[Ovarian and para-aortic recurrence from cervix cancer detected by PET/CT]. / Recurrencia ovárica y paraaórtica de un carcinoma de cuello uterino detectada mediante PET/TC.

We present the case of a 34-year-old woman diagnosed of an adenosquamous carcinoma of the uterine cervix, stage IIB of the FIGO classification (International Federation of Gynecology and Obstetrics), treated with quimiotherapy, radiotheraphy and brachytheraphy with posterior hysterectomy. A recurrence of the disease was suspected due to the progressive rise of CEA levels. A PET/CT revealed abnormal foci in both ovaries, that had been transposed to avoid lesions due to radiation, and in a left para-aortic adenopathy. The diagnosis of recurrence in these sites was confirmed by biopsy. PET with FDG (F18-fluorodeoxyglucose) is useful in the staging of primary tumour and in the detection of recurrence in uterine cervical carcinoma, with better sensitivity and specificity than CT and MRI. PET/CT improves anatomic resolution and helps to resolve the origin of unclear foci like in the case presented in which ovaries were not in their normal situation due to transposition.

Degeneración cerebelosa paraneoplásica. Utilidad de la tomografía por emisión de positrones con [F-18]-fluordesoxiglucosa (18F-DDG) / Paraneoplastic cerebellar degeneration. Usefulness of positron emission tomography with 18-fluorodeoxyglucose

- Propósito: destacar la utilidad de la PET de cuerpo entero en el síndrome cerebeloso paraneoplásico.- Material y Método: se presenta el caso de una paciente con síndrome cerebeloso paraneoplásico asociado a anticuerpos anti-Yo y sin tumor primario conocido a la que se practicó PET con 18 F-FDG.- Conclusiones: la PET con 18F-FDG fue la única exploración que detectó tejido tumoral maligno, en adenopatías abdominales, muy probablemente relacionado con el síndrome paraneoplásico que presentaba la paciente (AU)

111Indium labelled leukocyte scintigraphy in the detection of acute prostatitis.

Although prostatitis is a common problem the diagnosis is still controversial despite the availability of a wide variety of diagnostic tools. In fact, there is still no accurate method of localizing the infected tissue. The aims of the present study were to assess whether 111In labelled leukocytes (ILLs) accumulated in the infected tissue of acute prostatitis and if such uptake responded to treatment. We prospectively studied 10 adult male patients who had community acquired prostatitis and compared them with six male patients who had urinary tract infections but without prostatitis. An initial urinary culture and two blood cultures were carried out for each patient. All patients were followed up for 8 weeks after therapy was completed. Pre- and post-treatment scintigraphies were performed. Before treatment, all patients with prostatitis showed uptake of ILLs in the prostate area. After the patients had completed treatment with antibiotics, the scintigraphy results showed no uptake in the prostate area in 9/10 patients. The remaining patient showed a marked decrease in the uptake of ILLs. None of the six patients with urinary tract infection showed ILL uptake in the prostate region. It is suggested that ILLs could be useful for detecting acute prostatitis, especially in clinically ambiguous patients with urological infections. Furthermore, scintigraphy with 111In labelled leukocytes could help to determine the most appropriate course of therapy.

[Diagnosis of recurrent secondary hyperparathyroidism using double-phase 99m-Tc-MIBI gammagraphy after total parathyroidectomy with autotransplantation]. / Diagnóstico de recurrencia de hiperparatiroidismo secundario mediante gammagrafía con 99mTc-MIBI en doble fase tras paratiroidectomía total con autotrasplante.

We present two cases of uremic patients with poor medical control of their secondary hyperparathyroidism. They had to undergo surgery to control symptoms. A total parathyroidectomy with autotransplant in the forearm muscles was performed. After a symptom-free period, both showed a recurrence of their hyperparathyroidism. A double phase 99mTc-MIBI scintigraphy was essential in order to correctly locate hypertrophic parathyroid gland. In one case there was a cervical recurrence and in the second patient hyperplasia in a forearm gland autotransplant was found. Both patients remained asymptomatic with medication during their follow up.

Diagnóstico de recurrencia de hiperparatiroidismo secundario mediante gammagrafía con 99mTc-MIBI en doble fase tras paratiroidectomía total con autotrasplante / Diagnosis of recurrence of secondary hyperparathyroidism using double phase 99mTc-MIBI scintigraphy after total parathyroidectomy with autotransplant

En este trabajo se presentan dos casos de pacientes urémicos con inadecuado control de su hiperparatiroidismo secundario con tratamiento médico, que tuvieron que ser sometidos a intervención quirúrgica. Se les realizó una paratiroidectomía total con autotrasplante autólogo de tejido paratiroideo en los músculos del antebrazo. Tras un período libre de síntomas, ambos pacientes mostraron una recurrencia de su clínica de hiperparatiroidismo. La gammagrafía con 99mTc-MIBI en doble fase fue fundamental en ambos pacientes para realizar el diagnóstico de localización de la glándula paratiroidea hiperplásica causante del cuadro de hiperparatiroidismo. En un caso se diagnosticó una recidiva cervical de su enfermedad y en el segundo paciente se encontró una hiperplasia del autotrasplante del antebrazo. Ambos pacientes permanecieron asintomáticos con tratamiento médico durante su seguimiento evolutivo (AU)

Quantified 99mTc-MIBI scintigraphy for predicting chemotherapy response in breast cancer patients: factors that influence the level of 99m Tc-MIBI uptake.

The aim of this study was to establish whether tumour uptake of 99mTc-MIBI can predict response to chemotherapy in patients with breast carcinoma. Forty women suffering from breast carcinoma confirmed by tumour biopsy were studied prospectively. Fifteen patients subsequently underwent surgery and 25 were candidates for neoadjuvant chemotherapy. Breast scintigraphy was performed and planar and tomographic views (single photon emission computed tomography (SPECT)) were obtained after injection of 740 MBq of 99mTc-MIBI. The tumoural uptake was quantified by computer analysis. P-glycoprotein was evaluated by immunohistochemistry only in operable patients. The response to chemotherapy was evaluated at 3 months upon completion of treatment. The results of this study showed no relationship between 99mTc-MIBI uptake and the histological type or tumour size. There was an inverse correlation with the degree of tumour differentiation (P<0.05). 99mTc-MIBI uptake in negative P-glycoprotein lesions (2.36+/-1.72) was higher than in positive P-glycoprotein lesions (1.53+/-1.29), although the difference was not statistically significant. Lesions which responded to chemotherapy (16) showed higher 99mTc-MIBI uptake (7.70+/-5.20) than non-responding lesions (nine) (2.21+/-1.0) (P<0.001). In conclusion, there is a correlation between 99mTc-MIBI uptake in breast cancer and response to chemotherapy. Furthermore, 99mTc-MIBI uptake may be influenced by other factors such as the degree of tumour differentiation or tumour P-glycoprotein levels.

123Iodine-labelled anti-VCAM-1 antibody scintigraphy in the assessment of experimental colitis.

OBJECTIVES: To evaluate the usefulness of 123I-labelled anti-vascular cell adhesion molecule-1 (VCAM-1) monoclonal antibody (MAb) scintigraphy in the assessment of colonic inflammatory damage. DESIGN: Colitis was induced by intracolonic administration of 30 mg trinitrobenzenesulphonic acid in 0.5 ml of 50% (v/v) ethanol. Rats injected with vehicle served as controls. Animals were studied at day 7 after induction of colitis. METHODS: Scintigraphy was performed in control and trinitrobenzenesulphonic acid-induced colitic rats 2, 4 and 24 h after intravenous administration of 123I-anti-VCAM-1 MAb. Scintigraphic uptake was quantified in selected areas on scintigraphs. Animals were killed, tissue 123I radioactivity accumulation was measured, and accumulation of anti-VCAM-1 MAb in each organ was calculated. 99mTc-hexamethyl propylene amine oxime-labelled leucocyte scintigraphy was performed in additional groups of animals for comparison. RESULTS: Colonic tracer uptake was visible in scans of colitic, but not control animals. Quantification of scintigraphic uptake in the colon was significantly higher in colitic rats than in control animals (P< 0.0001). The specificity of the increase was demonstrated by lack of 123I-labelled non-binding MAb uptake in the colon, and by displacement of 123I-anti-VCAM-1 MAb colonic uptake by pre-treatment with unlabelled MAb. Accumulation of anti-VCAM-1 MAb in the colon of colitic rats was eightfold higher than in control animals. Strong correlations were found between quantification of scintigraphic uptake, anti-VCAM-1 MAb accumulation, histological damage and myeloperoxidase activity in the colon. CONCLUSION: 123I-labelled anti-VCAM-1 MAb scintigraphy allows an accurate evaluation of colonic inflammatory damage in trinitrobenzenesulphonic acid-induced colitis, suggesting a potential role for this imaging technique in the assessment of human IBD.

Noninvasive assessment of cardiac risk in type I diabetic patients being evaluated for combined pancreas-kidney transplantation using dipyridamole-MIBI perfusion tomographic scintigraphy.

This study was performed to determine the value of dipyridamole-99m Tc-methoxy-isobutyl isonitrile perfusion (99mTC-MIBI) tomographic scintigraphy in the assessment of cardiac risk in patients being evaluated prior to combined pancreas-kidney transplantation (PKT). We performed perfusion tomographic scintigraphy using single photon emission computed tomography (SPECT) on 77 patients. The tomographic images did not show clinically relevant findings in 65 patients. In the remaining 12 patients, coronary arteriography was performed: 2 showed normal results, 4 showed no stenosis, and 6 showed significant stenosis ( > or = 70%). Seventy-two patients underwent PKT. During the follow-up (6-48 months), there were seven cardiac events, 4 patients with significant stenosis, and 3 with nonsignificant stenosis upon coronary arteriography, and all had pathological tomographic images. 99mTc-MIBI tomographic scintigraphy may be useful in identifying patients at low risk of incurring cardiac events after PKT and may, in a large group of patients, obviate the need for routine coronary angiography.

Gammagrafía hepatoesplénica en un caso de esplenosis abdominal múltiple / Hepatosplenic scintigraphy in a case of multiple abdominal splenosis

No disponible

Indium-111 labelled platelet scintigraphy can predict the immunological origin of fever in patients on dialysis carrying a non-functioning renal allograft.

The purpose of this study was to evaluate the usefulness of labelled platelet scintigraphy in the differential diagnosis of a prolonged febrile syndrome (PFS) in patients on dialysis carrying a non-functioning renal allograft. We prospectively performed an indium-111 mercaptopyridine-labelled platelet scan on 91 patients (54 men, 37 women; mean age 39.6+/-12 years). The mean duration of PFS was 35 days (range 7-122). Forty-six of the 91 patients underwent steroid therapy (2-10 mg/day). Platelet labelling was carried out following Thakur's method. Platelet scans were performed 48 h after reinjection of labelled platelets. The platelet uptake index (PUI) was calculated by dividing the cpm/pixel in the allograft ROI by cpm/pixel in a mirror background ROI. The final diagnosis of PFS was established depending on the outcome after treatment. In 61/91 patients the fever had an immunological origin because it disappeared after graft embolisation or transplantectomy. In 30/91 patients the PFS disappeared after antibiotic therapy (non-immunological origin). The PUI in patients with immunological PFS was 1.80+/-0.7, while in patients with non-immunological PFS it was 1.12+/-0.1 (P<0.05). When a PUI of > or =1.5 was considered as the threshold to establish PFS of immunological origin, the sensitivity of platelet scan was 76%, the specificity 100%, and the negative and positive predictive values 69% and 100%, respectively. In patients classified with immunological PFS who underwent steroid therapy, the PUI was significantly lower than in patients without steroids (P<0.05). These results suggest that 111In-labelled platelet scintigraphy can accurately predict an immunological PFS in patients on dialysis carrying a non-functioning renal allograft. Therapy with steroids could reduce the sensitivity of 111In-labelled platelet scintigraphy in detecting immunological PFS.

Radioimmunoguided surgery of colorectal carcinoma with an 111In-labelled anti-TAG72 monoclonal antibody.

Radioimmunoscintigraphy (RIS) and radioimmunoguided surgery (RIGS) were assessed for their usefulness in patients with colorectal carcinoma. Twenty-nine patients (18 primary tumours, 10 with a suspicion of recurrence and one colonic diverticulitis) were studied. Radioimmunoscintigraphy was performed 48 and 72 h after the injection of an anti-TAG72 monoclonal antibody (CYT-103) labelled with 111In. Radioimmunoguided surgery was performed between 72 and 96 h post-injection. During surgery, a systematic screening was performed with a hand-held gamma detecting probe and a surgical index (tumour-to-normal tissue) was obtained. There were statistically significant differences between counts in normal tissue versus tumour (P < 0.001) and RIGS was considered positive for the detection of tumour if the ratio between the counts in the area suspicious of tumour and the counts in the normal tissue was greater than 1.5. The overall sensitivity for RIS and RIGS was 71.4% (55.6% in primary tumours and 100% in recurrences) and 82.1% (83.3% in primary tumours and 80% in recurrences), respectively. Radioimmunoguided surgery changed the surgical procedure in two cases with small tumour deposits. Occult regional lymph node involvement in primary tumours was not found; therefore, RIGS, as a complementary technique to RIS, is particularly useful in recurrences and can help the surgeon in the resection of small tumour deposits which are difficult to localize.

A case of renal artery stenosis after transplantation: can losartan be more accurate than captopril renography?

Hypertension is a common complication observed after renal transplantation. If the hypertension is of renovascular origin, transluminal angioplasty or surgery of the renal artery stenosis can lead help cure the hypertension. The blood pressure of a 31-year-old man who underwent renal transplantation 2 years earlier gradually increased. Arteriography showed stenosis (>80%) in the two branches of the renal artery. To help confirm the presence of renovascular hypertension, captopril renography was performed but showed no significant changes compared with baseline renography. Renography was performed again after losartan administration and showed impaired renal function. In this case, losartan renography was more useful than captopril in suggesting renovascular hypertension.

Single photon emission computed tomography (SPECT) in a patient with bilateral temporal seizures: correlation between ictal EEG and postictal/ictal SPECT.

We report a patient with bilateral independent temporal lobe seizures in whom two [99mTc]HMPAO single photon emission computed tomograph (SPECT) scans were performed during two different seizures. In the first periictal SPECT, [99mTc]HMPAO was injected in the interval between two closely spaced seizures (one localized in the left temporal lobe and the other in the right temporal lobe). SPECT images showed hypoperfusion in the left lateral temporal lobe, hyperperfusion of the left mesial temporal region, and pronounced hyperperfusion in the right anterior temporal lobe. These results suggest both a postictal left temporal SPECT pattern and an ictal right temporal pattern. In the second periictal SPECT, [99mTc]HMPAO was injected immediately after a right temporal lobe seizure and showed right lateral temporal lobe hypoperfusion and right mesial hyperperfusion, suggesting a postictal right temporal SPECT pattern. Interpretation of the periictal SPECT should take into account EEG changes at the time or in the minutes immediately after injection of [99mTc]HMPAO.

[Use of bone SPECT of the dorsolumbar spine in oncological patients with suspected bone metastases]. / Utilidad del SPECT óseo de columna dorsolumbar en pacientes oncológicos con sospecha de metástasis óseas.

UNLABELLED: A retrospective study was made to evaluate the usefulness of bone SPECT of the dorsolumbar spine in identifying benign and malignant lesions. A study was made of oncological patients who presented active images in the spinal column visible on planar radionuclide scans who also underwent SPECT. The average follow-up period was 25+/-13 months. MATERIAL AND METHOD: In 43 neoplastic patients 55 visible lesions on SPECT were evaluated, of which 29 were benign and 26 metastatic. The criteria for benign lesions were the absence of change or involution without treatment in the follow-up period. The criteria for classifying metastases were: 1. Positive biopsy. 2. Neurological complications derived from the lesion. 3. Increased extension and tracer uptake by the lesion, and the appearance of other bone metastases. RESULTS: Twelve of 15 lesions located in the vertebral body or pedicle and 11/16 located in the body with extension toward the pedicles were metastases. Twenty-one of 24 lesions located on the anterior face of the vertebral body, articular processes, lamina, or intervertebral disk were benign. CONCLUSION: Bone SPECT was useful for locating the vertebral lesion, which in many cases allows differentiation of benign and metastatic lesions.

[Anatomopathological bases of latent ventricular dysfunction in insulin-dependent diabetics]. / Bases anatomopatológicas de la disfunción ventricular latente en diabéticos insulinodependientes.

INTRODUCTION AND OBJECTIVES: The natural history of diabetic cardiomyopathy remains unclear, mainly due to concurrent coronary disease or hypertension. Since the presence of confounding factors is less likely in youngsters, they constitute a suitable study model to analyze early stages of diabetic cardiomyopathy. PATIENTS AND METHODS: We screened 33 young normotensive asymptomatic patients with type I diabetes mellitus. Mean age was 28 +/- 8 y (range 18 to 46 y) and there were 14 men. RESULTS: 2-D Echo showed normal left ventricular size and wall motion in all patients but one. Radionuclide basal ejection fraction was 56.5 +/- 6.6% and increased to 63 +/- 7.4% (p < 0.02) on exercise. According to Rozansky criteria, 16 patients had an abnormal response. Abnormal stress sestamibi was detected in 18 patients and only 3 had reversible defects. Coronary angiography was performed in 11 patients with at least one abnormal non-invasive study response. Coronary angiography revealed normal vessels in all patients and left anterior descending blood flow velocity (Doppler) increased 4 fold after papaverine infusion. Left ventricular biopsies showed hypertrophy (either nuclear or cellular) in 11, myocytolysis in 6, interstitial fibrosis in 9 and lipid deposits in 4. Morphometric analysis of cardiac samples comparing the diabetic group and a control group showed that the volume fraction of fibrosis (0.19 +/- 0.06 vs 0.10 +/- 0.06; p < 0.01), fiber area -mu2- (1,062 +/- 547 vs 600 +/- 167; p < 0.02) and fiber diameter -mu- (24.2 +/- 3.3 vs 15.1 +/- 3.4; p < 0.001) were higher in the former; and volume fraction of the myocytes was higher in the latter (0.71 +/- 0.006 vs 0.89 +/- 0.07; p < 0.001). CONCLUSIONS: Left ventricular dysfunction, not related to coronary atherosclerosis or small vessel disease, is frequent in asymptomatic young diabetic patients. Abnormal pathologic findings are common in the type of cell hypertrophy, interstitial fibrosis, myocytolysis and lipid deposits.

67Ga scintigraphy for the evaluation of recurrences and residual masses in patients with lymphoma.

67Ga scintigraphy has proven to be of value in the evaluation of patients with lymphoma, especially in their management after treatment. In this study, computed tomography (CT) and 67Ga scans were compared in 53 patients with lymphoma who had previously been treated. Twenty-eight were patients in continuous clinical remission in whom recurrence was suspected. The remaining 25 patients were studied between 1 and 3 months post-treatment to assess a residual mass. The sensitivity for the detection of lymphoma recurrence was 88% for 67Ga, with two false-negative results, and 59% for CT, with seven false-negative results. In the diagnosis of recurrence, the specificity of 67Ga was 100% and that of CT 72%, with three false-positive results. Therapeutic response was assessed in 25 patients and the ability to predict response to treatment resulted in a specificity of 86% for 67Ga and 81% for CT. Treatment failed in four patients, as detected by 67Ga scan, whereas CT did not detect any of these. In the remaining 21 patients who showed good response to treatment, there were three false-positive results for 67Ga and four for CT. 67Ga scintigraphy can detect relapse more accurately and much earlier than CT, as well as diagnose complete remission after treatment. Therefore, 67Ga scintigraphy should be used routinely in monitoring response to treatment in lymphoma.