Renograma en trasplante renal. Utilidad de imágenes tardías con SPECT/TC para el diagnóstico de fuga urinaria / Renogram in kidney transplant. Utility of delayed images with SPECT/CT in the diagnosis of urinary leak

La fuga urinaria en los pacientes trasplantados renales es una complicación quirúrgica relativamente frecuente que requiere un diagnóstico e intervención precoces. El renograma isotópico es un método no invasivo y efectivo para evaluar la perfusión y función del trasplante renal, y nos permite diagnosticar complicaciones urológicas como la fuga urinaria. En estos casos es de gran utilidad completar el estudio con imágenes planares y SPECT/TC tardío para precisar el diagnóstico y localizar la fuga. Se exponen 2 casos diagnosticados de fuga urinaria tras realizar renograma con imágenes planares precoz y tardía y SPECT/TC tardío, a la semana de ser sometidos a trasplante. En ambos casos se colocó una sonda de nefrostomía percutánea, así como un catéter ureteral doble J, resolviéndose la complicación quirúrgica

Urinary leakage in patients with kidney transplantation is a relatively common surgical complication that requires early diagnosis and intervention. The isotopic renogram is a non-invasive and effective method to evaluate the perfusion and function of kidney transplantation, and allows us to diagnose urological complications such as urinary leakage. In these cases, it is useful to complete the study with planar images and delayed SPECT/CT to specify the diagnosis and locate the leak. We expose two cases diagnosed with urinary leak after performing a renogram with early and delayed planar images and delayed SPECT/CT a week after transplantation. In both cases, a percutaneous nephrostomy catheter was placed, as well as a double J catheter, resolving the surgical complication

Renogram in kidney transplant. Utility of delayed images with SPECT/CT in the diagnosis of urinary leak. / Renograma en trasplante renal. Utilidad de imágenes tardías con SPECT/TC para el diagnóstico de fuga urinaria.

Urinary leakage in patients with kidney transplantation is a relatively common surgical complication that requires early diagnosis and intervention. The isotopic renogram is a non-invasive and effective method to evaluate the perfusion and function of kidney transplantation, and allows us to diagnose urological complications such as urinary leakage. In these cases, it is useful to complete the study with planar images and delayed SPECT/CT to specify the diagnosis and locate the leak. We expose two cases diagnosed with urinary leak after performing a renogram with early and delayed planar images and delayed SPECT/CT a week after transplantation. In both cases, a percutaneous nephrostomy catheter was placed, as well as a double J catheter, resolving the surgical complication.

SPECT-CT finding of 99mTc-HMDP uptake in abdominal adenopathies in a patient with metastasic breast cancer / Hallazgo mediante SPECT-TC de captación de 99mTc-HMDP en adenopatías abdominales en una paciente con cáncer de mama metastásico

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Valoración mediante SPECT-CT de un timoma y un carcinoma de mama hallados de forma casual en un SPECT de perfusión miocardica con 99mTc-MIBI / Evaluation by SPECT-CT of an incidental finding of a thymoma and breast cancer in a myocardial perfusion SPECT with 99mTc-MIBI

Presentamos una paciente de 78 años, derivada para estudio de angor de esfuerzo, que en el SPECT de perfusión miocárdica presentó captación aumentada del trazador en dos lesiones tumorales sincrónicas: un timoma y un cáncer de mama. Este caso clínico pone de manifiesto la aportación del SPECT-CT en la caracterización de estos hallazgos y su papel esencial para una rápida toma de decisiones. La paciente fue intervenida quirúrgicamente de las dos lesiones, insospechadas previamente a la realización del SPECT miocárdico(AU)

We present a case of a 78-year-old female with effort angina. A myocardial perfusion SPECT (MPS) showed increased tracer uptake in two synchronic tumor lesions, a thymoma and a breast cancer. This case highlights the contribution of SPECT-CT in the characterization of these findings and its essential role in rapid decision-making. The patient underwent surgery of both lesions that had gone undetected prior to the conduction of the MPS(AU)

Evaluation by SPECT-CT of an incidental finding of a thymoma and breast cancer in a myocardial perfusion SPECT with 99mTc-MIBI.

We present a case of a 78-year-old female with effort angina. A myocardial perfusion SPECT (MPS) showed increased tracer uptake in two synchronic tumor lesions, a thymoma and a breast cancer. This case highlights the contribution of SPECT-CT in the characterization of these findings and its essential role in rapid decision-making. The patient underwent surgery of both lesions that had gone undetected prior to the conduction of the MPS.

[Assessment of cerebral blood flow in patients with eating disorders in the acute clinical phase using Tc99m-HMPAO spect]. / Valoración del flujo sanguíneo cerebral en pacientes con trastornos de la conducta alimentaria en fase aguda mediante SPECT con HMPAO-Tc99m.

OBJECTIVE: To assess the status of cerebral perfusion in patients with eating disorders (ED) in the acute phase of the disease. MATERIALS AND METHODS: Seventeen patients, with a mean age of 22 years, diagnosed with ED according to DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders) criteria and under close clinical monitoring were studied in the initial acute phase of their disease. Brain SPECT with 15 mCi of Tc99m HMPAO was performed on all patients and assessed using visual and semi-quantitative analysis. The latter was carried out by obtaining left/right indices in sixteen symmetrical 5 x 5 pixel regions of interest (ROI) in three transverse slices, one below the cantho-meatal line and two above, at 2 and 5 cm, respectively. RESULTS; Visual analysis showed hypoperfusion of the anteroinferior region of the left temporal lobe in 7/17 patients, and in the homonymous region of the right temporal lobe in 1/17. Semi-quantitative analysis did not show statistically significant differences in the slices above the cantho-meatal line when the means of the asymmetry indices were compared between the anterior (frontal), middle (temporal and parietal) and posterior (occipital) regions of each slice, obtaining values ranging between 0.99 +/- 0.05 and 1.02 +/- 0.03. However, in the lowest slice, the anterior (temporal) region showed a mean asymmetry value of 0.89 +/- 0.15, and on comparing it with the mean of the asymmetry indices of the posterior region (cerebellum), it showed a statistically significant difference (p < 0.05). CONCLUSION: Patients with ED frequently show hypoperfusion of the anteroinferior region of the temporal lobe, predominantly in the left hemisphere, in the acute phase of the illness.

Valoración del flujo sanguíneo cerebral en pacientes con trastornos de la conducta alimentaria en fase aguda mediante SPECT con HMPAO-Tc99m / Assessment Of Cerebral Blood Flow in patients with eating disorders in the acute clinical phase using Tc99m-HMPAO SPECT

Objetivo. Valorar el estado de la perfusión cerebral en pacientes con trastornos de la conducta alimentaria (TCA) en fase aguda de la enfermedad. Material y métodos. Se estudiaron 17 pacientes, con una edad media de 22 años, diagnosticados de TCA según los criterios del DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders) bajo control clínico estrecho en la fase aguda inicial de su enfermedad. A cada paciente se le realizó una tomografía computarizada por emisión de fotón único (SPECT) cerebral con 15 mCi de hexametil propileno amino oxima (HMPAO)-Tc99m que fue valorado mediante análisis visual y semicuantitativo. Este último se realizó obteniendo índices izquierda/derecha en 16 regiones de interés (ROI) simétricas de 5 ¥ 5 píxeles en tres cortes transversales, uno por debajo de la línea canto-meatal y dos por encima, a 2 y 5 cm, respectivamente. Resultados. El análisis visual mostró la existencia de hipoperfusión de la región anteroinferior del lóbulo temporal izquierdo en 7/17 pacientes y en la región homónima del lóbulo temporal derecho en 1/17. El análisis semicuantitativo no reveló diferencias estadísticamente significativas en los cortes por encima de la línea canto-meatal cuando se compararon entre sí las medias de los índices de asimetría entre las regiones anterior (frontal), media (temporal y parietal) y posterior (occipital) de cada corte; obteniéndose valores en un rango entre 0,99 ± 0,05 y 1,02 ± 0,03. Sin embargo, en el corte más inferior, la región anterior (temporal) mostró un valor promedio de asimetría de 0,89 ± 0,15 y al compararla con el promedio de los índices de asimetría de la región posterior (cerebelo) mostró una diferencia estadísticamente significativa (p < 0,05). Conclusión. En los pacientes con TCA existe frecuentemente hipoperfusión de la región anteroinferior del lóbulo temporal, de predominio izquierdo, en la fase aguda de la enfermedad

Objective. To assess the status of cerebral perfusion in patients with eating disorders (ED) in the acute phase of the disease. Materials and methods. Seventeen patients, with a mean age of 22 years, diagnosed with ED according to DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders) criteria and under close clinical monitoring were studied in the initial acute phase of their disease. Brain SPECT with 15 mCi of Tc99m HMPAO was performed on all patients and assessed using visual and semi-quantitative analysis. The latter was carried out by obtaining left/right indices in sixteen symmetrical 5 ¥ 5 pixel regions of interest (ROI) in three transverse slices, one below the cantho-meatal line and two above, at 2 and 5 cm, respectively. Results. Visual analysis showed hypoperfusion of the anteroinferior region of the left temporal lobe in 7/17 patients, and in the homonymous region of the right temporal lobe in 1/17. Semi-quantitative analysis did not show statistically significant differences in the slices above the cantho-meatal line when the means of the asymmetry indices were compared between the anterior (frontal), middle (temporal and parietal) and posterior (occipital) regions of each slice, obtaining values ranging between 0.99 ± 0.05 and 1.02 ± 0.03. However, in the lowest slice, the anterior (temporal) region showed a mean asymmetry value of 0.89 ± 0.15, and on comparing it with the mean of the asymmetry indices of the posterior region (cerebellum), it showed a statistically significant difference (p < 0.05). Conclusion. Patients with ED frequently show hypoperfusion of the anteroinferior region of the temporal lobe, predominantly in the left hemisphere, in the acute phase of the illness

[18F-FDG PET/CT in response evaluation of gastrointestinal stromal tumours treated with imatinib]. / La PET/TAC con 18F-FDG en la evaluación de la respuesta de los tumores del estroma gastrointestinal al tratamiento con imatinib.

OBJECTIVE: Several studies have demonstrated the effective use of adjuvant treatment with Imatinib mesylate for unresectable, metastatic or recurrent gastrointestinal stromal tumours (GIST). We retrospectively evaluated the role of 18F-FDG PET/CT scanning in assessing the response of GIST patients to imatinib mesylate therapy. MATERIALS AND METHODS: Eight consecutive patients with GIST confirmed by surgery (4 stomach, 2 small bowel, 1 small bowel and peritoneum, and 1 rectum) underwent eighteen 18F-FDG PET/CT imaging after beginning imatinib mesylate therapy (400 mg/day or greater if disease progression). PET/CT scan was acquired 60-90 minutes after the intravenous injection of 333-707 MBq of 18F-FDG. Visual and semiquantitative (standardized uptake value [SUV]) analysis of images was performed. Response to therapy was assessed according to EORTC recommendations for PET. Results were confirmed by clinical follow-up, radiographic findings or histological analysis. RESULTS: Complete response to imatinib mesylate was observed in 5 patients. Four had abdominal lymph nodes, associated with liver metastases in 2, and the other had a residual tumour mass. Partial response (reduction in SUV and in the extent of FDG uptake) was demonstrated in a patient with lung nodules. Disease progression was observed in one patient who had developed new liver metastases on the PET/CT scan. One patient with multiple peritoneal implants and abdominal mass was a non-responder and died 2 months after the 18F-FDG PET/CT. CONCLUSION: 18F-FDG PET/CT scan identified the degree of GIST response to imatinib therapy. Patients who responded to therapy showed normalisation of FDG uptake or a decrease in the SUV of lesions.

La PET/TAC con 18F-FDG en la evaluación de la respuesta de los tumores del estroma gastrointestinal al tratamiento con imatinib / 18F-FDG PET/CT in response evaluation of gastrointestinal stromal tumours treated with imatinib

Objetivo. Diferentes trabajos han demostrado la efectividad del tratamiento adyuvante con mesilato de imatinib en el tumor del estroma gastrointestinal (GIST) irresecable, metastásico o recidivado. Hemos estudiado, retrospectivamente, el papel de la PET/TAC con 18F-FDG en la valoración de la respuesta del GIST al tratamiento con imatinib. Material y métodos. El estudio incluyó 8 pacientes consecutivos con GIST confirmado por cirugía (4 estómago, 2 intestino delgado, 1 intestino delgado y peritoneo y 1 recto) a los cuales se les realizaron 18 PET/TAC con 18F-FDG después de iniciar el tratamiento con mesilato de imatinib (400 mg/día o dosis mayores si se detectó progresión). La PET/TAC se adquirió a los 60-90 minutos después de la administración intravenosa de 333-707 MBq de 18F-FDG. Se realizó un análisis visual y semicuantitativo (standardized uptake value [SUV]) de las imágenes. La respuesta a la terapia se valoró siguiendo las recomendaciones de la EORTC para la PET. Los resultados se confirmaron por seguimiento clínico, hallazgos radiológicos o histología. Resultados. La respuesta al imatinib fue completa en 5 pacientes. Cuatro de ellos tuvieron adenopatías abdominales, asociadas a metástasis hepáticas en dos; el otro paciente tuvo una masa tumoral residual. La respuesta fue parcial (disminución del SUV y de la extensión de la captación de FDG) en un paciente con nódulos pulmonares. Se observó progresión de la enfermedad en un paciente por la aparición de nuevas metástasis hepáticas en la PET/TAC. Una paciente no respondió a la terapia y tuvo múltiples implantes peritoneales y una masa abdominal, falleciendo a los 2 meses de la PET/TAC. Conclusión. La PET/TAC con 18F-FDG identificó el grado de respuesta del GIST a la terapia con imatinib. En los pacientes que respondieron al tratamiento se observó la normalización de la captación de FDG o un descenso en el SUV de las lesiones (AU)

Objective. Several studies have demonstrated the effective use of adjuvant treatment with Imatinib mesylate for unresectable, metastatic or recurrent gastrointestinal stromal tumours (GIST). We retrospectively evaluated the role of 18F-FDG PET/CT scanning in assessing the response of GIST patients to imatinib mesylate therapy. Materials and methods. Eight consecutive patients with GIST confirmed by surgery (4 stomach, 2 small bowel, 1 small bowel and peritoneum, and 1 rectum) underwent eighteen 18F-FDG PET/CT imaging after beginning imatinib mesylate therapy (400 mg/day or greater if disease progression). PET/CT scan was acquired 60-90 minutes after the intravenous injection of 333-707 MBq of 18F-FDG. Visual and semiquantitative (standardized uptake value [SUV]) analysis of images was performed. Response to therapy was assessed according to EORTC recommendations for PET. Results were confirmed by clinical follow-up, radiographic findings or histological analysis. Results. Complete response to imatinib mesylate was observed in 5 patients. Four had abdominal lymph nodes, associated with liver metastases in 2, and the other had a residual tumour mass. Partial response (reduction in SUV and in the extent of FDG uptake) was demonstrated in a patient with lung nodules. Disease progression was observed in one patient who had developed new liver metastases on the PET/CT scan. One patient with multiple peritoneal implants and abdominal mass was a non-responder and died 2 months after the 18F-FDG PET/CT. Conclusion. 18F-FDG PET/CT scan identified the degree of GIST response to imatinib therapy. Patients who responded to therapy showed normalisation of FDG uptake or a decrease in the SUV of lesions (AU)

[Potential sources of diagnostic pitfall and variants in FDG-PET/CT]. / Potenciales fuentes de error diagnóstico y variantes de la FDG-PET/TAC.

UNLABELLED: Oncological FDG PET show variants and findings that may lead to a diagnostic error and that may be clarified by the morfofunctional imaging from PET/CT. In this article we show the experience acquired since a Siemens PET/CT Biograph LSO Pico3D was applied in our centre. We describe some representative examples of FDG distribution patterns which may lead to erroneous interpretations of the clinical studies when they refer to specific clinical situations. The examples included are classified into two main groups according to the cause: Technical and biological, and the latter into physiological and non-physiological (pathophysiological). Patterns are described within the biological group showing changes of the FDG biodistribution that may reduce the uptake in tumoural lesions, the physiological variants that may be interpreted as pathology, the effects of previous treatment and uptakes related to benign diseases. CONCLUSION: We consider that knowledge of these variants and findings to be crucial in order to obtain optimal performance of PET/CT and to overcome the PET limitations.

Potenciales fuentes de error diagnóstico y variantes de la FDG-PET/TAC / Potential sources of diagnostic pitfall and variants in FDG-PET/CT

Las exploraciones oncológicas con FDG presentan variantes y hallazgos que pueden inducir a un error diagnóstico y que la imagen morfofuncional de la PET/TAC puede resolver. En este artículo presentamos la experiencia adquirida desde que comenzara a ser operativo un equipo PET/TAC Biograph LSO Pico3D de Siemens en nuestro centro. Describimos aquí algunos ejemplos representativos de patrones de distribución de la FDG que pueden dar lugar a interpretaciones erróneas de los estudios cuando se refieren a situaciones clínicas concretas. Los ejemplos incluidos se clasifican según el tipo de causa que los origina en dos grandes grupos: de causa técnica y de causa biológica y a su vez este último en fisiológicos y no fisiológicos (fisiopatológicos). Dentro de los biológicos se describen patrones que muestran alteraciones de la biodistribución de la FDG disminuyendo su captación por las lesiones tumorales, las variantes fisiológicas que pueden simular patología, los efectos de los tratamientos previos y las captaciones relacionables con patologías no malignas. Conclusión: podemos decir que consideramos esencial el conocimiento de estas variantes y hallazgos para obtener el óptimo rendimiento de la PET/TAC y para la superación de las limitaciones de la PET

Oncological FDG PET show variants and findings that may lead to a diagnostic error and that may be clarified by the morfofunctional imaging from PET/CT. In this article we show the experience acquired since a Siemens PET/CT Biograph LSO Pico3D was applied in our centre. We describe some representative examples of FDG distribution patterns which may lead to erroneous interpretations of the clinical studies when they refer to specific clinical situations. The examples included are classified into two main groups according to the cause: Technical and biological, and the latter into physiological and non-physiological (pathophysiological). Patterns are described within the biological group showing changes of the FDG biodistribution that may reduce the uptake in tumoural lesions, the physiological variants that may be interpreted as pathology, the effects of previous treatment and uptakes related to benign diseases. Conclusion: We consider that knowledge of these variants and findings to be crucial in order to obtain optimal performance of PET/CT and to overcome the PET limitations (AU)

Osteomielitis de pubis en adolescente como causa de fiebre sin foco conocido / No disponible

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[Primary localized conjunctival amyloidosis: two case reports]. / Amiloidosis primaria conjuntival: análisis de dos casos.

CASE REPORTS: Two male patients, 21 and 61 years old presenting with hyperemia resistant to topical treatment. Ocular examination showed reddish conjunctival mass, painless, highly vascularized in bulbar conjunctiva. The conjunctival biopsy revealed the presence of amyloid within the conjunctiva itself. CONCLUSIONS: Primary localized conjunctival amyloidosis is a rare disease. Diagnosis consists of biopsy in order to detect amyloid material in the conjunctival tissue together with a systemic evaluation in order to rule out the presence of primary systemic amyloidosis.

Amiloidosis primaria conjuntival: análisis de dos casos / Primary localized conjunctival amyloidosis: two case report

Caso clínico: Se presentan dos pacientes varones de 21 y 61 años de edad con hiperemia resistente al tratamiento tópico. En el examen ocular se observó una masa rosada, no dolorosa y muy vascularizada, en conjuntiva bulbar. La biopsia excisional diagnóstica reveló la presencia de amiloide en la sustancia propia conjuntival.Conclusiones: La amiloidosis conjuntival primaria es una enfermedad rara. El diagnóstico consiste la realización de una biopsia detectando material amiloide en el tejido conjuntival junto con un examen sistémico que descarte la presencia de una amiloidosis primaria sistémica

Case Reports: Two male patients, 21 and 61 years old presenting with hyperemia resistant to topical treatment. Ocular examination showed reddish conjunctival mass, painless, highly vascularized in bulbar conjunctiva. The conjunctival biopsy revealed the presence of amyloid within the conjunctiva itself.Conclusions: Primary localized conjunctival amyloidosis is a rare disease. Diagnosis consists of biopsy in order to detect amyloid material in the conjunctival tissue together with a systemic evaluation in order to rule out the presence of primary systemic amyloidosis