Physiological expression of pancreatic somatostatin receptors in 99mTc-HYNIC-TOC scintigraphy.

PURPOSE: To describe the frequency of head and/or pancreas uncinate process uptake of 99mTc-HYNIC-TOC, to study its nature, and analyze its diagnostic value. MATERIALS AND METHODS: Retrospective evaluation of 47 consecutive 99mTc-HYNIC-TOC examinations was conducted. Head and/or pancreas uncinate process uptake was considered to be physiological in patients with normal CT at the same episode and in follow-up. It was analyzed if age or diabetes mellitus was justifying the existence or not of uptake. RESULTS: 32.5% patients showed uptake; 73% of them were mild. 84.6% patients with uptake have no pathology and 4% had neuroendocrine pancreatic disease at CT. Neither the age nor the diabetes mellitus established differences in patients without lesion. CONCLUSIONS: Near one-third of patients show physiological uptake by head and/or pancreas uncinate process at 99mTc-HYNIC-TOC scintigraphy. It seems that neither the diabetes nor the ages are factors that determine this physiological uptake.

[Thalamic metabolism and neurological outcome after traumatic brain injury. A voxel-based morphometric FDG-PET study]. / Metabolismo talámico y situación neurológica tras un traumatismo craneoencefálico. Estudio mediante PET-FDG y morfometría basada en vóxel.

OBJECTIVE: to study the relationship between thalamic metabolism and neurological outcome in patients who had sustained a traumatic brain injury (TBI). METHODS: nineteen patients who had sustained a severe TBI and ten control subjects were included in this study. Six of the 19 patients had a low level of consciousness (vegetative state or minimally conscious state), while thirteen showed normal consciousness. All patients underwent a PET with 18F-FDG, 459.4 +/- 470.9 days after the TBI. The FDG-PET images were normalized in intensity, with a metabolic template being created from data derived from all subjects. The thalamic trace was generated automatically with a mask of the region of interest in order to evaluate its metabolism. A comparison between the two groups was carried out by a two sample voxel-based T-test, under the General Linear Model (GLM) framework. RESULTS: patients with low consciousness had lower thalamic metabolism (MNI-Talairach coordinates: 12, -24, 18; T = 4.1) than patients with adequate awareness (14, -28, 6; T = 5.5). Control subjects showed the greatest thalamic metabolism compared to both patients groups. These differences in metabolism were more pronounced in the internal regions of the thalamus. CONCLUSIONS: the applied method may be a useful ancillary tool to assess neurological outcomes after a TBI, since it permits an objective quantitative assessment of metabolic function for groups of subjects. Our results confirm the vulnerability of the thalamus to suffering the effects of the acceleration-deceleration forces generated during a TBI. It is hypothesized that patients with low thalamic metabolism represent a subset of subjects highly vulnerable to neurological and functional disability after TBI.

[Indication for bone scans in early breast cancer staging]. / Indicación del rastreo óseo en la estadificación del cáncer de mama de inicio.

OBJECTIVE: Evaluate the indication for bone scanning during staging of early breast cancer in the light of scientific evidence to assess the need to modify practices with scant effectiveness. MATERIAL AND METHODS: The bone scans carried out in our Nuclear Medicine Department in 2007 on patients with primary breast cancer were reviewed retrospectively. Results were analyzed in relation to the clinical and histopathologic findings for each tumor. Bone scan results of tumors >2 cm y 3 cm, and pre-treatment clinical stage. RESULTS: Out of 245 bone scans of patients with breast cancer, 237 (97%) were negative for metastatic disease and 8 (3%) were positive. Lesions <2 cm (Tis and T1) were diagnosed in 131 patients (53.5%), none of which had bone metastasis at time of diagnosis. Lesions >2 cm and 3 cm. The bone scan findings did not modify staging in any of the 66 patients with T2 tumors stage IIA, but it did modify staging in 2 of 12 patients with stage IIB tumors. Twenty percent of 15 patients with T3 tumors and 13% of patients with T4 tumors had bone metastasis at time of diagnosis. CONCLUSIONS: Ineffective practices should be modified and bone scanning should not be indicated in patients with early breast cancer Tis, T1 and T2 with tumor

[67Ga SPECT/low-dose CT. A case report of spondylodiscitis and Schmorl's node]. / SPECT-TAC de baja dosis con 67Ga en un caso de espondilodiscitis y hernia de Schmorl.

A 61-year-old male patient with microbiological diagnosis of L3-L4 spondylodiscitis and persist pain underwent a (67)Ga scintigraphic study to assess the antibiotic treatment response. Pathological uptake foci in vertebral bodies of L2 and L4 were observed in the (67)Ga planar scintigraphy. A SPECT low-dose CT of the lumbar spine was performed as part of anatomical correlated protocol, detecting an active spondylodiscitis in L3-L4 and a second uptake foci in L2 that was identify as a Schmorl's node. In this case the SPECT-CT hybrid image allowed us to avoid a false positive diagnosis to by locate and characterize an image with abnormal uptake of (67)Ga, improving the test specificity and avoiding a wrong diagnosis.

[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.

[Endoluminal percutaneous thrombectomy as a treatment for acute vascular access thrombosis: long-term results of 123 procedures]. / La trombectomía endoluminal percutánea como tratamiento de la trombosis aguda del acceso vascular: resultados a largo plazo de 123 procedimientos.

UNLABELLED: Percutaneous treatment of thrombosis of occluded vascular access (VA) for haemodialysis (HD) has been an alternative to surgical and pharmacological treatments, but long term results are not well defined. The aim of our study was to analyse the long term results of percutaneous thrombectomy as a treatment of occluded VA for HD. We conducted a prospective study from june 1995 to april 1999, including 123 consecutive thrombectomies in 64 VA in patients submitted to our hospital because of recent thrombosis of VA for HD. We used two different techniques, hydrodynamic catheter thrombectomy (Hydrolyser) in the 42 first procedures (34.1%), and since october 1996 we used mechanical balloon thrombolysis in the remaining 81 patients (65.9%). Underlying stenoses were evaluated by angiography, and treated by angioplasty. After the procedure, intravenous heparin was administered for 24 hours. The VA were 28 Brescia-Cimino arteriovenous fistulae (30.4%) and 64 PTFE grafts (69.6%). PATIENT CHARACTERISTICS: mean age: 63 +/- 15 years (18-84), previous VA: 3.3 +/- 2.5 (0-9). The mean follow-up was 10.5 +/- 8.6 months (3-35). Percutaneous thrombectomy was able to remove the clots in 120 instances (technical success: 97.5%). After the thrombectomy 15 patients (16.3%) were immediately referred to the surgeon to perform a new VA due to vascular lesions in which percutaneous treatment was not indicated. Thirteen cases (14.1%) showed early thrombosis (< 72 hours). During the follow-up, 27 cases developed thrombosis (30%) and 26 VA were still patent (28.3%). In 23% of perfusion lung scans and in 2 of the 5 angiographies performed after thrombectomy, subsegmentary or segmentary perfusion defects were detected, without clinical significance. There were no relevant undesirable effects related to the technique and no symptomatic pulmonary embolism. In summary, percutaneous thrombectomy, whether hydrodynamic or mechanical, has shown to be an efficacious treatment of VA thrombosis for HD, preserving the VA with satisfactory long-term results.