Gated-SPECT de reposo tras inyección intradolor de 99mTc-MIBI en paciente sin antecedentes de cardiopatía isquémica / Rest gated-SPECT myocardial perfusion post 99mTc-MIBI injection in a patient with acute chest pain and with no medical history of ischemic heart disease

El estudio gated-SPECT de perfusión miocárdica es una técnica utilizada e indicada para la valoración de los pacientes con un diagnóstico no claro de cardiopatía isquémica. El estudio gated-SPECT de reposo precoz en fase aguda tiene una alta sensibilidad y alto valor predictivo negativo para descartar enfermedad coronaria. Presentamos el caso de una paciente ingresada para el estudio de dolor torácico, a la que se le realizó un estudio de perfusión miocárdica de esfuerzo-reposo, cuyo resultado podría haber sido equívoco debido al estado clínico de la paciente durante la inyección del radiofármaco (AU)

Gated-SPECT myocardial perfusion imaging is a widely used technique indicated for assessment of patients with no clear diagnosis of ischemic heart disease. Early rest gated-SPECT myocardial perfusion study in patients with acute chest pain has high sensitivity and high negative predictive value for ruling out coronary disease. We report a case of a patient admitted for the study of her chest pain. She underwent a myocardial perfusion stress-rest whose interpretation could have been equivocal due to the clinical status of the patient during the injection of the radiotracer (AU)

[Rest gated-SPECT myocardial perfusion post (99m)Tc-MIBI injection in a patient with acute chest pain and with no medical history of ischemic heart disease]. / Gated-SPECT de reposo tras inyección intradolor de (99m)Tc-MIBI en paciente sin antecedentes de cardiopatía isquémica.

Gated-SPECT myocardial perfusion imaging is a widely used technique indicated for assessment of patients with no clear diagnosis of ischemic heart disease. Early rest gated-SPECT myocardial perfusion study in patients with acute chest pain has high sensitivity and high negative predictive value for ruling out coronary disease. We report a case of a patient admitted for the study of her chest pain. She underwent a myocardial perfusion stress-rest whose interpretation could have been equivocal due to the clinical status of the patient during the injection of the radiotracer.

El SPECT con 201Talio en la detección de recidiva del carcinoma de laringe / 201Thalium SPECT in the detection of recurrent laryngeal carcinoma

Objetivo. Evaluar el rendimiento del SPECT con 201Talio en la detección de la recidiva local y/o diseminación ganglionar regional del carcinoma faringolaríngeo. Material y métodos. Se estudiaron 29 pacientes con el diagnóstico de carcinoma faringolaríngeo (media: 60,9 años), tratados con cirugía, quimioterapia y radioterapia. Entre 3 a 6 meses después de finalizar el tratamiento, a todos se les practicó un estudio planar y SPECT una hora después de la administración de 148 MBq de 201Talio. La captación se valoró en 4 grados (0 no captante-3 muy intenso) y se constató la presencia o no de ganglios captantes. El resultado gammagráfico se correlacionó con el seguimiento clínico y radiológico a largo plazo (media: 2,50 años). Se valoraron como positivos de recurrencia, los estudios con captación centrocervical focal de grado 2-3 o la presencia de adenopatías captantes. Resultados. Se obtuvieron 9 verdaderos positivos, 14 verdaderos negativos, tres falsos positivos y tres falsos negativos. La sensibilidad fue del 75%, la especificidad del 82,4%, el valor predictivo positivo del 75% y el valor predictivo negativo del 82,4%. De los tres falsos positivos, dos correspondieron a captaciones en el lecho quirúrgico y uno a captación atribuida a ganglios laterocervicales. Los tres falsos negativos presentaron captaciones de grado 1, correspondiendo dos de ellos a metástasis pulmonares sin evidencia de recidiva local. Conclusión. El uso del SPECT con 201Talio en la evaluación pronóstica del paciente con carcinoma de laringe tratado muestra unos resultados muy aceptables para la detección de recidiva local y/o diseminación ganglionar regional(AU)

Objective. To evaluate the diagnostic yield of 201Thallium SPECT in the detection of local and/or regional lymph node dissemination of pharyngolaryngeal carcinoma. Material and methods. 29 patients who had been diagnosed with pharyngolaryngeal carcinoma were studied (mean age: 60.9 years). These patients had been treated by surgery, chemotherapy and radiotherapy. At between 3 to 6 month after finishing the treatment, all of them underwent a planar and SPECT study at one hour after the administration of 148 MBq of 201Thallium. Uptake was scored on four grades: from 0 (no uptake) to 3 (very intense uptake). The presence or non-presence of lymph nodes with uptake was also evaluated. All the results on the scintigraphy were correlated with long term clinical and radiological follow-up (mean: 2.5 years). The studies were classified as positive for recurrence when the uptake was 2-3 and/or with presence of lymph nodes with uptake. Results. We obtained 9 true positive, 14 true negative, 3 false positive and 3 false negative results. Sensitivity was 75%, specificity was 82.4%, positive predictive value was 75% and negative predictive value was 82.4%. Two out of three false positives corresponded to the surgical bed uptake and one was attributed to the laterocervical lymph nodes. The three false negatives had grade 1 uptakes, two of them corresponding to pulmonary metastasis without evidence of local recurrence. Conclusions. The use of 201Thallium SPECT in the prognostic evaluation in patients with a treated laryngeal carcinoma shows very acceptable results in the detection of local recurrence and/or regional lymph node dissemination(AU)

[201Thalium SPECT in the detection of recurrent laryngeal carcinoma]. / El SPECT con (201)Talio en la detección de recidiva del carcinoma de laringe.

OBJECTIVE: To evaluate the diagnostic yield of (201)Thallium SPECT in the detection of local and/or regional lymph node dissemination of pharyngolaryngeal carcinoma. MATERIAL AND METHODS: 29 patients who had been diagnosed with pharyngolaryngeal carcinoma were studied (mean age: 60.9 years). These patients had been treated by surgery, chemotherapy and radiotherapy. At between 3 to 6 month after finishing the treatment, all of them underwent a planar and SPECT study at one hour after the administration of 148 MBq of (201)Thallium. Uptake was scored on four grades: from 0 (no uptake) to 3 (very intense uptake). The presence or non-presence of lymph nodes with uptake was also evaluated. All the results on the scintigraphy were correlated with long term clinical and radiological follow-up (mean: 2.5 years). The studies were classified as positive for recurrence when the uptake was 2-3 and/or with presence of lymph nodes with uptake. RESULTS: We obtained 9 true positive, 14 true negative, 3 false positive and 3 false negative results. Sensitivity was 75%, specificity was 82.4%, positive predictive value was 75% and negative predictive value was 82.4%. Two out of three false positives corresponded to the surgical bed uptake and one was attributed to the laterocervical lymph nodes. The three false negatives had grade 1 uptakes, two of them corresponding to pulmonary metastasis without evidence of local recurrence. CONCLUSIONS: The use of (201)Thallium SPECT in the prognostic evaluation in patients with a treated laryngeal carcinoma shows very acceptable results in the detection of local recurrence and/or regional lymph node dissemination.

Osteomielitis aguda bacteriana multifocal en un niño con antecedentes de malformación cardíaca / Acute bacterial multifocal osteomyelitis in a boy with congenital cardiac malformation

No disponible

[Value of brain perfusion SPECT in the follow-up of patients surgically treated for chronic adult hydrocephalus syndrome]. / Valor del SPECT de perfusión cerebral en el seguimiento del tratamiento quirúrgico de pacientes con hidrocefalia crónica del adulto.

OBJECTIVE: The aim of this study was to characterize regional cerebral blood flow in patients with Adult Hydrocephalus Syndrome (AHS) and to evaluate the changes in brain perfusion after surgical derivation treatment. PATIENTS AND METHODS: 20 patients with AHS (age: 72 +/- 14, 12 men) were studied before and six months after surgery. All patients underwent a brain perfusion SPECT (99mTc-HMPAO) prior to surgery and at 6 months post-surgery. Semi-quantitative analysis was done for brain uptake: 0=Normal, 1=Mild, 2=Moderate, 3= Severe, 4=No uptake. The severity of ventricular dilatation was assessed by classifying the intensity and extension of subcortical defects: 0=Normal, 1=Mild, 2=Moderate, 3=Severe. The scores of the pre- and post-surgical studies were compared using the Student-t test. RESULTS: A global reduction of brain uptake was observed (mean score 12.85), mainly in frontal, parietal and temporal lobes, with a significant improvement in post surgical studies (mean score 6, p<0,001). After surgery, 16 (80%) of the 20 patients improved brain uptake. In relationship to subcortical uptake, 5 patients showed mild defects, 9 moderate defects and 6 patients presented severe uptake reduction. In post-surgical studies 15 (75%) patients improved almost one degree in the subcortical score and 65% of the patients showed a normal or mild subcortical uptake reduction. CONCLUSIONS: Brain perfusion SPECT is useful in patients with AHS, detecting brain perfusion defects and evaluating cerebral blood flow improvement after shunt operation.

Valor del SPECT de perfusión cerebral en el seguimiento del tratamiento quirúrgico de pacientes con hidrocefalia crónica del adulto / Brain perfusion spect in patients with chronic adult hydrocephalus syndrome. Pre- and post-surgical study

Objetivo: Evaluar el estado de la perfusión cerebral en pacientes con hidrocefalia crónica del adulto (HCA) y los cambios producidos en la misma tras la derivación de líquido cefalorraquideo (LCR).Material y métodos: Se han evaluado 20 pacientes diagnosticados de HCA (edad: 72 ñ 14; 12 hombres) tratados quirúrgicamente. A todos los pacientes se les realizó un SPECT de perfusión cerebral (99mTc-HMPAO) pre-operatorio y a los 6 meses de la intervención quirúrgica. Se realizó un análisis semicuantitativo del grado de captación en las diferentes regiones cerebrales: 0 = normal; 1 = leve; 2 = moderado; 3 = severo; 4 = ausencia de captación. La hipoactividad subcortical secundaria a la dilatación ventricular se cuantificó en cuatro grados: 0 = normal; 1 = leve; 2 = moderado; 3 = severo. Se compararon los valores obtenidos en el primer y segundo estudio (t-Student).Resultados: Se observó una reducción global de la captación en prácticamente todos los lóbulos (puntuación media 12,85), predominantemente en los lóbulos frontal, temporal y parietal, que mejoró significativamente de forma global y para cada uno de los territorios analizados en el estudio postoperatorio (puntuación media 6, p < 0,001). De los 20 pacientes estudiados 16 (80 por ciento) mejoraron la captación cortical y 4 no presentaron cambios. Respecto a la hipoactividad subcortical, 5 pacientes presentaron un grado leve, 9 presentaban grado moderado y 6 un grado severo. En el estudio postoperatorio 15 (75 por ciento) pacientes mejoraron al menos un grado de captación y un 65 por ciento pasaron a un grado normal o leve de dilatación. Conclusiones: El SPECT de perfusión cerebral es una técnica que permite valorar las alteraciones de la perfusión ocasionadas por la HCA y objetivar la recuperación que produce la implantación de una derivación de LCR (AU)