One-day protocol versus two-day protocol in acquisition of scintigraphy with "in vitro" labelled white blood cells for diagnosis of osteoarticular infection. / Protocolo de un día vs protocolo de dos días de adquisición mediante gammagrafía con leucocitos marcados in vitro para el diagnóstico de infección osteoarticular.

INTRODUCTION: It is difficult to determine osteoarticular infection and differentiate inflammation from infection with laboratory and imaging procedures (CT, MRI, US). Labelled white-blood-cell scintigraphy (WBCS) is the nuclear medicine test of choice but it takes two days, sometimes finds it difficult to differentiate soft tissue from bone infection and therefore causes interobserver variability, which decreases its specificity. OBJECTIVE: To demonstrate the usefulness of the one-day protocol with time decay-corrected acquisition in WBCS to diagnose osteoarticular infection and to reduce interobserver variability. The role of SPECT/CT in WBCS in locating the infected focus was also evaluated. METHODS: 110 patients with suspected osteoarticular infection were studied prospectively. Planar images were obtained with time decay-corrected acquisition at 30min, 4h, 8h and 24h. WBCS planar images were grouped in two protocols: One-day protocol: experts evaluated 30min, 4h and 8h images. Two-day protocol: experts evaluated 30min, 4h and 24h images. Both protocols were classified as: SPECT/CT was performed in 72 patients. Kappa index was calculated to evaluate interobserver variability. RESULTS: Infection was confirmed in 34 cases. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 97.1%, 97.4%, 94.3%, 98.7%, and 97.3% for the one-day protocol and 94.1%, 97.4%, 94.1%, 97.4%, and 96.4% for two-days-protocol. SPECT/CT contributed to diagnosis in 45/50 patients with planar WBCS positive. Kappa index: 0.8 for one-day protocol and 0.79 for two-day protocol, respectively. CONCLUSION: One-day protocol with time decay-corrected acquisition WBCS and SPECT/CT enables early and accurate diagnosis of osteoarticular infection.

[Interpretation of thyroid incidentalomas in (18)F-FDG PET/CT studies]. / Interpretación de incidentalomas tiroideos en estudios PET/TC con (18)F-FDG.

OBJECTIVE: Thyroid findings or incidentalomas in (18)F-FDG PET/CT studies are relatively frequent, being its clinical significance subject of controversy. The aim of this study was to show our experience in the detection of thyroid incidentalomas by PET/CT studies as well as its follow up. MATERIAL AND METHODS: A retrospective and descriptive review was conducted on patients who had thyroid incidentalomas detected in (18)F-FDG PET/CT studies between June 2010 and March 2013. Patient's medical records were reviewed for age, genre, maximum standardized uptake value (SUVmax), thyroid diseases, TSH and antithyroid antibodies levels, ultrasound, fine-needle aspiration (FNA) and cytology. RESULTS: 4085 PET/CT studies for several purposes were performed. Eighty-three of these studies (2.03%) showed thyroid incidentalomas. Thirty-seven patients showed a diffuse increase of glucose metabolism in the thyroid gland and 46 showed a focal increase of glucose metabolism. Five out of 46 patients with focal uptake were diagnosed of a neoplastic disease by cytology (11%). The SUVmax of malignant pathology did not differ from that of benign thyroid diseases (Mean: 10,26 and 5,92 respectively). CONCLUSION: In our experience, focal thyroid incidentalomas detected in (18)F-FDG PET/CT studies are related to a significant risk of malignancy (11%). Therefore, in these situations, an ultrasound study with fine needle biopsy should be recommended. Moreover, a diffuse increase of glucose metabolism in the thyroid gland is often associated with benign thyroid pathology.

Osteoporosis y factores de riesgo en una población masculina latinoamericana / Osteoporosis and risk factors in a Latinoamerican male population

La osteoporosis es una de las principales causas de morbilidad y de mortalidad en la gente mayor. Aunque la presencia de osteoporosis es menos común en hombres que en mujeres, cerca de 1,5 millones de hombres por encima de 65 años en los Estados Unidos tienen osteoporosis, y otros 3,5 millones de hombres están en riesgo de padecer la enfermedad. En los últimos años el impacto de la osteoporosis en hombres se ha reconocido como problema importante de salud pública. Objetivos: para determinar la prevalencia y los factores de riesgo asociados a osteoporosis en hombres, se evaluó en un grupo de pacientes masculinos que asistían al Centro de Reumatología y Ortopedia, en Barranquilla, durante 2002-2005 para la realización del examen densitométrico. Métodos: realizamos un análisis descriptivo, transversal, incluyendo todos los varones mayores de 20 años en nuestra clínica ambulatoria (n=401), que no sabían que pudieran tener osteoporosis. Aplicamos una prueba centrada en los factores de riesgo relacionados con la osteoporosis, y se invitó a cada paciente a realizarse una medida central de la densitometría, en columna dorsal y fémur. Resultados: la edad media era de 57,65 años (SD+/-: 14,7); 71,4% eran mayores de 49 años. La prevalencia general de osteoporosis fue del 17,96%, y de osteopenia del 34,41%. La prevalen-cia más alta de osteoporosis fue encontrada en la categoría de edad de 70 a 79 años, y en el grupo de 40 a 49 años con 20,9%. La osteoporosis primaria estuvo presente en el 46,62% de todos los casos. En los pacientes con osteoporosis secundaria, 18,06% son fumadores, 13,9% han utilizado los corticoides por lo menos tres años, 11,1% tienen enfermedad prostática, 11,1% tienen artritis reumatoide, y cuando comparamos los factores de riesgo entre pacientes osteoporóticos con hombres sin osteoporosis, la diferencia era estadísticamente significativa (p<0,05) en todos. Conclusiones: la prevalencia de osteoporosis y de osteopenia encontrada en nuestro estudio, fue similar a las informadas por otros investigadores. Una proporción significativa de hombres tenía os-teoporosis primaria. Un número importante de hombres con osteoporosis tenían factores de riesgo para esta enfermedad. Adicionalmente, encontramos dos picos de prevalencia de osteoporosis por edad, en los grupos de 40 a 49 y 70 a 79, probablemente debido a la causa secundaria.

Osteoporosis is a leading cause of morbidity and mortality in elderly people. While less common in men than women, about 1.5 million men over age 65 years in the United States have osteoporosis, and another 3.5 million men are at risk. In the last few years the burden of osteoporosis in men has been recognized as an important public health issue. Objetive: to determine the prevalence and the risk factors associated with osteoporosis in a group of male outpatients assisting to the Centro de Reumatologia y Ortopedia, in Barranquilla, Colombia, during 2002-2005. Methods: we performed a descriptive, transversal survey, including all males older than 20 years in our ambulatory clinic (n= 401), who don’t knew they have osteoporosis. We apply a test focused on risk factors related to osteoporosis, and each patient was invited to do a central densitometry measure, in spine and femur . Results: the mean age was 57.65 years (SD+/-: 14.7); 71.4% was older than 49 years. The general prevalence of osteoporosis was 17.96%, and osteopenia 34.41%. The highest prevalence of os-teoporosis was found in the age group of 70 to 79 years, and in the group of 40 to 49 years with 20.9%. Primary osteoporosis was present in 46,62% from all cases. In patients with secondary osteoporosis, 18.06% are smokers, 13.9% have used corticoids for at least 3 years, 11.1% have prostatic disease, 11.1% have rheumatoid arthri-tis, and when we compare this risk factors between men patient with and without osteoporosis, the dif-ference was statistically significance (p<0.05) in all of them. Conclusions: the prevalence of osteoporosis and osteopenia was similar to those found by other groups. A high proportion of men had primary osteoporosis. An important number of men with osteoporosis had risk factors for this dis-ease. Additionally, we found two osteoporosis peaks by age, in the groups of 40 to 49 and 70 to 79, probably due to secondary cause.