Relevancia de la PET/TC con [18F]FDG en la detección de enfermedad localizada en el colon en pacientes estudiados por bacteriemia o endocarditis infecciosa causadas por microorganismos enteropatógenos / Relevance of [18F]FDG-PET/CT in the detection of colon pathology in patients studied by bacteriemia or infectious endocarditis caused by enteropathogenic microorganisms

Objetivo La asociación entre la endocarditis infecciosa (EI) por Streptococcus gallolyticus y las lesiones malignas del tracto gastrointestinal está bien descrita. Asumimos que otros microorganismos enteropatógenos, como el Streptococcus viridans y Enterococcus faecalis también pueden estar relacionados con la enfermedad colorrectal. Nuestro objetivo fue determinar la frecuencia de depósitos focales de la [18F]FDG en localización colorrectal, sugestivos de lesiones tumorales, y su correlación con la enfermedad de colon y recto en pacientes con infección causada por diferentes microorganismos comensales del tracto gastrointestinal. Métodos Examinamos retrospectivamente 61 pacientes con diagnóstico de bacteriemia y de EI (posible o concluyente) según los criterios de Duke y causada por microorganismos enteropatógenos, y que fueron sometidos a una PET/TC de cuerpo entero con [18F]FDG en nuestra institución. Buscamos depósitos de la [18F]FDG en localización colorrectal, así como la presencia de lesiones morfológicas. A todos los pacientes con EI se les realizó una colonoscopia completa y los resultados histológicos se clasificaron según 4 grupos: lesión maligna, lesión premaligna, lesión benigna y ausencia de lesión. Se evaluó la correlación existente entre los hallazgos de la PET/TC con [18F]FDG y el diagnóstico histopatológico y el microorganismo implicado. Resultados La PET/TC detectó 20 depósitos de [18F]FDG en localización colorrectal (32,79%-OR: 47,28), 2 de ellos en pacientes con bacteriemia (16,7%) confirmados como lesiones malignas y premalignas y 18 en el grupo con EI (36,6%), 17 de ellos correspondientes a enfermedad colorrectal: 11 lesiones malignas, 5 premalignas y una benigna. En el subgrupo con EI la colonoscopia detectó lesiones colorrectales en el 51,02% de los pacientes: 11 malignas, 8 premalignas y 6 benignas. En el subgrupo de Streptococcus spp. se detectó una mayor incidencia de depósitos de [18F]FDG en localización colorrectal (AU)

Objective Association between Streptococcus gallolyticus infective endocarditis (IE) and malignant lesions of the gastrointestinal tract is well described. We hypothesize that other enteropathogenic microorganisms, such as Streptococcus viridans and Enterococcus faecalis are also related with colorectal pathology. Our aim is to determine the frequency of focal colorectal FDG deposits, suggestive of tumoral lesions and their correlation with colorectal pathology, in patients with infection caused by different commensal microorganisms of the gastrointestinal tract. Methods We retrospectively examined 61 patients diagnosed with bacteremia (BSI) and IE (possible or definite) according to Duke's criteria, caused by enteropathogenic microorganisms, who underwent a full-body [18F]FDG-PET/CT in our institution. We looked for colorrectal FDG deposits and morphological lesions. All IE patients underwent a complete colonoscopy and the histological results were classified into four groups: malignant lesion, premalignant lesion, benign lesion and no lesion. We evaluated the correlation between the findings of the [18F]FDG-PET/CT with the histopathological diagnosis and the involved microorganism. Results PET/CT detected 20 colorectal FDG deposits (32.79%-OR: 47.28), 2 within bacteriemic patients (16.7%) confirmed as malignant and premalignant lesions and 18 in IE group (36.6%), 17 of them corresponding to colorrectal pathology: 11 malignant, 5 premalignant and 1 benign lesions. In the IE subgroup, the colonoscopy detected colorectal lesions in 51.02% of the patients: 11 malignant, 8 premalignant and 6 benign. We found a higher incidence of colorectal FDG deposits in Streptococcus spp. subgroup. Regarding the anatomopathological colonic findings there was a predominance of patients affected by S. viridans, followed by E. faecalis and S. gallolyticus (AU)

Downstaging de carcinoma hepatocelular bilobar tras radioembolización con microesferas de 90Y como puente al trasplante hepático / Downstaging of bilobar hepatocellular carcinoma after radioembolization with 90Y microspheres as a bridge to liver transplantation

La radioembolización hepática con 90Y es una terapia locorregional cada vez más ampliamente empleada en el tratamiento del carcinoma hepatocelular. Recientemente, se ha descrito su potencial beneficio como tratamiento de downstaging, logrando una disminución de la carga tumoral que permite rescatar a los pacientes para tratamientos más radicales como el trasplante hepático. Presentamos el caso de un paciente con el diagnóstico de carcinoma hepatocelular estadio intermedio de la Barcelona Clinic Liver Cancer (BCLC), multicéntrico y bilobar, en quien el tratamiento de radioembolización con 90Y consiguió una adecuada respuesta radiológica, reduciéndose de forma muy significativa la carga tumoral, permitiendo su rescate con trasplante hepático (AU)

Hepatic radioembolization with 90Y is an increasingly widely used locoregional therapy in the treatment of hepatocellular carcinoma. Its potential benefit has recently been described as a downstaging treatment, achieving a decreased tumour burden and allowing patients to be rescued for more radical treatments, such as liver transplantation. The case is presented of a patient diagnosed with multifocal bilobar hepatocellular carcinoma, Barcelona Clinic Liver Cancer (BCLC) intermediate stage, in whom treatment with 90Y achieved a satisfactory radiological response with a very significant reduction of tumour burden, allowing rescue with liver transplantation (AU)

Downstaging of bilobar hepatocellular carcinoma after radioembolization with 90Y microspheres as a bridge to liver transplantation. / Downstaging de carcinoma hepatocelular bilobar tras radioembolización con microesferas de 90Y como puente al trasplante hepático.

Hepatic radioembolization with 90Y is an increasingly widely used locoregional therapy in the treatment of hepatocellular carcinoma. Its potential benefit has recently been described as a downstaging treatment, achieving a decreased tumour burden and allowing patients to be rescued for more radical treatments, such as liver transplantation. The case is presented of a patient diagnosed with multifocal bilobar hepatocellular carcinoma, Barcelona Clinic Liver Cancer (BCLC) intermediate stage, in whom treatment with 90Y achieved a satisfactory radiological response with a very significant reduction of tumour burden, allowing rescue with liver transplantation.

Estudio prospectivo para determinar el valor real de la captación de 18F-FDG mesentérica en pacientes oncológicos: ¿paniculitis mesentérica inflamatoria o tumoral? / A prospective study to determine the real value of mesenteric 18F-FDG uptake in cancer patients. inflammatory or tumoral mesenteric paniculitis?

Objetivo. Determinar el comportamiento metabólico de la paniculitis mesentérica (PM), los posibles patrones de presentación en la imagen 18F-FDG-PET/TAC y conocer si es una técnica diagnóstica fiable para diferenciar enfermedad tumoral y patología inflamatoria en este contexto. Material y métodos. Dos mil seiscientas sesenta y seis exploraciones PET/TAC fueron evaluadas de forma prospectiva desde abril de 2012 hasta agosto de 2013. Se incluyeron en nuestro estudio a 30 pacientes (37 exploraciones) que presentaban signos radiológicos de PM, 8 mujeres y 22 hombres, con edades comprendidas entre 39 y 81 años. Según la captación de 18F-FDG en las lesiones mesentéricas, expresado como SUVmax, los pacientes fueron clasificados en dos grupos: Grupo A: conformado por 10 pacientes con captación aumentada, SUVmax ≥ 2 o superior a la actividad hallada en el tejido mesentérico sano circundante y Grupo B (conformado por 20 pacientes): SUVmax < 2 o indistinguible del tejido sano. Resultados. En el 80% de los pacientes del Grupo A (media de SUVmax 7,11) no se demostraron criterios de afectación tumoral mesentérica durante un seguimiento medio de 13 meses (falsos positivos), exceptuando a dos pacientes de este grupo que sí mostraron signos de afectación tumoral (SUVmax 7,57 y 9,46), obteniéndose un valor predictivo positivo de 49,79%. En el 100% de los pacientes del Grupo B se confirmó ausencia de afectación tumoral mesentérica. Conclusiones. Ante la presencia de signos radiológicos de PM, un aumento del metabolismo glucídico, incluso intenso y focal en estas lesiones, aunque no excluye la posibilidad de afectación tumoral, puede corresponder, con una alta probabilidad, a actividad inflamatoria (AU)

Aim. To assess the metabolic behavior of mesenteric panniculitis (MP), possible manifestation patterns in 18F-FDG PET/CT imaging and to discover if it is a reliable diagnostic method to differentiate tumor disease from inflammatory condition in this context. Material and methods. A total of 2,666 PET/CT scans were evaluated prospectively from April 2012 to August 2013. Thirty patients were included (37 scans) with radiological signs of MP. There were 8 women and 22 men, aged between 39 and 81 years, in the sample. According to the 18F-FDG uptake in the mesenteric lesions, expressed as SUVmax, patients were classified into two different groups: Group A consisted of 10 patients with increased uptake, SUVmax ≥ 2 or greater than the activity found in the surrounding healthy mesenteric tissue, and Group B (20 patients) SUVmax < 2 or indistinguishable from healthy tissue. Results. No signs of mesenteric tumour involvement were demonstrated during a mean follow up of 13 months (false positives) in 80% of the Group A patients (mean SUVmax 7.11). Signs of the presence of tumor were only demonstrated in two patients of Group A (SUVmax 7.57 and 9.46) with a positive predictive value of 49.79%. All Group B patients were confirmed to be free of mesenteric involvement. Conclusions. The presence of radiological signs of suggestive of MP, increase in glycidic metabolism, even intense and focal in these lesions, which may not exclude the possibility of an ongoing tumour process, would have a high likelihood of being indicative of intense inflammatory activity (AU)

[A prospective study to determine the real value of mesenteric ¹8F-FDG uptake in cancer patients. inflammatory or tumoral mesenteric paniculitis?]. / Estudio prospectivo para determinar el valor real de la captación de ¹8F-FDG mesentérica en pacientes oncológicos: ¿paniculitis mesentérica inflamatoria o tumoral?

AIM: To assess the metabolic behavior of mesenteric panniculitis (MP), possible manifestation patterns in ¹8F-FDG PET/CT imaging and to discover if it is a reliable diagnostic method to differentiate tumor disease from inflammatory condition in this context. MATERIAL AND METHODS: A total of 2,666 PET/CT scans were evaluated prospectively from April 2012 to August 2013. Thirty patients were included (37 scans) with radiological signs of MP. There were 8 women and 22 men, aged between 39 and 81 years, in the sample. According to the ¹8F-FDG uptake in the mesenteric lesions, expressed as SUVmax, patients were classified into two different groups: Group A consisted of 10 patients with increased uptake, SUVmax ≥ 2 or greater than the activity found in the surrounding healthy mesenteric tissue, and Group B (20 patients) SUVmax <2 or indistinguishable from healthy tissue. RESULTS: No signs of mesenteric tumour involvement were demonstrated during a mean follow up of 13 months (false positives) in 80% of the Group A patients (mean SUVmax 7.11). Signs of the presence of tumor were only demonstrated in two patients of Group A (SUVmax 7.57 and 9.46) with a positive predictive value of 49.79%. All Group B patients were confirmed to be free of mesenteric involvement. CONCLUSIONS: The presence of radiological signs of suggestive of MP, increase in glycidic metabolism, even intense and focal in these lesions, which may not exclude the possibility of an ongoing tumour process, would have a high likelihood of being indicative of intense inflammatory activity.

Utilidad de la cirugía radioguiada en la esplenosis / Utility of radioguided surgery in splenosis

La esplenosis es un hallazgo frecuente tras las la rotura traumática del bazo o esplenectomía terapéutica, definiéndose como un autotrasplante heterotópico del bazo por la superficie y cavidad peritoneal. En pacientes esplenectomizados por enfermedad hematológica, la esplenosis puede llevar a recidiva de la enfermedad. Presentamos un caso de esplenosis en un paciente con púrpura trombocitopénica idiopática (PTI) que presentó una recidiva tras esplenectomía. Para su localización se realizaron pruebas de imagen convencional y gammagrafía con hematíes desnaturalizados marcados con 99mTc, donde se apreciaron al menos 5 focos esplénicos. Dada la difícil localización intraoperatoria de dichos nódulos, se practicó cirugía radioguiada, con excelente localización y extirpación de los nódulos conocidos y de múltiples implantes peritoneales de tamaño milimétrico no visualizados previamente. Concluimos que la cirugía radioguiada es una excelente herramienta para la localización de focos de esplenosis peritoneal de difícil acceso y visualización, evitando así una recurrencia precoz de la enfermedad (AU)

Splenosis is a common finding after traumatic rupture of the spleen or therapeutic splenectomy, defined as a heterotopic autotransplantation of the spleen in peritoneal cavity and surface. In splenectomized patients due to hematologic disease, splenosis can lead to disease recurrence. We present a case of splenosis in a patient with idiopathic thrombocytopenic purpura who relapsed after splenectomy. For its localization, conventional imaging and scintigraphy with 99mTc-denatured red cells was performed, and at least five splenic foci were observed. Given the difficult intraoperative localization of these nodules, radioguided surgery was performed, with excellent localization and removal of all known nodules and multiple peritoneal implants of millimeter size that were not previously observed. We conclude that radioguided surgery is an excellent tool for locating foci of peritoneal splenosis, which have difficult access, thus avoiding early recurrence of the disease (AU)

[Utility of radioguided surgery in splenosis]. / Utilidad de la cirugía radioguiada en la esplenosis.

Splenosis is a common finding after traumatic rupture of the spleen or therapeutic splenectomy, defined as a heterotopic autotransplantation of the spleen in peritoneal cavity and surface. In splenectomized patients due to hematologic disease, splenosis can lead to disease recurrence. We present a case of splenosis in a patient with idiopathic thrombocytopenic purpura who relapsed after splenectomy. For its localization, conventional imaging and scintigraphy with (99m)Tc-denatured red cells was performed, and at least five splenic foci were observed. Given the difficult intraoperative localization of these nodules, radioguided surgery was performed, with excellent localization and removal of all known nodules and multiple peritoneal implants of millimeter size that were not previously observed. We conclude that radioguided surgery is an excellent tool for locating foci of peritoneal splenosis, which have difficult access, thus avoiding early recurrence of the disease.