Sarcoma radioinducido tras radioterapia en cáncer de mama en un estudio 18F-FDG PET/TC / Radiation-induced sarcoma after radiotherapy for breast cancer in a 18F-FDG PET/CT study

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Estudio 18F-FDG PET/TC en un caso inusual de enfermedad de Rosai-Dorfman / Inusual case of Rosai-Dorfman disease in a 18F-FDG PET/CT study

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Pancreatic accessory spleen. False positive with 99mTc-Octreotide / Bazo accesorio intrapancreático. Falso positivo con 99mTc-Octreotide

The case is presented on a patient with abdominal pain and suspicion of neuroendocrine tumor in the tail of the pancreas shown in the abdominal CT and MRI. Whole-body scintigraphy and abdominal SPECT/CT with 99mTc-octreotide were performed that showed a nodular lesion partially on the posterior side of the pancreas tail. This nodule showed faint tracer uptake, and was reported as probable neuroendocrine tumor. Partial pancreatectomy and splenectomy were performed, and the histological study identified the lesion as an ectopic spleen. There are similar cases in the literature that match these findings, but this lesion is still frequently diagnosed after performing unnecessary surgery. When an asymptomatic intrapancreatic mass is detected, an accessory spleen should be considered and specific diagnostic techniques should be performed, such as labeled and denatured red blood cell SPECT/CT (AU)

Presentamos un paciente con dolor abdominal y sospecha de tumor neuroendocrino por medio de TC y RM abdominales. Se realizaron imágenes de cuerpo entero y SPECT/TCcon 99mTc-Octreotide que mostraron una lesión captadora en la cara posterior del páncreas que fue interpretada como un tumor neuroendocrino. Se realizó una pancreatectomía y esplenectomía cuyo resultado anatomopatológico identificó la lesión como un bazo ectópico. Existen datos en la bibliografía que coinciden con estos hallazgos pero todavía se diagnostica con frecuencia tras la realización de una intervención quirúrgica innecesaria. Cuando se aprecia una masa intrapancreática asintomática, debe incluirse en el diagnóstico diferencial un bazo accesorio y realizar técnicas diagnósticas más específicas, como el SPECT/TC con hematíes marcados y desnaturalizados (AU)

Pancreatic accessory spleen. False positive with 99mTc-Octreotide.

The case is presented on a patient with abdominal pain and suspicion of neuroendocrine tumor in the tail of the pancreas shown in the abdominal CT and MRI. Whole-body scintigraphy and abdominal SPECT/CT with 99mTc-octreotide were performed that showed a nodular lesion partially on the posterior side of the pancreas tail. This nodule showed faint tracer uptake, and was reported as probable neuroendocrine tumor. Partial pancreatectomy and splenectomy were performed, and the histological study identified the lesion as an ectopic spleen. There are similar cases in the literature that match these findings, but this lesion is still frequently diagnosed after performing unnecessary surgery. When an asymptomatic intrapancreatic mass is detected, an accessory spleen should be considered and specific diagnostic techniques should be performed, such as labeled and denatured red blood cell SPECT/CT.

Aportación diagnóstica de la SPECT de perfusión cerebral en un caso de malaria cerebral / Contribution of brain perfusion SPECT in the diagnosis of a case of cerebral malaria

La malaria cerebral constituye una complicación severa de la infección por Plasmodium falciparum. Sus mecanismos fisiopatológicos y manifestaciones clínicas continúan siendo motivo de estudio en la actualidad. Durante el proceso diagnóstico, las técnicas de imagen estructural como la TC y la RM aportan una información poco específica. Sin embargo, apenas existen referencias bibliográficas que constaten la utilización y posibles beneficios de los procedimientos radioisotópicos para esta patología. En este artículo exponemos el caso de un paciente diagnosticado de malaria cerebral atendido en nuestro centro, sometido a control evolutivo mediante SPECT de perfusión (AU)

Cerebral malaria is a serious complication of infection with Plasmodium falciparum. Its pathophysiological mechanisms and clinical manifestations are still currently being studied. Structural imaging techniques such as CT and MRI provide non-specific information during the diagnostic process. However, there are hardly any references on the use and potential benefits of radioisotope procedures for this pathology. In this article we present the case of a patient diagnosed with cerebral malaria treated in our centre, subjected to progressive monitoring using SPECT perfusion (AU)

Role of SPECT-CT in breast cancer sentinel node biopsy when internal mammary chain drainage is observed

Introduction: SPECT-CT in the detection of the sentinel lymph node (SLN) of breast cancer offers known advantages over conventional planar lymphoscintigraphy. Sometimes, it shows atypical findings like mediastinal lymphatic drainage. We have evaluated these atypical findings showed by SPECT-CT performed in patients with migration to the internal mammary chain (IMC) and their roles in the management of the patients. Materials and methods: We reviewed the 56 lymphoscintigraphies (planar and SPECT-CT) of 56 women (average age: 55 years) diagnosed with breast cancer with IMC migration observed in the planar images. We compared the two techniques, obtaining the number of depicted nodes, atypical locations, their exact anatomical location and their role in the management of the patient. Results: Planar images showed a total number of 81 IMC nodes. SPECT-CT showed 74 nodes in the IMC territory and 14 mediastinal lymphatic nodes in 6 patients. Out of the 81 IMC nodes reported by planar images, seven corresponded to mediastinal nodes. Planar and hybrid images showed 110 and 130 axillary nodes, respectively. SPECTCT showed additional findings in five patients: three infraclavicular and two supraclavicular nodes that were exactly located. One intramammary node was discarded by the SPECT-CT as a focal skin contamination. Conclusion: Mediastinal nodes are unexpected, but not uncommon findings that are important in the planning of SLN biopsy. SPECT-CT found more nodes than planar images, being able to separate mediastinal and IMC nodes, helping to exactly depict the SLN and its relations with anatomical structures (AU)

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Contribution of brain perfusion SPECT in the diagnosis of a case of cerebral malaria. / Aportación diagnóstica de la SPECT de perfusión cerebral en un caso de malaria cerebral.

Cerebral malaria is a serious complication of infection with Plasmodium falciparum. Its pathophysiological mechanisms and clinical manifestations are still currently being studied. Structural imaging techniques such as CT and MRI provide non-specific information during the diagnostic process. However, there are hardly any references on the use and potential benefits of radioisotope procedures for this pathology. In this article we present the case of a patient diagnosed with cerebral malaria treated in our centre, subjected to progressive monitoring using SPECT perfusion.

Role of SPECT-CT in breast cancer sentinel node biopsy when internal mammary chain drainage is observed.

INTRODUCTION: SPECT-CT in the detection of the sentinel lymph node (SLN) of breast cancer offers known advantages over conventional planar lymphoscintigraphy. Sometimes, it shows atypical findings like mediastinal lymphatic drainage. We have evaluated these atypical findings showed by SPECT-CT performed in patients with migration to the internal mammary chain (IMC) and their roles in the management of the patients. MATERIALS AND METHODS: We reviewed the 56 lymphoscintigraphies (planar and SPECT-CT) of 56 women (average age: 55 years) diagnosed with breast cancer with IMC migration observed in the planar images. We compared the two techniques, obtaining the number of depicted nodes, atypical locations, their exact anatomical location and their role in the management of the patient. RESULTS: Planar images showed a total number of 81 IMC nodes. SPECT-CT showed 74 nodes in the IMC territory and 14 mediastinal lymphatic nodes in 6 patients. Out of the 81 IMC nodes reported by planar images, seven corresponded to mediastinal nodes. Planar and hybrid images showed 110 and 130 axillary nodes, respectively. SPECT-CT showed additional findings in five patients: three infraclavicular and two supraclavicular nodes that were exactly located. One intramammary node was discarded by the SPECT-CT as a focal skin contamination. CONCLUSION: Mediastinal nodes are unexpected, but not uncommon findings that are important in the planning of SLN biopsy. SPECT-CT found more nodes than planar images, being able to separate mediastinal and IMC nodes, helping to exactly depict the SLN and its relations with anatomical structures.

SPECT-perfusión cerebral regional "off-on": a propósito de un caso de catatonia / Regional cerebral blood flow-SPECT "OFF-ON": a case report of catatonia

Se expone el caso de una paciente con distimia de larga evolución y episodios depresivos graves que precisaron hospitalización. En el último de ellos, que se describe a continuación, se asoció sintomatología de tipo catatoniforme junto a rasgos sugerentes de deterioro cognitivo. La ausencia de una clara respuesta psicofarmacológica inicial junto a la severidad clínica de la paciente plantearon la posibilidad de utilizar terapia electroconvulsiva (TEC). Para descartar una posible enfermedad de Alzheimer (EA) concomitante se exploró mediante tomografía de perfusión cerebral regional (SPECT-PCr) observándose una marcada hipocaptación neocortical sin un claro patrón de deterioro primario sobreañadido. El inicio de una mejoría clínica gradual y la objetivación de una reperfusión cerebral global, corroborada en una segunda SPECT-PCr a 2 semanas de su ingreso, desestimaron el empleo de TEC sugiriendo la pertinencia de adoptar una actitud expectante (AU)

We report the case of a patient with a long history of dysthymia and major depressive episodes requiring repeated hospitalization. We describe the most recent episode, associated with catatonia symptomatology and features suggestive of cognitive impairment. The absence of a clear initial psychopharmacological response alongside the clinical severity made the patient a potential candidate for electroconvulsive therapy (ECT). A regional cerebral blood flow SPECT (SPECT-rCBF), performed to rule out concomitant Alzheimer disease (AD), revealed a markedly decreased neocortical uptake, with no definitive pattern of concomitant primary cognitive impairment. Because a gradual clinical improvement was observed in the patient, with evidence of enhanced cerebral reperfusion in a second SPECT-rCBF study at two weeks after admission, the application of ECT was discounted and an expectant attitude was adopted (AU)

[Regional cerebral blood flow-SPECT "OFF-ON": a case report of catatonia]. / SPECT-perfusión cerebral regional «off-on¼: a propósito de un caso de catatonia.

We report the case of a patient with a long history of dysthymia and major depressive episodes requiring repeated hospitalization. We describe the most recent episode, associated with catatonia symptomatology and features suggestive of cognitive impairment. The absence of a clear initial psychopharmacological response alongside the clinical severity made the patient a potential candidate for electroconvulsive therapy (ECT). A regional cerebral blood flow SPECT (SPECT-rCBF), performed to rule out concomitant Alzheimer disease (AD), revealed a markedly decreased neocortical uptake, with no definitive pattern of concomitant primary cognitive impairment. Because a gradual clinical improvement was observed in the patient, with evidence of enhanced cerebral reperfusion in a second SPECT-rCBF study at two weeks after admission, the application of ECT was discounted and an expectant attitude was adopted.

Parametrization of textural patterns in 123I-ioflupane imaging for the automatic detection of Parkinsonism.

PURPOSE: A novel approach to a computer aided diagnosis system for the Parkinson's disease is proposed. This tool is intended as a supporting tool for physicians, based on fully automated methods that lead to the classification of (123)I-ioflupane SPECT images. METHODS: (123)I-ioflupane images from three different databases are used to train the system. The images are intensity and spatially normalized, then subimages are extracted and a 3D gray-level co-occurrence matrix is computed over these subimages, allowing the characterization of the texture using Haralick texture features. Finally, different discrimination estimation methods are used to select a feature vector that can be used to train and test the classifier. RESULTS: Using the leave-one-out cross-validation technique over these three databases, the system achieves results up to a 97.4% of accuracy, and 99.1% of sensitivity, with positive likelihood ratios over 27. CONCLUSIONS: The system presents a robust feature extraction method that helps physicians in the diagnosis task by providing objective, operator-independent textural information about (123)I-ioflupane images, commonly used in the diagnosis of the Parkinson's disease. Textural features computation has been optimized by using a subimage selection algorithm, and the discrimination estimation methods used here makes the system feature-independent, allowing us to extend it to other databases and diseases.

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)

[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.