Development of a leakage monitoring system in isolated limb perfusion with portable gamma camera. / Desarrollo de un protocolo de monitorización de fuga en perfusión de miembro aislado con gammacámara portátil.

Isolated limb perfusion (ILP) is a method for treating unresectable lesions of limbs in patients with melanoma or sarcoma by using high doses of tumor necrosis factor alpha and melphalan. These high doses can result in high systemic toxicity if there is a drug leak from the isolated circulation of the limb to the systemic. This makes it imperative to monitor the leakage rate (F[%]) during the infusion, currently performed with radiotracers. The objective of this work was to develop a leakage monitoring protocol as accurate as possible to ensure safe ILP. MATERIAL AND METHOD: We built a phantom with 3compartments (body, limb and precordial area) and a high sensitivity collimator fitted to a portable gammacamera. We simulate ILP with scheduled leaks every 10minutes from 1% to 9% (theorical F[%]). We mesured F(%) using 2equation: one is the proposed in the literature and another corrected by decay of the radioisotope. We test the optimal radiopharmaceutical doses to minimize the detector dead time error and compare F(%) mesured by both equations regarding the theoretical F(%). The leakage monitoring protocol was used in 17 ILP of 16 patients and an analysis of the recorded data was performed. RESULTS: We found significant differences between F(%) mesured using the first equation and theoretical F(%), obtaining results very adjusted to the theorical after applying the decay correction. CONCLUSIONS: The decay correction of the radioisotope is a simple manner to carry out the procedure more safely, reducing the error in the calculation of F(%).

Metástasis cutánea de carcinoma tiroideo folicular de células de Hürthle / Cutaneous metastasis from Hürthle cell follicular thyroid carcinoma

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Falso positivo en rastreo con 131I por quiste de Naboth / False-positive 131I uptake secondary to nabothian cyst

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Diagnóstico incidental de hernia vesical mediante PET/TC con 18F-FDG / Incidental diagnosis of bladder herniation by 18F-FDG PET/CT

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Bone scintigraphy as cornerstone in the diagnosis of Erdheim-Chester disease / Papel crucial de la gammagrafía ósea en el diagnóstico de la enfermedad de Erdheim–Chester

The Erdheim-Chester disease (ECD) is an extremely rare form of non-Langerhans cell histiocytosis. The main difficulty for its diagnosis lies in the wide variety of non-specific symptoms and signs that can occur in the disease process, leading, therefore, to there being no clear-cut algorithm as a guide for an optimal biopsy to confirm the diagnosis. An 81-year-old male with history of diabetes insipidus was admitted due to non-specific respiratory signs. Imaging techniques revealed osteoblastic lesions in the lumbar spine. Whole-body bone-scintigraphy (BS) was performed, in which lesions involving the axial and appendicular skeleton, with different rates of osteoblastic activity, were observed. This highlighted a symmetrical severely intense uptake in the knees, leading to an accurate biopsy specimen that enabled making the definitive diagnosis. BS is a widely available, safe, and inexpensive technique that shows a characteristic pattern of uptake for ECD, thus its use is highly recommended for screening and guiding biopsy if clinical suspicion exists. Furthermore, when the scintigraphy pattern is incidentally observed, biopsy of increased uptake areas (tibia preferably) is mandatory in order to rule out the disease (AU)

La enfermedad de Erdheim-Chester es una histiocitosis no-Larngerhans extremadamente rara. La dificultad en su diagnóstico se debe a los signos y síntomas inespecíficos que presenta, que conlleva la ausencia de un claro algoritmo diagnóstico. Reportamos el caso de un varón de 81 años con diabetes insipidus en estudio por síntomas respiratorios inespecíficos. Lesiones osteoblásticas en la columna fueron referidas en técnicas radiológicas. Mediante gammagrafía ósea (GO) se observaron lesiones osteoblásticas con diferente actividad metabólica en esqueleto axial y apendicular, destacando una actividad muy elevada y simétrica en rodillas, cuya biopsia permitió el diagnóstico definitivo. La GO es una técnica disponible, segura y barata que muestra un patrón característico, por lo que recomendamos su realización como screening y guía para toma de biopsia. Ante el hallazgo incidental de dicho patrón debería realizarse biopsia (AU)

Bone scintigraphy as cornerstone in the diagnosis of Erdheim-Chester disease.

The Erdheim-Chester disease (ECD) is an extremely rare form of non-Langerhans cell histiocytosis. The main difficulty for its diagnosis lies in the wide variety of non-specific symptoms and signs that can occur in the disease process, leading, therefore, to there being no clear-cut algorithm as a guide for an optimal biopsy to confirm the diagnosis. An 81-year-old male with history of diabetes insipidus was admitted due to non-specific respiratory signs. Imaging techniques revealed osteoblastic lesions in the lumbar spine. Whole-body bone-scintigraphy (BS) was performed, in which lesions involving the axial and appendicular skeleton, with different rates of osteoblastic activity, were observed. This highlighted a symmetrical severely intense uptake in the knees, leading to an accurate biopsy specimen that enabled making the definitive diagnosis. BS is a widely available, safe, and inexpensive technique that shows a characteristic pattern of uptake for ECD, thus its use is highly recommended for screening and guiding biopsy if clinical suspicion exists. Furthermore, when the scintigraphy pattern is incidentally observed, biopsy of increased uptake areas (tibia preferably) is mandatory in order to rule out the disease.

[Detection by SPECT-CT scan with (99m)Tc-(V) DMSA of bone metastases in patient with medullary thyroid cancer]. / Detección mediante SPECT-TAC con (99m)Tc-(V) DMSA de metástasis óseas en paciente con cáncer medular de tiroides.

Multiple endocrine neoplasia syndrome, type 2B (MEN 2B), is a rare entity characterized by the presence of medullary thyroid cancer in 100% of the cases. The phenotype of this syndrome consists in the presence of marfanoid features and mucocutaneous neuromas. We describe the case of a male patient with MEN 2B syndrome who was diagnosed with medullary thyroid cancer after lung metastases was found. We analyze the role of DMSA-V and the new hybrid SPECT-CT scan systems in the extension study and monitoring of medullary thyroid cancer.

Neurosarcoidosis asociada a hepatitis C no tratada con interferón / Neurosarcoidosis associated to hepatitis C that was not treated with interferon

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Captación atípica de la vesícula biliar como causa de falso positivo en rastreo postablación de restos tiroideos con 131I / Atypical uptake of gallbladder as cause of False-positive iodine-131 in post-surgical removalscanning of thyroid remains

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[Confirmation of cortical lesions of progressive prosopagnosia by cerebral SPECT]. / Confirmación de lesiones corticales de la prosopagnosia progresiva mediante la SPECT cerebral.

We present the case of a 78 year old man admitted to the hospital with progressive memory disorder. Neuropsychological examination showed inability to recognize familiar faces (prosopagnosia). MRI documented cortical atrophy, which did not explain the neurological deficit. CT did not show abnormalities. Most patients with prosopagnosia present brain atrophy, as they are more than 65 years old. Scanning by SPECT revealed hypoperfusion in the right parietotemporal region, which was worse in a later examination.

Confirmación de lesiones corticales de la prosopagnosia progresiva mediante la SPECT cerebral / Confirmation of cortical lesions of progressive prospagnosia by cerebral spect

Se presenta el caso de un varón de 78 años que acudió al hospital por deterioro progresivo de la memoria. El estudio neuropsicológico informó que el paciente presentaba incapacidad para reconocer caras familiares (prosopagnosia). La prueba de RMN mostró atrofia cortical generalizada, que no explicaba la sintomatología. La TAC no evidenció anormalidades. La mayoría de los pacientes con prosopagnosia primaria presentan atrofia senil, debido a que son mayores de 65 años. La SPECT cerebral mostró áreas de hipoperfusión en región parietotemporal derecha, que empeoran en un control posterior (AU)