[Rest gated-SPECT myocardial perfusion post (99m)Tc-MIBI injection in a patient with acute chest pain and with no medical history of ischemic heart disease]. / Gated-SPECT de reposo tras inyección intradolor de (99m)Tc-MIBI en paciente sin antecedentes de cardiopatía isquémica.

Gated-SPECT myocardial perfusion imaging is a widely used technique indicated for assessment of patients with no clear diagnosis of ischemic heart disease. Early rest gated-SPECT myocardial perfusion study in patients with acute chest pain has high sensitivity and high negative predictive value for ruling out coronary disease. We report a case of a patient admitted for the study of her chest pain. She underwent a myocardial perfusion stress-rest whose interpretation could have been equivocal due to the clinical status of the patient during the injection of the radiotracer.

[201Thalium SPECT in the detection of recurrent laryngeal carcinoma]. / El SPECT con (201)Talio en la detección de recidiva del carcinoma de laringe.

OBJECTIVE: To evaluate the diagnostic yield of (201)Thallium SPECT in the detection of local and/or regional lymph node dissemination of pharyngolaryngeal carcinoma. MATERIAL AND METHODS: 29 patients who had been diagnosed with pharyngolaryngeal carcinoma were studied (mean age: 60.9 years). These patients had been treated by surgery, chemotherapy and radiotherapy. At between 3 to 6 month after finishing the treatment, all of them underwent a planar and SPECT study at one hour after the administration of 148 MBq of (201)Thallium. Uptake was scored on four grades: from 0 (no uptake) to 3 (very intense uptake). The presence or non-presence of lymph nodes with uptake was also evaluated. All the results on the scintigraphy were correlated with long term clinical and radiological follow-up (mean: 2.5 years). The studies were classified as positive for recurrence when the uptake was 2-3 and/or with presence of lymph nodes with uptake. RESULTS: We obtained 9 true positive, 14 true negative, 3 false positive and 3 false negative results. Sensitivity was 75%, specificity was 82.4%, positive predictive value was 75% and negative predictive value was 82.4%. Two out of three false positives corresponded to the surgical bed uptake and one was attributed to the laterocervical lymph nodes. The three false negatives had grade 1 uptakes, two of them corresponding to pulmonary metastasis without evidence of local recurrence. CONCLUSIONS: The use of (201)Thallium SPECT in the prognostic evaluation in patients with a treated laryngeal carcinoma shows very acceptable results in the detection of local recurrence and/or regional lymph node dissemination.

[Value of brain perfusion SPECT in the follow-up of patients surgically treated for chronic adult hydrocephalus syndrome]. / Valor del SPECT de perfusión cerebral en el seguimiento del tratamiento quirúrgico de pacientes con hidrocefalia crónica del adulto.

OBJECTIVE: The aim of this study was to characterize regional cerebral blood flow in patients with Adult Hydrocephalus Syndrome (AHS) and to evaluate the changes in brain perfusion after surgical derivation treatment. PATIENTS AND METHODS: 20 patients with AHS (age: 72 +/- 14, 12 men) were studied before and six months after surgery. All patients underwent a brain perfusion SPECT (99mTc-HMPAO) prior to surgery and at 6 months post-surgery. Semi-quantitative analysis was done for brain uptake: 0=Normal, 1=Mild, 2=Moderate, 3= Severe, 4=No uptake. The severity of ventricular dilatation was assessed by classifying the intensity and extension of subcortical defects: 0=Normal, 1=Mild, 2=Moderate, 3=Severe. The scores of the pre- and post-surgical studies were compared using the Student-t test. RESULTS: A global reduction of brain uptake was observed (mean score 12.85), mainly in frontal, parietal and temporal lobes, with a significant improvement in post surgical studies (mean score 6, p<0,001). After surgery, 16 (80%) of the 20 patients improved brain uptake. In relationship to subcortical uptake, 5 patients showed mild defects, 9 moderate defects and 6 patients presented severe uptake reduction. In post-surgical studies 15 (75%) patients improved almost one degree in the subcortical score and 65% of the patients showed a normal or mild subcortical uptake reduction. CONCLUSIONS: Brain perfusion SPECT is useful in patients with AHS, detecting brain perfusion defects and evaluating cerebral blood flow improvement after shunt operation.