Valoración de la extensión en partes blandas de las úlceras por presión y diagnóstico de osteomielitis mediante PET/TC con 18F-FDG / Assessment of the extension of pressure ulcers into soft tissue and osteomyelitis diagnosis using 18F-FDG PET/CT

La correcta valoración de la extensión de las úlceras de presión en los pacientes con enfermedad neurológica presenta implicaciones terapéuticas, en especial en la detección precoz de la fistulización hacia estructuras profundas y la osteomielitis. Presentamos aquí a dos pacientes con una úlcera isquiática similar y en los que la PET/TC con 18F-FDG permitió delimitar adecuadamente las complicaciones infecciosas profundas, por lo que se sugiere la necesidad de incluir esta técnica como primera línea diagnóstica (AU)

The precise assessment of pressure ulcer extension in patients with neurological diseases has crucial therapeutic implications, especially in the early detection of fistula to interior structures and osteomyelitis. Two case reports are presented on patients with a similar ischial ulcer, in whom an 18F-FDG PET/CT study enabled a precise assessment of infectious complications in underlying tissues. These cases support the implementation of 18F-FDG PET/CT as a first-line technique in their management (AU)

Assessment of the extension of pressure ulcers into soft tissue and osteomyelitis diagnosis using 18F-FDG PET/CT. / Valoración de la extensión en partes blandas de las úlceras por presión y diagnóstico de osteomielitis mediante PET/TC con 18F-FDG.

The precise assessment of pressure ulcer extension in patients with neurological diseases has crucial therapeutic implications, especially in the early detection of fistula to interior structures and osteomyelitis. Two case reports are presented on patients with a similar ischial ulcer, in whom an 18F-FDG PET/CT study enabled a precise assessment of infectious complications in underlying tissues. These cases support the implementation of 18F-FDG PET/CT as a first-line technique in their management.

Procedure for red blood cell labelling with 99mTc-HMPAO. Methodology and quality control.

We present here results on the labelling of red blood cells with 99mTc-HMPAO as an alternative method to the usual in vitro technique. Anticoagulant agents, the labelling medium with plasma, and the lapse of time between 99mTc-HMPAO preparation and labelling are the main factors which affect the efficiency of the procedure. A 93.9 +/- 2.3% labelling yield was obtained with freshly prepared 99mTc-HMPAO. In vitro (tracer elution of 4.3 +/- 1.2% at 60 mins) and in vivo (percentage of plasma activity at 60 mins, 7.8 +/- 2.8%) stability of the label, as well as image quality, qualify 99mTc-HMPAO labelled red blood cells as a suitable agent for clinical use.

Evaluation of myocardial perfusion defects by means of "bull's eye" images.

The purpose of this study was to evaluate the usefulness of so-called "bull's eye" imaging as a simplified display of tomographic slices in the detection of coronary artery disease (CAD). A total of 64 patients were studied at stress and at rest, by single photon emission computed tomography (SPECT), either with thallium-201 (201Tl) or with technetium-99m methoxy-isobutyl-isonitril (Tc-MIBI). The myocardial perfusion defects detected by bull's eye image alone and in combination with visual analysis of tomographic images were evaluated in all cases, taking coronary arteriographic results as a gold standard. The overall sensitivity and specificity for detection of CAD were as follows: bull's eye imaging, 100% and 70.8%; tomographic imaging (SPECT), 90% and 91.6%. The results of bull's eye imaging and SPECT interpreted together were 96.6% and 83.3%. The regional sensitivity and specificity of bull's eye for individual coronary arteries were: right coronary artery (RCA), 100% and 73.7%; left anterior descending (LAD), 100% and 87.2%; left circumflex (LCx), 100% and 97.3%. For SPECT they were: RCA, 93.7% and 89.5%; LAD, 86.6% and 92.3%; LCx, 73.3% and 97.4%. For bull's eye with SPECT they were: RCA, 94.4% and 86.1%; LAD, 87.5% and 92.1%; LCx, 82.3% and 97.2%. We conclude that the bull's eye image display allows an easier and more objective assessment of myocardial perfusion defects and shows higher sensitivity. However, it has a relatively low specificity which can cause an overestimation of perfusion defects. Thus, visual analysis of bull's eye imaging is a useful diagnostic tool but must be evaluated in conjunction with tomographic imaging.