RESUMEN
OBJECTIVE: The aim of this study is to compare several uptake indexes between specific and non-specific activity to determine the existence of degenerative Parkinsonism according to different reference areas. MATERIAL AND METHODS: A total of 46 patients (23 men and 23 women), randomly selected from individuals referred to our center with a movement disorder, were included in the study. Mean age was 70.2 ± 10.2 years (41-87). The uptake indexes were obtained through the areas of interest (ROIs) located in the striate (specific uptake) and other reference ROIs located in areas with different concentrations of serotonin receptors: low-cerebellum, medium-occipital cortex and high-midbrain. RESULTS: A high linear correlation was found between indexes having low and medium concentration of serotonin receptors. The ROC curve analysis shows an area under the curve of 0.874, 0.886 and 0.739 and regression coefficients of 5.41, 6.62 and 3.41, respectively for the striatum/cerebellum (E/C), striatum/occipital (E/O) and striatum midbrain (E/M) indexes. Optimal cutoff for E/O (1.35), index with the best behavior, provides a sensitivity of 0.84 and specificity of 0.89. CONCLUSION: The reference area selected may alter the predictive power of the different indexes to determine the existence of a degenerative Parkinsonism.
Asunto(s)
Encéfalo/diagnóstico por imagen , Radioisótopos de Carbono , Radioisótopos de Yodo , Trastornos Parkinsonianos/diagnóstico por imagen , Radiofármacos , Tomografía Computarizada de Emisión de Fotón Único , Tropanos , Adulto , Anciano , Anciano de 80 o más Años , Radioisótopos de Carbono/farmacocinética , Cerebelo/química , Cerebelo/diagnóstico por imagen , Cuerpo Estriado/química , Femenino , Humanos , Radioisótopos de Yodo/farmacocinética , Masculino , Mesencéfalo/química , Persona de Mediana Edad , Degeneración Nerviosa/diagnóstico por imagen , Especificidad de Órganos , Enfermedad de Parkinson/diagnóstico por imagen , Enfermedad de Parkinson Secundaria/diagnóstico por imagen , Valor Predictivo de las Pruebas , Curva ROC , Radiofármacos/farmacocinética , Receptores de Serotonina/análisis , Estudios Retrospectivos , Muestreo , Sensibilidad y Especificidad , Distribución Tisular , Tropanos/farmacocinéticaRESUMEN
OBJECTIVE: To evaluate diagnostic efficacy of rest myocardial perfusion scintigraphy in the detection of acute coronary syndrome in patients with chest pain and non diagnostic electrocardiogram, comparing it with reference techniques, in Emergency Department. MATERIAL AND METHODS: Myocardial perfusion scintigraphy was carried out in 40 patients with those defined characteristics in the Emergency Department, administering the radiopharmaceutical in the next 6 hours after the pain was over. All subjects followed routine diagnostic and treatment management. Final diagnosis of coronary disease was established by coronariography and/or stress perfusion myocardial scintigraphy. Patients were followed up for 9-12 months. RESULTS: Myocardial perfusion scintigraphy showed a negative predictive value of 96,15 % (CI 95 %: 86.84-100.00). The main limitation of its application was breast and diaphragmatic attenuation phenomenon, given that correction algorithms were not available. Global kappa coefficient was 0.78 when to compared interobserver agreement. CONCLUSION: Rest myocardial perfusion scintigraphy is a safe and efficient test in the screening of patients with chest pain suggestive of angor with non-diagnostic ECG in Emergency Department, and also provides prognostic information and risk stratification.
Asunto(s)
Angina Inestable/diagnóstico por imagen , Dolor en el Pecho/diagnóstico por imagen , Servicio de Urgencia en Hospital , Corazón/diagnóstico por imagen , Infarto del Miocardio/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único , Enfermedad Aguda , Angina Inestable/sangre , Angina Inestable/complicaciones , Fibrilación Atrial/diagnóstico por imagen , Biomarcadores , Dolor en el Pecho/etiología , Angiografía Coronaria , Estudios Transversales , Diagnóstico Diferencial , Electrocardiografía , Prueba de Esfuerzo , Femenino , Humanos , Hipertensión/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Infarto del Miocardio/sangre , Infarto del Miocardio/complicaciones , Valor Predictivo de las Pruebas , Radiofármacos/uso terapéutico , Descanso , Tecnecio Tc 99m Sestamibi , Tomografía Computarizada de Emisión de Fotón Único/métodos , Troponina/sangreRESUMEN
OBJECTIVE: To determine the diagnostic accuracy of FP-CIT SPECT in entities with and without presynaptic involvement of the nigral-striatal dopaminergic pathway in a large group of patients with movement disorders, evaluating the usefulness of quantitative analysis. MATERIALS AND METHODS: A group of 183 consecutive patients clinically diagnosed as either having or not having degenerative Parkinsonism. These results were then contrasted with those of FP-CIT SPECT to determine the diagnostic accuracy of the procedure. The specific binding index was evaluated with ROC curves. RESULTS: FP-CIT SPECT was highly accurate in the diagnosis of neurodegenerative Parkinsonism (sensitivity: 95 %, specificity: 90 %). Most of the false positive results arose in patients with vascular Parkinsonism and the false negative results in patients with Parkinson disease. ROC curve analysis of semiquantitative evaluation had a sensitivity of 83 % and specificity of 82 % with an optimal cut-off of 1.44. The area under the curve was not significantly different between patients = 60 and > 60 years (0.899 vs 0.884) of age. CONCLUSIONS: FP-CIT SPECT has a high degree of diagnostic accuracy for striatal dopaminergic involvement. No significant changes in diagnostic accuracy were seen with respect to patient age.
Asunto(s)
Encéfalo/diagnóstico por imagen , Radioisótopos de Yodo , Trastornos Parkinsonianos/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único , Tropanos , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los ResultadosRESUMEN
The term splenosis, first used in the medical literature in 1939, refers to the autotransplantation of splenic tissue in a heterotopic location. We report the case of a known hepatitis C carrier in whom computed tomography scanning revealed a hepatic lesion suggestive of hepatocarcinoma. Magnetic Resonance imaging was performed for suspected hepatic splenosis, which was confirmed by Tc-99m labeled heat-denatured red blood cell scintigraphy. In addition to confirming the suspected diagnosis, this technique showed several pathological foci in distinct abdominal locations compatible with splenosis that had not previously been identified.
Asunto(s)
Eritrocitos/diagnóstico por imagen , Hígado , Esplenosis/diagnóstico por imagen , Tecnecio , Humanos , Masculino , CintigrafíaRESUMEN
INTRODUCTION: 123I-FP-CIT scan has been supported in the last years by numerous studies as a technique of undeniable value to assess presynaptic integrity of the nigrostriatal pathway. The objective of this study is to perform a descriptive analysis of the main diagnostic aspects obtained from the first 110 studies made with FP-CIT in our center. MATERIAL AND METHODS: The study population consisted of 110 consecutive patients distributed into 5 groups according to the clinical diagnosis, after a follow-up period of at least one year. Qualitative and quantitative scintigraphy was done. RESULTS: A total of 61.8 % (68/110) of the studies were considered abnormal and 38.2 % (42/110) as normal. Among the abnormal examinations there was 88.3 % (60/68) agreement with the clinical diagnosis and agreement was 83.4 % (35/42) in the normal examinations. Inverse significant correlation was assessed between striatal binding and severity according to the H and Y scale (r = -0.4) and between qualitative and quantitative assessment (r = -0.86). There was no significant correlation between the degeneration of dopaminergic function according to age and degree of asymmetry on striatal binding in the different groups. CONCLUSIONS: Generally an adequate agreement between clinical diagnosis and SPECT-FP-CIT was observed. Inverse correlation between striatal binding and H and Y scale and greater asymmetry at striatal binding was obtained among Parkinson patients than in the rest of groups.
Asunto(s)
Cuerpo Estriado/diagnóstico por imagen , Radioisótopos de Yodo , Enfermedad de Parkinson/diagnóstico por imagen , Radiofármacos , Tomografía Computarizada de Emisión de Fotón Único , Tropanos , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades de los Ganglios Basales/diagnóstico por imagen , Cuerpo Estriado/metabolismo , Dopamina/metabolismo , Proteínas de Transporte de Dopamina a través de la Membrana Plasmática , Femenino , Estudios de Seguimiento , Humanos , Enfermedad por Cuerpos de Lewy/diagnóstico por imagen , Masculino , Glicoproteínas de Membrana/metabolismo , Proteínas de Transporte de Membrana/metabolismo , Persona de Mediana Edad , Proteínas del Tejido Nervioso/metabolismo , Enfermedad de Parkinson/metabolismo , Enfermedad de Parkinson Secundaria/diagnóstico por imagen , Examen Físico , Parálisis Supranuclear Progresiva/diagnóstico por imagenRESUMEN
OBJECTIVES: To describe the preliminary results of the application of this new technique in the diagnostic protocol in the management of differentiated thyroid cancer (DTC). MATERIAL AND METHODS: 131I Whole body scan (WBS) was made under rhTSH stimulation in a group of 102 patients with DTC in follow-up, all treated by means of total thyroidectomy. The administration guideline was a dose of 0.9 mg of rhTSH (intramuscular) for two consecutive days, followed by oral activity of 185 MBq of 131I 24 hours after the last rhTSH injection, and later scintigraphic scan after 48 hours of the administration of 131I. Serum samples for TSH, thyroglobulin and antithyroglobulin antibodies determination were collected at 24 and 72 hours of the last administration of the rhTSH. Measures were made by means of immunometric assays. RESULTS: TSH values at 24 hours after exogenous stimulation were 147.54 +/- 46.46 mIU/l. In 62 patients values of negative Tg were obtained (< 1 ng/ml), 50 of which presented negative WBS and 12 positive. 37 patients had positive Tg, 17 of whom presented negative WBS (confirming presence of disease in 7 patient by means of other imaging techniques) and 20 positive. CONCLUSIONS: In every case, administration of rhTSH produced a significant increase of the TSH, making it possible to perform the usual controls of patient management (determination of serum Tg and WBS), similarly to the hormone withdrawal situation. There is no evidence of significant side effects, and its use makes it possible to avoid disadvantages derived from the hormonal withdrawal, maintaining a good quality of life in patients.
Asunto(s)
Adenocarcinoma Folicular/secundario , Biomarcadores de Tumor/sangre , Carcinoma Papilar/secundario , Recurrencia Local de Neoplasia/diagnóstico por imagen , Tiroglobulina/sangre , Neoplasias de la Tiroides/diagnóstico por imagen , Tirotropina , Recuento Corporal Total/métodos , Adenocarcinoma Folicular/diagnóstico por imagen , Adenocarcinoma Folicular/cirugía , Adolescente , Adulto , Anciano , Autoanticuerpos/sangre , Carcinoma Papilar/diagnóstico por imagen , Carcinoma Papilar/cirugía , Femenino , Estudios de Seguimiento , Terapia de Reemplazo de Hormonas , Humanos , Hipotiroidismo/etiología , Hipotiroidismo/prevención & control , Radioisótopos de Yodo , Metástasis Linfática/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Cintigrafía , Proteínas Recombinantes/sangre , Estimulación Química , Síndrome de Abstinencia a Sustancias/etiología , Síndrome de Abstinencia a Sustancias/prevención & control , Hormonas Tiroideas/administración & dosificación , Hormonas Tiroideas/uso terapéutico , Tiroidectomía , Tirotropina/sangreRESUMEN
OBJECTIVE: This study was designed to assess the diagnostic accuracy of single photon emission computed tomography with Tl-201 (SPECT Tl-201) to establish the tumoral or non-tumoral nature of brain space occupying lesions in comparison with usual diagnostic techniques. MATERIAL AND METHODS: The study population consisted of 37 patients, 24 men (64.9 %) and 13 women (35.1 %), mean age 48 +/- 16 years. After establishing the clinical and radiological diagnosis of brain lesion, all patients underwent SPECT Tl-201, evaluating it only by subjective analysis and blinded to neuroestructural techniques. After surgical resection all patients were evaluated anatomopathologically to establish the histologic nature. RESULTS: The sensitivity of SPECT Tl-201 (0.87) was higher than standard neuroimaging techniques (0.78). Specificity (0.43), positive (0.87) and negative (0.43) predictive values of SPECT were similar to neuroestructural procedures (MRI and CT scan) with 0.43, 0.82 and 0.38 values. Tumoral disease prevalence was 0.81. Neuroestructural procedures were non-conclusive in 18.9 % of the studies. No non-conclusive results were obtained with SPECT Tl-201. CONCLUSIONS: SPECT Tl-201 is a diagnostic procedure of high sensitivity to establish the tumoral nature of brain lesions, with poor specificity, similar to structural X-ray techniques.
Asunto(s)
Absceso Encefálico/diagnóstico por imagen , Neoplasias Encefálicas/diagnóstico por imagen , Glioma/diagnóstico por imagen , Talio , Tomografía Computarizada de Emisión de Fotón Único , Adolescente , Adulto , Anciano , Absceso Encefálico/cirugía , Neoplasias Encefálicas/clasificación , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/cirugía , Femenino , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico por imagen , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Radiografía , Sensibilidad y EspecificidadAsunto(s)
Neoplasias Óseas/secundario , Diagnóstico por Imagen/métodos , Neoplasias Óseas/complicaciones , Neoplasias Óseas/diagnóstico por imagen , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Osteólisis/diagnóstico por imagen , Osteólisis/etiología , Tomografía Computarizada de Emisión , Tomografía Computarizada por Rayos XRESUMEN
Vascular parkinsonism is the second cause of secondary parkinsonism, and can cause a complex clinical syndrome. In spite of this, it is not common to find an isolated vascular injury in the mesencephalic region, and even rarer for it to give rise to clinical parkinsonism. We present the case of a young patient who developed left hemiparkinsonism with a fluctuating clinical evolution and unpredictable response to the treatment after suffering right mesencephalic bleeding. Structural and functional neuroimaging techniques showed injury on the mesencephalic level and no uptake in the right striatal region, respectively.
Asunto(s)
Hemorragias Intracraneales/complicaciones , Mesencéfalo/patología , Enfermedad de Parkinson Secundaria/etiología , Adulto , Humanos , Hemorragias Intracraneales/patología , Imagen por Resonancia Magnética , Mesencéfalo/metabolismo , Enfermedad de Parkinson Secundaria/patología , Corteza Visual/metabolismo , Corteza Visual/patologíaAsunto(s)
Síndrome de ACTH Ectópico/complicaciones , Síndrome de ACTH Ectópico/diagnóstico por imagen , Tumor Carcinoide/diagnóstico por imagen , Tumor Carcinoide/metabolismo , Síndrome de Cushing/etiología , Radioisótopos de Indio , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/metabolismo , Ácido Pentético/análogos & derivados , Adulto , Femenino , Humanos , Cintigrafía , Receptores de Somatostatina/biosíntesisAsunto(s)
Carcinoma/diagnóstico por imagen , Neoplasias Hepáticas/secundario , Radiofármacos/farmacocinética , Medronato de Tecnecio Tc 99m/análogos & derivados , Anciano , Biomarcadores de Tumor/análisis , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/secundario , Carcinoma/secundario , Carcinoma Broncogénico/química , Femenino , Hepatomegalia/diagnóstico por imagen , Hepatomegalia/etiología , Humanos , Neoplasias Hepáticas/química , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Primarias Desconocidas , Células Neoplásicas Circulantes , Tumores Neuroendocrinos/química , Neoplasias Peritoneales/diagnóstico por imagen , Neoplasias Peritoneales/secundario , Cintigrafía , Medronato de Tecnecio Tc 99m/farmacocinéticaRESUMEN
OBJECTIVE: To determine diagnostic accuracy of FP-CIT SPECT in a subgroup of patients who clinically present nonconclusive or atypical characteristics of parkinsonism (Clinically Uncertain Parkinsonian Syndromes, CUPS), and assess the contribution of the quantitative analysis in this group of patients. PATIENTS AND METHODS: We included 54 patients who make up the CUPS group. After a variable follow-up period, we evaluated the existence of a degenerative parkinsonism and compared it with the result of the FP-CIT SPECT, establishing the diagnostic accuracy of this procedure in the CUPS patient group. RESULTS: We obtained a high diagnostic accuracy of neurodegenerative Parkinsonism in the CUPS patient group (sensitivity: 85%; specificity: 93%). False positive results were obtained in patients with vascular parkinsonism and most of the false negative results in patients with Parkinson's disease. The quantitative evaluation did not contribute data of relevance to the qualitative evaluation. CONCLUSIONS: FP-CIT SPECT makes it possible to show the involvement of nigrostriatal dopaminergic pathway, also contributing with information of relevance to the clinician about the etiology of the extrapyramidal symptomatology in patients with nonconclusive signs and symptoms of the existence of a Parkinsonism.
Asunto(s)
Enfermedad de Parkinson/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único , Adulto , Anciano , Anciano de 80 o más Años , Encéfalo/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Radiofármacos , Sensibilidad y Especificidad , TropanosAsunto(s)
Tumor Carcinoide/secundario , Neoplasias Cardíacas/secundario , Neoplasias del Íleon/patología , Imagen Multimodal , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Anciano , Tumor Carcinoide/diagnóstico por imagen , Neoplasias Cardíacas/diagnóstico por imagen , Humanos , Radioisótopos de Indio , Hígado/diagnóstico por imagen , Masculino , Radiofármacos , Somatostatina/análogos & derivadosAsunto(s)
Osteonecrosis de los Maxilares Asociada a Difosfonatos/diagnóstico por imagen , Conservadores de la Densidad Ósea/efectos adversos , Neoplasias Óseas/secundario , Neoplasias de la Mama/complicaciones , Carcinoma/secundario , Difosfonatos/efectos adversos , Imidazoles/efectos adversos , Enfermedades Mandibulares/diagnóstico por imagen , Osteonecrosis de los Maxilares Asociada a Difosfonatos/etiología , Conservadores de la Densidad Ósea/uso terapéutico , Enfermedades Óseas Metabólicas/prevención & control , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/tratamiento farmacológico , Neoplasias de la Mama/cirugía , Carcinoma/diagnóstico por imagen , Diagnóstico Diferencial , Difosfonatos/uso terapéutico , Femenino , Humanos , Imidazoles/uso terapéutico , Enfermedades Mandibulares/inducido químicamente , Neoplasias Mandibulares/secundario , Persona de Mediana Edad , Osteoartritis/complicaciones , Osteoartritis/diagnóstico por imagen , Cintigrafía , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Neoplasias de la Columna Vertebral/tratamiento farmacológico , Neoplasias de la Columna Vertebral/secundario , Vértebras Torácicas/diagnóstico por imagen , Ácido ZoledrónicoAsunto(s)
Humanos , Femenino , Adulto , Síndrome de Cushing/diagnóstico , Síndrome de ACTH Ectópico/diagnóstico , Síndrome de ACTH Ectópico , Hormona Adrenocorticotrópica , /instrumentación , /métodos , Medicina Nuclear/métodos , Somatostatina , Gadolinio DTPA , Síndrome de Cushing , Neoplasias Pulmonares , Síndrome de Cushing/complicacionesRESUMEN
Objetivo. Evaluar la validez diagnóstica de la gammagrafía de perfusión miocárdica precoz en reposo para la detección de síndrome coronario agudo en pacientes con dolor torácico y electrocardiograma no diagnóstico, comparándola con las técnicas de referencia. Material y métodos. Se realizó una gammagrafía de perfusión miocárdica en 40 de estos pacientes atendidos en el servicio de urgencias, inyectando el radiofármaco en las primeras seis horas tras la finalización del dolor. Todos los sujetos siguieron su curso diagnóstico y terapéutico de rutina. El diagnóstico final de enfermedad coronaria se estableció mediante coronariografía y/o gammagrafía de esfuerzo. Se realizó un tiempo de seguimiento clínico de todos los pacientes entre 9-12 meses. Resultados. El valor predictivo negativo de la gammagrafía de perfusión miocárdica fue del 96,15 % (IC 95 %: 86,84-100,00 %). La principal limitación de su aplicación fue el fenómeno de atenuación mamaria y diafragmática, al no disponer de algoritmos de corrección de atenuación. El índice global de kappa obtenido para valorar la concordancia interobservadores fue del 0,78. Conclusiones. La gammagrafía de perfusión miocárdica en reposo es una técnica eficiente y segura para el screening en urgencias de pacientes con dolor torácico sugestivo de ángor con electrocardiograma normal o no diagnóstico, y proporciona además información pronóstica y estratificación del riesgo
Objective. To evaluate diagnostic efficacy of rest myocardial perfusion scintigraphy in the detection of acute coronary syndrome in patients with chest pain and non diagnostic electrocardiogram, comparing it with reference techniques, in Emergency Department. Material and methods. Myocardial perfusion scintigraphy was carried out in 40 patients with those defined characteristics in the Emergency Department, administering the radiopharmaceutical in the next 6 hours after the pain was over. All subjects followed routine diagnostic and treatment management. Final diagnosis of coronary disease was established by coronariography and/or stress perfusion myocardial scintigraphy. Patients were followed up for 9-12 months. Results. Myocardial perfusion scintigraphy showed a negative predictive value of 96,15 % (CI 95 %: 86.84-100.00). The main limitation of its application was breast and diaphragmatic attenuation phenomenon, given that correction algorithms were not available. Global kappa coefficient was 0.78 when to compared interobserver agreement. Conclusion. Rest myocardial perfusion scintigraphy is a safe and efficient test in the screening of patients with chest pain suggestive of angor with non-diagnostic ECG in Emergency Department, and also provides prognostic information and risk stratification