Fatal consequences of decreased sensitivity to pain and temperature in a frontotemporal dementia patient.

Frontotemporal dementia (FTD) is a heterogeneous syndrome characterized by the progressive damage of frontal and temporal brain regions. These networks largely overlap with those involved in pain and temperature processing. Although the impaired perception of pain and temperature has been previously described to be relatively common in patients with FTD, these symptoms are often not consistently assessed by Neurologists. We present the case of a patient with a probable behavioral variant FTD who died due to scalding with hot water in the shower. Impairments in the perception of pain and temperature might have played a fundamental role in this accident.

Preparación, radiomarcaje con 99mTc y 67Ga y estudios de biodistribución de nanopartículas de albúmina con recubrimientos poliméricos / Preparation, radiolabeling with 99mTc and 67Ga and biodistribution studies of albumin nanoparticles covered with polymers

OBJETIVO: Optimizar el radiomarcaje con 99mTc y 67Ga de nanopartículas de albúmina recubiertas con 4 polímeros sintéticos distintos y evaluar su estabilidad in vivo e in vitro, así como su biodistribución in vivo tras su administración intravenosa. MATERIAL Y MÉTODOS: Las nanopartículas se prepararon empleando albúmina y albúmina modificada con NOTA mediante el método de desolvatación y se recubrieron con 4 polímeros distintos; HPMC, GMN2, GPM2 y GTM2. Se purificaron, liofilizaron y caracterizaron. El marcaje con 99mTc se realizó con 74MBq de pertecnetato [99mTc] sódico previamente reducido con una disolución ácida de cloruro de estaño a diferentes concentraciones (0,003; 0,005; 0,007; 0,01; 0,05 y 0,1mg/ml), a distintos tiempos (5, 10, 15, 30 y 60min) y temperaturas (temperatura ambiente, 40°C y 60°C). El marcaje con 67Ga se llevó a cabo mediante incubación de las nanopartículas con 37MBq de cloruro de 67Ga (obtenido a partir de citrato de 67Ga comercial) a distintos tiempos (10 y 30min) y temperaturas (temperatura ambiente, 30°C y 60°C) y posterior purificación con microconcentradores. La pureza radioquímica de ambos marcajes se evaluó mediante TLC. Se llevaron a cabo estudios de estabilidad de las nanopartículas marcadas en suero fisiológico y plasma sanguíneo. Los estudios de biodistribución de las nanopartículas recubiertas con el polímero GPM2 se llevaron a cabo en ratas Wistar tras la administración intravenosa de las nanopartículas. Se realizaron animales control con pertecnetato [99mTc] sódico y cloruro de 67Ga. Posteriormente, los animales fueron sacrificados y se midió la actividad de los órganos en un contador gamma. RESULTADOS: El marcaje con 99mTc se llevó a cabo de forma óptima con una concentración de estaño de 0,007mg/ml para las nanopartículas GPM2 y de 0,005mg/ml para el resto de formulaciones, con un tiempo de marcaje de 10min y a temperatura ambiente. En el caso del 67Ga el marcaje se optimizó a 30°C de temperatura y 30min de incubación. En ambos casos, la pureza radioquímica obtenida fue superior al 97%. Las nanopartículas presentaron una elevada estabilidad in vitro pasadas las 48h del marcaje (70% las nanopartículas marcadas con 99mTc y 90% las marcadas con 67Ga). Los estudios de biodistribución de las nanopartículas [99mTc]-GPM2 y [67Ga]-NOTA-GPM2 mostraron una elevada acumulación de actividad en el hígado tanto a las 2h como a las 24h de la administración intravenosa. CONCLUSIÓN: El procedimiento de marcaje con 99mTc y 67Ga de nanopartículas de albúmina y albúmina modificada con NOTA permite la obtención de nanopartículas con elevados rendimientos de marcaje y una adecuada estabilidad in vitro, permitiendo su utilización para la realización de estudios in vivo

OBJECTIVE: To optimize radiolabeling with 99mTc and 67Ga of albumin nanoparticles coated with 4 differents synthetic polymers and to evaluate their stability in vivo and in vitro, as well as their biodistribution in vivo after intravenous administration. MATERIAL AND METHODS: The nanoparticles were prepared using albumin and NOTA-modified albumin by the desolvation method and coated with 4 different polymers; HPMC, GMN2, GPM2 and GTM2. They were purified, lyophilized and characterized. Radiolabelling with 99mTc was perfomed with 74 MBq of 99mTc sodium pertechnetate, previously reduced with and acid solution of tin chloride at different concentrations (0.003, 0.005, 0.007, 0.01, 0.05 and 0.1mg/ml) and at different times (5, 10, 15, 30 and 60minutes) and temperatures (room temperature, 40°C and 60°C). Radiolabelling with 67Ga was perfomed by incubation of the nanoparticles with 37 MBq of 67Gallium chloride (obtained from commercial gallium-67 citrate) at different times (10 and 30minutes) and temperatures (room temperature, 30°C and 60°C), and posterior purification with microconcentrators. The radiochemical purity was evaluated by TLC. Stability studies of radiolabeled nanoparticles in physiological serum and blood plasma were perfomed. Biodistribution studies of nanoparticles coated with GPM2 polymer were carried out in Wistar rats after intravenous administration of the nanoparticles. Control animals were carried out with 99mTc sodium pertechnetate and 67Ga chloride. To do so, the animals were killed and activity in organs was measured in a gamma counter. RESULTS: 99mTc labeling was carried out optimally with a tin concentration of 0.007mg/ ml for the GPM2 nanoparticles and 0.005mg / ml for the rest of the formulations, with a radiolabelling time of 10minutes at room temperature. In the case of 67Ga the label was optimized at 30° C temperature and 30minutes of incubation. In both cases the radiochemical purity obtained was greater than 97%. The nanoparticles showed high stability in vitro after 48hours of labeling (70% nanoparticles labeled with 99mTc and 90% those labeled with 67Ga). Biodistribution studies of nanoparticles 99mTc -GPM2 and 67Ga -NOTA-GPM2 showed a high accumulation of activity in the liver at 2 and 24hours after intravenous administration. CONCLUSION: The labeling procedure with 99mTc and 67Ga of albumin and albumin modified with NOTA nanoparticles allows obtaining nanoparticles with high labeling yields and adequate in vitro stability, allowing their use for in vivo studies

Detección de meningioma en un paciente con deterioro cognitivo leve evaluado mediante 11C-PIB y 18F-FDG PET/TC / Detection of meningioma in a patient with mild cognitive impairment assessed by 11C-PIB and 18F-FDG PET/CT

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Preparation, radiolabeling with 99mTc and 67Ga and biodistribution studies of albumin nanoparticles covered with polymers. / Preparación, radiomarcaje con 99mTc y 67Ga y estudios de biodistribución de nanopartículas de albúmina con recubrimientos poliméricos.

OBJECTIVE: To optimize radiolabeling with 99mTc and 67Ga of albumin nanoparticles coated with 4 differents synthetic polymers and to evaluate their stability in vivo and in vitro, as well as their biodistribution in vivo after intravenous administration. MATERIAL AND METHODS: The nanoparticles were prepared using albumin and NOTA-modified albumin by the desolvation method and coated with 4 different polymers; HPMC, GMN2, GPM2 and GTM2. They were purified, lyophilized and characterized. Radiolabelling with 99mTc was perfomed with 74 MBq of 99mTc sodium pertechnetate, previously reduced with and acid solution of tin chloride at different concentrations (0.003, 0.005, 0.007, 0.01, 0.05 and 0.1mg/ml) and at different times (5, 10, 15, 30 and 60minutes) and temperatures (room temperature, 40°C and 60°C). Radiolabelling with 67Ga was perfomed by incubation of the nanoparticles with 37 MBq of 67Gallium chloride (obtained from commercial gallium-67 citrate) at different times (10 and 30minutes) and temperatures (room temperature, 30°C and 60°C), and posterior purification with microconcentrators. The radiochemical purity was evaluated by TLC. Stability studies of radiolabeled nanoparticles in physiological serum and blood plasma were perfomed. Biodistribution studies of nanoparticles coated with GPM2 polymer were carried out in Wistar rats after intravenous administration of the nanoparticles. Control animals were carried out with 99mTc sodium pertechnetate and 67Ga chloride. To do so, the animals were killed and activity in organs was measured in a gamma counter. RESULTS: 99mTc labeling was carried out optimally with a tin concentration of 0.007mg/ ml for the GPM2 nanoparticles and 0.005mg / ml for the rest of the formulations, with a radiolabelling time of 10minutes at room temperature. In the case of 67Ga the label was optimized at 30° C temperature and 30minutes of incubation. In both cases the radiochemical purity obtained was greater than 97%. The nanoparticles showed high stability in vitro after 48hours of labeling (70% nanoparticles labeled with 99mTc and 90% those labeled with 67Ga). Biodistribution studies of nanoparticles 99mTc -GPM2 and 67Ga -NOTA-GPM2 showed a high accumulation of activity in the liver at 2 and 24hours after intravenous administration. CONCLUSION: The labeling procedure with 99mTc and 67Ga of albumin and albumin modified with NOTA nanoparticles allows obtaining nanoparticles with high labeling yields and adequate in vitro stability, allowing their use for in vivo studies.

Inesperada metástasis mamaria de melanoma cutáneo en PET/TC con 18F-FDG / Unexpected breast metastasis from cutaneous melanoma on 18F-FDG PET/CT

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Aportación de la PET/TC con 11C-colina en la recidiva bioquímica del cáncer de próstata con antígeno específico prostático sérico inferior a 1 ng/ml / Contribution of 11C-Choline PET/CT in prostate carcinoma biochemical relapse with serum PSA level below 1 ng/ml

Objetivo. La PET/TC con 11C-colina ha mostrado buenos resultados en la reestadificación del cáncer de próstata (CP) con antígeno específico prostático (PSA) elevado. Su uso con niveles bajos es controvertido. Nuestro objetivo fue evaluar la aportación de la 11C-colina PET/TC en pacientes con CP, recidiva bioquímica y PSA <1ng/ml. Material y método. Se evaluaron retrospectivamente 50 pacientes consecutivos (edad: 65,9±5,6 años) con recidiva bioquímica de CP y PSA <1ng/ml (media: 0,4±0,2). La PET/TC fue adquirida a los 20 min de la administración intravenosa de 555-740 MBq de 11C-colina. El seguimiento mínimo fue de 30 meses. Resultados. De los 50 pacientes, 21 (42%) mostraron una 11C-colina PET/TC anormal. En 7 (14%) se confirmó la afectación tumoral (4 en lecho prostático, 4 en ganglios pélvicos, 2 en ganglios mediastínicos y un tumor síncrono sigmoide) y se modificó en todos ellos el tratamiento inicialmente previsto. En 2 pacientes (4%) se confirmó enfermedad benigna (uno con sarcoidosis, otro con secuelas de TBC) y en 3 pacientes (6%) ausencia de enfermedad. En los otros 9 pacientes (18%) los hallazgos no fueron estudiados (7 en ganglios mediastínicos y 4 en pélvicos). La 11C-colina PET/TC fue normal en 29 pacientes (58%). Solo en 2 de ellos se confirmó recidiva a los 30 meses. Conclusión. La 11C-colina PET/TC demostró su utilidad en la recidiva bioquímica de CP y PSA <1 ng/ml en el 14% de los pacientes al mostrar enfermedad tumoral, lo que tuvo implicaciones terapéuticas. En un 4% se detectó enfermedad benigna. Una 11C-colina PET/TC normal se asoció a una tasa de recurrencia muy baja a los 30 meses

Objective. 11C-choline PET/CT has demonstrated good results in the restaging of prostate cancer (PCa) with high serum prostate specific antigen (PSA), but its use in patients with low serum PSA is controversial. Our aim was to evaluate the contribution of 11C-choline PET/CT in patients with PCa, biochemical relapse and PSA <1 ng/ml. Material and method. Fifty consecutive patients (mean age: 65.9±5.6 years) with biochemical relapse of PCa and serum PSA <1ng/ml were evaluated retrospectively. PET/CT was performed 20min after intravenous administration of 555-740 MBq of 11C-choline. Minimum follow up time was 30 months. Results. Twenty-one out of 50 patients (42%) had an abnormal 11C-choline PET/CT. In 7 out of 21 patients (14%) tumor was confirmed (4 in prostatic bed, 4 in pelvic lymph nodes, 2 in mediastinal lymph nodes and one synchronous sigmoid carcinoma), and in all cases the initial therapeutic planning was modified. In 2 patients (4%) subsequent tests diagnosed a benign disease (one sarcoidosis, one tuberculosis sequelae) and in 3 patients (6%) they ruled out pathology. The other 9 patients (18%) had no further assessment (7 mediastinal and 4 pelvic lymph nodes). Twenty-nine out of 50 patients (58%) had a normal PET/CT. At 30 months, follow up recurrence was confirmed only in 2 of these patients. Conclusions. 11C-choline PET/CT proved its usefulness in demonstrating tumor in 14% of patients with BR of PCa and serum PSA <1ng/ml, with therapeutic implications. In 4% of patients a benign condition was detected. A normal 11C-choline PET/CT was associated with a very low rate of recurrence at 30 months

Imagen de PET/TC con 18F-FDG en "casco de minero" de una metástasis solitaria del hueso frontal secundaria a adenocarcinoma rectal / "Miner's cap-like" solitary frontal bone metastasis from rectal adenocarcinoma on 18F-FDG PET/CT

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Patrones de retención de 11C-PIB en la sustancia blanca y en la sustancia gris cerebral de pacientes con hidrocefalia a presión normal idiopática. Un análisis visual / 11C-PIB retention patterns in white and grey cerebral matter in idiopathic normal pressure hydrocephalus patients. A visual analysis

Objetivo. El depósito cortical de amiloide, una seña de identidad de la enfermedad de Alzheimer, se ha observado en la hidrocefalia a presión normal (HPN). Nuestro objetivo fue comparar el patrón de retención de 11C-PIB PET/TC en pacientes con HPN y sujetos sanos. Material y métodos. Hemos comparado el patrón de retención de 11C-PIB en 13 casos de HPN seleccionados para cirugía derivativa con una población control normal. Las imágenes se analizaron visualmente y puntuaron de 1-4 (de ligera a muy alta retención de PIB) tanto en la sustancia gris como en la sustancia blanca (SB). La puntuación se analizó por separado en las regiones infra y supratentoriales de ambos grupos. Se emitió un informe clínico en términos de positivo, negativo o dudoso/equívoco. Resultados. Ocho 11C-PIB PET/TC se informaron como negativos, 3 positivos y 2 dudosos. Cinco de 13 pacientes mostraron al menos una región cortical con retención de PIB de intensidad mayor que la observada en el grupo control. En general, la retención de PIB en la SB de los pacientes con HPN tuvo puntuaciones menores que en el grupo control, mostrando una diferencia estadísticamente significativa en la SB infratentorial (92/104 vs. 54/56, p<0,05) y una tendencia a ser menor en las regiones supratentoriales (70/84 vs. 122/156; p=0,327), en particular en la región periventricular superior (25/28 vs. 40/52; p=0,134). Conclusiones. Los patrones de retención de 11C-PIB parecen ser diferentes en los pacientes con HPN comparados con sujetos normales. La retención de PIB en la SB de la HPN aparece menos intensa que en sujetos sanos y estos muestran un mayor grado de retención de PIB en las regiones corticales. Esto merece ser tomado en consideración (AU)

Objective. Cortical cerebral amyloid disease, a hallmark of Alzheimer's disease, has also been observed in idiopathic normal pressure hydrocephalus (iNPH). The aim of this study was to compare the 11C-PIB PET/CT retention pattern in iNPH patients and healthy subjects. Material and methods. A comparison was made of the 11C-PIB PET/CT retention pattern in 13 iNPH patients selected for surgical deviation, compared to a normal control population. Images were visually analyzed and scored for gray matter and white matter (WM) from 1 to 4 (slight to very high PIB retention). The scoring was analyzed in both groups separately for infra- and supra-tentorial regions. A comprehensive clinical report was presented in terms of positive, negative, or equivocal. Results. 11C-PIB PET/CT scan were reported as negative in 8, positive in 3, and equivocal in 2. Five of 13 patients showed at least one cortical area with PIB retention with an intensity higher than that observed in the control group. Overall, white matter (WM) PIB retention of iNPH scored lower than in the control group, showing a statistically significant difference in the infratentorial WM (92/104 vs 54/56; p<.05) and a tendency to be lower in the supratentorial regions (70/84 vs 122/156, p=.327), in particular in the upper periventricular region (25/28 vs 40/52; p=.134). Conclusions. The PIB retention pattern seems to be different in NPH, compared to normal subjects. PIB retention in WM of NPH appears less intense than in healthy subjects, and they show a higher degree of PIB retention in cortical regions. This deserves to be taken it into account (AU)

Contribution of 11C-Choline PET/CT in prostate carcinoma biochemical relapse with serum PSA level below 1 ng/ml. / Aportación de la PET/TC con 11C-colina en la recidiva bioquímica del cáncer de próstata con antígeno específico prostático sérico inferior a 1 ng/ml.

OBJECTIVE: 11C-choline PET/CT has demonstrated good results in the restaging of prostate cancer (PCa) with high serum prostate specific antigen (PSA), but its use in patients with low serum PSA is controversial. Our aim was to evaluate the contribution of 11C-choline PET/CT in patients with PCa, biochemical relapse and PSA <1 ng/ml. MATERIAL AND METHOD: Fifty consecutive patients (mean age: 65.9±5.6 years) with biochemical relapse of PCa and serum PSA <1ng/ml were evaluated retrospectively. PET/CT was performed 20min after intravenous administration of 555-740 MBq of 11C-choline. Minimum follow up time was 30 months. RESULTS: Twenty-one out of 50 patients (42%) had an abnormal 11C-choline PET/CT. In 7 out of 21 patients (14%) tumor was confirmed (4 in prostatic bed, 4 in pelvic lymph nodes, 2 in mediastinal lymph nodes and one synchronous sigmoid carcinoma), and in all cases the initial therapeutic planning was modified. In 2 patients (4%) subsequent tests diagnosed a benign disease (one sarcoidosis, one tuberculosis sequelae) and in 3 patients (6%) they ruled out pathology. The other 9 patients (18%) had no further assessment (7 mediastinal and 4 pelvic lymph nodes). Twenty-nine out of 50 patients (58%) had a normal PET/CT. At 30 months, follow up recurrence was confirmed only in 2 of these patients. CONCLUSIONS: 11C-choline PET/CT proved its usefulness in demonstrating tumor in 14% of patients with BR of PCa and serum PSA <1ng/ml, with therapeutic implications. In 4% of patients a benign condition was detected. A normal 11C-choline PET/CT was associated with a very low rate of recurrence at 30 months.

11C-PIB retention patterns in white and grey cerebral matter in idiopathic normal pressure hydrocephalus patients. A visual analysis. / Patrones de retención de 11C-PIB en la sustancia blanca y en la sustancia gris cerebral de pacientes con hidrocefalia a presión normal idiopática. Un análisis visual.

OBJECTIVE: Cortical cerebral amyloid disease, a hallmark of Alzheimer's disease, has also been observed in idiopathic normal pressure hydrocephalus (iNPH). The aim of this study was to compare the 11C-PIB PET/CT retention pattern in iNPH patients and healthy subjects. MATERIAL AND METHODS: A comparison was made of the 11C-PIB PET/CT retention pattern in 13 iNPH patients selected for surgical deviation, compared to a normal control population. Images were visually analyzed and scored for gray matter and white matter (WM) from 1 to 4 (slight to very high PIB retention). The scoring was analyzed in both groups separately for infra- and supra-tentorial regions. A comprehensive clinical report was presented in terms of positive, negative, or equivocal. RESULTS: 11C-PIB PET/CT scan were reported as negative in 8, positive in 3, and equivocal in 2. Five of 13 patients showed at least one cortical area with PIB retention with an intensity higher than that observed in the control group. Overall, white matter (WM) PIB retention of iNPH scored lower than in the control group, showing a statistically significant difference in the infratentorial WM (92/104 vs 54/56; p<.05) and a tendency to be lower in the supratentorial regions (70/84 vs 122/156, p=.327), in particular in the upper periventricular region (25/28 vs 40/52; p=.134). CONCLUSIONS: The PIB retention pattern seems to be different in NPH, compared to normal subjects. PIB retention in WM of NPH appears less intense than in healthy subjects, and they show a higher degree of PIB retention in cortical regions. This deserves to be taken it into account.

Candida Esophagitis Incidentally Detected by 18F-FDG PET/CT in Metastatic Lung Adenocarcinoma.

The diagnostic significance of esophageal 18F-FDG uptake in oncologic patient is challenging. It may represent normal physiological uptake, inflammation, infection, or neoplasia. We present a patient with a recent diagnosis of non-small cell lung cancer stage IV and esophageal mild uptake on 18F-FDG PET/CT scan. Biopsy of esophageal mucosa demonstrated Candida esophagitis.

Ventilation/Perfusion SPECT lung scintigraphy and computed tomography pulmonary angiography in patients with clinical suspicion of pulmonary embolism / Gammagrafía pulmonar SPECT de Ventilación/Perfusión y angiografía pulmonar computerizada en pacientes con sospecha clínica de tromboembolismo pulmonar

The aim was to compare ventilation/perfusion SPECT lung scintigraphy (V/Q-SPECT) and computed tomography pulmonary angiography (CTPA) in patients with suspicion of pulmonary embolism (PE). Material and methods. This prospectively designed study included 53 patients with intermediate or high clinical probability of PE. A V/Q-SPECT and CTPA was performed on all patients. The V/Q-SPECT was interpreted according to the European Association of Nuclear Medicine and Molecular Imaging (EANMMI) guidelines. CTPA was reported as positive, negative, or indeterminate. Results. CTPA was positive in 22 cases, negative in 28, and indeterminate in 3. V/Q-SPECT was positive in 27 cases, negative in 24, and non-diagnostic in 2. In the 22 with positive CTPA, V/Q-SPECT was positive in 18, negative in 3, and non-diagnostic in 1. In the 28 with negative CTPA, V/Q-SPECT was positive in 8, negative in 19, and non-diagnostic in 1. In the 3 with indeterminate CTPA, V/Q-SPECT was positive in 1 and negative in 2. In the 2 non-diagnostic cases V/Q-SPECT, CTPA was positive in 1 and negative in one. In the 10 high clinical probabilities, CTPA and V/Q-SPECT were positive in 7, negative in 2, and in 1, CTPA was positive and V/Q-SPECT negative. In the 38 intermediate probability group, CTPA and V/Q-SPECT were positive in 11, negative in 17, with CTPA negative and V/Q-SPECT positive in 8, and in 2 CTPA was positive and V/Q-SPECT negative. The results show that V/Q-SPECT detected PE in 5 patients more than CTPA. Conclusion. Our results show a 77% concordance of both techniques. Overall V/Q-SPECT detected PE in 18% more patients than CTPA in the intermediate group. Both techniques have a complementary role when a diagnosis cannot be made with one of them (AU)

Objetivo. Comparar la gammagrafía pulmonar SPECT de ventilación/perfusión (SPECT-V/Q) y la angiografía pulmonar computarizada (CTPA) en pacientes con sospecha de tromboembolismo pulmonar (TEP). Material y métodos. Estudio prospectivo en 53 pacientes con probabilidad intermedia y alta de TEP. A todos se les realizó SPECT-V/Q y CTPA. La SPECT-V/Q fue interpretada según la guía publicada por la European Association of Nuclear Medicine and Molecular Imaging (EANMMI). La CTPA fue reportada como positiva, negativa o indeterminada. Resultados. La CTPA fue positiva en 22, negativa en 28 e indeterminada en 3. La SPECT-V/Q fue positiva en 27, negativa en 24 y no diagnóstica en 2. En 22 con CTPA positiva, la SPECT-V/Q fue positiva en 18, negativa en 3 y no diagnóstica en una. En 28 con CTPA negativa, la SPECT-V/Q fue positiva en 8, negativa en 19 y no diagnóstica en uno. En 3 con CTPA indeterminada, la SPECT-V/Q fue positiva en una y negativa en 2. En 2 con SPECT-V/Q no diagnóstica, la CTPA fue positiva en una y negativa en una. En 10 con probabilidad clínica alta la CTPA y la SPECT-V/Q fueron positivas en 7, negativas en 2 y en una la CTPA fue positiva y la SPECT-V/Q negativa. En 38 con probabilidad intermedia la CTPA y la SPECT-V/Q fueron positivas en 11 y negativas en 17. En 8 la CTPA fue negativa y la SPECT-V/Q positiva, en 2 la CTPA fue positiva y la SPECT-V/Q negativa; por lo tanto, la SPECT-V/Q detectó TEP en 5 pacientes más de la CTPA. Conclusión. Nuestros resultados muestran un 77% de concordancia entre ambas técnicas. En general la SPECT-V/Q detectó TEP en 18% más pacientes que la CTPA en el grupo con probabilidad intermedia. Ambas técnicas tienen un papel complementario cuando el diagnóstico no puede ser alcanzado por una de ellas (AU)

Patterns of 11C-PIB cerebral retention in mild cognitive impairment patients / Patrones de retención cerebral de 11C-PIB en pacientes con deterioro cognitivo leve

Objective. To evaluate the patterns of cerebral cortical distribution of 11C-PIB in patients with mild cognitive impairment (MCI). Material and methods. The study included 69 patients (37 male, age range 42-79 years) with MCI, sub-classified as 53 with amnestic-MCI (A-MCI), and 16 with non-amnestic-MCI (NA-MCI). Patients underwent 11C-PIB PET/CT scan 60 min after intravenous injection of the radiotracer. A visual analysis of the images was performed by 2 experienced physicians. 11C-PIB-positive studies were considered when gray matter uptake was equal to or greater than white matter. According to the regions involved, 11C-PIB-positive studies were classified into A-pattern (predominant retention in frontal, anterior cingulate, lateral temporal, and basal ganglia) and B-pattern (generalized retention). Results. Thirty-nine of the 69 (56%) patients with MCI showed 11C-PIB retention. Of the 53 A-MCI patients, 36 (68%) showed 11C-PIB retention. Eleven out of 36 (30%) positive scans in A-MCI patients showed A-pattern, and 25 out of 36 (70%) patients had a B-pattern. Positive 11C-PIB was observed in 3 out of 16 (19%) patients with NA-MCI. Regional distribution in these 3 patients showed A-pattern in 1, and B-pattern in 2 patients. Conclusion. Cortical retention of 11C-PIB was more frequent in A-MCI than in NA-MCI patients, and also B-pattern than A-pattern in the 11C-PIB positive group. The recognition of 11C-PIB distribution patterns allows MCI patients to be classified, and the A-pattern may offer a therapeutic window for potential future treatments (AU)

Objetivo. Evaluar los patrones de distribución cortical cerebral de 11C-PIB en pacientes con deterioro cognitivo leve (DCL). Material y métodos. El estudio incluyó 69 pacientes (37 varones, rango de edad 42-79 años) con DCL, que fueron clasificados en 53 DCL amnésico (DCL-A) y 16 DCL no amnésico (DCL-NA). Se obtuvo una PET/TC 11C-PIB 60 min después de la inyección intravenosa del radiotrazador. Se realizó un análisis visual de las imágenes por 2 médicos con experiencia. Los estudios 11C-PIB se consideraron positivos cuando la captación en la sustancia gris fue igual o superior a la captación en la sustancia blanca. Dependiendo de las regiones afectadas, los estudios 11C-PIB positivos se clasificaron en patrón A (retención predominante en frontal, cingulado anterior, lateral temporal y ganglios basales) y patrón B (retención generalizada). Resultados. De los 69 pacientes con DCL, 39 (56%) mostraron retención de 11C-PIB. De los 53 pacientes DCL-A, 36 (68%) tuvieron retención cerebral de 11C-PIB. Once de los 36 (30%) estudios positivos en los pacientes DCL-A mostraron un patrón A y 25 de los 36 (70%) pacientes presentaron un patrón B. Se observaron estudios 11C-PIB positivos en 3 de los 16 (19%) pacientes con DCL-NA. En estos 3 pacientes la distribución regional mostró patrón A en uno y patrón B en 2 pacientes. Conclusión. La retención cortical de 11C-PIB fue más frecuente en pacientes con DCL-A que en pacientes con DCL-NA, y, asimismo, el patrón B que el patrón A en el grupo 11C-PIB positivo. La identificación de los patrones de distribución de 11C-PIB permite una caracterización de los pacientes con DCL; el patrón A puede ofrecer una ventana para potenciales tratamientos en el futuro (AU)

Ventilation/Perfusion SPECT lung scintigraphy and computed tomography pulmonary angiography in patients with clinical suspicion of pulmonary embolism.

UNLABELLED: The aim was to compare ventilation/perfusion SPECT lung scintigraphy (V/Q-SPECT) and computed tomography pulmonary angiography (CTPA) in patients with suspicion of pulmonary embolism (PE). MATERIAL AND METHODS: This prospectively designed study included 53 patients with intermediate or high clinical probability of PE. A V/Q-SPECT and CTPA was performed on all patients. The V/Q-SPECT was interpreted according to the European Association of Nuclear Medicine and Molecular Imaging (EANMMI) guidelines. CTPA was reported as positive, negative, or indeterminate. RESULTS: CTPA was positive in 22 cases, negative in 28, and indeterminate in 3. V/Q-SPECT was positive in 27 cases, negative in 24, and non-diagnostic in 2. In the 22 with positive CTPA, V/Q-SPECT was positive in 18, negative in 3, and non-diagnostic in 1. In the 28 with negative CTPA, V/Q-SPECT was positive in 8, negative in 19, and non-diagnostic in 1. In the 3 with indeterminate CTPA, V/Q-SPECT was positive in 1 and negative in 2. In the 2 non-diagnostic cases V/Q-SPECT, CTPA was positive in 1 and negative in one. In the 10 high clinical probabilities, CTPA and V/Q-SPECT were positive in 7, negative in 2, and in 1, CTPA was positive and V/Q-SPECT negative. In the 38 intermediate probability group, CTPA and V/Q-SPECT were positive in 11, negative in 17, with CTPA negative and V/Q-SPECT positive in 8, and in 2 CTPA was positive and V/Q-SPECT negative. The results show that V/Q-SPECT detected PE in 5 patients more than CTPA. CONCLUSION: Our results show a 77% concordance of both techniques. Overall V/Q-SPECT detected PE in 18% more patients than CTPA in the intermediate group. Both techniques have a complementary role when a diagnosis cannot be made with one of them.

Un trabajo apasionante / A fascinating job

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