[Authorized specifications for human use in clinical practice of radiopharmaceuticals composed of iobenguane (123I) marketed in Spain]. / Condiciones de uso humano autorizadas en la práctica clínica para los radiofármacos compuestos de iobenguano (123I) comercializados en España.

This article details the specifications authorised for human use in the clinical practice for the radiopharmaceutical products composed of iobenguane ((123)I) marketed in Spain.

Condiciones de uso humano autorizadas en la práctica clínica para los radiofármacos compuestos de iobenguano (123I) comercializados en España / Authorized specifications for human use in clinical practice of radiopharmaceuticals composed of iobenguane (123I) marketed in Spain

Este artículo detalla las condiciones de usohumano autorizadas en la práctica clínica para los radiofármacos compuestos de iobenguano (123I) legalmente comercializados en España

This article details the specifications authorisedfor human use in the clinical practice for the radiopharmaceutical products composed of iobenguane (123I) marketed in Spain (AU)

Influence of the normalization template on the outcome of statistical parametric mapping of PET scans.

Spatial normalization is an essential preprocessing step in statistical parametric mapping (SPM)-based analysis of PET scans. The standard template provided with the SPM99 software package was originally constructed using (15)O-H(2)O PET scans and is commonly applied regardless of the tracer actually used in the scans being analyzed. This work studies the effect of using three different normalization templates in the outcome of the statistical analysis of PET scans: (1) the standard SPM99 PET template; (2) an (18)F-FDG PET template, constructed by averaging PET scans previously normalized to the standard template; and (3) an MRI-aided (18)F-FDG PET template, constructed by averaging PET scans normalized according to the deformation parameters obtained from MRI scans. A strictly anatomical MRI normalization of each PET was used as a reference, under the rationale that a normalization based only upon MRI should provide higher spatial accuracy. The potential bias involved in the normalization process was estimated in a clinical SPM study comparing schizophrenic patients with control subjects. For each between-group comparison, three SPM maps were obtained, one for each template. To evaluate the influence of the template, these SPM maps were compared to the reference SPM map achieved using the anatomical normalization. SPMs obtained by MRI-aided normalization showed the highest spatial specificity, and also higher sensitivity when compared to the standard normalization using the SPM99 (15)O-H(2)O template. These results show that the use of the standard template under inappropriate conditions (different tracer or mental state) may lead to inconsistent interpretations of the statistical analysis.

[Atypical findings of the combined scintigraphy of bone marrow and labeled leukocytes in osteonecrosis of the hip secondary to infection]. / Hallazgos atípicos de la gammagrafía combinada de médula ósea y leucocitos marcados en osteonecrosis de la cadera secundaria a infección.

Avascular osteonecrosis can be associated with septic arthritis and osteomyelitis. Combined labeled leukocyte-marrow imaging scintigraphy has demonstrated excellent accuracy for the detection of infection since both tracers accumulate in the bone marrow and only leukocytes accumulate in infection. We report an unusual total absence of 99mTc HMPAO leukocytes/9mTc-sulfur colloid tracer accumulation, not only in the femoral head but also in the acetabulum and hip in hip osteonecrosis secondary to septic arthritis and osteomyelitis.

Hallazgos atípicos de la gammagrafía combinada de médula ósea y leucocitos marcados en osteonecrosis de la cadera secundaria a infección / Atypical findings of the combined scintigraphy of bone marrow and labeled leukocytes in osteonecrosis of the hip secondary to infection

La osteonecrosis avascular puede asociarse con artritis séptica y osteomielitis. La gammagrafía combinada de médula ósea y leucocitos marcados ha demostrado una excelente fiabilidad para la detección de infección, ya que ambos marcadores se acumulan en la médula ósea y únicamente los leucocitos se concentran en los focos infecciosos. Presentamos un caso atípico de ausencia completa de acúmulo de sulfuro coloidal-99mTc y leucocitos-HMPAO-99mTc, no sólo en la cabeza femoral sino también en el acetábulo y pelvis, en osteonecrosis de la cadera secundaria a artritis séptica y osteomielitis (AU)

Do high glucose levels have differential effect on FDG uptake in inflammatory and malignant disorders?

BACKGROUND: The association of hyperglycaemia with reduced fluorodeoxyglucose (FDG) uptake by tumour cells is well established. Therefore, it is standard practice that all patients must fast for at least several hours prior to FDG positron emission tomography (PET) imaging. However, the effect of hyperglycaemia on FDG uptake by inflammatory and infectious lesions is unknown. The aim of this study was to investigate this important issue. METHODS: For in vitro studies human mononuclear cells were isolated from 12 normal volunteers and FDG uptake was determined in medium containing differing concentrations of glucose. FDG uptake by human mesothelioma cells was also measured for comparison. For studies involving patients, 416 FDG PET scans of patients with confirmed malignancy (n=321) or benign lesions (n=95) were reviewed retrospectively. The relationship between serum glucose level and FDG uptake by the lesions was assessed utilizing the standardized uptake value (SUV) technique. RESULTS: In the in vitro studies, while FDG uptake by mesothelioma cells decreased as glucose concentration increased, there was no differential uptake of FDG uptake by mononuclear cells at glucose concentrations less than 250 mg x dl(-1). In clinical patients, FDG uptake by malignant lesions was slightly, but negatively affected by serum glucose level (r= -0.21, P<0.01) (glucose range 49-187 mg x dl(-1)). In contrast, FDG uptake by inflammatory lesions was positively associated with serum glucose level (r=0.43, P<0.01) (glucose range 54-215 mg x dl(-1)). DISCUSSION AND CONCLUSION: While the degree of FDG uptake is primarily influenced by the nature of the underlying lesion, serum glucose concentration appears to have a small effect on FDG uptake, which differs between malignant disorders and inflammatory processes. Our data suggest that below a certain level, elevated glucose concentration might not have a negative effect on FDG uptake in inflammatory cells, contrary to that observed in malignant disorders.

[Hormonal reference values for adrenocortical function in healthy children from Zaragoza]. / Valores de referencia hormonales de función corticosuprarrenal en niños sanos zaragozanos.

OBJECTIVE: Estimation of reference values for basal serum concentrations of adrenocorticotropic hormone (ACTH), cortisol, 11-deoxycortisol, 17-OH-progesterone (17-OHP), plasma renin activity (PRA), aldosterone, -4-androstendione ( 4A) and dehydroepiandrosterone sulphate (DHA-S) in healthy children from Zaragoza. METHODS: Reference population were healthy children aged 0 to 14, with normal weight and height, living in the metropolitan area of Zaragoza (Spain). It is a transversal study. Reference values and ranges for ACTH, cortisol, 11-deoxycortisol, 17-OHP, PRA, aldosterone, 4A and DHA-S were estimated, and changes in concentrations were analyzed in relation to age, sex and puberal stage. RESULTS: Reference values have been classified by puberal stage and age in eleven groups for every sex: Tanner I (umbilical cordon, 3 days, 4-30 days, 1-6 months, 6 months-4 years, 4-7 years, 7-10 years, 10-14 years), Tanner II, Tanner III and Tanner IV-V. Sex did not influence ACTH, cortisol, 17-OHP and PRA concentrations, and there are punctual differences in 11-deoxycortisol, aldosterone, 4A and DHA-S levels. 17-OHP, 11-deoxycortisol and aldosterone concentrations significantly decreased from birth to 6 months-4 years and subsequently kept steady. The maximal concentration of ACTH, and ARP in blood cord significantly decreased until the period 6 months-4 years, and subsequent differences among different age groups, and between prepuberal and puberal groups are scarce. The highest concentration of 4A and DHA-S were observed in blood cord and third day of life, decreased until the lowest level in 6 months-4 years and progressively increased with age in prepuberty, and between prepuberty and puberty. The lowest concentration of cortisol was detected in 4-30 days, increased until 6 months-4 years and kept steady along the prepuberty and puberty. CONCLUSION: It is necessary that every population establish own reference values for ACTH, cortisol, 11-deoxycortisol, 17-OHP, PRA, aldosterone, 4A and DHA-S during infancy, childhood and adolescence, according to age, sex and puberal stage.

[Reproducibility of the qualitative interpretation of dynamic salivary radionuclide scans with excretory stimulation]. / Reproducibilidad de la interpretación cualitativa de la gammagrafía salival dinámica con estímulo excretor.

OBJECTIVE: To evaluate intraobserver and interobserver agreement in the qualitative interpretation of dynamic salivary radionuclide scans to detect salivary disease, and the agreement between interpretation of dynamic and static image compositions. MATERIAL AND METHODS: Two observers (A, B) interpreted 110 dynamic salivary radionuclide scans with excretory stimulation based on dynamic image composition. Both again interpreted every studies: A based on dynamic image composition and B on static image composition. Kappa statistics were used to determine the degree of intraobserver and interobserver agreement. RESULTS: Considering all the studies, the dynamic composition showed an intraobserver agreement of 0.76 and interobserver agreements of 0.58 and 0.61. In patients with clinical sicca syndrome, agreements were 0.60, 0.52 and 0.62, respectively. For all the cases, the agreements between dynamic and static composition was 0.62 (intraobserver), and 0.42 and 0.43 (interobserver). For patients with clinical sicca syndrome these agreements were 0.63 (intraobserver), and 0.36 and 0.51 (interobserver). CONCLUSION: Intraobserver and interobserver agreement in the qualitative interpretation of dynamic salivary radionuclide scan with excretory stimulation are moderate and notable-moderate overall and in patients with clinical sicca syndrome. These agreements are greater than between dynamic and static image composition.

Reproducibilidad de la interpretación cualitativa de la gammagrafía salival dinámica con estímulo excretor / Reproducibility of the qualitative interpretation of dynamic salivary radionuclide scans with excretory stimulation

Objetivo: Valorar las concordancias intraobservador e interobservador en la interpretación cualitativa de la gammagrafla salival dinámica para detectar patología salivar, y las concordancias entre la interpretación de una composición dinámica y de una composición estática de las imágenes. Material y métodos: Dos observadores (A, B) interpretaron 110 gammagrafías salivales dinámicas con estímulo excretor basándose en una composición dinámica de las imágenes. Ambos las interpretaron nuevamente: A basándose en la composición dinámica y B en una composición estática. El estadístico kappa determinó el grado de concordancia intraobservador e interobservador. Resultados: Considerando todos los estudios, la composición dinámica reveló un grado de acuerdo intraobservador de 0,76 e interobservador de 0,58 y 0,61, y en pacientes con síndrome seco clínico obtuvo un grado de 0,60, 0,52 y 0,62, respectivamente. Para todos los casos, la concordancia entre la composición dinámica y estática fue 0,62 (intraobservador) y 0,42 y 0,43 (interobservador), y en pacientes con síndrome seco clínico fue 0, 63 (intraobservador) y 0, 36 y 0, 51 (interobservador). Conclusión: Las concordancias intraobservador e interobservador en la interpretación cualitativa de la gammagrafía salival dinámica son moderada y notable-moderada, globalmente y en pacientes con síndrome seco clínico, y mayores que aquéllas entre la composición dinámica y estática de las imágenes (AU)

OBJECTIVE: To evaluate intraobserver and interobserver agreement in the qualitative interpretation of dynamic salivary radionuclide scans to detect salivary disease, and the agreement between interpretation of dynamic and static image compositions. MATERIAL AND METHODS: Two observers (A, B) interpreted 110 dynamic salivary radionuclide scans with excretory stimulation based on dynamic image composition. Both again interpreted every studies: A based on dynamic image composition and B on static image composition. Kappa statistics were used to determine the degree of intraobserver and interobserver agreement. RESULTS: Considering all the studies, the dynamic composition showed an intraobserver agreement of 0.76 and interobserver agreements of 0.58 and 0.61. In patients with clinical sicca syndrome, agreements were 0.60, 0.52 and 0.62, respectively. For all the cases, the agreements between dynamic and static composition was 0.62 (intraobserver), and 0.42 and 0.43 (interobserver). For patients with clinical sicca syndrome these agreements were 0.63 (intraobserver), and 0.36 and 0.51 (interobserver). CONCLUSION: Intraobserver and interobserver agreement in the qualitative interpretation of dynamic salivary radionuclide scan with excretory stimulation are moderate and notable-moderate overall and in patients with clinical sicca syndrome. These agreements are greater than between dynamic and static image composition (AU)

Valores de referencia hormonales de función corticosuprarrenal en niños sanos zaragozanos / Hormonal reference values for adrenocortical function in healthy children from Zaragoza (Spain)

Objetivo : Estimar los valores de referencia de las concentraciones séricas/plasmáticas basales de hormona corticotropa (ACTH), cortisol, 11-desoxicortisol, 17-OH-progesterona (17-OHP), actividad renina plasmática (ARP), aldosterona, (4-androstendiona (4A) y sulfato de dehidroepiandrosterona (DHA-S) en niños sanos zaragozanos. Métodos La población de referencia de este estudio transversal han sido niños sanos de 0-14 años, con peso y talla normales, residentes en el área urbana de Zaragoza. Se han estimado los valores e intervalos de referencia de ACTH, cortisol, 11-desoxicortisol, 17-OHP, ARP, aldosterona, 4A y DHA-S. Resultados Los valores de referencia se han clasificado por estadios puberales y edad, en 11 grupos para cada sexo: Tanner I (cordón umbilical, 3 días, 4-30 días, 1-6 meses, 6 meses-4 años, 4-7 años, 7-10 años, 10-14 años), Tanner II, Tanner III y Tanner IV-V. No existen diferencias entre sexos para ACTH, cortisol, 17-OHP y ARP, y las diferencias son puntuales para 11-desoxicortisol, aldosterona, 4A y DHA-S. Las concentraciones de 17-OHP, 11-desoxicortisol y aldosterona disminuyen significativamente con la edad desde el nacimiento hasta el período 6 meses-4 años y posteriormente se estabilizan. Las concentraciones de ACTH y ARP de cordón umbilical descienden significativamente hasta el período 6 meses-4 años, con escasas diferencias puntuales entre edades prepuberales y entre prepúberes y púberes. Las concentraciones máximas de 4A y DHA-S se aprecian en cordón y al tercer día, disminuyen hasta el nivel mínimo del período 6 meses-4 años y aumentan progresivamente con la edad en prepubertad y entre prepúberes y púberes. La concentración mínima de cortisol en el grupo 4-30 días aumenta hasta el período 6 meses-4 años en que se alcanzan los niveles estables de la prepubertad y pubertad. Conclusiones Las diferencias en los valores de referencia de ACTH, cortisol, 11-desoxicortisol, 17-OHP, ARP, aldosterona, 4A y DHA-S durante la infancia, niñez y adolescencia hacen necesario que cada población establezca sus propios valores en función de edad, sexo y estadio puberal, y para cada método de cuantificación utilizado (AU)