Metástasis pancreática y tiroidea detectadas con 18F-FDG PET/TAC en paciente con cáncer colorrectal / Pancreatic and thyroid metastases detected with 18F-FDG PET/CT in patient with colorectal cancer

Mujer de 53 años diagnosticada de cáncer colorrectal, quien recibió tratamiento quirúrgico y quimioterápico, tras 5 años de remisión completa presenta una evolución atípica de su patología oncológica. La utilidad de la PET/TAC con 18F-FDG ha sido fundamental para la detección de las recidivas, sospechadas y no sospechadas, y para la monitorización de la respuesta al tratamiento(AU)

A 53-year-old woman with diagnosis of colorectal cancer, who received surgical treatment and chemotherapy. After 5-years of complete remission, she showed an atypical oncological evolution. The utility of 18F-FDG PET/CT scan has been fundamental to detect suspected and unsuspected recurrence and to monitor response to treatment(AU)

Pancreatic and thyroid metastases detected with 18F-FDG PET/CT in patient with colorectal cancer.

A 53-year-old woman with diagnosis of colorectal cancer, who received surgical treatment and chemotherapy. After 5-years of complete remission, she showed an atypical oncological evolution. The utility of (18)F-FDG PET/CT scan has been fundamental to detect suspected and unsuspected recurrence and to monitor response to treatment.

Diagnóstico no invasivo de la esplenosis torácica postraumática / Non-invasive diagnosis of posttraumatic thoracic splenosis

La esplenosis intratorácica es una entidad generalmente asintomática que se diagnostica de forma incidental tras la realización de una radiografía, TAC o RM por otro motivo. La realización de una gammagrafía con hematíes desnaturalizados marcados con 99mTc permite el diagnóstico no invasivo de esta entidad y evita técnicas de diagnóstico más agresivas. Dado que este tejido esplénico puede ser parcial o totalmente funcionante, y por tanto tener cierta función inmunológica beneficiosa para el paciente (suficiente para brindar protección frente a la sepsis postesplenectomía), el manejo de esta entidad debe ser conservador. La técnica radioisotópica de gammagrafía con hematíes desnaturalizados marcados con 99mTc es la que presenta mayor especificidad para la demostración de tejido esplénico. La presencia de nódulos pulmonares subpleurales, asociados o no a nódulos intraabdominales, junto con la existencia de antecedentes de esplenectomía parcial o total, traumática o no, deben hacer sospechar la presencia de una esplenosis intratorácica(AU)

Intrathoracic splenosis is a generally asymptomatic entity incidentally diagnosed after the completion of an Rx, CT scan or MRI for another reason. The performance of scintigraphy with 99mTc-labelled heat-denatured erythrocytes allows the noninvasive diagnosis of this entity and avoids more aggressive diagnostic techniques such as FNAP or thoracotomy. Because this splenic tissue may be partially or fully functioning and therefore may have some beneficial immune function for the patient, the management of this entity should be conservative. Radioisotopic scintigraphy with 99mTc labelled heat-denatured erythrocytes is the technique with the greatest specificity in the demonstration of splenic tissue. The presence of subpleural pulmonary nodules, associated or not with intra-abdominal nodules, together with the existence of previous partial or total splenectomy, traumatic or not, with or without associated rupture of the diaphragm, should raise suspicion of the presence of intrathoracic splenosis(AU)

[Non-invasive diagnosis of posttraumatic thoracic splenosis]. / Diagnóstico no invasivo de la esplenosis torácica postraumática.

Intrathoracic splenosis is a generally asymptomatic entity incidentally diagnosed after the completion of an Rx, CT scan or MRI for another reason. The performance of scintigraphy with (99m)Tc-labelled heat-denatured erythrocytes allows the noninvasive diagnosis of this entity and avoids more aggressive diagnostic techniques such as FNAP or thoracotomy. Because this splenic tissue may be partially or fully functioning and therefore may have some beneficial immune function for the patient, the management of this entity should be conservative. Radioisotopic scintigraphy with (99m)Tc labelled heat-denatured erythrocytes is the technique with the greatest specificity in the demonstration of splenic tissue. The presence of subpleural pulmonary nodules, associated or not with intra-abdominal nodules, together with the existence of previous partial or total splenectomy, traumatic or not, with or without associated rupture of the diaphragm, should raise suspicion of the presence of intrathoracic splenosis.

Captación torácica de 131I en el seguimiento del cáncer diferenciado de tiroides / Iodine uptake in the chest in the follow-up of well-differentiated thyroid cancer

El cáncer diferenciado de tiroides es una enfermedad con muy buen pronóstico si se trata adecuadamente. El tratamiento ablativo con 131I frecuentemente se asocia al tratamiento quirúrgico en estos pacientes ya que mejora la supervivencia, y el rastreo corporal total con 131I es una de las modalidades de diagnóstico de elección en el seguimiento de esta enfermedad. Tras tratamiento ablativo del tejido tiroideo, cualquier depósito del radiotrazador en una localización no fisiológica representa habitualmente la presencia de metástasis. Así pues, será fundamental el reconocimiento de cualquier posible falso positivo con el fin de evitar la radiación innecesaria debida a tratamientos inadecuados. Presentamos un caso clínico de captación torácica por bronquiectasias que puede malinterpretarse como metástasis pulmonar(AU)

Differentiated thyroid cancer is a disease having a very good prognosis when treated adequately. Ablation treatment with 131I is frequently adjunct to surgery in these patients since it improves survival. Radioiodine whole-body scan is one of the imaging modality of choice in the follow-up of patients with this kind of pathology. After ablation treatment of the thyroid gland, any radioiodine accumulation in a non-physiological location usually means the presence of functioning metastasis. Recognition of potential false-positives is essential to avoid unnecessary exposure to further radiation from repeated therapeutic doses of radioactive iodine. We report a case of uptake in the chest due to bronchiectasis, potentially masquerading as pulmonary metastasis(AU)

[Iodine uptake in the chest in the follow-up of well-differentiated thyroid cancer]. / Captación torácica de (131)I en el seguimiento del cáncer diferenciado de tiroides.

Differentiated thyroid cancer is a disease having a very good prognosis when treated adequately. Ablation treatment with (131)I is frequently adjunct to surgery in these patients since it improves survival. Radioiodine whole-body scan is one of the imaging modality of choice in the follow-up of patients with this kind of pathology. After ablation treatment of the thyroid gland, any radioiodine accumulation in a non-physiological location usually means the presence of functioning metastasis. Recognition of potential false-positives is essential to avoid unnecessary exposure to further radiation from repeated therapeutic doses of radioactive iodine. We report a case of uptake in the chest due to bronchiectasis, potentially masquerading as pulmonary metastasis.

Experiencia con 123I-Iodobenzamida en el diagnóstico diferencial de enfermedad de Parkinson frente a Parkinson plus / Experience with 123I-Iodobenzamide in the differential diagnosis of Parkinson's disease and Parkinson-plus disease

ObjetivoRealizar un análisis descriptivo de la implicación clínico-diagnóstica de la exploración con 123I-Iodobenzamida (IBZM) en los pacientes estudiados en nuestro centro por trastornos del movimiento sugerentes de Parkinson plus (PP).Material y métodoSe realizó SPECT con 123I-IBZM a 46 pacientes, procedentes de la consulta de trastornos del movimiento, por sospecha de PP. Según la clínica se distribuyeron en 3 grupos: 35 pacientes presentaban clínica atípica (CA) para enfermedad de Parkinson, 2 mostraban falta de respuesta al tratamiento habitual (FR) y en 9 se presentaban ambos factores (CA y FR). El resultado del SPECT se valoró únicamente de forma cualitativa.ResultadosDe los 35 pacientes con CA el 123I-IBZM apoyó el diagnóstico de PP en 15(42,9%), de los 2 con FR el estudio fue patológico en 1 y, de los 9 que presentaban ambos factores (CA y FR), el 123I-IBZM fue patológico en 6 casos (66,7%).ResultadosEn el 95,7% de la muestra (44 pacientes) la CA, con o sin FR, era el principal factor de sospecha de PP, y sólo en el 47,7% (22 pacientes) el 123I-IBZM resultó alterado. De estos 22 casos, en 20 el diagnóstico definitivo fue de PP (elevado valor predictivo positivo).ConclusiónEl estudio con 123I-IBZM es de gran utilidad en la práctica clínica, al proporcionar una información diagnóstica objetiva con implicaciones en el tratamiento y pronóstico de los pacientes con sospecha de PP(AU)

ObjectiveTo perform a descriptive analysis of the clinical and diagnostic implications of 123I-IBZM SPECT in the patients studied in our center for movement disorders suggestive of Parkinson-Plus Disease (PP).Subjects and methods123I-IBZM SPECT was performed in 46 patients referred from the movement disorders consultation due to suspicion of PP. According to their symptoms, they were distributed into 3 groups: 35 patients had atypical symptoms (AS) for Parkinson's Disease, 2 showed no response to standard therapy (NR) and 9 presented both factors (AS, NR). The results of SPECT were only assessed qualitatively.ResultsThe 123I-IBZM supported the diagnosis of PP in 15(42.9%) out of the 35 patients with AS. The 123I-IBZM was pathological in one of the two NR patients. Regarding the third group of patients (AS+NR), the 123I-IBZM was pathological in 6 cases (66.7%).ResultsIn 95.7% of our sample (44 patients), AS with or without NR was the main factor leading to suspicion of PP and the 123I-IBZM was altered in only 47.7% (22 patients). Of these 22 cases, the final diagnosis was PP (with high positive predictive value) in 20(91%).ConclusionThe study with 123I-IBZM is useful in the clinical practice because it provides objective diagnostic information with implications for the treatment and prognosis of patients with suspicion of PP(AU)

[Experience with 123I-Iodobenzamide in the differential diagnosis of Parkinson's disease and Parkinson-plus disease]. / Experiencia con 123I-Iodobenzamida en el diagnóstico diferencial de enfermedad de Parkinson frente a Parkinson plus.

OBJECTIVE: To perform a descriptive analysis of the clinical and diagnostic implications of (123)I-IBZM SPECT in the patients studied in our center for movement disorders suggestive of Parkinson-Plus Disease (PP). SUBJECTS AND METHODS: (123)I-IBZM SPECT was performed in 46 patients referred from the movement disorders consultation due to suspicion of PP. According to their symptoms, they were distributed into 3 groups: 35 patients had atypical symptoms (AS) for Parkinson's Disease, 2 showed no response to standard therapy (NR) and 9 presented both factors (AS, NR). The results of SPECT were only assessed qualitatively. RESULTS: The (123)I-IBZM supported the diagnosis of PP in 15(42.9%) out of the 35 patients with AS. The (123)I-IBZM was pathological in one of the two NR patients. Regarding the third group of patients (AS+NR), the (123)I-IBZM was pathological in 6 cases (66.7%). In 95.7% of our sample (44 patients), AS with or without NR was the main factor leading to suspicion of PP and the (123)I-IBZM was altered in only 47.7% (22 patients). Of these 22 cases, the final diagnosis was PP (with high positive predictive value) in 20(91%). CONCLUSION: The study with (123)I-IBZM is useful in the clinical practice because it provides objective diagnostic information with implications for the treatment and prognosis of patients with suspicion of PP.

[Brain perfusion study in patients with systemic lupus erythematosus and neuropsychiatric symptoms]. / Estudio de perfusión cerebral en paciente con lupus eritematoso sistémico y clínica neuropsiquiátrica.

Neuropsychiatric manifestations in 25% to 70% of patients with systemic lupus erythematosus (SLE), generally in young people. The variability in its clinical expression and lack of diagnostic methods have hindered the diagnosis of Central Nervous System Lupus. When the literature was reviewed on this subject, an important variability was found between the Single Photon Emission Computed Tomography (SPECT) findings and the patient's clinical symptoms and disease course. The case we are presenting shows the usefulness of brain perfusion SPECT because it shows alterations in the central nervous system that are not detected with other imaging modalities.

Estudio de perfusión cerebral en paciente con lupus eritematoso sistémico y clínica neuropsiquiátrica / Brain perfusion study in patients with systemic lupus erythematosus and neuropsychiatric symptoms

La clínica neuropsiquiátrica aparece entre un 25 y un 70% de los pacientes con lupus eritematoso sistémico (LES), fundamentalmente en jóvenes. La variedad en la expresión clínica y la falta de métodos diagnósticos ha dificultado el diagnóstico de la afectación neurológica del lupus. Revisada la literatura al respecto, se observa una importante variabilidad entre los hallazgos de la tomografía computarizada por emisión de fotón único (SPECT) con los síntomas clínicos de los pacientes y la evolución de la enfermedad. El caso que presentamos muestra la utilidad de la SPECT de perfusión cerebral, porque evidencia alteraciones en el sistema nervioso central que no se observan con otras técnicas de imagen(AU)

Neuropsychiatric manifestations in 25% to 70% of patients with systemic lupus erythematosus (SLE), generally in young people. The variability in its clinical expression and lack of diagnostic methods have hindered the diagnosis of Central Nervous System Lupus. When the literature was reviewed on this subject, an important variability was found between the Single Photon Emission Computed Tomography (SPECT) findings and the patient's clinical symptoms and disease course. The case we are presenting shows the usefulness of brain perfusion SPECT because it shows alterations in the central nervous system that are not detected with other imaging modalities(AU)

[Prenatal diagnosis of hydronephrosis: utility of diuretic renography]. / Diagnóstico prenatal de hidronefrosis: utilidad del renograma isotópico diurético.

OBJECTIVE: To investigate the value of diuretic renography in patients with prenatally diagnosed unilateral hydronephrosis. MATERIAL AND METHOD: We reviewed 44 patients who underwent ultrasonography in the first week of life and 1 month after birth, and cystography and diuretic renography at 1 month to evaluate differential renal function and the diuretic washout pattern. Patients with vesicoureteral reflux were followed-up according to the protocol for this disorder. In the remaining patients, ultrasonography and/or diuretic renography was performed every 3-6 months. RESULTS: In 4/44 patients vesicoureteral reflux was detected as cause a of hydronephrosis. In the remaining 40 patients, diuretic renography showed a washout pattern not suggestive of obstruction in 32 (only one patient needed surgery due to pyohydronephrosis). An indeterminate washout pattern was detected in one patient (who required surgery due to worsening of the washout pattern). A pattern suggestive of obstruction was detected in seven patients, four of whom required surgery (three due to a decrease in differential renal function and one due to worsening of the degree of pelvic dilatation). CONCLUSIONS: Diuretic renography is highly useful in risk stratification and in the management of newborn infants with hydronephrosis since infants with washout patterns not suggestive of obstruction will rarely develop obstructive hydronephrosis and can initially be followed-up with ultrasonography alone. In indeterminate and obstructive patterns, however, close monitoring that includes diuretic renography is mandatory.

Diagnóstico prenatal de hidronefrosis: utilidad del renograma isotópico diurético / Prenatal diagnosis of hydronephrosis: Utility of diuretic renography

Objetivo: Determinar el papel del renograma isotópico diurético en los pacientes con diagnóstico prenatal de hidronefrosis unilateral. Material y método: Se estudiaron 44 pacientes a los que se les realizó ecografía en la primera semana y al mes de vida, cistografía miccional seriada y renograma isotópico diurético al mes de vida en el que se valoró la función renal relativa y la curva de eliminación del radiotrazador. Los pacientes a los que se detectó reflujo vesicoureteral se siguieron mediante el protocolo de dicha patología. Al resto de los pacientes se les realizó ecografía y/o renograma cada 3-6 meses. Resultados: En 4 de 44 pacientes se detectó reflujo como causa de la hidronefrosis. En los 40 pacientes restantes, el renograma mostró un patrón de eliminación del radiotrazador no sugerente de obstrucción en 32 (tan sólo uno precisó cirugía por desarrollar piohidronefrosis), en uno un patrón indeterminado (precisó cirugía por empeoramiento en la curva del renograma) y en siete un patrón sugerente de obstrucción; de éstos, tres mejoraron sin necesidad de cirugía y cuatro precisaron pieloplastia (tres por descenso de la función renal relativa y uno por progresión ecográfica de la hidronefrosis). Conclusiones: El renograma isotópico diurético muestra un alto valor en la estratificación del riesgo y en el manejo de los neonatos con hidronefrosis ya que los patrones de eliminación no sugerentes de obstrucción raramente desarrollarán hidronefrosis obstructiva y pueden seguirse, en principio, exclusivamente con ecografía, mientras que los patrones de eliminación indeterminado y obstructivo obligan a un seguimiento estricto en el que debe incluirse el renograma isotópico diurético

Objective To investigate the value of diuretic renography in patients with prenatally diagnosed unilateral hydronephrosis Material and method: We reviewed 44 patients who underwent ultrasonography in the first week of life and 1 month after birth, and cystography and diuretic renography at 1 month to evaluate differential renal function and the diuretic washout pattern. Patients with vesicoureteral reflux were followed-up according to the protocol for this disorder. In the remaining patients, ultrasonography and/or diuretic renography was performed every 3-6 months. Results: In 4/44 patients vesicoureteral reflux was detected as cause a of hydronephrosis. In the remaining 40 patients, diuretic renography showed a washout pattern not suggestive of obstruction in 32 (only one patient needed surgery due to pyohydronephrosis). An indeterminate washout pattern was detected in one patient (who required surgery due to worsening of the washout pattern). A pattern suggestive of obstruction was detected in seven patients, four of whom required surgery (three due to a decrease in differential renal function and one due to worsening of the degree of pelvic dilatation). Conclusions: Diuretic renography is highly useful in risk stratification and in the management of newborn infants with hydronephrosis since infants with washout patterns not suggestive of obstruction will rarely develop obstructive hydronephrosis and can initially be followed-up with ultrasonography alone. In indeterminate and obstructive patterns, however, close monitoring that includes diuretic renography is mandatory

[Left distal femoral diaphysis-metaphyseal injury in a 13-year-old patient]. / Lesión diafiso-metafisaria distal femoral izquierda en paciente de 13 años.

This paper aims to present the usefulness of the different diagnosis imaging methods (anatomical and functional) in the characterization of bone injury. Any data, however insignificant, is justified and should be specified. In this case, the discrepancy between the vascular and pool phases in the bone scintigraphy with 99mTc-MDP reveals revealed a lesion with an intense reaction secondary to the "foreign body effect", which is not necessarily malignant.

Lesión diafiso-metafisaria distal femoral izquierda en paciente de 13 años / Left distal femoral diaphysis-metaphyseal injury in a 13 years old patient

El objetivo es presentar la utilidad de los distintos métodos de diagnóstico por imagen (anatómicos y funcionales), en la caracterización de una lesión ósea.Cualquier dato, por insignificante que este sea, tiene su justificación y debe ser especificado. En este caso, la discrepancia en la gammagrafía ósea con 99mTc-MDP, entre las fases vascular y 'pool', revela a una lesión con intensa reacción secundaria al efecto de 'cuerpo extraño', que necesariamente no tiene que ser maligna (AU)