Concordancia entre SPECT portátil y la gammagrafía convencional para detección de ganglio centinela en cáncer de mama / Concordance between freehand SPECT and conventional scintigraphy for sentinel lymph node detection in breast cancer

Introducción: La SPECT portátil puede ser una técnica de imagen útil para la planificación preoperatoria de la biopsia selectiva del ganglio centinela (BSGC) ya que permite la localización del ganglio centinela (GC) mediante imágenes tomográficas en 3D y en tiempo real y determina su profundidad, después de unos minutos de exploración. El objetivo del estudio fue evaluar la correlación entre el número de GC detectados entre las imágenes de la SPECT portátil y la linfogammagrafía (LG). Materiales y métodos: Cien pacientes con diagnóstico de cáncer de mama infiltrante y sin evidencia clínica de afectación ganglionar, se sometieron prospectivamente a una BSGC. El estudio preoperatorio incluyó imágenes de SPECT portátil a los 15 min tras la inyección y de LG a los 25 y 60-90 min (precoz y tardía). Se analizó el acuerdo observado y se realizó un estudio de concordancia entre el número de GC detectados con SPECT portátil y LG. Resultados: El acuerdo observado en la detección de GC entre SPECT portátil y LG precoz fue del 72%; entre SPECT portátil y LG tardía del 85%, y entre la LG precoz y la tardía de un 87%. En el estudio de concordancia se registró una concordancia moderada entre la SPECT portátil y la LG precoz (coeficiente kappa: 0,42); una concordancia moderada-alta entre la SPECT portátil y la LG tardía (coeficiente kappa: 0,60), y una concordancia de moderada-alta entre la LG precoz y la tardía (coeficiente kappa: 0,70), sin diferencias significativas entre ellos (valor p=0,16). Conclusión: La SPECT portátil presentó una concordancia moderada-alta con los estudios de imagen convencional y podría ser una alternativa válida para el estudio prequirúrgico de la BSGC en el cáncer de mama.(AU)

Introduction: Freehand SPECT can be a useful imaging technique for preoperative planning of sentinel lymph node biopsy (SLNB) as it allows localization of the sentinel node by 3D and real-time tomographic imaging and determines its depth after a few minutes of scanning. The aim of the study was to evaluate the correlation between the number of detected SNs between freehand SPECT images and lymphoscintigraphy (LS). Materials and methods: One hundred patients with a diagnosis of invasive breast cancer and no clinical evidence of lymph node involvement prospectively underwent SLNB. The preoperative study included freehand SPECT imaging at 15min after injection and LS imaging at 25 and 60–90min after injection (early and late). The observed agreement was analyzed and a concordance study was performed between the number of SNs detected with freehand SPECT and LS. Results: The observed agreement in the detection of SNs between freehand SPECT and early LS was 72%; between freehand SPECT and late LS was 85%; and between early and late LS was 87%. In the concordance study, there was moderate concordance between freehand SPECT and early LS (kappa coefficient: 0.42); moderate-high concordance between freehand SPECT and late LS (kappa coefficient: 0.60); and moderate-high concordance between early and late LS (kappa coefficient: 0.70), with no significant differences between them (p-value=0.16). Conclusion: Freehand SPECT showed a moderate-high concordance with conventional imaging studies and could be a valid alternative for the presurgical study of SLNB in breast cancer.(AU)

Concordance between freehand SPECT and conventional scintigraphy for sentinel lymph node detection in breast cancer.

INTRODUCTION: Freehand SPECT can be a useful imaging technique for preoperative planning of sentinel lymph node biopsy (SLNB) as it allows localization of the sentinel node by 3D and real-time tomographic imaging and determines its depth after a few minutes of scanning. The aim of the study was to evaluate the correlation between the number of detected SNs between freehand SPECT images and lymphoscintigraphy (LS). MATERIALS AND METHODS: 100 patients with a diagnosis of invasive breast cancer and no clinical evidence of lymph node involvement prospectively underwent SLNB. The preoperative study included freehand SPECT imaging at 15min after injection and LS imaging at 25 and 60-90min after injection (early and late). The observed agreement was analyzed and a concordance study was performed between the number of SNs detected with freehand SPECT and LS. RESULTS: The observed agreement in the detection of SNs between freehand SPECT and early LS was 72%; between freehand SPECT and late LS was 85%; and between early and late LS was 87%. In the concordance study, there was moderate concordance between freehand SPECT and early LS (kappa coefficient: 0.42); moderate-high concordance between freehand SPECT and late LS (kappa coefficient: 0.60); and moderate-high concordance between early and late LS (kappa coefficient: 0.70), with no significant differences between them (p-value=0.16). CONCLUSION: Freehand SPECT showed a moderate-high concordance with conventional imaging studies and could be a valid alternative for the presurgical study of SLNB in breast cancer.

Radioguided surgery in primary hyperparathyroidism: a review of the different available techniques. / Cirugía radioguiada en el hiperparatiroidismo primario: revisión de las diferentes técnicas disponibles.

Parathyroidectomy has evolved over the years from bilateral neck exploration to a single gland approach using minimally invasive surgery. The precise presurgical localization of the problem gland, using functional techniques, such as double-phase scintigraphy with [99mTc] Tc-MIBI including SPECT-CT and PET-CT with [18F]-Choline and morphological ones, such as ultrasound have played a crucial role in this paradigm's shift. Radioguided surgery techniques have also adapted and grown with new contributions known for their indication in other fields. Thus, we currently have a wide range of techniques that have been added to the minimally invasive radioguided parathyroidectomy with [99mTc] Tc-MIBI, which was the first on the stage and for which more experience exists. Among them, in this update, we will discuss parathyroidectomy using ultrasound-guided ROLL technique as well as with the use of 125I seeds and finally, hybrid techniques that use radiotracer and fluorescence.

Utilidad del diagnóstico por la imagen en el mielolipoma extraadrenal / Utility of diagnostic imaging in the diagnosis of extra adrenal myelolipoma

No disponible

[The clinical relevance of FDG-PET imaging in severe traumatic brain injuries]. / Relevancia clínica de la FDG-PET en los traumatismos craneoencefálicos graves.

AIM: To evaluate the usefulness of positron emission tomography (PET) as a predictor of long-term disability after a severe traumatic brain injury (TBI). PATIENTS AND METHODS: Fifty-six patients who had sustained a severe TBI were assessed with a broad battery of cognitive and functional scales at baseline and 6-months after inclusion in a multidisciplinary rehabilitation program. All patients underwent a FDG-PET at baseline. A physician blind to clinical data performed a semiquantitative analysis (normal vs altered) of functional neuroimaging (PET), including four cortical and three subcortical areas. The total number of lesions (cortical, subcortical and total) was correlated to the intensity of the TBI and to clinical data at admission and at follow-up. RESULTS: All patients showed changes in cerebral metabolism, being the thalamus the area most frequently affected. The degree of cerebral hypometabolism showed a significant correlation with TBI severity, functional disability, global outcome and cognitive impairment not only at baseline but also at follow-up. CONCLUSIONS: According to our results, FDG-PET may be a useful tool when studying brain dysfunction after severe TBI. FDG-PET findings correlate with the TBI severity, and with the level of patients' disability, as well as with the degree of memory and intelligence impairment. However, clinical variables related to the severity of the TBI, still are the best predictors of functional outcome after TBI.

Relevancia clínica de la FDG-PET en los traumatismos craneoencefálicos graves / The clinical relevance of FDG-PET imaging in severe traumatic brain injuries

Resumen. Objetivo. Demostrar la utilidad de la tomografía por emisión de positrones (PET) como predictor de la discapacidad a largo plazo tras un traumatismo craneoencefálico (TCE). Pacientes y métodos. Se evaluó neuropsicológica y funcionalmente a 56 pacientes que habían sufrido un TCE grave al inicio y aproximadamente seis meses después de su inclusión en un programa de rehabilitación multidisciplinar. A todos los pacientes se les realizó una tomografía por emisión de positrones con fluordeoxiglucosa al inicio del tratamiento. De forma ciega, se determinó la presencia o ausencia de alteraciones en cuatro áreas corticales y tres subcorticales, y se determinaron tres índices cualitativos de metabolismo cerebral (cortical, subcortical y total). Los índices de metabolismo se correlacionaron con las variables relacionadas con la gravedad del traumatismo, y con la situación cognitiva y funcional de los pacientes en el momento de realizar la PET y al finalizar el programa de rehabilitación. Resultados. Todos los pacientes mostraron alteraciones en el metabolismo cerebral, y el tálamo fue el área más frecuentemente afectada. La intensidad del hipometabolismo cerebral se correlacionó significativamente con la gravedad del TCE y con la alteración cognitiva y funcional tanto al inicio como al final del tratamiento. Conclusiones. Las técnicas de neuroimagen funcional presentan una excelente sensibilidad para detectar alteraciones tras un TCE, además de ofrecer una buena correlación anatomoclínica. No obstante, las variables relacionadas con la gravedad del TCE, siguen siendo las mejores predictoras de la discapacidad resultante tras un TCE (AU)

Summary. Aim. To evaluate the usefulness of positron emission tomography (PET) as a predictor of long-term disability after a severe traumatic brain injury (TBI). Patients and methods. Fifty-six patients who had sustained a severe TBI were assessed with a broad battery of cognitive and functional scales at baseline and 6-months after inclusion in a multidisciplinary rehabilitation program. All patients underwent a FDG-PET at baseline. A physician blind to clinical data performed a semiquantitative analysis (normal vs altered) of functional neuroimaging (PET), including four cortical and three subcortical areas. The total number of lesions (cortical, subcortical and total) was correlated to the intensity of the TBI and to clinical data at admission and at follow-up. Results. All patients showed changes in cerebral metabolism, being the thalamus the area most frequently affected. The degree of cerebral hypometabolism showed a significant correlation with TBI severity, functional disability, global outcome and cognitive impairment not only at baseline but also at follow-up. Conclusions. According to our results, FDG-PET may be a useful tool when studying brain dysfunction after severe TBI. FDG-PET findings correlate with the TBI severity, and with the level of patients’ disability, as well as with the degree of memory and intelligence impairment. However, clinical variables related to the severity of the TBI, still are the best predictors of functional outcome after TBI (AU)

Determinación del factor de calibración para el samario-153 en el activímetro de dosis CRC®-35R / Determination of dose calibrator setting of the capintec CRC®-35R for samarium-153

Determination of dose calibrator setting of the capintec CRC®-35R for samarium-153 Objetivo. Determinar el factor de calibración del activímetro para el radionucleido samario-153 (153Sm) y estudiar la influencia de la geometría en la medida de la actividad, de forma que se pueda determinar con exactitud la actividad administrada al paciente.Material y métodos. El factor de calibración del actinímetro para el 153Sm se determinó a partir del valor medio de la respuesta del detector en un canal de factor de calibración conocido, utilizando fuentes de 153Sm de uso clínico. El factor de corrección según geometría se calculó a partir del valor de actividad real indicada por el fabricante y las medidas de actividad realizadas en vial y jeringa. Resultados. El factor de calibración obtenido es de 239 ± 4. El factor de corrección que tiene en cuenta la geometría es de 0,87 ± 0,07. La actividad medida en jeringa es un 18 % superior a la medida en vial. Conclusiones. El método empleado permite medir correctamente la actividad de 153Sm, tanto en vial como en jeringa para dosificar con exactitud la actividad de Samario [153Sm] lexidronam administrada al paciente

Objetive. The aim of this work is to determine the calibration factor for Sm-153 and evaluate the influenceof the geometry in the activity measurements in order to administer accurately the activity to the patient.Methods. The calibration factor for Sm-153 was determinated using the Sm-153 sources commonly used in clinical practice and the calibrator response in a known calibration setting. The geometry correction factor for the vial and the plastic syringe was calculated using the real activity indicated by the manufacturer and the activity measured in the vial and in the plastic syringe.Results. The calibration factor obtained is 239 ± 4 and the correction factor which takes in consideration the geometry is 0,87 ± 0,07. The activity measured in the syringe is eighteen percent higher to activity measured in the vial. Conclusion. This method allows to measure accurately the activity of Sm-153 in vial and syringe applying this geometry correction factor to determine accurately the activity administered to the patient (AU)

[Determination of dose calibrator setting of the capintec CRC-35R for samarium-153]. / Determinación del factor de calibración para el samario-153 en el activímetro de dosis CRC-35R.

OBJECTIVE: The aim of this work is to determine the calibration factor for Sm-153 and evaluate the influence of the geometry in the activity measurements in order to administer accurately the activity to the patient. METHODS: The calibration factor for Sm-153 was determinated using the Sm-153 sources commonly used in clinical practice and the calibrator response in a known calibration setting. The geometry correction factor for the vial and the plastic syringe was calculated using the real activity indicated by the manufacturer and the activity measured in the vial and in the plastic syringe. RESULTS: The calibration factor obtained is 239 +/- 4 and the correction factor which takes in consideration the geometry is 0,87 +/- 0,07. The activity measured in the syringe is eighteen percent higher to activity measured in the vial. CONCLUSION: This method allows to measure accurately the activity of Sm-153 in vial and syringe applying this geometry correction factor to determine accurately the activity administered to the patient.

Carcinoma bronquioloalveolar como causa potencial de falso negativo con PET-FDG / Bronchioloalveolar carcinoma as potencial cause of false negative with PET-FDG

No disponible

Gammagrafía con leucocitos marcados en la pancreatitis aguda. Resultados preliminares / Scintigraphy with labelled leukocytes in acute pancreatitis. Preliminary results

El propósito de este trabajo es analizar la aportación del estudio con leucocitos marcados con 99mTcHMPAO en la valoración pronóstica de los enfermos con pancreatitis aguda. Para ello, hemos comparado los métodos habituales de evaluación pronóstica, la tomografía computarizada (TC) y la escala clínica de Ranson con los hallazgos gammagráficos en 23 pacientes consecutivos, con diagnóstico de pancreatitis aguda leve o severa. Todos los pacientes con diagnóstico de pancreatitis severa (6 pacientes), presentaron captación y esta fue mayoritariamente poco intensa. 9 de los pacientes con diagnóstico de pancreatitis leve (17 pacientes) mostraron captación, también predominantemente poco intensa. Al comparar el índice de severidad de la TC con los resultados de los leucocitos, el único paciente con índice de severidad alto mostró captación de grado 3. Sin embargo, en más de la mitad de los pacientes con índice de severidad bajo se encontró captación, generalmente poco intensa. Al comparar el grado de captación con el nivel de gravedad según la clasificación de Ranson, se observó un predominio de la captación leve tanto en los pacientes con pancreatitis leve como en los pacientes con pancreatitis severa. Antes estos resultados, pensamos que la ausencia de captación en el estudio con leucocitos en pacientes con pancreatitis aguda, puede interpretarse como signo de buen pronóstico. El hallazgo de captación en área pancreática tiene un significado incierto y es necesario el estudio con muestras de mayor tamaño. (AU)

[Scintigraphy with labelled leukocytes in acute pancreatitis. Preliminary results]. / Gammagrafía con leucocitos marcados en la pancreatitis aguda. Resultados preliminares.

This study aims to evaluate the contribution of the 99mTc-HMPAO labelled leukocyte in the prognostic assessment of patients with acute pancreatitis. We have compared the usual methods of prognostic evaluation (computed tomography CT and the Ranson clinical score scale) with the scintigraphic findings in 23 consecutive patients with a clinical diagnosis of mild or severe acute pancreatitis. All 6 patients with severe pancreatitis showed an uptake which was mostly mild. 9/17 patients with mild pancreatitis showed uptake, which also frequently had a low intensity. When the severity index of CT was compared with the leukocyte results, the only patient with a high severity index showed a grade 3 uptake. However, in over 50% of the patients with a low severity index, uptake, generally having a low intensity, was found. When the uptake degree was compared with the Ranson score level, we observed a predominance of mild uptake in both patients with mild and severe pancreatitis. Considering these results, we believe that the lack of uptake in the leukocyte study in a patient with acute pancreatitis can be interpreted as a good prognosis sign. The significance of the finding of uptake in the pancreatic area is uncertain and studies should be performed in larger sized samples.