Evaluation of the contribution of the dynamic phase of lymphoscintigraphy to the detection of sentinel lymph node in breast cancer.

AIM: The aim of this study was to evaluate the contribution of an early dynamic phase (DP) of the lymphoscintigraphy (LS) to the detection of the sentinel lymph node (SLN) in breast cancer. METHODS: This prospective study included 164 breast lesions in 161 consecutive patients (160 women, mean age 57.5 years). Patients with tumor >5 cm, multicentric, palpable nodes, axillary involvement, previous surgery, lymphadenectomy, radio or chemotherapy were not included. All patients underwent preoperative LS before surgery. DP immediately after injection of [99mTc]Nanocolloid followed by early and delayed planar images (EPI and DPI) were acquired. RESULTS: SLN was detected in 162/164 lesions (98.8%). In 115 (71%) DP showed no lymph node uptake and the SLN was identified only by EPI and DPI. A focal uptake by at least one lymph node was observed in DP in the remaining 47 lesions (29%). Although in 30/74 lesions DP did not provide additional information to EPI and DPI, nevertheless in 17 cases (10.5%) DP was essential to identify correctly the SLN. CONCLUSION: We concluded that DP, by allowing a better interpretation of the lymphatic drainage pattern, provides unique information to distinguish the correct SLN from other lymph nodes and is recommended as the first part of LS.

Comparison of early (60 min) and delayed (180 min) acquisition of 18F-FDG PET/CT in large vessel vasculitis

Objetivo. Comparar la contribución de la adquisición con 18F-FDG-PET/TC a 180 min con la de 60 min en sospecha de vasculitis de grandes vasos (VGV). Material y métodos. Este estudio prospectivo incluyó 23 pacientes. El estudio PET/TC fue adquirido a 60 y 180 min (precoz y tardío) tras la administración de 18F-FDG. Se realizó un análisis visual de las imágenes valorando los troncos supraaórticos (TSA), la aorta torácica (AT), la abdominal (AA), las arterias ilíacas (AI) y las femoro/tibioperoneas (AFT). En las 115 regiones vasculares se evaluó la intensidad (0-3) y el patrón de captación (difuso/lineal). Resultados. En 20/115 regiones vasculares (17,4%) no hubo captación en la adquisición precoz y tardía. De las 95 regiones (82,6%) con captación en la adquisición precoz la intensidad no cambió en la tardía en 46 y cambió en 49. De esas 49 regiones en las que la intensidad cambió, esta disminuyó en 36 y aumentó en 13 (AT: 8, TSA: 5). En ningún caso la intensidad aumentó en la AA, las AI y las AFT. El patrón de captación en la AT fue difuso en la adquisición precoz en 16 pacientes, en 7 de ellos cambió a lineal en la tardía y desapareció en 9. El patrón precoz fue lineal en 7 pacientes, 6 de ellos mostraron un aumento de intensidad en la tardía y en uno permaneció igual. Conclusión. La adquisición tardía de 180 min con FDG-PET/TC proporciona una más detallada visualización de la pared vascular, mostrando la desaparición de la actividad del pool vascular y contribuyendo a un más correcto diagnóstico de VGV(AU)

Purpose. To compare the contribution of the 18F-FDG-PET/CT acquisition at 180 min and at 60 min in suspicion of large vessel vasculitis (LVV). Material and methods. A prospective study including 23 patients was performed. PET/CT was acquired at 60 and 180 min (early and delayed scan) after 18F-FDG injection. A visual analysis was performed at the supra-aortic trunks (SAT), thoracic aorta (TA), abdominal aorta (AA), iliac arteries (IA) and femoral/tibioperoneal arteries (FTA). Intensity (0–3) and uptake pattern (diffuse/linear) were assessed in the 115 vascular regions. Results. There was no FDG uptake in the early and delayed acquisition in 20/115 vascular regions (17.4%). Of the 95 regions (82.6%) showing FDG uptake at the early, delayed or both acquisitions, intensity did not change in the delayed acquisition in 46 and changed in 49. Of the 49 regions in which the intensity changed, it decreased in 36 and increased in 13 (TA:8, SAT:5). AA, IA and FTA intensity did not increase in any of the cases. Uptake pattern at the TA in the early acquisition was diffuse in 16 patients. In 7, it changed to linear and in 9 the uptake disappeared. The early pattern was linear in 7 patients and 6 of them showed increased intensity in the delayed acquisition and in 1 remained the same. Conclusion. The 180 min delayed FDG-PET/CT acquisition provides a more detailed visualized of the vessel wall, showing the washout of the blood pool activity. Therefore, it may contribute to a more accurate diagnosis of LVVAU)(AU)

Comparison of early (60 min) and delayed (180 min) acquisition of 18F-FDG PET/CT in large vessel vasculitis.

PURPOSE: To compare the contribution of the (18)F-FDG-PET/CT acquisition at 180 min and at 60 min in suspicion of large vessel vasculitis (LVV). MATERIAL AND METHODS: A prospective study including 23 patients was performed. PET/CT was acquired at 60 and 180 min (early and delayed scan) after (18)F-FDG injection. A visual analysis was performed at the supra-aortic trunks (SAT), thoracic aorta (TA), abdominal aorta (AA), iliac arteries (IA) and femoral/tibioperoneal arteries (FTA). Intensity (0-3) and uptake pattern (diffuse/linear) were assessed in the 115 vascular regions. RESULTS: There was no FDG uptake in the early and delayed acquisition in 20/115 vascular regions (17.4%). Of the 95 regions (82.6%) showing FDG uptake at the early, delayed or both acquisitions, intensity did not change in the delayed acquisition in 46 and changed in 49. Of the 49 regions in which the intensity changed, it decreased in 36 and increased in 13 (TA:8, SAT:5). AA, IA and FTA intensity did not increase in any of the cases. Uptake pattern at the TA in the early acquisition was diffuse in 16 patients. In 7, it changed to linear and in 9 the uptake disappeared. The early pattern was linear in 7 patients and 6 of them showed increased intensity in the delayed acquisition and in 1 remained the same. CONCLUSION: The 180 min delayed FDG-PET/CT acquisition provides a more detailed visualized of the vessel wall, showing the washout of the blood pool activity. Therefore, it may contribute to a more accurate diagnosis of LVV.

Evaluation of the contribution of the dynamic phase of lymphoscintigraphy to the detection of sentinel lymph node in breast cancer.

Aim: The aim of this study was to evaluate the contribution of an early dynamic phase (DP) of the lymphoscintigraphy (LS) to the detection of the sentinel lymph node (SLN) in breast cancer. Methods: This prospective study included 164 breast lesions in 161 consecutive patients (160 women, mean age 57.5 years). Patients with tumor >5 cm, multicentric, palpable nodes, axillary involvement, previous surgery, lymphadenectomy, radio or chemotherapy were not included. All patients underwent preoperative LS before surgery. DP immediately after injection of [99mTc]Nanocolloid followed by early and delayed planar images (EPI and DPI) were acquired. Results: SLN was detected in 162/164 lesions (98.8%). In 115 (71%) DP showed no lymph node uptake and the SLN was identified only by EPI and DPI. A focal uptake by at least one lymph node was observed in DP in the remaining 47 lesions (29%). Although in 30/74 lesions DP did not provide additional information to EPI and DPI, nevertheless in 17 cases (10.5%) DP was essential to identify correctly the SLN. Conclusion: We concluded that DP, by allowing a better interpretation of the lymphatic drainage pattern, provides unique information to distinguish the correct SLN from other lymph nodes and is recommended as the first part of LS.

Contribution of 18F-sodium fluoride PET/CT to the study of the carotid atheroma calcification / Caracterizacion de la calcificacion del ateroma carotideo mediante 18F-fluoruro PET/TAC

Aim. To assess the calcification process of the carotid plaque by 18F-sodium fluoride PET/CT imaging. Material and methods. A prospectively designed study including 15 patients in whom an atheroma plaque was detected by contrast enhanced CT scan during a neurological work-up was performed. A total of 29 plaques, 19 asymptomatic and 10 symptomatic, were studied. An 18F-sodium fluoride PET/CT scan was acquired 180min after the i.v. injection of 370 MBq of 18F-sodium fluoride in all the patients. The images obtained were analyzed visually according to the intensity of the uptake. Results. All the plaques showed 18F-sodium fluoride uptake, regardless of the intensity. However, the plaques of the symptomatic group showed a level of 2 or greater intensity while the intensity in 6 of the 19 in the asymptomatic group was lower than 2. Conclusions. Although the study is limited by the small number of cases, the results show the feasibility of the technique to study the calcification of the atheroma using 18F-sodium fluoride and suggest an association between symptomatology and higher uptake of 18F-sodium fluoride. Thus, these results encourage us to continue this study, with the inclusion of a larger number of patients (AU)

Objetivo. Estudiar el proceso de calcificación de la placa de ateroma carotideo mediante 18F-fluoruro sódico PET/TAC. Material y métodos. Estudio prospectivo en 15 pacientes con ateromatosis carotidea detectada por angio-TAC durante su estudio neurológico. El total de placas de ateroma estudiadas fue de 29, 19 asintomáticas y 10 sintomáticas. En todos los pacientes se adquirió un estudio PET/TAC a los 180min De la administración intravenosa de 370 MBq de 18F-fluoruro sódico. Las imágenes se analizaron visualmente considerando la intensidad de captación. Resultados. Todas las placas captaron 18F-fluoruro sódico, con independencia de la intensidad. Sin embargo las placas del grupo sintomático mostraron una intensidad de 2 o mayor mientras que 6 de las 19 del grupo asintomático mostraron una intensidad inferior a 2. Conclusiones. Aunque el estudio está limitado por el pequeño número de casos, los resultados muestran la aplicabilidad de la técnica al estudio de la calcificación del ateroma con 18F-fluoruro sódico y sugieren una asociación entre la sintomatología y una mayor captación de 18F-fluoruro sódico. Por ello, estos resultados nos animan a continuar este estudio incluyendo un mayor número de pacientes (AU)

Contribution of 18F-sodium fluoride PET/CT to the study of the carotid atheroma calcification.

AIM: To assess the calcification process of the carotid plaque by (18)F-sodium fluoride PET/CT imaging. MATERIAL AND METHODS: A prospectively designed study including 15 patients in whom an atheroma plaque was detected by contrast enhanced CT scan during a neurological work-up was performed. A total of 29 plaques, 19 asymptomatic and 10 symptomatic, were studied. An (18)F-sodium fluoride PET/CT scan was acquired 180min after the i.v. injection of 370 MBq of (18)F-sodium fluoride in all the patients. The images obtained were analyzed visually according to the intensity of the uptake. RESULTS: All the plaques showed (18)F-sodium fluoride uptake, regardless of the intensity. However, the plaques of the symptomatic group showed a level of 2 or greater intensity while the intensity in 6 of the 19 in the asymptomatic group was lower than 2. CONCLUSIONS: Although the study is limited by the small number of cases, the results show the feasibility of the technique to study the calcification of the atheroma using (18)F-sodium fluoride and suggest an association between symptomatology and higher uptake of (18)F-sodium fluoride. Thus, these results encourage us to continue this study, with the inclusion of a larger number of patients.

Evaluación de la gammagrafía ósea y la 18F-FDG PET/TAC en las metástasis óseas del cáncer de pulmón / Evaluation of bone scintigraphy and 18F-FDG PET/CT in bone metastases of lung cancer patients

Objetivo. Comparar los hallazgos de la gammagrafía ósea (GO) y la gammagrafía PET/TAC con FDG (FDG PET/TAC) en la detección de metástasis óseas en el cáncer de pulmón. Material y métodos. Se estudió a 32 pacientes con cáncer de pulmón que fueron sometidos a una GO y una FDG PET/TAC en un periodo de tiempo de 15,9±18,6 días. Los resultados de ambas técnicas se compararon con la histología, cuando estuvo disponible, con técnicas estructurales radiológicas y con el seguimiento clínico. En 30 pacientes se llegó a un diagnóstico definitivo de los hallazgos gammagráficos. En 2 pacientes no se obtuvo diagnóstico final. Resultados. La GO fue positiva en 25/30 pacientes (83,3%) y negativa en 5 pacientes. La FDG PET/TAC fue positiva en 21/30 pacientes (710%) y negativa en 9. La GO y la FDG PET/TAC fueron positivas en 19/30 pacientes (63,3%). En 6 de los 19, ambas técnicas mostraron igual número de lesiones óseas. En 10 de los 19, la FDG PET/TAC mostró mayor número de metástasis óseas que la GO. En 3 de los 19 pacientes la GO mostró más lesiones que la FDG PET/TAC. En 2/30 pacientes (6,6%), la GO fue normal y la FDG PET/TAC demostró lesiones óseas confirmadas como metástasis. En 6/30 pacientes (20%) la FDG PET/TAC fue negativa y la GO positiva. La GO y la FDG PET/TAC fueron normales en 3/30 pacientes (10%). Conclusión. En pacientes con cáncer de pulmón, la FDG PET/TAC detecta un mayor número de lesiones óseas metastásicas que la GO. Asimismo identifica metástasis óseas en GO negativas. En nuestra experiencia, cuando la GO fue positiva y la FDG PET/TAC negativa las lesiones observadas estuvieron en su mayoría relacionadas con procesos óseos degenerativos y fracturas. En la práctica clínica la FDG PET/TAC y la GO tienen un papel complementario en la valoración ósea de los pacientes con cáncer de pulmón(AU)

Objective. To compare the bone scintigraphy (BS) findings and PET/CT scintigraphy with FDG (FDG PET/CT) in the detection of bone metastases in lung cancer. Material and methods. We studied 32 patients with lung cancer who underwent FDG PET/CT and BS in a period of 15.9±18.6 days. The results of both techniques were compared with the histology, where available, radiological structural techniques and the clinical follow-up. In 30 patients, a definitive diagnosis was reached with the scintigraphic findings. No final diagnosis was obtained in 2 patients. Results. BS was positive in 25/30 patients (83.3%) and negative in 5 patients. FDG PET/CT was positive in 21/30 patients (70%) and negative in 9. The BS and the FDG PET/CT were positive in 19/30 patients (63.3%) for the detection of bone metastases. In 6/19, both techniques showed the same number of bone lesions. In 10/19, FDG PET/CT showed a greater number of bone metastases than BS. In 3/19 patients, BS showed more lesions than FDG PET/CT and in 2/30 patients (6.6%), the BS was normal and the FDG PET/CT showed bone lesions which were confirmed as metastasis. In 6/30 patients (20%), the FDG PET/CT was negative and the BS was positive. BS and FDG PET/CT scan were normal in 3/30 patients (10%). Conclusions. In patients with lung cancer, FDG PET/CT scan detected more metastatic bone lesions than BS. It also identified bone metastasis in negative BS. In our experience, when the BS was positive and the FDG PET/CT scan was negative, the lesions observed were mostly related with degenerative bone conditions and bone fractures. In the clinical practice, the FDG PET/CT and BS have a complementary role for the assessment of bone status in lung cancer patients(AU)

[Evaluation of bone scintigraphy and (18)F-FDG PET/CT in bone metastases of lung cancer patients]. / Evaluación de la gammagrafía ósea y la (18)F-FDG PET/TAC en las metástasis óseas del cáncer de pulmón.

OBJECTIVE: To compare the bone scintigraphy (BS) findings and PET/CT scintigraphy with FDG (FDG PET/CT) in the detection of bone metastases in lung cancer. MATERIAL AND METHODS: We studied 32 patients with lung cancer who underwent FDG PET/CT and BS in a period of 15.9±18.6 days. The results of both techniques were compared with the histology, where available, radiological structural techniques and the clinical follow-up. In 30 patients, a definitive diagnosis was reached with the scintigraphic findings. No final diagnosis was obtained in 2 patients. RESULTS: BS was positive in 25/30 patients (83.3%) and negative in 5 patients. FDG PET/CT was positive in 21/30 patients (70%) and negative in 9. The BS and the FDG PET/CT were positive in 19/30 patients (63.3%) for the detection of bone metastases. In 6/19, both techniques showed the same number of bone lesions. In 10/19, FDG PET/CT showed a greater number of bone metastases than BS. In 3/19 patients, BS showed more lesions than FDG PET/CT and in 2/30 patients (6.6%), the BS was normal and the FDG PET/CT showed bone lesions which were confirmed as metastasis. In 6/30 patients (20%), the FDG PET/CT was negative and the BS was positive. BS and FDG PET/CT scan were normal in 3/30 patients (10%). CONCLUSIONS: In patients with lung cancer, FDG PET/CT scan detected more metastatic bone lesions than BS. It also identified bone metastasis in negative BS. In our experience, when the BS was positive and the FDG PET/CT scan was negative, the lesions observed were mostly related with degenerative bone conditions and bone fractures. In the clinical practice, the FDG PET/CT and BS have a complementary role for the assessment of bone status in lung cancer patients.