ABSTRACT
The tools currently used to evaluate the extent of paracoccidioidomycosis (PCM) may be of limited value in detecting subclinical lesions. The aim of this study was to verify the role of gallium-67 whole-body scan in evaluating the extent of disease of 65 patients with active PCM. The (67)Ga scan findings were compared with the results of clinical evaluation, chest radiography and/or high-resolution computed tomography (CT), abdominal ultrasound (US) or CT, laryngoscopy, CT or magnetic resonance imaging (MRI) of the head, and technetium-99m methylene diphosphonate bone scan, obtained before treatment. Clinically unsuspected lesions were detected by imaging procedures in 21 patients (32%), mainly in the lungs (n=11), adrenals (n=6), and superficial (n=3) and deep lymph nodes (n=14). (67)Ga scan detected 100% of the cases with subclinical involvement in the lungs. Scintigraphy was superior to chest radiography in demonstrating lung disease (94% vs 81%). The lymphatic lesions were demonstrated by (67)Ga scan in all the clinically suspected cases and in nearly all unsuspected cases, and also revealed more extensive involvement than was clinically suspected in many of them. There was good agreement between (67)Ga scan and the other imaging procedures for the initial detection of thoracic and abdominal lymph nodes and bone involvement. (67)Ga imaging detected most cases of laryngopharyngeal disease with active inflammatory lesions found at indirect laryngoscopy. On the other hand, (67)Ga scan failed to demonstrate most of the adrenal and CNS lesions detected by abdominal US/CT and head CT/MRI. In conclusion, (67)Ga imaging is a useful tool for evaluating the location and extent of suspected and unsuspected lesions in PCM. It could serve as a screening method before the use of other diagnostic procedures, particularly in the detection of lung, superficial and deep lymph node and bone involvement.
Subject(s)
Gallium Radioisotopes , Mycoses/diagnostic imaging , Paracoccidioidomycosis/diagnostic imaging , Adolescent , Adult , Aged , Child , Female , Humans , Lymph Nodes/diagnostic imaging , Lymph Nodes/microbiology , Magnetic Resonance Imaging , Male , Middle Aged , Radionuclide Imaging , Reproducibility of Results , Sensitivity and Specificity , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Active chronic osteomyelitis or complicating osteomyelitis are difficult to be diagnosed by radiological imaging modalities, such as plain radiograph and CT. They frequently cause increased bone remodeling, leading to nonspecific uptake of Tc-99m-bone scan agents and gallium-67. New radiopharmaceuticals with greater infection avidity are being developed, including the nonspecific polyclonal immunoglobulin (IgG) labeled with technetium-99m. Tc-99m-IgG may be available as a ready to use kit, with no reported side effects, low patient absorbed radiation dose and low cost. MATERIAL AND METHODS: 23 bone segments with suspected active chronic osteomyelitis or violated bone osteomyelitis were studied by Tc-99m-IgG scintigraphy. All patients underwent standard three-phase bone scintigraphy using methylene diphosphonate (Tc-99m-MDP), gallium-67 scintigraphy and plain radiographs, compared with clinical evaluation and laboratory tests values. RESULTS: Infection was found in 8 sites. Sensitivity and specificity for Tc-99m-MDP, gallium-67 and Tc-99m-IgG scintigraphy were, respectively, 88 and 36%, 75 and 73%, 88 and 82%. CONCLUSION: Tc-99m-IgG may be usefull in the scintigraphic evaluation of osteomyelitis.
Subject(s)
Antibodies , Bacterial Infections/diagnostic imaging , Osteomyelitis/diagnostic imaging , Technetium , Adolescent , Adult , Aged , Aged, 80 and over , Bacterial Infections/metabolism , Bacterial Infections/physiopathology , Chronic Disease , Female , Humans , Male , Middle Aged , Osteomyelitis/metabolism , Osteomyelitis/physiopathology , Radionuclide Imaging , Sensitivity and SpecificityABSTRACT
OBJETIVO: O diagnóstico de osteomielite crônica em atividade ou sobreposta a outras patologias é difícil, pois estas situações mascaram os achados radiológicos de infecção. A especificidade da cintilografia do esqueleto ou com gálio-67 também é reduzida pela influência da remodelação óssea na captação destes radiofármacos. Anticorpos policlonais marcados com tecnécio-99m (Tc-99m-IgG) apresentam captação independente do metabolismo ósseo, sendo um dos radiofármacos em investigação para avaliação mais específica de infecção. CASUÍSTICA E MÉTODO: Neste estudo comparou-se a cintilografia com Tc-99m-IgG, cintilografia óssea trifásica e cintilografia com gálio-67 no diagnóstico da osteomielite crônica em atividade em 23 segmentos ósseos; correlacionando-as com dados clínico-laboratoriais e radiológicos. RESULTADOS: Oito dos 23 segmentos foram classificados como infectados, 11 não infectados e quatro inconclusivos. A sensibilidade e especificidade encontradas para cintilografia óssea, com gálio-67 e com Tc-99m-IgG foram, respectivamente, 88 e 36 por cento, 75 e 73 por cento, 88 e 82 por cento. CONCLUSÃO: Os resultados sugerem que a Tc-99m-IgG possa ser utilizada no diagnóstico da osteomielite crônica em atividade.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Antibodies , Bacterial Infections , Osteomyelitis , Technetium , Aged, 80 and over , Bacterial Infections/metabolism , Bacterial Infections/physiopathology , Chronic Disease , Osteomyelitis/metabolism , Osteomyelitis/physiopathology , Sensitivity and SpecificityABSTRACT
Single photon emission tomography (SPECT) was performed in 27 patients with refractory complex partial seizures from the temporal lobes due to mesial temporal sclerosis. Independent blinded observers assessed the 28 interictal studies and 9 ictal/postictal studies. Visual analysis of interictal studies detected hypoperfusion in 22, ipsilateral to the epileptogenic zone in 19 (67%) and contralateral in 3 (10.7%). Quantified temporal lobe asymmetry, greater than a previously derived normal range, correctly identified the epileptogenic zone in 16 (61.5%) with false lateralization in 4 (15.3%). In all 9 cases in which they were performed, ictal/postictal studies showed hyperperfusion at the region of epileptic focus. In 3 patients with complex partial seizures followed by symmetric generalized tonic-clonic seizures, hyperperfusion restricted to the temporal lobe was demonstrated. In 5 of these patients the interical studies were unable to demonstrate localized changes. There were no significant correlations between SPECT findings and clinical parameters or EEG slowing in the temporal lobes.
