Evaluation of the contribution of the dynamic phase of lymphoscintigraphy to the detection of sentinel lymph node in breast cancer.

AIM: The aim of this study was to evaluate the contribution of an early dynamic phase (DP) of the lymphoscintigraphy (LS) to the detection of the sentinel lymph node (SLN) in breast cancer. METHODS: This prospective study included 164 breast lesions in 161 consecutive patients (160 women, mean age 57.5 years). Patients with tumor >5 cm, multicentric, palpable nodes, axillary involvement, previous surgery, lymphadenectomy, radio or chemotherapy were not included. All patients underwent preoperative LS before surgery. DP immediately after injection of [99mTc]Nanocolloid followed by early and delayed planar images (EPI and DPI) were acquired. RESULTS: SLN was detected in 162/164 lesions (98.8%). In 115 (71%) DP showed no lymph node uptake and the SLN was identified only by EPI and DPI. A focal uptake by at least one lymph node was observed in DP in the remaining 47 lesions (29%). Although in 30/74 lesions DP did not provide additional information to EPI and DPI, nevertheless in 17 cases (10.5%) DP was essential to identify correctly the SLN. CONCLUSION: We concluded that DP, by allowing a better interpretation of the lymphatic drainage pattern, provides unique information to distinguish the correct SLN from other lymph nodes and is recommended as the first part of LS.

Evaluation of the contribution of the dynamic phase of lymphoscintigraphy to the detection of sentinel lymph node in breast cancer.

Aim: The aim of this study was to evaluate the contribution of an early dynamic phase (DP) of the lymphoscintigraphy (LS) to the detection of the sentinel lymph node (SLN) in breast cancer. Methods: This prospective study included 164 breast lesions in 161 consecutive patients (160 women, mean age 57.5 years). Patients with tumor >5 cm, multicentric, palpable nodes, axillary involvement, previous surgery, lymphadenectomy, radio or chemotherapy were not included. All patients underwent preoperative LS before surgery. DP immediately after injection of [99mTc]Nanocolloid followed by early and delayed planar images (EPI and DPI) were acquired. Results: SLN was detected in 162/164 lesions (98.8%). In 115 (71%) DP showed no lymph node uptake and the SLN was identified only by EPI and DPI. A focal uptake by at least one lymph node was observed in DP in the remaining 47 lesions (29%). Although in 30/74 lesions DP did not provide additional information to EPI and DPI, nevertheless in 17 cases (10.5%) DP was essential to identify correctly the SLN. Conclusion: We concluded that DP, by allowing a better interpretation of the lymphatic drainage pattern, provides unique information to distinguish the correct SLN from other lymph nodes and is recommended as the first part of LS.

La neuroimagen molecular en el estudio del deterioro cognitivo: contribución de la SPECT de perfusión cerebral con 99mTc-HMPAO y la 18F-FDG PET/TAC / Molecular neuroimaging in the study of cognitive impairment: contribution of the cerebral blood flow SPECT with 99mTc-HMPAO and 18F-FDG PET/CT scan

Objetivo. Analizar la perfusión cerebral y el metabolismo cerebral de glucosa en el deterioro cognitivo mediante SPECT 99mTc-HMPAO y 18F-FDG PET/TAC. Material y métodos. Se incluyeron 22 pacientes con deterioro cognitivo: 4 quejas subjetivas de memoria (QSM), 8 deterioro cognitivo leve (DCL) amnésico, 5 enfermedad de Alzheimer (EA) prodrómica y 5 EA. Se realizó una comparación visual de la SPECT 99mTc-HMPAO y 18F-FDG PET/TAC en cada grupo clínico. Resultados. La SPECT 99mTc-HMPAO mostró áreas de hipoperfusión en 15 pacientes y fue normal en 7. La 18F-FDG PET/TAC mostró hipometabolismo regional cerebral en 19 pacientes y fue normal en tres. La distribución de las alteraciones en la SPECT 99mTc-HMPAO y en la 18F-FDG PET/TAC fue similar en 9 pacientes (2 QSM, 2 DCL amnésico, 2 EA prodrómica y 3 EA). En 6 pacientes (1 DCL amnésico, 2 EA prodrómica y 3 EA) el hipometabolismo de FDG fue más extenso que la hipoperfusión cerebral. En 4 pacientes (1 QSM, 3 DCL amnésico) la 18F-FDG PET/TAC fue patológica con SPECT 99mTc-HMPAO normal. Ambos estudios fueron normales en tres pacientes (1 QSM, 2 DCL amnésico). Conclusión. La SPECT de perfusión cerebral 99mTc-HMPAO SPECT y la 18F-FDG PET/TAC mostraron alteraciones en la perfusión y en el metabolismo cerebral de pacientes con deterioro cognitivo, incluso en pacientes con QSM. En pacientes con SPECT de perfusión cerebral normal se puede detectar hipometabolismo cerebral de la glucosa. En algunos pacientes la extension del hipometabolismo de la FDG es mayor que la correspondiente área de hipoperfusión(AU)

Objective. The aim of this study was to analyze cerebral perfusion and glucose metabolism in patients with cognitive impairment using cerebral blood flow 99mTc-HMPAO SPECT and 18F-FDG PET/CT scans. Material and methods. Twenty-two patients with cognitive impairment were included: 4 subjective memory complaints (SMC), 8 amnestic mild cognitive impairment (MCI), 5 prodromic Alzheimer's disease (AD) and 5 AD. In each clinical group, 99mTc-HMPAO SPECT and 18F-FDG PET/CT scans were performed. Results. 99mTc-HMPAO SPECT showed regions of cerebral hypoperfusion in 15 patients and was normal in 7 of the 22 patients. 18F-FDG PET/CT scan showed cerebral regional hypometabolism in 19 patients and was normal in the other 3 patients. The distribution of abnormalities on 99mTc-HMPAO SPECT and 18F-FDG PET/CT scans was similar in 9 patients (2 SMC, 2 amnestic MCI, 2 prodromic AD, and 3 AD). In 6 patients (1 amnestic MCI, 2 prodromic AD, and 3 AD), FDG hypometabolism was more extensive than the cerebral hypoperfusion. Four patients (1SMC, 3 amnestic MCI) had an abnormal 18F-FDG PET/CT scan and normal 99mTc-HMPAO SPECT. There were 3 patients (1 SMC 2, amnestic MCI) with normal 99mTc-HMPAO SPECT and 18F-FDG PET/CT scans. Conclusion. 99mTc-HMPAO SPECT and 18F-FDG PET/CT scans showed cerebral hypoperfusion and hypometabolism in patients with cognitive impairment, even in patients with clinical diagnosis of SMC. In patients with a normal cerebral blood flow SPECT, brain glucose cerebral hypometabolism can be detected. In some patients, the extension of FDG hypometabolism is more pronounced than that corresponding to the hypoperfusion area(AU)

[Molecular neuroimaging in the study of cognitive impairment: contribution of the cerebral blood flow SPECT with 99mTc-HMPAO and 18F-FDG PET/CT scan]. / La neuroimagen molecular en el estudio del deterioro cognitivo: contribución de la SPECT de perfusión cerebral con 99mTc-HMPAO y la 18F-FDG PET/TAC.

OBJECTIVE: The aim of this study was to analyze cerebral perfusion and glucose metabolism in patients with cognitive impairment using cerebral blood flow (99m)Tc-HMPAO SPECT and (18)F-FDG PET/CT scans. MATERIAL AND METHODS: Twenty-two patients with cognitive impairment were included: 4 subjective memory complaints (SMC), 8 amnestic mild cognitive impairment (MCI), 5 prodromic Alzheimer's disease (AD) and 5 AD. In each clinical group, (99m)Tc-HMPAO SPECT and (18)F-FDG PET/CT scans were performed. RESULTS: (99m)Tc-HMPAO SPECT showed regions of cerebral hypoperfusion in 15 patients and was normal in 7 of the 22 patients. (18)F-FDG PET/CT scan showed cerebral regional hypometabolism in 19 patients and was normal in the other 3 patients. The distribution of abnormalities on (99m)Tc-HMPAO SPECT and (18)F-FDG PET/CT scans was similar in 9 patients (2 SMC, 2 amnestic MCI, 2 prodromic AD, and 3 AD). In 6 patients (1 amnestic MCI, 2 prodromic AD, and 3 AD), FDG hypometabolism was more extensive than the cerebral hypoperfusion. Four patients (1SMC, 3 amnestic MCI) had an abnormal (18)F-FDG PET/CT scan and normal (99m)Tc-HMPAO SPECT. There were 3 patients (1 SMC 2, amnestic MCI) with normal (99m)Tc-HMPAO SPECT and (18)F-FDG PET/CT scans. CONCLUSION: (99m)Tc-HMPAO SPECT and (18)F-FDG PET/CT scans showed cerebral hypoperfusion and hypometabolism in patients with cognitive impairment, even in patients with clinical diagnosis of SMC. In patients with a normal cerebral blood flow SPECT, brain glucose cerebral hypometabolism can be detected. In some patients, the extension of FDG hypometabolism is more pronounced than that corresponding to the hypoperfusion area.

Evaluación de la gammagrafía ósea y la 18F-FDG PET/TAC en las metástasis óseas del cáncer de pulmón / Evaluation of bone scintigraphy and 18F-FDG PET/CT in bone metastases of lung cancer patients

Objetivo. Comparar los hallazgos de la gammagrafía ósea (GO) y la gammagrafía PET/TAC con FDG (FDG PET/TAC) en la detección de metástasis óseas en el cáncer de pulmón. Material y métodos. Se estudió a 32 pacientes con cáncer de pulmón que fueron sometidos a una GO y una FDG PET/TAC en un periodo de tiempo de 15,9±18,6 días. Los resultados de ambas técnicas se compararon con la histología, cuando estuvo disponible, con técnicas estructurales radiológicas y con el seguimiento clínico. En 30 pacientes se llegó a un diagnóstico definitivo de los hallazgos gammagráficos. En 2 pacientes no se obtuvo diagnóstico final. Resultados. La GO fue positiva en 25/30 pacientes (83,3%) y negativa en 5 pacientes. La FDG PET/TAC fue positiva en 21/30 pacientes (710%) y negativa en 9. La GO y la FDG PET/TAC fueron positivas en 19/30 pacientes (63,3%). En 6 de los 19, ambas técnicas mostraron igual número de lesiones óseas. En 10 de los 19, la FDG PET/TAC mostró mayor número de metástasis óseas que la GO. En 3 de los 19 pacientes la GO mostró más lesiones que la FDG PET/TAC. En 2/30 pacientes (6,6%), la GO fue normal y la FDG PET/TAC demostró lesiones óseas confirmadas como metástasis. En 6/30 pacientes (20%) la FDG PET/TAC fue negativa y la GO positiva. La GO y la FDG PET/TAC fueron normales en 3/30 pacientes (10%). Conclusión. En pacientes con cáncer de pulmón, la FDG PET/TAC detecta un mayor número de lesiones óseas metastásicas que la GO. Asimismo identifica metástasis óseas en GO negativas. En nuestra experiencia, cuando la GO fue positiva y la FDG PET/TAC negativa las lesiones observadas estuvieron en su mayoría relacionadas con procesos óseos degenerativos y fracturas. En la práctica clínica la FDG PET/TAC y la GO tienen un papel complementario en la valoración ósea de los pacientes con cáncer de pulmón(AU)

Objective. To compare the bone scintigraphy (BS) findings and PET/CT scintigraphy with FDG (FDG PET/CT) in the detection of bone metastases in lung cancer. Material and methods. We studied 32 patients with lung cancer who underwent FDG PET/CT and BS in a period of 15.9±18.6 days. The results of both techniques were compared with the histology, where available, radiological structural techniques and the clinical follow-up. In 30 patients, a definitive diagnosis was reached with the scintigraphic findings. No final diagnosis was obtained in 2 patients. Results. BS was positive in 25/30 patients (83.3%) and negative in 5 patients. FDG PET/CT was positive in 21/30 patients (70%) and negative in 9. The BS and the FDG PET/CT were positive in 19/30 patients (63.3%) for the detection of bone metastases. In 6/19, both techniques showed the same number of bone lesions. In 10/19, FDG PET/CT showed a greater number of bone metastases than BS. In 3/19 patients, BS showed more lesions than FDG PET/CT and in 2/30 patients (6.6%), the BS was normal and the FDG PET/CT showed bone lesions which were confirmed as metastasis. In 6/30 patients (20%), the FDG PET/CT was negative and the BS was positive. BS and FDG PET/CT scan were normal in 3/30 patients (10%). Conclusions. In patients with lung cancer, FDG PET/CT scan detected more metastatic bone lesions than BS. It also identified bone metastasis in negative BS. In our experience, when the BS was positive and the FDG PET/CT scan was negative, the lesions observed were mostly related with degenerative bone conditions and bone fractures. In the clinical practice, the FDG PET/CT and BS have a complementary role for the assessment of bone status in lung cancer patients(AU)

[Evaluation of bone scintigraphy and (18)F-FDG PET/CT in bone metastases of lung cancer patients]. / Evaluación de la gammagrafía ósea y la (18)F-FDG PET/TAC en las metástasis óseas del cáncer de pulmón.

OBJECTIVE: To compare the bone scintigraphy (BS) findings and PET/CT scintigraphy with FDG (FDG PET/CT) in the detection of bone metastases in lung cancer. MATERIAL AND METHODS: We studied 32 patients with lung cancer who underwent FDG PET/CT and BS in a period of 15.9±18.6 days. The results of both techniques were compared with the histology, where available, radiological structural techniques and the clinical follow-up. In 30 patients, a definitive diagnosis was reached with the scintigraphic findings. No final diagnosis was obtained in 2 patients. RESULTS: BS was positive in 25/30 patients (83.3%) and negative in 5 patients. FDG PET/CT was positive in 21/30 patients (70%) and negative in 9. The BS and the FDG PET/CT were positive in 19/30 patients (63.3%) for the detection of bone metastases. In 6/19, both techniques showed the same number of bone lesions. In 10/19, FDG PET/CT showed a greater number of bone metastases than BS. In 3/19 patients, BS showed more lesions than FDG PET/CT and in 2/30 patients (6.6%), the BS was normal and the FDG PET/CT showed bone lesions which were confirmed as metastasis. In 6/30 patients (20%), the FDG PET/CT was negative and the BS was positive. BS and FDG PET/CT scan were normal in 3/30 patients (10%). CONCLUSIONS: In patients with lung cancer, FDG PET/CT scan detected more metastatic bone lesions than BS. It also identified bone metastasis in negative BS. In our experience, when the BS was positive and the FDG PET/CT scan was negative, the lesions observed were mostly related with degenerative bone conditions and bone fractures. In the clinical practice, the FDG PET/CT and BS have a complementary role for the assessment of bone status in lung cancer patients.