RESUMO
Objetivo: Los incidentalomas tiroideos en estudios PET/TC con 18F-FDG son relativamente frecuentes y su significado clínico es causa de controversia. El presente estudio muestra nuestra experiencia en la detección de incidentalomas tiroideos a partir de estudios PET/TC y de su seguimiento. Material y métodos: Estudio retrospectivo descriptivo de los pacientes que presentaron incidentalomas tiroideos en los estudios PET/TC con 18F-FDG, entre junio de 2010 y marzo de 2013. Se evaluaron los siguientes datos y antecedentes clínicos: edad, sexo, valor máximo estandarizado de captación (SUVmáx), enfermedades tiroideas, niveles de TSH y anticuerpos antitiroideos, ecografía, punción-aspiración con aguja fina (PAAF) y citología. Resultados: Se realizaron 4.085 PET/TC, de los cuales 83 (2,03%) mostraron incidentalomas tiroideos. Treinta y siete de estos pacientes presentaron un incremento difuso del metabolismo glicídico tiroideo y 46 un incremento focal. Cinco de los 46 pacientes con captación focal (11%) fueron diagnosticados de enfermedad neoplásica por citología. No se encontraron diferencias significativas entre los valores del SUVmáx de las enfermedades tiroideas benignas y de las malignas (media: 10,26 y 5,92 respectivamente). Conclusión: En nuestra experiencia, los incidentalomas tiroideos de características focales detectados en los estudios PET/TC con18F-FDG, presentan un considerable riesgo de malignidad (11%). Por este motivo, se debe indicar siempre el seguimiento de estos hallazgos mediante ecografía y PAAF. Por otra parte, y tal como está descrito en la literatura, el incremento difuso del metabolismo glicídico tiroideo se asocia casi siempre a patología tiroidea benigna (AU)
Objective: Thyroid findings or incidentalomas in 18F-FDG PET/CT studies are relatively frequent, being its clinical significance subject of controversy. The aim of this study was to show our experience in the detection of thyroid incidentalomas by PET/CT studies as well as its follow up. Material and methods: A retrospective and descriptive review was conducted on patients who had thyroid incidentalomas detected in18F-FDG PET/CT studies between June 2010 and March 2013. Patients medical records were reviewed for age, genre, maximum standardized uptake value (SUVmax), thyroid diseases, TSH and antithyroid antibodies levels, ultrasound, fine-needle aspiration (FNA) and cytology. Results: 4085 PET/CT studies for several purposes were performed. Eighty-three of these studies (2.03%) showed thyroid incidentalomas. Thirty-seven patients showed a diffuse increase of glucose metabolism in the thyroid gland and 46 showed a focal increase of glucose metabolism. Five out of 46 patients with focal uptake were diagnosed of a neoplastic disease by cytology (11%). The SUVmax of malignant pathology did not differ from that of benign thyroid diseases (Mean: 10,26 and 5,92 respectively). Conclusion: In our experience, focal thyroid incidentalomas detected in18F-FDG PET/CT studies are related to a significant risk of malignancy (11%). Therefore, in these situations, an ultrasound study with fine needle biopsy should be recommended. Moreover, a diffuse increase of glucose metabolism in the thyroid gland is often associated with benign thyroid pathology (AU)
Assuntos
Humanos , Neoplasias da Glândula Tireoide , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Fluordesoxiglucose F18 , Achados Incidentais , Biópsia por Agulha Fina/métodos , Estudos RetrospectivosRESUMO
OBJECTIVE: Thyroid findings or incidentalomas in (18)F-FDG PET/CT studies are relatively frequent, being its clinical significance subject of controversy. The aim of this study was to show our experience in the detection of thyroid incidentalomas by PET/CT studies as well as its follow up. MATERIAL AND METHODS: A retrospective and descriptive review was conducted on patients who had thyroid incidentalomas detected in (18)F-FDG PET/CT studies between June 2010 and March 2013. Patient's medical records were reviewed for age, genre, maximum standardized uptake value (SUVmax), thyroid diseases, TSH and antithyroid antibodies levels, ultrasound, fine-needle aspiration (FNA) and cytology. RESULTS: 4085 PET/CT studies for several purposes were performed. Eighty-three of these studies (2.03%) showed thyroid incidentalomas. Thirty-seven patients showed a diffuse increase of glucose metabolism in the thyroid gland and 46 showed a focal increase of glucose metabolism. Five out of 46 patients with focal uptake were diagnosed of a neoplastic disease by cytology (11%). The SUVmax of malignant pathology did not differ from that of benign thyroid diseases (Mean: 10,26 and 5,92 respectively). CONCLUSION: In our experience, focal thyroid incidentalomas detected in (18)F-FDG PET/CT studies are related to a significant risk of malignancy (11%). Therefore, in these situations, an ultrasound study with fine needle biopsy should be recommended. Moreover, a diffuse increase of glucose metabolism in the thyroid gland is often associated with benign thyroid pathology.
Assuntos
Neoplasias da Glândula Tireoide/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Feminino , Fluordesoxiglucose F18 , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
La realización de un correcto diagnóstico inicial ayuda al manejo clínico de los pacientes con Demencia con Cuerpos de Lewy (DCLw). La imagen tardía de la gammagrafía cardíaca con 123I-MIBG permite diferenciar entre DCLw y otro tipo de demencias. El objetivo del estudio es valorar la utilidad de la imagen precoz de la gammagrafía cardíaca con 123I-MIBG para el diagnóstico diferencial entre DCLw y otras demencias neurodegenerativas. Material y métodos. Estudio retrospectivo de 106 pacientes (51 hombres, edad media 78 años) a los que se les realizó una gammagrafía de inervación miocárdica por estudio de demencia. Se obtuvieron imágenes planares en proyección anterior a los 15min (precoz) y a las 4h (tardía) de la administración del trazador. La captación miocárdica de 123I-MIBG se semicuantificó mediante la obtención del índice de captación corazón/mediastino (ICM) a los 15min (ICM15m) y a las 4h (ICM4h). Resultados. El diagnóstico clínico a los 4 años fue de 52 pacientes con DCLw. El ICM15m para los pacientes con DCLw fue significativamente inferior al de los otros pacientes (1,27±0,15 vs 1,76±0,15,p<0,05), así como el ICM4h (1,14±0,13 vs 1,68±0,19,p<0,01). A partir del análisis ROC se obtuvo un punto de corte del ICM15m de 1,56 con un área bajo la curva del 0,99, para poder diferenciar DCLw respecto a los otros tipos de demencia, con una sensibilidad y especificidad del 98%. Conclusión. La imagen precoz de la gammagrafía de inervación miocárdica con 123I-MIBG, puede ser útil para diferenciar la DCLw de otro tipo de demencias neurodegenerativas (AU)
The importance of accurate and early diagnosis of dementia with Lewy bodies (DLB) lies in its pharmacological management. Delayed imaging of cardiac 123I-MIBG scintigraphy allows differentiation between DLB and other neurodegenerative diseases with cognitive impairment. The aim of this study was to assess the utility of early imaging of cardiac 123I-MIBG scintigraphy for differentiating DLB from others neurodegenerative disease with cognitive impairment. Material and methods. We assess retrospectively 106 patients (51 men, mean age 78 years) with cognitive impairment that underwent a cardiac 123I-MIBG study. Planar images were acquired in anterior view of the thorax 15min (early) and 4h (delayed) after tracer administration. The heart-to-mediastinum ratios (HMR) at 15m (HMR15m) and at 4h (HMR4h) were obtained. Results. After four years, 52 patients were diagnosed of DLB.HMR15m and HMR4h were significantly inferior in DLB respect to the others neurodegenerative diseases (1,27±0,15 vs 1,76±0,15,p<0,05) and (1,14±0,13 vs 1,68±0,19,p<0.01), respectively. The ROC analysis showed a HMR15m cut off point of 1.56 to differentiated DLB from the other dementias with a sensitivity and a specificity of 98%. Conclusions. Early imaging of cardiac 123I-MIBG scintigraphy can help to differentiate DLB from other neurodegenerative diseases with cognitive impairment (AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Corpos de Lewy , Doença por Corpos de Lewy , Diagnóstico Precoce , 3-Iodobenzilguanidina , Coração/inervação , Coração/efeitos da radiação , Diagnóstico Diferencial , Doenças Neurodegenerativas/complicações , Doenças Neurodegenerativas , Estudos Retrospectivos , Cardiomiopatias , Análise de VariânciaRESUMO
UNLABELLED: The importance of accurate and early diagnosis of dementia with Lewy bodies (DLB) lies in its pharmacological management. Delayed imaging of cardiac (123)I-MIBG scintigraphy allows differentiation between DLB and other neurodegenerative diseases with cognitive impairment. The aim of this study was to assess the utility of early imaging of cardiac (123)I-MIBG scintigraphy for differentiating DLB from others neurodegenerative disease with cognitive impairment. MATERIAL AND METHODS: We assess retrospectively 106 patients (51 men, mean age 78 years) with cognitive impairment that underwent a cardiac (123)I-MIBG study. Planar images were acquired in anterior view of the thorax 15min (early) and 4h (delayed) after tracer administration. The heart-to-mediastinum ratios (HMR) at 15m (HMR15m) and at 4h (HMR4h) were obtained. RESULTS: After four years, 52 patients were diagnosed of DLB.HMR15m and HMR4h were significantly inferior in DLB respect to the others neurodegenerative diseases (1,27±0,15 vs 1,76±0,15,p<0,05) and (1,14±0,13 vs 1,68±0,19,p<0.01), respectively. The ROC analysis showed a HMR15m cut off point of 1.56 to differentiated DLB from the other dementias with a sensitivity and a specificity of 98%. CONCLUSIONS: Early imaging of cardiac (123)I-MIBG scintigraphy can help to differentiate DLB from other neurodegenerative diseases with cognitive impairment.
