Rentabilidad diagnóstica de los estudios PET/TC basal y de seguimiento en la terapia ablativa del cáncer de pulmón de células no pequeñas / Diagnostic yield of baseline and follow-up PET/CT studies in ablative therapy for non-small cell lung cancer

Aunque con efectividad probada, las técnicas de ablación por radiofrecuencia y microondas presentan un elevado índice de respuestas parciales. Es imprescindible contar con estudios diagnósticos que se anticipen a los cambios morfológicos para una detección más temprana del tejido tumoral residual viable o de recurrencias locales para determinar los pacientes que serán beneficiados de un nuevo tratamiento. Determinamos mediante nuestro estudio la rentabilidad diagnóstica de los estudios de PET/CT basal y de seguimiento y el tiempo adecuado entre estos y la intervención por ablación. Incluimos 7 pacientes con lesión tumoral única con un total de 8 ablaciones. Hemos realizado estudios CT y PET/CT basales y de seguimiento tras ablación. Los tiempos medios entre estudios PET basales y de seguimiento y la terapia ablativa fueron 1,8 y 3,4 meses respectivamente. Las cuentas medias en actividades metabólicas de los PET basales y de seguimiento han sido de 7,6 y 4,3g/ml de SUVmax respectivamente. La técnica de Dual Time Point ayudó en 3 casos a identificar tejido viable tras ablación. Los estudios de seguimiento PET/CT han condicionado las diversas estrategias terapéuticas adoptadas por los oncólogos clínicos. El alto rendimiento del estudio PET/CT incluyendo la técnica de Dual Time Point puede plantearse como estudio de sustitución de los CT con CIV basales y de seguimiento previo y posterior al tratamiento con ARF o AMO logrando reducir de manera considerable la exposición a altas cifras de radiación. Proponemos realizar el primer estudio PET/CT de seguimiento a los 3 meses de realizada la ARF o AMO(AU)

Although they have proven effectiveness, radiofrequency and microwave ablation techniques have a high rate of partial responses. Diagnostic studies that anticipate the changes in morphology are essential for earlier detection of residual viable tumor tissue or local recurrences to identify patients who will benefit from a new treatment. Our study has determined the diagnostic yield of PET/CT studies at baseline and follow-up and adequate time between them and the ablation intervention. Seven patients with single tumor lesion with a total of 8 ablations were included. CT and PET/CT studies were performed at baseline and follow-up after ablation. Average times between PET studies at baseline and follow-up and the ablative therapy were 1.8 and 3.4 months, respectively. Mean scores in metabolic activities of the PET at baseline and follow-up were 7.6 and 4.3g/ml of SUVmax, respectively. The Dual Time Point technique helped to identify viable tissue after ablation in 3 cases. Follow-up PET/CT studies have conditioned the various treatment strategies adopted by clinical oncologists. The high yield of the PET/CT study including the Dual Time Point technique may be considered as a study replacement of initial and follow-up Contrast-Enhanced CT before and after treatment with RFA and AMO, this achieving considerable reduction in the exposure to high radiation levels. We propose conducting the first PET/CT follow-up study at 3 months of the RFA and AMO(AU)

Diagnostic yield of baseline and follow-up PET/CT studies in ablative therapy for non-small cell lung cancer.

Although they have proven effectiveness, radiofrequency and microwave ablation techniques have a high rate of partial responses. Diagnostic studies that anticipate the changes in morphology are essential for earlier detection of residual viable tumor tissue or local recurrences to identify patients who will benefit from a new treatment. Our study has determined the diagnostic yield of PET/CT studies at baseline and follow-up and adequate time between them and the ablation intervention. Seven patients with single tumor lesion with a total of 8 ablations were included. CT and PET/CT studies were performed at baseline and follow-up after ablation. Average times between PET studies at baseline and follow-up and the ablative therapy were 1.8 and 3.4 months, respectively. Mean scores in metabolic activities of the PET at baseline and follow-up were 7.6 and 4.3g/ml of SUVmax, respectively. The Dual Time Point technique helped to identify viable tissue after ablation in 3 cases. Follow-up PET/CT studies have conditioned the various treatment strategies adopted by clinical oncologists. The high yield of the PET/CT study including the Dual Time Point technique may be considered as a study replacement of initial and follow-up Contrast-Enhanced CT before and after treatment with RFA and AMO, this achieving considerable reduction in the exposure to high radiation levels. We propose conducting the first PET/CT follow-up study at 3 months of the RFA and AMO.

[A clinico-anatomical correlation study of logorrhoea]. / Estudio de correlación clinicoanatómica de la logorrea.

INTRODUCTION: The degree of verbal production necessary to be considered logorrhoea has still not been defined, and no clear correlation has been established between the topography of the dysfunction and this symptom. AIMS: To provide quantitative data about normal verbal production and to identify the location within the brain of the alterations observed in neuroimage of patients with logorrhoea. SUBJECTS AND METHODS: The oral verbal production of 60 control subjects between 20 and 80 years of age was quantified by analysing five speeches. Ten patients who exceeded the 75th percentile in at least two of the five speeches underwent structural and functional neuroimaging tests. RESULTS. The data on verbal production of normal subjects are reported. Age, sex and habits (smoking, coffee, alcoholic drinks) did not exert an influence, but the degree of schooling was seen to have an effect. All the patients were diagnosed with frontotemporal degeneration, although in one case there were also coexisting vascular risk factors and subcortical vascular lesions, which reduce the degree of certainty of the diagnosis. Cortical atrophy is located in the right anterior temporal lobes (100% anteromedial, 100% anteroinferior, 70% anterolateral), left anterior temporal (90% anteromedial, 90% anteroinferior, 60% anterolateral), right prefrontal (30% basal, 50% dorsolateral, 20% medial) and left prefrontal (20% basal, 30% dorsolateral, 20% medial). CONCLUSIONS: Oral verbal production is influenced by level of education and, in a sample of patients with probable frontotemporal degeneration and logorrhoea, all the patients showed alterations in the anteroinferior and anteromedial regions of the right temporal lobe.

Estudio de correlación clinicoanatómica de la logorrea / A clinico anatomical correlation study of logorrhoeaa

Resumen. Introducción. Aún no se ha definido el grado de producción verbal necesario para identificar una logorrea y tampoco se ha establecido una correlación clara entre la topografía de la disfunción y el síntoma. Objetivos. Aportar datos cuantitativos de producción verbal normal e identificar la localización cerebral de las alteraciones en neuroimagen de pacientes con logorrea. Sujetos y métodos. Se ha cuantificado la producción verbal oral de 60 sujetos de control de entre 20 y 80 años, analizando cinco discursos. A 10 pacientes que superaron el percentil 75 en al menos dos de los cinco discursos se les realizaron pruebas de neuroimagen estructural y funcional. Resultados. Se presentan los datos de producción verbal de los sujetos normales. La edad, el sexo y hábitos (tabaco, café, bebidas alcohólicas) no mostraron influencia, pero sí el grado de formación académica. Todos los enfermos fueron diagnosticados de degeneración frontotemporal, aunque en un caso coexistían factores de riesgo vascular y lesiones vasculares subcorticales, que reducen seguridad al diagnóstico. La atrofia cortical se localiza en los lóbulos temporal anterior derecho (el 100% anteromedial, el 100% anteroinferior, el 70% anterolateral), temporal anterior izquierdo (el 90% anteromedial, el 90% anteroinferior, el 60% anterolateral), prefrontal derecho (el 30% basal, el 50% dorsolateral, el 20% medial) y prefrontal izquierdo (el 20% basal, el 30% dorsolateral, el 20% medial). Conclusiones. La producción verbal oral está influida por la formación académica y, en una muestra de pacientes con degeneración frontotemporal probable y logorrea, todos los enfermos mostraron alteración en las regiones anteroinferior y anteromedial del lóbulo temporal derecho (AU)

Summary. Introduction. The degree of verbal production necessary to be considered logorrhoea has still not been defined, and no clear correlation has been established between the topography of the dysfunction and this symptom. Aims. To provide quantitative data about normal verbal production and to identify the location within the brain of the alterations observed in neuroimage of patients with logorrhoea. Subjects and methods. The oral verbal production of 60 control subjects between 20 and 80 years of age was quantified by analysing five speeches. Ten patients who exceeded the 75th percentile in at least two of the five speeches underwent structural and functional neuroimaging tests. Results. The data on verbal production of normal subjects are reported. Age, sex and habits (smoking, coffee, alcoholic drinks) did not exert an influence, but the degree of schooling was seen to have an effect. All the patients were diagnosed with frontotemporal degeneration, although in one case there were also coexisting vascular risk factors and subcortical vascular lesions, which reduce the degree of certainty of the diagnosis. Cortical atrophy is located in the right anterior temporal lobes (100% anteromedial, 100% anteroinferior, 70% anterolateral), left anterior temporal (90% anteromedial, 90% anteroinferior, 60% anterolateral), right prefrontal (30% basal, 50% dorsolateral, 20% medial) and left prefrontal (20% basal, 30% dorsolateral, 20% medial). Conclusions. Oral verbal production is influenced by level of education and, in a sample of patients with probable frontotemporal degeneration and logorrhoea, all the patients showed alterations in the anteroinferior and anteromedial regions of the right temporal lobe (AU)

[Utility of FDG-PET for early evaluation of efficiency of imatinib mesylate (Glivec) in the treatment of gastrointestinal stromal tumors]. / Utilidad de la FDG-PET en la evaluación precoz de la eficacia de imatinib (Glivec) en el tratamiento de tumores del estroma gastrointestinal.

The management of gastrointestinal stromal tumors, usually defined as c-KIT-positive mesenchymal neoplasias, has evolved very rapidly in the last five years. Imatinib mesylate (Glivec(R)) is the standard treatment in unresectable or metastatic gastrointestinal stromal tumors. Imatinib should be given until development of intolerance or progressive disease. It is not uncommon for gastrointestinal stromal tumors to become larger during the early post-treatment phase and conventional response to treatment criteria in solid tumors have a limited value for evaluation the efficiency of imatinib in this period. FDG-PET has proven to be highly sensitive in detecting early response tumor. A 53-year old woman was diagnosed of relapsed gastrointestinal stromal tumor 18 months after adyuvant imatinib mesylate finished. Imatinib was started and 72 hours later the tumor showed a decrease of fluorodeoxyglucose F18 uptake on positron emission tomography scan.

Utilidad de la FDG-PET en la evaluación precoz de la eficacia de imatinib (Glivec) en el tratamiento de tumores del estroma gastrointestinal / Utility of FDG-PET for early evaluation of efficiency of imatinib mesylate (Glivec) in the treatment of gastrointestinal stromal tumors

El manejo de los tumores del estroma gastrointestinal, definidos como neoplasias mesenquimales c-Kit positivas, ha cambiado rápidamente en los últimos cinco años. El mesilato de imatinib (Glivec®) es el tratamiento estándar de los tumores del estroma gastrointestinal irresecables o metastáticos. El imatinib debe administrarse hasta el desarrollo de intolerancia o la progresión de la enfermedad. No es infrecuente que los tumores del estroma gastrointestinal aumenten de tamaño durante los primeros meses de tratamiento, de ahí el valor limitado de los criterios convencionales de evaluación de respuesta de los tumores sólidos para determinar la eficacia del imatinib durante este período. La tomografía de emisión de positrones empleando 18F-fluorodesoxiglucosa ha demostrado tener una alta sensibilidad en la evaluación precoz de la respuesta tumoral al imatinib. Presentamos el caso de una mujer de 53 años diagnosticada de recidiva de tumor del estroma gastrointestinal 18 meses después de finalizar tratamiento adyuvante con imatinib. Tras 72 horas de tratamiento con imatinib el tumor mostraba en la tomografía de emisión de positrones una disminución en la captación de 18F-fluorodesoxiglucosa

The management of gastrointestinal stromal tumors, usually defined as c-KIT-positive mesenchimal neoplasias, has evolved very rapidly in the last five years. Imatinib mesylate (Glivec®) is the standard treatment in unresectable or metastatic gastrointestinal stromal tumors. Imatinib should be given until development of intolerance or progressive disease. It is not uncommon for gastrointestinal stromal tumors to become larger during the early post-treatment phase and conventional response to treatment criteria in solid tumors have a limited value for evaluation the efficiency of imatinib in this period. FDG-PET has proven to be highly sensitive in detecting early response tumor. A 53-year old woman was diagnosed of relapse gastrointestinal stromal tumor 18 months after adyuvant imatinib mesylate finished. Imatinib was started and 72 hours later the tumor showed a decrease of fluorodeoxyglucose F18 uptake on positron emission tomography scan

PET in abdominal pathology: advantages and limitations.

New oncologic procedures are currently more focused on the biological features of tumors. The ideal objective is the administration of personalized effective treatments for each patient that affects not just the location and spread of disease but also special metabolic characteristics of tumoral cells. Radiologic diagnostic methods are extremely important in the management of the patient for staging, restaging, and evaluation of treatment response, and clinicians are avid for some additional functional and metabolic information. Further, they need more dynamic methods for follow-up. Nuclear Medicine and positron emission tomography (PET) in many cases can meet this requirement, although it is not perfect, at least at the present time. Currently 2-((18)F)fluoro-2-desoxi-D: -glucose positron emission tomography is being widely used for oncologic purposes. Its information can be very useful in abdominal diseases and must be taken into account with the results of radiologic imaging. Thus, many changes in the choice of treatment are seen. However, it is very important to know that sometimes there is a lack of specificity that has to be considered.

[Spontaneous intracranial hypotension: the value of isotope cisternoscintigraphy using 99mTc-DTPA]. / Síndrome de hipotensión intracraneal espontánea: utilidad de la cisternogammagrafía isotópica con 99mTc-DTPA.

INTRODUCTION: Spontaneous intracranial hypotension (SIH) is an infrequent clinical entity that is found predominantly in young adults and is characterised by the presence of acute or subacute headaches that appear on standing up and subsides on lying down. CASE REPORT: A 35-year-old female with a three-month history of holocranial headaches, accompanied by dizziness and gait instability, which increase on standing up and diminish to a certain extent on lying down, associated to bilateral tinnitus. The patient's history included a slight strain made 4 months earlier, with a sudden non-irradiated pain in the back of the neck that got better spontaneously. On the basis of the clinical and radiological findings from an MRI scan of the head and neck, our service was asked to perform a cisternoscintigraphy. CONCLUSIONS: Isotope cisternoscintigraphy using 99mTc-DTPA confirmed the diagnosis of the process and enabled us to locate the CSF leak. We therefore think it advisable to highlight its value in the diagnosis of SIH syndrome so as to be able to avoid the use of other invasive complementary explorations that entail a certain degree of morbidity and mortality.

La gammagrafía ósea en el granuloma eosinófilo / Bone scintigraphy of eosinophilic granuloma

- Propósito: La histiocitosis de células de Langerhans es una enfermedad rara, que clínicamente se presenta con un espectro muy amplio. Destacamos el manejo diagnóstico de la HCL con estudios gammagráficos, que son casi patognomónicos.- Material y métodos: En este trabajo presentamos un caso de granuloma eosinófilo con una imagen típica en la gammagrafía ósea, lesión única hipercaptante en 5º arco costal.- Conclusiones: La gammagrafía ósea es útil en el diagnóstico de HCL y en el manejo de dichos pacientes (AU)

Hallazgo incidental de divertículo vesical en gammagrafía ósea / Incidental finding of bladder diverticulum in bone scintigraphy

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