[Fibrous dysplasia of the bone. Contribution of nuclear medicine in the diagnosis of suspicion of sarcomatous degeneration]. / Displasia fibrosa ósea. Aportación de la Medicina Nuclear al diagnóstico de sospecha de degeneración sarcomatosa.

Fibrous dysplasia (FD) is a relatively frequent benign disease of the bone in which there is a maturation disorder of the bone-forming mesenchyme where the lamellar bone marrow is replaced with abnormal fibrous tissue. Its diagnosis is often an accidental finding when X-ray studies or bone scans are performed for other reasons since it is usually asymptomatic. There may be complications such as deformities, pathological fractures and exceptionally malignant transformation. The differential diagnosis between malignancy and FD can be complicated and lead to late diagnosis when sarcomatous degeneration already exists. In this context, the positron tomography with (18)F-fluorodeoxyglucose (FDG-PET) may be useful in the monitoring of this condition. We present two cases of patients diagnosed of FD with suspicion of malignization of their bone lesions who were referred to Nuclear Medicin.

[Gallbladder cancer staging with 18F-FDG PET-CT]. / Estadificación del cáncer de vesícula mediante tomografía de positrones con 18F-fluorodesoxiglucosa.

Gallbladder cancer is the most common biliary tract neoplasm. It generally affects the elderly, who are usually clinically asymptomatic. When symptoms appear, they suggest the presence of complications locally or due to tumour progression. Late diagnosis of the disease indicates a poor prognosis for these patients. Surgery is the only treatment with curative intent, but it is only possible in the early stages. Diagnostic imaging of this type of tumour is usually performed with ultrasonography, computed tomography or magnetic resonance cholangiography. Positron emission tomography (PET) with fluorodeoxyglucose (FDG) with dedicated scanners or hybrid PET-CT scans are new diagnostic tools which could help in the pre-surgical diagnosis of these tumours. We present three cases to illustrate the usefulness of PET-FDG in the pre-surgical staging of gallbladder cancer.

[Desmoid tumor of the thoraco-abdominal wall characterized with 18F-fluorodeoxyglucose PET/ CT scan. Correlation with magnetic resonance and bone scintigraphy. Review of the literature]. / Tumor desmoide de la pared torácico-abdominal. Caracterización con PET-TAC con 18F-fluorodesoxiglucosa y correlación con resonancia magnética y gammagrafía ósea. Revisión de la literatura.

Desmoid tumours are uncommon benign tumours but with aggressive behaviour, resulting from the proliferation of well-differentiated fibroblasts. Clinically, they present as a painless firm soft tissue mass. They can be solitary or multiple and have potential infiltrative capacity. When planning treatment, it is important to assess the correct tumour extent to permit curative radical surgery minimizing possible local recurrence. Different imaging techniques help to characterise these tumours. At present, magnetic resonance is the tool of choice for studying these tumours. The role of nuclear medicine techniques, such as bone scintigraphy, or more recently FDG-PET, has not been defined in the evaluation of these neoplasms. We present the case of a patient with a desmoid tumour of the abdominal-chest wall and we review the related literature.

[Usefulness of labelled red-cell scintigraphy in Blue Rubber-Bleb Nevus syndrome]. / Utilidad de la gammagrafía con hematíes marcados en el síndrome de Blue Rubber Bleb Nevus.

Blue Rubber Bleb Nevus syndrome is a rare disorder characterized by distinctive cutaneous and gastrointestinal venous malformations that usually cause episodes of occult gastrointestinal haemorrhage and iron deficiency anaemia. We describe an 8-year-old girl who had multiple cutaneous venous malformations since birth. She also suffered from several episodes of severe chronic iron deficiency anaemia and required blood transfusions. To evaluate the presence of gastrointestinal bleeding secondary to intestinal angiomatosis, we decided to perform 99mTc-labelled red blood cell scintigraphy, which confirmed cutaneous venous malformations and also showed gastrointestinal vascular lesions that suggested the diagnosis of Blue Rubber Bleb Nevus Syndrome.

[False negative of the scintigraphy with 99mTc-sestamibi in parathyroid carcinoma with associated brown tumors. Contributions of the 18F-FDG-PET/CT]. / Falso negativo de la gammagrafía con 99mTc-sestamibi en un carcinoma paratiroideo con tumores pardos asociados. Aportaciones de la PET/TAC-18F-FDG.

Parathyroid carcinoma (PTC) is a rare malignant disease that is usually hyperfunctioning, which produces an excess of parathyroid hormone. Hyperparathyroidism causes bone metabolism disorders, as osteopenia and sometimes brown tumors. Brown tumors are benign but locally aggressive bone lesions, whose differential diagnosis with metastases or other primary malignancies may be complicated. (99m)Tc-Sestamibi scan is the usual procedure for the detection of parathyroid pathology, with a sensitivity of 85-100% and specificity close to 100% in parathyroid adenomas, it having similar percentages in the detection of PTC. We present the case of a patient diagnosed of a malignant hyperparathyroidism associated with bone lesions in which the (99m)Tc-Sestamibi scan showed a false negative result in the detection of parathyroid condition. However, (18)F-FDG-PET/CT detected the PTC and helped in the differential diagnosis of associated bone lesions, which were finally confirmed as brown tumors.

Extravasación subaracnoidea de contraste intravenoso tras arteriografía en paciente con tromboembolismo pulmonar agudo / Subarachnoid extravasation of intravenous contrast after arteriography in a patient with acute pulmonary thromboembolism

No disponible

Hallazgos radiológicos en ecografía y tomografía computada multidetector de 64 canales de una invaginación colo-cólica secundaria a lipoma / Radiological findings on ultrasonography and multidetector computed tomography of 64 channels of a colo-colonic intussusception secondary to lipoma

Si bien la mayoría de los lipomas intestinales son asintomáticos y se diagnostican de manera casual, en algunas ocasiones pueden tener síntomas, como sangrado, diarrea o, con menor frecuencia, obstrucción o invaginación intestinal. Esta última en el adulto es una patología poco común y por lo general tiene una presentación subaguda crónica, cuyo diagnóstico es complicado. La principal técnica de imagen para el diagnóstico de la invaginación intestinal en adultos es la tomografía computada (TC). Solamente un 20% de las invaginaciones son colo-cólicas y en su mayoría son secundarias a un carcinoma. No obstante, en algunas pocas oportunidades pueden ser secundarias a una causa benigna, siendo el lipoma la más usual.

Even though most of the intestinal lipomas are asymptomatic and are diagnosed by chance, sometimes may have symptoms such as bleeding or diarrhea, and less frequently obstruction or intussusception. Intussusception in adults is a rare condition, and usually has a chronic-subacute presentation, and diagnosis is difficult. CT is the main radiological imaging test for diagnosis. Only 20% of the colonic invaginations are colo-colic, and in most cases are secondary to carcinoma. Rarely are secondary to a benign cause, being the intussusception secondary to a lipoma the most frecuent.

Falso negativo de la gammagrafía con 99mTc-sestamibi en un carcinoma paratiroideo con tumores pardos asociados. Aportaciones de la PET/TAC-18F-FDG / False negative of the scintigraphy with 99mTc-sestamibi in parathyroid carcinoma with associated brown tumors. Contributions of the 18F-FDG-PET/CT

El carcinoma paratiroideo (CPT) es un tumor poco frecuente que suele ser hiperfuncionante, produciendo un exceso de hormona paratiroidea. El hiperparatiroidismo produce trastornos del metabolismo óseo, como osteopenia y en ocasiones tumores pardos. Los tumores pardos son lesiones óseas benignas, pero localmente destructivas, cuyo diagnóstico diferencial con metástasis u otros tipos de tumores primarios puede ser complicado. La técnica habitual para la detección de patología paratiroidea es la gammagrafía con 99mTc-sestamibi, con una sensibilidad del 85–100% y una especificidad cercana al 100% en adenomas paratiroideos, presentando cifras muy similares en la detección del CPT. Presentamos el caso de un paciente diagnosticado de hiperparatiroidismo de origen tumoral con lesiones óseas asociadas en el que la gammagrafía con 99mTc-sestamibi presentó un falso negativo en la detección de patología paratiroidea. Sin embargo, la PET/TAC-18F-FDG detectó el CPT y ayudó en el diagnóstico diferencial de las lesiones óseas asociadas, que fueron finalmente tumores pardos(AU)

Parathyroid carcinoma (PTC) is a rare malignant disease that is usually hyperfunctioning, which produces an excess of parathyroid hormone. Hyperparathyroidism causes bone metabolism disorders, as osteopenia and sometimes brown tumors. Brown tumors are benign but locally aggressive bone lesions, whose differential diagnosis with metastases or other primary malignancies may be complicated. 99mTc-Sestamibi scan is the usual procedure for the detection of parathyroid pathology, with a sensitivity of 85–100% and specificity close to 100% in parathyroid adenomas, it having similar percentages in the detection of PTC. We present the case of a patient diagnosed of a malignant hyperparathyroidism associated with bone lesions in which the 99mTc-Sestamibi scan showed a false negative result in the detection of parathyroid condition. However, 18F-FDG-PET/CT detected the PTC and helped in the differential diagnosis of associated bone lesions, which were finally confirmed as brown tumors(AU)

Displasia fibrosa ósea. Aportación de la Medicina Nuclear al diagnóstico de sospecha de degeneración sarcomatosa / Fibrous dysplasia of the bone. Contribution of Nuclear Medicine in the diagnosis of suspicion of sarcomatous degeneration

La displasia fibrosa (DF) es una enfermedad benigna del hueso relativamente frecuente, en la que existe un trastorno de la maduración del mesénquima óseo con sustitución del tejido lamelar de la cavidad medular de los huesos por un tejido fibroso anómalo. Su diagnóstico a menudo es un hallazgo casual al realizar estudios radiológicos o gammagráficos óseos por otros motivos ya que normalmente es asintomática. En ocasiones puede presentar complicaciones como deformidades, fracturas patológicas y excepcionalmente transformación maligna. El diagnóstico diferencial entre DF y neoplasia maligna puede ser complicado y llevar a un diagnóstico tardío de cuando ya existe degeneración sarcomatosa. En este contexto, la tomografía de positrones con 18F-fluorodesoxiglucosa (PET-FDG) puede ser de utilidad en el seguimiento de esta patología. Presentamos 2 casos de pacientes diagnosticadas de DF con sospecha de malignización de sus lesiones y a las que se les solicitaron estudios complementarios de medicina nuclear(AU)

Fibrous dysplasia (FD) is a relatively frequent benign disease of the bone in which there is a maturation disorder of the bone-forming mesenchyme where the lamellar bone marrow is replaced with abnormal fibrous tissue. Its diagnosis is often an accidental finding when X-ray studies or bone scans are performed for other reasons since it is usually asymptomatic. There may be complications such as deformities, pathological fractures and exceptionally malignant transformation. The differential diagnosis between malignancy and FD can be complicated and lead to late diagnosis when sarcomatous degeneration already exists. In this context, the positron tomography with 18F-fluorodeoxyglucose (FDG-PET) may be useful in the monitoring of this condition. We present two cases of patients diagnosed of FD with suspicion of malignization of their bone lesions who were referred to Nuclear Medicin(AU)

Tumor desmoide de la pared torácico-abdominal. Caracterización con PET-TAC con 18F-fluorodesoxiglucosa y correlación con resonancia magnética y gammagrafía ósea. Revisión de la literatura / Desmoid tumor of the chest wall characterized with 18F-fluorodeoxyglucose PET/ CT scan. Correlation with magnetic resonancy and bone scintigraphy. Review of the literature

Los tumores desmoides son una entidad benigna infrecuente, pero con un comportamiento agresivo, que provienen de una proliferación de fibroblastos bien diferenciados. Clínicamente se muestran como una masa dura e indolora de partes blandas, que puede ser solitaria o múltiple. Presenta un potencial infiltrativo local del que deriva su agresividad. A la hora de planear su tratamiento es fundamental determinar sus correctas extensión y delimitación para permitir una cirugía curativa y minimizar el riesgo de recurrencias locales. Diferentes técnicas de imagen ayudan a la caracterización de estos tumores. En la actualidad, la resonancia magnética es la herramienta de elección en la evaluación de estas neoplasias. Queda por definir el papel de las técnicas de medicina nuclear, como la gammagrafía ósea o, más recientemente, la tomografía de positrones con 18F-fluorodesoxiglucosa, en el diagnóstico y la evaluación de este tipo de tumores. Presentamos el caso de un paciente con un tumor desmoide de la pared toracicoabdominal en que estudiamos las técnicas de medicina nuclear y revisamos la literatura al respecto(AU)

Desmoid tumours are uncommon benign tumours but with aggressive behaviour, resulting from the proliferation of well-differentiated fibroblasts. Clinically, they present as a painless firm soft tissue mass. They can be solitary or multiple and have potential infiltrative capacity. When planning treatment, it is important to assess the correct tumour extent to permit curative radical surgery minimizing possible local recurrence. Different imaging techniques help to characterise these tumours. At present, magnetic resonance is the tool of choice for studying these tumours. The role of nuclear medicine techniques, such as bone scintigraphy, or more recently FDG-PET, has not been defined in the evaluation of these neoplasms. We present the case of a patient with a desmoid tumour of the abdominal-chest wall and we review the related literature(AU)

Estadificación del cáncer de vesícula mediante tomografía de positrones con 18F-fluorodesoxiglucosa / Gallbladder cancer staging with 18F-FDG PET-CT

El cáncer de vesícula es el más frecuente del tracto biliar. Suele afectar a ancianos y, clínicamente, suele ser asintomático. Los síntomas indican que hay complicaciones sobreañadidas o progresión tumoral por afección de estructuras vecinas, lo que condiciona un diagnóstico tardío de la enfermedad y un mal pronóstico de los pacientes con este tipo de neoplasias. El único tratamiento eficaz con intención curativa es la cirugía, sólo posible en estadios precoces. El diagnóstico por imagen de este tipo de neoplasias incluye técnicas como la ecografía, la tomografía computarizada (TAC) o la colangiorresonancia. La tomografía de positrones (PET) con 18F-fluorodesoxiglucosa (FDG), con tomógrafos dedicados o con equipos híbridos PET-TAC, es una nueva herramienta diagnóstica que puede ayudar en el diagnóstico prequirúrgico de este tipo de neoplasias. Presentamos a continuación tres casos para ilustrar la utilidad de la PET-FDG en la estadificación prequirúrgica del cáncer de vesícula(AU)

Gallbladder cancer is the most common biliary tract neoplasm. It generally affects the elderly, who are usually clinically asymptomatic. When symptoms appear, they suggest the presence of complications locally or due to tumour progression. Late diagnosis of the disease indicates a poor prognosis for these patients. Surgery is the only treatment with curative intent, but it is only possible in the early stages. Diagnostic imaging of this type of tumour is usually performed with ultrasonography, computed tomography or magnetic resonance cholangiography. Positron emission tomography (PET) with fluorodeoxyglucose (FDG) with dedicated scanners or hybrid PET-CT scans are new diagnostic tools which could help in the pre-surgical diagnosis of these tumours. We present three cases to illustrate the usefulness of PET-FDG in the pre-surgical staging of gallbladder cancer(AU)

Utilidad de la gammagrafía con hematíes marcados en el síndrome de Blue Rubber Bleb Nevus / Usefulness of labelled red cell scintigraphy in Blue Rubber Bleb Nevus syndrome

El síndrome de Blue Rubber Bleb Nevus (BRBNS) es una rara enfermedad que se caracteriza por múltiples malformaciones venosas (cutáneas y gastrointestinales) asociadas a episodios de sangrado gastrointestinal, generalmente oculto, y anemia ferropénica. Se presenta el caso de una niña de 8 años de edad que desde los primeros meses de vida presentó angiomas cutáneos y numerosos episodios de anemia ferropénica grave que requirió transfusiones en varias ocasiones. Ante la sospecha de angiomatosis intestinal por hemorragia digestiva, se le solicitó una gammagrafía con hematíes marcados con 99mTc, que evidenció las lesiones vasculares intestinales y, a su vez, confirmó las ya conocidas a nivel cutáneo, llegándose al diagnóstico de BRBNS (AU)

Blue Rubber Bleb Nevus syndrome is a rare disorder characterized by distinctive cutaneous and gastrointestinal venous malformations that usually cause episodes of occult gastrointestinal haemorrhage and iron deficiency anaemia. We describe an 8-year-old girl who had multiple cutaneous venous malformations since birth. She also suffered from several episodes of severe chronic iron deficiency anaemia and required blood transfusions. To evaluate the presence of gastrointestinal bleeding secondary to intestinal angiomatosis, we decided to perform 99mTc-labelled red blood cell scintigraphy, which confirmed cutaneous venous malformations and also showed gastrointestinal vascular lesions that suggested the diagnosis of Blue Rubber Bleb Nevus Syndrome (AU)

Vacuna antigripal y PET-FDG / FDG-PET and influenza vaccine

No disponible

No disponible