Colon Transit Scintigraphy in Schaaf-Yang Syndrome.

ABSTRACT: Schaaf-Yang syndrome is a genetic disorder characterized by delayed psychomotor development, hypotonia, intellectual disability, feeding difficulties, and variable dysmorphic facial features. It is an extremely rare disorder with over 250 cases reported in the medical literature. This condition has been determined to be inherited by an autosomal dominant pattern. We present colon transit scintigraphy of a 6-year-old boy with history of chronic constipation with poor response to medical treatment, clinical characteristics, and gene mutations consistent with this syndrome. After oral administration of 111In-DTPA, planar and SPECT/CT images showed rapid proximal colonic transit and anorectal retention.

Aplicación de la técnica ROLL como método de biopsia excisional en patología oncológica / Application of the ROLL technique as a method of excisional biopsy in oncological pathology

OBJETIVO: Valorar la utilidad de la técnica ROLL (Radioguided Occult Lesion Localization) como método de biopsia excisional en lesiones hipermetabólicas sospechosas de malignidad evidenciadas en exploraciones [18F]Fluordesoxiglucosa PET/TC. MATERIAL Y MÉTODOS: Se valoraron retrospectivamente 33 pacientes remitidos para la realización de un estudio metabólico por patología tumoral conocida o por sospecha de proceso neoplásico y que presentaban adenopatías hipermetabólicas con alta probabilidad de malignidad. El grupo estaba constituido por 19 mujeres y 14 hombres, con rango de 23 a 77 años. Los pacientes fueron sometidos a la técnica ROLL para la localización y extirpación de las adenopatías seleccionadas, mediante inyección de [99mTc] macroagregados de albúmina guiada con ecográfica o TC. Durante el acto quirúrgico se utilizaron una sonda de detección y una gammacámara portátil. RESULTADOS: En 31 pacientes (94%) se consiguió la localización y extirpación de las adenopatías radiomarcadas. En un paciente no fue posible la localización de la lesión y un segundo paciente no fue operado al confirmarse en estudio gammagráfico previo la inyección inadecuada de la dosis. El resultado del estudio anatomopatológico de las adenopatías dio como resultado 23 afectaciones tumorales y 8 procesos benignos, incluyendo un proceso granulomatoso. CONCLUSIÓN: La técnica ROLL demostró su utilidad como método de biopsia excisional radiodirigida para el estudio de lesiones sospechosas de malignidad evidenciadas en pacientes sometidos a estudios PET/TC. La técnica permitió confirmar la persistencia de proceso oncológico en unos casos y la existencia de falsos positivos del estudio de imagen en otros, modificando el manejo terapéutico de los pacientes

OBJECTIVE: To evaluate the utility of the ROLL (Radioguided Occult Lesion Localization) technique as a method of excisional biopsy in hypermetabolic lesions suspected of malignancy evidenced in [18F]Fluordeoxiglucose PET/CT scans. MATERIAL AND METHODS: 33 patients were retrospectively evaluated referred for metabolic studies due to tumoral pathology or suspected neoplastic process and presenting hypermetabolic adenopathies with high probability of malignancy. The group consisted of 19 women and 14 men, ranging from 23 to 77 years old. Patients were performed a ROLL technique for localization and removal the selected adenopathies, through the injection of [99mTc] macro-aggregates of albumin guided by ultrasound or CT. A detection probe and a portable gamma camera were used during the surgical procedure. RESULTS: In 31 patients (94%) the location and removal of the radiolabeled adenopathies was achieved. In one patient the location of the lesion was not possible and a second patient was not operated due to inadequate dose injection confirmed by gammagraphy study. The result of the anatomopathological study of adenopathies resulted in 23 tumor affections and 8 benign processes, including a granulomatous process. CONCLUSION: The ROLL technique proved its utility as a radioguided excisional biopsy method for the study of lesions suspected of malignancy evidenced in patients undergoing PET/CT studies. The technique allowed to confirm the persistence of oncological process in some cases and the existence of false positives from the imaging study in others, modifying the patients therapeutic management

Application of the ROLL technique as a method of excisional biopsy in oncological pathology. / Aplicación de la técnica ROLL como método de biopsia excisional en patología oncológica.

OBJECTIVE: To evaluate the utility of the ROLL (Radioguided Occult Lesion Localization) technique as a method of excisional biopsy in hypermetabolic lesions suspected of malignancy evidenced in [18F]Fluordeoxiglucose PET/CT scans. MATERIAL AND METHODS: 33 patients were retrospectively evaluated referred for metabolic studies due to tumoral pathology or suspected neoplastic process and presenting hypermetabolic adenopathies with high probability of malignancy. The group consisted of 19 women and 14 men, ranging from 23 to 77 years old. Patients were performed a ROLL technique for localization and removal the selected adenopathies, through the injection of [99mTc] macro-aggregates of albumin guided by ultrasound or CT. A detection probe and a portable gamma camera were used during the surgical procedure. RESULTS: In 31 patients (94%) the location and removal of the radiolabeled adenopathies was achieved. In one patient the location of the lesion was not possible and a second patient was not operated due to inadequate dose injection confirmed by gammagraphy study. The result of the anatomopathological study of adenopathies resulted in 23 tumor affections and 8 benign processes, including a granulomatous process. CONCLUSION: The ROLL technique proved its utility as a radioguided excisional biopsy method for the study of lesions suspected of malignancy evidenced in patients undergoing PET/CT studies. The technique allowed to confirm the persistence of oncological process in some cases and the existence of false positives from the imaging study in others, modifying the patients therapeutic management.

Gastrointestinal Transit Scintigraphy in a Case of Syringomyelia.

Syringomyelia is a rare degenerative disease affecting the spinal cord and brain stem causing progressive neurological dysfunction. The presence of gastrointestinal symptoms in these patients is common, although references related to nuclear medicine imaging procedures in this pathology are limited, focusing on the study of gastric emptying. We present a 47-year-old male patient diagnosed with syringomyelia and persistent digestive symptoms who underwent gastrointestinal transit scintigraphy to assess the extent of dysmotility. Liquid gastric emptying and small-bowel transit were normal. Large bowel showed poor activity in descending and rectosigmoid colon, being compatible with generalized slow colon transit.

Positron Emission Tomography-Computed Tomography in a Case of POEMS Syndrome.

The POEMS syndrome is a rare and multisystemic disease characterized by the presence of polyneuropathy, organomegaly, endocrinopathy, presence of M protein, and alterations in the skin. The existence of bone lesions is frequent, being generally blastic or mixed and rarely lytic. We present the case of a 54-year-old male patient diagnosed with POEMS syndrome, with atypical presence of lytic lesions, who was referred for an 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) study for initial staging of the process. There were several hypermetabolic foci coinciding with bone lesions, reaching a maximum standardized uptake value of 15 at the level of the right iliac bone with associated soft-tissue mass. PET-CT is an adequate tool for evaluation, diagnosis, and monitoring of the pathology. The scan allows the detection and selection for its biopsy of bone lesions and lymphadenopathies.

PET/CT in a Patient Diagnosed With Dandy-Walker Syndrome.

The Dandy-Walker syndrome (DWS) is a rare congenital posterior fossa malformation characterized by aplasia or hypoplasia of the cerebellar vermis, cystic dilatation of the fourth ventricle, and enlargement of the posterior fossa. We present a 52-year-old Caucasian man diagnosed with gastrointestinal stromal tumor and submitted to 18F-FDG PET/CT as a staging procedure. The patient was previously diagnosed with DWS in brain CT scan. PET/CT images revealed an ametabolic large cyst in the posterior fossa and hypoplasia of cerebellar vermis. The case is presented with the aim to show the appearance of this syndrome on PET/CT study.

Functional fecal retention visualized by (111)In-DTPA colon transit scintigraphy.

Constipation is an extremely common problem in children, varying from mild and short-lived to severe and chronic. Chronic constipation is a serious childhood condition and requires further investigation, including blood test, colonoscopy, radio-opaque marker study, and/or scintigraphy. We present small bowel and colon transit scintigraphy of a 14-year-old girl with history of chronic constipation, abdominal pain, weight loss, and poor response to medical treatment. After oral administration of In-DTPA in water, planar and SPECT/CT images showed normal small bowel transit time and functional fecal retention in colon transit study.

High liver FDG uptake on PET/CT in patient with lymphoma diagnosed with hereditary hemochromatosis.

Hereditary hemochromatosis is an autosomal recessive disorder of iron metabolism resulting in toxic accumulation of iron in vital organs. We present a 64-year-old white man with non-Hodgkin lymphoma treated with high-dose chemotherapy and stem cell transplant that was subsequently diagnosed with hereditary hemochromatosis. F-FDG PET/CT was performed as routine follow-up and showed a pathological finding of homogeneous increased liver glucose metabolism. Increased FDG avidity in the liver suggested the presence of damage caused by hemochromatosis.

Levels of immune cells in transcendental meditation practitioners.

CONTEXT: Relationships between mind and body have gradually become accepted. Yogic practices cause modulation of the immune system. Transcendental meditation (TM) is a specific form of mantra meditation. We reported previously different plasma levels of catecholamines and pituitary hormones in TM practitioners comparing with a control group, and patterns of the daytime secretion of these hormones different from those normally described. AIMS: The aim of the following study is to evaluate the immune system in these meditation practitioners, by determining leukocytes and lymphocytes subsets. METHODS: TM group consisted of 19 subjects who regularly practice either TM or the more advanced Sidhi-TM technique. A control group consisted of 16 healthy subjects who had not previously used any relaxation technique. Total leukocytes, granulocytes, lymphocytes and monocytes were counted by an automated quantitative hematology analyzer, whereas lymphocytes subsets were determined by flow cytometry. Samples were taken from each subject at 0900 h after an overnight fast. RESULTS: The results indicated that the TM group had higher values than the control group in CD3+CD4-CD8+ lymphocytes (P < 0.05), B lymphocytes (P < 0.01) and natural killer cells (P < 0.01), whereas CD3+CD4+CD8- lymphocytes showed low levels in meditation practitioners (P < 0.001). No significant differences were observed in total leukocytes, granulocytes, monocytes, total lymphocytes or CD3+ lymphocytes comparing both groups. CONCLUSIONS: The technique of meditation studied seems to have a significant effect on immune cells, manifesting in the different circulating levels of lymphocyte subsets analyzed. The significant effect of TM on the neuroendocrine axis and its relationship with the immune system may partly explain our results.

Leptomeningeal carcinomatosis as only pathological finding at FDG-PET/CT in case of tumor marker elevation in breast cancer.

Leptomeningeal carcinomatosis is an infrequent disease and although its treatment is palliative, earlier diagnosis will lead to prolonged survival and improve functional outcome. Whole-body FDG-PET allows the entire spinal cord to be examined noninvasively, so close attention should be paid to the spinal canal, since these lesions can easily be mistaken for physiologic uptake, sometimes there is no clinical suspicion and may occur without concurrent active cancer. We present a female patient with a history of carcinoma of the breast, who presented an elevation of serum tumor marker CA 15-3. An FDG-PET/CT study only revealed multiple abnormal uptake at the vertebral foramen at thoracic and lumbosacral regions suggesting leptomeningeal metastases that were confirmed by MRI and cerebrospinal fluid cytology.

Brain hypoperfusion on Tc-99m-ethylene dicysteine diethyl ester single-photon emission computed tomography in Hashimoto's encephalopathy.

We present a 17-year-old female, previously diagnosed of autoimmune hyperthyroidism who had an acute neurological episode and presented high antithyroid antibodies titers, cerebral spinal fluid and electroencephalogram changes. Tc-99m ethylene dicysteine diethyl ester brain single-photon emission computed tomography (SPECT) showed global and patchy hypoperfusion. With glucocorticoid therapy, clinical symptoms disappeared; there was a decrease in antithyroid antibody levels and repeat brain SPECT revealed improvement of perfusion.

Utility of 67Ga scintigraphy in disseminated infection after BCG instillation for treatment of bladder carcinoma.

Intravesical instillations of bacille Calmette-Guérin (BCG), an attenuated live strain of Mycobacterium bovis, is the treatment of choice for superficial bladder cancer. Local side effects are frequent, although adverse systemic reactions are uncommon, but more serious. We present 2 patients who developed disseminated M. bovis infection with multiorgan involvement after intravesical BCG therapy. (67)Ga scintigraphy was very helpful for the diagnosis as the only imaging tool with pathological findings.

Scintigraphy in Ochoa syndrome.

The Ochoa or urofacial syndrome is a disease characterized by non-neurogenic bladder dysfunction and unusual facial expressions when smiling or crying. It is an extremely rare disorder with over 150 cases reported in the medical literature. This condition has been determined to be inherited by an autosomal recessive pattern. We present radionuclide renogram and renal scan of a boy with a history of incontinence, frequent infections of the urinary tract, and gene mutations consistent with this syndrome. Nuclear medicine images showed extensive bilateral renal scarring and obstructive pattern in diuretic renogram.

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.