Septic pulmonary emboli detected by 18F-FDG PET/CT in children with S. aureus catheter-related bacteremia.

PURPOSE: The role of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) in the diagnosis of metastatic infectious foci in children with catheter-related blood stream infection has been hardly studied, although some authors have reported it benefit in the screening of metastatic foci in adult population. Septic pulmonary emboli are among the most difficult to identify, because many cases do not present pulmonary complaints or abnormal chest radiography. However, diagnosis of these foci has important therapeutic consequences. The purpose of this article is to describe the role of 18F-FDG PET/CT in the diagnosis of septic pulmonary embolism in children with S. aureus catheter-related bacteremia. METHODS: We report 3 children with S. aureus catheter-related bacteremia and normal chest X-ray at admission, in whom 18F-FDG PET/CT led to the diagnosis of unsuspected septic pulmonary emboli, with an impact on clinical management. RESULTS: All patients had hemophilia and implantable venous access ports and presented with fever and normal lung auscultation. Only 1 reported non-specific symptoms (undifferentiated left chest pain). All patients had normal chest X-ray on admission. Catheters were removed within 48 h after admission in 2 cases, and 5 days after admission in the last case, subsiding fever. In 2 children, paired blood cultures were not able to identify bacteremia. However, in all cases catheter tip and subcutaneous port cultures yielded S. aureus and PET/CT detected unsuspected pulmonary metastatic emboli. CONCLUSIONS: 18F-FDG PET/CT should be considered as a useful tool to diagnose septic pulmonary embolism in S. aureus catheter-related bacteremia, especially if conventional diagnostic imaging techniques have failed to reveal possible metastatic foci. Further studies are needed to clarify the usefulness of PET/CT performance in children with CRBSI.

Semiología de la PET/TAC con 18F-FDG / No disponible

No disponible

La satisfacción del usuario como indicador de calidad en un servicio de Medicina Nuclear / Patient satisfaction as quality indicator in a nuclear medicine department

Objetivo. Valorar el grado de satisfacción e insatisfacción del paciente con el servicio de Medicina Nuclear. Material y métodos. Se diseñó un cuestionario compuesto por 9 preguntas cerradas, una de escala numérica y otra pregunta abierta que recogió comentarios y sugerencias. Las preguntas consideraron diferentes dimensiones de calidad del servicio relacionadas con el tiempo de espera en la realización de la exploración, información, instalaciones, trato recibido por el personal del servicio y satisfacción global (escala numérica 1-10). El grado de insatisfacción se estableció mediante el análisis de quejas escritas recibidas en los últimos 6 años. Resultados. Se obtuvieron 671 cuestionarios. El 58 % de los encuestados fueron mujeres. La edad media fue de 56,5 años (DE: 16,26). La información suministrada fue correcta para el 81,7 % de los encuestados. El equipamiento y las instalaciones fueron satisfactorios para el 74,5 % de los pacientes. La lista de espera y el tiempo de espera fueron correctos para el 70 % y el 66,4 % respectivamente. El trato correcto fue el parámetro más favorablemente valorado (98,7 %). La satisfacción global fue positiva (mas menos 7 sobre 10) para el 82,8 % de los pacientes. Se recibieron un total de 29 quejas. La mayoría se basó en aspectos relacionados con la lista de espera (12) y disconformidad con la asistencia (9). Conclusiones. El grado de satisfacción fue alto en la mayoría de los pacientes. El tiempo de espera constituyó el parámetro con menor satisfacción y, por lo tanto, subsidiario demejora. La principal queja espontánea referida por nuestros pacientes fue la lista de espera

Objective. To assess patient satisfaction and dissatisfaction with a Nuclear Medicine department.Material and methods. A questionnaire was designed with 9 closed questions, 1 with a numerical scale (1-10) and 1 with an open question for suggestions. The questions included different quality dimensions of the department related with waiting time for the scan, information, facilities, attention manner with department staff and global satisfaction (numerical scale, 1-10). Dissatisfaction was determined by analyzing the written complaints for the last 6 years. Results. A total of 671 questionnaires were obtained, 58% of those surveyed being women. The mean age of patients was 56.5 (mas menos 16.26). The information provided was correct in 81.7 % of cases. Equipment and facilities were correct for 74.5 % of patients. Waiting list and waiting time were correct for 70 % and 66.4% respectively. The attention manner of the department staff was the most satisfactory dimension (98.7 %). Global satisfaction was positive (7 out of 10) in 82.8 % of the patients. 29 complaints were received. Most of them were based on waiting list (12) and disagreement with assistance (9). Conclusions. Global satisfaction was high in most of patients. Waiting time was the dimension with the lowest level of satisfaction and subsidiary of improvement plans. The primary spontaneous complain by our patients was due to the waiting list

[Patient satisfaction as quality indicator in a nuclear medicine department]. / La satisfacción del usuario como indicador de calidad en un servicio de Medicina Nuclear.

OBJECTIVE: To assess patient satisfaction and dissatisfaction with a Nuclear Medicine department. MATERIAL AND METHODS: A questionnaire was designed with 9 closed questions, 1 with a numerical scale (1-10) and 1 with an open question for suggestions. The questions included different quality dimensions of the department related with waiting time for the scan, information, facilities, attention manner with department staff and global satisfaction (numerical scale, 1-10). Dissatisfaction was determined by analyzing the written complaints for the last 6 years. RESULTS: A total of 671 questionnaires were obtained, 58 % of those surveyed being women. The mean age of patients was 56.5 (+/- 16.26). The information provided was correct in 81.7 % of cases. Equipment and facilities were correct for 74.5 % of patients. Waiting list and waiting time were correct for 70 % and 66.4 % respectively. The attention manner of the department staff was the most satisfactory dimension (98.7 %). Global satisfaction was positive (> or = 7 out of 10) in 82.8 % of the patients. 29 complaints were received. Most of them were based on waiting list (12) and disagreement with assistance (9). CONCLUSIONS: Global satisfaction was high in most of patients. Waiting time was the dimension with the lowest level of satisfaction and subsidiary of improvement plans. The primary spontaneous complain by our patients was due to the waiting list.

[Clinical and prognostic value of X-ray based attenuation correction in post-stress myocardial perfusion SPECT]. / Valor clínico y pronóstico de la corrección de atenuación con rayos X en la SPECT de perfusión miocárdica post-estrés.

OBJECTIVE: The purpose of the study was to validate the X-ray-based attenuation correction technique applied to post-stress myocardial perfusion single photon emission computed tomography (SPECT). MATERIALS AND METHODS: Fifty-six patients with clinically suspected ischemic heart disease and no history of myocardial infarction or coronary revascularization were studied. All patients underwent a myocardial perfusion SPECT after exercise (38) or pharmacological stress (18). Mean clinical follow-up time was 18.6 months. Studies were assessed after reconstruction using the filtered back projection technique and after application of the X-ray-based attenuation correction technique, and the results obtained were related to the final clinical diagnosis. RESULTS: Eleven uncorrected studies were normal, while 45 studies showed perfusion defects. After attenuation correction, absence of significant perfusion defects was observed in 24 cases (42.9 % of all cases), and ischemic heart disease was finally ruled out in 22 cases. A greater study normalization rate was seen in men (p = 0.048; odds ratio = 2,923), but this fact was not shown to be significantly correlated to the following variables: pre-test probability of ischemic heart disease, body mass index greater than 30, presence of cardiovascular risk factors or otherwise, and age. CONCLUSIONS: Application of the X-ray-based attenuation correction technique would have allowed for obviating the conduct of a resting perfusion study in 42.9 % of patients without apparently changing the diagnostic safety of the test. This fact was seen more frequently in men. This method seems to be both safe and time- and cost-effective.

Valor clínico y pronóstico de la corrección de atenuación con rayos X en la SPECT de perfusión miocárdica post-estrés / Valor clínico y pronóstico de la corrección de atenuación con rayos X en la SPECT de perfusión miocárdica post-estrés

Objetivo. El propósito del estudio fue validar la técnica de corrección de atenuación con rayos X, aplicada a la tomografía por emisión de fotón único (SPECT) de perfusión miocárdica post-estrés. Material y métodos. Se estudiaron 56 pacientes con sospecha clínica de cardiopatía isquémica y sin antecedentes de infarto de miocardio ni de revascularización coronaria. A todos se les realizó una tomografía por emisión de fotón único (SPECT) de perfusión miocárdica post-estrés ergométrico (38) o farmacológico (18). El tiempo medio de seguimiento clínico fue de 18,6 meses. Se valoraron los estudios tras su reconstrucción mediante la técnica de retroproyección filtrada, y después de aplicar la técnica de corrección de atenuación con rayos X. Los resultados obtenidos se relacionaron con el diagnóstico clínico final. Resultados. Once estudios no corregidos fueron normales y 45 mostraron defectos de perfusión. Tras la corrección de atenuación, se observó la ausencia de defectos significativos de perfusión en 24 casos (42,9 % del total) y finalmente se descartó cardiopatía isquémica en 22. Se observó una mayor frecuencia de normalización del estudio en hombres (p = 0,048; odds ratio = 2.923), pero este hecho no mostró correlación significativa con las siguientes variables: probabilidad pre-test de cardiopatía isquémica, índice de masa corporal superior a 30, presencia o ausencia de factores de riesgo cardiovascular y edad del paciente. Conclusiones. La aplicación de la técnica de corrección de atenuación con rayos X hubiera permitido obviar la realización de un estudio de perfusión de reposo en el 42,9 % de los pacientes, sin modificarse aparentemente la seguridad diagnóstica del test. Este hecho se observó con mayor frecuencia en hombres. El método parece ser seguro, así como tiempo y coste-efectivo

Materials and methods. Fifty-six patients with clinically suspected ischemic heart disease and no history of myocardial infarction or coronary revascularization were studied. All patients underwent a myocardial perfusion SPECT after exercise (38) or pharmacological stress (18). Mean clinical follow-up time was 18.6 months. Studies were assessed after reconstruction using the filtered back projection technique and after application of the X-ray-based attenuation correction technique, and the results obtained were related to the final clinical diagnosis. Results. Eleven uncorrected studies were normal, while 45 studies showed perfusion defects. After attenuation correction, absence of significant perfusion defects was observed in 24 cases (42.9 % of all cases), and ischemic heart disease was finally ruled out in 22 cases. A greater study normalization rate was seen in men (p = 0.048; odds ratio = 2,923), but this fact was not shown to be significantly correlated to the following variables: pre-test probability of ischemic heart disease, body mass index greater than 30, presence of cardiovascular risk factors or otherwise, and age. Conclusions. Application of the X-ray-based attenuation correction technique would have allowed for obviating the conduct of a resting perfusion study in 42.9 % of patients without apparently changing the diagnostic safety of the test. This fact was seen more frequently in men. This method seems to be both safe and time- and cost-effective

[Assessment of cortical brain blood flood by brain perfusion spect in patients with a diagnosis of eating behavior disorders]. / Valoración del flujo cortical cerebral mediante SPECT de perfusión cerebral en pacientes con diagnóstico de trastornos de la conducta alimentaria.

OBJECTIVE: To evaluate cortical brain blood flow by 99mTc-HMPAO SPECT in patients with Eating Disorders (ED): restrictive anorexia (RA) and purgative bulimia (PB). MATERIAL AND METHOD: The study included 7 women with diagnostic criteria of RA and 12 with PB. The control group was made up of 12 healthy women. All subjects underwent brain 99mTc-HMPAO SPECT. The SPECT studies were quantified, yielding semiquantitative indexes relating to cerebellar activity in different regions. Body dissatisfaction was assessed by means of the BSQ (Body Shape Questionnaire). The results were analyzed with the ANOVA variance and had a statistical significance of p < 0.05. RESULTS: Mean BSQ scores were 98.28 (range 71-159) in the RA group, 145.05 (range 73-191) in the PB group, and 57.4 (range 37-88) in the control group. All patients in the sample (i.e., both RA and PB) showed global cerebral hypoperfusion versus the controls, although the difference only reached statistical significance in the RA group in the left parietal lobe (p = 0.02) and in the right (p = 0.004) and left temporal lobes (p = 0.015). In the PB group, the significantly hypoperfused regions were the right (p < 0.001) and left (p = 0.008) superior frontal lobe, the right inferior frontal lobe (p = 0.042), the right (p = 0.042) and left (p = 0.002) parietal lobes, and the right temporal lobe (p = 0.002). CONCLUSION: The results obtained showed that patients with ED had cerebral hypoperfusion compared with healthy subjects. This pattern is common in parietotemporal regions for both PB and AR although with temporal and parietal predominance in RA and PB, respectively. In addition, patients with PB had frontal region involvement.

Valoración del flujo cortical cerebral mediante SPECT de perfusión cerebral en pacientes con diagnóstico de trastornos de la conducta alimentaria / Assessment of cortical brain blood flood by brain perfusion spect in patients with a diagnosisof eating behavior disorders

Objetivo. Valorar el flujo cortical cerebral mediante 99mTc-HMPAO SPECT en pacientes con trastornos de la conducta alimentaria (TCA): anorexia restrictiva (AR) y bulimia purgativa (BP). Material y método. Se estudiaron 7 mujeres con criterios de AR y 12 de BP. Se constituyó un grupo control de 12 mujeres sanas, realizando un estudio de SPECT cerebral con 99mTc-HMPAO. Se obtuvieron índices semicuantitativos respecto a cerebelo en regiones frontales superiores, inferiores, parietales, temporales y occipitales. Se valoró la insatisfacción corporal con el BSQ (Body Shape Questionnaire). El análisis de los datos se realizó utilizando la varianza de un factor (ANOVA), con un nivel de significación estadística de p < 0,05. Resultados. Los valores medios obtenidos en el BSQ fueron de 98,28 (71-159) en el grupo de las AR, de 145,05 (73-191) en las BP y de 57,4 (37-88) en el grupo control. En sujetos normales se evidenció un predominio fisiológico de la perfusión en hemisferio derecho, más evidente en lóbulos temporales (11 %). Se evidenció una menor actividad global en todas las regiones corticales en el conjunto de los pacientes respecto al grupo control, aunque sólo significación estadística en lóbulo parietal izquierdo (p = 0,02), y lóbulos temporales derecho (p = 0,004) e izquierdo (p = 0,015) en las AR, y en lóbulos frontal superior derecho (p < 0,001) e izquierdo (p = 0,008), frontal inferior derecho (p = 0,042), parietales derecho (p = 0,042) e izquierdo (p = 0,002) y temporal derecho (p = 0,002) en las BP. Conclusión. Las pacientes con TCA mostraron una significativa hipoperfusión cortical respecto al grupo control en regiones parietotemporales, con predominio en lóbulo temporal en AR y en parietal en BP. Además, las pacientes con BP mostraron afectación concomitante de regiones frontales

Objective. To evaluate cortical brain blood flow by 99mTc-HMPAO SPECT in patients with Eating Disorders (ED): restrictive anorexia (RA) and purgative bulimia (PB). Material and method. The study included 7 women with diagnostic criteria of RA and 12 with PB. The control group was made up of 12 healthy women. All subjects underwent brain 99mTc-HMPAO SPECT. The SPECT studies were quantified, yielding semiquantitative indexes relating to cerebellar activity in different regions. Body dissatisfaction was assessed by means of the BSQ (Body Shape Questionnaire). The results were analyzed with the ANOVA variance and had a statistical significance of p < 0.05. Results. Mean BSQ scores were 98.28 (range 71-159) in the RA group, 145.05 (range 73-191) in the PB group, and 57.4 (range 37-88) in the control group. All patients in the sample (i.e., both RA and PB) showed global cerebral hypoperfusion versus the controls, although the difference only reached statistical significance in the RA group in the left parietal lobe (p = 0.02) and in the right (p = 0.004) and left temporal lobes (p = 0.015). In the PB group, the significantly hypoperfused regions were the right (p < 0.001) and left (p = 0.008) superior frontal lobe, the right inferior frontal lobe (p = 0.042), the right (p = 0.042) and left (p = 0.002) parietal lobes, and the right temporal lobe (p = 0.002). Conclusion. The results obtained showed that patients with ED had cerebral hypoperfusion compared with healthy subjects. This pattern is common in parietotemporal regions for both PB and AR although with temporal and parietal predominance in RA and PB, respectively. In addition, patients with PB had frontal region involvement

[Myocardial perfusion SPECT with 99mTc-tetrofosmin and thoracic SPECT with Gallium-67 SPECT in a patient with chest pain and a history of sarcoidosis]. / SPECT de perfusión miocárdica con 99mTc-Tetrofosmin y SPECT torácica con Galio-67 en paciente con dolor torácico y antecedente de sarcoidosis.

We present the case of a 54-year-old male patient, with history of diagnosed sarcoidosis some years ago and myocardial involvement, who being asymptomatic, shows chest pain because of which he goes to the emergency room of the hospital. During the first hours of his admission the pain relieves with nonsteroidal antiinflammatory medication, an electrocardiogram demonstrates changes of early repolarisation with pericardial involvement, the enzymes don't rise and the echocardiogram reveals a slight pericardial effusion. The differential diagnosis is between a chest pain due to ischemia, and the secondary to myopericarditis in the clinical context of a sarcoidosis. Myocardial perfusion rest SPECT is required which is compatible with lateral acute myocardial infarction (AMI) with extension to inferior wall. A coronary angiography was carried out and showed two vessels disease (RCA and Cx), PTCA and stent were carried out successfully. During the admission a thoracic scintigraphy and SPECT with gallium -67 showed an uptake in lateral wall of left ventricle (LV). Nothing about active sarcoidosis was found.

SPECT de perfusión miocárdica con 99mTc-Tetrofosmin y SPECT torácica con Galio-67 en paciente con dolor torácico y antecedente de sarcoidosis / Myocardial perfusion SPECT with 99mTc-Tetrofosmin and thoracic SPECT with Gallium-67 SPECT in patient with chest pain and history of sarcoidosis

Presentamos el caso de un varón 54 años, con antecedentes personales de sarcoidosis diagnosticada años atrás y afectación cardíaca secundaria que, estando inicialmente asintomático, presenta un episodio de dolor torácico por lo que acude a urgencias del hospital. Durante las primeras horas de su ingreso cede el dolor con antiinflamatorios noesteroideos (AINE), el electrocardiograma (ECG) muestra cambios de repolarización precoz con afectación pericárdica, no eleva enzimas y en el ecocardiograma aparece un ligero derrame pericárdico. Se plantea el diagnóstico diferencial entre un dolor torácico de causa isquémica y el secundario a una miopericarditis en el contexto clínico de una sarcoidosis. Se solicita SPECT de perfusión miocárdica en reposo que resulta compatible con infarto agudo de miocardio (IAM) lateral con extensión a pared inferior. Se realizó coronariografía objetivándose enfermedad de dos vasos (CD y Cx), realizándose angiografía coronaria trasluminal percutánea (ACTP) y stent en ambas con buen resultado. Durante el ingreso se realizó una gammagrafía torácica y SPECT con Galio-67 que mostró una captación en pared lateral de ventrículo izquierdo (VI). No se encontraron datos de sarcoidosis activa

We present the case of a 54 years old male patient, with history of diagnosed sarcoidosis some years ago and myocardial involvement, who being asymptomatic, shows chest pain because of which he goes to the emergency room of the hospital. During the first hours of his admission the pain relieves with nonsteroidal antiinflamatory medication, an electrocardiogram demostrates changes of early repolarisation with pericardial involvement, the enzymes don't rise and the Echocardiogram reveals a slight pericardial effusion. The differential diagnosis is arise between a chest pain due to ischemia, and the secondary to myopericarditis in the clinic context of a sarcoidosis. Myocardial perfusion rest SPECT is required which is compatible with lateral acute myocardial infarction (AMI) with extension to inferior wall. A coronary angiography was carried out and showed two vessels disease (RCA and Cx), PTCA and stent were carried out successfully. During the admission a thoracic scintigraphy and SPECT with Gallium ­67 showed an uptake in lateral wall of left ventricle (LV). Nothing about active sarcoidosis was found

[Radioguided occult breast lesion location (ROLL)]. / Localización radioguiada de lesiones ocultas de mama (ROLL).

OBJECTIVE: To obtain correct location of occult breast lesions by radiopharmaceutical methods. MATERIAL AND METHODS: Sixty-one patients whose ages ranged from 32 to 83 years (average: 57), with non-palpable breast lesions detected by mammography were studied. Six of them had a background of previous breast cancer. Sixty-three lesions were found. The lesions were classified into 34 clusters of microcalcifications, 25 nodules and 4 others parenchymal distortions. All patients received one dose of 0.3-0.5 mCi (11.1-18.5 MBq) of macroaggregates of 99mTc-labelled human serum albumin (99mTc-MAA) into the lesion under stereotactic mammographic or ultrasonography guidance. Anterior and lateral scintigraphic images were acquired in order to verify the correct location of the radiopharmaceutical. Intraoperative location of the lesion was performed using a gammaprobe. In case of microcalcifications, the entire removal of the lesion was verified by X-ray of the specimen. RESULTS: Placement of the radiotracer was good in 60 of 63 (95.2%) cases. Sixty-one lesions were completely removed. Pathological examination revealed 29 (47.6%) breast cancers and 32 (52.4%) benign lesions. CONCLUSION: Radioguided occult breast lesion location by radiopharmaceutical methods is a simple, safe and well-tolerated method by patients.

[Utility of 123-I ioflupane SPECT in the assessment of patients with Parkinsonian syndrome and cerebral vasculopathy]. / SPECT con ioflupano I-123 en la catalogación de pacientes con síndrome parkinsoniano y vasculopatía cerebral.

OBJECTIVE: To assess the utility of 123-I Ioflupane SPECT (IS) in the identification of the origin of Parkinsonism (vascular or idiopathic) in patients with cerebral vasculopathy (CV) demonstrated by morphological imaging techniques. Also, to assess the therapeutic impact. MATERIALS AND METHODS: 42 patients (16 males and 26 females) with a Parkinsonian syndrome were studied. Average age was 78.7 years (50-88). A dose of 185 MBq of 123 I-Ioflupane was injected in all subjects. SPECT imaging was obtained 5 hours later. All patients had a CT and/or MRI. The final diagnoses, after a minimal follow-up of 12 months, was established by a neurologist expert in movement disorders, based on clinical and imaging features and response to treatment. RESULTS: 14 patients were diagnosed of functional vascular Parkinsonism by alteration of association pathways, 3 of structural vascular Parkinsonism (SVP) with anatomical and functional vascular lesion in striatum, 14 of Parkinson's disease (PD) with CV, 2 of mixed Parkinsonism (PD + SVP) and 9 with others diagnoses different to the previous. The result of IS changed the treatment in 7/42 patients. CONCLUSION: The IS can have a complementary role to clarify the etiology of Parkinsonism in patients with cerebral vasculopathy. Interpretation of functional and anatomical images within the clinical context of each patient is necessary.

Localización radioguiada de lesiones ocultas de mama (ROLL) / Radioguided occult breast lesion location (ROLL)

Objetivo: Obtener una correcta localización de lesiones ocultas de mama mediante técnicas radioisotópicas. Material y métodos: Se han estudiado 61 pacientes con edades comprendidas entre 32 y 83 años (media de 57 años), con lesiones no palpables de mama, detectadas por mamografía. Seis pacientes tenían antecedentes de cáncer de mama. Sesenta y tres lesiones fueron encontradas. Las lesiones se clasificaron en 34 grupos de microcalcificaciones, 25 nódulos y 4 otras distorsiones de parénquima. Todas las pacientes recibieron una dosis de 0,3-0,5 mCi (11,1-18,5 MBq) de macroagregados de albúmina humana marcados con 99mTc ( 99mTc-MAA) intralesionalmente mediante mamografía estereotáxica o ecografía. Se adquirieron imágenes gammagráficas en proyecciones anterior y lateral, para valorar la correcta colocación del radiotrazador. La localización quirúrgica se realizó mediante la ayuda de una sonda gammadetectora (SGD). En el caso de microcalcificaciones, se realizó comprobación mamográfica de la pieza quirúrgica para confirmar su correcta exéresis. Resultados: La colocación del radiotrazador fue correcta en 60 de 63 casos (95,2 %). Sesenta y una lesiones fueron extraídas totalmente. La anatomía patológica reveló 29 (47,6 %) lesiones malignas y las 32 (52,4 %) restantes fueron benignas. Conclusión: La localización radioguiada de lesiones ocultas de mama mediante técnica radioisotópica es un método sencillo, seguro y bien tolerado por las pacientes

Objective: To obtain correct location of occult breast lesions by radiopharmaceutical methods. Material and methods: Sixty-one patients whose ages ranged from 32 to 83 years (average: 57), with non-palpable breast lesions detected by mammography were studied. Six of them had a background of previous breast cancer. Sixty-three lesions were found. The lesions were classified into 34 clusters of microcalcifications, 25 nodules and 4 others parenchymal distortions. All patients received one dose of 0.3-0.5 mCi (11.1-18.5 MBq) of macroaggregates of 99mTc-labelled human serum albumin ( 99mTc-MAA) into the lesion under stereotactic mammographic or ultrasonography guidance. Anterior and lateral scintigraphic images were acquired in order to verify the correct location of the radiopharmaceutical. Intraoperative location of the lesion was performed using a gammaprobe. In case of microcalcifications, the entire removal of the lesion was verified by X-ray of the specimen. Results: Placement of the radiotracer was good in 60 of 63 (95.2 %) cases. Sixty-one lesions were completely removed. Pathological examination revealed 29 (47.6 %) breast cancers and 32 (52.4 %) benign lesions. Conclusion: Radioguided occult breast lesion location by radiopharmaceutical methods is a simple, safe and well-tolerated method by patients

SPECT con ioflupano I-123 en la catalogación de pacientes con síndrome parkinsoniano y vasculopatía cerebral / Utility of 123I-Ioflupane SPECT in the assessment of patients with parkinsonian syndrome and cerebral vasculopathy

Objetivo: Establecer la utilidad del SPECT con ioflupano (SIP) I-123 en la identificación del origen del parkinsonismo (vascular o idiopático) en pacientes con vasculopatía cerebral demostrada por técnicas de imagen morfológica. Así mismo determinar el posible impacto en el manejo terapéutico. Material y métodos: Se estudiaron 42 pacientes (16 hombres y 26 mujeres) con síndrome parkinsoniano y vasculopatía cerebral, con una edad media de 78,7 años (50-88). A todos se les administró una dosis de 185 MBq de IP I-123, realizándose el SPECT 5 horas después. Todos los pacientes poseían tomografía computarizada (TC) y/o resonancia magnética (RM) craneales. El diagnóstico final fue establecido por un neurólogo especializado en trastornos del movimiento según datos clínicos, de imagen y de respuesta al tratamiento farmacológico tras un seguimiento de al menos 12 meses. Resultados: Catorce pacientes fueron diagnosticados de parkinsonismo vascular funcional por alteración de áreas de asociación, 3 de parkinsonismo vascular estructural (PVE), por lesión vascular anatómica y funcional en cuerpo estriado, 14 de enfermedad de Parkinson con encefalopatía vascular asociada, 2 de parkinsonismo mixto (EP + PVE) y 9 con otros diagnósticos distintos a los anteriores. El resultado del SIP I-123 indujo un cambio en el manejo terapéutico en 7 de 42 pacientes. Conclusión: El SIP I-123 puede tener un papel complementario para esclarecer el origen del parkinsonismo en pacientes con vasculopatía cerebral diversa. Es necesaria la valoración integral de la imagen funcional y estructural enmarcada siempre en el contexto clínico de cada paciente

Objective: To assess the utility of 123-I Ioflupane SPECT (IS) in the identification of the origin of Parkinsonism (vascular or idiopathic) in patients with cerebral vasculopathy (CV) demonstrated by morphological imaging techniques. Also, to assess the therapeutic impact. Materials and methods: 42 patients (16 males and 26 females) with a Parkinsonian syndrome were studied. Average age was 78.7 years (50-88). A dose of 185 MBq of 123 I-Ioflupane was injected in all subjects. SPECT imaging was obtained 5 hours later. All patients had a CT and/or MRI. The final diagnoses, after a minimal follow-up of 12 months, was established by a neurologist expert in movement disorders, based on clinical and imaging features and response to treatment. Results: 14 patients were diagnosed of functional vascular Parkinsonism by alteration of association pathways, 3 of structural vascular Parkinsonism (SVP) with anatomical and functional vascular lesion in striatum, 14 of Parkinson's disease (PD) with CV, 2 of mixed Parkinsonism (PD + SVP) and 9 with others diagnoses different to the previous. The result of IS changed the treatment in 7/42 patients. Conclusion: The IS can have a complementary role to clarify the etiology of Parkinsonism in patients with cerebral vasculopathy. Interpretation of functional and anatomical images within the clinical context of each patient is necessary

[SPECT with 123I-IBZM: utility in differential diagnosis of degenerative Parkinsonisms and establishment of quantification method]. / SPECT con 123I-IBZM: utilidad en el diagnóstico diferencial de Parkinsonismos degenerativos y establecimiento de un método de cuantificación.

OBJECTIVES: To assess utility of SPECT with 123I-Iolopride ( 123I-IBZM) in the differential diagnosis of patients with Parkinsonian symptoms and try to establish an adequate quantification method. MATERIAL AND METHOD: We analyzed a total of 34 patients who underwent a study with 123I-IBZM SPECT. Studies were analyzed qualitatively (visually) and quantitatively, using different quantification methods. We used different sums of slices (2, 3, 4, and 7 slices) with different cortical regions as a reference (frontal and occipital regions). Results were analyzed statistically. The final diagnosis of patients was established by two neurologists, specialized in movement disorders. RESULTS: Studies were visually assessed as normal in 24 cases and as pathologic in the other 10 cases. Scintigraphic studies had an adequate diagnostic correlation in 33 of the 34 patients. Four of the 8 methods used in the quantification were statistically significant in the differentation between normal and pathological. The use of different cortical brain regions as reference did not improve differentation between normal and pathologic studies. Global quantitative assessment of the studies showed that normal studies had higher values than pathological ones, with important overlapping between both categories. CONCLUSIONS: 123I-IBZM SPECT is an effective diagnostic tool in the establishment of the differential diagnosis in patients with Parkinson's disease and Parkinson-Plus. Quantification of these studies had limited utility since the overlapping of index values between normal and pathological restricts their use in individual cases.

SPECT con 123I-IBZM: utilidad en el diagnóstico diferencial de parkinsonismos degenerativos y establecimiento de un método de cuantificación / SPECT with 123I-IBZM: utility in differential diagnosis of degenerative Parkinsonisms and establishment of quantification method

Objetivos: Valorar la utilidad de la SPECT con 123I-Iolopride ( 123I-IBZM) en el diagnóstico diferencial de pacientes con síntomas parkinsonianos e intentar establecer un método adecuado de cuantificación. Material y método: Hemos analizado un total de 34 pacientes a los que se les realizó un estudio de SPECT con 123I-IBZM. Los estudios fueron valorados de manera cualitativa (visual), y de manera semicuantitativa, utilizando diferentes métodos de cuantificación. Se emplearon diferentes sumas de cortes (2, 3, 4 y 7 cortes) así como diferentes regiones corticales (frontal y occipital) como referencia. Los resultados fueron analizados estadísticamente. El diagnóstico final de los pacientes fue establecido por dos neurólogos especialistas en trastornos del movimiento. Resultados: En 24 casos el estudio fue valorado visualmente como dentro de la normalidad, y patológico en los 10 casos restantes. Los estudios gammagráficos mostraron una adecuada correlación con el diagnóstico clínico final en 33 de los 34 pacientes. 4 de los 8 métodos utilizados en la cuantificación fueron estadísticamente significativos para diferenciar índices de normalidad respecto a patológicos. El uso de diferentes regiones corticales cerebrales de referencia no mejoró la diferenciación entre estudios normales y patológicos. La valoración cuantitativa global de los estudios mostró que los normales presentaban valores superiores a los patológicos, aunque con importante solapamiento entre ambas categorías. Conclusión: La SPECT con 123I­IBZM es una herramienta diagnóstica eficaz en el establecimiento del diagnóstico diferencial de pacientes con enfermedad de Parkinson (EP) y Parkinson-Plus. La cuantificación de estos estudios muestra una utilidad limitada, ya que el solapamiento de valores entre normales y patológicos limita su uso de manera individual

Objectives: To assess utility of SPECT with 123I-Iolopride ( 123I-IBZM) in the differential diagnosis of patients with Parkinsonian symptoms and try to establish an adequate quantification method. Material and method: We analyzed a total of 34 patients who underwent a study with 123I-IBZM SPECT. Studies were analyzed qualitatively (visually) and quantitatively, using different quantification methods. We used different sums of slices (2, 3, 4, and 7 slices) with different cortical regions as a reference (frontal and occipital regions). Results were analyzed statistically. The final diagnosis of patients was established by two neurologists, specialized in movement disorders. Results: Studies were visually assessed as normal in 24 cases and as pathologic in the other 10 cases. Scintigraphic studies had an adequate diagnostic correlation in 33 of the 34 patients. Four of the 8 methods used in the quantification were statistically significant in the differentation between normal and pathological. The use of different cortical brain regions as reference did not improve differentation between normal and pathologic studies. Global quantitative assessment of the studies showed that normal studies had higher values than pathological ones, with important overlapping between both categories. Conclusions: 123I-IBZM SPECT is an effective diagnostic tool in the establishment of the differential diagnosis in patients with Parkinson's disease and Parkinson-Plus. Quantification of these studies had limited utility since the overlapping of index values between normal and pathological restricts their use in individual cases

Ergometría positiva y SPECT de perfusión miocárdica normal. Significado clínico / Positive exercise test and normal exercise myocardial perfusion SPECT. Clinical significance

Objetivos: Determinar, en nuestro medio, el significado clínico de un resultado normal en el estudio de perfusión miocárdica de estrés, en pacientes con ergometría positiva para isquemia. Material y métodos: Se realizó un estudio retrospectivo de los últimos cuatro años en nuestro Servicio. Se obtuvieron datos de 45 pacientes (41 mujeres y 4 hombres) que presentaron ergometría concluyente positiva para isquemia y SPECT de perfusión miocárdica normal, durante un período de seguimiento medio de 13,2 meses. Se consideró el diagnóstico clínico final según la evolución clínica, la respuesta al tratamiento y el resultado de coronariografía. Resultados: La presencia de ergometría positiva y SPECT normal fue predominante en el sexo femenino (93,3 %). En 35 pacientes (77,8 %), el diagnóstico final fue de dolor torácico de probable origen no coronario (no secundario a enfermedad arterial coronaria): 18 pacientes diagnosticados de miocardiopatía hipertensiva, 3 de valvulopatía, 2 de angina vasoespástica, 1 de miocardiopatía hipertrófica obstructiva, 1 de angor microvascular, 1 de angor arritmogénico y en 9 pacientes dolor atípico de causa funcional o no cardíaca. En 10 pacientes (22,2 %) el diagnóstico final fue de dolor torácico de probable origen coronario. No se observó ningún evento cardíaco mayor (muerte cardíaca o infarto de miocardio no mortal) durante el tiempo de seguimiento. Conclusiones: Los pacientes con dolor torácico, ergometría positiva y SPECT normal, presentan un excelente pronóstico a medio plazo. El 77,8 % de ellos fueron diagnosticados de dolor torácico de origen no coronario. La causa más frecuente de dolor no coronario fue la miocardiopatía hipertensiva (51,4 %), seguida por causas funcionales o no cardíacas (28,6 %)

Objective: To establish, in our area, the clinical significance of a normal exercise myocardial perfusion study, in patients with an ischemic response of the exercise test. Material and Methods: A retrospective study was carried out in our Service for the last four years. We studied 45 patients (41 women and 4 men) with an ischemic response of the exercise test and normal myocardial perfusion SPECT, during a mean follow-up of 13,2 months. We considered the final clinical diagnosis according to clinical evolution, therapy outcome and coronary angiography results. Results: The presence of positive exercise test and normal SPECT was predominant in women (93.3 %). In 35 patients (77.8 %), the final diagnosis was chest pain of probable non-coronary origin (not secondary to coronary artery disease): 18 patients were diagnosed of hypertensive cardiomyopathy, 3 of valvulopathy, 2 of vasospastic angina, 1 of hypertrophic obstructive cardiomyopathy, 1 of microvascular angina, 1 of angina due to arrhythmia, and 9 patients diagnosed of atypical chest pain due to functional or non-cardiac origin. In 10 patients (22.2 %), the final diagnosis was chest pain of probable coronary origin. We did not observe any major cardiac events (cardiac death and nonfatal myocardial infarction) during the follow-up period. Conclusions: Patients with chest pain, positive exercise test and normal SPECT have an excellent prognosis within an intermediate follow-up period. 77.8 % of patients were diagnosed of chest pain of non-coronary origin. The most common cause of non-coronary chest pain was hypertensive cardiomyopathy (51.4 %), followed by functional or non-cardiac chest pain (28,6 %)

[Positive exercise test and normal exercise myocardial perfusion SPECT. Clinical significance]. / Ergometría positiva y SPECT de perfusión miocárdica normal. Significado clínico.

OBJECTIVE: To establish, in our area, the clinical significance of a normal exercise myocardial perfusion study, in patients with an ischemic response of the exercise test. MATERIAL AND METHODS: A retrospective study was carried out in our Service for the last four years. We studied 45 patients (41 women and 4 men) with an ischemic response of the exercise test and normal myocardial perfusion SPECT, during a mean follow-up of 13,2 months. We considered the final clinical diagnosis according to clinical evolution, therapy outcome and coronary angiography results. RESULTS: The presence of positive exercise test and normal SPECT was predominant in women (93.3%). In 35 patients (77.8%), the final diagnosis was chest pain of probable non-coronary origin (not secondary to coronary artery disease): 18 patients were diagnosed of hypertensive cardiomyopathy, 3 of valvulopathy, 2 of vasospastic angina, 1 of hypertrophic obstructive cardiomyopathy, 1 of microvascular angina, 1 of angina due to arrhythmia, and 9 patients diagnosed of atypical chest pain due to functional or non-cardiac origin. In 10 patients (22.2%), the final diagnosis was chest pain of probable coronary origin. We did not observe any major cardiac events (cardiac death and nonfatal myocardial infarction) during the follow-up period. CONCLUSIONS: Patients with chest pain, positive exercise test and normal SPECT have an excellent prognosis within an intermediate follow-up period. 77.8% of patients were diagnosed of chest pain of non-coronary origin. The most common cause of non-coronary chest pain was hypertensive cardiomyopathy (51.4%), followed by functional or non-cardiac chest pain (28.6%).

[Differential diagnosis between Mesulam's aphasia and aphasia secondary to ischemic disorder by brain perfusion SPECT]. / Diagnóstico diferencial entre afasia de Mesulam y afasia secundaria a trastorno isquémico mediante SPECT cerebral de perfusión.

Two cases with aphasic dysfunction with similar clinical features and structural neuroimaging studies results are presented. In these cases, brain perfusion SPECT was the most useful complementary study in the differential diagnosis of two pathologies with different etiologies: primary progressive aphasia or Mesulam's aphasia and aphasia secondary to a stroke.