[Octreotide scintigraphy in thyroid orbitopathy]. / Gammagrafía con octreótido en la orbitopatía distiroidea.

INTRODUCTION: Graves' disease, which has an autoimmune basis, is associated with the infiltration of activated lymphocytes into the retrobulbar tissues of the eye. These activated lymphocytes express somatostatin receptors on their surface which mediate the inflammatory response. OBJECTIVE: To evaluate the efficiency of (111) In-Octreotide scintigraphy in the identification of orbital activity in Graves' disease and the usefulness of treatment with a somatostatin analogue, based on a pre-established protocol within the Nuclear Medicine Department. METHODS: We studied a group of eighteen patients with symptomatic Graves' ophthalmopathy of between two months and four years duration. We injected 6 mCi of (111) In-Octreotide parenterally, and performed scintigraphy four and twenty-four hours later. Four patients, all in the active phase, showed orbital somatostatin receptors, for which they were treated with lanreotide 60 mg every fifteen days for three months. Patients were reviewed after 3 months treatment with a further scintigraphy and clinical study. RESULTS: In our study all four treated patients had less than sixteen months of ophthalmopathy, and three responded well to the treatment. CONCLUSION: Scintigraphy with Octreotide is a useful procedure allowing identification of patients in the active phase of the ophthalmopathy who are likely to respond well to treatment with somatostatin analogues.

[99mTc-HMPAO-leukocyte-labeled scintigraphy in the detection and follow-up of inflammatory bowel disease]. / La gammagrafía con leucocitos marcados con Tc-HMPAO en el diagnóstico y seguimiento de la enfermedad inflamatoria intestinal.

To assess the clinical value of 99mTc-HMPAO-leukocyte-labeled scintigraphy (LLS) in the detection and follow-up of inflammatory bowel disease (IBD) in the pediatric population, we retrospectively reviewed 33 patients (15 boys; mean age 10.7 +/- 2.2 years) with suspected IBD. A total of 58 examinations were performed: 29 for screening purposes, 23 for follow-up and 6 to detect relapses. LLS was compared with clinical symptoms (PCDAI index), biologic markers of inflammation, barium contrast radiology (BCR; n = 22), sonography (n = 22), colonoscopy (n = 16), and biopsy (n = 13). The final diagnosis was Crohn's disease in 12, ulcerative colitis in 4, and no IBD in 17. In the 17 patients without IBD, LLS was always negative. Among the 16 patients with IBD, LLS showed concordant results with BCR in 7/10 patients, with sonography in 6/11, with colonoscopy in 9/12 and with biopsy in 8/9. The severity of LLS increased with the PCDAI index (p < 0.001), with a positive correlation between the scintigraphic activity index/PCDAI r = 0.76. An increase in the PCDAI index with the severity of LLS (p < 0.001) was also observed in the follow-up, and a weak correlation (r = 0.50) between erythrocyte sedimentation rate/scintigraphic activity index was obtained. In 5 patients with normal biologic markers, LLS detected inflammation. All 6 patients with relapses were symptomatic; 5 had inflammation on LLS and 5 had abnormal biologic markers. In conclusion, LLS can be a useful screening tool in the detection of IBD in children to assess the grade of inflammation and extension of IBD. This technique can detect the presence of inflammation during follow-up and should be performed when relapses are suspected.

Contribution to the diagnosis of idiopathic femoral head necrosis by scintigraphy with 99mTc-MDP assessed quantitatively by computer.

The authors have studied by quantification the bone uptake of 99mTc-MDP in femoral head necrosis in order to evaluate in an objective manner conventional scintigraphy, and thus to increase the sensitiveness and efficacy of an exploration for an early diagnosis of these patients. Twenty cases of femoral necrosis have been studied, diagnosed in all cases by histopathological analysis; in twelve of them the process was unilateral and in the other eight bilateral. All explorations were carried out with 99mTc-MDP, a gamma camera and a PDP 11/40 computer for the quantitative study with the obtention of indices relating the activity between the femoral heads and, of these, to a normal vertebra. Quantification in the control group showed that the uptake of the nuclide was similar in both femoral heads and is lower than this in the vertebra. In all cases of unilateral necrosis the abnormal deviations of the indices relating the pathological head to the contralateral head and the lumbar vertebra were significant. In bilateral femoral head necrosis, an increase has been observed in all indices, although only the index relating the contralateral femoral head suspect of a lesion to vertebral activity was statistically significant. The proposed method for quantifying can be carried out easily and is very useful for diagnosing femoral necrosis since it improves the results of a subjective assessment of the scintigraphic image and can earlier detect the abnormal uptake of the lesion.

[False positive with Tl-201 in the study of Ewing's sarcoma of the astragalus caused by reflex sympathetic dystrophy]. / Falso positivo con T1201 en el estudio de un sarcoma de Ewing de astrágalo causado por una distrofia simpático-refleja.

We describe a 14 year old male, diagnosed of Ewing sarcoma in left astragalus. We performed two 201-Thallium scan for evaluating the response to chemotherapy (before and after the treatment). The scan performed after chemotherapy showed patchy uptake in astragalus, calcaneus and some joints of the foot. The following radiology and scintigraphy diagnosed a reflex sympathetic dystrophy in the left foot due to disuse of the limb. The 201-Thallium overestimated viability of the tumour for this reason. We must discard the presence of this kind of associated pathology in order that they could be cause of false positives.

[Extraosseous accumulation of 99mTc-HMDP in knees with synovial effusion]. / Acúmulo extraóseo de 99mTc-HMDP en rodillas con derrame sinovial.

In the presence of extraosseous activity seen in the late phase of the bone scintigraphy (BS) localized in the distal femur of patients prior to radiation synovectomy, we decided to review the frequency of this finding in 20 patients (24 joints) and its relationship with scintigraphic and clinical parameters. Mild soft tissue accumulation was seen in the late phase of the BS in 14 out of 24 joints, without association between this finding and knee uptake in vascular blood pool and late phases of the BS. However, a significant association with synovial effusion was found, and patients with higher degree of effusion presented extraosseous activity more frequently. In conclusion, we think that soft tissue accumulation in the late phase of the BS is a sign of synovial effusion.

[Bone metastasis versus insufficiency fractures due to pelvic radiotherapy for gynecologic neoplasm]. / Metástasis óseas versus fracturas por insuficiencia en pelvis irradiadas por neoplasia ginecológica.

Five cases of patients with gynecological neoplasm (four cervix carcinoma and one endometrial sarcoma) who underwent pelvic external radiotherapy and intracavitary brachytherapy in whom pathologic pelvic uptake was found in the bone scan are presented. The diagnosis was pelvic insufficiency fractures due to radiotherapy adverse effects on the skeletal system confirmed by CT and by the favorable scintigraphy and clinical outcome. Both bone metastases and insufficiency fractures must be considered in the differential diagnosis of bone pain in irradiated pelvises. The bone scintigraphy detects these insufficiency fractures early and can show a typical symmetric uptake pattern. In asymmetric lesions, the CT and clinical follow-up as well as the scintigraphic evolution of the lesions should confirm the findings of the bone scintigraphies.

[Value of studying oncologic patients using bone gammagraphy for the diagnosis of skeletal metastasis. Review of 200 cases]. / Interés del estudio de los pacientes oncológicos mediante gammagrafía óseapara el diagnóstico de metástasis en esqueleto. Revisión de 200 casos.

Two hundred cancer patients with bone metastases were studied by gammagraphy employing 555 MBq of 99mTc-MDP. The results were compared with those obtained by radiology and alkaline phosphatase determination, showing that gammagraphy is positive in 93 per 100 of the cases and is more useful than the other procedures to make a pre-radiologic diagnosis of bone metastases (27 per 100).

[Bone and vascular gammagraphy in the study of primary bone neoplasms. Diagnostic value and monitoring of clinical course. Review of 50 cases]. / La gammagrafía osea y vascular en el estudio de los tumores primitivos del hueso. Interés diagnóstico y control evolutivo. Revisión de 50 casos.

Fifty patients with bone primary tumors (multiple myeloma, osteogenic sarcoma, Ewing's sarcoma, giant cell tumor, and others) were studied gammagraphically after injecting 555 MBq of 99mTc-MDP. Eighty per cent of the cases were found in long bones, specially femur and tibia. These two bones were the preferent localization of osteosarcomas. Ewing's neoplasms were mostly diaphysial and osteoclastomas epiphysial.

[Nuclear medicine in osteoarticular pathology]. / La medicina nuclear en la patología osteoarticular.

The author writes about some facts related to the use of 99m-Tc-phosphate in skeletal scanning, specially to recognize cancer metastases, and vascular and inflammatory osseous diseases, and indicates some conditions to carry out the study.

Gammagrafía con octreótido en la orbitopatía distiroidea / Octreotide Scintigraphy in Thyroid Orbitopathy

Introducción: La enfermedad de Graves es una enfermedad de base autoinmune en la cual existe una infiltración por linfocitos activados en el tejido retroorbitario. Estos linfocitos activados se caracterizan por aumentar la expresión de receptores de somatostatina en su superficie que median la respuesta inflamatoria. Objetivo: Valorar la efectividad de la gammagrafía con 111In-octreótido en la identificación de actividad orbitaria en la Enfermedad de Graves y valorar qué pacientes son subsidiarios de recibir tratamiento con análogos de la somatostatina, así como su evolución con el tratamiento, según un protocolo establecido con el Servicio de Medicina Nuclear. Métodos: Se estudió un grupo de dieciocho pacientes con oftalmopatía tiroidea sintomática de dos meses a cuatro años de evolución. Se les inyectó 6 mCi de 111In-octreótido vía endovenosa siendo estudiados mediante SPECT a las cuatro y veinticuatro horas. Cuatro enfermos, todos en fase activa, mostraron captación orbitaria, por lo que fueron tratados con lanreotida 60 mg cada quince días. Se controló a estos pacientes a los tres meses con un nuevo estudio clínico-gammagráfico. Resultados: En nuestra serie, de los cuatro pacientes que presentaron receptores, todos ellos con evolución menor de dieciséis meses, tres respondieron bien al tratamiento según la valoración posterior. Conclusión: La gammagrafía con octreótido es un procedimiento útil que diferencia las fases activas, subsidiarias de tratamiento inmunosupresor, en pacientes con oftalmopatía tiroidea. El tratamiento con análogos de la somatostatina fue eficaz en nuestra serie

Introduction: Graves' disease, which has an autoimmune basis, is associated with the infiltration of activated lymphocytes into the retrobulbar tissues of the eye. These activated lymphocytes express somatostatin receptors on their surface which mediate the inflammatory response. Objective: To evaluate the efficiency of 111In-Octreotide scintigraphy in the identification of orbital activity in Graves’ disease and the usefulness of treatment with a somatostatin analogue, based on a pre-established protocol within the Nuclear Medicine Department. Methods: We studied a group of eighteen patients with symptomatic Graves’ ophthalmopathy of between two months and four years duration. We injected 6 mCi of 111In-Octreotide parenterally, and performed scintigraphy four and twenty-four hours later. Four patients, all in the active phase, showed orbital somatostatin receptors, for which they were treated with lanreotide 60 mg every fifteen days for three months. Patients were reviewed after 3 months treatment with a further scintigraphy and clinical study. Results: In our study all four treated patients had less than sixteen months of ophthalmopathy, and three responded well to the treatment. Conclusion: Scintigraphy with Octreotide is a useful procedure allowing identification of patients in the active phase of the ophthalmopathy who are likely to respond well to treatment with somatostatin analogues

Gammagrafía abdominal con leucocitos marcados en la isquemia intestinal / Abdominal scintigraphy using labelled leukocytes in intestinal ischaemia

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La gammagrafía con leucocitos marcados con 99mTc-HMPAO en el diagnóstico y seguimiento de la enfermedad inflamatoria intestinal / 99mTc-Leukocyte-labeled scintigraphy in the detection and follow-up of inflammatory bowel disease

Para valorar si la gammagrafía con leucocitos marcados con 99mTc-HMPAO (GLM) es útil en el diagnóstico y seguimiento de la enfermedad inflamatoria intestinal (EII) en pediatría, se han estudiado retrospectivamente 33 pacientes, 15 varones, edad 10,7 6 2,2 años, con sospecha de EII. El total de exploraciones ha sido 58, 29 con fines diagnósticos, 23 para el seguimiento de la enfermedad, y seis para la detección de recidiva. En el diagnóstico se comparó la GLM con la clínica (PCDAI), estudio analítico de sangre, radiología con contraste baritado (RCB; n 5 22), ecografía (ECO; n 5 22), colonoscopia (n 5 16) y biopsia (n 5 13). El diagnóstico final fue: enfermedad de Crohn (n 5 12), colitis ulcerosa (n 5 4), y no EII (n 5 17). En los 17 pacientes sin EII la GLM fue siempre normal. Entre los 16 pacientes con EII la concordancia de resultados de la GLM con RCB fue 7/10, con ECO 6/11, con colonoscopia 9/12, y con biopsia 8/9. Conforme aumentó el grado de severidad en la GLM se incrementó el PCDAI (p < 0,001), con una correlación índice de actividad gammagráfico/PCDAI r 5 0,76. Durante el seguimiento evolutivo también se ha observado un incremento del PCDAI con la severidad en la GLM (p < 0,001), y una débil correlación velocidad de sedimentación globular/índice de actividad gammagráfico r 5 0,5. En 5 pacientes con analítica normal la GLM fue patológica. Los 6 pacientes con recidiva de la EII presentaron síntomas, cinco de ellos tenían una GLM patológica y cinco una analítica alterada. En conclusión la GLM es una técnica aplicable en pediatría, útil en el diagnóstico inicial para valoración del grado de inflamación y extensión de la EII. Es capaz de detectar la presencia de inflamación activa durante el seguimiento evolutivo, y se debe realizar cuando se sospeche recidiva de la enfermedad

To assess the clinical value of 99mTc-HMPAO-leukocyte-labeled scintigraphy (LLS) in the detection and follow-up of inflammatory bowel disease (IBD) in the pediatric population, we retrospectively reviewed 33 patients (15 boys; mean age 10.7 6 2.2 years) with suspected IBD. A total of 58 examinations were performed: 29 for screening purposes, 23 for follow-up and 6 to detect relapses. LLS was compared with clinical symptoms (PCDAI index), biologic markers of inflammation, barium contrast radiology (BCR; n 5 22), sonography (n 5 22), colonoscopy (n 5 16), and biopsy (n 5 13). The final diagnosis was Crohn's disease in 12, ulcerative colitis in 4, and no IBD in 17. In the 17 patients without IBD, LLS was always negative. Among the 16 patients with IBD, LLS showed concordant results with BCR in 7/10 patients, with sonography in 6/11, with colonoscopy in 9/12 and with biopsy in 8/9. The severity of LLS increased with the PCDAI index (p < 0.001), with a positive correlation between the scintigraphic activity index/PCDAI r 5 0.76. An increase in the PCDAI index with the severity of LLS (p < 0.001) was also observed in the follow-up, and a weak correlation (r 5 0.50) between erythrocyte sedimentation rate/scintigraphic activity index was obtained. In 5 patients with normal biologic markers, LLS detected inflammation. All 6 patients with relapses were symptomatic; 5 had inflammation on LLS and 5 had abnormal biologic markers. In conclusion, LLS can be a useful screening tool in the detection of IBD in children to assess the grade of inflammation and extension of IBD. This technique can detect the presence of inflammation during follow-up and should be performed when relapses are suspected

Un paciente con xerostomía

La xerostomía es la sensación subjetiva de sequedad bucal debido a la disminución de saliva. Puede afectar hasta a un 30 por ciento de la población general.Aunque en sí misma no es una enfermedad, altera la calidad de vida, especialmente en la población anciana.Suele recibir escasa atención, incluso por los propios médicos y, en ocasiones, el mismo paciente no lo refiere hasta que se pregunta directamente por su existencia. Sin embargo, puede ser el síntoma que oriente de la presencia de enfermedad sistémica, como el síndrome de Sjögren. Las causas más frecuentes son el uso de fármacos xerogénicos, la radioterapia cervical y el síndrome de Sjögren. El diagnóstico inicial de la xerostomía se basa en demostrarla mediante sialometría (flujo salival basal) y el diagnóstico diferencial en la combinación de pruebas dinámicas o funcionales que analizan la reserva salival glandular (flujo salival estimulado, gammagrafía salival) y estructurales (biopsia labial). El primer paso del tratamiento se basa en mantener una hidratación adecuada y evitar el uso de fármacos xerogénicos. El uso de saliva artificial y de fármacos sialogogos como la pilocarpina son la base del tratamiento actual de la xerostomía. (AU)

Acúmulo extraóseo de 99mTc-HMDP en rodillas con derrame sinovial / Extraosseous accumulation of 99mtc-hmpd in knees with synovial effusion

Ante la observación de actividad extraósea alrededor del tercio distal del fémur durante la fase tardía en algunos pacientes a los que se realizó una gammagrafía ósea (GO) y posterior radiosinoviortesis, revisamos en 20 pacientes (24 articulaciones) la frecuencia con la que apareció este hallazgo y su relación con parámetros gammagráficos o clínicos. Hemos encontrado una leve captación extraósea en la imagen tardía de la GO en 14 de 24 articulaciones, sin que haya existido asociación entre ésta y la intensidad de captación de la rodilla en las fases de pool vascular y tardía de la GO, pero sí con la presencia de derrame articular siendo más frecuente en aquellos con derrame más severo. En conclusión, pensamos que la presencia de captación (AU)

In the presence of extraosseous activity seen in the late phase of the bone scintigraphy (BS) localized in the distal femur of patients prior to radiation synovectomy, we decided to review the frequency of this finding in 20 patients (24 joints) and its relationship with scintigraphic and clinical parameters. Mild soft tissue accumulation was seen in the late phase of the BS in 14 out of 24 joints, without association between this finding and knee uptake in vascular blood pool and late phases of the BS. However, a significant association with synovial effusion was found, and patients with higher degree of effusion presented extraosseous activity more frequently. In conclusion, we think that soft tissue accumulation in the late phase of the BS is a sign of synovial effusion (AU)