Prognostic value of myocardial perfusion scintigraphy in diabetic patients and without coronary lesion. / Valor pronóstico de la gammagrafía de perfusión miocárdica en pacientes diabéticos sin lesiones coronarias.

OBJECTIVE: To determine the prognostic value of myocardial perfusion scintigraphy-gated SPECT in patients with diabetes mellitus and without obstructive coronary artery disease. MATERIALS AND METHODS: This retrospective study included consecutive patients undergoing adenosine stress-rest myocardial perfusion imaging (MPI) by 99mTc-tetrofosmin between 2009 and 2011. The patients had diabetes mellitus and coronary angiography without significant coronary lesions. In total, 37 diabetic patients (female/male: 20/17; mean age: 65.2 (range: 40-78). 29 non-diabetic patients were included wich are matched with the group of diabetic patients with positive MPI. The group of non-diabetic patients had scintigraphy with myocardial ischemia and without angiographic lesions. A 36-month clinical follow-up was performed, and major cardiac events were recorded. RESULTS: In 78.3% (29/37) of diabetic patients the scintigraphic study showed myocardial ischemia, while it was negative in the 21.7%. The cardiac event rate in both groups was 6%. In diabetics with a myocardial perfusion study with myocardial ischemia, there were 3 major cardiac events. In diabetic patients with negative study had no cardiac event. In the non-diabetic control group the cardiac events rate was 3.4% (1/29). CONCLUSION: In diabetic patients without obstructive coronary disease, myocardial perfusion study can be predictor of cardiac events. A negative study can be an indicator of a better cardiovascular prognosis.

[A colon adenocarcinoma and a pharyngeal carcinoma incidentally detected by means of (18)F-FDG PET in a patient diagnosed of lung cancer]. / Adenocarcinoma de colon y carcinoma faríngeo detectados incidentalmente mediante (18)F-FDG PET en paciente diagnosticado de cáncer de pulmón.

It is not uncommon to find two or more tumors in the same patient, usually based on similar etiologic factors or the use of radiotherapy and/or chemotherapy. This occurs quite often in the case of lung cancer. In this sense, the positron emission tomography with (18)F-FDG (FDG-PET) is widely used for the diagnosis and treatment of cancer patients. It is also especially useful in patients with solitary pulmonary nodule, bronchogenic carcinoma, head and neck cancer, colon cancer, tumors of unknown origin, lymphomas, etc. Its capacity to detect previously unsuspected second or third primary tumors has also been demonstrated. We report a clinical case showing how two synchronous cancers were incidentally detected in a 73-year old patient diagnosed with lung cancer and referred for (FDG-PET) study.

[Validation of the renogram with immediate diuretic stimulus]. / Validación del renograma con estímulo diurético inmediato.

OBJECTIVE: The aim of this study is to determine the diagnostic reliability of the renogram with diuretic stimulus simultaneously at the administration of the dose, comparing two groups of 59 patients each one (F0 and F+10), to select patients for surgery. MATERIAL AND METHODS: This is an retrospective study about two groups of 59 patients to whom the diuretic renogram was carried out by stimulus (furosemide), by suspicion of ureteropelvic or vesicoureteral obstruction, using (99m)Tc-Mercaptoacetylglicine. In the first one, the study was conducted applying the diuretic stimulus 600 seconds after the administration of the dose of the radiotracer (F+10). In the second one it was carried out simultaneously to the administration (F0). For the interpretation there was used the visual analysis, the parameters of the curves and the percentage of elimination after modification by the severity and micturition. Statistical analysis of the information was made. RESULTS: The F+10 renogram shows a sensitivity of 96,7%, specificity of 96,1%, positive predictive value of 90,6%, and a negative predictive value of 98,6%. The F0 renogram shows a sensitivity of 95,2%, specificity of 98,9%, positive predictive value of 95,2%, and a negative predictive value of 98,9%. CONCLUSION: The performance of renogram by means of the administration of diuretic stimulus at the same time as the administration of the radiotracer is a useful and comfortable method in paediatric patients, not supposing a significant wastage in the parameters of efficiency of the test in the patients selection for surgery.

Primary squamous cell carcinoma of the thyroid. Initial assessment and follow-up using 18F-FDG PET/CT. / Carcinoma epidermoide primario de tiroides. Valoración inicial y control evolutivo mediante 18F-FDG PET/TC.

Squamous cell carcinoma of thyroid is an uncommon, very aggressive neoplasm, having a poor prognosis and poor response to chemotherapy and radiotherapy. Surgery is the initial treatment of choice, although it often presents as a widespread disease at the time of diagnosis, usually with cervical swelling that causes most of the symptoms due to local infiltration or metastasis. Local infiltration from adjacent tumour and metastatic disease needs to be excluded from other primary epidermoid carcinomas, in order to make a correct diagnosis. This also requires the typical cytokeratin pattern seen in histological studies. The case is presented of a 53 year-old man with a medical history of hepatocarcinoma, with a cervical hypermetabolic lesion detected in an 18F-FDG PET/CT performed to exclude widespread disease. The follow-up of this lesion with this technique and its usefulness is also described.

[Effectivity and clinical impact of (18)F-FDG-PET in the diagnosis of unsuspected second primary tumors]. / Efectividad e impacto clínico de la PET-(18)F-FDG en el diagnóstico de segundos tumores primarios insospechados.

OBJECTIVE: This study has aimed to determine the capacity and clinical impact of the (18)F-FDG-PET to detect previously unsuspected second primary tumors. MATERIAL AND METHODS: This is a retrospective cross-sectional study of 1984 consecutive scans performed between March 2004 and March 2005, identifying those studies that had reported the presence of hypermetabolic lesions, that had not been previously suspected or detected and that could be suggestive of second primary tumors. Diagnosis was made histopathologically or by clinical and radiological follow-up for a period exceeding one year. RESULTS: 62 findings suggestive of second primary tumors were detected in 58 patients (3.1%). The reasons for the study for this group of patients were diverse, the most common being the differential diagnosis of solitary pulmonary nodules. A total of 43.5% of lesions were not followed-up. We confirmed the existence of 35 lesions, either by pathology study (21 lesions, 13 second primary tumors, the incidence in our population was 0.65%) or clinical and radiological follow-up (14 lesions, none of which corresponded to second primary tumors). The total clinical impact was the discovery of unexpected 14 lesions in 12 patients. CONCLUSION: The presence of second primary tumors on (18)F-FDG-PET is relatively common. These lesions should be monitored clinically for accurate diagnosis. In a high percentage, they correspond to unexpected second primary tumors in an early stage and therefore amenable to curative treatment or for which tumor treatment planning may be modified.