Terapia con péptidos radiomarcados con [177Lu]Lu-DOTA-TATE / Peptide receptor radionuclide therapy with [177Lu]Lu-DOTA-TATE

Esta formación pretende presentar, de forma clara y de fácil comprensión, la biología de los tumores neuroendocrinos (TNE), las características de los receptores de somatostatina, cómo debe realizarse la selección de pacientes candidatos a terapia con péptidos radiomarcados (PRRT), si el paciente cumple los criterios para beneficiarse del tratamiento con los mínimos efectos adversos posibles, el protocolo de administración, seguimiento y evaluación de respuesta. También, se desarrollan los estudios de imagen funcional necesarios para explorar la biología del tumor e individualizar el tratamiento, que constituyen la piedra angular para el desarrollo de la teragnosis.Se están desarrollando ensayos clínicos para definir mejor la posición de PRRT dentro del amplio panorama terapéutico y, entre las perspectivas de futuro, hay varias líneas de investigación para mejorar la tasa de respuesta objetiva y la supervivencia con PRRT, centradas en el desarrollo de nuevos agonistas y antagonistas del receptor de somatostatina, nuevos radionúclidos y terapias combinadas radiosensibilizantes.En conclusión, la PRRT es un tratamiento bien tolerado, seguro y con efectos secundarios agudos, generalmente leves y autolimitados, que constituye una gran herramienta terapéutica que debe secuenciarse en el mejor momento de la evolución de la enfermedad de los pacientes con TNE. Los pacientes candidatos a la PRRT deben ser valorados siempre por un comité clínico multidisciplinar (AU)

This continuing education aims to present in a clear and easy-to-understand way, the biology of neuroendocrine tumors (NETs), the characteristics of somatostatin receptors, the selection of patients for radiolabelled peptide therapy (PRRT), the inclusion criteria to benefit from treatment with the minimum possible adverse effects, the administration protocol, follow-up and response evaluation. The functional imaging studies necessary to explore the biology of the tumor and to individualize the treatment are also carried out, and constitute the cornerstone for the development of teragnosis.Clinical trials are being developed to better define the position of PRRT within the broad therapeutic options, and among the future perspectives, there are several lines of research to improve the objective response rate and survival with PRRT, focused on the development of new agonists and somatostatin receptor antagonists, new radionuclides and radiosensitizing combination therapies.In conclusion, PRRT is a great therapeutic, well-tolerated and safe tool with generally mild and self-limited acute side effects, that must be sequenced at the best moment of the evolution of the disease of patients with NET. Candidate patients for PRRT should always be evaluated by an multidisciplinary clinical committee (AU)

Peptide receptor radionuclide therapy with [177Lu]Lu-DOTA-TATE.

This continuing education aims to present in a clear and easy-to-understand way, the biology of neuroendocrine tumors (NETs), the characteristics of somatostatin receptors, the selection of patients for radiolabelled peptide therapy (PRRT), the inclusion criteria to benefit from treatment with the minimum possible adverse effects, the administration protocol, follow-up and response evaluation. The functional imaging studies necessary to explore the biology of the tumor and to individualize the treatment are also carried out, and constitute the cornerstone for the development of teragnosis. Clinical trials are being developed to better define the position of PRRT within the broad therapeutic options, and among the future perspectives, there are several lines of research to improve the objective response rate and survival with PRRT, focused on the development of new agonists and somatostatin receptor antagonists, new radionuclides and radiosensitizing combination therapies. In conclusion, PRRT is a great therapeutic, well-tolerated and safe tool with generally mild and self-limited acute side effects, that must be sequenced at the best moment of the evolution of the disease of patients with NET. Candidate patients for PRRT should always be evaluated by a multidisciplinary clinical committee.

Estudios de imagen funcional de la corteza adrenal / Functional imaging of adrenal cortex

El aumento en el número de exploraciones de imagen de alta resolución ha incrementado la detección de lesiones adrenales, que precisan un diagnóstico diferencial. En la actualidad las exploraciones más utilizadas son la TC y la RM, pero estas en ocasiones son poco específicas, por lo que las exploraciones de medicina nuclear con 131I-norcolesterol, 11C-metomidato y 18F-fludeoxiglucosa ayudan a diferenciar entre benignidad y malignidad, a lateralizar la afectación en caso de hipersecreción y a orientar la estrategia terapéutica tanto en las lesiones unilaterales como bilaterales

The rising number of high-resolution imaging scans has increased the adrenal lesions detection, which require a differential diagnosis. Currently, the most commonly used scans are CT and MRI, but these are sometimes not very specific. In these cases, nuclear medicine scans with 131I-norcolesterol, 11C-metomidate and 18F-fludeoxyglucose help to differentiate benign vs. malignant lesions, to lateralize the involvement in hypersecretion disease, as well as to guide the therapeutic strategy in both unilateral and bilateral lesions

Functional imaging of adrenal cortex. / Estudios de imagen funcional de la corteza adrenal.

The rising number of high-resolution imaging scans has increased the adrenal lesions detection, which require a differential diagnosis. Currently, the most commonly used scans are CT and MRI, but these are sometimes not very specific. In these cases, nuclear medicine scans with 131I-norcolesterol, 11C-metomidate and 18F-fludeoxyglucose help to differentiate benign vs. malignant lesions, to lateralize the involvement in hypersecretion disease, as well as to guide the therapeutic strategy in both unilateral and bilateral lesions.

Detección inesperada de carcinoma ductal infiltrante no palpable de mama con 99mTc-HYNIC-TOC (Tektrotyd®) / Unexpected detection of non-palpable breast ductal invasive carcinoma with 99mTc-HYNIC-TOC (Tektrotyd®)

No disponible

Captación de 18F-florbetapir en un hemangioma intraóseo visualizado en una PET/TC cerebral / 18F-florbetapir uptake in a primary intraosseous haemangioma displayed in a cerebral PET/CT

No disponible

Coexistencia de metástasis óseas por cáncer gástrico y osteopoiquilia diagnosticadas mediante gammagrafía ósea y 18F-FDG PET/TC / Gastric cancer bone metastases together with osteopoikilosis diagnosed using bone scintigraphy and 18F-FDG PET/CT

La coexistencia de distintas alteraciones óseas en un mismo paciente es un hallazgo que plantea un diagnóstico diferencial complejo. Presentamos el caso de una paciente en estudio por una lesión renal, que en la radiografía convencional y en la TC presentó múltiples lesiones esclerosas en columna y extremidades, que se valoraron mediante gammagrafía ósea con 99mTc-HDP y 18F-FDG PET/TC, obteniéndose el diagnóstico definitivo mediante la anatomía patológica de coexistencia de metástasis óseas por cáncer gástrico y osteopoiquilia (OP). Entre las técnicas de imagen realizadas, la gammagrafía aportó el mayor rendimiento diagnóstico por su capacidad de discriminación entre enfermedad ósea benigna y metastásica (AU)

The coexistence of different bone diseases in the same patient involves a complex differential diagnosis. A patient is presented who was studied due to a renal mass that showed many sclerotic lesions in spine and limbs in conventional radiology and CT. These lesions were evaluated with 99mTC-HDP bone scintigraphy and 18F-FDG PET/CT, which helped to obtain the definitive pathological diagnosis of osteopoikilosis (OP) co-existing with gastric cancer bone metastases. Of the different imaging scans performed, bone scintigraphy was particularly relevant due to its ability to discriminate between benign and metastatic bone disease (AU)

Gastric cancer bone metastases together with osteopoikilosis diagnosed using bone scintigraphy and 18F-FDG PET/CT. / Coexistencia de metástasis óseas por cáncer gástrico y osteopoiquilia diagnosticadas mediante gammagrafía ósea y 18F-FDG PET/TC.

The coexistence of different bone diseases in the same patient involves a complex differential diagnosis. A patient is presented who was studied due to a renal mass that showed many sclerotic lesions in spine and limbs in conventional radiology and CT. These lesions were evaluated with 99mTC-HDP bone scintigraphy and 18F-FDG PET/CT, which helped to obtain the definitive pathological diagnosis of osteopoikilosis (OP) co-existing with gastric cancer bone metastases. Of the different imaging scans performed, bone scintigraphy was particularly relevant due to its ability to discriminate between benign and metastatic bone disease.

Experiencia inicial en la radiolocalización intraoperatoria del adenoma paratiroideo con freehand SPECT y valoración comparativa con gammacámara portátil / Initial experience in intraoperative radiolocalization of the parathyroid adenoma with freehand SPECT and comparative assessment with portable gamma-camera

Presentamos nuestra experiencia inicial con freehand SPECT en la radiolocalización intraoperatoria del adenoma paratiroideo en 2 pacientes, uno de ellos mediastínico. Existe solo una publicación anterior de 3 pacientes con adenomas en localización paratiroidea habitual. Aportamos además por primera vez una valoración comparativa de resultados con gammacámara portátil en la misma intervención. Se obtuvieron imágenes con gammacámara portátil y reconstrucción 3 D con freehand SPECT en qui- rófano desde 15 min tras administración iv de 5 mCi de 99m Tc-MIBI, localizándose los 2 adenomas con ambos equipos, comprobando la actividad de la pieza extirpada y ausencia de captación significativa en el lecho postexéresis, con confirmación mediante PTH intraoperatoria pre- y postextirpación, anatomía patológica y seguimiento clínico durante 10 meses. Aunque con ambos equipos se consiguió la localiza- ción intraoperatoria correcta de los adenomas paratiroideos y confirmación de su extirpación, freehand SPECT aportó adicionalmente la profundidad (mm) del adenoma respecto al borde cutáneo, muy útil en cirugía radioguiada mínimamente invasiva (AU)

Initial experience is presented by using freehand SPECT in the intraoperative radiolocalization of a parathyroid adenoma in 2 patients, one which was mediastinal. There is only one previous publication including 3 patients with parathyroid adenomas in usual parathyroid localizations. We also report for the first time a comparative assessment of results with portable gammacamera during the same surgery. In the operating room, we obtained images with portable gamma-camera and 3 D reconstruction with freehand SPECT from 15 min after iv injection of 5 mCi of 99m Tc-MIBI. Both devices enabled the 2 adenomas to be detected intraoperatively, as well as checking activity of the excised gland and absence of significant uptake in surgical bed, with confirmation by intraoperative pre-postsurgical PTH levels, pathology and clinical follow-up for 10 months. Both devices accurately located the parathyroid adenomas intraopera- tively, as well as confirmation of their extirpation, but freehand SPECT provided additional information of adenoma depth (mm) from the skin border, very useful for minimally invasive radio-guided surgery (AU)

[Initial experience in intraoperative radiolocalization of the parathyroid adenoma with freehand SPECT and comparative assessment with portable gamma-camera]. / Experiencia inicial en la radiolocalización intraoperatoria del adenoma paratiroideo con freehand SPECT y valoración comparativa con gammacámara portátil.

Initial experience is presented by using freehand SPECT in the intraoperative radiolocalization of a parathyroid adenoma in 2 patients, one which was mediastinal. There is only one previous publication including 3 patients with parathyroid adenomas in usual parathyroid localizations. We also report for the first time a comparative assessment of results with portable gammacamera during the same surgery. In the operating room, we obtained images with portable gamma-camera and 3 D reconstruction with freehand SPECT from 15 min after iv injection of 5 mCi of (99m)Tc-MIBI. Both devices enabled the 2 adenomas to be detected intraoperatively, as well as checking activity of the excised gland and absence of significant uptake in surgical bed, with confirmation by intraoperative pre-postsurgical PTH levels, pathology and clinical follow-up for 10 months. Both devices accurately located the parathyroid adenomas intraoperatively, as well as confirmation of their extirpation, but freehand SPECT provided additional information of adenoma depth (mm) from the skin border, very useful for minimally invasive radio-guided surgery.