Cuantificación absoluta de la captación miocárdica de 99mTc-DPD en pacientes con amiloidosis cardiaca por depósitos de transtiretina (ATTR) / Absolute quantification of myocardial uptake of 99mTc-DPD in patients with cardiac amyloidosis due to transthyretin deposits (ATTR)

Objetivo Determinar la contribución diagnóstica de la cuantificación absoluta del depósito miocárdico de 99mTc-DPD en pacientes con amiloidosis cardiaca por depósitos de transtiretina (ATTR). Materiales y métodos Se realizó SPECT/TC a 41 pacientes con resultado gammagráfico positivo para amiloidosis cardiaca ATTR. Se dividió a los pacientes en dos grupos (grados2 y3 de Perugini) y se calcularon los SUVmax a nivel del hueso y de ambos ventrículos y el porcentaje de dosis calculado en estas áreas. Se empleó la prueba t de Student para comparar resultados y se calculó el área bajo la curva (AUC) para evaluar la eficacia diferencial y establecer unos puntos de corte discriminatorios entre ambos grupos de pacientes. Resultados Se observaron diferencias estadísticamente significativas en todas las variables a estudio, a excepción del SUVmax hueso. Las diferencias con mayor potencia estadística se observaron en las variables SUVmaxVD y el porcentaje de dosis en ambos ventrículos (p<0,001). El punto de corte obtenido para la variable SUVmaxVI fue de 8,620 (sensibilidad del 87,9% y especificidad del 100%; AUC: 0,966), mientras que el de la variable SUVmaxVD fue de 6,195 (sensibilidad del 81,8% y especificidad del 100%; AUC: 0,955). Conclusiones La cuantificación absoluta de la captación miocárdica de 99mTc-DPD en las imágenes SPECT/TC de pacientes con sospecha de amiloidosis cardiaca por depósitos de transtiretina supone una nueva herramienta diagnóstica que permite una adecuada clasificación de los pacientes, acorde a la escala de gradación visual de Perugini (AU)

Purpose To determine the diagnostic contribution of the absolute quantification of the myocardial deposit of 99mTc-DPD in patients with cardiac amyloidosis due to transthyretin deposits (ATTR). Materials and methods SPECT/CT was performed on 41 patients with positive scintigraphic results for ATTR cardiac amyloidosis. The patients were divided into two groups (Perugini grades2 and3) and the SUVmax at the level of the bone and both ventricles and the percentage of dose calculated in these areas were calculated. Student's t-test was used to compare results and the area under the curve (AUC) was calculated to assess differential efficacy and establish discriminatory cut-off points between both groups of patients. Results Statistically significant differences were observed in all the study variables, with the exception of SUVmax bone. The differences with the greatest statistical power were observed in the variables SUVmaxRV and the percentage of dose in both ventricles (P<.001). The cut-off point obtained for the variable SUVmaxLV was 8.620 (sensitivity 87.9% and specificity 100%; AUC: 0.966), while that of the variable SUVmaxRV was 6.195 (sensitivity 81.8% and specificity 100%; AUC: 0.955). Conclusions The absolute quantification of myocardial uptake of 99mTc-DPD in the SPECT/CT images of patients with suspected cardiac amyloidosis due to transthyretin deposits represents a new diagnostic tool that allows an adequate classification of patients, according to the visual grading scale of Perugini (AU)

Value of the bone scintigraphy in multiple osteochrondromatosis with sarcomatous degeneration.

Multiple osteochondromatosis can become malignant in 20% of the cases, this being more common when the lesion is multiple than when it is solitary. A male patient with multiple osteochondromatosis who had several local recurrences of secondary chondrosarcoma and who is still under follow-up by the Nuclear Medicine Department is presented. The bone scintigraphy findings were compared with the histopathologic results, and the importance of the patient's symptoms was verified when a sarcomatous transformation is suspected. The bone scintigraphy has the potential to detect malignization of the benign bone lesions. It also makes it possible to obtain whole-body images in a single examination, this being very useful to detect the presence of new bone lesions.

Valor de la gammagrafía ósea en la osteocondromatosis múltiple con degeneración sarcomatosa / Value of the bone scintigraphy in multiple osteochrondromatosis with sarcomatous degeneration

La osteocondromatosis múltiple puede malignizar hasta en un 20% de los casos, siendo mucho más frecuente que cuando la lesión es solitaria. Presentamos el caso de un paciente con osteocondromatosis múltiple que ha presentado varias recidivas locales de un condrosarcoma secundario en años sucesivos y que sigue controles gammagráficos en nuestro servicio. Los hallazgos de la gammagrafía ósea se compararon con los resultados anatomopatológicos y se comprobó la importancia de la sintomatología del paciente ante la sospecha de transformación sarcomatosa. La gammagrafía ósea puede aportar datos sobre la posible malignización de las lesiones benignas y permite obtener imágenes de cuerpo completo en una sola exploración, siendo muy útil ante la aparición de nuevas lesiones(AU)

Multiple osteochondromatosis can become malignant in 20% of the cases, this being more common when the lesion is multiple than when it is solitary. A male patient with multiple osteochondromatosis who had several local recurrences of secondary chondrosarcoma and who is still under follow-up by the Nuclear Medicine Department is presented. The bone scintigraphy findings were compared with the histopathologic results, and the importance of the patient‘s symptoms was verified when a sarcomatous transformation is suspected. The bone scintigraphy has the potential to detect malignization of the benign bone lesions. It also makes it possible to obtain whole-body images in a single examination, this being very useful to detect the presence of new bone lesions(AU)

[Influence of tumor location in patients with breast cancer on the sentinel node detection]. / Influencia de la localización del cáncer de mama en la detección del ganglio centinela.

OBJECTIVE: To evaluate the influence of tumour quadrant localization on the sentinel node (SN) detection and the visualisation of internal mammary chain (IM) drainage by radioisotopic techniques. 316 patients with breast cancer were studied. Mean age 57 years (range 29-88). All patients received 37-74 MBq of 99mTc-albumin nanocolloid in 2 ml by peritumoral injection. The breast cancer was located in the upper outer quadrant in 189 patients, in the upper inner in 57, in the lower outer in 57, in the lower inner in 55 and in the subareolar area in 18 patients. At two hours p.i., anterior and lateral chest lymphographies were obtained. The SN location was marked on the patient skin with permanent ink. SN was identified intraoperatively by the gamma probe. Histopatological analysis included imprints, delayed hematoxilin-eosin, inmunohistochemistry CAM 19-2 and PCR. RESULTS: The scintigraphy and surgical detection was in the upper outer quadrant of 90 % and 93 % respectively; in the lower outer quadrant of 91 % and 95 %, in the upper inner quadrant of 93 % and 95 %, in the lower inner quadrant 87 % and 95 % and in the subareolar area in 94 % and 83 %. The IM chain drainage was of 6 % in the UO, in the LO of 5 %, in the UI of 12 %, in the LI of 20 % and none in subareolar. CONCLUSIONS: Our data suggest that sentinel node location (quadrant) is not a influential factor in the scintigraphy and surgical detection. Tumours localised in internal quadrant show a higher rate of IM chain drainage.