Valor pronóstico de los criterios PERCIST y los parámetros metabólicos de la PET/TC en pacientes con cáncer de esófago tras tratamiento neoadyuvante / Prognostic value of PERCIST and PET/CT metabolic parameters in patients with esophageal cancer after neoadjuvant treatment

Objetivo Valorar la utilidad clínica de los criterios PERCIST y de los cambios en los parámetros cuantitativos de la PET/TC con [18F]FDG como factores pronósticos para la supervivencia libre de progresión y la supervivencia cáncer-específica en pacientes con cáncer de esófago tratados mediante quimiorradioterapia. Material y métodos Se valoraron retrospectivamente 50 pacientes (48 hombres) diagnosticados de cáncer de esófago durante un intervalo de 7,5 años. Se utilizaron los criterios PERCIST para valorar la respuesta a la neoadyuvancia. Asimismo, se determinaron las variaciones del SUV máximo, volumen metabólico tumoral y glucólisis tumoral total entre los estudios PET/TC pre- y postratamiento. Las curvas ROC, el método de Kaplan-Meier y el modelo de regresión de Cox se aplicaron para el análisis de factores pronósticos y curvas de supervivencia. Resultados El seguimiento medio fue de 26,8 meses, produciéndose 40 recurrencias-progresiones y 41 muertes. El análisis de supervivencia mostró curvas de supervivencia cáncer-específica con diferencias estadísticamente significativas en relación con los criterios PERCIST y la variación del volumen metabólico tumoral y la glucólisis tumoral total. Los criterios PERCIST fueron el único factor predictivo independiente en el análisis multivariante. Ni el SUV máximo ni el tamaño tumoral fueron predictores para ninguno de los criterios de evaluación. Conclusión La aplicación de los criterios PERCIST, así como el cambio de volumen metabólico tumoral y glucólisis tumoral total de los estudios PET/TC demostraron ser factores pronósticos para la supervivencia cáncer-específica en pacientes de nuestro entorno tratados por cáncer de esófago. Los resultados podrían ayudar a personalizar el tratamiento (AU)

Aim To assess the clinical utility of PERCIST criteria and changes in [18F]FDG PET/CT quantitative parameters as prognostic factors for progression-free survival and cancer-specific survival in patients with esophageal cancer treated by chemoradiotherapy. Material and methods Fifty patients (48 men) diagnosed with esophageal cancer were retrospectively evaluated over a 7.5-year interval. PERCIST criteria were used to assess response to neoadjuvant therapy. Variations in the metabolic parameters maximum SUV, metabolic tumor volume and total lesion glycolysis between pre- and post-treatment PET/CT studies were also determined. ROC curves, Kaplan-Meier method and Cox regression model were used for the analysis of prognostic factors and survival curves. Results The average follow-up was 26.8 months, with 40 recurrences-progressions and 41 deaths. Survival analysis showed statistically significant differences in cancer-specific survival curves for PERCIST criteria and variation of metabolic tumor volume and total lesion glycolysis. PERCIST criteria were the only independent predictor in the multivariate analysis. Neither maximum SUV nor tumor size were predictors for any of the assessment criteria Conclusion Application of PERCIST criteria as well as change in metabolic tumor volume and total lesion glycolysis from PET/CT studies proved to be prognostic factors for cancer-specific survival in patients in our setting treated for esophageal cancer. The results could help to personalize treatment (AU)

Prognostic value of PERCIST and PET/CT metabolic parameters after neoadjuvant treatment in patients with esophageal cancer.

AIM: To assess the clinical utility of PERCIST criteria and changes in [18F]FDG PET/CT quantitative parameters as prognostic factors for progression-free survival and cancer-specific survival (CSS) in patients with esophageal cancer treated by chemoradiotherapy. MATERIAL AND METHODS: Fifty patients (48 men) diagnosed with esophageal cancer were retrospectively evaluated over a 7.5-year interval. PERCIST criteria were used to assess response to neoadjuvant therapy. Variations in the metabolic parameters maximum SUV (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) between pre- and post-treatment PET/CT studies were also determined. ROC curves, Kaplan-Meier method and Cox regression model were used for the analysis of prognostic factors and survival curves. RESULTS: The average follow-up was 26.8 months, with 40 recurrences-progressions and 41 deaths. Survival analysis showed statistically significant differences in CSS curves for PERCIST criteria and variation of MTV and TLG. PERCIST criteria were the only independent predictor in the multivariate analysis. Neither SUVmax nor tumor size were predictors for any of the assessment criteria. CONCLUSION: Application of PERCIST criteria as well as change in MTV and TLG from PET/CT studies proved to be prognostic factors for CSS in patients in our setting treated for esophageal cancer. The results could help to personalize treatment.

Utilidad de la gammagrafía de tránsito gastrointestinal en la valoración del estreñimiento crónico / Utility of gastrointestinal transit scintigraphy in chronic constipation evaluation

Objetivo El estreñimiento crónico es una patología frecuente en la práctica clínica. Ante la falta de respuesta al tratamiento se recomienda evaluar la función gastrointestinal. Para ello puede ser útil la gammagrafía, aunque su uso no es generalizado. El objetivo del estudio fue valorar la utilidad de la gammagrafía de tránsito gastrointestinal en pacientes con estreñimiento crónico. Material y métodos Se valoraron 20 pacientes (13 niños) remitidos para estudio gammagráfico por estreñimiento crónico refractario al tratamiento, siringomielia, rectocele o migraña abdominal. Todos fueron sometidos a valoración clínica, determinación analítica, estudio de imagen radiológica y/o biopsia rectal. Se realizó un protocolo de estudio completo, incluyendo gammagrafía de vaciamiento gástrico, tránsito de intestino delgado y colónico. Para ello, se administró una dosis de [111In]In-DTPA diluida en agua (37MBq) junto con comida estandarizada. Siguiendo las guías internacionales, se definieron áreas de interés en el estómago, en el íleon terminal y en diferentes regiones del intestino grueso para calcular el centro geométrico como medida de progresión. Resultados De los 13 pacientes en edad pediátrica, 10 presentaron patrones gammagráficos anormales, modificando el tratamiento en 8 de ellos. La mayoría de los niños no mostraron alteraciones en las exploraciones radiológicas. En pacientes adultos, el resultado de la prueba conllevó el cambio del manejo terapéutico en todos ellos, Conclusiones El estudio gammagráfico proporcionó información útil en el estudio del estreñimiento crónico, influyendo en el diagnóstico y en el manejo terapéutico del paciente. La información fisiológica y cuantitativa que proporciona permite la determinación global y regional del tránsito gastrointestinal (AU)

Aim Chronic constipation is a common pathology in clinical practice. In the absence of response to treatment, assessment of gastrointestinal function is recommended. This can be performed by scintigraphy, although its use is not widespread. The aim of this paper was to assess the utility of gastrointestinal transits scintigraphy in patients with chronic constipation. Material and methods Twenty patients (13 children) sent for scintigraphy for chronic constipation refractory to treatment, syringomyelia, rectocele or abdominal migraine were evaluated. All underwent clinical assessment, analytical determination, radiological imaging and/or rectal biopsy. A complete study protocol was performed, including gastric emptying, small bowel and colonic transits scintigraphy. For this, a dose of [111In]In-DTPA diluted in water (37MBq) was administered together with standardized food. Following international guidelines, regions of interest were defined in the stomach, terminal ileum and different regions of the large intestine to calculate the geometric center as a measure of progression. Results Of the 13 pediatric patients, 10 had abnormal gammagraphic patterns, with treatment being modified in 8 of them. Most of the children showed no alterations on radiological explorations. In adult patients, the results of the test changed the therapeutic management in all of them. Conclusions Scintigraphic study provided useful information in the study of chronic constipation, influencing the diagnosis and therapeutic management of the patient. The physiological and quantitative information it provides allows both global and regional of gastrointestinal transit time determination (AU)

Utility of gastrointestinal transit scintigraphy in the evaluation of chronic constipation.

AIM: Chronic constipation is a common pathology in clinical practice. In the absence of response to treatment, assessment of gastrointestinal function is recommended. This can be performed by scintigraphy, although its use is not widespread. The aim of this paper was to assess the utility of gastrointestinal transits scintigraphy in patients with chronic constipation. MATERIAL AND METHODS: Twenty patients (13 children) sent for scintigraphy for chronic constipation refractory to treatment, syringomyelia, rectocele or abdominal migraine were evaluated. All underwent clinical assessment, analytical determination, radiological imaging and/or rectal biopsy. A complete study protocol was performed, including gastric emptying, small bowel and colonic transits scintigraphy. For this, a dose of [111In]In-DTPA diluted in water (37MBq) was administered together with standardized food. Following international guidelines, regions of interest were defined in the stomach, terminal ileum and different regions of the large intestine to calculate the geometric center as a measure of progression. RESULTS: Of the 13 pediatric patients, 10 had abnormal gammagraphic patterns, with treatment being modified in 8 of them. Most of the children showed no alterations on radiological explorations. In adult patients, the results of the test changed the therapeutic management in all of them. CONCLUSIONS: Scintigraphic study provided useful information in the study of chronic constipation, influencing the diagnosis and therapeutic management of the patient. The physiological and quantitative information it provides allows both global and regional of gastrointestinal transit time determination.

Parámetros cuantitativos de la PET/TC basal con 18F-FDG como factores pronósticos en el carcinoma de células escamosas de esófago / Baseline 18F-FDG PET/CT quantitative parameters as prognostic factors in esophageal squamous cell cancer

Objetivo: Determinar la utilidad de los parámetros cuantitativos de la PET/TC con 18F-FDG como factores pronósticos para la respuesta al tratamiento neoadyuvante, la supervivencia libre de progresión (SLP) y la supervivencia cáncer específica (SCE) en pacientes con carcinoma de células escamosas de esófago (CCE). Material y métodos: Se valoraron retrospectivamente 30 pacientes (29 hombres) diagnosticados de CCE durante un intervalo de 6años. Se determinaron los parámetros metabólicos SUV máximo (SUVmax), SUV medio (SUVmed), volumen metabólico tumoral (MTV) y glucólisis tumoral total (TLG) del estudio PET/TC al diagnóstico. Tras tratamiento con quimioterapia y/o radioterapia, se valoró la respuesta al tratamiento y la supervivencia de los pacientes. La comparación de parámetros entre grupos de respondedores y no respondedores se realizó mediante la prueba U de Mann-Whitney. Las curvas ROC y el método de Kaplan-Meier se utilizaron para el análisis de factores pronósticos y curvas de supervivencia. Resultados: El seguimiento medio fue de 22,4meses, produciéndose 22 recurrencias-progresiones y 25 fallecimientos. Se demostraron diferencias significativas entre respondedores y no respondedores con respecto al tamaño tumoral, el MTV y la TLG. El análisis de supervivencia halló diferencias significativas para SCE y SLP dependiendo de estos tres parámetros. Conclusión: Los parámetros metabólicos MTV y TLG, así como el tamaño tumoral, fueron factores pronósticos para la respuesta al tratamiento neoadyuvante, la SLP y la SCE en pacientes diagnosticados de CCE. Ni el SUVmax ni el SUVmed fueron predictores para ninguno de los criterios de evaluación. Los resultados permitirían personalizar el tratamiento de los pacientes (AU)

Aim: To determine the utility of 18F-FDG PET/CT quantitative parameters as prognostic factors for the response to neoadjuvant treatment, progression-free survival (PFS) and cancer-specific survival (CSS) in patients with esophageal squamous cell carcinoma (SCC). Material and methods: Thirty patients (29 men) diagnosed with SCC were retrospectively evaluated over a 6-year interval. Metabolic parameters were determined: maximum SUV (SUVmax), mean SUV (SUVmed), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) from baseline PET/CT study. After treatment with chemotherapy and/or radiotherapy, response to treatment and patient survival were assessed. The comparison of parameters between groups of responders and non-responders was carried out using a Mann-Whitney U test. ROC curves and the Kaplan-Meier method were used for analysis of prognostic factors and survival curves. Results: The average follow-up was 22.4months, with 22 recurrence-progressions and 25 deads. Significant differences were demonstrated between responders and non-responders with respect to tumor size, MTV and TLG. Survival analysis found significant differences for SCE and CSS depending on these three parameters. Conclusion: Metabolic parameters MTV and TLG, and tumor size were prognostic factors for neoadjuvant treatment response, PFS, and CSS in patients diagnosed with SCC. Neither SUVmax nor SUVmed were predictive for any of the evaluation criteria. Results could help to personalize patient treatment (AU)

Baseline 18F-FDG PET/CT quantitative parameters as prognostic factors in esophageal squamous cell cancer.

AIM: To determine the utility of [18F]FDG PET/CT quantitative parameters as prognostic factors for the response to neoadjuvant treatment, progression-free survival (PFS) and cancer-specific survival (CSS) in patients with esophageal squamous cell carcinoma (SCC). MATERIAL AND METHODS: Thirty patients (29 men) diagnosed with SCC were retrospectively evaluated over a 6-year interval. Metabolic parameters were determined: maximum SUV (SUVmax), mean SUV (SUVmed), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) from baseline PET/CT study. After treatment with chemotherapy and/or radiotherapy, response to treatment and patient survival were assessed. The comparison of parameters between groups of responders and non-responders was carried out using a Mann-Whitney U test ROC curves and the Kaplan-Meier method were used for analysis of prognostic factors and survival curves. RESULTS: The average follow-up was 22.4 months, with 22 recurrence-progressions and 25 deaths. Significant differences were demonstrated between responders and non-responders with respect to tumor size, MTV and TLG. Survival analysis found significant differences for SCE and CSS depending on these three parameters. CONCLUSION: Metabolic parameters MTV and TLG, and tumor size were prognostic factors for neoadjuvant treatment response, PFS, and CSS in patients diagnosed with SCC. Neither SUVmax nor SUVmed were predictive for any of the evaluation criteria. Results could help to personalize patient treatment.

Baseline 18F-FDG PET/CT quantitative parameters as prognostic factors in esophageal squamous cell cancer. / Parámetros cuantitativos de la PET/TC basal con 18F-FDG como factores pronósticos en el carcinoma de células escamosas de esófago.

AIM: To determine the utility of 18F-FDG PET/CT quantitative parameters as prognostic factors for the response to neoadjuvant treatment, progression-free survival (PFS) and cancer-specific survival (CSS) in patients with esophageal squamous cell carcinoma (SCC). MATERIAL AND METHODS: Thirty patients (29 men) diagnosed with SCC were retrospectively evaluated over a 6-year interval. Metabolic parameters were determined: maximum SUV (SUVmax), mean SUV (SUVmed), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) from baseline PET/CT study. After treatment with chemotherapy and/or radiotherapy, response to treatment and patient survival were assessed. The comparison of parameters between groups of responders and non-responders was carried out using a Mann-Whitney U test. ROC curves and the Kaplan-Meier method were used for analysis of prognostic factors and survival curves. RESULTS: The average follow-up was 22.4months, with 22 recurrence-progressions and 25 deads. Significant differences were demonstrated between responders and non-responders with respect to tumor size, MTV and TLG. Survival analysis found significant differences for SCE and CSS depending on these three parameters. CONCLUSION: Metabolic parameters MTV and TLG, and tumor size were prognostic factors for neoadjuvant treatment response, PFS, and CSS in patients diagnosed with SCC. Neither SUVmax nor SUVmed were predictive for any of the evaluation criteria. Results could help to personalize patient treatment.

18F-FDG PET/CT quantitative parameters as prognostic factor in localized and inoperable lung cancer. / Parámetros cuantitativos de la PET/TC con 18F-FDG como factores pronósticos en el cáncer de pulmón localizado e inoperable.

AIM: To assess the utility of 18F-FDG PET/CT quantitative parameters as prognostic factor in patients diagnosed with localized and inoperable lung cancer treated by stereotactic body radiotherapy (SBRT). MATERIAL AND METHODS: Fifty patients (42 men) diagnosed in the last 7years with early-stage lung cancer and treated with SBRT alone were assessed by a prospective study. After PET/CT study, metabolic parameters maximum SUV (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were determined at different thresholds. The prognostic factors for overall survival (OS), cause-specific survival (CS) and disease-free survival (DFS) were analysed by Cox proportional hazards model and the survival analysis by Kaplan-Meier method. RESULTS: The average follow-up was 39.6months, with 21 recurrences and 24 dead. Univariate analysis determined MTV30 and MTV40 as predictors for OS; MTV30, MTV40, TLG30 and TLG40 for CS, and MTV2, MTV30, MTV40, TLG2, TLG30 and TLG40 for DFS. Survival analysis found statistically significant differences for CS and DFS depending on tumor size and for DFS considering the cut-off values of MTV2 and TLG2 (threshold SUVmax=2). SUVmax, age and sex were not shown to be significant factors. CONCLUSION: Pre-treatment quantitative assessment using metabolic parameters MTV2 and TLG2 as well as tumor size proved to be prognostic factors in patients diagnosed with localized and inoperable lung cancer treated by SBRT. Results could help to personalize treatment.

Gastrointestinal transit scintigraphy in chronic constipation evaluation in pediatric age; an infrequent test. / Gammagrafía de tránsito gastrointestinal en el estudio del estreñimiento crónico en edad pediátrica; una exploración infrecuente.

AIM: Chronic constipation is a common pathology in children. The aim of this paper was to show the usefulness of gastrointestinal transit scintigraphy in pediatric patients with chronic constipation, and the advantages with respect to other imaging techniques, despite our limited experience. MATERIAL AND METHODS: We evaluated 5 patients sent to our service with a diagnosis of chronic constipation refractory to treatment. We performed a complete study protocol, including liquid gastric emptying scintigraphy and small and large bowel transit times, using a single dose of 111In-DTPA. Following international guidelines regions of interest were defined in stomach, terminal ileum and in 6 regions of the large intestine. RESULTS: All patients showed altered scintigraphy study, showing 4 of them normal radiological tests. Radioisotopic study changed diagnosis in 2 patients and in other 2 patients contributed to clarify it, since discordance between normal radiological tests and abnormal rectal biopsy. One of the patients showed concordance between each imaging modality. The results of the test changed the therapeutic management in 2 cases. CONCLUSIONS: Our limited experience coincides with published data in which scintigraphy study turns out to be a reproducible and accurate method. It provides physiological, quantitative and useful information in the study of constipation, being the unique exploration that allows both global and regional gastrointestinal transit time determination.

Diagnostic contribution of quantitative analysis of salivary scintigraphy in patients with suspected Sjögren's syndrome.

AIM: The evaluation of the salivary scintigraphy is part of the classification criteria of Sjögren's syndrome (SS). The aim of the study was to determine a method of quantitative evaluation of this technique with easy application and high diagnostic accuracy. MATERIAL AND METHODS: A review was carried out on a total of 111 patients with clinical suspicion of SS, referred to our department over the last 4 years (94 women, range 14-82 years). Thirty-minute dynamic studies were performed after injection of (99m)Tc-pertechnetate, with secretory stimulus at 15 minutes. After drawing regions of interest in both parotids, submandibular glands, and in the background, quantitative parameters were determined. These included the ejection fraction, uptake ratio at 15 min, and the percentage uptake (PC). Based on the definitive diagnosis, the subjects were classified into patients with SS, with sicca syndrome, and healthy subjects. RESULTS: Significant differences were found between the SS group and healthy subjects in the 3 quantitative parameters for the 4 glands. Significant differences in the PC parameter were observed between the group with sicca syndrome and healthy subjects. ROC analysis showed that the best differentiation parameter for the 3 groups was the PC in both parotid and submandibular glands. CONCLUSIONS: The quantitative analysis of salivary scintigraphy has proved to be a useful method and easy to apply in daily practice to differentiate patients with SS from healthy subjects, with the PC, both in parotid and submandibular glands, being the parameter with highest diagnostic accuracy.

Uncommon isolated distant subcutaneous tissue and skeletal muscle metastasis from oesophageal cancer diagnosed by PET/CT (18)F-FDG.

Distant soft-tissue metastases (subcutaneous tissues and skeletal muscle) are extremely rare, particularly in oesophageal carcinoma. The case is described of a patient who was treated for oesophageal adenocarcinoma 2.5 years previously. A PET/CT was performed showing metastatic spread due to a solitary focus of increased tracer uptake corresponding to one subcutaneous node in the upper abdomen. An excisional biopsy showed a metastasis from the carcinoma. Restaging PET/CT (18)F-FDG study was performed 2 year later, demonstrating foci of increased uptake within several muscles as isolated distant haematogenous spread of metastases, histopathologically confirmed. As most of soft-tissue metastases are asymptomatic, the physicians should recommend a histopathological study of focal FDG uptake at subcutaneous tissues and/or skeletal muscles, because they may be the first sign of disease spread, so therapeutic management of these patients could be changed.

[Use of radioguided surgery in the surgical treatment of osteoid osteoma]. / Uso de la cirugía radiodirigida en el tratamiento quirúrgico del osteoma osteoide.

OBJECTIVE: Osteoid osteoma is the third most common benign bone tumor and complete surgical resection is definitive treatment. There are a limited number of publications on the use of radioguided surgery in this type of lesion. To assess the utility of radioguided surgery in our environment as a method of surgical treatment of this tumor. MATERIAL AND METHODS: We retrospectively evaluated 12 patients (2 women and 10 men, age range 9-44 years) with clinical and radiological suspicion of osteoid osteoma. Bone scintigraphy showed foci of pathology uptake compatible with suspected lesion in the femur (4 cases), tibia (3), vertebral column (3), humerus (1) and talus (1). Subsequently patients underwent surgical treatment by radioguided surgery after injection of a dose of (99m)Tc-hydroxy diphosphonate. The nidus was removed using gamma probe and mini gamma camera, considering the technique to be completed when its counts decreased to the levels of the surrounding bone counts. RESULTS: Lesions were located in all patients (12 of 12), and were confirmed histologically in 8 of them, including an osteoblastoma. The cure rate was 100%, based on the disappearance of pain after a minimum follow-up of 6 months. CONCLUSION: Use of radioguided surgery in the surgical treatment of osteoid osteoma showed satisfactory results, with 100% efficiency in both lesion location and outcome of treatment and without major postoperative complications.

[Clinical application of ROLL technique in non-breast diseases. Complementary use after PET-CT study]. / Aplicación clínica de la técnica ROLL en patología no mamaria. Uso complementario tras estudio PET-TAC.

OBJECTIVE: The aim of this study was to evaluate the usefulness of ROLL technique (Radioguided Occult Lesion Localization) as a verification method of suspicious lesions not related to breast disease found in PET-CT studies. MATERIAL AND METHODS: We retrospectively evaluated 9 patients diagnosed of cancer or with suspected tumor disease who showed hypermetabolic lymph nodes in (18)F-FDG PET-CT. Subjects underwent diagnostic testing for evaluation of treatment response in lymphoma (3), suspected recurrence in other tumors (3) or biopsy guide (3). The study group consisted of 4 women and 5 men, age range 25-72 years. ROLL technique was performed in surgically accessible lesions (supraclavicular region, lateral cervical, axillary and inguinal) with an intralesional injection of (99m)Tc-albumin macroaggregates guided by ultrasound the day before surgery. A scintigraphic study confirmed the focal tracer deposit and absence of skin contamination. During surgery, a gamma probe and portable gammacamera were used to locate lymph nodes. RESULTS: Surgical localization of radiolabeled lymph nodes was achieved in all cases with minimally invasive surgery and few postoperative complications. Histological study resulted in five tumor involvement (3 lymphoma, 1 germ cell tumor and 1 neuroendocrine carcinoma) and confirmed the existence of four false-positives in PET-CT study (1 sarcoidosis and 3 reactive follicular hyperplasia). CONCLUSION: The ROLL technique proved to be a useful and relatively simple method for the study of no breast lesions suspicious of malignancy in PET-CT study.

Utilidad de la densitometría como método de valoración del estado nutricional del deportista. Comparación con el índice de masa corporal / The usefulness of densitometry as a method of assessing the nutritional status of athletes. Comparison with body mass index

El índice de masa corporal (IMC) es utilizado para valorar el estado nutricional. En los deportistas su resultado puede estar sobreestimado por un aumento de la masa muscular. Objetivo. Valorar la utilidad de la determinación mediante densitometría de los índices de masa grasa (IMG) y magra (IMM) como indicadores del estado nutricional, comparando los resultados con el IMC. Material y métodos. Se estudiaron 28 deportistas aficionados, jugadores de rugby, de sexo masculino. Tras ser sometidos a una densitometría de cuerpo entero mediante absorciometría dual de rayos X se determinaron, entre otros parámetros, la masa grasa y magra del cuerpo. Se calcularon los IMG (grasa en kg/talla en metros2), IMM (magra en kg/talla en metros2) y el índice de masa muscular apendicular (IMMA, musculatura en brazos y piernas en kg/talla en metros2). Resultados. Utilizando el IMC, 18 jugadores presentaban sobrepeso y 4 obesidad de tipo i . Al considerar el IMG, 7 de estos deportistas presentaban valores normales con IMM e IMMA elevados, uno pasaba de obesidad a sobrepeso y otro de sobrepeso a obesidad. De los 6 jugadores con IMC normal, uno de ellos mostraba exceso de grasa y otro defecto. Los resultados cambiaron la valoración del estado nutricional en el 39% de los jugadores estudiados. Conclusiones. Aunque para la población general el IMC es un parámetro adecuado para la valoración del estado nutricional, en los deportistas debe tenerse en cuenta el porcentaje de grasa y de musculatura determinando sus índices correspondientes. La densitometría de cuerpo entero resulta ser una técnica fiable y sencilla para este propósito(AU)

The body mass index (BMI) is used to assess nutritional status. The result in athletes may be overestimated due to increase in muscle mass. Objective. To assess the usefulness of fat mass index (FMI) and lean mass index (LMI) determination as indicators of nutritional status and to compare the results with BMI. Material and methods. We studied 28 amateur rugby players, male. After being subjected to whole body densitometry by dual X-ray absorptiometry, we determined fat and lean body mass together with other parameters. FMI (fat in kg/height in meters2), LMI (lean in kg/height in meters2) and appendicular muscle mass index (AMMI, arms and legs musculature in kg/height in meters2) were calculated. Results. Using BMI, 18 players were overweight and 4 obese type I. Considering FMI, 7 of them had normal values and high LMI and AMMI, one of them changed from overweight to obese and another one from obese to overweight. Of the 6 players with normal BMI, one of them showed fat excess and another one fat defect. The results changed the assessment of nutritional status in 39% of players. Conclusions. Although BMI is an appropriate parameter in general population for the assessment of nutritional status, in athletes should be taken into account fat and muscle body percentage and their corresponding indexes. The whole body densitometry appears to be a simple and reliable technique for this purpose(AU)

The usefulness of densitometry as a method of assessing the nutritional status of athletes. Comparison with body mass index.

UNLABELLED: The body mass index (BMI) is used to assess nutritional status. The result in athletes may be overestimated due to increase in muscle mass. OBJECTIVE: To assess the usefulness of fat mass index (FMI) and lean mass index (LMI) determination as indicators of nutritional status and to compare the results with BMI. MATERIAL AND METHODS: We studied 28 amateur rugby players, male. After being subjected to whole body densitometry by dual X-ray absorptiometry, we determined fat and lean body mass together with other parameters. FMI (fat in kg/height in meters(2)), LMI (lean in kg/height in meters(2)) and appendicular muscle mass index (AMMI, arms and legs musculature in kg/height in meters(2)) were calculated. RESULTS: Using BMI, 18 players were overweight and 4 obese type I. Considering FMI, 7 of them had normal values and high LMI and AMMI, one of them changed from overweight to obese and another one from obese to overweight. Of the 6 players with normal BMI, one of them showed fat excess and another one fat defect. The results changed the assessment of nutritional status in 39% of players. CONCLUSIONS: Although BMI is an appropriate parameter in general population for the assessment of nutritional status, in athletes should be taken into account fat and muscle body percentage and their corresponding indexes. The whole body densitometry appears to be a simple and reliable technique for this purpose.

Lymphoscintigraphy for differential diagnosis of peripheral edema: diagnostic yield of different scintigraphic patterns.

UNLABELLED: Edema of the limbs is a common reason for medical consultation, for which the lymphoscintigraphy is considered to be a reliable method for its differential diagnosis. OBJECTIVE: To evaluate the usefulness of radionuclide studies in the differential diagnosis of edema, and the diagnostic yield of different scintigraphic patterns. MATERIAL AND METHODS: A total of 61 patients, mean age 43 years, referred to our Department in the last three years for suspected lymphoedema, were considered. One patient was discarded due to lack of diagnosis, 56 had lower limb edema and 4 upper limb edema. After intradermal injection of two doses of (99m)Tc-nanocolloid, scintigraphic scans were made at 30 and 120minutes. The final diagnosis was based on imaging tests, clinical course, and response to treatment. We calculated the parameters of the diagnostic yield of four different scintigraphic patterns (presence of dermal backflow, asymmetry-alteration in inguinal/axillary nodes, presence of collateral pathways, and visualization of intermediate lymph nodes), considering them individually and jointly. RESULTS: The best diagnostic yield was achieved by considering dermal backflow and asymmetry in inguinal/axillary nodes (accuracy 88.9%, specificity 96.4%, PPV 95.5%). Evaluation of intermediate lymph nodes and presence of collateral pathways contributed little to the diagnostic yield, showing poor sensitivity and high false positive rates. CONCLUSION: The lymphoscintigraphy had high diagnostic yield, allowing early treatment of lymphœdema. The dermal backflow and asymmetry in inguinal/axillary nodes had the greatest diagnostic accuracy. Evaluation of intermediate lymph nodes and visualization of collateral pathways contributed little to improving the diagnosis.

Linfogammagrafía en el diagnóstico diferencial del edema. Rendimiento diagnóstico de diferentes patrones gammagráficos / Lymphoscintigraphy for differential diagnosis of peripheral edema: diagnostic yield of different scintigraphic patterns

El edema de extremidades constituye un motivo frecuente de consulta médica, considerándose la linfogammagrafía un método fiable para su diagnóstico diferencial. Objetivo. Valorar la utilidad del estudio isotópico en el diagnóstico diferencial del edema y el rendimiento diagnóstico de diferentes patrones gammagráficos encontrados. Material y Métodos. Se consideraron 61 pacientes remitidos a nuestro Servicio en los últimos tres años por sospecha de linfedema, descartándose uno por falta de diagnóstico. La media de edad fue de 43 años. Cincuenta y seis pacientes presentaban edema en miembros inferiores y 4 en superiores. Tras inyección intradérmica de dos dosis de 99mTc-nanocoloide, se realizaron rastreos gammagráficos de extremidades a los 30 y 120 minutos de su administración. El diagnóstico definitivo se basó en pruebas de imagen, evolución clínica y respuesta a tratamiento. Se calculó el rendimiento diagnóstico de cuatro diferentes patrones gammagráficos (presencia de flujo dérmico, asimetría-alteración en ganglios inguinales/axilares, presencia de vías colaterales y visualización de ganglios intermedios) considerándose de manera individual y conjunta. Resultados. El mayor rendimiento diagnóstico se alcanzó considerando el flujo dérmico y la asimetría en ganglios inguinales/axilares (exactitud 88,9%, especificidad 96,4%, VPP 95,5%). La valoración de ganglios intermedios y presencia de vías colaterales aportó escaso rendimiento diagnóstico, con baja sensibilidad y elevada tasa de falsos positivos. Conclusión. La linfogammagrafía presentó un alto rendimiento diagnóstico, permitiendo un tratamiento precoz del linfedema. El flujo dérmico y asimetría en ganglios inguinales/axilares mostraron la mayor exactitud diagnóstica. La valoración de ganglios intermedios y visualización de vías colaterales no aportaron mejoría al diagnóstico(AU)

Edema of the limbs is a common reason for medical consultation, for which the lymphoscintigraphy is considered to be a reliable method for its differential diagnosis. Objective. To evaluate the usefulness of radionuclide studies in the differential diagnosis of edema, and the diagnostic yield of different scintigraphic patterns. Material and Methods. A total of 61 patients, mean age 43 years, referred to our Department in the last three years for suspected lymphoedema, were considered. One patient was discarded due to lack of diagnosis, 56 had lower limb edema and 4 upper limb edema. After intradermal injection of two doses of 99mTc-nanocolloid, scintigraphic scans were made at 30 and 120minutes. The final diagnosis was based on imaging tests, clinical course, and response to treatment. We calculated the parameters of the diagnostic yield of four different scintigraphic patterns (presence of dermal backflow, asymmetry-alteration in inguinal/axillary nodes, presence of collateral pathways, and visualization of intermediate lymph nodes), considering them individually and jointly. Results. The best diagnostic yield was achieved by considering dermal backflow and asymmetry in inguinal/axillary nodes (accuracy 88.9%, specificity 96.4%, PPV 95.5%). Evaluation of intermediate lymph nodes and presence of collateral pathways contributed little to the diagnostic yield, showing poor sensitivity and high false positive rates. Conclusion. The lymphoscintigraphy had high diagnostic yield, allowing early treatment of lymphœdema. The dermal backflow and asymmetry in inguinal/axillary nodes had the greatest diagnostic accuracy. Evaluation of intermediate lymph nodes and visualization of collateral pathways contributed little to improving the diagnosis(AU)

SPECT-TAC con 67Ga-citrato en el manejo de las espondilodiscitis / SPECT-CT with 67Ga-citrate in the management of spondylodiscitis

La espondilodiscitis afecta a una pequeña proporción de los pacientes con infecciones del aparato locomotor, aunque su diagnóstico es importante por su potencial morbilidad. La resonancia magnética es el método diagnóstico de elección, aunque tiene sus limitaciones y no es adecuada para todos los pacientes. Los estudios gammagráficos para la evaluación de la espondilodiscitis son los realizados con 99mTc-HDP y 67Ga-citrato, pero tienen el inconveniente de su baja resolución. La utilización de equipos híbridos SPECT-TAC (Single Photon Emission Computed Tomography-Tomografía computarizada) mejora la detección de la enfermedad al combinar imágenes funcionales y anatómicas. Presentamos 9 pacientes con sospecha de espondilodiscitis, a los que se les realizaron secuencialmente estudios isotópicos con 99mTc-HDP y SPECT-TAC con 67Ga-citrato, con hallazgos positivos que se confirmaron con un seguimiento clínico de al menos 6 meses(AU)

Spondylodiscitis affects a small proportion of all patients with locomotor system infections, however its early diagnosis is important due to its potential morbidity. Magnetic resonance imaging is the diagnostic method of choice. Nonetheless, it has certain limitations and is not suitable for all patients. The conventional scintigraphic studies for evaluating spondylodiscitis are those performed with 99mTc-HDP and 67Ga-citrate. However, their poor image resolution is a disadvantage of these techniques. The use of hybrid Single Photon Emission Computed Tomography-Computed Tomography (SPECT-CT) improves detection of the disease by combining functional and anatomical images. We present 9 patients with suspicion of spondylodiscitis who underwent sequential bone scintigraphy with 99mTc-HDP and SPECT-CT with 67Ga-citrate, with positive findings confirmed by clinical monitoring for at least 6 months(AU)

SPECT-CT with 67Ga-citrate in the management of spondylodiscitis.

Spondylodiscitis affects a small proportion of all patients with locomotor system infections, however its early diagnosis is important due to its potential morbidity. Magnetic resonance imaging is the diagnostic method of choice. Nonetheless, it has certain limitations and is not suitable for all patients. The conventional scintigraphic studies for evaluating spondylodiscitis are those performed with (99m)Tc-HDP and (67)Ga-citrate. However, their poor image resolution is a disadvantage of these techniques. The use of hybrid Single Photon Emission Computed Tomography-Computed Tomography (SPECT-CT) improves detection of the disease by combining functional and anatomical images. We present 9 patients with suspicion of spondylodiscitis who underwent sequential bone scintigraphy with (99m)Tc-HDP and SPECT-CT with (67)Ga-citrate, with positive findings confirmed by clinical monitoring for at least 6 months.