Detección inesperada de carcinoma ductal infiltrante no palpable de mama con 99mTc-HYNIC-TOC (Tektrotyd®) / Unexpected detection of non-palpable breast ductal invasive carcinoma with 99mTc-HYNIC-TOC (Tektrotyd®)

No disponible

Captación de 18F-florbetapir en un hemangioma intraóseo visualizado en una PET/TC cerebral / 18F-florbetapir uptake in a primary intraosseous haemangioma displayed in a cerebral PET/CT

No disponible

Coexistencia de metástasis óseas por cáncer gástrico y osteopoiquilia diagnosticadas mediante gammagrafía ósea y 18F-FDG PET/TC / Gastric cancer bone metastases together with osteopoikilosis diagnosed using bone scintigraphy and 18F-FDG PET/CT

La coexistencia de distintas alteraciones óseas en un mismo paciente es un hallazgo que plantea un diagnóstico diferencial complejo. Presentamos el caso de una paciente en estudio por una lesión renal, que en la radiografía convencional y en la TC presentó múltiples lesiones esclerosas en columna y extremidades, que se valoraron mediante gammagrafía ósea con 99mTc-HDP y 18F-FDG PET/TC, obteniéndose el diagnóstico definitivo mediante la anatomía patológica de coexistencia de metástasis óseas por cáncer gástrico y osteopoiquilia (OP). Entre las técnicas de imagen realizadas, la gammagrafía aportó el mayor rendimiento diagnóstico por su capacidad de discriminación entre enfermedad ósea benigna y metastásica (AU)

The coexistence of different bone diseases in the same patient involves a complex differential diagnosis. A patient is presented who was studied due to a renal mass that showed many sclerotic lesions in spine and limbs in conventional radiology and CT. These lesions were evaluated with 99mTC-HDP bone scintigraphy and 18F-FDG PET/CT, which helped to obtain the definitive pathological diagnosis of osteopoikilosis (OP) co-existing with gastric cancer bone metastases. Of the different imaging scans performed, bone scintigraphy was particularly relevant due to its ability to discriminate between benign and metastatic bone disease (AU)

Gastric cancer bone metastases together with osteopoikilosis diagnosed using bone scintigraphy and 18F-FDG PET/CT. / Coexistencia de metástasis óseas por cáncer gástrico y osteopoiquilia diagnosticadas mediante gammagrafía ósea y 18F-FDG PET/TC.

The coexistence of different bone diseases in the same patient involves a complex differential diagnosis. A patient is presented who was studied due to a renal mass that showed many sclerotic lesions in spine and limbs in conventional radiology and CT. These lesions were evaluated with 99mTC-HDP bone scintigraphy and 18F-FDG PET/CT, which helped to obtain the definitive pathological diagnosis of osteopoikilosis (OP) co-existing with gastric cancer bone metastases. Of the different imaging scans performed, bone scintigraphy was particularly relevant due to its ability to discriminate between benign and metastatic bone disease.

[Nuclear medicine and radiopharmaceuticals]. / Medicina nuclear y radiofármacos.

Nuclear Medicine is a medical specialty that allows modern diagnostics and treatments using radiopharmaceuticals original radiotracers (drugs linked to a radioactive isotope). In Europe, radiopharmaceuticals are considered a special group of drugs and thus their preparation and use are regulated by a set of policies that have been adopted by individual member countries. The radiopharmaceuticals used in diagnostic examinations are administered in very small doses. So, in general, they have no pharmacological action, side effects or serious adverse reactions. The biggest problem associated with their use are the alterations in their biodistribution that may cause diagnostic errors. Nuclear Medicine is growing considerably influenced by the appearance and development of new radiopharmaceuticals in both the diagnostic and therapeutic fields and primarily to the impact of new multimodality imaging techniques (SPECT-CT, PET-CT, PET-MRI, etc.). It's mandatory to know the limitations of these techniques, distribution and eventual physiological alterations of radiopharmaceuticals, contraindications and adverse reactions of radiological contrasts, and the possible interference of both.

Medicina nuclear y radiofármacos / Nuclear medicine and radiopharmaceuticals

La medicina nuclear es una moderna especialidad médica que permite realizar diagnósticos y tratamientos mediante la utilización de radiofármacos o radiotrazadores (fármacos unidos a un isótopo radioactivo). En Europa los radiofármacos se consideran un grupo especial de medicamentos y, por tanto, su preparación y su uso están regulados por un conjunto de directivas que han sido adoptadas por los distintos países miembros. Los radiofármacos que se emplean en las exploraciones diagnósticas se administran en dosis muy pequeñas por lo que, en general, no tienen ninguna acción farmacológica, ni efectos secundarios, ni reacciones adversas graves. El mayor problema asociado a su utilización son las alteraciones de su biodistribución, lo cual puede condicionar errores diagnósticos. La medicina nuclear está experimentando un notable crecimiento condicionado por la aparición y desarrollo de nuevos radiofármacos, tanto en el campo diagnóstico como en el terapéutico, y fundamentalmente por el impacto de las nuevas técnicas de imagen multimodalidad (SPECT-TC, PET-TC, PET-RM, etc.). Es necesario conocer las limitaciones de estas técnicas, la distribución fisiológica y las posibles alteraciones de los radiofármacos, las contraindicaciones y las reacciones adversas de los contrastes radiológicos, así como la posible interferencia de ambos (AU)

Nuclear Medicine is a medical specialty that allows modern diagnostics and treatments using radiopharmaceuticals original radiotracers (drugs linked to a radioactive isotope). In Europe, radiopharmaceuticals are considered a special group of drugs and thus their preparation and use are regulated by a set of policies that have been adopted by individual member countries. The radiopharmaceuticals used in diagnostic examinations are administered in very small doses. So, in general, they have no pharmacological action, side effects or serious adverse reactions. The biggest problem associated with their use are the alterations in their biodistribution that may cause diagnostic errors. Nuclear Medicine is growing considerably influenced by the appearance and development of new radiopharmaceuticals in both the diagnostic and therapeutic fields and primarily to the impact of new multimodality imaging techniques (SPECT-CT, PET-CT, PET-MRI, etc.). It's mandatory to know the limitations of these techniques, distribution and eventual physiological alterations of radiopharmaceuticals, contraindications and adverse reactions of radiological contrasts, and the possible interference of both (AU)

[The clinical relevance of FDG-PET imaging in severe traumatic brain injuries]. / Relevancia clínica de la FDG-PET en los traumatismos craneoencefálicos graves.

AIM: To evaluate the usefulness of positron emission tomography (PET) as a predictor of long-term disability after a severe traumatic brain injury (TBI). PATIENTS AND METHODS: Fifty-six patients who had sustained a severe TBI were assessed with a broad battery of cognitive and functional scales at baseline and 6-months after inclusion in a multidisciplinary rehabilitation program. All patients underwent a FDG-PET at baseline. A physician blind to clinical data performed a semiquantitative analysis (normal vs altered) of functional neuroimaging (PET), including four cortical and three subcortical areas. The total number of lesions (cortical, subcortical and total) was correlated to the intensity of the TBI and to clinical data at admission and at follow-up. RESULTS: All patients showed changes in cerebral metabolism, being the thalamus the area most frequently affected. The degree of cerebral hypometabolism showed a significant correlation with TBI severity, functional disability, global outcome and cognitive impairment not only at baseline but also at follow-up. CONCLUSIONS: According to our results, FDG-PET may be a useful tool when studying brain dysfunction after severe TBI. FDG-PET findings correlate with the TBI severity, and with the level of patients' disability, as well as with the degree of memory and intelligence impairment. However, clinical variables related to the severity of the TBI, still are the best predictors of functional outcome after TBI.

Relevancia clínica de la FDG-PET en los traumatismos craneoencefálicos graves / The clinical relevance of FDG-PET imaging in severe traumatic brain injuries

Resumen. Objetivo. Demostrar la utilidad de la tomografía por emisión de positrones (PET) como predictor de la discapacidad a largo plazo tras un traumatismo craneoencefálico (TCE). Pacientes y métodos. Se evaluó neuropsicológica y funcionalmente a 56 pacientes que habían sufrido un TCE grave al inicio y aproximadamente seis meses después de su inclusión en un programa de rehabilitación multidisciplinar. A todos los pacientes se les realizó una tomografía por emisión de positrones con fluordeoxiglucosa al inicio del tratamiento. De forma ciega, se determinó la presencia o ausencia de alteraciones en cuatro áreas corticales y tres subcorticales, y se determinaron tres índices cualitativos de metabolismo cerebral (cortical, subcortical y total). Los índices de metabolismo se correlacionaron con las variables relacionadas con la gravedad del traumatismo, y con la situación cognitiva y funcional de los pacientes en el momento de realizar la PET y al finalizar el programa de rehabilitación. Resultados. Todos los pacientes mostraron alteraciones en el metabolismo cerebral, y el tálamo fue el área más frecuentemente afectada. La intensidad del hipometabolismo cerebral se correlacionó significativamente con la gravedad del TCE y con la alteración cognitiva y funcional tanto al inicio como al final del tratamiento. Conclusiones. Las técnicas de neuroimagen funcional presentan una excelente sensibilidad para detectar alteraciones tras un TCE, además de ofrecer una buena correlación anatomoclínica. No obstante, las variables relacionadas con la gravedad del TCE, siguen siendo las mejores predictoras de la discapacidad resultante tras un TCE (AU)

Summary. Aim. To evaluate the usefulness of positron emission tomography (PET) as a predictor of long-term disability after a severe traumatic brain injury (TBI). Patients and methods. Fifty-six patients who had sustained a severe TBI were assessed with a broad battery of cognitive and functional scales at baseline and 6-months after inclusion in a multidisciplinary rehabilitation program. All patients underwent a FDG-PET at baseline. A physician blind to clinical data performed a semiquantitative analysis (normal vs altered) of functional neuroimaging (PET), including four cortical and three subcortical areas. The total number of lesions (cortical, subcortical and total) was correlated to the intensity of the TBI and to clinical data at admission and at follow-up. Results. All patients showed changes in cerebral metabolism, being the thalamus the area most frequently affected. The degree of cerebral hypometabolism showed a significant correlation with TBI severity, functional disability, global outcome and cognitive impairment not only at baseline but also at follow-up. Conclusions. According to our results, FDG-PET may be a useful tool when studying brain dysfunction after severe TBI. FDG-PET findings correlate with the TBI severity, and with the level of patients’ disability, as well as with the degree of memory and intelligence impairment. However, clinical variables related to the severity of the TBI, still are the best predictors of functional outcome after TBI (AU)

¿Es la adenomastectomía una alternativa a la mastectomía total en el carcinoma ductal in situ no tributario de tratamiento conservador? / No disponible

Se estudia la adenomastectomía (ADM) como alternativaterapéutica a la mastectomía simple en carcinoma ductal insitu (CDIS).Ochenta y dos pacientes diagnosticadas de CDIS con indicaciónde mastectomía, han sido tratadas con ADM y reconstruccióninmediata. Con una mediana de seguimiento de86,33 meses, se han diagnosticado 8 recidivas.La ADM puede ser una opción menos agresiva y estéticamentemejor aceptada en los casos de CDIS, con una tasa derecaídas locales intermedia entre la de la mastectomía simple yel tratamiento conservador(AU)

Subcutaneous mastectomy has been studied as an alternativesurgical treatment to conventional total mastectomy in thosepatients, diagnosed of ductal carcinoma in situ (DCIS). Subcutaneousmastectomy has been performed in 82 women withimmediate reconstruction. With a median follow-up of 86,3months, 8 recurrences have been diagnosed.Subcutaneous mastectomy may be a good and acceptedtreatment option in cases were radical surgery is needed withan intermediate local failure rate(AU)

Carcinoma bronquioloalveolar como causa potencial de falso negativo con PET-FDG / Bronchioloalveolar carcinoma as potencial cause of false negative with PET-FDG

No disponible

[Lympho-gammagraphy and study of sentinel node in cutaneous melanoma]. / Linfogammagrafía y estudio del ganglio centinela en el melanoma cutáneo.

OBJECTIVE: To evaluate the role of selective sentinel lymph node dissection to reduce the number of unnecessary lymphadenectomies in patients with intermediate risk of melanoma and without clinical evidence of regional node and distant metastases. MATERIAL AND METHOD: We studied 65 patients with stage I and II melanoma. Only vital blue dye mapping was carried out in nine patients and combined lymphatic mapping with both blue dye and lymphoscintigraphy was used in the remaining 56 patients. RESULTS: The sentinel node was identified in 63 of 65 patients (97%). Only eighth patients (12%) were found to have metastatic melanoma cells in their sentinel node. CONCLUSIONS: Our findings confirm that the intraoperative lymphatic mapping of the sentinel node using both blue dye and radiodetection is an appropriate and simple technique for selecting patients who are more likely to benefit from lymph node dissection.

Linfogammagrafía y estudio del ganglio centinela en el melanoma cutáneo / Lymphogammagraphy and study of sentinel node in cutaneous melanoma

Objetivo: Valorar el papel de la disección selectiva del ganglio centinela para reducir el número de linfadenectomías innecesarias en pacientes con melanoma de riesgo intermedio y sin evidencia clínica de adenopatías regionales ni metástasis a distancia. Material y método: Hemos estudiado 65 pacientes con Melanoma estadios I y II. Se usó solo la técnica del azul vital en nueve pacientes; en los restantes 56 se combinó en la detección linfática, el azul vital y la linfogammagrafía. Resultados: El ganglio centinela fue identificado en 63 de 65 pacientes (97 por ciento). Solamente en ocho enfermos (12 por ciento) se encontró afectación metastásica por M.M. en el ganglio centinela. Conclusiones: Nuestros hallazgos confirman que la detección linfática intraoperatoria del ganglio centinela, usando el colorante azul y la radiodetección, es una técnica apropiada y sencilla para seleccionar los pacientes que más se beneficiaran de la disección del ganglio linfático (AU)

Rhabdomyolysis in DOMS.

A 26-year-old man with a previous history of external twin bursitis was remitted to our Department for a bone scintigraphy. Before the study, the patient performed an elevated number of intense sprints. Bone scintigraphy showed a bilaterally increased activity in both anterior rectum muscles suggesting rhabdomyolysis. Biochemical studies and MRT confirmed the diagnosis.

Cold metastases detected by bone scintigraphy in aggressive lung cancer.

A case of a 55-year-old man was remitted to Traumatology Department to present back pain of two weeks of evolution. The results of bone scintigraphy and the patient's evolution allowed the diagnosis. This case report and a literature review showed the importance of using a routine bone scan in diagnosis of bone metastases.