Cortical and subcortical patterns of I-123 iodobenzamide SPECT in striatal D(2) receptor parkinsonisms.

INTRODUCTION: The D(2) receptor is the most widely expressed dopaminergic receptor in the central nervous system, and it is present at the pre- and postsynaptic dopaminergic regions. It is mainly located in the neostriatum as well as in the globus pallidus, substantia nigra, cerebral cortex, thalamus, etc. The objective of this study was to analyze qualitatively and quantitatively the distribution pattern of the postsynaptic dopamine receptors through SPECT with iodobenzamide (IBZM) in patients with parkinsonism and to determine the benefit of this imaging technique in the differential diagnosis of the parkinsonian syndromes. MATERIALS: A total of 26 patients with clinical and imaging (Iodine-123 fluoropropyl-carbomethoxy-3 beta-(4-iodophenyltropane) [FP-CIT]) diagnostics of parkinsonism, to all of which a study of postsynaptic D(2) receptors with IBZM was made, were retrospectively reviewed. Of total, 12 patients were male (42.85%). The average age was 73 years old (range, 64-83 years). The patients were imaged using SPECT 2 hours after administration of I-123 Iolopride (IBZM) and their images were evaluated qualitatively and quantitatively. To measure the relative density of the D(2) receptors, the studies were registered to a common space in which the structures to be analyzed were delimited over a RM template. Caudate/frontal (C/FI) and putamen/frontal (P/FI) activity indexes were obtained. RESULTS: Of total, 10 patients presented normal IBZM uptake (C/FI of 1.23 + or - 0.13; P/FI of 1.53 + or - 0.11). The 16 studies listed as abnormal were divided into 2 degrees: (I) appearance of thalamic activity with preserved striatal uptake and (II) thalamus and frontal increased uptake with decrease of striatal activity. In the patients with abnormal patterns, the region that showed a greater reduction of uptake was the putamen (P/FI of 1.1 + or - 0.07 for degree 1, P < 0.05 and P/FI of 1.25 + or - 0.19 for degree 2, P < 0.001). For the differential diagnosis of Parkinson disease in relation to the atypical parkinsonisms, the sensitivity was 68.4% (confidence interval, 51.9-87.6) and the specificity was 57.1% (confidence interval, 20.2-88.2). The patients with Parkinson disease with longer evolution times showed a decrease of D(2) activity (3/7). CONCLUSION: The appearance of thalamic activity may be an early indicator of a decrease of D(2) striatal receptors in atypical parkinsonisms and in patients with long-term Parkinson disease.

PET/CT fusion scan in lung cancer: current recommendations and innovations.

Combined fluorodeoxyglucose-positron emission tomography (PET)/ computed tomography (CT) imaging has the potential to become the new standard imaging modality for the staging and restaging of patients with lung cancer. PET/CT is superior to PET alone, CT alone, and visual correlation of both techniques separately. In particular, it improves T3 and T4 staging and delineation of tumors associated with atelectasis. CT contrast media enhancement is probably only still needed when a substantial mediastinal tumor component is present and delineation of tumor from vascular structures is relevant. PET/CT is very accurate in detecting mediastinal nodal disease, but false-positive results are sufficiently frequent to require sampling in some positive cases. Whole-body PET/CT is the most sensitive technique for detecting extracranial metastatic disease, unexpected additional primary malignancies, and recurrence. Innovations include therapy monitoring, prognostic information, evaluation of small-cell lung cancer, its use for radiotherapy planning, and four-dimensional respiratory gating acquisition.

Radiolocalización de lesiones mamarias no palpables combinada con la biopsia del ganglio centinela en mujeres con cáncer de mama / Radio-guided occult lesion localization combined with sentinel node biopsy in women with breast cancer

Introducción. La modalidad intralesional de inyección de los radiocoloides en la biopsia del ganglio centinela (BGC) permite la localización de tumores mamarios primitivos no palpables, en un mismo acto quirúrgico, mediante la técnica conocida como ROLL. Pacientes y método. Presentamos nuestra experiencia con la combinación de ambas técnicas (BGC y ROLL). Se analizó retrospectivamente a 233 pacientes: en 65 pacientes se practicó ROLL y en 168 la lesión fue localizada mediante la inserción de guías metálicas (grupo control). Ambos grupos eran comparables en cuanto a sus variables anatomorradiológicas. Resultados. La resección de la lesión se llevó a cabo en un solo tiempo en 169 pacientes. No se observaron diferencias significativas entre ambos grupos en cuanto a la afección de los márgenes quirúrgicos (márgenes correctos del 80% con ROLL frente al 69,9% sin ROLL) ni en el diámetro máximo de la pieza (6,85 frente a 6,52 cm, respectivamente). Conclusión. En pacientes sometidas a la BGC con lesiones mamarias no palpables, la técnica ROLL es una alternativa a las guías metálicas que ofrece una mayor facilidad para la exéresis y más comodidad para la paciente (AU)

Introduction. The practice of intratumoral radiocolloid injection for sentinel node biopsy (SNB) allows localization of nonpalpable breast tumors in the same surgical intervention, using the technique known as radio-guided occult lesion localization (ROLL). Patients and method. We present our experience with the combined use of both techniques (SNB and ROLL). A total of 233 patients were retrospectively analyzed: 65 patients underwent ROLL and 168 patients underwent wire-guided localization (control group) as the excision modality. Both groups had comparable pathologic and radiologic features. Results. Complete excision of the lesion was achieved at the first attempt in only 169 patients. There were no significant differences among groups in surgical margin status (margins were adequate in 80% of ROLL patients vs 69.9% of non-ROLL patients) or in maximum specimen diameter (6.85 cm vs 6.52 cm, respectively). Conclusion. We conclude that ROLL is an acceptable alternative to wire-guided localization in patients with nonpalpable breast tumors undergoing SNB, leading to easier lesion excision and greater patient comfort (AU)

[Radio-guided occult lesion localization combined with sentinel node biopsy in women with breast cancer]. / Radiolocalización de lesiones mamarias no palpables combinada con la biopsia del ganglio centinela en mujeres con cáncer de mama.

INTRODUCTION: The practice of intratumoral radiocolloid injection for sentinel node biopsy (SNB) allows localization of nonpalpable breast tumors in the same surgical intervention, using the technique known as radio-guided occult lesion localization (ROLL). PATIENTS AND METHOD: We present our experience with the combined use of both techniques (SNB and ROLL). A total of 233 patients were retrospectively analyzed: 65 patients underwent ROLL and 168 patients underwent wire-guided localization (control group) as the excision modality. Both groups had comparable pathologic and radiologic features. RESULTS: Complete excision of the lesion was achieved at the first attempt in only 169 patients. There were no significant differences among groups in surgical margin status (margins were adequate in 80% of ROLL patients vs 69.9% of non-ROLL patients) or in maximum specimen diameter (6.85 cm vs 6.52 cm, respectively). CONCLUSION: We conclude that ROLL is an acceptable alternative to wire-guided localization in patients with nonpalpable breast tumors undergoing SNB, leading to easier lesion excision and greater patient comfort.