18F-FDG PET/CT in locally advanced cervical cancer: A review. / PET/TC con 18F-FDG en cáncer de cérvix localmente avanzado.

Cervical cancer is the second most common gynecological cancer worldwide. In locally advanced cervical cancer, 18F-FDG PET/CT has become important in the initial staging, particularly in the detection of nodal and distant metastasis, aspects with treatment implications and prognostic value. The aims of this study were to review the role of 18F-FDG PET/CT in uterine cervical cancer, according to the guidelines of the main scientific institutions (FIGO, NCCN, SEGO, SEOM, ESGO, and ESMO) and its diagnostic accuracy compared to conventional radiological techniques, as well as to review the acquisition protocol and its utility in radiotherapy planning, response assessment and detection of recurrence.

Radium-223 in the treatment of bone metastasis in patients with castration-resistant prostate cancer. Review and procedure. / Radio-223 en el tratamiento de metástasis óseas en pacientes con cáncer de próstata resistente a la castración. Revisión de la literatura y procedimiento.

Bone metastatic disease is the main cause of morbidity / mortality in patients with prostate cancer, presenting frequently as bone pain, pathological fractures or spinal cord compression, which requires early and timely therapy. Although, for the moment, the therapeutic window for its use has not been definitively established, radium-223 (223Ra), an alpha particle emitter, has proved to be an effective therapeutic tool, pre or post-chemotherapy, in patients with castration-resistant prostate cancer with symptomatic bone metastases and absence of visceral metastases, significantly modifying the prognosis of the disease. It is therefore imperative to define the ideal scenarios and the correct protocol for the use of this therapy and thus offer the greatest possible clinical benefit to the patient.

68Ga-PSMA PET/CT in prostate cancer. / La PET/TC con 68Ga-PSMA en el cáncer de próstata.

Positron emission tomography/computed tomography (PET/CT) with 68Ga-PSMA is a non-invasive diagnostic technique to image prostate cancer with increased prostate-specific membrane antigen (PSMA) expression. PSMA is a transmembrane protein present in all prostatic tissues. Increased PSMA expression is seen in several malignancies, although prostate cancer is the tumour where it presents higher concentrations. Almost all prostate adenocarcinomas show PSMA expression in most of lesions, primary and metastatic. Immunohistochemistry has demonstrated that the expression of PSMA increases in patients with de-differentiated, metastatic or hormone-refractory tumours. Moreover, the expression level of PSMA has a prognostic value for disease outcome. PET measures the three-dimensional distribution of 68Ga-PSMA, producing semi-quantitative images that allow for non-invasive assessment of PSMA expression.

[Effectiveness of (67)Ga scintigraphy in the diagnosis of lymphoma relapse]. / Efectividad de la gammagrafía con 67Ga en el diagnóstico de recidiva de linfomas.

PURPOSE: To establish the clinical effectiveness of 67Ga in lymphoma recurrence. PATIENTS AND METHODS: Thirty-nine patients were assessed on 43 occasions (31 for Hodgkin's disease and 12 for non-Hodgkin's lymphoma) either for a suspected recurrence or to monitor the evolution of the disease. A computed tomography (CT) and a 67Ga whole body scan were performed. Independent observers who did not know the definitive diagnosis performed the CT and 67Ga readings. The gold standard was the biopsy results or the follow-up during a 12 months period. RESULTS: Recurrence was confirmed in 17 cases, while 26 continued to have complete remission. Using 67Ga resulted in true positive (TP), 24 true negative (TN), 2 false positive (FP) and 2 false negative (FN) results with a sensitivity of 0.88 (15/17), specificity of 0.92 (24/26), positive predictive value (PPV) of 0.88 (15/17) and negative predictive value (NPV) of 0.92 (24/26), while CT produced 12 TP, 20 TN, 6 FP and 5 FN, with a sensitivity of 0.7 (12/17), specificity of 0.77 (20/26), PPV of 0.88 (12/18) and NPV of 0.92 (20/25). CONCLUSIONS: 67Ga is a useful indicator and has better diagnostic effectiveness than CT for both the confirmation and exclusion of lymphoma recurrence.

[Diuretic renography in the diagnostic approach of prenatal hydronephrosis]. / El renograma diurético en la estrategia diagnóstica de la hidronefrosis prenatal.

OBJECTIVE: To verify the utility of diuretic renography using 99mTc-MAG3 in the evaluation of the urinary tract obstruction in patients with prenatal diagnosis of hydronephrosis. In a neonate with upper urinary tract dilatation, it is difficult to differentiate a true obstruction from a dilated non-obstructed system. MATERIAL AND METHODS: The retrospective study (january 1993-december 1998) included 40 consecutive patients selected from 181 newborns with a prenatal diagnosis of hydronephrosis. The mean age of the performance of the first renography was 2.6 months. RESULTS: The final diagnosis (once the vesicoureteral reflux was ruled out) was: ureteropelvic junction obstruction (UPJ) 16, megaureter 15, ureterocele 3 and stasis 6. Conservative treatment was applied in most of the patients. Nevertheless, 17 of them needed surgical treatment due to the high risk of the permanent renal damage. CONCLUSIONS: 1) UPJ is the most frequent cause of neonatal hydronephrosis (NH) and consequently, of the request for diuretic renographies. The renography with 99mTc-MAG3 has the greatest influence in the therapeutic decision (identifying who should be operated on and when this should be done), due to the fact that it is the disease with the highest rate of surgical interventions. 2). The surgical indication in NH is based on the diuretic renography parameters and/or on the presence of symptomatology. In our series of surgical patients, none of those who had a differential renal function <20% with regard to the contralateral one showed recuperation after surgery (control 6 months later).

[Ochronotic arthropathy: the value of bone scintigraphy in alkaptonuria]. / Artropatía ocronótica: utilidad diagnóstica de la gammagrafía ósea en la alcaptonuria.

We report the case of a 62 year old man diagnosed of alkaptonuria who was referred to our department to undergo bone scintigraphy for polyarthralgia. The patient had a history of pain in lumbar and thoracic spine, right shoulder and left knee. Bone scintigraphy showed multiple joint disease with increased uptake in both shoulders, knees and spine. Higher uptake stood out in painful right shoulder and left knee joints. Ochronotic arthropathy that is developed in alkaptonuric patients is a degenerative joint disease. X-ray studies in this patient showed marked degenerative arthrosis in knees and shoulders, without more intense involvement in the symptomatic joints. Lumbar spine X-rays showed intervertebral disk calcification with disk collapse and fusion of the vertebral bodies with relative sparing of sacroiliac joint, which is a classic feature of ochronotic arthropathy. This case highlights the utility of bone scintigraphy in the evaluation of joint involvement as well as its correlation with clinical course and potential usefulness in the follow-up of this disease.

PET/TC con 18F-FDG en cáncer de cérvix localmente avanzado / 18F-FDG PET/CT in locally advanced cervical cancer: A review

El cáncer de cérvix es el segundo cáncer ginecológico en frecuencia a nivel mundial. En tumores localmente avanzados la PET/TC con 18F-FDG tiene un papel relevante en la detección de enfermedad ganglionar y a distancia, factores en los que se basan el tratamiento y el pronóstico de estas pacientes. El objetivo de este trabajo es revisar las indicaciones actuales de la PET/TC con 18F-FDG en el cáncer de cérvix para cada una de las principales sociedades científicas (FIGO, NCCN, SEGO, SEOM, ESGO, ESMO) y la rentabilidad diagnóstica de la prueba comparada con las técnicas radiológicas convencionales, así como el procedimiento y su utilidad en la planificación de la radioterapia, en la valoración de respuesta y en la detección de recidiva

Cervical cancer is the second most common gynecological cancer worldwide. In locally advanced cervical cancer, 18F-FDG PET/CT has become important in the initial staging, particularly in the detection of nodal and distant metastasis, aspects with treatment implications and prognostic value. The aims of this study were to review the role of 18F-FDG PET/CT in uterine cervical cancer, according to the guidelines of the main scientific institutions (FIGO, NCCN, SEGO, SEOM, ESGO, and ESMO) and its diagnostic accuracy compared to conventional radiological techniques, as well as to review the acquisition protocol and its utility in radiotherapy planning, response assessment and detection of recurrence

Radio-223 en el tratamiento de metástasis óseas en pacientes con cáncer de próstata resistente a la castración. Revisión de la literatura y procedimiento / Radium-223 in the treatment of bone metastasis in patients with castration-resistant prostate cancer. Review and procedure

La enfermedad metastásica ósea es la principal causa de morbimortalidad en pacientes con cáncer de próstata, presentándose frecuentemente como dolor óseo, fracturas patológicas o compresión medular, lo que requiere la instauración de una terapia precoz y oportuna. Aunque, por el momento, no se ha establecido de manera definitiva la ventana terapéutica para su utilización, el radio-223, fármaco emisor de partículas alfa, ha demostrado ser un arma terapéutica eficaz, pre o posquimioterapia, en pacientes con cáncer de próstata resistente a la castración con metástasis óseas sintomáticas y ausencia de enfermedad visceral, modificando de manera significativa el pronóstico de la enfermedad. Resulta, por tanto, imperativo definir los escenarios idóneos y el correcto protocolo para el empleo de esta terapia y así ofrecer el mayor beneficio clínico posible al paciente

Bone metastatic disease is the main cause of morbidity / mortality in patients with prostate cancer, presenting frequently as bone pain, pathological fractures or spinal cord compression, which requires early and timely therapy. Although, for the moment, the therapeutic window for its use has not been definitively established, radium-223 (223Ra), an alpha particle emitter, has proved to be an effective therapeutic tool, pre or post-chemotherapy, in patients with castration-resistant prostate cancer with symptomatic bone metastases and absence of visceral metastases, significantly modifying the prognosis of the disease. It is therefore imperative to define the ideal scenarios and the correct protocol for the use of this therapy and thus offer the greatest possible clinical benefit to the patient

La PET/TC con 68Ga-PSMA en el cáncer de próstata / 68Ga-PSMA PET/CT in prostate cancer

La tomografía por emisión de positrones/tomografía computarizada (PET/TC) con 68Ga-PSMA es una técnica de imagen no invasiva para el estudio del cáncer de próstata con incremento de la expresión del antígeno prostático específico de membrana (prostate-specific membrane antigen, PSMA). El PSMA es una proteína transmembrana presente en todos los tejidos prostáticos. El incremento de la expresión de PSMA está presente en varios tumores, aunque su concentración es más elevada en el cáncer de próstata. Casi todos los adenocarcinomas de próstata muestran expresión de PSMA en la mayoría de las lesiones, tanto primarias como metastásicas. Estudios inmunohistoquímicos han demostrado que la expresión de PSMA está incrementada en pacientes con tumores desdiferenciados, metastásicos u hormonorrefractarios. Más aún, el nivel de expresión del PSMA tiene un valor pronóstico para la evolución de la enfermedad. La tomografía por emisión de positrones proporciona una medida de la distribución tridimensional del 68Ga-PSMA, obteniendo imágenes semicuantitativas que permiten valorar de forma no invasiva la expresión de PSMA (AU)

Positron emission tomography/computed tomography (PET/CT) with 68Ga-PSMA is a non-invasive diagnostic technique to image prostate cancer with increased prostate-specific membrane antigen (PSMA) expression. PSMA is a transmembrane protein present in all prostatic tissues. Increased PSMA expression is seen in several malignancies, although prostate cancer is the tumour where it presents higher concentrations. Almost all prostate adenocarcinomas show PSMA expression in most of lesions, primary and metastatic. Immunohistochemistry has demonstrated that the expression of PSMA increases in patients with de-differentiated, metastatic or hormone-refractory tumours. Moreover, the expression level of PSMA has a prognostic value for disease outcome. PET measures the three-dimensional distribution of 68Ga-PSMA, producing semi-quantitative images that allow for non-invasive assessment of PSMA expression (AU)

Unusual clinical presentation of amyloidosis: bilateral stenosis of the external auditory canal, hoarseness and a rapid course of cutaneous lesions.

We report a patient with multiple myeloma associated with primary systemic amyloidosis who had a rapid evolution and a very unusual form of presentation. The association of amyloidosis in patients with multiple myeloma is 15%, and clinically evident mucocutaneous involvement occurs in up to 40% of patients.

Scintigraphic evaluation of lumbosacral pain in brucellosis.

Low back pain is the most frequent rheumatologic manifestation of brucellosis. The diagnosis of brucellar sacroiliitis is hampered by the poor specificity of the clinical data and the poor sensitivity of the radiologic data. In this report, we show that scintigraphy not only increases the sensitivity but also allows an earlier diagnosis of disease and permits the detection of osteoarticular brucellar involvement in areas adjacent to the sacroiliac joint.

Maculopapular eruption with enlarged macrophages in eight patients receiving G-CSF or GM-CSF.

In the last years, granulocyte and granulocyte-macrophage colony-stimulating factors (G-CSF and GM-CSF) are being increasingly used and several cutaneous eruptions have been reported in relation to these treatments. In 1991 Horn et al. described three patients with maculopapular eruption that paralleled the time of infusion of GM-CSF. Two of the cases showed an increase in the number and size of macrophages in the biopsy specimen. Since then, several cases have been reported showing this histopathological alteration that has been considered characteristic of reaction to G-CSF or GM-CSF. Although maculopapular eruption with enlarged macrophages can appear after chemotherapy treatment, we have found that the presentation of this eruption after the beginning of cytokine treatment is suggestive of the involvement of G-CSF and GM-CSF in the eruption. We described eight cases of patients treated with G-CSF or GM-CSF that developed maculopapular eruptions with enlarged macrophages.

[Usefulness of pulmonary clearance of 99mTc-DTPA in diffuse alveolo-interstitial pulmonary diseases]. / Utilidad del aclaramiento pulmonar de 99mTc-DTPA en las enfermedades pulmonares alvéolo-intersticiales difusas.

The aim of the present work was dual: to study the pulmonary clearance of 99mTC-DTPA (Cl 99mTc-DTPA) in patients suspected (n = 16) of suffering (n = 42) from diffuse interstitial lung disease (DILD) and to compare the technique with other classic clinical methods. Results showed that pulmonary clearance of Cl 99mTc-DTPA is of little value in patients with DILD who smoke, although in non-smokers the technique serves as a complementary test to other classic methods and detects alterations in epithelial permeability not only in cases of confirmed DILD but also in other cases with suspicion of DILD and normal radiology.