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1.
Clin Nucl Med ; 47(2): e197-e198, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-35006119

RESUMO

ABSTRACT: A 61-year-old woman presenting with hyperthyroidism received 131I therapy for a toxic adenoma diagnosed by 123I scintigraphy. Six months later, the patient had a relapse of hyperthyroidism, and 123I scintigraphy showed a mirror image of the first scintigraphy: a high and diffuse uptake in the thyroid gland except for the previously treated nodule. Graves disease was confirmed by elevated thyrotropin receptor antibodies. The patient was cured by a second radioiodine therapy. Radioiodine-induced Graves disease may occur within 6 months of 131I treatment of toxic adenoma and can be treated with a second line of 131I.


Assuntos
Adenoma , Doença de Graves , Hipertireoidismo , Feminino , Humanos , Radioisótopos do Iodo , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Cintilografia
2.
BMC Musculoskelet Disord ; 23(1): 22, 2022 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-34980054

RESUMO

BACKGROUND: Whole body standing alignment (WBSA) in terms of biomechanics can be evaluated accurately only by referring the gravity line (GL) which lies on the gravity center (GC). Here, we introduce a method for estimating GL and simultaneous WBSA measurement using the EOS® imaging system and report on the reproducibility and reliability of the method. METHODS: A 3-dimensional (3D) avatar to estimate GC was created following three steps: 3D reconstruction of the bone based on EOS images; deformation into a generic morphotype (MakeHuman statistical model) before density integration with 3D rasterization of the full body into 1-mm3 voxels (the content of each voxel is considered homogeneous); computation of the density of all the voxels provides the center of mass, which can be projected onto the floor as the GC of the full body, providing the GL in relation to the WBSA. The repeatability, reproducibility, and accuracy of the estimated GC and body weight of the avatar were compared with clinical estimation using a force plate in healthy volunteers and patients with degenerative and deformative diseases. RESULTS: Statistical analyses of the data revealed that the repeatability and reproducibility of the estimation was high with intra-rater and inter-rater intraclass correlation coefficient. ≥0.999. The coordinate values of the GC and body weight estimation did not differ significantly between the avatar and force plate measurements, demonstrating the high accuracy of the method. CONCLUSION: This new method of estimating GC and WBSA is reliable and accurate. Application of this method could allow clinicians to quickly and qualitatively evaluate WBSA with GL with various spinal malalignment pathologies.


Assuntos
Coluna Vertebral , Posição Ortostática , Humanos , Imageamento Tridimensional , Radiografia , Cintilografia , Reprodutibilidade dos Testes
3.
Clin Nucl Med ; 47(1): 1-6, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34874343

RESUMO

PURPOSE: Current guidelines for sincalide-stimulated cholescintigraphy (SSC) call for a 60-minute sincalide infusion, and a gallbladder ejection fraction (GBEF) ≥38% is considered normal. In this retrospective study, we hypothesize that most patients reach a normal GBEF by 30 minutes. METHODS: Eligible patients had undergone a 60-minute SSC from January to December 2019. The clinical SSC data were previously processed on a Xeleris workstation (GE Healthcare). In subjects with GBEF ≥38% based on standard SSC, the GBEF at 20 minutes and 30 minutes were retrospectively calculated using manual pixel height measurements. Receiving operating characteristic was analyzed to determine the best GBEF cutoff at 30 minutes. RESULTS: Of 302 subjects, mean age of 46 ± 17 years, 33 (10.9%) showed an abnormal GBEF <38% suggestive of functional gallbladder disorder. In the remaining 269 patients (89.1%) with a normal GBEF, 60.6% and 86.6% reached a normal GBEF at 20 minutes and 30 minutes, respectively. Moreover, a GBEF threshold >29.1% at 30 minutes was associated with a negative predictive value of 99.6%, indicating that a 60-minute SSC was not necessary. The GBEF values were not associated with sex, age, patient symptoms, or type of referral. Manually calculated GBEFs on the time-activity curve showed excellent correlation with the primary values. We propose a modified workflow that splits the 60-minute SSC into two 30-minute image sets to allow for a screening GBEF at 30 minutes. If GBEF is >29.1% at 30 minutes, the second image set may be stopped, and the examination is complete. CONCLUSIONS: The majority of patients (77.2%) undergoing the standard 60-minute SSC reach a normal GBEF already by 30 minutes. The proposed workflow shortens the SCC procedure by 30 minutes, while maintaining high diagnostic accuracy and contributing to improved procedure efficiency and reduced patient discomfort as well as symptoms.


Assuntos
Esvaziamento da Vesícula Biliar , Sincalida , Adulto , Vesícula Biliar , Humanos , Pessoa de Meia-Idade , Cintilografia , Estudos Retrospectivos , Fluxo de Trabalho
4.
Clin Nucl Med ; 47(1): 26-35, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34874347

RESUMO

PURPOSE: Gastroenteropancreatic neuroendocrine neoplasms (GEP NEN) are widely heterogeneous in their biological behavior, and predicting prognosis and optimal treatment strategies can be challenging. 68Ga-DOTATATE PET/CT is a sensitive imaging modality for well-differentiated NEN and indicates a favorable prognosis, whereas 18F-FDG PET/CT avidity indicates disease that is potentially more aggressive. There has been emerging interest in the combined interpretation of 68Ga-DOTATATE and 18F-FDG PET and its prognostic significance. We aimed to assess the prognostic utility of a classification system that incorporates the complex findings of 68Ga-DOTATATE and 18F-FDG PET interpreted side-by-side in patients with metastatic GEP NEN. METHODS: We defined 3 68Ga-DOTATATE/18F-FDG "dual-tracer PET" groups: D1 (68Ga-DOTATATE positive/18F-FDG negative), D2 (68Ga-DOTATATE positive/18F-FDG positive), and D3 (68Ga-DOTATATE negative/18F-FDG positive). We retrospectively assessed the association between the dual-tracer PET classification and progression-free and overall survival (OS) using Kaplan-Meier analysis. Univariate and multivariate analyses were performed using the Cox proportional hazards model. RESULTS: Eighty-seven patients with metastatic GEP NEN and contemporaneous 68Ga-DOTATATE and 18F-FDG PET were included. The dual-tracer PET classification was an independent predictor of OS (multivariate P = 0.016) and also predicted progression-free survival (univariate P = 0.030). Other independent predictors of OS included chromogranin A and World Health Organization (WHO) grade. WHO grade was not associated with OS from the time of dual-tracer PET but was an independent predictor of OS from the date of histological diagnosis (multivariate P = 0.003). CONCLUSION: Our study demonstrates that a classification system combining the complex findings of 68Ga-DOTATATE and 18F-FDG PET is correlated with prognosis. Further research is needed to prospectively validate these findings and to explore whether dual-tracer PET scores may also be able to predict response to treatment.


Assuntos
Tumores Neuroendócrinos , Compostos Organometálicos , Fluordesoxiglucose F18 , Humanos , Tumores Neuroendócrinos/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tomografia por Emissão de Pósitrons , Prognóstico , Cintilografia , Estudos Retrospectivos
5.
Clin Nucl Med ; 47(1): 88-89, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34874352

RESUMO

ABSTRACT: A 50-year-old man presented with right chest pain and persistent increased parathyroid hormone after parathyroidectomy for parathyroid carcinoma. 68Ga-DOTATATE PET/CT and 18F-FDG PET/CT were performed consecutively for restaging to determine subsequent treatment strategy. An osteolytic lesion on the right sixth rib showed increased uptake on both 68Ga-DOTATATE and 18F-FDG PET/CT. Subsequent biopsy confirmed it to be a brown tumor.


Assuntos
Neoplasias , Compostos Organometálicos , Fluordesoxiglucose F18 , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tomografia por Emissão de Pósitrons , Cintilografia
6.
Clin Nucl Med ; 47(1): e56-e58, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34028403

RESUMO

ABSTRACT: COVID vaccination has begun in most of the countries. Older population and high-risk groups are prioritized for vaccination. Postvaccination imaging in cancer patients may show effects of the immune response to the vaccine. As such, it is important to know the timing and laterality of the vaccination as the reactive lymph nodes in the ipsilateral axilla can be seen on the imaging. We present a case of DOTATATE-avid nonpathologically enlarged lymph nodes in ipsilateral axilla and linear tracer uptake in the deltoid muscle on a patient imaged for a recent diagnosis of rectal neuroendocrine neoplasm.


Assuntos
Vacinas contra COVID-19/administração & dosagem , Linfonodos , Neoplasias/diagnóstico por imagem , Receptores de Somatostatina , Axila , COVID-19/prevenção & controle , Humanos , Linfonodos/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Cintilografia
7.
Clin Nucl Med ; 47(1): e77-e78, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34284474

RESUMO

ABSTRACT: A 48-year-old man, a case of metastatic insulinoma, who failed transarterial chemoembolization of liver metastases underwent multiple cycles of peptide receptor radionuclide therapy with 177Lu-DOTATATE, following which a complete morphologic and metabolic response was demonstrated on 68Ga-DOTATATE PET/CT. Patient had a remarkable improvement in his quality of life as intractable hypoglycemic episodes resolved after treatment. Peptide receptor radionuclide therapy is a promising targeted radionuclide therapy in patients of metastatic insulinomas that can result in reduced tumor burden and improved quality of life, particularly those who fail the conventional treatment modalities as seen in the present case.


Assuntos
Carcinoma Hepatocelular , Quimioembolização Terapêutica , Insulinoma , Neoplasias Hepáticas , Compostos Organometálicos , Neoplasias Pancreáticas , Carcinoma Hepatocelular/patologia , Humanos , Insulinoma/radioterapia , Insulinoma/secundário , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Octreotida/uso terapêutico , Compostos Organometálicos/uso terapêutico , Neoplasias Pancreáticas/radioterapia , Neoplasias Pancreáticas/secundário , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tomografia por Emissão de Pósitrons , Qualidade de Vida , Radioisótopos , Cintilografia , Receptores de Peptídeos
8.
Clin Nucl Med ; 47(1): e71-e73, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34115704

RESUMO

ABSTRACT: A 59-year-old man with a parapharyngeal paraganglioma incidentally discovered on a cervical swelling was referred to our nuclear medicine department for a morpho-metabolic assessment. An 18F-FDG PET/CT was initially performed and found an intense hypermetabolism of the lesion and a hypermetabolism of the periadrenal brown fat evoking catecholamine secretion. An additional 68Ga-DOTATOC PET/CT was performed, showing an overexpression of the somatostatin receptors of this isolated paraganglioma. After multidisciplinary discussion, a peptide receptor radionuclide therapy with somatostatin analogs using 177Lu-DOTATATE as a compassionate measure was carried out.


Assuntos
Tumores Neuroendócrinos , Compostos Organometálicos , Paraganglioma , Humanos , Masculino , Pessoa de Meia-Idade , Octreotida/uso terapêutico , Paraganglioma/diagnóstico por imagem , Paraganglioma/radioterapia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tomografia por Emissão de Pósitrons , Radioisótopos , Cintilografia , Receptores de Somatostatina
9.
Clin Nucl Med ; 47(1): e41-e42, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34132679

RESUMO

ABSTRACT: 68Ga-DOTATATE PET/CT is an imaging technique used in the diagnosis of neuroendocrine tumors. Since renal cell carcinoma (RCC) expresses the somatostatin receptors, 68Ga-DOTATATE PET/CT could be used in the surveillance of RCC. However, limited cases showing 68Ga-DOTATATE uptake in the metastases of RCC have been reported before. Herein, we report a case of a 55-year-old woman with a history of left nephrectomy for clear cell renal cell carcinoma 2 years before, and referred to 68Ga-DOTATATE PET/CT for the evaluation of adrenal mass. 68Ga-DOTATATE PET/CT showed intense 68Ga-DOTATATE uptake on the adrenal mass. Histopathology of the adrenal mass confirmed the diagnosis of clear cell renal cell carcinoma metastasis.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Tumores Neuroendócrinos , Compostos Organometálicos , Carcinoma de Células Renais/diagnóstico por imagem , Feminino , Humanos , Neoplasias Renais/diagnóstico por imagem , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tomografia por Emissão de Pósitrons , Cintilografia
10.
Clin Nucl Med ; 47(1): e85-e86, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34172599

RESUMO

ABSTRACT: Schaaf-Yang syndrome is a genetic disorder characterized by delayed psychomotor development, hypotonia, intellectual disability, feeding difficulties, and variable dysmorphic facial features. It is an extremely rare disorder with over 250 cases reported in the medical literature. This condition has been determined to be inherited by an autosomal dominant pattern. We present colon transit scintigraphy of a 6-year-old boy with history of chronic constipation with poor response to medical treatment, clinical characteristics, and gene mutations consistent with this syndrome. After oral administration of 111In-DTPA, planar and SPECT/CT images showed rapid proximal colonic transit and anorectal retention.


Assuntos
Anormalidades Craniofaciais , Deficiência Intelectual , Criança , Colo/diagnóstico por imagem , Constipação Intestinal/diagnóstico por imagem , Constipação Intestinal/genética , Humanos , Masculino , Cintilografia
11.
Semin Nucl Med ; 52(1): 11-16, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34246451

RESUMO

The pandemic of coronavirus 2019 disease (COVID-19) not only directly causes high morbidity and mortality of the disease, but also indirectly affects patients with pre-existing medical conditions, particularly cardiovascular diseases, with delayed or deferred outpatient care and procedure including nuclear medicine studies because of concerns about exposure to the virus. In this article, the impact of COVID-19 on hospital operation and nuclear medicine practice in the United States along with recommendations and guidance from major academic organizations are presented. Safe operation of specific nuclear medicine scans, such as lung scintigraphy and nuclear cardiac imaging, are reviewed in the context of balancing benefits to patients against the risk of exacerbating the spread of the virus. Thoughtful reintroduction of nuclear medicine services are discussed based on ethical considerations that maximize benefits to those who are likely to benefit most, taking into consideration baseline health inequities, and ensuring that all decisions reflect best available evidence with transparent communication. Finally, potential correlation between decreased volume of nuclear cardiac studies performed during the pandemic and corresponding increased deaths from ischemic and hypertensive cardiac disease is discussed.


Assuntos
COVID-19 , Medicina Nuclear , Humanos , Cintilografia , SARS-CoV-2 , Estados Unidos
12.
Clin Nucl Med ; 47(1): 56-58, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34269726

RESUMO

ABSTRACT: Pineal region metastases are very rare, occurring in 0.4% to 3.8% of patients with solid tumors and most frequently arise from a lung cancer primary tumor. We present a case of a 67-year-old man with a gastric well-differentiated neuroendocrine tumor (NET) metastatic to the pineal gland identified on 68Ga-DOTATATE PET/CT imaging followed by MRI confirmation. To our knowledge, this is the third NET case to be reported in the literature with such presentation and first case to be described on 68Ga-DOTATATE PET/CT. A case of metastatic bronchial NET as well as a case of metastatic esophageal NET to the pineal gland were reported previously.


Assuntos
Tumor Carcinoide , Tumores Neuroendócrinos , Compostos Organometálicos , Glândula Pineal , Idoso , Tumor Carcinoide/diagnóstico por imagem , Humanos , Masculino , Glândula Pineal/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tomografia por Emissão de Pósitrons , Cintilografia
13.
Semin Nucl Med ; 52(1): 48-55, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34330450

RESUMO

One of the major effects of the COVID-19 pandemic within nuclear medicine was to halt performance of lung ventilation studies, due to concern regarding spread of contaminated secretions into the ambient air. A number of variant protocols for performing lung scintigraphy emerged in the medical literature which minimized or eliminated the ventilation component, due to the persistent need to provide this critical diagnostic service without compromising the safety of staff and patients. We have summarized and reviewed these protocols, many of which are based on concepts developed earlier in the history of lung scintigraphy. It is possible that some of these interim remedies may gain traction and earn a more permanent place in the ongoing practice of nuclear medicine.


Assuntos
COVID-19 , Humanos , Pulmão/diagnóstico por imagem , Pandemias , Cintilografia , SARS-CoV-2
14.
Clin Nucl Med ; 47(1): e79-e80, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34392280

RESUMO

ABSTRACT: Herein, we present a 72-year-old woman with metastatic thymic carcinoma, referred for salvage peptide receptor radionuclide therapy with 177Lu-DOTATATE after completing all treatment options according to current clinical practice and guidelines. However, the patient was not eligible for 177Lu-DOTATATE peptide receptor radionuclide therapy and underwent 68Ga-FAPI04 PET/CT to assess the potential for a FAP-targeted therapy.


Assuntos
Compostos Organometálicos , Timoma , Neoplasias do Timo , Idoso , Feminino , Fluordesoxiglucose F18 , Humanos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tomografia por Emissão de Pósitrons , Cintilografia , Neoplasias do Timo/diagnóstico por imagem
15.
Hell J Nucl Med ; 24(3): 234-238, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34954785

RESUMO

OBJECTIVE: The purpose of this study was to evaluate a standard 4-h imaging protocol for gastric emptying scintigraphy (GES) in detecting delayed gastric emptying (GE). SUBJECTS AND METHODS: Gamma camera imaging was performed in the anterior and posterior views at 0, 0.5, 1, 1.5, 2, 2.5 and 4-h as per established Miami method (MIA) and National Standard Protocol (NSP), in accordance with the consensus guidelines of the ANMS/SNM [SNMMI] Societies. Patients (N=1002) received a standardized solid meal radiolabeled with 1mCi of technetium-99 (99mTc) sulfur colloid. Quantitative analysis was performed using geometric mean calculation of decay-corrected counts at each imaging time point, expressed as percent emptying or retention. RESULTS: In our patient cohort, 21% had delayed GE at 4h, whereas 79% had normal emptying with less than 10% retention at 4h. There was a 25% increase in delayed GE studies at 4h versus 2h. From those patients who had delayed GE at 2h, 30% normalized at 4h, while 10% of patients with normal GE at 2h became delayed at 4h thus indicating that more studies changed from abnormal to normal than from normal to abnormal at 4h. Greater than 90% GE was found in 9% of patients at 2 h and 25% of patients at 2.5h and this persisted at 4h. The study at 2h as compared with 4h, had 56% sensitivity, 95% specificity, 70% PPV and 91% NPV. CONCLUSION: The 4-h imaging was very important in detecting cases that were delayed at 2h but normalized at 4h, and also cases with normal GE at 2h that became abnormal at 4h. These findings support the ANMS/SNM [SNMMI] recommendations. Gastric emptying value ≥90% at 2.5h can be used as threshold in predicting normal GE and the study could be terminated without additional imaging.


Assuntos
Esvaziamento Gástrico , Humanos , Cintilografia , Coloide de Enxofre Marcado com Tecnécio Tc 99m
17.
Rev Assoc Med Bras (1992) ; 67(11): 1665-1669, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34909896

RESUMO

OBJECTIVE: Nonalcoholic fatty liver disease is the most prevalent cause of chronic liver disease worldwide. Nonalcoholic steatohepatitis is associated with increased mortality rates due to the liver and cardiovascular diseases. The gold standard for discriminating nonalcoholic fatty liver disease activity and staging is the anatomopathological examination, which is an invasive method. In this regard, noninvasive methods, such as scintigraphy, have been under investigation. This study investigated the role of scintigraphy in the diagnosis of nonalcoholic steatohepatitis in obese patients with nonalcoholic fatty liver disease undergoing bariatric surgery. METHODS: Patients undergoing bariatric surgery and liver biopsy were prospectively included. 99mTc-phytate scintigraphy was performed to assess liver/spleen, spleen/heart, and liver/heart uptake ratios, while 99mTc-isonitrile scintigraphy assessed liver/heart ratio. To evaluate the presence of nonalcoholic steatohepatitis, the results of 99mTc-phytate scintigraphy and 99mTc-isonitrile scintigraphy were compared with the anatomopathological examination. RESULTS: Sixty-one patients with nonalcoholic fatty liver disease were allocated into two groups, namely, nonalcoholic steatohepatitis (n=49) and non-nonalcoholic steatohepatitis (n=12). The results of scintigraphic images obtained after the infusion of radiopharmaceutical 99mTc-phytate in liver/spleen, spleen/heart, liver/heart ratios and 99mTc-isonitrile liver/heart ratio presented no difference between groups with and without nonalcoholic steatohepatitis with an accuracy of 47.5, 37.7, 50.8, and 52.5%, respectively. CONCLUSION: Scintigraphy was not proven to be a useful method to differentiate patients with and without nonalcoholic steatohepatitis.


Assuntos
Cirurgia Bariátrica , Hepatopatia Gordurosa não Alcoólica , Biópsia , Humanos , Fígado/diagnóstico por imagem , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Cintilografia
18.
Rev Med Chil ; 149(5): 790-795, 2021 May.
Artigo em Espanhol | MEDLINE | ID: mdl-34751333

RESUMO

Sjögren Syndrome (SS), a slowly Progressive disease that has unified, validated diagnostic criteria, with excellent evidence and performance in adults, but not in adolescents. We report a 17 year old teenager with a family history of SS in his sister and mother. He presented with fever and fatigue. He had an elevated C reactive protein, leukopenia, positive antinuclear and anti-Rho antibodies and rheumatoid factor. A scintigraphy showed a severe salivary gland dysfunction. The syndrome in this patient had a pediatric clinical behavior despite his proximity to adulthood.


Assuntos
Síndrome de Sjogren , Adolescente , Adulto , Criança , Humanos , Masculino , Cintilografia , Síndrome de Sjogren/diagnóstico
19.
Clin Nucl Med ; 46(12): 999-1001, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34735410

RESUMO

ABSTRACT: A 75-year-old woman had an occasional finding of a left tonsil mass for dysphagia, which resulted a high-grade squamous carcinoma. Therefore, the patient was sent to have a left pharyngectomy. After the pharyngectomy, the patient reported persistent swallowing disorders and nasal reflux. Consequently, she had an oropharyngoesophageal scintigraphy, demonstrating irregular oral and pharyngeal swallowing phases and confirming reflux episodes into the rhinopharynx and into the oropharynx. In line with these findings, the patient was send to rehabilitation; the abnormal functional mechanisms, previously identified by the scintigraphy, allowed to guide the speech therapy, with a progressive clinical improvement.


Assuntos
Carcinoma de Células Escamosas , Transtornos de Deglutição , Procedimentos Cirúrgicos Bucais , Idoso , Carcinoma de Células Escamosas/cirurgia , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Feminino , Humanos , Faringectomia , Cintilografia
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