Cáncer diferenciado de tiroides en tiroides lingual, presentación de un caso / Differentiated thyroid cancer in the lingual thyroid, presentation of a case

The lingual thyroid carcinoma is very uncommon neoplasia with an incidence of less than 1 percent. The papillary variant is the most frequent. Cervical MRI helps differentiate muscle from thyroid tissue. The definitive diagnosis is given by histology. Management is similar to that of orthotopic thyroid cancer. We present the case of a 23-year-old woman with hypothyroidism undergoing treatment with dysphagia and sensation of pharyngeal foreign body and malodorous oral bleeding. Nasopharyngoscopy showed a rounded mass at the base of the tongue; the biopsy was compatible with thyroid neoplasia. Image study with ultrasound confirms empty thyroid bed with presence of lingual ectopic thyroid. The team of surgeons performed surgery with Trotter Technique, they removed a tumor of 4 centimeters of diameter. The definitive biopsy concludes minimally invasive follicular carcinoma. The treatment was completed with 100 mCi of radioiodine. Systemic screening at 7 days was negative, as the post-operative thyroglobulin (Tg)

Bone scintigraphy in children with cat scratch disease.

AIM: The objective of this study was to evaluate the degree and incidence of bone involvement in patients with cat scratch disease. METHODS: Patients admitted between 2004 and 2011 at the pediatric department for cat scratch disease and a positive serology for Bartonella henselae were identified. Only those having undergone a bone scintigraphy (BS) were included in this retrospective study. RESULTS: Sixteen girls and 8 boys with a mean age of 7 years were studied. Bone scintigraphy was positive in 6 (25%), but only 2 had bone pain. Axial involvement was present in all 6 patients, and appendicular lesions in 3 of them. Three patients had a BS control, with improvement or normalization after treatment with antibiotics. CONCLUSIONS: Bone involvement occurs infrequently in patients with cat scratch disease and is not always associated with specific signs. Cat scratch disease must be suspected in patients with fever of unknown origin presenting multifocal lesions on BS.

Inter- and intra-observer reproducibility of quantitative renographic parameters of differential function and renal drainage in children.

PURPOSE: To evaluate inter- and intra-observer reproducibility of renographic quantitative parameters of input and output in children. METHODS: 100 children with unilateral or bilateral uropathy were selected, aiming to cover the entire range of ages, overall glomerular filtration rate (GFR), differential renal function (DRF) and quality of drainage. Renograms were acquired and processed according to the EANM guidelines, using a non-commercial software. Following parameters were tested: DRF using integral and Patlak methods, normalized residual activity (NORA) and output efficiency (OE) at 20 min and on the late post-erect post-micturition acquisition. Three observers from the same department and one from Santiago (Chile) processed independently the 100 renograms using the same renal software. Two observers reprocessed the 100 renograms again two months later in order to evaluate the intra-observer reproducibility. RESULTS AND CONCLUSION: No significant difference was observed between the four observers, whatever the considered parameter of input function or output. For left DRF (Integral and Patlak methods), 95% of the individual differences were between -5% and +5 %. They were between -0.5 and +0.5 units for both NORA 20 and NORA PM, and between -10% and +10% for OE 20 and OE PM. Inter-and intra- observer reproducibility were comparable. Outliers tended to be more frequent for Patlak than for Integral. Very low GFR (< 20 mL/min/1.73 m(2)), very young age (first days of life), huge megaureters, NORA values higher than 2.0, OE values below 60% and bladder in the renal background area (ectopic kidney) were the main characteristics of extreme differences.

Una lesión en el cintigrama renal DMSA 6 meses post fase aguda de una pielonefritis representa siempre una cicatriz: un debate abierto / Evolution of scintigraphic renal lesions in children after an episode of acute pyelonephritis

Background: Abnormal Dimercaptosuccinic acid (DMSA) renal scintigraphy performed six months after an acute pyelonephritis (AP) is generally interpreted as scarring. Aim: To perform a follow up of childhood patients showing scintigraphic renal lesions during the acute phase of pyelonephritis (within 7 days from the beginning of fever). Material and Methods: A scintigraphic control was carried out at 5-7 months and, in case of persistent lesions, an additional late scintigraphy at 10-13 months. All patients were followed clinically for one year and those with a relapse of urinary tract infection were excluded from the study. Results: Eighty five patients with a median age of 8 months were included. Among these, the first scintigraphic control was normal in 59 (69%) and abnormal in 26 patients (31%). In five of these 26 patients (5/26:19%-5/85: 6%), a considerable regression of the lesions was obvious on the early control, and normalized completely on the late control. When expressing the results in kidney units, 107 showed lesions during the acute phase of infection; 69% was normal at the early control. Thirty three showed lesions persisting at the early control (31%) and 7 out of these 33 (21%) became normal on the late control (7/107: 7%). In total, 25% of the children included in the study (24% of the kidney units) remained with renal sequelae one year after the initial episode of AP. Conclusions: The persistence of scintigraphic lesions six months after an episode of AP, does not necessarily correspond to permanent scars, since normalization can sometimes be observed on late controls.

[Evolution of scintigraphic renal lesions in children after an episode of acute pyelonephritis]. / Una lesión en el cintigrama renal DMSA 6 meses post fase aguda de una pielonefritis representa siempre una cicatriz: un debate abierto.

BACKGROUND: Abnormal Dimercaptosuccinic acid (DMSA) renal scintigraphy performed six months after an acute pyelonephritis (AP) is generally interpreted as scarring. AIM: To perform a follow up of childhood patients showing scintigraphic renal lesions during the acute phase of pyelonephritis (within 7 days from the beginning of fever). MATERIAL AND METHODS: A scintigraphic control was carried out at 5-7 months and, in case of persistent lesions, an additional late scintigraphy at 10-13 months. All patients were followed clinically for one year and those with a relapse of urinary tract infection were excluded from the study. RESULTS: Eighty five patients with a median age of 8 months were included. Among these, the first scintigraphic control was normal in 59 (69%) and abnormal in 26 patients (31%). In five of these 26 patients (5/26:19%-5/85: 6%), a considerable regression of the lesions was obvious on the early control, and normalized completely on the late control. When expressing the results in kidney units, 107 showed lesions during the acute phase of infection; 69% was normal at the early control. Thirty three showed lesions persisting at the early control (31%) and 7 out of these 33 (21%) became normal on the late control (7/107: 7%). In total, 25% of the children included in the study (24% of the kidney units) remained with renal sequelae one year after the initial episode of AP. CONCLUSIONS: The persistence of scintigraphic lesions six months after an episode of AP, does not necessarily correspond to permanent scars, since normalization can sometimes be observed on late controls.

Registration of renal SPECT and 2.5D US images.

Image registration is the process of transforming different image data sets of an object into the same coordinate system. This is a relevant task in the field of medical imaging; one of its objectives is to combine information from different imaging modalities. The main goal of this study is the registration of renal SPECT (Single Photon Emission Computerized Tomography) images and a sparse set of ultrasound slices (2.5D US), combining functional and anatomical information. Registration is performed after kidney segmentation in both image types. The SPECT segmentation is achieved using a deformable model based on a simplex mesh. The 2.5D US image segmentation is carried out in each of the 2D slices employing a deformable contour and Gabor filters to capture multi-scale image features. Moreover, a renal medulla detection method was developed to improve the US segmentation. A nonlinear optimization algorithm is used for the registration. In this process, movements caused by patient breathing during US image acquisition are also corrected. Only a few reports describe registration between SPECT images and a sparse set of US slices of the kidney, and they usually employ an optical localizer, unlike our method, that performs movement correction using information only from the SPECT and US images. Moreover, it does not require simultaneous acquisition of both image types. The registration method and both segmentations were evaluated separately. The SPECT segmentation was evaluated qualitatively by medical experts, obtaining a score of 5 over a scale from 1 to 5, where 5 represents a perfect segmentation. The 2.5D US segmentation was evaluated quantitatively, by comparing our method with an expert manual segmentation, and obtaining an average error of 3.3mm. The registration was evaluated quantitatively and qualitatively. Quantitatively the distance between the manual segmentation of the US images and the model extracted from the SPECT image was measured, obtaining an average distance of 1.07 pixels on 7 exams. The qualitative evaluation was carried out by a group of physicians who assessed the perceived clinical usefulness of the image registration, rating each registration on a scale from 1 to 5. The average score obtained was 4.1, i.e. relevantly useful for medical purposes.

Evaluación de la actividad de 99mTc-DMSA efectivamente inyectada en pacientes pediátricos / Evaluation of the activity of 99mTc-DMSA effectively delivered in pediatric patients

Objetivo. Evaluar el porcentaje de dosis inyectada de 99mTc-DMSA que ingresa efectivamente al paciente. Método. Se analizaron cintigramas renales con 99mTc-DMSA realizados en de 2 centros, con métodos de punción diferente, con y sin llave de tres pasos (Centros 1 y 2 respectivamente). Adquisición de jeringa llena, vacía (y/o sistema extra) y sitio de inyección, calculando actividad ingresada al paciente con y sin considerar sitio de inyección y evaluando la actividad persistente en él. Se aplicó el T test. Resultados. Se analizaron estudios de 65 pacientes, 71 por ciento mujeres, edad promedio 61 meses. Todas las imágenes obtenidas fueron de buena calidad según observadores experimentados. El porcentaje ingresado promedio fue 87,70 por ciento al sustraer sitio de inyección y 91,02 por ciento sin restarlo (p<0,05). Actividad en sitio de inyección: 1,5 por ciento en centro 1 y 3,27 por ciento en centro 2 (p<0,05). Conclusiones. Con ambas técnicas de inyección se obtiene adecuado porcentaje de actividad ingresada, que permite obtener imágenes óptimas y poca extravasación.

Aim- To evaluate the percentage of the injected dose of 99mTc-DMSA that is effectively delivered to the patient. Methods. Renal DMSA scintigrams from 2 centers with different puncture methods: direct puncture with a needle or with a three-way stop-cock (Centers 1 and 2). Acquisition of filled and empty syringe (and/or additional system) and injection site, calculating entered dose to the patients considering and not considering the injection site, and assessing the persistent activity. T test was applied. Results. Studies from 65 patients were analyzed, 71 percent female, mean age 61 months. All images were of good quality, according to experienced observers. Average percentage of entered dose by substracting the injection site was 87.70 percent and 91.02 percent with no subtraction (p<0.05). Injection site activity was 1.5 percent for center 1 and 3.27 percent for center 2 (p<0.05). Conclusions: Appropriate percentage of activity is delivered with both injection techniques, which allows optimum images and little extravasation.

Correlación entre cintigrama renal DMSA (CR) planar y tomográfico en 180° y 360° / Correlation between Tc99m-DMSA renal planar scintigraphy and tomography technique in 180 degrees and 360 degrees

El C.R. planar es un examen habitual en la práctica clínica , cuya sensibilidad y especificidad han sido validadas en el estudio de infección urinaria en niños. El uso de técnica tomográfica es discutido , por lo que quisimos correlacionar los resultados obtenidos en el CR planar versus estudios tomográficos,considerando el planar nuestro gold estándar. 25 pacientes referidos por estudio de infección urinaria fueron estudiados con técnica planar habitual y el mismo día, tomografía en 180 ° y en 360°. Se analizaron independientemente las imágenes planares de las tomográficas .Se realizó una tabla de correlación entre el CR planar y cada tomografía para evaluar las coincidencias (análisis Kappa). La mayor concordancia se observó entre el CR planar y la tomografía de 180º, índice kappa de 0.66, vs. 0.50 con la tomografía en 360º. Conclusión: Si se realiza tomografía renal ésta debe ser en 180º.

Planar DMSA scintigraphy is a well established method for evaluating kidney in the urinary tract infection. There is no agreement of the utility of SPECT DMSA imaging. We compared the results of planar DMSA scintigraphy with tomography technique ( gold standard was planar DMSA). 25 children were evaluated with planar DMSA, 180º posterior and 360º full tomography in the same day. Images were interpreted independently in a blinded fashion. We made a correlation table and Kappa analysis were aplicated. The best concordancy were obtained between planar and 180º SPECT, with a Kappa index : 0.66 vs 0.50 with the 360º tomography. Conclusion: the 180º acquisition technique is preferable for kidney tomography.

[Tc 99M DMSA scintigraphy in children with a first episode of acute pyelonephritis: correlation with laboratory tests, echography and the presence of vesico-ureteral reflux]. / Cintigrama renal DMSA en niños con primera pielonefritis aguda: correlación con exámenes de laboratorio, ecografía y la presencia de reflujo vésico ureteral.

BACKGROUND: Tc99m DMSA (dimercaptosuccinic acid) scintigraphy has a high sensitivity for the detection of cortical kidney damage. AIM: To evaluate the Tc99m DMSA renal scintigraphy in children with a first episode of acute pyelonephritis and its association with laboratory parameters, kidney ultrasound and vesicoureteral reflux. PATIENTS AND METHODS: We studied 143 children (age range 8 days, 12 years, 66% female) hospitalized with the clinical diagnosis of acute pyelonephritis (first episode) with a positive urine culture and a renal scintigraphy performed within seven days of diagnosis. DMSA was considered the gold standard for the detection of cortical lesions. Its results were related to the presence of fever, C-reactive protein (CRP), erythrocyte sedimentation rate (VHS), white blood count (WBC), ultrasound examination and vesicoureteral reflux. RESULTS: Seventy nine percent of the population had an abnormal DMSA scan. There were no differences between sex, age and laboratory parameters in children with normal or abnormal DMSA scans, except for CRP (p <0.005). Ultrasound was coincident with the scan in 32% of patients. Eighteen percent had vesicoureteral reflux. CONCLUSIONS: There is a high proportion of abnormal DMSA scans in children with a first episode of acute pyelonephritis.

[Tc99m-pertechnetate thyroid scintigraphy in newborns with congenital hypothyroidism]. / Cintigrafía tiroidea (CT) con Tc99m-pertecnectato en recién nacidos (RN) con hipotiroidismo congénito (HC).

BACKGROUND: Congenital hypothyroidism is one of the most frequent endocrine diseases of the newborn and requires an early diagnosis to avoid its deleterious effects on neurological and intellectual functions. AIM: To evaluate thyroid scintigraphy (TS) findings in newborns with congenital hypothyroidism (CH), detected in the national program of newborn screening, which is working in Chile since 1992. MATERIAL AND METHODS: TS findings of 189 newborns with CH (68% female) were analyzed. Tc99m pertechnetate TS was performed at 19 +/- 11 days of life. The gland was classified as eutopic, ectopic or absence of contrast (AC). Eutopic glands were classified by visual and quantitative criteria as: normal, goiter and decreased contrast (DC). TS results were compared by gender and hormonal levels. RESULTS: Forty seven percent of newborns had ectopy, 29.1% eutopy and 24.3% AC. Eutopic gland predominated in males (44.2% vs 22.7%) and ectopy was more frequent in girls (53.1% vs 32.8%, p < 0.05). Newborns with AC had the most severe hormonal alterations, without gender differences. Newborns with normal TS had less hormonal alterations than those with goiter. CONCLUSIONS: TS allows an etiological classification of CH. Thyroid dysgenesis is the most frequent cause, most of which correspond to ectopy, especially in girls. Eutopic glands are present in one third of newborns with CH. Goiter predominates, especially in males.