Asimetría en la función relativa en CR DMSA en riñones con doble sistema excretor no complicado: variante normal / Asymmetry in the relative function in CR DMSA in kidneys weith double non complicated excretor system: normal Variant

Introducción: El doble sistema excretor (DS) al Cintigrama Renal (CR) DMSA, con asimetría en la función relativa es un hallazgo relativamente frecuente. Evaluamos su incidencia, correlación con ecografía y valores de función relativa. Material y Método: Se seleccionaron los CR DMSA con diagnóstico cintigráfico de DS sin otras alteraciones. Ecografías sin otros hallazgos. Se comparó la función relativa entre riñones con y sin DS y entre riñones con y sin asimetría de tamaño. T-Test para muestras independientes. Se correlacionó el DMSA con la ecografía. Resultados: 79 pacientes en que se dispuso ecografía fueron estudiados. 17 con DS bilateral (21,5 por ciento). 72 por ciento mujeres, promedio de edad: 54,4 meses (1–204). Función relativa promedio en riñones con DS unilateral: 51,8 por ciento (43-61 por ciento) y 48,19 por ciento (39-57por ciento) en riñones sin DS. p<0,0001. En riñones con DS y aumentados de tamaño la diferencia con el contralateral fue mayor que en los de igual tamaño. Ecografía concordante con el CR DMSA en 52,63 por ciento. Conclusiones: 1.- La función relativa en riñones con Doble Sistema fue significativamente mayor que en riñones sin Doble Sistema, especialmente cuando existió asimetría en el tamaño renal. Esta condición debe considerarse variante normal para evitar la interpretación errada de riñones contralaterales hipofuncionantes. 2.- En la mitad de los pacientes hubo concordancia con la ecografía en diagnóstico de DS, hallazgo esperable.

Aim: Duplex system in DMSA with asymmetry in relative function it’s a frequent finding. We evaluated the incidence, correlation with sonography and the relative functions in these kidneys. Method: We selected patients with scintigraphic diagnosis of duplex system in the DMSA, without any other scintigraphic lesions and had a normal ultrasound. We compared the relative renal function in kidneys with and without duplex system and in kidney with and without size asymmetry. Independent samples t test was applied. DMSA results were compared with ultrasound. Results: 79 patients had ultrasound. 17 with bilateral DS (21.5 percent). 72 percent women; median age: 54.4 months (1–204). Relative function in unilateral DS kidney was 51.8 percent (43-61 percent) and 48.19 percent in kidneys without DS (39-57 percent), p< 0.0001. In kidneys larger and DS the difference in relative function with the contralateral kidney was more important than kidney with similar size. The ultrasound was concordant with DMSA in 52.63 percent of the patients. Conclusions: 1.- The relative function values were significantly higher in kidneys with Duplex System than kidneys without it, especially with asymmetry of the renal size .This condition should be consider a normal variant for to avoid the wrong interpretation of hipofunctioning contralateral kidney. 2.- Half of the patients had duplex system in DMSA scintigraphy and ultrasound, which was predictable.

[Fusion of SPECT with computed tomography or magnetic resonance for the interpretation of abnormal tracer uptake]. / Utilidad clínica de la fusión SPECT/CT con marcadores externos en patología oncológica.

BACKGROUND: Interpretation of abnormal foci with high tracer uptake may require morphological correlation. Fusion of functional images obtained by single photon emission computed tomography (SPECT) and anatomical images obtained by computed tomography (CT) or magnetic resonance (RM) allows an integrated comprehension of complementary information. AIM: To demonstrate that SPECT/CT fusion with external markers is useful in clinical practice to clarify the location and pathological meaning of questionable foci. MATERIAL AND METHODS: Thirty four pairs of images from separate equipments (31 SPECT/CT and 3 SPECT/RM) pertaining to 29 patients, were fused. Fifty one foci of abnormal tracer uptake of uncertain pathological meaning were analyzed. These were classified before and after the fusion as probably malignant or probably benign. RESULTS: Seventy percent of patients had a differentiated thyroid carcinoma. The fusion localized 100% of foci. Nine percent had a normal and 26% an abnormal anatomy. Before fusion 82% of foci were classified as potentially malignant. This figure changed to 59% after the fusion (p <0.01). Therefore the suspicion of malignancy was presumptively confirmed in 72% of foci and fusion results would have reached a 27% of incremental diagnostic value in 14 cases that changed of category (11 with differentiated thyroid carcinoma, one with colorectal cancer, one with a nasal Ewing sarcoma and one with a brain tumor). CONCLUSIONS: The fusion of SPECT and CT is useful in selected patients, specially those with differentiated thyroid carcinoma. The fusion of SPECT and RM is also feasible.

Utilidad clínica de la fusión SPECT/CT con marcadores externos en patología oncológica / Fusion of SPECT with computed tomography or magnetic resonance for the interpretation of abnormal tracer uptake

Background: Interpretation of abnormal foci with high tracer uptake may require morphological correlation. Fusion of functional images obtained by single photon emission computed tomography (SPECT) and anatomical images obtained by computed tomography (CT) or magnetic resonance (RM) allows an integrated comprehension of complementary information. Aim To demonstrate that SPECT/CT fusion with external markers is useful in clinical practice to clarify the location and pathological meaning of questionable foci. Material and methods: Thirty four pairs of images from separate equipments (31 SPECT/CT and 3 SPECT/RM) pertaining to 29 patients, were fused. Fifty one foci of abnormal tracer uptake of uncertain pathological meaning were analyzed. These were classified before and after the fusion as probably malignant or probably benign. Results: Seventy percent of patients had a differentiated thyroid carcinoma. The fusion localized 100 percent of foci. Nine percent had a normal and 26 percent an abnormal anatomy. Before fusion 82 percent of foci were classified as potentially malignant. This figure changed to 59 percent after the fusion (p <0.01). Therefore the suspicion of malignancy was presumptively confirmed in 72 percent of foci and fusion results would have reached a 27 percent of incremental diagnostic value in 14 cases that changed of category (11 with differentiated thyroid carcinoma, one with colorectal cancer, one with a nasalEwingsarcoma and one with a brain tumor). Conclusions: The fusion of SPECT and CT is useful in selected patients, specially those with differentiated thyroid carcinoma. The fusion of SPECT and RM is also feasible.

Hemorragia digestiva en el niño / Digestive hemorrhage in children

La hemorragia digestiva en el niño generalmente provoca gran alarma en los padres, afortunadamente los casos en que el sangramiento es masivo y provoca compromiso hemodinámico son raros. En la actualidad gracias a la introducción de equipos pediátricos de endoscopia digestiva y al perfeccionamiento en el uso de distintos procedimientos diagnósticos y terapéuticos, es posible obtener un diagnóstico etiólogico en aproximadamente un 80 a 90 por ciento de los casos