Assuntos
Carcinoma/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Compostos Radiofarmacêuticos/farmacocinética , Medronato de Tecnécio Tc 99m/análogos & derivados , Idoso , Biomarcadores Tumorais/análise , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Carcinoma/secundário , Carcinoma Broncogênico/química , Feminino , Hepatomegalia/diagnóstico por imagem , Hepatomegalia/etiologia , Humanos , Neoplasias Hepáticas/química , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Primárias Desconhecidas , Células Neoplásicas Circulantes , Tumores Neuroendócrinos/química , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/secundário , Cintilografia , Medronato de Tecnécio Tc 99m/farmacocinéticaAssuntos
Humanos , Feminino , Adulto , Síndrome de Cushing/diagnóstico , Síndrome de ACTH Ectópico/diagnóstico , Síndrome de ACTH Ectópico , Hormônio Adrenocorticotrópico , /instrumentação , /métodos , Medicina Nuclear/métodos , Somatostatina , Gadolínio DTPA , Síndrome de Cushing , Neoplasias Pulmonares , Síndrome de Cushing/complicaçõesAssuntos
Síndrome de ACTH Ectópico/complicações , Síndrome de ACTH Ectópico/diagnóstico por imagem , Tumor Carcinoide/diagnóstico por imagem , Tumor Carcinoide/metabolismo , Síndrome de Cushing/etiologia , Radioisótopos de Índio , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/metabolismo , Ácido Pentético/análogos & derivados , Adulto , Feminino , Humanos , Cintilografia , Receptores de Somatostatina/biossínteseAssuntos
Tumor Carcinoide/secundário , Neoplasias Cardíacas/secundário , Neoplasias do Íleo/patologia , Imagem Multimodal , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Idoso , Tumor Carcinoide/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Humanos , Radioisótopos de Índio , Fígado/diagnóstico por imagem , Masculino , Compostos Radiofarmacêuticos , Somatostatina/análogos & derivadosAssuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/diagnóstico por imagem , Conservadores da Densidade Óssea/efeitos adversos , Neoplasias Ósseas/secundário , Neoplasias da Mama/complicações , Carcinoma/secundário , Difosfonatos/efeitos adversos , Imidazóis/efeitos adversos , Doenças Mandibulares/diagnóstico por imagem , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/etiologia , Conservadores da Densidade Óssea/uso terapêutico , Doenças Ósseas Metabólicas/prevenção & controle , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/tratamento farmacológico , Neoplasias da Mama/cirurgia , Carcinoma/diagnóstico por imagem , Diagnóstico Diferencial , Difosfonatos/uso terapêutico , Feminino , Humanos , Imidazóis/uso terapêutico , Doenças Mandibulares/induzido quimicamente , Neoplasias Mandibulares/secundário , Pessoa de Meia-Idade , Osteoartrite/complicações , Osteoartrite/diagnóstico por imagem , Cintilografia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/tratamento farmacológico , Neoplasias da Coluna Vertebral/secundário , Vértebras Torácicas/diagnóstico por imagem , Ácido ZoledrônicoRESUMO
OBJECTIVE: The aim of this study is to compare several uptake indexes between specific and non-specific activity to determine the existence of degenerative Parkinsonism according to different reference areas. MATERIAL AND METHODS: A total of 46 patients (23 men and 23 women), randomly selected from individuals referred to our center with a movement disorder, were included in the study. Mean age was 70.2 ± 10.2 years (41-87). The uptake indexes were obtained through the areas of interest (ROIs) located in the striate (specific uptake) and other reference ROIs located in areas with different concentrations of serotonin receptors: low-cerebellum, medium-occipital cortex and high-midbrain. RESULTS: A high linear correlation was found between indexes having low and medium concentration of serotonin receptors. The ROC curve analysis shows an area under the curve of 0.874, 0.886 and 0.739 and regression coefficients of 5.41, 6.62 and 3.41, respectively for the striatum/cerebellum (E/C), striatum/occipital (E/O) and striatum midbrain (E/M) indexes. Optimal cutoff for E/O (1.35), index with the best behavior, provides a sensitivity of 0.84 and specificity of 0.89. CONCLUSION: The reference area selected may alter the predictive power of the different indexes to determine the existence of a degenerative Parkinsonism.
Assuntos
Encéfalo/diagnóstico por imagem , Radioisótopos de Carbono , Radioisótopos do Iodo , Transtornos Parkinsonianos/diagnóstico por imagem , Compostos Radiofarmacêuticos , Tomografia Computadorizada de Emissão de Fóton Único , Tropanos , Adulto , Idoso , Idoso de 80 Anos ou mais , Radioisótopos de Carbono/farmacocinética , Cerebelo/química , Cerebelo/diagnóstico por imagem , Corpo Estriado/química , Feminino , Humanos , Radioisótopos do Iodo/farmacocinética , Masculino , Mesencéfalo/química , Pessoa de Meia-Idade , Degeneração Neural/diagnóstico por imagem , Especificidade de Órgãos , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson Secundária/diagnóstico por imagem , Valor Preditivo dos Testes , Curva ROC , Compostos Radiofarmacêuticos/farmacocinética , Receptores de Serotonina/análise , Estudos Retrospectivos , Estudos de Amostragem , Sensibilidade e Especificidade , Distribuição Tecidual , Tropanos/farmacocinéticaRESUMO
OBJECTIVE: To determine the diagnostic accuracy of FP-CIT SPECT in entities with and without presynaptic involvement of the nigral-striatal dopaminergic pathway in a large group of patients with movement disorders, evaluating the usefulness of quantitative analysis. MATERIALS AND METHODS: A group of 183 consecutive patients clinically diagnosed as either having or not having degenerative Parkinsonism. These results were then contrasted with those of FP-CIT SPECT to determine the diagnostic accuracy of the procedure. The specific binding index was evaluated with ROC curves. RESULTS: FP-CIT SPECT was highly accurate in the diagnosis of neurodegenerative Parkinsonism (sensitivity: 95 %, specificity: 90 %). Most of the false positive results arose in patients with vascular Parkinsonism and the false negative results in patients with Parkinson disease. ROC curve analysis of semiquantitative evaluation had a sensitivity of 83 % and specificity of 82 % with an optimal cut-off of 1.44. The area under the curve was not significantly different between patients = 60 and > 60 years (0.899 vs 0.884) of age. CONCLUSIONS: FP-CIT SPECT has a high degree of diagnostic accuracy for striatal dopaminergic involvement. No significant changes in diagnostic accuracy were seen with respect to patient age.
Assuntos
Encéfalo/diagnóstico por imagem , Radioisótopos do Iodo , Transtornos Parkinsonianos/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Tropanos , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos TestesRESUMO
Vascular parkinsonism is the second cause of secondary parkinsonism, and can cause a complex clinical syndrome. In spite of this, it is not common to find an isolated vascular injury in the mesencephalic region, and even rarer for it to give rise to clinical parkinsonism. We present the case of a young patient who developed left hemiparkinsonism with a fluctuating clinical evolution and unpredictable response to the treatment after suffering right mesencephalic bleeding. Structural and functional neuroimaging techniques showed injury on the mesencephalic level and no uptake in the right striatal region, respectively.
Assuntos
Hemorragias Intracranianas/complicações , Mesencéfalo/patologia , Doença de Parkinson Secundária/etiologia , Adulto , Humanos , Hemorragias Intracranianas/patologia , Imageamento por Ressonância Magnética , Mesencéfalo/metabolismo , Doença de Parkinson Secundária/patologia , Córtex Visual/metabolismo , Córtex Visual/patologiaAssuntos
Neoplasias Ósseas/secundário , Diagnóstico por Imagem/métodos , Neoplasias Ósseas/complicações , Neoplasias Ósseas/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Osteólise/diagnóstico por imagem , Osteólise/etiologia , Tomografia Computadorizada de Emissão , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To evaluate diagnostic efficacy of rest myocardial perfusion scintigraphy in the detection of acute coronary syndrome in patients with chest pain and non diagnostic electrocardiogram, comparing it with reference techniques, in Emergency Department. MATERIAL AND METHODS: Myocardial perfusion scintigraphy was carried out in 40 patients with those defined characteristics in the Emergency Department, administering the radiopharmaceutical in the next 6 hours after the pain was over. All subjects followed routine diagnostic and treatment management. Final diagnosis of coronary disease was established by coronariography and/or stress perfusion myocardial scintigraphy. Patients were followed up for 9-12 months. RESULTS: Myocardial perfusion scintigraphy showed a negative predictive value of 96,15 % (CI 95 %: 86.84-100.00). The main limitation of its application was breast and diaphragmatic attenuation phenomenon, given that correction algorithms were not available. Global kappa coefficient was 0.78 when to compared interobserver agreement. CONCLUSION: Rest myocardial perfusion scintigraphy is a safe and efficient test in the screening of patients with chest pain suggestive of angor with non-diagnostic ECG in Emergency Department, and also provides prognostic information and risk stratification.
Assuntos
Angina Instável/diagnóstico por imagem , Dor no Peito/diagnóstico por imagem , Serviço Hospitalar de Emergência , Coração/diagnóstico por imagem , Infarto do Miocárdio/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Doença Aguda , Angina Instável/sangue , Angina Instável/complicações , Fibrilação Atrial/diagnóstico por imagem , Biomarcadores , Dor no Peito/etiologia , Angiografia Coronária , Estudos Transversais , Diagnóstico Diferencial , Eletrocardiografia , Teste de Esforço , Feminino , Humanos , Hipertensão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/complicações , Valor Preditivo dos Testes , Compostos Radiofarmacêuticos/uso terapêutico , Descanso , Tecnécio Tc 99m Sestamibi , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Troponina/sangueRESUMO
Objetivo. Evaluar la validez diagnóstica de la gammagrafía de perfusión miocárdica precoz en reposo para la detección de síndrome coronario agudo en pacientes con dolor torácico y electrocardiograma no diagnóstico, comparándola con las técnicas de referencia. Material y métodos. Se realizó una gammagrafía de perfusión miocárdica en 40 de estos pacientes atendidos en el servicio de urgencias, inyectando el radiofármaco en las primeras seis horas tras la finalización del dolor. Todos los sujetos siguieron su curso diagnóstico y terapéutico de rutina. El diagnóstico final de enfermedad coronaria se estableció mediante coronariografía y/o gammagrafía de esfuerzo. Se realizó un tiempo de seguimiento clínico de todos los pacientes entre 9-12 meses. Resultados. El valor predictivo negativo de la gammagrafía de perfusión miocárdica fue del 96,15 % (IC 95 %: 86,84-100,00 %). La principal limitación de su aplicación fue el fenómeno de atenuación mamaria y diafragmática, al no disponer de algoritmos de corrección de atenuación. El índice global de kappa obtenido para valorar la concordancia interobservadores fue del 0,78. Conclusiones. La gammagrafía de perfusión miocárdica en reposo es una técnica eficiente y segura para el screening en urgencias de pacientes con dolor torácico sugestivo de ángor con electrocardiograma normal o no diagnóstico, y proporciona además información pronóstica y estratificación del riesgo
Objective. To evaluate diagnostic efficacy of rest myocardial perfusion scintigraphy in the detection of acute coronary syndrome in patients with chest pain and non diagnostic electrocardiogram, comparing it with reference techniques, in Emergency Department. Material and methods. Myocardial perfusion scintigraphy was carried out in 40 patients with those defined characteristics in the Emergency Department, administering the radiopharmaceutical in the next 6 hours after the pain was over. All subjects followed routine diagnostic and treatment management. Final diagnosis of coronary disease was established by coronariography and/or stress perfusion myocardial scintigraphy. Patients were followed up for 9-12 months. Results. Myocardial perfusion scintigraphy showed a negative predictive value of 96,15 % (CI 95 %: 86.84-100.00). The main limitation of its application was breast and diaphragmatic attenuation phenomenon, given that correction algorithms were not available. Global kappa coefficient was 0.78 when to compared interobserver agreement. Conclusion. Rest myocardial perfusion scintigraphy is a safe and efficient test in the screening of patients with chest pain suggestive of angor with non-diagnostic ECG in Emergency Department, and also provides prognostic information and risk stratification
Assuntos
Pessoa de Meia-Idade , Humanos , Angina Instável , Dor no Peito , Serviço Hospitalar de Emergência , Coração , Infarto do Miocárdio , Angina Instável/sangue , Angina Instável/complicações , Fibrilação Atrial , Biomarcadores , Dor no Peito/etiologia , Angiografia Coronária , Eletrocardiografia , Hipertensão , Infarto do Miocárdio/sangue , Infarto do Miocárdio/complicações , Tomografia Computadorizada de Emissão de Fóton Único/métodosRESUMO
OBJECTIVE: To determine diagnostic accuracy of FP-CIT SPECT in a subgroup of patients who clinically present nonconclusive or atypical characteristics of parkinsonism (Clinically Uncertain Parkinsonian Syndromes, CUPS), and assess the contribution of the quantitative analysis in this group of patients. PATIENTS AND METHODS: We included 54 patients who make up the CUPS group. After a variable follow-up period, we evaluated the existence of a degenerative parkinsonism and compared it with the result of the FP-CIT SPECT, establishing the diagnostic accuracy of this procedure in the CUPS patient group. RESULTS: We obtained a high diagnostic accuracy of neurodegenerative Parkinsonism in the CUPS patient group (sensitivity: 85%; specificity: 93%). False positive results were obtained in patients with vascular parkinsonism and most of the false negative results in patients with Parkinson's disease. The quantitative evaluation did not contribute data of relevance to the qualitative evaluation. CONCLUSIONS: FP-CIT SPECT makes it possible to show the involvement of nigrostriatal dopaminergic pathway, also contributing with information of relevance to the clinician about the etiology of the extrapyramidal symptomatology in patients with nonconclusive signs and symptoms of the existence of a Parkinsonism.
Assuntos
Doença de Parkinson/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Adulto , Idoso , Idoso de 80 Anos ou mais , Encéfalo/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Compostos Radiofarmacêuticos , Sensibilidade e Especificidade , TropanosRESUMO
INTRODUCTION: 123I-FP-CIT scan has been supported in the last years by numerous studies as a technique of undeniable value to assess presynaptic integrity of the nigrostriatal pathway. The objective of this study is to perform a descriptive analysis of the main diagnostic aspects obtained from the first 110 studies made with FP-CIT in our center. MATERIAL AND METHODS: The study population consisted of 110 consecutive patients distributed into 5 groups according to the clinical diagnosis, after a follow-up period of at least one year. Qualitative and quantitative scintigraphy was done. RESULTS: A total of 61.8 % (68/110) of the studies were considered abnormal and 38.2 % (42/110) as normal. Among the abnormal examinations there was 88.3 % (60/68) agreement with the clinical diagnosis and agreement was 83.4 % (35/42) in the normal examinations. Inverse significant correlation was assessed between striatal binding and severity according to the H and Y scale (r = -0.4) and between qualitative and quantitative assessment (r = -0.86). There was no significant correlation between the degeneration of dopaminergic function according to age and degree of asymmetry on striatal binding in the different groups. CONCLUSIONS: Generally an adequate agreement between clinical diagnosis and SPECT-FP-CIT was observed. Inverse correlation between striatal binding and H and Y scale and greater asymmetry at striatal binding was obtained among Parkinson patients than in the rest of groups.
Assuntos
Corpo Estriado/diagnóstico por imagem , Radioisótopos do Iodo , Doença de Parkinson/diagnóstico por imagem , Compostos Radiofarmacêuticos , Tomografia Computadorizada de Emissão de Fóton Único , Tropanos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças dos Gânglios da Base/diagnóstico por imagem , Corpo Estriado/metabolismo , Dopamina/metabolismo , Proteínas da Membrana Plasmática de Transporte de Dopamina , Feminino , Seguimentos , Humanos , Doença por Corpos de Lewy/diagnóstico por imagem , Masculino , Glicoproteínas de Membrana/metabolismo , Proteínas de Membrana Transportadoras/metabolismo , Pessoa de Meia-Idade , Proteínas do Tecido Nervoso/metabolismo , Doença de Parkinson/metabolismo , Doença de Parkinson Secundária/diagnóstico por imagem , Exame Físico , Paralisia Supranuclear Progressiva/diagnóstico por imagemRESUMO
The term splenosis, first used in the medical literature in 1939, refers to the autotransplantation of splenic tissue in a heterotopic location. We report the case of a known hepatitis C carrier in whom computed tomography scanning revealed a hepatic lesion suggestive of hepatocarcinoma. Magnetic Resonance imaging was performed for suspected hepatic splenosis, which was confirmed by Tc-99m labeled heat-denatured red blood cell scintigraphy. In addition to confirming the suspected diagnosis, this technique showed several pathological foci in distinct abdominal locations compatible with splenosis that had not previously been identified.
Assuntos
Eritrócitos/diagnóstico por imagem , Fígado , Esplenose/diagnóstico por imagem , Tecnécio , Humanos , Masculino , CintilografiaRESUMO
OBJECTIVES: To describe the preliminary results of the application of this new technique in the diagnostic protocol in the management of differentiated thyroid cancer (DTC). MATERIAL AND METHODS: 131I Whole body scan (WBS) was made under rhTSH stimulation in a group of 102 patients with DTC in follow-up, all treated by means of total thyroidectomy. The administration guideline was a dose of 0.9 mg of rhTSH (intramuscular) for two consecutive days, followed by oral activity of 185 MBq of 131I 24 hours after the last rhTSH injection, and later scintigraphic scan after 48 hours of the administration of 131I. Serum samples for TSH, thyroglobulin and antithyroglobulin antibodies determination were collected at 24 and 72 hours of the last administration of the rhTSH. Measures were made by means of immunometric assays. RESULTS: TSH values at 24 hours after exogenous stimulation were 147.54 +/- 46.46 mIU/l. In 62 patients values of negative Tg were obtained (< 1 ng/ml), 50 of which presented negative WBS and 12 positive. 37 patients had positive Tg, 17 of whom presented negative WBS (confirming presence of disease in 7 patient by means of other imaging techniques) and 20 positive. CONCLUSIONS: In every case, administration of rhTSH produced a significant increase of the TSH, making it possible to perform the usual controls of patient management (determination of serum Tg and WBS), similarly to the hormone withdrawal situation. There is no evidence of significant side effects, and its use makes it possible to avoid disadvantages derived from the hormonal withdrawal, maintaining a good quality of life in patients.
Assuntos
Adenocarcinoma Folicular/secundário , Biomarcadores Tumorais/sangue , Carcinoma Papilar/secundário , Recidiva Local de Neoplasia/diagnóstico por imagem , Tireoglobulina/sangue , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Tireotropina , Contagem Corporal Total/métodos , Adenocarcinoma Folicular/diagnóstico por imagem , Adenocarcinoma Folicular/cirurgia , Adolescente , Adulto , Idoso , Autoanticorpos/sangue , Carcinoma Papilar/diagnóstico por imagem , Carcinoma Papilar/cirurgia , Feminino , Seguimentos , Terapia de Reposição Hormonal , Humanos , Hipotireoidismo/etiologia , Hipotireoidismo/prevenção & controle , Radioisótopos do Iodo , Metástase Linfática/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Cintilografia , Proteínas Recombinantes/sangue , Estimulação Química , Síndrome de Abstinência a Substâncias/etiologia , Síndrome de Abstinência a Substâncias/prevenção & controle , Hormônios Tireóideos/administração & dosagem , Hormônios Tireóideos/uso terapêutico , Tireoidectomia , Tireotropina/sangueRESUMO
OBJECTIVE: This study was designed to assess the diagnostic accuracy of single photon emission computed tomography with Tl-201 (SPECT Tl-201) to establish the tumoral or non-tumoral nature of brain space occupying lesions in comparison with usual diagnostic techniques. MATERIAL AND METHODS: The study population consisted of 37 patients, 24 men (64.9 %) and 13 women (35.1 %), mean age 48 +/- 16 years. After establishing the clinical and radiological diagnosis of brain lesion, all patients underwent SPECT Tl-201, evaluating it only by subjective analysis and blinded to neuroestructural techniques. After surgical resection all patients were evaluated anatomopathologically to establish the histologic nature. RESULTS: The sensitivity of SPECT Tl-201 (0.87) was higher than standard neuroimaging techniques (0.78). Specificity (0.43), positive (0.87) and negative (0.43) predictive values of SPECT were similar to neuroestructural procedures (MRI and CT scan) with 0.43, 0.82 and 0.38 values. Tumoral disease prevalence was 0.81. Neuroestructural procedures were non-conclusive in 18.9 % of the studies. No non-conclusive results were obtained with SPECT Tl-201. CONCLUSIONS: SPECT Tl-201 is a diagnostic procedure of high sensitivity to establish the tumoral nature of brain lesions, with poor specificity, similar to structural X-ray techniques.