Detección inesperada de carcinoma ductal infiltrante no palpable de mama con 99mTc-HYNIC-TOC (Tektrotyd®) / Unexpected detection of non-palpable breast ductal invasive carcinoma with 99mTc-HYNIC-TOC (Tektrotyd®)

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Captación de 18F-florbetapir en un hemangioma intraóseo visualizado en una PET/TC cerebral / 18F-florbetapir uptake in a primary intraosseous haemangioma displayed in a cerebral PET/CT

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Coexistencia de metástasis óseas por cáncer gástrico y osteopoiquilia diagnosticadas mediante gammagrafía ósea y 18F-FDG PET/TC / Gastric cancer bone metastases together with osteopoikilosis diagnosed using bone scintigraphy and 18F-FDG PET/CT

La coexistencia de distintas alteraciones óseas en un mismo paciente es un hallazgo que plantea un diagnóstico diferencial complejo. Presentamos el caso de una paciente en estudio por una lesión renal, que en la radiografía convencional y en la TC presentó múltiples lesiones esclerosas en columna y extremidades, que se valoraron mediante gammagrafía ósea con 99mTc-HDP y 18F-FDG PET/TC, obteniéndose el diagnóstico definitivo mediante la anatomía patológica de coexistencia de metástasis óseas por cáncer gástrico y osteopoiquilia (OP). Entre las técnicas de imagen realizadas, la gammagrafía aportó el mayor rendimiento diagnóstico por su capacidad de discriminación entre enfermedad ósea benigna y metastásica (AU)

The coexistence of different bone diseases in the same patient involves a complex differential diagnosis. A patient is presented who was studied due to a renal mass that showed many sclerotic lesions in spine and limbs in conventional radiology and CT. These lesions were evaluated with 99mTC-HDP bone scintigraphy and 18F-FDG PET/CT, which helped to obtain the definitive pathological diagnosis of osteopoikilosis (OP) co-existing with gastric cancer bone metastases. Of the different imaging scans performed, bone scintigraphy was particularly relevant due to its ability to discriminate between benign and metastatic bone disease (AU)

Gastric cancer bone metastases together with osteopoikilosis diagnosed using bone scintigraphy and 18F-FDG PET/CT. / Coexistencia de metástasis óseas por cáncer gástrico y osteopoiquilia diagnosticadas mediante gammagrafía ósea y 18F-FDG PET/TC.

The coexistence of different bone diseases in the same patient involves a complex differential diagnosis. A patient is presented who was studied due to a renal mass that showed many sclerotic lesions in spine and limbs in conventional radiology and CT. These lesions were evaluated with 99mTC-HDP bone scintigraphy and 18F-FDG PET/CT, which helped to obtain the definitive pathological diagnosis of osteopoikilosis (OP) co-existing with gastric cancer bone metastases. Of the different imaging scans performed, bone scintigraphy was particularly relevant due to its ability to discriminate between benign and metastatic bone disease.

[The clinical relevance of FDG-PET imaging in severe traumatic brain injuries]. / Relevancia clínica de la FDG-PET en los traumatismos craneoencefálicos graves.

AIM: To evaluate the usefulness of positron emission tomography (PET) as a predictor of long-term disability after a severe traumatic brain injury (TBI). PATIENTS AND METHODS: Fifty-six patients who had sustained a severe TBI were assessed with a broad battery of cognitive and functional scales at baseline and 6-months after inclusion in a multidisciplinary rehabilitation program. All patients underwent a FDG-PET at baseline. A physician blind to clinical data performed a semiquantitative analysis (normal vs altered) of functional neuroimaging (PET), including four cortical and three subcortical areas. The total number of lesions (cortical, subcortical and total) was correlated to the intensity of the TBI and to clinical data at admission and at follow-up. RESULTS: All patients showed changes in cerebral metabolism, being the thalamus the area most frequently affected. The degree of cerebral hypometabolism showed a significant correlation with TBI severity, functional disability, global outcome and cognitive impairment not only at baseline but also at follow-up. CONCLUSIONS: According to our results, FDG-PET may be a useful tool when studying brain dysfunction after severe TBI. FDG-PET findings correlate with the TBI severity, and with the level of patients' disability, as well as with the degree of memory and intelligence impairment. However, clinical variables related to the severity of the TBI, still are the best predictors of functional outcome after TBI.

Relevancia clínica de la FDG-PET en los traumatismos craneoencefálicos graves / The clinical relevance of FDG-PET imaging in severe traumatic brain injuries

Resumen. Objetivo. Demostrar la utilidad de la tomografía por emisión de positrones (PET) como predictor de la discapacidad a largo plazo tras un traumatismo craneoencefálico (TCE). Pacientes y métodos. Se evaluó neuropsicológica y funcionalmente a 56 pacientes que habían sufrido un TCE grave al inicio y aproximadamente seis meses después de su inclusión en un programa de rehabilitación multidisciplinar. A todos los pacientes se les realizó una tomografía por emisión de positrones con fluordeoxiglucosa al inicio del tratamiento. De forma ciega, se determinó la presencia o ausencia de alteraciones en cuatro áreas corticales y tres subcorticales, y se determinaron tres índices cualitativos de metabolismo cerebral (cortical, subcortical y total). Los índices de metabolismo se correlacionaron con las variables relacionadas con la gravedad del traumatismo, y con la situación cognitiva y funcional de los pacientes en el momento de realizar la PET y al finalizar el programa de rehabilitación. Resultados. Todos los pacientes mostraron alteraciones en el metabolismo cerebral, y el tálamo fue el área más frecuentemente afectada. La intensidad del hipometabolismo cerebral se correlacionó significativamente con la gravedad del TCE y con la alteración cognitiva y funcional tanto al inicio como al final del tratamiento. Conclusiones. Las técnicas de neuroimagen funcional presentan una excelente sensibilidad para detectar alteraciones tras un TCE, además de ofrecer una buena correlación anatomoclínica. No obstante, las variables relacionadas con la gravedad del TCE, siguen siendo las mejores predictoras de la discapacidad resultante tras un TCE (AU)

Summary. Aim. To evaluate the usefulness of positron emission tomography (PET) as a predictor of long-term disability after a severe traumatic brain injury (TBI). Patients and methods. Fifty-six patients who had sustained a severe TBI were assessed with a broad battery of cognitive and functional scales at baseline and 6-months after inclusion in a multidisciplinary rehabilitation program. All patients underwent a FDG-PET at baseline. A physician blind to clinical data performed a semiquantitative analysis (normal vs altered) of functional neuroimaging (PET), including four cortical and three subcortical areas. The total number of lesions (cortical, subcortical and total) was correlated to the intensity of the TBI and to clinical data at admission and at follow-up. Results. All patients showed changes in cerebral metabolism, being the thalamus the area most frequently affected. The degree of cerebral hypometabolism showed a significant correlation with TBI severity, functional disability, global outcome and cognitive impairment not only at baseline but also at follow-up. Conclusions. According to our results, FDG-PET may be a useful tool when studying brain dysfunction after severe TBI. FDG-PET findings correlate with the TBI severity, and with the level of patients’ disability, as well as with the degree of memory and intelligence impairment. However, clinical variables related to the severity of the TBI, still are the best predictors of functional outcome after TBI (AU)

Carcinoma bronquioloalveolar como causa potencial de falso negativo con PET-FDG / Bronchioloalveolar carcinoma as potencial cause of false negative with PET-FDG

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Síndrome de Sapho. Hallazgos gammagráficos y radiológicos / Sapho syndrome. Scintigraphic and radiologic findings

Se presenta el caso de una paciente de 39 años con antecedentes personales de pustulosis palmoplantar de varios años de evolución y dolores ocasionales en la pared anterior del tórax, columna lumbar y ambas sacroilíacas. Acude por dolor esternoclavicular y en los primeros arcos costales izquierdos con tumefacción, palpación dolorosa y febrícula. Se diagnostica como síndrome de SAPHO basándonos en los hallazgos clínicos, radiológicos (TC), gammagráficos y manifestaciones cutáneas. La gammagrafía ósea es una prueba diagnóstica sensible y precoz para este síndrome que proporciona la ventaja de obtener imagen del cuerpo completo. (AU)

[SAPHO syndrome. Scintigraphic and radiologic findings]. / Síndrome de SAPHO. Hallazgos gammagráficos y radiológicos.

We present the case of a 39 year old woman with a several year long history of palmoplantar pustulosis and occasional pain in the anterior wall of the thorax, lumbar spine and both sacroiliac joints. As a consequence of low grade fever, severe sternoclavicular pain and discomfort and swelling in the first left rib arches, the patient was admitted to hospital. Based on the clinical, radiologic, scintigraphic and cutaneous findings, the SAPHO syndrome was diagnosed. Bone scintigraphy is an accurate and early diagnostic test for this syndrome which also provides the advantage of being able to obtain a whole body scan.