[67Ga SPECT/low-dose CT. A case report of spondylodiscitis and Schmorl's node]. / SPECT-TAC de baja dosis con 67Ga en un caso de espondilodiscitis y hernia de Schmorl.

A 61-year-old male patient with microbiological diagnosis of L3-L4 spondylodiscitis and persist pain underwent a (67)Ga scintigraphic study to assess the antibiotic treatment response. Pathological uptake foci in vertebral bodies of L2 and L4 were observed in the (67)Ga planar scintigraphy. A SPECT low-dose CT of the lumbar spine was performed as part of anatomical correlated protocol, detecting an active spondylodiscitis in L3-L4 and a second uptake foci in L2 that was identify as a Schmorl's node. In this case the SPECT-CT hybrid image allowed us to avoid a false positive diagnosis to by locate and characterize an image with abnormal uptake of (67)Ga, improving the test specificity and avoiding a wrong diagnosis.

[Indication for bone scans in early breast cancer staging]. / Indicación del rastreo óseo en la estadificación del cáncer de mama de inicio.

OBJECTIVE: Evaluate the indication for bone scanning during staging of early breast cancer in the light of scientific evidence to assess the need to modify practices with scant effectiveness. MATERIAL AND METHODS: The bone scans carried out in our Nuclear Medicine Department in 2007 on patients with primary breast cancer were reviewed retrospectively. Results were analyzed in relation to the clinical and histopathologic findings for each tumor. Bone scan results of tumors >2 cm y 3 cm, and pre-treatment clinical stage. RESULTS: Out of 245 bone scans of patients with breast cancer, 237 (97%) were negative for metastatic disease and 8 (3%) were positive. Lesions <2 cm (Tis and T1) were diagnosed in 131 patients (53.5%), none of which had bone metastasis at time of diagnosis. Lesions >2 cm and 3 cm. The bone scan findings did not modify staging in any of the 66 patients with T2 tumors stage IIA, but it did modify staging in 2 of 12 patients with stage IIB tumors. Twenty percent of 15 patients with T3 tumors and 13% of patients with T4 tumors had bone metastasis at time of diagnosis. CONCLUSIONS: Ineffective practices should be modified and bone scanning should not be indicated in patients with early breast cancer Tis, T1 and T2 with tumor

[Scintimammography with 99mTC-MIBI in the clinical practice: repercussion on the clinical management of the patient]. / Gammagrafía de mama con 99mTc-MIBI en la práctica clínica. Repercusión en el manejo clínico del paciente.

OBJECTIVE: Establish the usefulness of scintimammography (SM) in day-to-day clinical practice. MATERIAL AND METHODS: We have evaluated 308 SM consecutively performed in our Department. The diagnosis was established by way of biopsy or clinical and mammography follow-up (minimum 18 months). In all cases we evaluated the kind of lesions (palpable or non-palpable) and their degree of suspicion of malignancy in the mammography (BIRADS). We determined the number of fine-needle aspiration cytology (FNAC) or biopsies performed in dependence of kind of lesions, mammography and SM results. RESULTS: Final diagnosis was cancer in 18 % of the patients, and 71 % of the lesions were non palpable. Negative predictive value (NPV) of SM was 96 %. Pathological diagnosis was performed in 100 % of lesions with SM+ and 16 % of lesions with SM-. According to the kind of lesion, FNAC and/or biopsy was performed in 62 % of palpable lesions and in 20 % of non-palpable lesions; and according to the mammography in 21 % of lesions BIRADS I-II, 14 % in BIRADS III, 70 % in BIRADS IV and 100 % in BIRADS V. The number of FNAC and/or biopsies performed is significantly higher in all cases when SM is positive (p > 0,001), excepting in BIRADS V lesions. CONCLUSIONS: In day-to-day clinical practice SM is generally performed in low prevalence of breast cancer population, in the evaluation of non-palpable lesions with a low suspicion of malignancy. SM has a high NPV, increase the diagnostic accuracy of the mammography and has repercussion on patient management, except in BIRADS V lesions.

In-111 DTPA octreotide scintigraphy and intraoperative gamma probe detection in the diagnosis and treatment of residual lymph node metastases of a rectal carcinoid tumor.

PURPOSE: We report a case of a rectal carcinoid tumor that was treated using endoscopic resection. This case highlights the usefulness of using somatostatin receptor scintigraphy in the postresection endoscopy of the tumor and the intraoperative use of a gamma probe detector for the surgical resection of metastatic adenopathy that had not been detected using computed tomography (CT) scanning. METHODS: The patient was studied using CT scanning, somatostatin receptor scintigraphy (SRS), and rectal endoscopic ultrasonography (EUS). A gamma probe detector was scheduled for use during the subsequent surgical intervention. RESULTS: The SRS demonstrated a pelvic metastatic lymphatic node that had not been detected on CT scanning. Additional EUS did not show regional metastatic lymph nodes. Histopathology following removal of retroperitoneal and presacral lymphatic nodes confirmed the diagnosis of metastatic carcinoid tumor. At follow up at 6 months, SRS and rectoscopy were normal. CONCLUSION: Somatostatin receptor scintigraphy is very useful in identifying the presence of lymph node metastases, even with a small rectal carcinoid tumor. This is of considerable importance when scheduling surgery and the CT and EUS are normal. The use of an intraoperative gamma-probe detector assists in the surgical excision of the metastatic lymphatic nodes, especially because they had been detected only using SRS, and when their exact location is uncertain.

[Treatment of bone metastatic pain with Sm153-EDTMP. Evaluation of the analgesic response and the existence of differences according to the primary tumor and the metastatic pattern]. / Tratamiento del dolor óseo metastásico con Sm153-EDTMP. Valoración de la respuesta analgésica y de la existencia de diferencias según el tipo de tumor y el patrón metastásico.

AIMS: To evaluate the response to Sm153-EDTMP treatment in patients with metastatic bone pain and the existence of differences in the response according to the scintigraphic pattern (99mTc-MDP) and the primary tumor. MATERIAL AND METHODS: We have evaluated the response to Sm153-EDTMP treatment in 32 patients (17 male and 15 female) who received 38 doses (1 mCi/kg). The primary tumor was prostate cancer in 15 patients, breast in 13, lung in 2, intestinal carcinoid in one and unknown in one. Two types of response were considered: a) effective and b) non-effective. Patients were classified into 3 groups according to the metastatic pattern: 1) Superscan (SS), 2) Generalized metastases (GM) and 3) Regional metastases (RM). RESULTS: There was effective response in 24 doses (63.15%) and non-effective in 14 (36.84%). The mean duration of the response was 12.08 weeks. Patients with GM pattern showed 16 effective responses (76.19%) and 5 non-effective (23.8%). In SS pattern there were 6 effective responses (60%) and 4 non-effective (40%) and 2 effective (28.57%) and 5 non-effective (71.53%) in RM pattern. These differences did not reach statistical significance (p > 0.05). We did not find differences in the response between prostate cancer (12 effective and 6 non-effective) and breast cancer (10 effective and 6 non-effective) (p = 0.79968). CONCLUSIONS: Sm153-EDTMP treatment is efficacious in patients with metastatic bone pain with effective response in 63.15% of the treatments. The response percentage was lower in patients with RM pattern but the differences did not reach statistical significance. There were no differences in the response between prostate and breast cancer patients.

Mammography and 99mTc-MIBI scintimammography in suspected breast cancer.

UNLABELLED: The aim of this work has been to evaluate whether a diagnostic protocol based on the joint use of mammography and 99mTc-methoxyisobutyl isonitrile (MIBI) scintimammography is capable of reducing the number of biopsies required in patients with suspected breast cancer. METHODS: We performed prone scintimammography in 90 patients with suspected breast cancer, involving 97 lesions. In all patients, the diagnosis was established by way of biopsy. On mammography, we evaluated the degree of suspicion of malignancy and the size of the lesion (smaller or larger than 1 cm in diameter). RESULTS: The results of only 41 of the biopsies indicated malignancy. On mammography, 20 lesions (of which 1 was breast cancer) were considered to be of low suspicion of malignancy, 31 (of which 4 were breast cancer) as indeterminate and 46 (of which 36 were breast cancer) as high. Fourteen lesions (2 low probability, 2 indeterminate and 10 high) were smaller than 1 cm, whereas 83 (18 low probability, 29 indeterminate and 36 high) were larger. The sensitivity, specificity, positive predictive value and negative predictive value of scintimammography were 85%, 79%, 74% and 88%, respectively. Scintimammography was positive in all cases of breast cancer that initially had a low or indeterminate suspicion of malignancy according to mammography, as well as in 30 cases of breast cancer that initially were highly suspicious. Six false-negative scintimammography studies were obtained in lesions with a high suspicion of malignancy. CONCLUSION: We propose a diagnostic protocol with a biopsy performed on lesions that have a high suspicion of malignancy as well as those with low or indeterminate suspicion that are smaller than 1 cm or with positive scintimammography results. This would have reduced the total number of biopsies performed by 34%. More importantly, there would have been a 65% reduction in number of biopsies performed in the low and indeterminate mammographic suspicion groups. All 41 cases of breast cancer would have been detected.

Diagnosis of prosthetic vascular graft infection by technetium-99m-HMPAO-labeled leukocytes.

UNLABELLED: The purpose of this study was to determine the usefulness of 99mTc-HMPAO-labeled leukocyte scans in the diagnosis of prosthetic vascular graft infection. METHODS: We performed 75 scans in 61 patients with vascular grafts. Thirty-six patients were evaluated for suspected infection and 25 were control patients. Scintigraphic images were performed at 5 min, 30 min, 3 hr and, occasionally, 24 hr. Persistent increased uptake at 3 hr along the suspected area of the graft was considered evidence of graft infection. RESULTS: All 20 infected grafts were detected with 99mTc-HMPAO leukocyte scan. The sensitivity and specificity of the scan in the detection of infected graft were 100%. We also detected two pelvic abscesses, two infected fistulae, two soft-tissue infections, three cases of ischemic colitis, one acute diverticulitis, one infected hematoma, one septic arthritis and one noninfected hematoma. One patient with a superficial groin infection had a negative scan. The eight pseudoaneurysms did not show scintigraphic evidence of graft infection. Correlative CT studies were performed in 12 cases. CONCLUSION: Technetium-99m-HMPAO-labeled leukocyte scan is an accurate and valuable diagnostic method for evaluation of suspected prosthetic vascular graft infection.

Pituitary responsiveness to gonadotropin-releasing hormone (GnRH) and thyrotropin-releasing hormone (TRH) during different phases of the same cycle of oral contraceptive steroid therapy.

To study the pituitary luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), and thyroid-stimulating hormone (TSH) secretory capacity and to determine whether the gonadotropes, lactotropes, and thyrotropes have a circatrigintan cycle of variation under hormonal contraception, women under combined oral contraceptive steroid treatment were challenged with a combination of 100 micrograms of gonadotropin-releasing hormone (GnRH) and 200 micrograms of thyrotropin-releasing hormone (TRH) given intravenously at weekly intervals. Significant releases of LH (P less than 0.001), FSH (P less than 0.05), PRL (P less than 0.001) and TSH (P less than 0.001) occurred in response to GnRH-TRH. The LH integrated change score (ICS), calculated as the difference between post-GnRH-TRH hormonal release and the average baseline levels, was higher (P less than 0.001) after ingestion of tablet 7 than after the 7th day after ending the previous cycle of treatment and after ingestion of tablet 21. The FSH ICS decreased as the cycle of treatment advanced in comparison with the ICS of the 7th day after the end of the previous cycle of treatment. The PRL and TSH ICS were not influenced by oral contraceptives. The LH, FSH, PRL, and TSH releases were not influenced by the dose of estrogens given daily.

Stimulatory effect of clebopride on human prolactin secretion.

Serum levels of prolactin (PRL), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were measured in normally cycling women and normal men before and after oral admiministration of 1 mg of clebopride, a derivative of procainamide used in the treatment of gastrointestinal diseases. Clebopride produced a significant increase (P < 0.001) in serum PRL to a 6-fold peak as compared with basal levels. After 240 minutes the levels remained significantly higher (P < 0.05) than the mean basal level at -30 and 0 minutes. No significant effects of clebopride were noted upon the circulating levels of LH and FSH. The peak PRL response to clebopride was unaffected by pretreatment with 100 mg of nomifensine, although the secretory area from 120 to 210 minutes after clebopride was greater (P < 0.05) in the nomifensine-treated group than in the control experiment. When 5 mg of bromocriptine were given before clebopride, the PRL response was completely abolished as compared with the control experiment (P < 0.001). Our data provide new evidence that dopaminergic receptors of the adeylate cyclase system are involved in the regulation of PRL secretion, acting at the pituitary level rather than acting on the hypothalamus. The PRL-releasing activity of clebopride could be the explanation for the occasional menstrual disorders and galactorrhea registered in some cases of long-term treatment.

Tc-99m HMPAO labeled platelets in the detection of left ventricular thrombosis post acute myocardial infarction.

A left ventricular thrombosis post acute myocardial infarction was detected with Tc-99m HMPAO labeled platelet imaging. The left ventricular thrombosis was already detected on early scans, which allowed for a precise diagnosis during the first 6 hours of the study.

[Spontaneous carotid-cavernous fistula: angiogammagraphic findings and computer analysis (author's transl)]. / Fístula carótido-cavernosa espontánea: hallazgos angiogrammagráficos y análisis mediante ordenador.

The case of a 74-year-old woman with a carotid-cavernous fistula is reported. She was admitted to hospital with oliguria and generalized edema. After improvement of the edematous condition she suddenly presented intense, pulsatile, frontal cephalea. It was more intense on the right side and was accompanied by nausea and vomiting and swelling of the right eye with reddening, sharp pains, difficulty of movement, and loss of vision. Cerebral angiogammagraphy was practiced in anterior-posterior and right lateral view. A righ carotid-cavernous fistula was discovered with drainage through the superior ophthalmic vein and the deep venous system. The angiogammagraphic findings can be considered characteristic; it is important to obtain activity/time curves from various areas of interest in order to evaluate the degree of shunting and the pathway of drainage from the fistula. There was a good coorelation with the arteriographic findings. Eight cases of carotid-cavernous fistulas diagnosed with radionuclids have been published previously, though the activity/time curves were not determined by computer for any of them.

[The use of SPECT with 201Tl in the evaluation of brain tumors]. / Utilidad de la SPECT con 201Tl en la evaluación de los tumores cerebrales.

There is increasing interest in the literature regarding the use of SPECT (single photon emission computed tomography) with 201Tl in the evaluation of cerebral tumours. Thallium (201Tl) is one of the isotopes most commonly used in studies of the myocardium and in the diagnosis of various tumours. Normal brain takes up very little 201Tl, but in viable tumour tissue the 201Tl becomes intracellular and is rapidly cleared from the blood stream. Such cerebral tumour uptake is related to changes in the permeability of the blood-brain barrier, regional blood flow and transport by means of the Na(+)-K+ adenosine triphosphate pump. Once the SPECT images have been obtained following administration of the radioisotope, one can calculate the indices of early and of late uptake together with the retention index. The usefulness of SPECT in the preoperative detection of malignant expansive pathology, choice of tumour region during stereotaxic biopsy, control of tumour reproduction and their differentiation from post-radiotherapy necrotic tissue, and evaluation of chemotherapy in treatment of cerebral tumours are analyzed. Finally the application of SPECT in metastatic conditions and the differential diagnosis of expansive lesions is considered.

[131I-treatment of the autonomous toxic nodule. Assessment of a fixed dose protocol]. / Tratamiento con 131I del nódulo autónomo tóxico. Valoración de un protocolo de dosis fijas.

Ninety six patients diagnosed of toxic thyroid adenomas received fixed doses of 131I (555MBq) for treatment of hyperthyroidism. The inclusion and exclusion criteria, the patient's characteristics and the advantages of the fixed doses are described. The hypothyroidism rate found at the end of the mean follow-up period (2.46 +/- 1.72 years) which was 27.08% significantly lower to that observed in patients treated for Graves-Basedow disease, is pointed out. No differences were found in the hypothyroidism rate when the patients were differentiated by sex or when this situation was related to pretreatment with the antithyroid drugs. The extensive differences in the hypothyroidism rates observed between the different series that have been published and the variability in the doses administered leads us to think that factors other than the dose of 131I may be responsible for this post-therapeutic hypothyroidism.

[Treatment with (131)I of toxic multinodular goiter. Assessment of a fixed dose protocol]. / Tratamiento con (131)I del bocio multinodular tóxico. Valoración de un protocolo de dosis fijas.

OBJECTIVE: Present the results of treatment with 131I in a cohort of 119 patients diagnosed of toxic multinodular goiter (TMG) from a specific geographic area who had been treated with fixed doses of isotopes (555 MBq). The indication for the administration of the 131I was hyperthyroidism correction in all of the cases. MATERIAL AND METHODS: 111 of the 119 patients treated were women (93%) and 8 were men (7%) and their ages ranged from 38 to 88 years. The follow-up periods were always greater than one year (1.78 +/- 1.05 years). Treatment with thyroid medication was discontinued in all of the patients at least 7 days prior to the administration of the isotope. RESULTS: 93 (78.1%) of the 119 patients remained euthyroidic, 10 (8.4%) presented hypothyroidism, 11 (9.2%) hyperthyroidism and 5 (4.2%) had sub-clinical levels of hyperthyroidism at the end of the follow-up period. No statistically significant relationship were found between hypothyroidism, gender and previous administration of thyroid medication. CONCLUSIONS: The use of 131I is an alternative to the treatment of TMG produced hyperthyroidism. The fixed doses of 555 Mbq that we propose are comfortable, make it unnecessary for the patients to travel in extensive geographic areas and produce a low rate of hypothyroidism. In our opinion, the differences in the iodine content of the diets that continue to exist are one of the factors that could influence in the differences in results observed in the different series, although other factors, such as the size of the goiter and the heterogeneity of the radioisotope uptake can contribute to the variations found in our patients.

[Bronchial carcinoid tumor and scintigraphy of somatostatin receptors: detection of bone metastasis]. / Tumor carcinoide bronquial y gammagrafía de receptores de somatostatina: detección de metástasis óseas.

UNLABELLED: Surgery is the treatment of choice for bronchial carcinoid tumor (BCT), whenever the staging is adequate. There is little information about the capability of the somatostatin receptor scintigraphy (SRS) to detect bone metastases in the carcinoid tumor. AIM: This work has aimed to evaluate retrospectively the diagnostic accuracy of the SRS in the detection of bone metastases in BCT. MATERIALS AND METHODS: Based on their clinical indication, the patients were classified into two different groups: Group A (n = 4), staging of a known BCT; and Group B (n = 6), treatment control. The SRS results could be correlated with the CT results in all 4 patients from the group A, and in one patient from the group B, and the SRS results were compared with the clinical follow up during at least one year in the other 5 patients. RESULTS: The SRS scan detected the 4 BCT from the group A; in 2 of them the patient staging was superior when the SRS was used than with the CT, whereas the scan overestimated the tumor stage (BCT + sarcoidosis) in another patient. During the clinical course, one of these patients developed bone and liver metastases. The SRS was normal in 5 asymptomatic patients from group B, whereas the scan showed disseminated metastatic disease (liver, bone, spleen and lymph nodes) in another patient. In the 2 patients with bone metastases, the total number of bone metastases detected by the bone scan was 12, and by the SRS 8. The four lesions that were not detected by SRS were located in the ribs (n = 3) and 12-D (n = 1). CONCLUSIONS: The capability of the SRS to detect bone metastases makes it more useful in BCT staging. Over the next few years, the role of the bone scan and SRS in the detection of bone metastases in carcinoid tumors needs to be established.

[Diabetes mellitus and pancreatic tumor]. / Diabetes mellitus y tumor pancreático.

A 68 year old Ecuadorian man was investigated for polyuria, polydipsia and weight loss of 3 kg during the previous two months. Insulin dependent diabetes mellitus was diagnosed 10 year before admission and treated with appropriate diet and insulin (35 U/d). 18 months before was diagnosed in El Ecuador of "multiple liver nodes non-suggestive of malignancy". Physical examination showed a large multinodular petrous hepatomegaly. There was no evidence of skin lesions. Results of laboratory studies included a basal plasma glucose level that ranged between 275-367 mg/dl (N=60-100), glycosylated haemoglobin of 8.9% (N<5) and a serum albumin of 2.8 gr./dl (N=3.4-4.8). At admission non-other laboratory alterations were detected. Computed tomography showed a mass on the head of the pancreas with loco-regional lymph nodes and liver metastases. Tumor markers were normal. Fine-needle aspiration cytology of the liver masses revealed the presence of liver metastases of a non-differentiated malignant tumor. A 111In-DTPAOC scintigraphy revealed the presence of somatostatin receptors in the liver metastases, also detecting the presence of multiple bone metastases in the axial and appendicular skeleton. Plasma glucagon level was 678 pg/ml (N<250). A diagnosis of metastatic glucagonoma was established and therapy with streptozocin, 5-FU, insulin and synthetic somatostatin analogs was initiated. Three months after the therapy initiation the patient was symptom free. Some weeks after the patient suffered from left hip pain, and a control 111In-DTPA scintigraphy showed progression of his bone metastases. In conclusion, glucagonoma must be suspected in all diabetic patients with metastatic liver, even in absence of necrotic migratory erythema. In these circumstances, plasmatic glucagon level and somatostatin receptors scintigraphy will be a useful tool for establishing the final diagnosis.

[Frostbite of the upper and lower limbs in an expert mountain climber: the value of bone scan in the prediction of amputation level]. / Congelaciones de manos y pies en un montañero de elite: utilidad de la gammagrafía ósea para predecir el nivel de amputación.

A 38 year old man was admitted to our hospital 10 days after suffering a frostbite injury in hands and feet while practicing mountain climbing, at 8,100 meters of altitude, while he was trying to reach the top of the K2 mountain. A 99mTc-MDP bone scan performed in aseptic conditions showed: in hands: absence of bone uptake in the 3rd phalanx and distal portion of 2nd phalanx of the 5th finger of the left hand, and multiple areas of increased uptake in the distal portion of both hands. In feet: uptake decreases in the 2nd phalanx of the first toe of the left foot, and absence of bone uptake in the 3rd phalanx of the 2nd toe of the left foot, and in 2nd phalanx of the 1st toe and 3rd phalanx of the 2nd, 3rd and 4th toes of the right foot. As in the hands, there were multiple areas of increased uptake in the distal portion of both feet. The phalanges with absence of bone uptake had to be amputated, while those that presented increased uptake recovered with conservative treatment. Bone scan is indicated in the evaluation of frostbite injuries and helps to establish the prognosis early.

[The scintigraphy of somatostatin receptors in the carcinoid tumor]. / La gammagrafía de receptores de somatostatina en el tumor carcinoide.

UNLABELLED: This study aimed to evaluate the diagnostic utility of 111In-DTPA-D-Phe1-octreotide scintigraphy in the different situations that can be present when an examination is requested during the clinical course of the carcinoid tumor (CT). MATERIALS AND METHODS: We have performed 41 scintigraphies with 111In-octreotide (145-185 MBq) in 35 patients (19 females and 16 males) with clinically suspected or confirmed CT. The patients were classified into five groups: Group A: Indolent symptoms of CT (n=9); B: CT staging located in lung (n=4), stomach (n=2), cecum (n=1), thymus (n=1) and pancreas (n=1); C: Carcinoid syndrome (n=1); D: CT staging after surgery located in pancreas (n=1), ovary (n=1), cecum (n=1), stomach (n=1), appendix (n=1) and ileum (n=1); and E: Post-treatment follow-up (n=13), with CT located in bronchial tree (n=5), small intestine (n=3), appendix (n=2), thymus (n=1), ovary (n=1) and unknown primary tumor (n=1). Three patients of this group had one scintigraphic study before the treatment. Head and neck, thorax and abdomen images were obtained at 4 and 24 h in all of the patients and SPECT images of the abdomen (n=14), thorax (n=10), and brain (n=1) were obtained at 24 h in 25 patients. RESULTS: Group A: In the 3 patients with a positive scintigraphy, the definitive diagnosis was meningioma, Hurtle cell's carcinoma and lung adenocarcinoma. The clinical follow-up in the six other patients, at least during one year, did not show any evidence of CT. Group B: Six of the 9 CT were detected with the scintigraphy. In 2 cases of bronchial CT, the scan showed sarcoidotic regional lymph node involvement and CT hepatic and bone metastases, respectively. Group C: The scintigraphy detected hepatic metastases from an unknown primary tumor. Group D: The scintigraphy was positive in 3 cases (hepatic or/and abdominal metastases) and was normal in the other 3. The scintigraphy was negative in one patient with peritoneal metastases. Group E: The scintigraphy was normal in 7 patients in concordance with the clinical follow-up. In 3 patients with a scintigraphy performed prior to treatment, the scintigraphy detected recurrence (thymic CT), progression of the metastatic disease (ovarian CT) and partial regression of the hepatic metastases (carcinoid syndrome). In the three other patients, the scintigraphy showed metastases located in liver in one patient and hepatic and extra-hepatic metastases in the two other patients. The sensitivity and specificity of 111In-Octreotide in the detection of the primary tumor and metastases were 72% and 84% respectively. CONCLUSIONS: The 111In-Octreotide scintigraphy has a low diagnostic utility in patients with indolent symptoms of CT. However, it is the first line of diagnosis for the staging of the CT and to evaluate the follow up after therapy.

[Carcinoid tumor and bone metastases: diagnosis by somatostatin receptor scintigraphy]. / Tumor carcinoide y metástasis óseas: diagnóstico mediante gammagrafía de receptores de somatostatina.

OBJECTIVE: The aim of this study has been to retrospectively assess the usefulness of 111In-DTPAOC scintigraphy in the detection of bone metastases (BM) in patients diagnosed of carcinoid tumour (CaT). MATERIALS AND METHODS: Between June 1995 and April 2003 78 111In-DTPAOC studies were consecutively performed in 58 patients, 31 females and 27 males, 28 to 73 years old, with a histological diagnosis of CaT. Moreover, whole body bone scans (BS) using 99mTc-MDP were performed in 13 of these patients. The patients were classified into three groups: Group A: Initial CaT staging (n = 23); Group B: CaT staging after surgery (n = 14); and Group C: Post-treatment CaT re-staging (n = 29). In this last group, 6 patients of group A and 2 patients of group B were included. In only 2 patients the diagnoses of bone metastases were established before the 111In-DTPAOC scan. RESULTS: Twenty six (44.8 %9 of the 58 patients with CaT had metastatic disease: 15 patients with hepatic metastases, associated with BM in 4 of them, 10 patients with hepatic and extra-hepatic metastases, abdominal and/or thoracic, associated with BM in 4 and in one patient, the BMs were the only metastases detected. The global incidence of BM in patients diagnosed with CaT was 15.5 % (9/58), whereas the incidence of BM in patients with metastasic disease was 34.6 % (9/26). Significant differences (p = 0.0035) were found on the incidence of BM in patients with or without hepatic metastases. In 4 patients, BMs were detected during the initial staging (group A), whereas in 5 patients, BMs were detected during the post-treatment re-staging (group C). During diagnosis, 4 of the 9 patients with BM had bone pain. BM were multiples in 8 patients, affecting axial skeleton in 4 and axial and appendicular skeleton in 4. One patient had a diffuse infiltration of bone marrow. BS was positive in 8 of the 9 patients with BM. In these 8 patients with abnormal BS, 111In-DTPAOC scintigraphy provides similar information to the BS in one patient, shows a greater number of bone lesions in 3, whereas BS was superior in 5 patients. Four of the patients with BM died between 6 and 47 months after diagnosis (mean: 29.7 months). CONCLUSIONS: BMs are preferably located on axial skeleton, can be asymptomatic and are associated with hepatic metastases. Although the 111In-DTPAOC scintigraphy is able to detect some BM earlier than BS, the information provided by both studies is complementary. In patients with CaT, any invasive therapy on the hepatic metastases make it necessary to exclude extrahepatic metastases, including bone ones, and the somatostatin receptor scintigraphy is the diagnostic method of choice.

[Somatostatin receptor scintigraphy. When would a SPECT study be performed?]. / Gammagrafía de receptores de somatostatina. Cuándo hacer una SPECT?

UNLABELLED: Somatostatin receptor scintigraphy has become an essential tool in the treatment planning of patients with carcinoid tumor (CaT) and pancreatic neuroendocrine tumors (PNET). However, the contribution of SPECT images in the diagnosis and staging of these tumors has not been well established. OBJECTIVE: 1) To find out if SPECT improves the sensitivity of planar imaging and adds any value to tumor diagnosis, and 2) To determine under which circumstances SPECT images must be obtained. MATERIAL AND METHODS: We have evaluated 49 patients, 26 females and 23 males, using both planar and SPECT 111In-DTPAOC images. The patients were classified into three groups according to their clinical indication: Group A: Indolent symptoms of CaT or PNET (n = 9); Group B: Known or functioning CaT or PNET tumors (n = 22); Group C: Post-surgical follow-up (n = 18). The total number of SPECT studies were 51 (37 abdomen, 13 thorax and 1 brain). In all cases SPECT was performed 24 hours after 111In-DTPAOC injection. Scintigraphic images were compared with surgical findings in 17 patients and with a synthesis of biochemical, clinical and CT findings in the other patients. RESULTS: 16 primary lesions were detected with planar images whereas SPECT detected 18. The two tumors detected only by SPECT were a bronchial CaT and an insulinoma located in the pancreatic tail. Planar and SPECT image sensitivities were 66.6% and 75% respectively. Twenty one patients developed metastatic disease. Sensitivities of planar and SPECT images for metastases were 76.1% and 90.4% respectively. Furthermore, SPECT helps planar images in the evaluation of six patients with uncertain images (lesions with low receptor density or with an uncertain scintigraphic localization). Therefore, in 15.6% of patients with primary or metastatic tumors, planar images were normal whereas SPECT was abnormal and SPECT provided an added value in 21.8% of the studies with abnormal planar images. CONCLUSIONS: We recommend the use of SPECT images in: 1) Patients with specific functional clinical syndrome or with a known CaT or PNET and normal planar images. 2) When planar images are abnormal only in primary tumor. 3) In order to confirm the absence of other metastases in patients with known liver metastases. 4) In order to enhance the detection of lesions with low receptor density and uncertain planar images and 5) In order to determine exactly the anatomic location of some lesions