[Relevance of septal hypokinesia as a finding in myocardial perfusion gated-SPECT]. / Relevancia de la hipocinesia septal como hallazgo en la gated-SPECT de perfusión miocárdica.

OBJECTIVE: To identify septal hypokinesia (SH) with signs of right ventricular (RV) overload. MATERIALS AND METHODS: Prospective study of consecutive patients divided into cases with SH (n = 39) and controls without SH (n = 27). Subjects with septal perfusion defects and alterations in conduction were excluded. Images were obtained after injection of 20 mCi (740 MBq) of technetium tracer. The perfusion and septal mobility, RV and left ventricle values were quantified and other clinical parameters were obtained. Multivariate non-parametric tests and Pearson's correlation tests were applied. RESULTS: RV perfusion was higher in the case group (31.7 % vs 27.5 %, p = 0.012). 35.9 % of cases had undergone cardiac surgery (CS) in the past. A higher number of subjects with valve diseases (VD) was found in the case group (23.1 % vs 3.7 %, p = 0.031); the same occurred with smoking (46.2 % in cases vs. 11.1 % in controls, p = 0.05). Correlation was obtained between septal mobility and RV perfusion (-0.374, p = 0.015 bilateral), and between mobility of the septum and the RV (0.299, p = 0.015 unilateral). DISCUSSION: This test has been scarcely applied in RV pathology; this entity has great repercussion on the prognosis of patients with heart failure. These findings may clarify certain aspects of its physiopathology. CONCLUSIONS: According to our study, SH is associated with the degree of RV perfusion and mobility, as well as the presence of history of CS, VD and smoking.

[Meta-analysis of the diagnostic performance of 18F-FDG PET in renal cell carcinoma]. / Meta-análisis sobre el rendimiento diagnóstico de la tomografía por emisión de positrones con 18F-FDG en el carcinoma de células renales.

AIM: Renal cell carcinoma is the most frequent solid kidney tumor. At present, PET is not the imaging test of choice, the helical CT being the best method to assess these patients. The aim of the study was to perform a meta-analysis of the literature to evaluate the performance and accuracy of 18F-FDG PET in the detection of primary disease, recurrence and metastasis of renal cell carcinoma. MATERIALS AND METHODS: A systematic search was done of the available literature in primary and secondary databases published until October 2004 indexed in MEDLINE and CANCERLIT. Exclusion/inclusion criteria were applied. Their quality was evaluated using the Flynn criteria and joint estimators of sensitivity (S), specificity (Sp), likelihood ratios (LR), diagnostic odds ratio (DOR) and summary ROC (SROC) curve were obtained. The presence of the threshold effect was evaluated and the summary ROC (SROC) curve was calculated. RESULTS: Seven out of 46 studies fulfilled the inclusion criteria and were analyzed. Three studies evaluated the use of 18F-FDG PET in the differential diagnosis of renal masses. Two studies analyzed restaging and two analyzed the role of 18F-FDG PET in the detection of metastatic disease. All the selected studies were classified according to Flynn's criteria. We found the highest S in restaging with S 0.87 (95 % CI, 0.75-0.95) and in metastases detection with S 0.72 (95 % CI, 0.56-0.85) as well as the high Sp in differential diagnosis of renal masses. CONCLUSIONS: The results of this meta-analysis suggest that 18F-FDG PET can be useful in restaging and detection of metastatic disease, based on its acceptable S and Sp. However, the performance of 18F-FDG PET in the detection of primary disease is limited, but this may improve with the new PET/CT systems.

[Graft viability of patients with renal transplantation from non heart beating donors]. / Viabilidad de injerto de pacientes con trasplante renal de donante de cadáver en asistolia.

INTRODUCTION: Renal transplantation (RT) is currently the treatment of choice in end-stage renal disease. The Gregorio Marañón hospital performed 65 RT, 97.01 pmp, this year. OBJECTIVE: To study the characteristics which RT patients from non-heart beating donors have in the immediate post-transplantation renogram. To know the evolution of the renal function, by renogram. METHODS: Ten patients with NHBD graft out of 65 patients with RT were studied in the year 2003. RESULTS: The study is made up of 10 patients with RT from NHBD, with an average timing of warm ischemia of 35 min and average timing of cool ischemia 21 h. In the post-transplantation renal function study, 9 of then showed hemodilution and one an acute tubular necrosis (ATN) pattern. In most of the cases, the study was performed the day after the RT except for one that was performed on the 4th day (1.7 +/- 1 days). Renal perfusion was conserved in every case. The renal graft maintained this type of record until post-RT day 7 (6.67 +/- 0.57 days) and evolved towards ATN after day 10 (11.65 +/- 1.5 days) and normal range on day 55 +/- 51.1 post-transplantation. All patients supported the graft, with acceptable renal function, except one of then who was treated with transplantectomy due to a renal venous thrombosis. CONCLUSION: The renal function study showed "hemodilution" in the first post-transplantation in 90 % of the RT from NHBD. Evolution went from ATN to normality. The NHBD are adequate for transplantation, significantly shortening the waiting time for RN.

Technetium-99m tetrofosmin scintigraphy to evaluate breast lesions.

UNLABELLED: The aim of this study is to characterise benign from malignant breast lesions by using 99mTc-Tetrofosmin. MATERIALS: Fifteen female patients with suspected breast lesions and ten normal controls underwent breast scintigraphy with 99mTc-Tetrofosmin. All patients had conventional mammography. Breast imaging begun 20 minutes after i.v. injection of 740 MBq 99mTc-Tetrofosmin. Patients were imaged in supine and prone position. Results of the 15 patients with suspected breast lesions, 13 showed breast uptake, and 6 of them had suspicious lesions on mammography. Surgery confirmed 10 carcinomas and 3 benign lesions. Two patients demonstrated no abnormal accumulation or suspicious findings in mammography. None of the normal controls had breast uptake or mammographic abnormalities. Our study has a sensibility of 100% and 60%, and a specificity of 80% and 100% in scintigraphy and mammography respectively. CONCLUSION: Our findings suggest that 99m Tc-Tetrofosmin may play a role in evaluating breast masses and that can differentiate benign from malignant lesions.

[Gammagraphy with HMPAO-99mTc leukocytes in intestinal inflammatory disease]. / Gammagrafía con leucocitos HMPAO-99mTc en la enfermedad inflamatoria intestinal.

The value of 99mTc-hexamethylpropyleneamine oxime (HMPAO) leukocyte images has been confirmed in patients with Inflammatory Bowel Disease. We performed 121 scintigraphic examination. The results were evaluated by radiologic and/or endoscopic examinations. The patients were divided into three subgroups: A) patients with active disease and less than 15 days of corticotherapy (n = 42). B) patients with active disease and more than 15 days of corticotherapy (n = 31). C) asymptomatic patients (n = 48). Over all sensitivity and specificity were 86% and 92.2% respectively. The sensitivity in subgroup A was 97.5% and 70% in the subgroup B. In the subgroup A the isotopic study showed the entire area of active inflammation in 95% (38/40) and colonoscopy in 32.5% (13/40). The leucocyte scanning showed clear pathologic activity in the ileum with a sensitivity of 86%. We conclude that 99mTc-leukocyte scintigraphy is the best method to assess the location of active inflammation in patients with less than 15 days of treatment. Scintigraphy was best in the assessment of active disease especially in Crohn's disease of the small bowel.

[Usefulness of spect with 99mTc-tetrofosmin and stimulus with dipyridamole in patients with left bundle branch block of His]. / Utilidad del SPECT con 99mTc-tetrofosmin y estímulo con dipiridamol en pacientes con bloqueo completo de rama izquierda del haz de His.

BACKGROUND: In patients with left bundle branch block, the 201Tl scintigraphic studies show high sensitivity, but with low specificity, in the diagnosis of coronary artery disease. OBJECTIVE: [corrected] To assess the value of 99mTc-tetrofosmin Single Photon Emission Computed Tomography (SPECT) and dipyridamole administration in patients with left bundle branch block. METHODS: 22 patients with angina and left bundle branch block were retrospectively studied by cardiac catheterization and Tc-Tf after dipyridamole administration (0,142 mg/kg/min. i.v.) and at rest. RESULTS: The mean number of territories with perfusion defects was 1.5+/-1.0, and the average number of diseased vessels in the coronariographic study was 1.6+/-1.3 (r = 0.77, p<0.001). Sensitivity, specificity, positive predictive value, negative predictive value, total predictive value and Kappa index in the diagnosis of multivessel disease were 92%, 90%, 92%, 90%, 91% and 0.82, respectively. In the diagnosis of anterior descending artery disease, these values were 83%, 70%, 77%, 78%, 77%, and 0.54, respectively. CONCLUSION: In patients with angina and left bundle branch block, SPECT with Tc-Tf-dipyridamole is of great value in the study of coronary artery disease extension. Sensitivity and specificity for the diagnosis of anterior descending artery disease were similar to that shown in series with thallium-dipyridamole.

[Bone scintigraphy findings in patients with recently diagnosed adenocarcinoma of the prostate: relationship with prostate specific antigen levels]. / Hallazgos de la gammagrafía ósea en pacientes con adenocarcinoma de próstata recién diagnosticado: relación con los niveles de antígeno específico prostático.

BACKGROUND AND OBJECTIVES: Although it has been suggested that bone scintigraphy (BS) may not be necessary in patients with prostate adenocarcinoma (PA) and normal prostate specific antigen (PSA) plasma levels, controversy still remains. The objective of the study was to evaluate the existing relationship between PSA plasma levels and BS findings in patients with a recently diagnosed PA in order to assess whether BS may be omitted on the basis of the PSA levels in these patients. METHODS: The 475 patients (70+/-7 years old) consecutively diagnosed of PA between 1994 and 1998 in our institution made up the study population. PSA plasmatic levels were determined and BS was performed (body planar study after 99mTc-methyl diphosphonate 900 MBq administration) in all the patients. RESULTS: In 362 patients (76.2%), BS was negative, in 108 (22.7%) positive and undetermined in the remaining 5 patients (1.1%). The mean PSA level in the whole study population was 74+/-267 ng/ml (range 0.4-4.200) and was higher in patients with positive GO (218+/-512 vs 31+/-89, p<0,0001). As PSA increased, the rate of patients with positive BS was significantly higher, this being 0%, 16.4%, 9.7%, 14.0%, 31.0% and 48.3% in patients with PSA 4, 4.1-10; 10.1-20; 20.1-30; 30.1-40, and >40 ng/ml, respectively (p<0.0001). In patients with positive BS, the PSA levels were 20 and 10 ng/ml in 30.6% and 18.6% of the patients, respectively. CONCLUSION: According to our experience, there is a significant association between PSA plasma levels and the BS results in patients with recently diagnosed PA. However, a significant proportion of patients with bone metastasis have normal PSA levels, and therefore BS should be performed in all patients with recently diagnosed PA regardless of the PSA levels.

[Integration of multimodal medical images]. / Integración de imágenes médicas multimodalidad.

Multimodality analysis is becoming a required tool in medical practice due to the development of different image techniques and new imaging processing tools. This paper is a review of the basis of medical image integration, image fusion techniques, and their clinical applications, especially addressing our experience with brain tomographic studies in nuclear medicine and radiology.

[Scintigraphy diagnosis of renovascular hypertension in renal transplanted patients]. / Diagnóstico gammagráfico de hipertensión renovascular en trasplantados renales.

UNLABELLED: Captopril renography (CR) has been shown to be a useful technique in the diagnosis of renovascular hypertension (RVH). This disease is a significant complication of the kidney transplanted patient so that early diagnosis would be extremely useful to preserve renal function and prevent graft loss. This work evaluates the role of CR, together with arteriography and doppler-ultrasound, in the diagnosis of RVH. MATERIALS: A total of 19 transplanted patients with clinical suspicion of RVH underwent an isotopic study, a doppler-ultrasound study and an arteriography. Scintigraphy was performed 1 hour after a 50 mg dose of captopril, with oral hydration and i.v. administration of approximately 111 MBq of 99mTc-MAG3 and 20 mg of furosemide. If abnormal, a subsequent renography in baseline conditions was performed for comparison. RESULTS: Overall, 11 patients had renovascular hypertension. Sensitivity and specificity of CR were 91% and 80% respectively, 100% and 60% for US and 91% and 100% for arteriography. The CR yielded one false positive result and 2 false negatives cases: one with 50% stenosis and one polar artery stenosis. Six patients were successfully dilated or operated. CONCLUSION: CR seems to be a reliable diagnostic tool for the diagnosis of renovascular hypertension in kidney transplanted patients.

[Results of myocardial scintigraphy with 99mTc-tetrofosmin and dipyridamole administration in patients diagnosed of microvascular angina]. / Resultados de la gammagrafía de perfusión miocárdica con 99mTc-tetrofosmina y estímulo con dipiridamol en pacientes diagnosticados de angina microvascular.

The objective of the study was to evaluate the results of the myocardial scintigraphy with 99mTc-tetrofosmin (Tc-Tf) and pharmacological stimulation with dipyridamole in patients diagnosed of microvascular angina. The study population is made up of 50 patients discharged with the diagnosis of microvascular angina who had undergone Tc-Tf-dipyridamole. Clinical and electrical positivity appeared in 40% and 12% of the patients, respectively. Myocardial perfusion defects were found in 35 patients (70%), and were reversible in 21 (60%), fixed in 11 (21%), and combined in 3 (9%). Abnormalities were inferior, anteroseptal and lateral in 21, 18, and 2 patients, respectively. Patients with a positive exercise treadmill test, compared with those with a negative one, had more frequent perfusion abnormalities (91% vs 50%, p = 0.0327) and myocardial ischemia (64% vs 20%, p = 0.392). Women, in comparison with men, had angina (56% vs 22%, p = 0.013), and anteroseptal perfusion abnormalities (26% vs 4%, p = 0.028) more frequently. On the contrary, men had inferior perfusion abnormalities more frequently (57% vs 30%, p = 0.057). Thus, Tc-Tf-dipyridamole shows perfusion abnormalities in 70% of patients with microvascular angina (91% in patients with a positive exercise treadmill test). Scintigraphic pattern may be partially conditioned by gender in these patients.

[Incidental diagnosis of medullary thyroid carcinoma (MTC) after performing 123I-metaiodobenzylguanidine (123I-MIBG) gammagraphy]. / Diagnóstico de carcinoma medular de tiroides (CMT) de forma casual tras realización de gammagrafía 123I-metayodobencilguanidina (123I-MIBG).

UNLABELLED: The objective of this clinical note is to emphasize diagnostic efficiency of 123I-MIBG scintigraphy in the initial diagnosis and follow-up of medullary thyroid carcinoma within MEN2. MATERIALS AND METHODS: We present the case of a patient who, during a scintigraphic study with 123I-MIBG for the diagnosis of pheochromocytoma, was unexpectedly found to suffer from medullary carcinoma of the thyroid. Prior to performing the test, we proceeded to block uptake into the thyroid gland through the administration of Lugol. We carried out the scintigraphic study by intravenously injecting 370 MBq 123I-MIBG. RESULTS: A pathological uptake of the radiopharmaceutical compound over the right suprarenal gland, and unexpectedly, over the thyroid gland was detected, thus confirming the existence of medullary carcinoma of the thyroid in this patient, and obtaining the diagnosis of Type MEN2A polyglandular syndrome. CONCLUSIONS: From our experience, we can manifest the value of scintigraphy using 123I-MIBG in the diagnosis and localization of medullary carcinoma of the thyroid. Furthermore, it is indicated in patients suspected of MEN, since it makes it possible to reach a diagnosis of this kind of syndrome through the performance of just one test.

[Meaning of clinical and electrical positivity in the myocardial perfusion scintigraphy during the administration of dipyridamole]. / Implicaciones de la positividad clínica y eléctrica en la gammagrafía de perfusión miocárdica durante la administración de dipiridamol.

BACKGROUND AND OBJECTIVES: Administration of dipyridamole produces angina and ST depression in 20%-30% and 6%-34% of patients, respectively. This study aimed to evaluate the clinical implications of the presentation of angina and/or ST depression during the administration of dipyridamole in the study of coronary heart disease by myocardial perfusion SPECT (MPS). METHODS: The study population is constituted by 593 consecutive patients without left branch block or ventricular pacemaker rhythm who were referred to our service to undergo MPS with dipyridamole. A SPECT was performed after the administration of 99mTc-tetrosfosmine and drug stimulation with dipyridamole (0.142 mg/kg/min for 4 minutes). A coronariography was performed in 338 patients (57%). The frequency of clinical and electrical positivity and their relationship with the MPS and the coronariography were studied. RESULTS: The rate of angina and ST depression was 32% (n = 190) and 10% (n = 58), respectively. Myocardial perfusion defects were observed in 465 patients (78%), and signs of scintigraphic ischemia in 311 (52%). The patients with ST depression presented a higher frequency of perfusion defects (93% vs 76%, p = 0.0012) and scintigraphic ischemia (89% vs 49%, p < 0.0001). In addition, perfusion defects in more than one territory were observed in these patients in a higher percentage (53% vs 34%, p = 0.0036). Among the patients who underwent cardiac catheterization, those who had a ST depression had a greater extension of coronary heart disease (1.8 +/- 1.2 vs 1.3 +/- 1.0 diseased vessels, respectively. p = 0.0100) and a higher frequency of multivessel disease (61% vs 43%, p = 0.0380). Those patients who had clinical positivity showed a scintigraphic ischemia more frequently (66% vs 47%, p < 0.0001), however no statistically significant differences were observed between the presence of patients with perfusion defects or in the extension of these defects as well as in the number of diseased vessels in the coronariographic study. CONCLUSIONS: During the administration of dipyridamole, the ST depression is associated with more frequent scintigraphic ischemia, larger extension of perfusion defects and more diseased vessels. The appearance of angina is associated with scintigraphic ischemia, but it is not necessarily associated with the extension of perfusion defects or greater number of diseased vessels.

[Utility of SPECT with 99m Tc-tetrofosmin and stimulus with dipyridamole in patients with permanent ventricular pacemakers]. / Utilidad del SPECT con 99mTc-tetrofosmin y estímulo con dipiridamol en pacientes portadores de marcapasos ventricular permanente.

BACKGROUND AND OBJECTIVE: Patients with permanent ventricular pacemakers (PP) are a difficult subgroup to assess in the study of coronary artery disease. The objective of this study was to evaluate the diagnostic value of the myocardial perfusion scintigraphy with 99mTC-Tetrofosmin (Tc-Tf) and stimulus with dipyridamole in patients with PP and suspected coronary artery disease. PATIENTS AND METHODS: Fourteen patients with suspected coronary artery disease and without structural cardiopathy, who underwent Tc-Tf and cardiac catheterization, were studied retrospectively. Sensitivity, specificity, predictive values and Kappa index were calculated for the diagnosis of coronary artery disease, multivessel disease, and for each one of the coronary arteries (left anterior descending, right coronary, and circumflex). In addition, the correlation between the number of territories with perfusion defects and the number of diseased vessels was studied. RESULTS: In regards to the diagnosis of coronary artery disease, sensitivity, specificity, positive predictive value, negative predictive value and the Kappa index were 100%, 50%, 83%, 100% and 0.55, respectively. For multi-vessel disease, these values were 83%, 64%, 64%, 83% and 0.43 respectively. The correlation coefficient between the number of territories with perfusion defects and the number of diseased vessels was 0.61 (p = 0.02). In the diagnosis of anterior descending disease, sensitivity and specificity were 83% and 88% respectively. For the right coronary artery, these values were 100% and 44% and for the circumflex artery 38% and 83%, respectively. CONCLUSION: In patients with PP and suspected coronary artery disease, myocardial perfusion scintigraphy with Tc-Tf and stimulus with dipyridamole is of great value in the diagnosis of coronary artery disease and in the assessment of its extension.

[Antiphospholipid antibodies in women with habitual abortions. Treatment with prednisone and acetylsalicylic acid during pregnancy]. / Anticuerpos antifosfolípidos en mujeres con abortos de repetición. Valoración del tratamiento con prednisona y ácido acetil salicílico durante el embarazo.

PURPOSE: To discover the prevalence of antiphospholipid antibodies in women with a history of repeated miscarriages. Therapy evaluation of aspirin and prednisone to achieve living term foetus from women in whom antiphospholipid antibodies had been detected and who had become pregnant again. PATIENTS AND METHODS: 82 consecutive women with history of at least of two miscarriages, with no live foetus in either case. 14 women positive for antiphospholipid antibodies who had become pregnant again (group of therapy evaluation), were treated with aspirin (125 mg/d) and prednisone (20 mg/d). 60 normal pregnant women (control group). Lupus anticoagulant evaluation: APTT tests caolin clotting time and APTT system neutralized with platelet phospholipids. Antiphospholipid antibodies: ELISA test. RESULTS: 13.4% were positive to antiphospholipid antibodies (ELISA), and 2.4% were positive in both positive in both test. Therapy evaluation: 75.5% (11 cases) of pregnancies were successful (normal foetus), 14% (2 cases) of fetal losses, and 7% (1 case) of foetal malformations (acranius). CONCLUSIONS: In our study the antiphospholipid antibodies represent one of the main causes of repeated foetal losses. We recommended in cases of infertile women to test for antiphospholipid antibodies regularly. We confirm the effectiveness of the therapy (aspirin and prednisone) in achieving successful pregnancies in patients with a history of infertility.

Clinical significance of abdominal scintigraphy using 99mTc-HMPAO-labelled leucocytes in patients with seronegative spondyloarthropathies.

Abdominal scintigraphy shows silent gut inflammation in patients with spondyloarthropathies (Sp) without clinical evidence of gut inflammation. Abdominal scintigraphy images are different than those obtained in patients with ulcerative colitis or Crohn's disease and are not related to the anti-inflammatory drugs administered. The aim of this study was to examine the clinical associations of findings on abdominal scintigraphy in patients with Sp. A total of 204 Sp patients (European Spondylarthropathy Study Group 1991 criteria) and 54 non-Sp controls receiving non-steroidal anti-inflammatory drugs were studied. Abdominal scintigraphy images were obtained at 30 and 120 min after injection of technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO)-labelled leucocytes. 99mTc-HMPAO-labelled leucocyte scans were positive in 104 Sp patients (50.9%) and in six non-Sp controls (2.9%) (P<0.001; OR=8.32; 95% CI=3.23-22.67). Silent gut inflammation was not associated with any of the following: age of onset, duration of evolution, sex, family history of Sp or psoriasis, articular manifestations, extra-articular manifestations, radiological findings or HLA-B27 positivity. Positive abdominal scintigraphy was associated with active disease (P < 0.0001; OR=52.7; 95% CI=19-145.6) and an increase in the C-reactive protein (P < 0.005; OR = 3.4; 95% CI = 1.5-7.4). It is concluded that (a) abdominal scintigraphy using 99mTc-HMPAO-labelled leucocytes is of value in detecting the silent gut inflammation in Sp patients, and (b) silent gut inflammation is related to the clinical activity, but is not associated with any particular type of illness or with HLA-B27.

Clinical significance of abdominal scintigraphy using (99m)Tc-HMPAO-labelled leucocytes in patients with seronegative spondyloarthropathies.

Abdominal scintigraphy shows silent gut inflammation in patients with spondyloarthropathies (Sp) without clinical evidence of gut inflammation. Abdominal scintigraphy images are different than those obtained in patients with ulcerative colitis or Crohn's disease and are not related to the anti-inflammatory drugs administered. The aim of this study was to examine the clinical associations of findings on abdominal scintigraphy in patients with Sp. A total of 204 Sp patients (European Spondylarthropathy Study Group 1991 criteria) and 54 non-Sp controls receiving non-steroidal anti-inflammatory drugs were studied. Abdominal scintigraphy images were obtained at 30 and 120 min after injection of technetium-99m hexamethylpropylene amine oxime ((99m)Tc-HMPAO)-labelled leucocytes. (99m)Tc-HMPAO-labelled leucocyte scans were positive in 104 Sp patients (50.9%) and in six non-Sp controls (2.9%) (P<0.001; OR=8.32; 95% CI=3.23-22.67). Silent gut inflammation was not associated with any of the following: age of onset, duration of evolution, sex, family history of Sp or psoriasis, articular manifestations, extra-articular manifestations, radiological findings or HLA-B27 positivity. Positive abdominal scintigraphy was associated with active disease (P<0.0001; OR=52.7; 95% CI=19-145.6) and an increase in the C-reactive protein (P<0.005; OR=3.4; 95% CI=1.5-7.4). It is concluded that (a) abdominal scintigraphy using (99m)Tc-HMPAO-labelled leucocytes is of value in detecting the silent gut inflammation in Sp patients, and (b) silent gut inflammation is related to the clinical activity, but is not associated with any particular type of illness or with HLA-B27.