Complications of shoulder arthroplasty: added value of SPECT/CT imaging. / Complicaciones de las prótesis de hombro: valor añadido de la imagen SPECT/TC.

The incidence of prosthetic shoulder replacements has increased considerably in recent years, as well as the complications derived from the procedure. The correct diagnosis of each type of complication is essential for therapeutic decision making, which is currently based on the information provided by radiological and nuclear medicine imaging. Nevertheless, both techniques have intrinsic limitations that could be mostly overcome with the advent of the hybrid SPECT/CT imaging, which is set to play a fundamental role in the evaluation of shoulder prostheses.

The Alzheimer's Prevention Initiative Generation Program: Evaluating CNP520 Efficacy in the Prevention of Alzheimer's Disease.

Alzheimer's disease pathology begins decades before the onset of clinical symptoms. This provides an opportunity for interventional clinical trials to potentially delay or prevent the onset of cognitive impairment or dementia. CNP520 (a beta-site-amyloid precursor protein-cleaving enzyme inhibitor) is in clinical development for the treatment of preclinical Alzheimer's disease under the Alzheimer's Prevention Initiative Generation Program. The Alzheimer's Prevention Initiative is a public-private partnership intended to accelerate the evaluation of Alzheimer's disease prevention therapies. The Generation Program comprises two pivotal phase II/III studies with similar designs to assess the efficacy and safety of investigational treatments in a cognitively unimpaired population at increased risk for developing Alzheimer's disease based on age and apolipoprotein E (APOE) genotype (i.e., presence of the APOE ε4 allele). The program has been designed to maximize benefit to Alzheimer's disease research. Generation Study 1 (NCT02565511) and Generation Study 2 (NCT03131453) are currently enrolling; their key features are presented here.

The selective metabotropic glutamate receptor 5 antagonist mavoglurant (AFQ056) reduces the incidence of reflux episodes in dogs and patients with moderate to severe gastroesophageal reflux disease.

BACKGROUND: Transient lower esophageal sphincter relaxations (TLESRs) induced by gastric distension are modulated by the metabotropic glutamate receptor 5 (mGluR5) that influences the vagal reflex loop. We therefore aimed to examine the effects of the selective mGluR5 antagonist mavoglurant (AFQ056) on the number of TLESRs in dogs and reflux episodes in patients with gastroesophageal reflux disease (GERD). METHODS: In a dog model, the number of meal-induced TLESRs was determined after intravenous (0.03, 0.1, 0.3, and 1 mg kg-1 ) and oral (1, 3, and 10 mg kg-1 ) doses of mavoglurant with reference to vehicle. In a multicenter, randomized, double-blind, placebo-controlled, three-period crossover study, the incidence of meal-induced reflux episodes was assessed by esophageal impedance monitoring after single, oral doses of mavoglurant (50 and 400 mg) or baclofen (40 mg) in 30 patients with moderate to severe GERD. KEY RESULTS: In dogs, mavoglurant reduced the number of TLESRs after intravenous and oral administration. In patients with GERD, the incidence of postprandial reflux episodes was significantly lower at a dose of 400 mg mavoglurant (-37.5% ; 90% confidence interval [CI]: -57.8, -17.2), whereas there was no significant difference at 50 mg of mavoglurant compared to placebo. A significantly lower incidence of reflux episodes was also noted with the active comparator baclofen (-50.3%; 90% CI: -66.2, -34.3), thereby validating this study. CONCLUSIONS AND INFERENCES: These data suggest a potential clinical benefit of mGluR5 antagonists such as mavoglurant in patients with GERD, particularly in those with persisting symptoms despite treatment with proton pump inhibitors.

Spontaneous intracranial hypotension syndrome: contribution of radioisotope cisternography. / Síndrome de hipotensión intracraneal espontánea: aportación de la cisternografía radioisotópica.

Spontaneous intracranial hypotension is a clinical syndrome caused by a loss of cerebrospinal fluid volume, usually secondary to leaking through structural defects of the spinal dura mater. Radioisotope cisternography (RC) can confirm the diagnosis of spontaneous intracranial hypotension, especially in doubtful or atypical case presentations. A retrospective study was conducted on 8 patients who underwent RC because spontaneous intracranial hypotension was suspected, and they presented with atypical clinical manifestations and/or inconclusive findings in other imaging techniques. RC detected paradural extravasation of cerebrospinal fluid in 7 patients. Moreover, there was indirect evidence of cerebrospinal fluid leaks in all 8 patients (early appearance of radioactivity in the bladder, soft tissue uptake of radioisotope and/or reduction in the amount of radiotracer in the brain at 24hours). RC had a significant impact on the diagnosis of 6 patients, and on the therapeutic management of 4 patients.

Diagnostic contribution of quantitative analysis of salivary scintigraphy in patients with suspected Sjögren's syndrome.

AIM: The evaluation of the salivary scintigraphy is part of the classification criteria of Sjögren's syndrome (SS). The aim of the study was to determine a method of quantitative evaluation of this technique with easy application and high diagnostic accuracy. MATERIAL AND METHODS: A review was carried out on a total of 111 patients with clinical suspicion of SS, referred to our department over the last 4 years (94 women, range 14-82 years). Thirty-minute dynamic studies were performed after injection of (99m)Tc-pertechnetate, with secretory stimulus at 15 minutes. After drawing regions of interest in both parotids, submandibular glands, and in the background, quantitative parameters were determined. These included the ejection fraction, uptake ratio at 15 min, and the percentage uptake (PC). Based on the definitive diagnosis, the subjects were classified into patients with SS, with sicca syndrome, and healthy subjects. RESULTS: Significant differences were found between the SS group and healthy subjects in the 3 quantitative parameters for the 4 glands. Significant differences in the PC parameter were observed between the group with sicca syndrome and healthy subjects. ROC analysis showed that the best differentiation parameter for the 3 groups was the PC in both parotid and submandibular glands. CONCLUSIONS: The quantitative analysis of salivary scintigraphy has proved to be a useful method and easy to apply in daily practice to differentiate patients with SS from healthy subjects, with the PC, both in parotid and submandibular glands, being the parameter with highest diagnostic accuracy.

Uncommon isolated distant subcutaneous tissue and skeletal muscle metastasis from oesophageal cancer diagnosed by PET/CT (18)F-FDG.

Distant soft-tissue metastases (subcutaneous tissues and skeletal muscle) are extremely rare, particularly in oesophageal carcinoma. The case is described of a patient who was treated for oesophageal adenocarcinoma 2.5 years previously. A PET/CT was performed showing metastatic spread due to a solitary focus of increased tracer uptake corresponding to one subcutaneous node in the upper abdomen. An excisional biopsy showed a metastasis from the carcinoma. Restaging PET/CT (18)F-FDG study was performed 2 year later, demonstrating foci of increased uptake within several muscles as isolated distant haematogenous spread of metastases, histopathologically confirmed. As most of soft-tissue metastases are asymptomatic, the physicians should recommend a histopathological study of focal FDG uptake at subcutaneous tissues and/or skeletal muscles, because they may be the first sign of disease spread, so therapeutic management of these patients could be changed.

[Use of radioguided surgery in the surgical treatment of osteoid osteoma]. / Uso de la cirugía radiodirigida en el tratamiento quirúrgico del osteoma osteoide.

OBJECTIVE: Osteoid osteoma is the third most common benign bone tumor and complete surgical resection is definitive treatment. There are a limited number of publications on the use of radioguided surgery in this type of lesion. To assess the utility of radioguided surgery in our environment as a method of surgical treatment of this tumor. MATERIAL AND METHODS: We retrospectively evaluated 12 patients (2 women and 10 men, age range 9-44 years) with clinical and radiological suspicion of osteoid osteoma. Bone scintigraphy showed foci of pathology uptake compatible with suspected lesion in the femur (4 cases), tibia (3), vertebral column (3), humerus (1) and talus (1). Subsequently patients underwent surgical treatment by radioguided surgery after injection of a dose of (99m)Tc-hydroxy diphosphonate. The nidus was removed using gamma probe and mini gamma camera, considering the technique to be completed when its counts decreased to the levels of the surrounding bone counts. RESULTS: Lesions were located in all patients (12 of 12), and were confirmed histologically in 8 of them, including an osteoblastoma. The cure rate was 100%, based on the disappearance of pain after a minimum follow-up of 6 months. CONCLUSION: Use of radioguided surgery in the surgical treatment of osteoid osteoma showed satisfactory results, with 100% efficiency in both lesion location and outcome of treatment and without major postoperative complications.

[Clinical application of ROLL technique in non-breast diseases. Complementary use after PET-CT study]. / Aplicación clínica de la técnica ROLL en patología no mamaria. Uso complementario tras estudio PET-TAC.

OBJECTIVE: The aim of this study was to evaluate the usefulness of ROLL technique (Radioguided Occult Lesion Localization) as a verification method of suspicious lesions not related to breast disease found in PET-CT studies. MATERIAL AND METHODS: We retrospectively evaluated 9 patients diagnosed of cancer or with suspected tumor disease who showed hypermetabolic lymph nodes in (18)F-FDG PET-CT. Subjects underwent diagnostic testing for evaluation of treatment response in lymphoma (3), suspected recurrence in other tumors (3) or biopsy guide (3). The study group consisted of 4 women and 5 men, age range 25-72 years. ROLL technique was performed in surgically accessible lesions (supraclavicular region, lateral cervical, axillary and inguinal) with an intralesional injection of (99m)Tc-albumin macroaggregates guided by ultrasound the day before surgery. A scintigraphic study confirmed the focal tracer deposit and absence of skin contamination. During surgery, a gamma probe and portable gammacamera were used to locate lymph nodes. RESULTS: Surgical localization of radiolabeled lymph nodes was achieved in all cases with minimally invasive surgery and few postoperative complications. Histological study resulted in five tumor involvement (3 lymphoma, 1 germ cell tumor and 1 neuroendocrine carcinoma) and confirmed the existence of four false-positives in PET-CT study (1 sarcoidosis and 3 reactive follicular hyperplasia). CONCLUSION: The ROLL technique proved to be a useful and relatively simple method for the study of no breast lesions suspicious of malignancy in PET-CT study.

Utilidad de la densitometría como método de valoración del estado nutricional del deportista. Comparación con el índice de masa corporal / The usefulness of densitometry as a method of assessing the nutritional status of athletes. Comparison with body mass index

El índice de masa corporal (IMC) es utilizado para valorar el estado nutricional. En los deportistas su resultado puede estar sobreestimado por un aumento de la masa muscular. Objetivo. Valorar la utilidad de la determinación mediante densitometría de los índices de masa grasa (IMG) y magra (IMM) como indicadores del estado nutricional, comparando los resultados con el IMC. Material y métodos. Se estudiaron 28 deportistas aficionados, jugadores de rugby, de sexo masculino. Tras ser sometidos a una densitometría de cuerpo entero mediante absorciometría dual de rayos X se determinaron, entre otros parámetros, la masa grasa y magra del cuerpo. Se calcularon los IMG (grasa en kg/talla en metros2), IMM (magra en kg/talla en metros2) y el índice de masa muscular apendicular (IMMA, musculatura en brazos y piernas en kg/talla en metros2). Resultados. Utilizando el IMC, 18 jugadores presentaban sobrepeso y 4 obesidad de tipo i . Al considerar el IMG, 7 de estos deportistas presentaban valores normales con IMM e IMMA elevados, uno pasaba de obesidad a sobrepeso y otro de sobrepeso a obesidad. De los 6 jugadores con IMC normal, uno de ellos mostraba exceso de grasa y otro defecto. Los resultados cambiaron la valoración del estado nutricional en el 39% de los jugadores estudiados. Conclusiones. Aunque para la población general el IMC es un parámetro adecuado para la valoración del estado nutricional, en los deportistas debe tenerse en cuenta el porcentaje de grasa y de musculatura determinando sus índices correspondientes. La densitometría de cuerpo entero resulta ser una técnica fiable y sencilla para este propósito(AU)

The body mass index (BMI) is used to assess nutritional status. The result in athletes may be overestimated due to increase in muscle mass. Objective. To assess the usefulness of fat mass index (FMI) and lean mass index (LMI) determination as indicators of nutritional status and to compare the results with BMI. Material and methods. We studied 28 amateur rugby players, male. After being subjected to whole body densitometry by dual X-ray absorptiometry, we determined fat and lean body mass together with other parameters. FMI (fat in kg/height in meters2), LMI (lean in kg/height in meters2) and appendicular muscle mass index (AMMI, arms and legs musculature in kg/height in meters2) were calculated. Results. Using BMI, 18 players were overweight and 4 obese type I. Considering FMI, 7 of them had normal values and high LMI and AMMI, one of them changed from overweight to obese and another one from obese to overweight. Of the 6 players with normal BMI, one of them showed fat excess and another one fat defect. The results changed the assessment of nutritional status in 39% of players. Conclusions. Although BMI is an appropriate parameter in general population for the assessment of nutritional status, in athletes should be taken into account fat and muscle body percentage and their corresponding indexes. The whole body densitometry appears to be a simple and reliable technique for this purpose(AU)

The usefulness of densitometry as a method of assessing the nutritional status of athletes. Comparison with body mass index.

UNLABELLED: The body mass index (BMI) is used to assess nutritional status. The result in athletes may be overestimated due to increase in muscle mass. OBJECTIVE: To assess the usefulness of fat mass index (FMI) and lean mass index (LMI) determination as indicators of nutritional status and to compare the results with BMI. MATERIAL AND METHODS: We studied 28 amateur rugby players, male. After being subjected to whole body densitometry by dual X-ray absorptiometry, we determined fat and lean body mass together with other parameters. FMI (fat in kg/height in meters(2)), LMI (lean in kg/height in meters(2)) and appendicular muscle mass index (AMMI, arms and legs musculature in kg/height in meters(2)) were calculated. RESULTS: Using BMI, 18 players were overweight and 4 obese type I. Considering FMI, 7 of them had normal values and high LMI and AMMI, one of them changed from overweight to obese and another one from obese to overweight. Of the 6 players with normal BMI, one of them showed fat excess and another one fat defect. The results changed the assessment of nutritional status in 39% of players. CONCLUSIONS: Although BMI is an appropriate parameter in general population for the assessment of nutritional status, in athletes should be taken into account fat and muscle body percentage and their corresponding indexes. The whole body densitometry appears to be a simple and reliable technique for this purpose.

Lymphoscintigraphy for differential diagnosis of peripheral edema: diagnostic yield of different scintigraphic patterns.

UNLABELLED: Edema of the limbs is a common reason for medical consultation, for which the lymphoscintigraphy is considered to be a reliable method for its differential diagnosis. OBJECTIVE: To evaluate the usefulness of radionuclide studies in the differential diagnosis of edema, and the diagnostic yield of different scintigraphic patterns. MATERIAL AND METHODS: A total of 61 patients, mean age 43 years, referred to our Department in the last three years for suspected lymphoedema, were considered. One patient was discarded due to lack of diagnosis, 56 had lower limb edema and 4 upper limb edema. After intradermal injection of two doses of (99m)Tc-nanocolloid, scintigraphic scans were made at 30 and 120minutes. The final diagnosis was based on imaging tests, clinical course, and response to treatment. We calculated the parameters of the diagnostic yield of four different scintigraphic patterns (presence of dermal backflow, asymmetry-alteration in inguinal/axillary nodes, presence of collateral pathways, and visualization of intermediate lymph nodes), considering them individually and jointly. RESULTS: The best diagnostic yield was achieved by considering dermal backflow and asymmetry in inguinal/axillary nodes (accuracy 88.9%, specificity 96.4%, PPV 95.5%). Evaluation of intermediate lymph nodes and presence of collateral pathways contributed little to the diagnostic yield, showing poor sensitivity and high false positive rates. CONCLUSION: The lymphoscintigraphy had high diagnostic yield, allowing early treatment of lymphœdema. The dermal backflow and asymmetry in inguinal/axillary nodes had the greatest diagnostic accuracy. Evaluation of intermediate lymph nodes and visualization of collateral pathways contributed little to improving the diagnosis.

Linfogammagrafía en el diagnóstico diferencial del edema. Rendimiento diagnóstico de diferentes patrones gammagráficos / Lymphoscintigraphy for differential diagnosis of peripheral edema: diagnostic yield of different scintigraphic patterns

El edema de extremidades constituye un motivo frecuente de consulta médica, considerándose la linfogammagrafía un método fiable para su diagnóstico diferencial. Objetivo. Valorar la utilidad del estudio isotópico en el diagnóstico diferencial del edema y el rendimiento diagnóstico de diferentes patrones gammagráficos encontrados. Material y Métodos. Se consideraron 61 pacientes remitidos a nuestro Servicio en los últimos tres años por sospecha de linfedema, descartándose uno por falta de diagnóstico. La media de edad fue de 43 años. Cincuenta y seis pacientes presentaban edema en miembros inferiores y 4 en superiores. Tras inyección intradérmica de dos dosis de 99mTc-nanocoloide, se realizaron rastreos gammagráficos de extremidades a los 30 y 120 minutos de su administración. El diagnóstico definitivo se basó en pruebas de imagen, evolución clínica y respuesta a tratamiento. Se calculó el rendimiento diagnóstico de cuatro diferentes patrones gammagráficos (presencia de flujo dérmico, asimetría-alteración en ganglios inguinales/axilares, presencia de vías colaterales y visualización de ganglios intermedios) considerándose de manera individual y conjunta. Resultados. El mayor rendimiento diagnóstico se alcanzó considerando el flujo dérmico y la asimetría en ganglios inguinales/axilares (exactitud 88,9%, especificidad 96,4%, VPP 95,5%). La valoración de ganglios intermedios y presencia de vías colaterales aportó escaso rendimiento diagnóstico, con baja sensibilidad y elevada tasa de falsos positivos. Conclusión. La linfogammagrafía presentó un alto rendimiento diagnóstico, permitiendo un tratamiento precoz del linfedema. El flujo dérmico y asimetría en ganglios inguinales/axilares mostraron la mayor exactitud diagnóstica. La valoración de ganglios intermedios y visualización de vías colaterales no aportaron mejoría al diagnóstico(AU)

Edema of the limbs is a common reason for medical consultation, for which the lymphoscintigraphy is considered to be a reliable method for its differential diagnosis. Objective. To evaluate the usefulness of radionuclide studies in the differential diagnosis of edema, and the diagnostic yield of different scintigraphic patterns. Material and Methods. A total of 61 patients, mean age 43 years, referred to our Department in the last three years for suspected lymphoedema, were considered. One patient was discarded due to lack of diagnosis, 56 had lower limb edema and 4 upper limb edema. After intradermal injection of two doses of 99mTc-nanocolloid, scintigraphic scans were made at 30 and 120minutes. The final diagnosis was based on imaging tests, clinical course, and response to treatment. We calculated the parameters of the diagnostic yield of four different scintigraphic patterns (presence of dermal backflow, asymmetry-alteration in inguinal/axillary nodes, presence of collateral pathways, and visualization of intermediate lymph nodes), considering them individually and jointly. Results. The best diagnostic yield was achieved by considering dermal backflow and asymmetry in inguinal/axillary nodes (accuracy 88.9%, specificity 96.4%, PPV 95.5%). Evaluation of intermediate lymph nodes and presence of collateral pathways contributed little to the diagnostic yield, showing poor sensitivity and high false positive rates. Conclusion. The lymphoscintigraphy had high diagnostic yield, allowing early treatment of lymphœdema. The dermal backflow and asymmetry in inguinal/axillary nodes had the greatest diagnostic accuracy. Evaluation of intermediate lymph nodes and visualization of collateral pathways contributed little to improving the diagnosis(AU)

SPECT-TAC con 67Ga-citrato en el manejo de las espondilodiscitis / SPECT-CT with 67Ga-citrate in the management of spondylodiscitis

La espondilodiscitis afecta a una pequeña proporción de los pacientes con infecciones del aparato locomotor, aunque su diagnóstico es importante por su potencial morbilidad. La resonancia magnética es el método diagnóstico de elección, aunque tiene sus limitaciones y no es adecuada para todos los pacientes. Los estudios gammagráficos para la evaluación de la espondilodiscitis son los realizados con 99mTc-HDP y 67Ga-citrato, pero tienen el inconveniente de su baja resolución. La utilización de equipos híbridos SPECT-TAC (Single Photon Emission Computed Tomography-Tomografía computarizada) mejora la detección de la enfermedad al combinar imágenes funcionales y anatómicas. Presentamos 9 pacientes con sospecha de espondilodiscitis, a los que se les realizaron secuencialmente estudios isotópicos con 99mTc-HDP y SPECT-TAC con 67Ga-citrato, con hallazgos positivos que se confirmaron con un seguimiento clínico de al menos 6 meses(AU)

Spondylodiscitis affects a small proportion of all patients with locomotor system infections, however its early diagnosis is important due to its potential morbidity. Magnetic resonance imaging is the diagnostic method of choice. Nonetheless, it has certain limitations and is not suitable for all patients. The conventional scintigraphic studies for evaluating spondylodiscitis are those performed with 99mTc-HDP and 67Ga-citrate. However, their poor image resolution is a disadvantage of these techniques. The use of hybrid Single Photon Emission Computed Tomography-Computed Tomography (SPECT-CT) improves detection of the disease by combining functional and anatomical images. We present 9 patients with suspicion of spondylodiscitis who underwent sequential bone scintigraphy with 99mTc-HDP and SPECT-CT with 67Ga-citrate, with positive findings confirmed by clinical monitoring for at least 6 months(AU)

SPECT-CT with 67Ga-citrate in the management of spondylodiscitis.

Spondylodiscitis affects a small proportion of all patients with locomotor system infections, however its early diagnosis is important due to its potential morbidity. Magnetic resonance imaging is the diagnostic method of choice. Nonetheless, it has certain limitations and is not suitable for all patients. The conventional scintigraphic studies for evaluating spondylodiscitis are those performed with (99m)Tc-HDP and (67)Ga-citrate. However, their poor image resolution is a disadvantage of these techniques. The use of hybrid Single Photon Emission Computed Tomography-Computed Tomography (SPECT-CT) improves detection of the disease by combining functional and anatomical images. We present 9 patients with suspicion of spondylodiscitis who underwent sequential bone scintigraphy with (99m)Tc-HDP and SPECT-CT with (67)Ga-citrate, with positive findings confirmed by clinical monitoring for at least 6 months.