RESUMEN
BACKGROUND: To study the possible relation between immunohistochemical expression of vascular endothelial growth factor receptor 1 (VEGFR1) and the maximum standardised uptake value (SUV max) of 18F-FDG PET in patients with non small cell lung cancer (NSCLC). MATERIAL AND METHODS: The study included 39 patients with NSCLC (24 squamous cell carcinomas and 15 adenocarcinomas). According to the clinical stage, the patients were distributed as follows: 8 stage I, 7 stage II, 15 stage III and 9 stage IV. Immunohistochemical expression of VEGFR1 was studied through the technique of tissue-matrix using Tissue Arrayer Device (Beecher Instruments, Sun Prairie, WI), using the polyclonal antibody against VEGFR1 (Santa Cruz Biotechnology, California, USA). RESULTS: Positive VEGFR1 immunohistochemical expression was noted in 23 cases (59%). The number of positive tumours was not related with clinical stage but there was a different statistically significant association (p:0,0009) between VEGFR1 positivity and histological type, corresponding the greater percentages of positive results to adenocarcinomas (93,3%) versus in squamous cell carcinomas (37,5%). Likewise, SUV max values were higher (p: 0,039) in negative VEGFR1 carcinomas than in positive VEGFR1 tumors (r: 4-32,1; 16,4+/-6,4 (median 16,1) vs r: 3-47; 14,5+/-8,6 (12,8)). CONCLUSIONS: Our results led us to consider that in NSCLC, the negative VEGFR1 immunohistochemical expression is associated significantly with squamous cell carcinomas subtype and with higher SUV max values in 18F-FDG-PET.
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Carcinoma de Pulmón de Células no Pequeñas , Carcinoma de Células Escamosas , Neoplasias Pulmonares , Receptor 1 de Factores de Crecimiento Endotelial Vascular/genética , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Carcinoma de Células Escamosas/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Tomografía de Emisión de Positrones , RadiofármacosRESUMEN
BACKGROUND: To study the possible relation between immunohistochemical expression of vascular endothelial growth factor receptor 1 (VEGFR1) and the maximum standardised uptake value (maxSUV) of 18F-FDG PET in patients with non small cell lung cancer. MATERIAL AND METHODS: The study included 39 patients with NSCLC (24 squamous cell carcinomas and 15 adenocarcinomas). According to the clinical stage, the patients were distributed as follows: 8 stage I, 7 stage II, 15 stage III and 9 stage IV. Immunohistochemical expression of VEGFR1 was studied through the technique of tissue-matrix using tissue arrayer device (Beecher Instruments, Sun Prairie, WI), using the polyclonal antibody against VEGFR1 (Santa Cruz Biotechnology, California, USA). RESULTS: Positive VEGFR1 immunohistochemical expression was noted in 23 cases (59%). The number of positive tumours was not related with clinical stage but there was a different statistically significant association (p:.0009) between VEGFR1 positivity and histological type, corresponding the greater percentages of positive results to adenocarcinomas (93.3%) versus in squamous cell carcinomas (37.5%). Likewise, maxSUV values were higher (p: .039) in negative VEGFR1 carcinomas than in positive VEGFR1 tumors (r: 4-32.1; 16.4+/-6.4 [median 16.1] vs. r: 3-47; 14.5+/-8.6 [12.8]). CONCLUSIONS: Our results led us to consider that in NSCLC, the negative VEGFR1 immunohistochemical expression is associated significantly with squamous cell carcinomas subtype and with higher maxSUV values in 18F-FDG-PET.
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We present a patient with clinical suspicion of intestinal carcinoid relapse confirmed by a somatostatin receptor scintigraphy. A very intense somatostatin avid abdominal lesion was located and radioguided surgery was proposed. Prior to the procedure, we performed a SPECT-CT that made it possible to detect and localize the lesion anatomically, thus facilitating the performance of the radioguided procedure. Furthermore, it modified the planning of the intervention with the adequate physical and human resources to prevent the possible surgical complications.
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Tumor Carcinoide/diagnóstico , Tumor Carcinoide/cirugía , Neoplasias Intestinales/diagnóstico , Neoplasias Intestinales/cirugía , Recurrencia Local de Neoplasia/diagnóstico , Recurrencia Local de Neoplasia/cirugía , Cirugía Asistida por Computador , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos X , Humanos , Masculino , Persona de Mediana EdadRESUMEN
INTRODUCTION: Sentinel node biopsy (SNB) by radioisotopes is a widely accepted and reliable surgical method for staging breast cancer in patients with unknown positive axillary lymph nodes involvement. The main limitation of this method is due to the appearance of false negatives that may be caused by tumor lymph node blockage of the sentinel lymph node and uptake in the neighboring lymph nodes. Infiltered sentinel nodes are generally increased in size and firm. Thus, they can be detected by intraoperative palpation, even when there is no uptake by the radiotracer. AIM: To reduce the false negative rates by applying intraoperative axillary palpation after SNB. METHOD: Over a two-year period, we complemented the SNB in 168 patients with careful intraoperative axillary palpation, detecting and removing all the palpable suspicious lymph nodes (SLN) that were analyzed as sentinel nodes RESULTS: In 32 out of 168 patients, 50 palpable SLN were found. In 3 out of 32 patients, 4 infiltrated SLNs were demonstrated with negative SNB and positive axillary lymphadenectomy. Thus, intraoperative palpation avoided false negative results. In one patient, one palpable SLN with tumor involvement was observed and SNB was also positive. In the remaining 28 patients, the histological analysis of 45 SLN was negative for tumor but SNB was positive in 3 patients. CONCLUSION: Intraoperative axillary palpation, once the SNB was done, reduced the false negative rate. Thus, we consider that it should be included as one more part of this procedure.
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Adenocarcinoma/secundario , Neoplasias de la Mama/cirugía , Escisión del Ganglio Linfático , Metástasis Linfática/diagnóstico , Palpación/métodos , Biopsia del Ganglio Linfático Centinela/métodos , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Axila , Reacciones Falso Negativas , Femenino , Humanos , Metástasis Linfática/diagnóstico por imagen , Metástasis Linfática/patología , Mastectomía , Cintigrafía , Radiofármacos/farmacocinética , Estudios RetrospectivosRESUMEN
OBJECTIVE: A non-degenerative etiology is supported by a normal SPI [normal SPECT with 123I-Ioflupane (SPI)] in a patient with movement disorders (MD). METHOD: A total of 196 SPIs were conducted during the period of 2004/05. Of these, 44 were selected in order to rule out degenerative MD (DMD), the results being normal in these patients. The clinical background of these patients were reviewed in a minimum period of 24 months (range 24-40), collecting the diagnoses reached by the neurology specialists. The SPI were evaluated using a consensus, according to subjective criteria and quantification. RESULTS: Thirty-six of the 44 patients (81%) were identified at 2 years of having nondegenerative movement disorders: 18 as essential tremor, 5 as drug-induced disorder, 4 as vascular disease, 3 as peripheral polyneuropathy, 2 postural tremors, 1 writer's cramp, 1 psychogenic tremor, 1 intercranial hypertension and 1 fibromyalgia. The remaining 8 patients were diagnosed with Parkinson's disease in 5 cases, 1 corticobasal degeneration, 1 multisystemic atrophy and another degenerative Parkinsonism with unclear etiology. CONCLUSION: The SPI in our hospital has a lower negative predictive value than the data reported in the literature. The false negatives could be explained because most of our patients come from neurologist physicians who are not movement disorder experts. In addition, a small proportion of degenerative Parkinsonism could evolve with normal SPI.
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Radioisótopos de Yodo , Trastornos del Movimiento/diagnóstico por imagen , Nortropanos , Radiofármacos , Tomografía Computarizada de Emisión de Fotón Único , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Neurodegenerativas/diagnóstico por imagen , Enfermedad de Parkinson/diagnóstico por imagen , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Adulto JovenRESUMEN
INTRODUCTION AND OBJECTIVE: Febrile syndromes of unknown origin (FSUO) are complex processes in hospital practice. Their management includes an exhaustive medical history and examination, as well as an extensive number of biochemical tests. If these are inconclusive, diagnostic imaging techniques such as SPECT/CT with 67-Gallium Citrate (67Ga-SPECT/CT) could play an important role. We evaluated its role in the management of FSUO in our healthcare area. MATERIAL AND METHODS: We reviewed 57 patients who underwent a 67Ga-SPECT/CT due to a FSUO (32 women and 25 men, age range: 32-83 years old) obtaining scintigraphic findings, previous treatments and final diagnosis. Values of sensitivity, specificity, positive predictive values (VPP) and negative values (NPV) were obtained and compared with the results for PET/CT with 18Fluor-deoxy-glucose (18F-FDG PET/CT) found in the literature. RESULTS: The diagnoses found were: infection in 27/57 (47%), inflammatory disease in 15/57 (26%), neoplasm in 1/57 (1.75%) and patients without final diagnosis in 14/57 (24%). The statistical values of 67Ga-SPECT/CT were: sensitivity, specificity, PPV and NPV of 67%, 93%, 97% y 48%, respectively which were slightly lower than those found for the 18F-FDG PET/CT (86%, 52%, 70% and 92%, respectively). The diagnostic yield was 73% which increased to 80% in the patients who lacked empirical treatment. CONCLUSION: Despite the better results of 18F-FDG PET/CT, 67Ga-SPECT/CT behaved as a useful technique in the management of FSUO. It is advisable to use it if 18F-FDG PET/CT is not available.
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Fiebre de Origen Desconocido/diagnóstico por imagen , Radioisótopos de Galio , Tomografía Computarizada por Tomografía de Emisión de Positrones , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fiebre de Origen Desconocido/etiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , SíndromeRESUMEN
Antecedentes: Estudiar la posible relación entre la expresión inmunohistoquímica del receptor 1 del factor de crecimiento endotelial vascular (VEGFR1) y el valor máximo de captación estandarizada (SUVmáx) de la PET 18F-FDG en pacientes con cáncer de pulmón de células no pequeñas.Material y métodos:El estudio incluyó 39 pacientes con NSCLC (24 carcinomas de células escamosas y 15 adenocarcinomas). Según el estadio clínico, los pacientes se distribuyeron de la siguiente manera: 8 en estadio I, 7 en estadio II, 15 en estadio III y 9 en estadio IV. Se estudió la expresión inmunohistoquímica del VEGFR1 mediante la técnica de la matriz tisular utilizando el dispositivo de arreglo de tejidos (Beecher Instruments, Sun Prairie, WI), utilizando el anticuerpo policlonal contra el VEGFR1 (Santa Cruz Biotechnology, California, EE. UU.).Resultados: Se observó una expresión inmunohistoquímica positiva del VEGFR1 en 23 casos (59%). El número de tumores positivos no se relacionó con el estadio clínico pero hubo una asociación estadísticamente significativa diferente (p: 0,0009) entre la positividad de VEGFR1 y el tipo histológico, correspondiendo los mayores porcentajes de resultados positivos a los adenocarcinomas (93,3%) frente a los carcinomas escamocelulares (37,5%). Asimismo, los valores SUVmáx fueron mayores (p: 0,039) en los carcinomas VEGFR1 negativos que en los tumores VEGFR1 positivos (r: 4-32,1; 16,4+/-6,4 [mediana 16,1] vs. r: 3-47; 14,5+/-8,6 [12,8]).Conclusiones: Nuestros resultados nos llevaron a considerar que en el CPCNP, la expresión inmunohistoquímica negativa de VEGFR1 se asocia significativamente con el subtipo de carcinomas de células escamosas y con valores SUVmáx más altos en 18F-FDG-PET (AU)
Background: To study the possible relation between immunohistochemical expression of vascular endothelial growth factor receptor 1 (VEGFR1) and the maximum standardised uptake value (maxSUV) of 18F-FDG PET in patients with non small cell lung cancer.Material and methods: The study included 39 patients with NSCLC (24 squamous cell carcinomas and 15 adenocarcinomas). According to the clinical stage, the patients were distributed as follows: 8 stage I, 7 stage II, 15 stage III and 9 stage IV. Immunohistochemical expression of VEGFR1 was studied through the technique of tissue-matrix using tissue arrayer device (Beecher Instruments, Sun Prairie, WI), using the polyclonal antibody against VEGFR1 (Santa Cruz Biotechnology, California, USA).Results: Positive VEGFR1 immunohistochemical expression was noted in 23 cases (59%). The number of positive tumours was not related with clinical stage but there was a different statistically significant association (p:.0009) between VEGFR1 positivity and histological type, corresponding the greater percentages of positive results to adenocarcinomas (93.3%) versus in squamous cell carcinomas (37.5%). Likewise, maxSUV values were higher (p: .039) in negative VEGFR1 carcinomas than in positive VEGFR1 tumors (r: 4-32.1; 16.4+/-6.4 [median 16.1] vs. r: 3-47; 14.5+/-8.6 [12.8]).Conclusions: Our results led us to consider that in NSCLC, the negative VEGFR1 immunohistochemical expression is associated significantly with squamous cell carcinomas subtype and with higher maxSUV values in 18F-FDG-PET (AU)
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Neoplasias Pulmonares/patología , Carcinoma Pulmonar de Células Pequeñas/patología , Factor A de Crecimiento Endotelial Vascular/análisis , Estadificación de Neoplasias , Inmunohistoquímica , Carcinoma Pulmonar de Células Pequeñas/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Radiofármacos , Tomografía de Emisión de Positrones , Biomarcadores de Tumor/análisisRESUMEN
The case is presented on a patient with abdominal pain and suspicion of neuroendocrine tumor in the tail of the pancreas shown in the abdominal CT and MRI. Whole-body scintigraphy and abdominal SPECT/CT with 99mTc-octreotide were performed that showed a nodular lesion partially on the posterior side of the pancreas tail. This nodule showed faint tracer uptake, and was reported as probable neuroendocrine tumor. Partial pancreatectomy and splenectomy were performed, and the histological study identified the lesion as an ectopic spleen. There are similar cases in the literature that match these findings, but this lesion is still frequently diagnosed after performing unnecessary surgery. When an asymptomatic intrapancreatic mass is detected, an accessory spleen should be considered and specific diagnostic techniques should be performed, such as labeled and denatured red blood cell SPECT/CT.
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Coristoma/diagnóstico por imagen , Errores Diagnósticos , Enfermedades Pancreáticas/diagnóstico por imagen , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único , Bazo/diagnóstico por imagen , Dolor Abdominal/etiología , Anciano , Coristoma/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Tumores Neuroendocrinos/diagnóstico , Octreótido/análogos & derivados , Compuestos de Organotecnecio , Pancreatectomía , Enfermedades Pancreáticas/cirugía , Neoplasias Pancreáticas/diagnóstico , Radiofármacos , Bazo/cirugía , Esplenectomía , Tecnecio , Tomografía Computarizada por Rayos X , Procedimientos Innecesarios , Imagen de Cuerpo EnteroRESUMEN
Brain tumours show uptake with Thallium-201 Chloride with high target/background rate and they would benefit from radioguided surgery. We report a patient with a brain tumor that was Thallium positive in a brain SPECT. On the next day in the operating room we injected 50 MBq of Thallium-201. At 40 minutes we confirmed tumour uptake with a gamma-probe and with a biopsy sample. After brain tumor resection was completed by conventional method, we found pathologic activity in tumoral bed with the gamma probe, that showed persistence of increased activity. After a new evaluation, residual tumor tissue was located in the pathological uptake area and was removed. Control CT showed complete resection, although the Thallium SPECT carried out after surgery showed faint uptake in the anterior pole of the surgical bed. Radioguided surgery was evaluated as a useful and promising technique by the neurosurgeon.
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Neoplasias Encefálicas/diagnóstico por imagen , Radiología Intervencionista/métodos , Radiofármacos , Cirugía Asistida por Computador/métodos , Lóbulo Temporal/diagnóstico por imagen , Radioisótopos de Talio , Talio , Biopsia , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/cirugía , Craneotomía , Humanos , Cuidados Intraoperatorios , Masculino , Persona de Mediana Edad , Neoplasia Residual , Radiofármacos/farmacocinética , Lóbulo Temporal/patología , Lóbulo Temporal/cirugía , Talio/farmacocinética , Radioisótopos de Talio/farmacocinética , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: SPECT-CT in the detection of the sentinel lymph node (SLN) of breast cancer offers known advantages over conventional planar lymphoscintigraphy. Sometimes, it shows atypical findings like mediastinal lymphatic drainage. We have evaluated these atypical findings showed by SPECT-CT performed in patients with migration to the internal mammary chain (IMC) and their roles in the management of the patients. MATERIALS AND METHODS: We reviewed the 56 lymphoscintigraphies (planar and SPECT-CT) of 56 women (average age: 55 years) diagnosed with breast cancer with IMC migration observed in the planar images. We compared the two techniques, obtaining the number of depicted nodes, atypical locations, their exact anatomical location and their role in the management of the patient. RESULTS: Planar images showed a total number of 81 IMC nodes. SPECT-CT showed 74 nodes in the IMC territory and 14 mediastinal lymphatic nodes in 6 patients. Out of the 81 IMC nodes reported by planar images, seven corresponded to mediastinal nodes. Planar and hybrid images showed 110 and 130 axillary nodes, respectively. SPECT-CT showed additional findings in five patients: three infraclavicular and two supraclavicular nodes that were exactly located. One intramammary node was discarded by the SPECT-CT as a focal skin contamination. CONCLUSION: Mediastinal nodes are unexpected, but not uncommon findings that are important in the planning of SLN biopsy. SPECT-CT found more nodes than planar images, being able to separate mediastinal and IMC nodes, helping to exactly depict the SLN and its relations with anatomical structures.
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Neoplasias de la Mama/diagnóstico por imagen , Drenaje/métodos , Ganglios Linfáticos/diagnóstico por imagen , Linfocintigrafia/métodos , Biopsia del Ganglio Linfático Centinela/métodos , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único/métodos , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Femenino , Estudios de Seguimiento , Humanos , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Persona de Mediana Edad , Estadificación de Neoplasias , PronósticoRESUMEN
Cerebral malaria is a serious complication of infection with Plasmodium falciparum. Its pathophysiological mechanisms and clinical manifestations are still currently being studied. Structural imaging techniques such as CT and MRI provide non-specific information during the diagnostic process. However, there are hardly any references on the use and potential benefits of radioisotope procedures for this pathology. In this article we present the case of a patient diagnosed with cerebral malaria treated in our centre, subjected to progressive monitoring using SPECT perfusion.
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Malaria Cerebral/diagnóstico por imagen , Imagen de Perfusión , Tomografía Computarizada de Emisión de Fotón Único , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada de Emisión de Fotón Único/métodosAsunto(s)
Divertículo/complicaciones , Hernia Inguinal/diagnóstico por imagen , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Enfermedades de la Vejiga Urinaria/complicaciones , Anciano , Diagnóstico Diferencial , Divertículo/diagnóstico por imagen , Hernia Inguinal/etiología , Humanos , Ganglios Linfáticos/diagnóstico por imagen , Linfoma no Hodgkin/diagnóstico por imagen , Masculino , Enfermedades de la Vejiga Urinaria/diagnóstico por imagenRESUMEN
A retrospective analysis (2000 to 2013) of cattle poisoning caused by toxic plants and other compounds was carried out in the Pampas region of Argentina by the Animal Health Group of INTA-EEA, Balcarce. During this period, 1263 reports of diseases of different etiologies (infectious, parasitic, toxic, metabolic and miscellaneous) were recorded in cattle, by collecting anamnestic, clinical and pathological information. A toxic etiology was diagnosed in 21.1% of these reports. Iatrogenic poisoning caused by ionophores was the most frequently recorded etiology. Consumption of toxic plants (Wedelia glauca, Solanum glaucophyllum, among others), mycotoxins (Claviceps purpurea, Claviceps paspali, Epichloë coenophiala, among others), and plants producing cyanide and nitrates/nitrites were also commonly diagnosed. The high frequency of toxic episodes and the difficulties in their diagnosis by practitioners in our livestock production systems emphasizes the importance of this report.(AU)
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Animales , Bovinos , Argentina , Ionóforos/toxicidad , Intoxicación por Plantas/veterinaria , Intoxicación/etiología , Plantas TóxicasRESUMEN
Sjögren syndrome is a chronic systemic autoimmune disease in which there is an increased risk of developing non-Hodgkin's lymphoma. Neoplastic lung involvement and the coexistence of different histological types of lymphoma are uncommon in these patients. These patients frequently have associated infectious processes, most of them due to oral candidiasis. When there is immunodeficiency, the hematogenous spread of the fungus may affect the lungs. We present the case of a female patient diagnosed with follicular non- Hodgkin lymphoma within the context of long-term Sjögren syndrome. In addition to the neoplastic nodal and splenic disease, the PET-CT study showed extensive lung involvement. Due to suspicion of a false positive result for pulmonary Candida infection, antifungal treatment was initiated, with no response. A further histological study showed the presence of a second and different type of lymphoma.
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Linfoma Folicular/diagnóstico por imagen , Linfoma de Células B Grandes Difuso/diagnóstico por imagen , Imagen Multimodal , Neoplasias Primarias Múltiples/diagnóstico por imagen , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Femenino , Humanos , Linfoma Folicular/complicaciones , Linfoma de Células B Grandes Difuso/complicaciones , Persona de Mediana Edad , Neoplasias Primarias Múltiples/complicaciones , Síndrome de Sjögren/complicacionesRESUMEN
Introducción y objetivo: Los síndromes febriles de origen desconocido (SFOD) son procesos complejos en la práctica hospitalaria. Su manejo incluye una anamnesis y exploración clínica exhaustivas, así como una extensa batería de pruebas. Cuando los resultados son inciertos, las técnicas diagnósticas de imagen como la SPECT/TC con galio-67 (67Ga-SPECT/TC) desempeñan un papel importante. Pretendemos evaluar su papel en el estudio de los SFOD en nuestro medio hospitalario. Material y métodos: Hemos revisado 57 pacientes con SFOD a los que se realizó una 67Ga-SPECT/TC (32 mujeres y 25 hombres, rango de edad: 32 a 83 años) recogiendo hallazgos gammagráficos, tratamientos empíricos y diagnóstico final. Se obtuvieron valores de sensibilidad, especificidad, valores predictivos positivos y negativos para la 67Ga-SPECT/TC y se compararon con los resultados descritos en la bibliografía para la PET/TC con Flúor-18-desoxiglucosa (18F-FDG PET/TC). Resultados: Los diagnósticos encontrados fueron: infección en 27/57 (47%), enfermedad inflamatoria en el 15/57 (26%), neoplasia en 1/57 (1,75%) y pacientes sin diagnóstico final en 14/57 (24%). Los valores estadísticos de la 67Ga-SPECT/TC fueron: sensibilidad, especificidad, valor predictivo positivo y negativo de 67%, 93%, 97% y 48%, respectivamente, que fueron levemente inferiores a los encontrados para la 18F-FDG PET/TC (86%, 52%, 70% y 92%, respectivamente). El rendimiento diagnóstico encontrado fue superior en aquellos pacientes que carecían de tratamiento empírico. Conclusión: A pesar los valores superiores del 18F-FDG PET/TC, la 67Ga-SPECT/TC es una técnica útil en el manejo de los SFOD. Es recomendable su uso si el primero no está disponible
Introduction and objective: Febrile syndromes of unknown origin (FSUO) are complex processes in hospital practice. Their management includes an exhaustive medical history and examination, as well as an extensive number of biochemical tests. If these are inconclusive, diagnostic imaging techniques such as SPECT/CT with 67-Gallium Citrate (67Ga-SPECT/CT) could play an important role. We evaluated its role in the management of FSUO in our healthcare area. Material and methods: We reviewed 57 patients who underwent a 67Ga-SPECT/CT due to a FSUO (32 women and 25 men, age range: 32-83 years old) obtaining scintigraphic findings, previous treatments and final diagnosis. Values of sensitivity, specificity, positive predictive values (VPP) and negative values (NPV) were obtained and compared with the results for PET/CT with 18Fluor-deoxy-glucose (18F-FDG PET/CT) found in the literature. Results: The diagnoses found were: infection in 27/57 (47%), inflammatory disease in 15/57 (26%), neoplasm in 1/57 (1.75%) and patients without final diagnosis in 14/57 (24%). The statistical values of 67Ga-SPECT/CT were: sensitivity, specificity, PPV and NPV of 67%, 93%, 97% y 48%, respectively which were slightly lower than those found for the 18F-FDG PET/CT (86%, 52%, 70% and 92%, respectively). The diagnostic yield was 73% which increased to 80% in the patients who lacked empirical treatment. Conclusion: Despite the better results of 18F-FDG PET/CT, 67Ga-SPECT/CT behaved as a useful technique in the management of FSUO. It is advisable to use it if 18F-FDG PET/CT is not available
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Radioisótopos de Galio , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único/métodos , Fiebre de Origen Desconocido/diagnóstico por imagen , Sensibilidad y Especificidad , Infecciones/diagnóstico por imagen , Inflamación/diagnóstico por imagen , Neoplasias/diagnóstico por imagen , Dosificación Radioterapéutica/normasRESUMEN
The case is presented on a patient with abdominal pain and suspicion of neuroendocrine tumor in the tail of the pancreas shown in the abdominal CT and MRI. Whole-body scintigraphy and abdominal SPECT/CT with 99mTc-octreotide were performed that showed a nodular lesion partially on the posterior side of the pancreas tail. This nodule showed faint tracer uptake, and was reported as probable neuroendocrine tumor. Partial pancreatectomy and splenectomy were performed, and the histological study identified the lesion as an ectopic spleen. There are similar cases in the literature that match these findings, but this lesion is still frequently diagnosed after performing unnecessary surgery. When an asymptomatic intrapancreatic mass is detected, an accessory spleen should be considered and specific diagnostic techniques should be performed, such as labeled and denatured red blood cell SPECT/CT (AU)
Presentamos un paciente con dolor abdominal y sospecha de tumor neuroendocrino por medio de TC y RM abdominales. Se realizaron imágenes de cuerpo entero y SPECT/TCcon 99mTc-Octreotide que mostraron una lesión captadora en la cara posterior del páncreas que fue interpretada como un tumor neuroendocrino. Se realizó una pancreatectomía y esplenectomía cuyo resultado anatomopatológico identificó la lesión como un bazo ectópico. Existen datos en la bibliografía que coinciden con estos hallazgos pero todavía se diagnostica con frecuencia tras la realización de una intervención quirúrgica innecesaria. Cuando se aprecia una masa intrapancreática asintomática, debe incluirse en el diagnóstico diferencial un bazo accesorio y realizar técnicas diagnósticas más específicas, como el SPECT/TC con hematíes marcados y desnaturalizados (AU)