[Gastric uptake of gallium67 in the human immunodeficiency virus infection]. / Captación gástrica de Galio67 en la infección por virus de la inmunodeficiencia humana.

Nowadays, the human immunodeficiency virus infection (HIV) is a chronic disease. In the frequent clinical situations with fever, lymph nodes and loss weight it is necessary to determine their etiology, for establishing a specific treatment. Gastrointestinal opportunistic infections or gastric lymphomatous or sarcomatous process, which can accumulate Ga67, may be present in the patient with acquired immunodeficiency syndrome. We report 2 cases with gastric uptake in which endoscopy and biopsy was obtained. In the first one, with previous treatment with omeprazol and almalgate for gastroesophagic reflux, endoscopy and biopsy were normal and in the second patient an Helicobacter pylori infection was diagnosed. We think that gastric uptake of Ga67 in HIV patients, must indicate to the clinician to rule out associated pathologies.

Captación gástrica de Galio67 en la infección por virus de la inmunodeficiencia humana / Gastric uptake of Gallium67 in the human immunodeficiency virus infection

Actualmente la infección por el virus de la inmunodeficiencia humana (VIH) es una enfermedad crónica en que son frecuentes presentaciones clínicas con fiebre, adenopatías y pérdida de peso, cuya etiología es preciso determinar, para indicar un tratamiento específico. El paciente con inmunodeficiencia adquirida puede presentar infecciones oportunistas gastrointestinales o procesos linfomatosos o sarcomatosos gástricos, que pueden acumular citrato de Galio67. Presentamos 2 casos con captación gástrica de Ga67 en los que se practicó endoscopia con biopsia. En el primero de ellos, que había recibido tratamiento previo con omeprazol y almalgato por reflujo gastroesofágico, no se demostró patología y en el segundo se diagnosticó infección por Helicobacter pylori. Creemos que en los casos con VIH la captación gástrica de Ga67 debe indicar al clínico la necesidad de descartar patologías asociadas (AU)

[Cardiac radionuclide scanning with 99mTc-MIBI-SPECT in acute myocardial infarction]. / Gammagrafía cardiaca con 99mTc-MIBI-SPECT en el infarto agudo de miocardio.

Several studies point out the importance of what is called rescue angioplasty or fibrinolysis (FB) when thrombolysis has been ineffective in acute myocardial infaction (AMI). Therefore, it is necessary to make use of new methods to asses reperfusion and to safely establish that such a treatment has not been effective. We present a work which is based on the assessment of patients with acute coronary heart disease: AMI patients treated with FB (N = 48), without FB (N = 15), unstable angina (N = 9); after determining cardiac imaging gammagraphies 99mTc-isonitrile-single-photon emission computed tomography (MIBI-SPECT) pre and post treatment, to assess myocardium at risk (MR), salvage (MS) and the existence or not of gammagraphic reperfusion. Unstable angina patients show a myocardial perfusion that is similar to AMI patients. However, in the case of unstable angina, perfusion is practically of a 100% 48 hours later, having almost completely saved the myocardium at risk (MS/MR = 81.5% +/- 27.7%), and with a non-existent residual myocardium (3.2% +/- 5.8%). In AMI patients treated with FB the salvage myocardium was higher [8.3 vs 3.0; p < 0.05). Considering that an improvement in perfusion defect (MS/MR)] higher than 30% can be viewed as an effective reperfusion, we can see that all the patients with unstable angina show reperfusion, the percentage in the AMI group treated with FB being 45.8%, and the percentage in the AMI group under conventional treatment being just 6.7%. Gammagraphy with 99mTc-MIBI-SPECT at admission allowed assessing regional perfusion in AMI patients during the early stage of their evolution. With a second exploration we could determine the amount of salvage myocardium and the existence of secondary reperfusion to FB treatment.

[Histological prediction of cerebral tumors using SPECT with 201T1]. / Predicción histológica de los tumores cerebrales mediante SPECT con 201T1.

INTRODUCTION AND OBJECTIVE: SPECT with 201Tl provides information regarding the degree of malignancy of cerebral tumours, their possible relapses, the differentiation of necrotic tissue in the tumours following chemotherapy or radiotherapy and permits differentiation into zones of various grades of histological malignancy. MATERIAL AND METHODS: We carried out a prospective analysis of the usefulness of SPECT with 201Tl for the histological prognosis of cerebral tumours. For one year 68 patients diagnosed (on CT and/or MR) as having an expansive cerebral lesion were studied. The early uptake (ICP) and retention (R) indices were calculated, and these results correlated with the morbid anatomy (AP) findings and the results obtained with surgery and stereotactic biopsy. Four patients were excluded due to lack of AP results. RESULTS: Significant differences were found between the ICP of grade I-II astrocytomas (1.34 +/- 0.52) and glioblastomas multiformes (2.56 +/- 0.57), between the ICP of meningiomas (4.53 +/- 1.68) and metastases (2.45 +/- 0.58) and between those of meningiomas and all glial tumours. With regard to IR, we saw significant differences between the figures for meningiomas (0.63 +/- 0.13) and meningiomas with malignant relapses (0.94 +/- 0.17) and between metastases (0.8 +/- 0.03) and all glial tumours. CONCLUSIONS: From our study, it may be concluded that rapid, high captation of 201Tl (high ICP) with a slow fall (high IR), is associated with a process showing malignancy on histological study (malignant relapse of meningioma, glioblastoma multiforme, metastasis), whilst high take-up (high ICP) with rapid elimination (low IR) corresponds to a benign hypervascularized tumour (meningioma).

[Intravenous brain angioscintigraphy and brain death (author's transl)]. / Muerte cerebral en niños. Valor diagnóstico de la angiogammagrafía cerebral intravenosa y de las imágenes precoces.

Intravenous brain angioscintigraphy in combination with immediate static scan are very useful as a complement to the clinical and electroencephalographic data in diagnosis of brain death. Confusion in the differentiation of extracerebral from intracerebral flow on the dynamic radionuclide angiogram can be accomplished by identifying presence or absence of uptake in cerebral sinuses. Authors consider that the radionuclide study should be carried out in posterior view. Exploration is safe, quick to perform and easy to interpret and it enables to distinguish brain death from comas due to drug intoxication.

Renal uptake of 67Ga-citrate in renal amyloidosis due to familiar Mediterranean fever.

Renal uptake of 67Ga-citrate is described in a patient with biopsy-proven amyloidosis of the kidneys, due to Familiar Mediterranean Fever. After administration 150 MBq (4 mCi) 67Ga-citrate, scans were done at 48, 72, and 120 h. Intense uptake was noted in both kidneys. A renal biopsy done 5 days after the 67Ga-citrate scan revealed a pattern typical of amyloidosis. Gallium scanning can be useful in patients with fever of unknown origin. Renal amyloidosis can be considered when renal uptake of 67Ga-citrate associated with nephrotic syndrome is observed.

[DTPA-99mTc in pediatric renal disease (author's transl)]. / Utilidad del DTPA-Sn 99mTc en patología renal pediátrica.

99MTc is an ideal nuclide for Pediatric use. Combined with DTPA is an adequate agent for renal studies. 15 patients with ages ranging from eight days to eleven years were studied (10 patients with congenital malformation and five with renal tumour). The dosimetric advantages, the obtention with a single nuclide dose of multiple images and the diagnostic usefulness in congenital malformation and renal tumour suggest their use.

Value of the brain angioscintigraphy in posterior view.

The results obtained with intravenous brain angioscintigraphy (IBAS) with 99 mTc-DTPA(Sn) are evaluated in 61 patients with clinical suspicion of cerebellar, cerebral or cranial lesions of posterior location or without focal signs or with a previous IBAS in anterior view being normal or of low significance. One hundred patients without demonstrable cerebral or cranial pathology were explored to define the normal characteristics and variation of the IBAS in posteior view. Of the 61 patients with pathology, 45 showed angioscintigraphic alterations. The following angioscintigraphic patterns were found: 1. Perfusion increased, 2. Perfusion diminished, 3. Flip-flop, 4. Mixed pattern, 5. Circulatory arrest, 6. Jugular venous reflux, 7. Normal IBAS associated with an abnormal morphologicall study, 8. Normal IBAS associated with a normal morphological study.

Diagnosis of intracranial space-occupying lesions with DTPA-Sn-99mTc.

DTPA-Sn-99 mTc is an excellent radionuclide for brain scintigraphy procedures with a rapid blood clearance through glomerular filatration. No previous preparation of the patient is necessary. We have studied forty nine patients with primary or metastatic brain tumours as well as calvarium metastases. There have been five false negatives. We have found three types of scintigraphic patterns depending on whether the lesion is better visualized in early or late images, or does not change throughout the study. The sequential brain study, obtaining views at five minutes, and at one and two hours post-injection allows for an adequate morphological characterization of the lesion and occasionally, a histological diagnosis.