerebral hypometabolism showed a significant correlation with TBI severity, functional disability, global outcome and cognitive impairment not only at baseline but also at follow-up. Conclusions. According to our results, FDG-PET may be a useful tool when studying brain dysfunction after severe TBI. FDG-PET findings correlate with the TBI severity, and with the level of patients’ disability, as well as with the degree of memory and intelligence impairment. However, clinical variables related to the severity of the TBI, still are the best predictors of functional outcome after TBI (AU)

[Usefulness of FDG-PET in the diagnosis of patients with chronic severe brain injury]. / Utilidad de la PET con FDG en la valoración del paciente con traumatismo craneoencefálico severo crónico.

INTRODUCTION: To describe the changes in cerebral glucose metabolism after a severe traumatic brain injury (TBI), at the beginning of the rehabilitation, to analyze its diagnostic agreement with morphologic neuroimaging technologies (MR/CT) and to correlate the neuroimaging findings with the intensity of the TBI and the functional ability for daily activities. MATERIAL AND METHODS: Prospective study of 55 patients who had sustained a severe TBI (GCS < or = 8) by means of 18F-FDG PET and MR/CT. The agreement between anatomical and functional neuroimagen studies was measured. Correlation between cerebral injury severity in neuroimaging, clinical functional evaluation assessed with Barthel-M Index and GCS were tested. RESULTS: 100 % of patients showed changes in cerebral metabolism, being the thalamus the area more frequently affected. 60 % of patients showed injuries in MR/CT, more frequently in frontal areas. The agreement for the diagnosis of pathology between morphologic and functional neuroimagen was very low. The TBI severity showed significant statistical correlation with the degree of cerebral metabolism and the level of disability. CONCLUSIONS: 18F-FDG PET allows to know the cerebral glucose metabolism at the beginning of the rehabilitation, being correlated with the TBI severity and the level of patient's disability for daily activities. 18F-FDG PET diagnoses major number of injuries that traditional neuroimaging and demonstrates a high thalamic vulnerability, with injuries in up to 76 % of patients with severe TBI.

Utilidad de la PET con FDG en la valoración del paciente con traumatismo craneoencefálico severo crónico / Usefulness of FDG-PET in the diagnosis of patients with chronic severe brain injury

Objetivo. Describir los cambios del metabolismo glucolítico cerebral tras un traumatismo craneoencefálico (TCE) severo en el momento de iniciar la rehabilitación, medir su nivel de acuerdo diagnóstico con las técnicas de neuroimagen morfológica (RM/TC) y correlacionar los hallazgos en neuroimagen con la intensidad del TCE sufrido y con la discapacidad funcional para las actividades de la vida diaria. Material y métodos. Estudio prospectivo de 55 pacientes con antecedente de TCE severo (GCS <= 8) mediante 18F-FDG PET y RM/TC. Medida del acuerdo entre los estudios de neuroimagen anatómica y funcional. Valoración funcional mediante el test de Barthel-M y cálculo de correlación entre la afectación cerebral en neuroimagen y el test de Barthel y la GCS. Resultados. El 100 % de los pacientes presentó alteración en el metabolismo cerebral, siendo los tálamos las áreas más frecuentemente afectadas. El 60 % de los pacientes mostró lesiones en RM/TC, más frecuentemente frontales. El grado de acuerdo para el diagnóstico de patología entre la neuroimagen morfológica y funcional fue muy bajo. La intensidad del traumatismo sufrido y el nivel de discapacidad se correlacionaron de forma estadísticamente significativa con el grado de afectación del metabolismo cerebral. Conclusiones. La PET con 18F-FDG permite conocer el estado del metabolismo glucolítico cerebral en el momento de iniciar la rehabilitación, correlacionándose con la severidad del traumatismo sufrido y con la discapacidad para las actividades de la vida diaria. La PET diagnostica mayor número de lesiones que la neuroimagen anatómica y demuestra una elevada vulnerabilidad talámica, con lesiones hasta en el 76 % de pacientes con antecedente de TCE severo

Introduction. To describe the changes in cerebral glucose metabolism after a severe traumatic brain injury (TBI), at the beginning of the rehabilitation, to analyze its diagnostic agreement with morphologic neuroimaging technologies (MR/CT) and to correlate the neuroimaging findings with the intensity of the TBI and the functional ability for daily activities. Material and methods. Prospective study of 55 patients who had sustained a severe TBI (GCS <= 8) by means of 18F-FDG PET and MR/CT. The agreement between anatomical and functional neuroimagen studies was measured. Correlation between cerebral injury severity in neuroimaging, clinical functional evaluation assessed with Barthel-M Index and GCS were tested. Results. 100 % of patients showed changes in cerebral metabolism, being the thalamus the area more frequently affected. 60 % of patients showed injuries in MR/CT, more frequently in frontal areas. The agreement for the diagnosis of pathology between morphologic and functional neuroimagen was very low. The TBI severity showed significant statistical correlation with the degree of cerebral metabolism and the level of disability. Conclusions. 18F-FDG PET allows to know the cerebral glucose metabolism at the beginning of the rehabilitation, being correlated with the TBI severity and the level of patient's disability for daily activities. 18F-FDG PET diagnoses major number of injuries that traditional neuroimaging and demonstrates a high thalamic vulnerability, with injuries in up to 76 % of patients with severe TBI

Carcinoma bronquioloalveolar como causa potencial de falso negativo con PET-FDG / Bronchioloalveolar carcinoma as potencial cause of false negative with PET-FDG

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Solitary adrenal gland metastasis of a follicular thyroid carcinoma presenting with hyperthyroidism.

Follicular thyroid carcinoma typically manifests under euthyroid conditions, and diagnostic scintigraphy usually identifies a cold nodule. Sometimes, such tumors can appear in the context of hyperthyroidism, which can be caused by a toxic multinodular goitre, a toxic adenoma, or even carcinoma. We report a case of follicular thyroid carcinoma discovered after surgical treatment of a toxic multinodular goiter, in which solitary adrenal gland metastasis was detected five years later. A (131)I whole body scan is the diagnostic method of choice for functioning thyroid metastasis.

[Association of thyroid hemiagenesis and Graves disease]. / Asociación de hemiagenesia tiroidea y enfermedad de Graves.

Thyroid hemiagenesis is a very infrequent abnormality. We present a case of Graves disease associated to a congenital hemiagenesis of the thyroid gland. The thyroid scintigraphy, ultrasonography and laboratory analysis (that showed the existence of thyroid hyperfunction and the present of thyroid stimulating antibodies) were decisive in the diagnosis.

Asociación de hemiagenesia tiroidea y enfermedad de Graves / Association of thyroid hemiagenesis and graves disease

La hemiagenesia tiroidea es una anomalía muy poco frecuente. Presentamos un caso de enfermedad de Graves asociada a una hemiagenesia congénita del tiroides. La gammagrafía de tiroides, la ecografía y la analítica (que demostraba la existencia de hiperfunción tiroidea junto con elevación de anticuerpos anti-receptor de la TSH) fueron decisivas para el diagnóstico. (AU)

Hiperprolactinemia como causa de captación mamaria en gammagrafía con 67Ga / Hyperprolactinemia as a cause of breast uptake in 67Ga scintigraphy

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[Evaluation of the usefulness of the antimyosin monoclonal antibody (AMA) uptake in the diagnosis of heart transplant (HT) rejection]. / Valoración de la utilidad del índice de captación de anticuerpos monoclonales antimiosina (AMA) en el diagnóstico de rechazo en el trasplante cardíaco (TC).

OBJECTIVE: To ascertain whether a given level of antimyosin monoclonal antibody (AMA) uptake in the endomyocardial biopsy (EMB) can identify patients with rejection. MATERIAL AND METHOD: 186 examinations were performed on 65 patients (8 women and 57 men) with orthotopic heat transplant (HT): Mean age 51 +/- 13 years. There were 3 examinations per patient (range 1-6). The studies were conducted 13 to 880 days after the HT. The C/p uptake indexes were obtained according to the Carrió y cols. method and the results were compared with the biopsy findings. Rejection was considered to be when the biopsy showed at least one site of necrosis. RESULTS: 1) We analyzed the C/P index in accordance with the post-HT interval and with the degree of rejection obtained by EMB. No group showed any significant differences between the patients with an without rejection (p > 0,05). 2) We applied a variable threshold based on post-HT interval, using an exponential curve defined on the basis of the interval of the values corresponding to patients without rejection and good progress compared with that of the rejection patients. This approach also did not contribute any improvement compared to the use of a fixed threshold due to the significant overlay of the values for patients with and without rejection. 3) Finally, we analyzed the individual evolution of the C/P indexes for each patient in terms of time. In patients whose clinical progress was good, the C/P indexes were observed to drop progressively over time. In those whose clinical progress was poor, abrupt increases in the index values were observed. CONCLUSION: We were unable to differentiate significantly between patients with and without rejection in EMB using fixed and variable thresholds of the C/P index. However, the different patterns of evolution for each patient provide information on the lack of complications and could be used as a follow-up technique.

Metastatic follicular thyroid carcinoma to the kidney: a case report.

Clinically detectable well-differentiated metastatic thyroid cancer to the kidney is rare, with only 12 cases reported in the medical literature. The authors report a case of metastatic thyroid carcinoma to the kidney in a patient with widespread dissemination. She underwent total thyroidectomy, radical left nephrectomy, radioactive ablation with I-131, radiotherapy, and thyroid suppression therapy. Well-differentiated thyroid metastatic cancer can be amenable to treatment with successful long-term results.

[Pericardial effusion as a possible cause of false positives in I-131 radionuclide scans]. / Derrame pericárdico como posible causa de falso positivo en un rastreo con 131I.

The case of a patient who had undergone surgery for papillary carcinoma of the thyroid is reported. After administering a therapeutic 131I capsule, the radionuclide scan showed a diffuse, "halo-like" thoracic uptake in the precordial region. The patient's normal thyroglobulin levels and the characteristics of radionuclide uptake did not suggest metastasis. Chest radiography and ultrasonography identified pericardial effusion, which was attributed to hypothyroidism.

[Normally functioning ectopic thyroid in adults. Apropos of 4 cases]. / Tiroides ectópico normofuncionante en la edad adulta. A propósito de cuatro casos.

Four cases are presented of ectopic thyroid tissue in adult women who underwent for thyroid study for different motives. Radioisotopic uptake was absent in the usual thyroid location. Thyroid function was normal in every case and no psychomotor abnormalities were present. In one case, echography revealed an atrophic thyroid in the usual location in association with thyroid ectopy. The literature of thyroid ectopy was reviewed and the preponderant role of radioisotopic scan is underlined, together with thyroid echography in the imaging diagnosis of neck masses.

Metástasis coroídea de carcinoma papilar de tiroides: subtipo tall cell / Choroidal metastasis of papillary thyroid carcinoma: tall cell subtypes

Se presenta un caso de metástasis coroidea de un cáncer papilar de tiroides. La metástasis es el mecanismo más frecuente de la aparición de patología ocular maligna. Sin embargo el tumor primario más frecuente es el de la mama y del pulmón seguido por riñón, testículo, próstata e intestino. El cáncer de tiroides es raro y menos frecuente aún es que envíe metástasis a la coroides. El paciente presentaba además metástasis a huesos largos, tórax y cerebro. La lesión coroidea fue tratada con radioterapia con mal resultado