RESUMO
PURPOSE: To examine the observer variation for bone scintigraphy in the detection of occult scaphoid fractures in daily practice, using only the early bone scanning images. METHODS: One hundred bone scans of patients with a suspected scaphoid fracture but negative initial radiographs were prospectively included to calculate the inter- and intraobserver variation. Three nuclear medicine physicians independently evaluated all bone scans at 2 different points in time with a 3-month interval. The observers filled out a blinded scoring sheet for each patient. They scored if a scaphoid fracture was present or not. In addition, they scored the presence or absence of another fracture. The inter- and intraobserver variation was analyzed using the kappa statistic. RESULTS: The interobserver variation showed substantial agreement for a scaphoid fracture and almost perfect agreement for another fracture. The intraobserver variation showed almost perfect agreement for both a scaphoid fracture and another fracture. CONCLUSIONS: In the present study, early static images of bone scintigraphy for suspected scaphoid fractures showed very little inter- and intraobserver variation. In addition, expertise does not seem to have a negative influence on the results. This enhances the possibility of using bone scintigraphy in daily practice.
Assuntos
Fraturas Ósseas/diagnóstico por imagem , Osso Escafoide/diagnóstico por imagem , Osso Escafoide/lesões , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas Ósseas/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Variações Dependentes do Observador , Cintilografia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/epidemiologia , Reprodutibilidade dos TestesRESUMO
Abdominal obesity is associated with reduced 24-h plasma GH concentrations. It is unclear whether hyposomatotropism in abdominally obese humans is compensated by up-regulation of GH receptor sensitivity or causes less biological effect in target tissues. We, therefore, determined the responsiveness of adipose tissue to the lipolytic action of GH in abdominally obese (OB) and normal weight (NW) postmenopausal women. An iv bolus of recombinant human GH or placebo was randomly administered to eight NW [body mass index (BMI): 22.2 +/- 1.6 kg/m(2)] and eight abdominally OB (BMI: 32.1 +/- 2.6 kg/m(2)) women. Lipolysis was measured by infusion of D5-glycerol and modeled as a function of plasma GH concentrations to describe adipose tissue responsiveness. Similar plasma GH concentration peaks ( approximately 20 mU/liter) were achieved by GH injection in both groups. During placebo conditions, the average plasma GH level was significantly lower in OB compared with NW women (0.74 +/- 0.52 vs. 2.08 +/- 1.18 mU/liter, P = 0.023). Adipose tissue responsiveness, expressed as glycerol rate of appearance per kilogram of fat mass per unit plasma GH concentration was not different in both groups (NW: 1.06, OB: 0.68, P > 0.05). These results suggest that hyposomatotropism in abdominally obese individuals is not compensated by increased adipose tissue responsiveness to GH bio-action and, therefore, blunts lipolysis in these individuals.
Assuntos
Hormônio do Crescimento Humano/administração & dosagem , Hipopituitarismo/metabolismo , Lipólise/efeitos dos fármacos , Obesidade/metabolismo , Abdome , Tecido Adiposo/efeitos dos fármacos , Tecido Adiposo/metabolismo , Índice de Massa Corporal , Feminino , Glicerol/sangue , Hormônio do Crescimento Humano/sangue , Humanos , Hipopituitarismo/sangue , Proteína 3 de Ligação a Fator de Crescimento Semelhante à Insulina/sangue , Fator de Crescimento Insulin-Like I/metabolismo , Pessoa de Meia-Idade , Obesidade/sangueRESUMO
PURPOSE: This study examined whether multidetector computed tomography (CT) is superior to bone scintigraphy for diagnosis of an occult scaphoid fracture. METHODS AND MATERIALS: In a study period of 22 months, 100 consecutive patients with a clinically suspected scaphoid fracture and no fracture on scaphoid radiographs, were evaluated with CT within 24 hours after injury and bone scintigraphy between 3 and 5 days after injury. The reference standard for a true (radiographic occult) scaphoid fracture was either (1) diagnosis of fracture on both CT and bone scintigraphy or (2) in case of discrepancy, clinical and/or radiographic evidence of a fracture during follow-up. RESULTS: CT showed 10 scaphoid and 18 other fractures. Bone scintigraphy showed 21 scaphoid and 36 other fractures. According to the reference standard, there were 14 scaphoid fractures. CT had a sensitivity of 64%, specificity of 99%, accuracy of 94%, a positive predictive value of 90%, and a negative predictive value of 94%. Bone scintigraphy had a sensitivity of 93%, specificity of 91%, accuracy of 91%, a positive predictive value of 62%, and a negative predictive value of 99%. CONCLUSION: This study could not confirm that early CT imaging is superior to bone scintigraphy for suspected scaphoid fractures.
Assuntos
Fraturas Ósseas/diagnóstico por imagem , Osso Escafoide/lesões , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cintilografia , Osso Escafoide/diagnóstico por imagem , Fatores de Tempo , Adulto JovemAssuntos
Fraturas Ósseas/diagnóstico por imagem , Osso Escafoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cintilografia , Tamanho da Amostra , Osso Escafoide/lesões , Fatores de Tempo , Adulto JovemAssuntos
Fraturas Ósseas/diagnóstico por imagem , Cintilografia/instrumentação , Osso Escafoide/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas Ósseas/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia , Cintilografia/métodos , Osso Escafoide/lesões , Adulto JovemRESUMO
In prostate cancer, confirmation of metastatic involvement of the skeleton has traditionally been achieved by bone scintigraphy, although the widespread availability of prostate-specific antigen (PSA) measurements has tended to eliminate the need for this investigation. The potential of bone scintigraphy to predict skeletal-related events, particularly spinal cord compression, after the onset of hormone refractoriness has never been investigated. The aim of this study was to establish whether a new method of evaluating bone scintigraphy would offer a better predictive value for this complication of the metastatic process than is achieved with currently available grading methods. We studied 84 patients with hormone-refractory prostate cancer who had undergone bone scintigraphy at the time of hormone escape. Tumour grading and parameters of tumour load (PSA and alkaline phosphatase activity) were available in all patients. The incidence of spinal cord compression was documented and all patients were followed up until death. Bone scintigraphy was evaluated by the conventional Soloway grading and by an additional analysis determining total or partial involvement of individual vertebrae. In contrast to the Soloway method, the new method was able to predict spinal cord compression at various spinal levels. Our data suggest that there is still a place for bone scintigraphy in the management of hormone-refractory prostate cancer.
Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/mortalidade , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/mortalidade , Medição de Risco/métodos , Compressão da Medula Espinal/diagnóstico por imagem , Antineoplásicos Hormonais/uso terapêutico , Neoplasias Ósseas/sangue , Neoplasias Ósseas/secundário , Vértebras Cervicais/diagnóstico por imagem , Intervalo Livre de Doença , Resistencia a Medicamentos Antineoplásicos , Humanos , Incidência , Vértebras Lombares/diagnóstico por imagem , Masculino , Países Baixos/epidemiologia , Prognóstico , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/tratamento farmacológico , Cintilografia , Fatores de Risco , Compressão da Medula Espinal/sangue , Compressão da Medula Espinal/etiologia , Vértebras Torácicas/diagnóstico por imagemRESUMO
Spinal cord compression (SCC) is a devastating complication of metastatic cancer. We investigated the potential beneficial effect of two palliative therapies--strontium-89 (Metastron) and the nitrogen-containing bisphosphonate olpadronate--on the incidence of SCC in hormone-refractory prostate cancer (HRPC) metastatic to the skeleton. We retrospectively studied 415 patients with histologically proven prostate cancer who underwent bone scintigraphy at the time of diagnosis and were followed up at the Leiden University Medical Center between 1990 and 1999. Medical or surgical castration was undertaken in 172 patients with evidence for skeletal metastases. Within 2 years, 147 of these patients (85%) developed HRPC associated with severe progressive bone pain. Palliative treatment was given to 131 patients in the form of local radiotherapy ( n=10), 89Sr ( n=46) or intravenous olpadronate ( n=66), with ( n=57) or without ( n=9) maintenance oral olpadronate. Nine patients received both 89Sr and olpadronate at various intervals. Sixteen patients who did not receive any of these treatments were used as historical controls. There was no significant difference in baseline characteristics between treatment modalities. The incidence of SCC was 17% in the whole group, and highest in controls receiving no palliation (50%). None of the patients treated with local radiotherapy, only 4% of patients receiving 89Sr and 21% of patients given olpadronate developed this complication. Our findings suggest a significant reduction in SCC in patients with symptomatic HRPC metastatic to the skeleton who receive palliative therapies. Local radiotherapy completely prevents the incidence of SCC, 89Sr leads to an important decrease in this complication and olpadronate induces a significant, albeit smaller decrease in the incidence of SCC. The use of these agents opens new avenues in the difficult management of patients with advanced prostate cancer who are most at risk of developing SCC.