[Graft viability of patients with renal transplantation from non heart beating donors]. / Viabilidad de injerto de pacientes con trasplante renal de donante de cadáver en asistolia.

INTRODUCTION: Renal transplantation (RT) is currently the treatment of choice in end-stage renal disease. The Gregorio Marañón hospital performed 65 RT, 97.01 pmp, this year. OBJECTIVE: To study the characteristics which RT patients from non-heart beating donors have in the immediate post-transplantation renogram. To know the evolution of the renal function, by renogram. METHODS: Ten patients with NHBD graft out of 65 patients with RT were studied in the year 2003. RESULTS: The study is made up of 10 patients with RT from NHBD, with an average timing of warm ischemia of 35 min and average timing of cool ischemia 21 h. In the post-transplantation renal function study, 9 of then showed hemodilution and one an acute tubular necrosis (ATN) pattern. In most of the cases, the study was performed the day after the RT except for one that was performed on the 4th day (1.7 +/- 1 days). Renal perfusion was conserved in every case. The renal graft maintained this type of record until post-RT day 7 (6.67 +/- 0.57 days) and evolved towards ATN after day 10 (11.65 +/- 1.5 days) and normal range on day 55 +/- 51.1 post-transplantation. All patients supported the graft, with acceptable renal function, except one of then who was treated with transplantectomy due to a renal venous thrombosis. CONCLUSION: The renal function study showed "hemodilution" in the first post-transplantation in 90 % of the RT from NHBD. Evolution went from ATN to normality. The NHBD are adequate for transplantation, significantly shortening the waiting time for RN.

Viabilidad de injerto de pacientes con trasplante renal de donante de cadáver en asistolia / Graft viability of patients with renal transplantation from non heart beating donors

Introducción: El trasplante renal (TR) es actualmente el tratamiento de elección en la enfermedad renal terminal. El HGU Gregorio Marañon realizó 65 TR. Objetivo: Estudiar las características que presentan los pacientes con TR de donante de cadáver en asistolia (NHBD) en el renograma post-trasplante inmediato. Conocer la evolución de la función renal, mediante renograma. Material: De 65 pacientes con TR en el año 2003, se estudian 10 con injerto NHBD. Resultados: 10 pacientes con TR de NHBD, con edad 44 ± 10 años (29-62 años), 6 mujeres, tiempo de isquemia caliente 35min y tiempo de isquemia fría 21 h. Nueve de ellos mostraron en el estudio de función renal post-transplante, curva dilución sanguínea y uno un patrón de NTA. El estudio fue realizado en la mayoría de los casos al día siguiente del TR excepto uno que se efectuó el 4.º día (1,7 ± 1 días) En todos los casos la perfusión renal estaba conservada. El injerto renal mantuvo este tipo de registro hasta el día 7.º post. TR (6,67 ± 0,57 días). Evolucionando, hacia NTA a partir del 10 día (11,65 ± 1,5 días) y a la normalidad el día 55 ± 51,1 post-transplante. Todos los pacientes mantienen el injerto, excepto uno de ellos, que hubo que realizar trasplantectomía a causa de trombosis de la vena renal. Conclusión: El 90 % de los TR procedentes de NHBD muestran en los primeros días post-trasplante un estudio de función renal de "dilución sanguínea". La evolución es a NTA y a la normalidad. Los NHBD son aptos para transplante, disminuyendo de forma significativa el tiempo de espera para TR

Introduction: Renal transplantation (RT) is currently the treatment of choice in end-stage renal disease. The Gregorio Marañón hospital performed 65 RT, 97.01 pmp, this year. Objective: To study the characteristics which RT patients from non-heart beating donors have in the immediate post-transplantation renogram. To know the evolution of the renal function, by renogram. Methods: Ten patients with NHBD graft out of 65 patients with RT were studied in the year 2003. Results: The study is made up of 10 patients with RT from NHBD, with an average timing of warm ischemia of 35 min and average timing of cool ischemia 21 h. In the post-transplantation renal function study, 9 of then showed hemodilution and one an acute tubular necrosis (ATN) pattern. In most of the cases, the study was performed the day after the RT except for one that was performed on the 4th day (1.7 ± 1 days). Renal perfusion was conserved in every case. The renal graft maintained this type of record until post-RT day 7 (6.67 ± 0.57 days) and evolved towards ATN after day 10 (11.65 ± 1.5 days) and normal range on day 55 ± 51.1 post-transplantation. All patients supported the graft, with acceptable renal function, except one of then who was treated with transplantectomy due to a renal venous thrombosis. Conclusion: The renal function study showed "hemodilution" in the first post-transplantation in 90 % of the RT from NHBD. Evolution went from ATN to normality. The NHBD are adequate for transplantation, significantly shortening the waiting time for RNIntroduction: Renal transplantation (RT) is currently the treatment of choice in end-stage renal disease. The Gregorio Marañón hospital performed 65 RT, 97.01 pmp, this year. Objective: To study the characteristics which RT patients from non-heart beating donors have in the immediate post-transplantation renogram. To know the evolution of the renal function, by renogram. Methods: Ten patients with NHBD graft out of 65 patients with RT were studied in the year 2003. Results: The study is made up of 10 patients with RT from NHBD, with an average timing of warm ischemia of 35 min and average timing of cool ischemia 21 h. In the post-transplantation renal function study, 9 of then showed hemodilution and one an acute tubular necrosis (ATN) pattern. In most of the cases, the study was performed the day after the RT except for one that was performed on the 4th day (1.7 ± 1 days). Renal perfusion was conserved in every case. The renal graft maintained this type of record until post-RT day 7 (6.67 ± 0.57 days) and evolved towards ATN after day 10 (11.65 ± 1.5 days) and normal range on day 55 ± 51.1 post-transplantation. All patients supported the graft, with acceptable renal function, except one of then who was treated with transplantectomy due to a renal venous thrombosis. Conclusion: The renal function study showed "hemodilution" in the first post-transplantation in 90 % of the RT from NHBD. Evolution went from ATN to normality. The NHBD are adequate for transplantation, significantly shortening the waiting time for RN

[Utility of SPECT with 99m Tc-tetrofosmin and stimulus with dipyridamole in patients with permanent ventricular pacemakers]. / Utilidad del SPECT con 99mTc-tetrofosmin y estímulo con dipiridamol en pacientes portadores de marcapasos ventricular permanente.

BACKGROUND AND OBJECTIVE: Patients with permanent ventricular pacemakers (PP) are a difficult subgroup to assess in the study of coronary artery disease. The objective of this study was to evaluate the diagnostic value of the myocardial perfusion scintigraphy with 99mTC-Tetrofosmin (Tc-Tf) and stimulus with dipyridamole in patients with PP and suspected coronary artery disease. PATIENTS AND METHODS: Fourteen patients with suspected coronary artery disease and without structural cardiopathy, who underwent Tc-Tf and cardiac catheterization, were studied retrospectively. Sensitivity, specificity, predictive values and Kappa index were calculated for the diagnosis of coronary artery disease, multivessel disease, and for each one of the coronary arteries (left anterior descending, right coronary, and circumflex). In addition, the correlation between the number of territories with perfusion defects and the number of diseased vessels was studied. RESULTS: In regards to the diagnosis of coronary artery disease, sensitivity, specificity, positive predictive value, negative predictive value and the Kappa index were 100%, 50%, 83%, 100% and 0.55, respectively. For multi-vessel disease, these values were 83%, 64%, 64%, 83% and 0.43 respectively. The correlation coefficient between the number of territories with perfusion defects and the number of diseased vessels was 0.61 (p = 0.02). In the diagnosis of anterior descending disease, sensitivity and specificity were 83% and 88% respectively. For the right coronary artery, these values were 100% and 44% and for the circumflex artery 38% and 83%, respectively. CONCLUSION: In patients with PP and suspected coronary artery disease, myocardial perfusion scintigraphy with Tc-Tf and stimulus with dipyridamole is of great value in the diagnosis of coronary artery disease and in the assessment of its extension.

Feocromocitoma vesical con determinaciones hormonales normales

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Utilidad del SPECT con 99mTc-tetrofosmin y estímulo con dipiridamol en pacientes portadores de marcapasos ventricular permanente / Utility of spect with 99mtc-tetrofosmin and stimulus with dipyridamole in patients with permanent ventricular pacemakers

Introducción y objetivo: En el estudio de la cardiopatía isquémica, los pacientes portadores de marcapasos ventricular permanente (MVP), constituyen un subgrupo de muy difícil valoración. El objetivo fue evaluar el valor de la gammagrafía de perfusión miocárdica con 99mTc-Tetrofosmina (Tc-Tf) y estímulo con dipiridamol en el diagnóstico de enfermedad coronaria en pacientes portadores de MVP. Pacientes y métodos: Se estudiaron retrospectivamente 14 pacientes con sospecha de enfermedad coronaria, y sin cariopatía estructura, a los que se realizó Tc-Tf y coronariografía. Se calcularon la sensibilidad, especificidad, valores predictivos e índice de concordancia Kappa para la existencia de enfermedad coronaria, para la enfermedad multivaso y para cada una de las arterias coronarias (descendente anterior, coronaria derecha, circunfleja). Asimismo, se estudió la correlación entre el número de territorios con defectos de perfusión y el número de vasos enfermos encontrados en la coronariografía. Resultados: En cuanto al diagnóstico de enfermedad coronaria, se obtuvo una sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo e índice Kappa de 100 por ciento, 50 por ciento, 83 por ciento, 100 por ciento y 0,55 por ciento, respectivamente. Para la enfermedad multivaso, estos valores fueron 83 por ciento, 63 por ciento, 63 por ciento, 83 por ciento y 0,43 por ciento respectivamente. La correlación entre el número de territorios con defectos de perfusión y el número de vasos enfermos mostró un índice de correlación de 0,61 (p = 0,02). Para la arteria descendente anterior, la sensibilidad y especificidad fueron 83 por ciento y 88 por ciento, respectivamente. Para la coronaria derecha, estos valores fueron 100 por ciento y 44 por ciento, y para la circunfleja 38 por ciento y 83 por ciento, respectivamente. Conclusiones: En pacientes portadores de MVP y con sospecha de enfermedad coronaria, la gammagrafía de perfusión miocárdica con Tc-Tf y estímulo con dipiridamol es de gran utilidad en la detección de enfermedad coronaria y la valoración de su extensión (AU)

[Meaning of clinical and electrical positivity in the myocardial perfusion scintigraphy during the administration of dipyridamole]. / Implicaciones de la positividad clínica y eléctrica en la gammagrafía de perfusión miocárdica durante la administración de dipiridamol.

BACKGROUND AND OBJECTIVES: Administration of dipyridamole produces angina and ST depression in 20%-30% and 6%-34% of patients, respectively. This study aimed to evaluate the clinical implications of the presentation of angina and/or ST depression during the administration of dipyridamole in the study of coronary heart disease by myocardial perfusion SPECT (MPS). METHODS: The study population is constituted by 593 consecutive patients without left branch block or ventricular pacemaker rhythm who were referred to our service to undergo MPS with dipyridamole. A SPECT was performed after the administration of 99mTc-tetrosfosmine and drug stimulation with dipyridamole (0.142 mg/kg/min for 4 minutes). A coronariography was performed in 338 patients (57%). The frequency of clinical and electrical positivity and their relationship with the MPS and the coronariography were studied. RESULTS: The rate of angina and ST depression was 32% (n = 190) and 10% (n = 58), respectively. Myocardial perfusion defects were observed in 465 patients (78%), and signs of scintigraphic ischemia in 311 (52%). The patients with ST depression presented a higher frequency of perfusion defects (93% vs 76%, p = 0.0012) and scintigraphic ischemia (89% vs 49%, p < 0.0001). In addition, perfusion defects in more than one territory were observed in these patients in a higher percentage (53% vs 34%, p = 0.0036). Among the patients who underwent cardiac catheterization, those who had a ST depression had a greater extension of coronary heart disease (1.8 +/- 1.2 vs 1.3 +/- 1.0 diseased vessels, respectively. p = 0.0100) and a higher frequency of multivessel disease (61% vs 43%, p = 0.0380). Those patients who had clinical positivity showed a scintigraphic ischemia more frequently (66% vs 47%, p < 0.0001), however no statistically significant differences were observed between the presence of patients with perfusion defects or in the extension of these defects as well as in the number of diseased vessels in the coronariographic study. CONCLUSIONS: During the administration of dipyridamole, the ST depression is associated with more frequent scintigraphic ischemia, larger extension of perfusion defects and more diseased vessels. The appearance of angina is associated with scintigraphic ischemia, but it is not necessarily associated with the extension of perfusion defects or greater number of diseased vessels.

Implicaciones de la positividad clínica y eléctrica en la gammagrafía de perfusión miocárdica durante la administración de dipiridamol / Meaning of clinical and electrical positi-vity in the myocardial perfusion scintigraphy during the administration of dipyridamole

Introducción y objetivos: La administración de dipiridamol produce angina y depresión del ST en el 20-30 por ciento y el 6-34 por ciento de los pacientes, respectivamente. El objetivo de este estudio fue evaluar las implicaciones diagnósticas de la producción de angina y/o depresión del segmento ST durante la administración de dipiridamol en el estudio de la enfermedad coronaria mediante gammagrafía de perfusión miocárdica (GPM). Métodos: La población de estudio está compuesta por 593 pacientes consecutivos sin bloqueo de rama izquierda ni ritmo de marcapasos ventricular que fueron remitidos a nuestro servicio para la realización de GPM con dipiridamol. Se realizó SPECT tras la administración de 99mTc-tetrofosmina y estímulo farmacológico con dipiridamol (0,142 mg/kg/min durante 4 minutos). En 338 pacientes (57 por ciento), se realizó coronariografía. Se estudió la frecuencia de positividad clínica y eléctrica, así como su relación con los resultados de la GPM y de la coronariografía. Resultados: La frecuencia de angina y de depresión del ST fue del 32 por ciento (n = 190) y 10 por ciento (n = 58), respectivamente. Se observaron defectos de perfusión en 465 pacientes (78 por ciento), y signos de isquemia gammagráfica en 311 (52 por ciento). Los pacientes con descenso del ST presentaron más frecuentemente defectos de perfusión (93 por ciento vs 76 por ciento, p = 0,0012) e isquemia gammagráfica (89 por ciento vs 49 por ciento, p < 0,0001). Además, en estos pacientes se observaron defectos de perfusión en más de un territorio con un mayor porcentaje (53 por ciento vs 34 por ciento, p = 0,0036). Entre los pacientes que fueron sometidos a coronariografía, los pacientes con descenso del ST tuvieron mayor extensión de la enfermedad coronaria (1,8 ñ 1,2 vs 1,3 ñ 1,0 vasos enfermos, respectivamente; p = 0,0100) y una mayor frecuencia de enfermedad multivaso (61 por ciento vs 43 por ciento, p = 0,0380). Los pacientes con positividad clínica presentaron isquemia gammagráfica con mayor frecuencia (66 por ciento vs 47 por ciento, p < 0,0001), pero no se observaron diferencias estadísticamente significativas en cuanto a la proporción de pacientes con defectos de perfusión ni en la extensión de estos defectos, así como en el número de vasos enfermos en la coronariografía. Conclusión: El descenso del ST durante la administración de dipiridamol se asocia a una más frecuente isquemia gammagráfica y a mayor extensión de los defectos de perfusión, así como a un mayor número de vasos enfermos. La aparición de angina se asocia a isquemia gammagráfica, pero no implica necesariamente una mayor extensión de los defectos de perfusión, ni tampoco una mayor extensión de la enfermedad coronaria (AU)

[Bone scintigraphy findings in patients with recently diagnosed adenocarcinoma of the prostate: relationship with prostate specific antigen levels]. / Hallazgos de la gammagrafía ósea en pacientes con adenocarcinoma de próstata recién diagnosticado: relación con los niveles de antígeno específico prostático.

BACKGROUND AND OBJECTIVES: Although it has been suggested that bone scintigraphy (BS) may not be necessary in patients with prostate adenocarcinoma (PA) and normal prostate specific antigen (PSA) plasma levels, controversy still remains. The objective of the study was to evaluate the existing relationship between PSA plasma levels and BS findings in patients with a recently diagnosed PA in order to assess whether BS may be omitted on the basis of the PSA levels in these patients. METHODS: The 475 patients (70+/-7 years old) consecutively diagnosed of PA between 1994 and 1998 in our institution made up the study population. PSA plasmatic levels were determined and BS was performed (body planar study after 99mTc-methyl diphosphonate 900 MBq administration) in all the patients. RESULTS: In 362 patients (76.2%), BS was negative, in 108 (22.7%) positive and undetermined in the remaining 5 patients (1.1%). The mean PSA level in the whole study population was 74+/-267 ng/ml (range 0.4-4.200) and was higher in patients with positive GO (218+/-512 vs 31+/-89, p<0,0001). As PSA increased, the rate of patients with positive BS was significantly higher, this being 0%, 16.4%, 9.7%, 14.0%, 31.0% and 48.3% in patients with PSA 4, 4.1-10; 10.1-20; 20.1-30; 30.1-40, and >40 ng/ml, respectively (p<0.0001). In patients with positive BS, the PSA levels were 20 and 10 ng/ml in 30.6% and 18.6% of the patients, respectively. CONCLUSION: According to our experience, there is a significant association between PSA plasma levels and the BS results in patients with recently diagnosed PA. However, a significant proportion of patients with bone metastasis have normal PSA levels, and therefore BS should be performed in all patients with recently diagnosed PA regardless of the PSA levels.

[Results of myocardial scintigraphy with 99mTc-tetrofosmin and dipyridamole administration in patients diagnosed of microvascular angina]. / Resultados de la gammagrafía de perfusión miocárdica con 99mTc-tetrofosmina y estímulo con dipiridamol en pacientes diagnosticados de angina microvascular.

The objective of the study was to evaluate the results of the myocardial scintigraphy with 99mTc-tetrofosmin (Tc-Tf) and pharmacological stimulation with dipyridamole in patients diagnosed of microvascular angina. The study population is made up of 50 patients discharged with the diagnosis of microvascular angina who had undergone Tc-Tf-dipyridamole. Clinical and electrical positivity appeared in 40% and 12% of the patients, respectively. Myocardial perfusion defects were found in 35 patients (70%), and were reversible in 21 (60%), fixed in 11 (21%), and combined in 3 (9%). Abnormalities were inferior, anteroseptal and lateral in 21, 18, and 2 patients, respectively. Patients with a positive exercise treadmill test, compared with those with a negative one, had more frequent perfusion abnormalities (91% vs 50%, p = 0.0327) and myocardial ischemia (64% vs 20%, p = 0.392). Women, in comparison with men, had angina (56% vs 22%, p = 0.013), and anteroseptal perfusion abnormalities (26% vs 4%, p = 0.028) more frequently. On the contrary, men had inferior perfusion abnormalities more frequently (57% vs 30%, p = 0.057). Thus, Tc-Tf-dipyridamole shows perfusion abnormalities in 70% of patients with microvascular angina (91% in patients with a positive exercise treadmill test). Scintigraphic pattern may be partially conditioned by gender in these patients.

Hallazgos de la gammagrafía ósea en pacientes con adenocarcinoma de próstata recién diagnosticado: relación con los niveles de antígeno específico prostático / Bone scintigraphy findings in patients with recently diagnosed prostate adenocarcinoma: relationship with the prostate specific antigen levels

Introducción y objetivos: Aunque se ha sugerido que en los pacientes con adenocarcinoma de próstata (AP) la existencia de unos niveles plasmáticos no elevados de antígeno específico prostático (PSA) podría hacer innecesaria la realización de gammagrafía ósea (GO), aún existen controversias al respecto. El objetivo del estudio fue analizar la relación existente entre los niveles de PSA y los hallazgos de la GO en pacientes con diagnóstico de AP, con objeto de evaluar si en nuestra experiencia la indicación de la GO puede ser omitida en función de los niveles de PSA en estos pacientes. Métodos: La población de estudio está compuesta por los 475 pacientes (70ñ7 años de edad) diagnosticados de AP entre 1994 y 1998. A todos los pacientes se les realizó GO (estudio planar de cuerpo completo tras la administración de 900 MBq de 99mTC-metil difosfonatos) y determinación de los niveles plasmáticos de PSA. Resultados: En 362 pacientes la GO fue negativa (76,2 por ciento) en 108 (22,7 por ciento) positiva y dudosa en los restantes cinco pacientes (1,1 por ciento). El nivel de PSA en el total de la población de estudio fue 74ñ267 ng/ml (rango 0,4-4.200). Los pacientes con metástasis óseas tenían unos niveles de PSA más elevados (218ñ512 vs 31ñ89, p40 ng/ml, respectivamente (p<0,0001). El 30,6 por ciento de los pacientes con metástasis tenían unos niveles de PSA 20 ng/ml, y el 18,6 por ciento 10 ng/ml. Conclusión: Según nuestra experiencia, en los pacientes con AP existe una relación entre los niveles plasmáticos de PSA y la probabilidad de presentar metástasis en la GO. Sin embargo, una proporción importante de pacientes con metástasis tienen unos niveles no elevados de PSA, por lo que la GO debería ser realizada con todo paciente con AP, independientemente de los niveles basales de PSA (AU)

Resultados de la gammagrafía de perfusión miocárdica con 99mTc-tetrofosmina y estímulo con dipiridamol en pacientes diagnosticados de angina microvascular / Results of myocardial scintigraphy with 99m Tc-tetrofosmin and dypiridamole administration in patients diagnosed of microvascular angina

El objetivo del estudio fue analizar los resultados de la gammagrafía de perfusión miocárdica con 99m Tc-tetrofosmina (Tc-Tf) y estímulo con dipiridamol en pacientes diagnosticados de angina microvascular. La población de estudio está compuesta por 50 pacientes que habían sido dados de alta con el diagnóstico de angina microvascular y a los que se había realizado Tc-Tf-dipiridamol. La prueba fue clínica y eléctricamente positiva en el 40 por ciento y el 12 por ciento de los casos, respectivamente. Se encontraron defectos de perfusión en 35 pacientes (70 por ciento), que fueron reversibles en 21 (60 por ciento), fijos en 11 (21 por ciento), y mixtos en 3 (9 por ciento). En cuanto a la localización de los defectos de perfusión, ésta fue en el territorio de la coronaria derecha en 21 pacientes, de la descendente anterior en 18, y de la circunfleja en 2.Los pacientes que habían realizado una prueba de esfuerzo positiva, en comparación con los que habían realizado una ergometría negativa, presentaron más frecuentemente defectos de perfusión (91 por ciento vs 50 por ciento, p = 0,0327) e isquemia gammagráfica (64 por ciento vs 20 por ciento, p = 0,392). La aparición de angina fue más frecuente en mujeres que en varones (56 por ciento vs 22 por ciento, p = 0,013), así como la existencia de defectos de perfusión en el territorio de la arteria descendente anterior (26 por ciento vs 4 por ciento, p = 0,028). Los varones, por el contrario, mostraron más frecuentemente defectos de perfusión en la cara inferior (57 por ciento vs 30 por ciento, p = 0,057). En conclusión, el Tc-Tf-dipiridamol muestra alteraciones de la perfusión en el 70 por ciento de los pacientes diagnosticados de angina microvascular, siendo esta proporción del 91 por ciento en pacientes con ergometría positiva. El patrón gammagráfico en estos pacientes puede estar condicionado, en parte, por el sexo. (AU)

[Usefulness of spect with 99mTc-tetrofosmin and stimulus with dipyridamole in patients with left bundle branch block of His]. / Utilidad del SPECT con 99mTc-tetrofosmin y estímulo con dipiridamol en pacientes con bloqueo completo de rama izquierda del haz de His.

BACKGROUND: In patients with left bundle branch block, the 201Tl scintigraphic studies show high sensitivity, but with low specificity, in the diagnosis of coronary artery disease. OBJECTIVE: [corrected] To assess the value of 99mTc-tetrofosmin Single Photon Emission Computed Tomography (SPECT) and dipyridamole administration in patients with left bundle branch block. METHODS: 22 patients with angina and left bundle branch block were retrospectively studied by cardiac catheterization and Tc-Tf after dipyridamole administration (0,142 mg/kg/min. i.v.) and at rest. RESULTS: The mean number of territories with perfusion defects was 1.5+/-1.0, and the average number of diseased vessels in the coronariographic study was 1.6+/-1.3 (r = 0.77, p<0.001). Sensitivity, specificity, positive predictive value, negative predictive value, total predictive value and Kappa index in the diagnosis of multivessel disease were 92%, 90%, 92%, 90%, 91% and 0.82, respectively. In the diagnosis of anterior descending artery disease, these values were 83%, 70%, 77%, 78%, 77%, and 0.54, respectively. CONCLUSION: In patients with angina and left bundle branch block, SPECT with Tc-Tf-dipyridamole is of great value in the study of coronary artery disease extension. Sensitivity and specificity for the diagnosis of anterior descending artery disease were similar to that shown in series with thallium-dipyridamole.

Utilidad del SPECT con 99mTc-tetrofosmin y estímulo con dipiridamol en pacientes con bloqueo completo de rama izquierda del haz de His / Usefulness of SPECT with 99mTc-tetrofosmin and stimulus with dipyridamole in patients with left bundle branch block of His

Introducción: En los pacientes con bloqueo de rama izquierda, los estudios isotópicos con 201Tl poseen una elevada sensibilidad en el diagnóstico de enfermedad coronaria, aunque con una escasa especificidad.Objetivo: Analizar la utilidad del Single Photon Emission Computed Tomography (SPECT) con 99mTc-tetrofosmin y estímulo con dipiridamol en pacientes con bloqueo de rama izquierda.Métodos: Se estudiaron retrospectivamente 22 pacientes con bloqueo de rama izquierda y clínica de angina mediante coronariografía y Tc-Tf tras administración de dipiridamol (0,142 mg/kg/min i.v.) y en reposo.Resultados: El número de territorios con defectos de perfusión fue 1,5 ñ 1,0, y el número de vasos enfermos en la coronariografía 1,6 ñ 1,3 (r = 0,77; p < 0,001). La sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo, valor predictivo total e índice Kappa para el diagnóstico de enfermedad multivaso fueron, respectivamente, 92 por ciento, 90 por ciento, 92 por ciento, 90 por ciento, 91 por ciento y 0,82. Para el diagnóstico de la enfermedad de la arteria descendente anterior, estos valores fueron, respectivamente, 83 por ciento, 70 por ciento, 77 por ciento, 78 por ciento, 77 por ciento y 0,54.Conclusión: En pacientes con angina y bloqueo de rama izquierda, el Tc-Tf y estímulo con dipiridamol es de gran utilidad en el estudio de extensión de enfermedad coronaria. La sensibilidad y especificidad para el diagnóstico de la enfermedad de la arteria descendente anterior fueron similares a las mostradas en estudios realizados mediante taliodipiridamol (AU)

Background: In patients with left bundle branch block, the 201Tl scintigraphic studies show high sensitivity, but with low specificity, in the diagnosis of coronary artery disease. Objetive: To assess the value of 99mTc-tetrofosmin Single Photon Emission Computed Tomography (SPECT) and dipyridamole administration in patients with left bundle branch block. Methods: 22 patients with angina and left bundle branch block were retrospectively studied by cardiac catheterization and Tc-Tf after dipyridamole administration (0,142 mg/kg/min. i.v.) and at rest. Results: The mean number of territories with perfusion defects was 1.5 ± 1.0, and the average number of diseased vessels in the coronariographic study was 1.6 ± 1.3 (r = 0.77, p < 0.001). Sensitivity, specificity, positive predictive value, negative predictive value, total predictive value and Kappa index in the diagnosis of multivessel disease were 92%, 90%, 92%, 90%, 91% and 0.82, respectively. In the diagnosis of anterior descending artery disease, these values were 83%, 70%, 77%, 78%, 77%, and 0.54, respectively. Conclusion: In patients with angina and left bundle branch block, SPECT with Tc-Tf-dipyridamole is of great value in the study of coronary artery disease extension. Sensitivity and specificity for the diagnosis of anterior descending artery disease were similar to that shown in series with thallium-dipyridamole (AU)

[Scintigraphy diagnosis of renovascular hypertension in renal transplanted patients]. / Diagnóstico gammagráfico de hipertensión renovascular en trasplantados renales.

UNLABELLED: Captopril renography (CR) has been shown to be a useful technique in the diagnosis of renovascular hypertension (RVH). This disease is a significant complication of the kidney transplanted patient so that early diagnosis would be extremely useful to preserve renal function and prevent graft loss. This work evaluates the role of CR, together with arteriography and doppler-ultrasound, in the diagnosis of RVH. MATERIALS: A total of 19 transplanted patients with clinical suspicion of RVH underwent an isotopic study, a doppler-ultrasound study and an arteriography. Scintigraphy was performed 1 hour after a 50 mg dose of captopril, with oral hydration and i.v. administration of approximately 111 MBq of 99mTc-MAG3 and 20 mg of furosemide. If abnormal, a subsequent renography in baseline conditions was performed for comparison. RESULTS: Overall, 11 patients had renovascular hypertension. Sensitivity and specificity of CR were 91% and 80% respectively, 100% and 60% for US and 91% and 100% for arteriography. The CR yielded one false positive result and 2 false negatives cases: one with 50% stenosis and one polar artery stenosis. Six patients were successfully dilated or operated. CONCLUSION: CR seems to be a reliable diagnostic tool for the diagnosis of renovascular hypertension in kidney transplanted patients.

Technetium-99m-HMPAO in Tourette's syndrome on neuroleptic therapy and after withdrawal.

UNLABELLED: Both decreased and increased perfusion and metabolism have been described with PET and SPECT in different areas of the brain in patients with Gilles de la Tourette's syndrome. The aim of this study was to define the regional cerebral perfusion pattern in drug-free patients and the changes in perfusion with the usual neuroleptic treatment. METHODS: A group of 13 normal control subjects and 15 unmedicated Gilles de la Tourette's syndrome patients were studied with 99mTc-HMPAO brain SPECT. Thirteen of the initial group of patients were retested on neuroleptic treatment. A semiquantitative analysis of the images was performed. RESULTS: Decreased perfusion in orbital and anterior medial regions of both frontal lobes as well as in both temporal lobes was observed in the nontreated group compared with control subjects. With treatment, a perfusion increase in these frontal regions and in the left medial temporal cortex was observed. CONCLUSION: Neuroleptic treatment could decrease the hyperactivity of the dopaminergic system leading to improvement of the clinical symptoms and reperfusion of some previously hypoperfused regions.

Technetium-99m tetrofosmin scintigraphy to evaluate breast lesions.

UNLABELLED: The aim of this study is to characterise benign from malignant breast lesions by using 99mTc-Tetrofosmin. MATERIALS: Fifteen female patients with suspected breast lesions and ten normal controls underwent breast scintigraphy with 99mTc-Tetrofosmin. All patients had conventional mammography. Breast imaging begun 20 minutes after i.v. injection of 740 MBq 99mTc-Tetrofosmin. Patients were imaged in supine and prone position. Results of the 15 patients with suspected breast lesions, 13 showed breast uptake, and 6 of them had suspicious lesions on mammography. Surgery confirmed 10 carcinomas and 3 benign lesions. Two patients demonstrated no abnormal accumulation or suspicious findings in mammography. None of the normal controls had breast uptake or mammographic abnormalities. Our study has a sensibility of 100% and 60%, and a specificity of 80% and 100% in scintigraphy and mammography respectively. CONCLUSION: Our findings suggest that 99m Tc-Tetrofosmin may play a role in evaluating breast masses and that can differentiate benign from malignant lesions.

[Gammagraphy with HMPAO-99mTc leukocytes in intestinal inflammatory disease]. / Gammagrafía con leucocitos HMPAO-99mTc en la enfermedad inflamatoria intestinal.

The value of 99mTc-hexamethylpropyleneamine oxime (HMPAO) leukocyte images has been confirmed in patients with Inflammatory Bowel Disease. We performed 121 scintigraphic examination. The results were evaluated by radiologic and/or endoscopic examinations. The patients were divided into three subgroups: A) patients with active disease and less than 15 days of corticotherapy (n = 42). B) patients with active disease and more than 15 days of corticotherapy (n = 31). C) asymptomatic patients (n = 48). Over all sensitivity and specificity were 86% and 92.2% respectively. The sensitivity in subgroup A was 97.5% and 70% in the subgroup B. In the subgroup A the isotopic study showed the entire area of active inflammation in 95% (38/40) and colonoscopy in 32.5% (13/40). The leucocyte scanning showed clear pathologic activity in the ileum with a sensitivity of 86%. We conclude that 99mTc-leukocyte scintigraphy is the best method to assess the location of active inflammation in patients with less than 15 days of treatment. Scintigraphy was best in the assessment of active disease especially in Crohn's disease of the small bowel.

Abdominal scintigraphy using 99mTc-HMPAO-labelled leucocytes in patients with seronegative spondylarthropathies without clinical evidence of inflammatory bowel disease.

Abdominal scintigraphy with technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO)-labelled leucocytes is an excellent tool for evaluating disease extent and activity of intestinal lesions in patients with inflammatory bowel disease (IBD). In some cases of seronegative spondylarthropathies (SSp), IBD may remain subclinical. The aim of this study was to evaluate the presence of positive abdominal scintigraphy in patients with SSp and without clinical symptoms or signs of IBD. To this end we studied 32 patients with active SSp (European Spondylarthropathy Study Group 1991 criteria) without clinical evidence of IBD (eight had ankylosing spondylitis, four psoriatic arthritis, three reactive arthritis an 17 undifferentiated SSp) and 11 controls without SSp. All SSp and control patients received similar doses of non-steroidal anti-inflammatory drugs (NSAIDs). Abdominal scintigraphic images were obtained at 30 and 120 min after re-injection of 99mTc-HMPAO-labelled leucocytes. The 99mTc-HMPAO-labelled leucocyte scan was positive in 17 patients with SSp (53.1%) (six with ankylosing spondylitis, three with psoriatic arthritis, two with reactive arthritis and six with undifferentiated SSp). Fourteen patients scored from 2 to 4 on the intensity of uptake scale. The colon and terminal ileum were predominantly involved. Axial involvement was more frequent in patients with a positive scan than in patients with negative results (P<0.05) (64.7% vs 26.6%; odds ratio: 5). No control patient showed a positive scan. It is concluded that 99mTc-HMPAO-labelled leucocyte scan shows increased uptake among patients with SSp without evidence of IBD. These findings provide new evidence linking SSp with intestinal inflammation and suggest that in some cases a bowel-related process could contribute to the development of SSp. Long-term follow-up studies with more patients are necessary to evaluate the diagnostic and therapeutic implications of these results.