Comparative study of 18F-FDG PET/CT and CT angiography in detection of large vessel vasculitis. / Estudio comparativo de la PET/TC con 18F-FDG y la angiografía por TC en la detección de la vasculitis de grandes vasos.

OBJECTIVE: Compare 18F-FDG PET/CT and CTangio in the diagnosis of extracraneal large vessel involvement in patients with suspicion of large vessel vasculitis (LVV). MATERIAL AND METHODS: A retrospective database reviewed 59 patients with clinical suspicion of LVV undergoing 18F-FDG PET/CT and CTangio. In 55 patients PET/TC and CTangio were done simultaneously in the same machine and in 4 patients with a scan interval of<1 month. PET/CT analyses included qualitatively and quantitative analysis (ratio SUVmax 18F-FDG vessel/SUVmax liver). CTangio was assessed for concentric mural thickening, contrast wall enhancement and structural vascular changes as potential complications of vasculitis. RESULTS: 18F-FDG PET/CT and CTangio show high specificity (97.2%) for LVV diagnosis, with an excellent sensitivity for 18F-FDG PET/CT (95.6%) and lower for CTangio (60.9%), which leads to a high negative predictive value for 18F-FDG PET/CT (97.2%) and a high false negative rate for CTangio (39.1%). A 70% concordance between 18F-FDG PET/CT and CTangio was obtained (Kappa index 0.70± 0.095 (P<.001). CONCLUSION: The results show the greater potential of 18F-FDG PET/CT for the detection and extension of LVV. Therefore, 18F-FDG PET/CT should be exploited to the maximum and consider as the first line imaging technique in the extracranial diagnosis of LVV and its possible association with polymyalgia rheumatica. The addition of CTangio could be more indicated in patients with Takayasu arteritis and in long-standing and/or severe vasculitis since it increases the accuracy in the detection of possible vascular complications.

[Giant cell tumor of the tendon sheath: characteristic findings of the bone scintigraphy and correlation with MRI]. / Tumor de células gigantes de la vaina tendinosa: hallazgos característicos de la gammagrafía ósea y correlación con la RMN.

We report 3 cases of an unusual tumor, that is, the giant cell tumor of the tendon sheath. The patients consulted due to the appearance of a well-defined, painless, soft tissue mass with mild-to-moderate inflammation located in the thumbs or toes. These clinical data, together with the bone scan findings, oriented the diagnostic suspicion that was confirmed by a pathology study of the tumor after resection. This work has aimed to review the characteristics of the bone scan (BS) image of this tumor and its correlation with the conventional X-ray imaging and magnetic resonance imaging (MRI).

[Evaluation of renal lesions using 99mTc-DMSA in children with urinary tract infection and the relation with vesicoureteral reflux]. / Evaluación de lesiones renales mediante 99mTc-DMSA en niños con antecedentes de infección del tracto urinario y su relación con el reflujo vesicoureteral.

OBJECTIVE: Paediatric patients with urinary tract infection (UTI) have risk of developing renal scarrings. Although it is known that vesicoureteral reflux (VUR) predisposes to UTIs and it seems to have an important role in the development of renal lesions, some recent published studies question that relation. The aim of the study was to evaluate renal scarring by using renal scintigraphy 99mTc-DMSA and see the relation with or without the presence of VUR. MATERIAL AND METHODS: We evaluated retrospectively a total of 230 patients (460 renal units), mean age: 11 months (range: 12d-5y), with UTI probed by urinoculture. All were studied with voiding cistourethrography (MCU) to evaluate the presence or absence of VUR. Patients were evaluated with 99mTc-DMSA scan 6 months after UTI to determine if UTI caused renal scarring. RESULTS: Renal scans with 99mTc-DMSA 6 months post-infection were abnormal in 62 renal units, affecting 54 patients (23 %). From all patients studied, 110 were diagnosis of VUR being affected 161 renal units, 43 of them (27 %) presented renal scarrings. From the remaining 120 patients without VUR that is 240 renal units, 19 of them (8 %) presented parenchymatous damage. CONCLUSION: Renal scarring resulting from UTI are in some cases related to VUR, but sometimes are caused by the infection itself. Not all patients with VUR develop renal lesions, and neither the presence of VUR always predispose children to renal lesions. MCU and direct isotopic cystography are useful for diagnosis of VUR but we shouldn't avoid 99mTc-DMSA scan in the management of children with UTI.

Evaluación de lesiones renales mediante 99mTc-DMSA en niños con antecedentes de infección del tracto urinario y su relación con el reflujo vesicoureteral / Evaluation of renal lesions using 99mTc-DMSA in children with urinary tract infection and the relation with vesicoureteral reflux

Objetivo. Los pacientes pediátricos con infección del tracto urinario (ITU) tienen riesgo de desarrollar lesiones renales. Aunque el reflujo vesicoureteral (RVU) predispone a ITU y parece tener un papel importante en el desarrollo de estas lesiones, estudios recientes cuestionan dicha relación. El objetivo del estudio fue evaluar mediante gammagrafía renal con 99mTc-DMSA la existencia de lesiones renales y su relación con la presencia o no de RVU. Material y métodos. Se evaluaron retrospectivamente 230 pacientes (460 unidades renales), edad media 11 meses (intervalo: 12 días-5 años), con ITU probada mediante urinocultivo. A todos ellos se les realizó cistografía miccional seriada (CUMS) para valorar la existencia o no de RVU. Para determinar si la ITU originó cicatrices se practicó 99mTc-DMSA a partir de los 6 meses postinfección. Resultados. El estudio con 99mTc-DMSA de control postinfección fue patológico en 62 unidades renales, afectando a 54 pacientes (23 %). De los pacientes estudiados, 110 fueron diagnosticados de RVU, afectando a 161 unidades renales, de las cuales 43 unidades (27 %) presentaron cicatrices. De los restantes 120 pacientes sin RVU, 240 unidades renales, 19 de ellas (8 %) presentaron afectación renal. Conclusión. Las cicatrices renales post-ITU están en algunos casos relacionadas con RVU, pero en ocasiones se asocian a la propia infección. No todos los pacientes con RVU desarrollan lesiones y su presencia no siempre predispone a mayor susceptibilidad a lesiones renales. La CUMS o cistografía isotópica directa son útiles para diagnosticar RVU, pero no deberíamos obviar el estudio con 99mTc-DMSA en el manejo del paciente con ITU

Objective. Paediatric patients with urinary tract infection (UTI) have risk of developing renal scarrings. Although it is known that vesicoureteral reflux (VUR) predisposes to UTIs and it seems to have an important role in the development of renal lesions, some recent published studies question that relation. The aim of the study was to evaluate renal scarring by using renal scintigraphy 99mTc-DMSA and see the relation with or without the presence of VUR. Material and methods. We evaluated retrospectively a total of 230 patients (460 renal units), mean age: 11 months (range: 12d-5y), with UTI probed by urinoculture. All were studied with voiding cistourethrography (MCU) to evaluate the presence or absence of VUR. Patients were evaluated with 99mTc-DMSA scan 6 months after UTI to determine if UTI caused renal scarring. Results. Renal scans with 99mTc-DMSA 6 months post-infection were abnormal in 62 renal units, affecting 54 patients (23 %). From all patients studied, 110 were diagnosis of VUR being affected 161 renal units, 43 of them (27 %) presented renal scarrings. From the remaining 120 patients without VUR that is 240 renal units, 19 of them (8 %) presented parenchymatous damage. Conclusion. Renal scarring resulting from UTI are in some cases related to VUR, but sometimes are caused by the infection itself. Not all patients with VUR develop renal lesions, and neither the presence of VUR always predispose children to renal lesions. MCU and direct isotopic cystography are useful for diagnosis of VUR but we shouldn't avoid 99mTc-DMSA scan in the management of children with UTI

Calcifilaxis: una causa poco común de acumulación de fosfonatos en partes blandas / Calciphylaxis: a rare cause of accumulation of phosphonates in soft tissues

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