XXXV Congreso de la SEMNIM. Conferencia Resumen / XXXV Congress of the SEMNIM. Highlights

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Rentabilidad diagnóstica de los estudios PET/TC basal y de seguimiento en la terapia ablativa del cáncer de pulmón de células no pequeñas / Diagnostic yield of baseline and follow-up PET/CT studies in ablative therapy for non-small cell lung cancer

Aunque con efectividad probada, las técnicas de ablación por radiofrecuencia y microondas presentan un elevado índice de respuestas parciales. Es imprescindible contar con estudios diagnósticos que se anticipen a los cambios morfológicos para una detección más temprana del tejido tumoral residual viable o de recurrencias locales para determinar los pacientes que serán beneficiados de un nuevo tratamiento. Determinamos mediante nuestro estudio la rentabilidad diagnóstica de los estudios de PET/CT basal y de seguimiento y el tiempo adecuado entre estos y la intervención por ablación. Incluimos 7 pacientes con lesión tumoral única con un total de 8 ablaciones. Hemos realizado estudios CT y PET/CT basales y de seguimiento tras ablación. Los tiempos medios entre estudios PET basales y de seguimiento y la terapia ablativa fueron 1,8 y 3,4 meses respectivamente. Las cuentas medias en actividades metabólicas de los PET basales y de seguimiento han sido de 7,6 y 4,3g/ml de SUVmax respectivamente. La técnica de Dual Time Point ayudó en 3 casos a identificar tejido viable tras ablación. Los estudios de seguimiento PET/CT han condicionado las diversas estrategias terapéuticas adoptadas por los oncólogos clínicos. El alto rendimiento del estudio PET/CT incluyendo la técnica de Dual Time Point puede plantearse como estudio de sustitución de los CT con CIV basales y de seguimiento previo y posterior al tratamiento con ARF o AMO logrando reducir de manera considerable la exposición a altas cifras de radiación. Proponemos realizar el primer estudio PET/CT de seguimiento a los 3 meses de realizada la ARF o AMO(AU)

Although they have proven effectiveness, radiofrequency and microwave ablation techniques have a high rate of partial responses. Diagnostic studies that anticipate the changes in morphology are essential for earlier detection of residual viable tumor tissue or local recurrences to identify patients who will benefit from a new treatment. Our study has determined the diagnostic yield of PET/CT studies at baseline and follow-up and adequate time between them and the ablation intervention. Seven patients with single tumor lesion with a total of 8 ablations were included. CT and PET/CT studies were performed at baseline and follow-up after ablation. Average times between PET studies at baseline and follow-up and the ablative therapy were 1.8 and 3.4 months, respectively. Mean scores in metabolic activities of the PET at baseline and follow-up were 7.6 and 4.3g/ml of SUVmax, respectively. The Dual Time Point technique helped to identify viable tissue after ablation in 3 cases. Follow-up PET/CT studies have conditioned the various treatment strategies adopted by clinical oncologists. The high yield of the PET/CT study including the Dual Time Point technique may be considered as a study replacement of initial and follow-up Contrast-Enhanced CT before and after treatment with RFA and AMO, this achieving considerable reduction in the exposure to high radiation levels. We propose conducting the first PET/CT follow-up study at 3 months of the RFA and AMO(AU)

18F-FDG-PET/TC en linfoma: dos décadas de experiencia / 18F-FDG-PET/CT in lymphoma: two decades of experience

El uso del 18F-FDG-PET/TC ha introducido cambios relevantes en el manejo de los pacientes con linfoma en las últimas dos décadas. Esta técnica de imagen funcional permite mejorar la estadificación inicial de la enfermedad, realizar una aproximación pronóstica y planificar un tratamiento adecuado, monitorizar la respuesta a las terapias instauradas y hacer un seguimiento para el diagnóstico de recidiva y reestadificación del linfoma. Sin embargo, aún existen controversias sobre el tema en la literatura médica que repercuten en la práctica diaria. Esta profunda revisión bibliográfica resume la información actual sobre el uso potencial de 18F-FDG-PET/TC en pacientes con linfoma, destacando sus principales aplicaciones y los dilemas que se presentan al evaluar este tipo de estudios, intentando estandarizar criterios para su valoración, particularmente en la reestadificación y monitorización de la terapia(AU)

The use of 18F-FDG-PET/CT has changed the management of patients with lymphoma for the last two decades. This technique improves initial staging of the disease, making a prognostic approach and appropriate treatment planning, as well as monitoring therapy response of lymphoma. However, there are still controversial issues in medical literature that impact on daily clinical practice. This comprehensive literature review summarizes the current information regarding the potential use of 18F-FDG-PET/CT in patients with lymphoma, highlighting the main applications and the current dilemmas for the nuclear medicine physicians at the time of the evaluation of these studies, trying to standardize criteria for its assessment, particularly in restaging and therapy monitoring(AU)

18F-FDG-PET/CT in lymphoma: two decades of experience.

The use of (18)F-FDG-PET/CT has changed the management of patients with lymphoma for the last two decades. This technique improves initial staging of the disease, making a prognostic approach and appropriate treatment planning, as well as monitoring therapy response of lymphoma. However, there are still controversial issues in medical literature that impact on daily clinical practice. This comprehensive literature review summarizes the current information regarding the potential use of (18)F-FDG-PET/CT in patients with lymphoma, highlighting the main applications and the current dilemmas for the nuclear medicine physicians at the time of the evaluation of these studies, trying to standardize criteria for its assessment, particularly in restaging and therapy monitoring.

[Clinical utility of (18)F-DOPA-PET in movement disorders. A systematic review]. / Utilidad clínica de la (18)FDOPA-PET en trastornos del movimiento. Una revisión sistemática.

INTRODUCTION: (18)F-fluorodopa ((18)F-DOPA) is a functional tracer of presynaptic dopaminergic neuron terminations in the nigrostriatal system. This review is aimed to assess the efficacy of (18)F-DOPA-PET in the diagnosis and evaluation of the progression of Parkinson's Disease (PD) and in the differential diagnosis with other Parkinsonism Syndromes. METHODS: A review was made of the literature by searching six databases and selecting the most relevant articles according to strict inclusion and exclusion criteria. The study data were systematically extracted and included in evidence tables. RESULTS: Of the 1478 registries recovered through the search of the literature, 48 studies were extracted. Of these, only 13 were included in the systematic review. It was observed in all of them that PD is manifested by a lower striatal uptake of (18)F-DOPA, especially in the putamen with posterior predominance. Prospective studies have shown that there is loss of uptake with disease progression. One article described regional differences in (18)F-DOPA striatal pattern between PD, multisystem atrophy (MSA) and progressive supranuclear palsy (PSP). Cognitive impairment in PD seems to be related with (18)F-DOPA abnormal uptake in some regions of frontal cortex and caudate nucleus. CONCLUSION: (18)F-DOPA-PET seems to be useful for the diagnosis and evaluation of PD progression. However, the evidence is not conclusive regarding its utility in the differential diagnosis with other Parkinsonism Syndromes and in the differentiation between ex novo and advanced PD.

Utilidad clínica de la 18FDOPA-PET en trastornos del movimiento. Una revisión sistemática / Clinical utility of 18F-DOPA-PET in movement disorders. A systematic review

Introducción: El radiofármaco 18F-fluorodopa (18FDOPA) es un marcador de la funcionalidad de las terminaciones neuronales dopaminérgicas presinápticas del sistema nigroestriado. El objetivo de esta revisión es determinar la eficacia del 18FDOPA en el diagnóstico y valoración de la progresión de la enfermedad de Parkinson (EP), así como en el diagnóstico diferencial con otros síndromes parkinsonianos. Métodos: Revisión de la literatura consultando seis bases de datos y seleccionando los artículos más relevantes según unos estrictos criterios de inclusión y exclusión. Los datos de los estudios fueron extraídos de forma sistemática e incluidos en tablas de evidencia. Resultados: En la búsqueda bibliográfica se recuperaron 1.478 registros, de los que se extrajeron 48 trabajos incluyendo finalmente sólo 13 estudios en la revisión sistemática. En todos ellos se observa que la EP se manifiesta por una menor captación estriatal de 18FDOPA, especialmente en el putamen, y de predominio posterior. Los estudios prospectivos muestran la pérdida de captación con la progresión de la enfermedad. Un estudio señala diferencias en el patrón regional de afectación entre la EP, la parálisis supranuclear progresiva (PSP) y la atrofia multisistémica (AMS). La afectación cognitiva en la EP parece relacionada con alteraciones en la fijación de 18FDOPA en determinadas regiones del córtex frontal y en el caudado. Conclusiones: La 18FDOPA parece útil para el diagnóstico y valoración de la progresión de la EP; sin embargo, la evidencia no es concluyente respecto a su utilidad en el diagnóstico diferencial con otros síndromes parkinsonianos, así como en la diferenciación entre EP ex novo y avanzada(AU)

Introduction: 18F-fluorodopa (18F-DOPA) is a functional tracer of presynaptic dopaminergic neuron terminations in the nigrostriatal system. This review is aimed to assess the efficacy of 18F-DOPA-PET in the diagnosis and evaluation of the progression of Parkinson's Disease (PD) and in the differential diagnosis with other Parkinsonism Syndromes. Methods: A review was made of the literature by searching six databases and selecting the most relevant articles according to strict inclusion and exclusion criteria. The study data were systematically extracted and included in evidence tables. Results: Of the 1478 registries recovered through the search of the literature, 48 studies were extracted. Of these, only 13 were included in the systematic review. It was observed in all of them that PD is manifested by a lower striatal uptake of 18F-DOPA, especially in the putamen with posterior predominance. Prospective studies have shown that there is loss of uptake with disease progression. One article described regional differences in 18F-DOPA striatal pattern between PD, multisystem atrophy (MSA) and progressive supranu-clear palsy (PSP). Cognitive impairment in PD seems to be related with 18F-DOPA abnormal uptake in some regions of frontal cortex and caudate nucleus. Conclusion: 18F-DOPA-PET seems to be useful for the diagnosis and evaluation of PD progression. However, the evidence is not conclusive regarding its utility in the differential diagnosis with other Parkinsonism Syndromes and in the differentiation between ex novo and advanced PD(AU)

[Hyperthyroidism due to an ectopic intrathoracic thyroid]. / Hipertiroidismo por tiroides ectópico intratorácico.

We present an 84-year-old woman with hyperthyroidism caused by an ectopic intrathoracic thyroid that was removed by sternotomy. Ectopic intrathoracic thyroid, also called primary intrathoracic goitre, is a rare presentation of thyroid disease and comprises about 1% of all mediastinal masses. Its coexistence with hyperthyroidism is extremely uncommon. Its removal usually requires thoracotomy or sternotomy.

Hipertiroidismo por tiroides ectópico intratorácico / Hyperthyroidism due to an ectopic intrathoracic thyroid

Se presenta el caso de una paciente de 84 años con hipertiroidismo por tiroides ectópico intratorácico que fue tratado quirúrgicamente. El tiroides ectópico intratorácico o bocio intratorácico primario es una presentación rara y comprende el 1% de todas las masas mediastínicas. La coexistencia con hipertiroidismo es extremadamente infrecuente. Su resección generalmente requiere una toracotomía o esternotomía (AU)

We present an 84-year-old woman with hyperthyroidism caused by an ectopic intrathoracic thyroid that was removed by sternotomy. Ectopic intrathoracic thyroid, also called primary intrathoracic goitre, is a rare presentation of thyroid disease and comprises about 1% of all mediastinal masses. Its coexistence with hyperthyroidism is extremely uncommon. Its removal usually requires thoracotomy or sternotomy (AU)

Efectividad del 123I-ioflupano (DaTSCAN©) en el diagnóstico de síndromes parkinsonianos. Una revisión sistemática / Effectiveness of 123I-ioflupane (DaTSCAN©) in the diagnosis of parkinsonian syndromes. A systematic review

Introducción. La enfermedad de Parkinson (EP) es la segunda enfermedad degenerativa más frecuente, afectando al 1-2 % de la población mayor de 65 años. Hasta el20-24 % de los síndromes parkinsonianos pueden ser erróneamente diagnosticados. La finalidad de este trabajo es valorar la eficacia del DaTSCAN© en el reconocimiento de la EP precoz y su diagnóstico diferencial del parkinsonismo vascular, el parkinsonismofarmacológico y el temblor esencial, así como laeficacia del 123I-FP en la diferenciación de la demencia de cuerpos de Lewy (DCL) y la enfermedad de Alzheimer (EA). Método. Revisión sistemática. La selección de los trabajos la realizaron dos investigadores independientes aplicando criterios predefinidos. La calidad de los estudios originales se valoró mediante una escala específicamente diseñada. Resultados. Se incluyeron 11 artículos originales. No se encontraron ensayos clínicos aleatorizados. Tres trabajos valoraron el impacto del DaTSCAN© en el tratamiento y encontraron que el 17-69 % de los pacientes cambiaron de terapia tras el SPECT. Seis estudios valoraron el cambio en el diagnóstico delsíndrome parkinsoniano tras el SPECT. Cuatro de ellos mostraron que el 123I-FP puede ser útil en el diagnóstico diferencial entre la EP y desórdenes no-degenerativos. Uno señala que el ioflupano puede ayudar a la diferenciación entre EA y DCL. Otra investigación muestra que el DaTSCAN© podría aportar datos de utilidad para el diagnóstico diferencial entre EP y síndromes parkinsonianos tales como la atrofia multisistémica(AMS) y la parálisis supranuclear progresiva (PSP).Conclusiones. La evidencia científica disponible indica que el 123I-FP puede ser útil para diferenciar la EP del temblor esencial y el parkinsonismo vascular o farmacológico y para diferenciar la EA de la DCL

Background. Parkinson disease (PD) is the secondmost frequent neurodegenerative disease, affecting the1-2 % of the population over 65. Around 20-24 % of diagnosed patients are estimated to be misdiagnosed. The aim of this paper is to assess the efficacy of DaTSCAN© in the diagnosis of early PD and to determine the efficacy of 123I-FP in the differential diagnosis of vascular parkinsonism, drug-induced parkinsonism, essential tremor, Lewy body dementia (LBD) and Alzheimer disease (AD). Methods. Systematic review. Two independent investigators reviewed and selected the papers according to predefined selection criteria. The quality of the original studies was assessed using one specifically designed scale. Results. Eleven original articles were included. No randomized clinical trials were found. Three papers assessed the effect of DaTSCAN© in medication of patients and found that 17 to69 % of the patients treatment changed after SPECT. Six studies assessed the change in the diagnosis for patients with parkinsonian syndromes after SPECT. Four of them showed that 123I-FP could be useful for the differential diagnosis between PD and non-degenerative disorders. One observed that ioflupane could help differentiate between PD and AD and between this last disease and LBD. The other investigation group showed that DaTSCAN© could help in the differential diagnosisbetween PD and parkinsonian syndromes such as multisystematrophy (MSA) and progressive supranuclear palsy (PSP).Conclusions. The scientific evidence available indicates that 123I-FP can be useful to differentiate PD from essential tremor and vascular and drug-induced parkinsonism, and also to differentiate AD from LBD

[Effectiveness of 123I-ioflupane (DaTSCAN) in the diagnosis of Parkinsonian syndromes. A systematic review]. / Efectividad del 123I-ioflupano (DaTSCAN) en el diagnóstico de síndromes parkinsonianos. Una revisión sistemática.

BACKGROUND: Parkinson disease (PD) is the second most frequent neurodegenerative disease, affecting the 1-2 % of the population over 65. Around 20-24 % of diagnosed patients are estimated to be misdiagnosed. The aim of this paper is to assess the efficacy of DaTSCAN in the diagnosis of early PD and to determine the efficacy of 123I-FP in the differential diagnosis of vascular parkinsonism, drug-induced parkinsonism, essential tremor, Lewy body dementia (LBD) and Alzheimer disease (AD). METHODS: Systematic review. Two independent investigators reviewed and selected the papers according to predefined selection criteria. The quality of the original studies was assessed using one specifically designed scale. RESULTS: Eleven original articles were included. No randomized clinical trials were found. Three papers assessed the effect of DaTSCAN in medication of patients and found that 17 to 69 % of the patients treatment changed after SPECT. Six studies assessed the change in the diagnosis for patients with parkinsonian syndromes after SPECT. Four of them showed that 123I-FP could be useful for the differential diagnosis between PD and non-degenerative disorders. One observed that ioflupane could help differentiate between PD and AD and between this last disease and LBD. The other investigation group showed that DaTSCAN could help in the differential diagnosis between PD and parkinsonian syndromes such as multisystem atrophy (MSA) and progressive supranuclear palsy (PSP). CONCLUSIONS: The scientific evidence available indicates that 123I-FP can be useful to differentiate PD from essential tremor and vascular and drug-induced parkinsonism, and also to differentiate AD from LBD.

SPECT de perfusión cerebral con 99mTc-HMPAO en un caso de encefalitis por VHS / 99mTc-HMPAO brain SPECT in a case of HSV encephalitis

Presentamos un caso de encefalitis aguda herpética en una mujer de 57 años con cuadro agudo sugestivo de infección vírica sin clínica neurológica asociada. Ante la aparición posterior de focalidad neurológica, se realizó análisis de líquido cefalorraquídeo (LCR) que mostró pleocitosis y linfocitosis, datos de proceso inflamatorio, y test serológico con positividad para Virus del Herpes Simple (VHS) subtipos I y II. Durante el ingreso, se practicaron otras pruebas complementarias: EEG, TC, RM, SPECT de perfusión cerebral; esta última aportó datos significativos con respecto a la neuroimagen anatómica (TC, RM) en cuanto a extensión bihemisférica del proceso encefalítico. Además, tras el alta clínica, demostró persistencia de la alteración metabólica en cortex temporal responsable de un cuadro de afasia mixta concomitante

We present a case of encephalitis caused by Herpes Simplex Virus in a 57 year old woman. The acute picture was suggestive of viral infection without associated neurological symptoms. Due to the posterior appearance of neurological focality, cerebral spinal fluid (CSF) was analyzed. It showed pleocytosis and lymphocytosis, inflammatory process data, and serological test with positivity for Simple Herpes Virus (SHV) subtypes I and II. During admission, other complementary tests were performed: EEG, CT, MRI, cerebral perfusion SPECT; the later supplied significant data regarding anatomical neuroimaging (CT, MRI) in regards to bihemispheral extension of the encephalic condition. Furthermore, after clinical discharge, persistent metabolic abnormality was demonstrated in temporal cortex, responsible for concomitant mixed aphasia

[99mTc-HMPAO brain SPECT in a case of HSV encephalitis]. / SPECT de perfusión cerebral con 99mTc-HMPAO en un caso de encefalitis por VHS.

We present a case of encephalitis caused by Herpes Simplex Virus in a 57 year old woman. The acute picture was suggestive of viral infection without associated neurological symptoms. Due to the posterior appearance of neurological focality, cerebral spinal fluid (CSF) was analyzed. It showed pleocytosis and lymphocytosis, inflammatory process data, and serological test with positivity for Simple Herpes Virus (SHV) subtypes I and II. During admission, other complementary tests were performed: EEG, CT, MRI, cerebral perfusion SPECT; the later supplied significant data regarding anatomical neuroimaging (CT, MRI) in regards to bihemispheral extension of the encephalic condition. Furthermore, after clinical discharge, persistent metabolic abnormality was demonstrated in temporal cortex, responsible for concomitant mixed aphasia.

Hallazgo incidental de divertículo vesical en gammagrafía ósea / Incidental finding of bladder diverticulum in bone scintigraphy

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[Detection of bronchopleural fistula by ventilation scintigraphy. Based on one case]. / Detección de fístula broncopleural mediante gammagrafía de ventilación. A propósito de un caso.

Bronchopleural fistula (BPF) is a rare but extremely serious complication of lung resection surgery. Its diagnosis is often overlooked in the clinical evolution of the patients undergoing surgery due to the subacute presentation of the picture. The procedures used to detect it are either invasive or have low accuracy. We report the case of a patient with lung carcinoma treated by left pneumonectomy in whom BPF was suspected after an episode of coughing and expectoration. The conventional chest x-ray did not show any significant findings while the (99m)Tc-DTPA ventilation lung scintigraphy demonstrated bronchopleural communication in a very early phase.

Detección de fístula broncopleural mediante gammagrafía de ventilación. A propósito de un caso / Detection of bronchopleural fistula by ventilation scintigraphy. Based on one case

La fístula broncopleural (FBP) es una complicación de la cirugía de resección pulmonar poco frecuente aunque de suma gravedad. A menudo pasa desapercibida en la evolución clínica de los pacientes sometidos a este tipo de cirugía debido a la instauración subaguda del cuadro. Los procedimientos que se han utilizado para detectarla son o bien invasivos o de bajo rendimiento. Presentamos el caso de un paciente diagnosticado de adenocarcinoma pulmonar tratado mediante neumectomía izquierda en el que se sospechó la existencia de una FBP. La radiología convencional no mostró hallazgos relevantes mientras que la gammagrafía de ventilación con 99mTc-DTPA puso de manifiesto la comunicación broncopleural en una fase muy inicial de la misma (AU)

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