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1.
World Neurosurg ; 151: 89-90, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33940269

RESUMO

Imaging in patients with Paget's disease of bone is very important clinically to show the presence of Pagetic abnormalities, assess disease progression, and identify adversely affected structures throughout disease course. Abnormalities and progression may be seen on radiographs, computed tomography, magnetic resonance imaging, and nuclear imaging. Herein, we report a case Paget's disease of bone showing diffuse characteristic pathology using technetium-99m-labelled diphosphonate tracer in bone scintigraphy (nuclear imaging). This case emphasizes the ability of nuclear imaging to rapidly visualize and assess progressive distribution of Pagetic involvement in a patient previously diagnosed with pituitary adenoma and mild Paget's disease of the skull.


Assuntos
Difosfonatos/metabolismo , Osteíte Deformante/diagnóstico por imagem , Osteíte Deformante/metabolismo , Crânio/diagnóstico por imagem , Compostos de Tecnécio/metabolismo , Tomografia Computadorizada de Emissão , Idoso , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Cintilografia/métodos , Crânio/metabolismo , Tomografia Computadorizada de Emissão/métodos
2.
Mod Rheumatol ; 31(2): 350-356, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32252574

RESUMO

OBJECTIVES: Molecular imaging constitutes a promising technique for the early detection of rheumatoid arthritis (RA). Macrophages and hypoxia play significant roles in inflamed synovium. In the present study, we evaluated the efficacy of radiopharmaceuticals that target macrophage mannose receptors (99mTc-labeled mannosylated dextran or 99mTc(CO)3-DCM20) and hypoxia (copper(II) diacetyl-di(N4-methylthiosemicarbazone) or Cu-ATSM) for the early detection of RA in collagen-induced arthritis (CIA) mice models. METHODS: CIA model was developed in DBA/1 mice, and the clinical score for arthritis was visually assessed on a regular basis. Two biodistribution studies were performed in a paired-labeled format using 2-deoxy-2-18F-fluoro-D-glucose (18F-FDG) as a reference: (1) 99mTc(CO)3-DCM20 with 18F-FDG and (2) 67Cu-ATSM with 18F-FDG. RESULTS: The accumulation levels of 99mTc(CO)3-DCM20 and 67Cu-ATSM in forepaws, hindpaws, and knee joints of CIA mice were significantly higher than that of control mice. In contrast, 18F-FDG uptake in hindpaws and knee joints showed no significant difference between CIA and control mice. The radioactivity levels of 99mTc(CO)3-DCM20 and 67Cu-ATSM were significantly correlated with the clinical scores for the paws. CONCLUSION: These results suggest the potential usefulness of 99mTc(CO)3-DCM20 and radiolabeled Cu-ATSM for the imaging and early detection of RA.


Assuntos
Artrite Experimental/diagnóstico por imagem , Compostos Organometálicos/farmacocinética , Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos/farmacocinética , Compostos de Tecnécio/farmacocinética , Tiossemicarbazonas/farmacocinética , Animais , Diagnóstico Precoce , Fluordesoxiglucose F18/farmacocinética , Humanos , Macrófagos/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos DBA , Distribuição Tecidual
3.
Medicine (Baltimore) ; 99(39): e22414, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991473

RESUMO

The purpose of this study was to investigate the role of Tc-antimony sulfide colloid (ASC) lymphoscintigraphy and single photon emission computed tomography/computed tomography (SPECT/CT) in the evaluation of rare lymphatic disorders, including Gorham--Stout disease (GSD), lymphangioma, and lymphangioleiomyomatosis (LAM).Nine patients suspected to have rare lymphatic disorders were included in this retrospective study. All patients underwent Tc-ASC lymphoscintigraphy and SPECT/CT to evaluate the lesions. The lymphoscintigraphy results were compared with the clinical and immunopathological findings.Tc-ASC lymphoscintigraphy and SPECT/CT could provide lymphatic draining and anatomical information for rare lymphatic disorders. Among the 9 patients, 3 were diagnosed with GSD (1 female, 2 males; aged 15-34 years, range 27.0 ±â€Š10.4 years), 3 with lymphangioma (1 female, 2 males; aged 17-42 years, range 32.0 ±â€Š13.2 years), and 3 patients were diagnosed with LAM (3 females; aged 33-50 years, range 43.7 ±â€Š9.3 years]. GSD is characterized by multiple bone destruction, including spine, ribs, ilium, pubis, ischium, and femur. The tracer uptake of involved bones and soft tissue around bone is increased, accompanied by chylothorax, chylopericardium, and chylous leakage in abdominal and pelvic cavity. Lymphangiomas present as multiple cystic lesions with increased tracer uptake in the peripancreatic, retroperitoneal, and iliac areas, and in the abdominopelvic cavity. LAM presents as multiple thin-walled cysts in the bilateral lungs and multiple retroperitoneal enlarged lymph nodes with increased tracer uptake.Tc-ASC lymphoscintigraphy and SPECT/CT could comprehensively and specifically detect some rare lymphatic disorders, namely, GSD, lymphangioma, and LAM. This technique is useful for the evaluation of GSD, lymphangioma, and LAM.


Assuntos
Antimônio , Linfangioleiomiomatose/diagnóstico por imagem , Linfangioma/diagnóstico por imagem , Linfocintigrafia , Osteólise Essencial/diagnóstico por imagem , Compostos de Tecnécio , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Adulto Jovem
5.
JACC Cardiovasc Imaging ; 13(6): 1314-1321, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31864976

RESUMO

OBJECTIVES: The aim of this study was to assess the diagnostic accuracy of bone scintigraphy in a large multicenter cohort of patients with cardiac amyloidotic involvement and Phe64Leu transthyretin (TTR) mutation. BACKGROUND: Diagnostic accuracy of bone scintigraphy for transthyretin-related cardiac amyloidosis (TTR-CA) is considered extremely high, enabling this technique to be the noninvasive diagnostic standard for TTR-CA. Nevertheless, this approach has not been systematically validated across the entire spectrum of TTR mutations. METHODS: A total of 55 patients with Phe64Leu TTR mutation were retrospectively analyzed and evaluated between 1993 and 2018 at 7 specialized Italian tertiary centers. Cardiac involvement was defined as presence of an end-diastolic interventricular septum thickness ≥12 mm, without other possible causes of left ventricular hypertrophy (i.e., arterial hypertension or valvulopathies). A technetium-99m (99mTc)-diphosphonate (DPD) or 99mTc-hydroxyl-methylene-diphosphonate (HMDP) bone scintigraphy was reviewed, and visual scoring was evaluated according to Perugini's method. RESULTS: Among 26 patients with definite cardiac involvement, 19 underwent 99mTc-DPD or 99mTc-HMDP bone scintigraphy. Of them, 17 (89.5%) patients had low or absent myocardial bone tracer uptake, whereas only 2 (10.5%) showed high-grade myocardial uptake. The sensitivity and the accuracy of bone scintigraphy in detecting TTR-CA were 10.5% and 37%, respectively. Patients with cardiac involvement and low or absent bone tracer uptake were similar to those with high-grade myocardial uptake in terms of age, sex, and electrocardiographic and echocardiographic findings. CONCLUSIONS: The sensitivity of bone scintigraphy (DPD and HMDP) in detecting TTR-CA is extremely low in patients with Phe64Leu TTR mutation, suggesting the need to assess diagnostic accuracy of bone scintigraphy to identify cardiac involvement across a wider spectrum of TTR mutations.


Assuntos
Neuropatias Amiloides Familiares/diagnóstico por imagem , Osso e Ossos/diagnóstico por imagem , Cardiomiopatias/diagnóstico por imagem , Difosfonatos/administração & dosagem , Mutação , Pré-Albumina/genética , Cintilografia , Compostos Radiofarmacêuticos/administração & dosagem , Compostos de Tecnécio/administração & dosagem , Medronato de Tecnécio Tc 99m/análogos & derivados , Imagem Corporal Total , Idoso , Neuropatias Amiloides Familiares/genética , Cardiomiopatias/genética , Feminino , Predisposição Genética para Doença , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medronato de Tecnécio Tc 99m/administração & dosagem
6.
J Nucl Cardiol ; 27(3): 915-920, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31845305

RESUMO

Cardiac amyloidosis is a restrictive infiltrative cardiomyopathy burdened by high mortality. The two more common forms are immunoglobulin light-chain amyloidosis and transthyretin-related amyloidosis with different prognoses and treatments. However, distinguishing between them is challenging. Appropriate utilization of the different available imaging techniques in the evaluation of patients with known or suspected cardiac amyloidosis is mandatory. We report two cases with cardiac amyloidosis of different etiology and with distinct imaging patterns. In the first case, the negative 99mTc-diphosphonate imaging was useful to support the diagnosis of cardiac amyloid light-chain; the second case emphasized the utility of whole-body scintigraphy in recognizing transthyretin-related cardiac amyloidosis and the potential role of cadmium-zinc-telluride SPECT imaging for the evaluation of segmental distribution of cardiac disease. Both cases support the growing interest in looking for noninvasive methods to type cardiac amyloidosis in the place of invasive myocardial biopsy highlighting both possibilities and limitations of available imaging techniques in diagnosis and treatment monitoring.


Assuntos
Amiloidose/diagnóstico por imagem , Difosfonatos , Cardiopatias/diagnóstico por imagem , Miocárdio/patologia , Compostos de Tecnécio , Idoso de 80 Anos ou mais , Albuminúria/complicações , Amiloide/análise , Angina Instável/diagnóstico por imagem , Biópsia , Eletrocardiografia , Humanos , Hipertensão/complicações , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Síndrome Nefrótica/complicações , Prognóstico , Cintilografia , Sístole
7.
Medicina (B Aires) ; 78(6): 395-398, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-30504105

RESUMO

Transthyretin cardiac amyloidosis (ATTR) is a restrictive cardiomyopathy that leads to heart failure in considerable number of patients. Early diagnosis allows specific treatment options. However, ATTR diagnosis is complex and requires invasive procedures. The utility of 99mTc-phosphate tracers for non-invasive diagnosis is well-known but the experience in Argentina is insufficient. The aim of this work was to assess the utility of 99m Tc-phosphate tracers for the diagnosis of ATTR. A total of 46 scintigraphies for detection of cardiac amyloidosis performed between September 2016 and January 2018 were analyzed. Cardiac retention after one hour was assessed in relation to bone uptake using two methods: A semi-quantitative visual score (grade 0 = absent, I = low II = moderate-III = high) and a quantitative method (heart/lung ratio). The final diagnosis and the amyloidosis subtype were carried out by our institution cardiomyopathy team according to international guidelines. The positive and negative predictive values for Grade ≥ II were 96% and 100% respectively for diagnosis of ATTR. Using 1.38 as cut-off value for heart/lung ratio the sensitivity and the specificity were 96% and 100%, respectively for differentiating transthyretin cardiac amyloidosis from light-chain cardiac amyloidosis and other cardiopathies. Scintigraphy with 99m Tc-phosphate tracers enable noninvasive diagnosis and subtype classification of cardiac amyloidosis. The use of this non-invasive, inexpensive and widely available tool will result in better patient management.


Assuntos
Amiloidose/diagnóstico por imagem , Cardiomiopatias/diagnóstico por imagem , Fosfatos , Cintilografia/métodos , Compostos de Tecnécio , Idoso , Idoso de 80 Anos ou mais , Amiloidose/fisiopatologia , Cardiomiopatias/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Compostos Radiofarmacêuticos , Reprodutibilidade dos Testes , Estatísticas não Paramétricas
8.
Taiwan J Obstet Gynecol ; 57(4): 541-545, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30122575

RESUMO

OBJECTIVE: The aim of this study was to investigate the feasibility of sentinel lymph node mapping characterized by a cervical tracer injection in endometrial cancer. MATERIALS AND METHODS: This retrospective study was carried out using data for 57 patients with endometrial carcinoma who had undergone intraoperative sentinel lymph node mapping and subsequent surgical staging. Technetium colloid and/or indocyanine green was injected into the uterine cervix and a gamma-detecting probe and/or photodynamic eye camera system was used intraoperatively to locate hot spots. RESULTS: Of the 57 patients, 52 (91.2%) had FIGO Stage I disease. Successful unilateral or bilateral mapping occurred in 54 patients (94.7%) and 46 (80.7%), respectively. The median number of sentinel lymph nodes detected was two (range, 0-5). Following sentinel lymph node mapping, 41 patients (71.9%) underwent pelvic lymphadenectomy alone and 16 (28.1%) full lymphadenectomy. The median number of lymph nodes resected was 17 (range, 8-110). Sentinel lymph nodes were involved in four patients (7.0%), two with macrometastases and two with low-volume metastases. The sensitivity and negative predictive value for detecting lymph node metastasis were both 100%. CONCLUSION: Sentinel lymph node mapping with the use of cervical tracer injection is highly feasible in Japanese women with early stage endometrial cancer.


Assuntos
Neoplasias do Endométrio/patologia , Verde de Indocianina/administração & dosagem , Linfonodo Sentinela/diagnóstico por imagem , Linfonodo Sentinela/patologia , Tecnécio/administração & dosagem , Adulto , Idoso , Colo do Útero/efeitos dos fármacos , Coloides , Neoplasias do Endométrio/diagnóstico por imagem , Estudos de Viabilidade , Feminino , Humanos , Japão , Excisão de Linfonodo/estatística & dados numéricos , Metástase Linfática/diagnóstico , Pessoa de Meia-Idade , Ácido Fítico , Cintilografia/métodos , Estudos Retrospectivos , Linfonodo Sentinela/cirurgia , Compostos de Tecnécio/administração & dosagem
10.
J Gynecol Obstet Hum Reprod ; 47(5): 205-207, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29510266

RESUMO

Pregnancy-associated breast cancer is rare, but this clinical situation arises in 1/10,000-1/3000 pregnancies. In patients presenting an early-stage breast tumor devoid of clinically pathological lymph node, sentinel lymph node (SLN) biopsy has not yet been validated as a routine procedure for pregnant women due to the lack of data in the literature. The blue dye injection is not recommended because of 2% theoretical risk of anaphylactic shock. Several studies have shown that Tc99m injection at conventional dose between 12.1 and 18.5MBq exposed the fetus to an irradiation between 0.011 and 0.0245mSv much below the 50mSv recommended threshold. As evidenced by lymphoscintigraphy scans, the dose of injected Tc99m is localized at the injection site and in the SLN. According to the literature, the SLN technique does not seem to impact the fetal or obstetrical prognosis. Studies involving larger cohorts are required to confirm these data and to indicate this technique in pregnant women. Considering the benefit for the patient and the low risk incurred on both fetal and obstetrical levels, it appears reasonable to discuss the indication of SLN on a case-by-case basis in multidisciplinary oncologic meetings.


Assuntos
Neoplasias da Mama/diagnóstico , Complicações Neoplásicas na Gravidez/diagnóstico , Cintilografia/normas , Compostos Radiofarmacêuticos/normas , Biópsia de Linfonodo Sentinela/normas , Compostos de Tecnécio/normas , Adulto , Neoplasias da Mama/diagnóstico por imagem , Feminino , Humanos , Gravidez , Complicações Neoplásicas na Gravidez/diagnóstico por imagem , Cintilografia/efeitos adversos , Compostos Radiofarmacêuticos/efeitos adversos , Biópsia de Linfonodo Sentinela/efeitos adversos , Compostos de Tecnécio/efeitos adversos
11.
World J Surg ; 42(5): 1391-1395, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29383426

RESUMO

BACKGROUND: The current standard-of-care for surgical staging of the axilla in clinically node-negative (N0) early breast cancers is sentinel lymph node biopsy (SLNB), which requires expensive radiopharmaceuticals for efficacious results. In-house produced low-cost radiopharmaceuticals may be the solution and have shown efficacy in earlier observational/pilot studies. We compared SLNB using in-house prepared radiopharmaceutical (99mTc-Antimony-colloid) versus commercially marketed radiopharmaceutical (99mTc-Sulphur-colloid) in this prospective randomized study. STUDY DESIGN: 78 clinically N0 early breast cancer patients (T1/2, N0 stages), undergoing primary surgery were prospectively randomized 1:1 into two groups; to receive SLNB using methylene blue, and either 99mTc-Antimony colloid (Group-1) or  99mTc-Sulphur colloid (Group-2). Completion axillary dissection was done in all (validation SLNB). SLNB indices were compared between the groups. RESULTS: The groups were comparable with regard to age, stage, tumour size, hormone receptors and HER2neu status. Cost of the in-house prepared 99mTc-antimony colloid was 16-times lesser compared to 99mTc-sulphur colloid. SLN identification rates (IR) in Groups 1 and 2 were 100 and 97.4% respectively, (p > 0.05). False negative rates (FNR) in Group 1 and 2 were 6.3% (1/16 patients) and 7.7% (1/13 patients), respectively, (p > 0.05). There were no major allergic reactions in either group. CONCLUSION: In this prospective randomized trial on early breast cancer patients, accuracy of SLNB was comparable using in-house prepared, 99mTc-antimony colloid and commercially marketed 99mTc-sulphur colloid as radiopharmaceutical, while 99mTc-antimony colloid was much cheaper than 99mTc-sulphur colloid.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/diagnóstico por imagem , Compostos Radiofarmacêuticos , Biópsia de Linfonodo Sentinela/métodos , Antimônio , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Feminino , Humanos , Indicadores e Reagentes , Azul de Metileno , Pessoa de Meia-Idade , Estudos Prospectivos , Cintilografia , Enxofre , Compostos de Tecnécio
12.
Int J Clin Oncol ; 23(2): 305-313, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29098518

RESUMO

BACKGROUND: The examination of a sentinel lymph node (SLN), where lymph node metastasis first occurs, may be advocated as an alternative staging technique. The aim of this study was to evaluate the feasibility and detection rates of an SLN biopsy in patients with endometrial cancer. STUDY DESIGN: Two hundred and eleven patients with endometrial cancer underwent an SLN biopsy at hysterectomy using three kinds of tracers including 99m-technetium-labeled tin colloid (99mTc), indigo carmine and indocyanine green. Factors related to the side-specific detection rate, sensitivity and false negative rate were analyzed. RESULTS: The detection rates of the SLN biopsy using 99mTc, indigo carmine and indocyanine green were 77.9, 17.0 and 73.4%, respectively. The detection rate was lower in elderly patients (≥60 years) (67.9 vs 89.2%, p < 0.01), patients with >50% myometrial invasion (68.3 vs 85.2%, p < 0.01), patients with high-grade tumors (69.5 vs 84.9%, p < 0.01) and patients who underwent laparotomy (71.2 vs 84.9%, p < 0.01). There were no significant differences in body mass index. The sensitivity was not significantly different in any factor. However, the false negative rate was higher in patients with > 50% myometrial invasion (11.5 vs 1.2%, p < 0.01), high-grade tumors (13.3 vs 0.8%, p < 0.01) and who underwent laparotomy (12.2 vs 0.4%, p < 0.01). CONCLUSION: Patients who underwent laparoscopy with < 50% myometrial invasion and low-grade tumors not only have higher detection rates, but also have lower false negative rates. These patients may avoid systemic lymphadenectomy according to the status of the SLN biopsy.


Assuntos
Neoplasias do Endométrio/patologia , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Metástase Linfática/patologia , Biópsia de Linfonodo Sentinela/métodos , Idoso , Índice de Massa Corporal , Reações Falso-Negativas , Feminino , Humanos , Histerectomia , Índigo Carmim , Verde de Indocianina , Metástase Linfática/diagnóstico , Pessoa de Meia-Idade , Compostos Radiofarmacêuticos , Sensibilidade e Especificidade , Linfonodo Sentinela/patologia , Compostos de Tecnécio , Compostos de Estanho
13.
Clin Nucl Med ; 42(12): 905-911, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29076910

RESUMO

AIM: The presence of somatostatin receptors in neuroendocrine tumors allows visualization with radiolabeled somatostatin analogs in vivo. The aim of this prospective study was to compare somatostatin receptor imaging using Tc-HYNICTOC with Ga-DOTATATE (DOTA-DPhe1,Tyr3-octreotate) with respect to sensitivity, specificity, and impact upon clinical decision making. METHODS: Sixty-eight patients (30 men, 38 women; aged 56.4 ± 13.5 years) with disseminated, histologically proven neuroendocrine tumor were enrolled. All patients with previous Tc-HYNICTOC (Tektrotyd; POLATOM, Otwock, Poland) underwent Ga-DOTATATE PET/CT. Both examinations were compared on a per-patient and per-lesion basis. RESULTS: The sensitivity, specificity, positive and negative predictive values, and accuracy of Ga-DOTATATE and Tc-HYNICTOC were 100% versus 82%, 85% versus 69%, 97% versus 92%, 100% versus 47%, and 97% versus 79%, respectively.Concordant results were observed in 58 patients (49/68 positive on both Ga-DOTATATE and Tc-HYNICTOC and 9/68 negative in both examinations). Ten of 68 patients had Ga-DOTATATE-positive, Tc-HYNICTOC-negative studies. Two hundred eighteen lesions were detected using Tc-HYNICTOC, compared with 546 lesions using Ga-DOTATATE (P < 0.0001). Ga-DOTATATE detected a higher number of lesions in bone and lymph nodes, liver, intestine, and pancreas and had a higher sensitivity for subcentimeter abnormalities than Tc-HYNICTOC. Ga-DOTATATE led to management change in 23 (34%) of 68 patients. CONCLUSIONS: Ga-DOTATATE has a higher sensitivity than Tc-HYNICTOC for the detection of neuroendocrine tumors. Ga-DOTATATE proved superior to Tc-HYNICTOC in detecting subcentimeter skeletal, lymph node, and liver metastases. Ga-DOTATATE PET/CT changed clinical decision making in one third of patients.


Assuntos
Tumores Neuroendócrinos/diagnóstico por imagem , Compostos Organometálicos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Receptores de Somatostatina/metabolismo , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/métodos , Compostos de Tecnécio , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/patologia , Estudos Prospectivos , Sensibilidade e Especificidade
14.
Transplant Proc ; 49(6): 1301-1306, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28735998

RESUMO

BACKGROUND: Functional hyposplenism (FH) is indicated by an anatomically present spleen that fails to take up radiolabeled colloid. The occurrence of FH has been reported in a small group of renal transplant recipients based on hematologic parameters. The aim of this study was to replicate this association in a larger group of renal transplant recipients with the use of technetium-99m-stannous colloid liver-spleen scan to assess the spleen function. METHODS: This survey based on single samples enrolled 101 unselected adult patients with functional kidney grafts >180 days after transplantation. All patients underwent 99mTc-stannous colloid scan to assess spleen function as well as bone marrow uptake of radiocolloid along with an anatomic and blood flow study of the spleen and kidney with the use of Doppler sonography. RESULTS: The prevalence of hyposplenism was 32.7% (33/101) for the cohort, and increased uptake of radiocolloid by the bone marrow was seen in 9.9% (10/101). According to the multivariate analysis, the frequency of hyposplenism was significantly influenced by indirect bilirubin and hemoglobin, and direct bilirubin and neutrophil count remained as independent predictors of bone marrow uptake. CONCLUSIONS: This study demonstrated that a group of renal transplant recipients has FH. In addition, bone marrow uptake might be interpreted as liver dysfunction. In this situation, the small amount of contrast (spleen compared with liver) would leave hyposplenism undiagnosed. Further prospective and longitudinal clinical studies are needed to determine the clinical impact of this condition on the management of renal transplant recipients.


Assuntos
Cintilografia/métodos , Compostos Radiofarmacêuticos , Baço/diagnóstico por imagem , Esplenopatias/diagnóstico por imagem , Compostos de Tecnécio , Compostos de Estanho , Adulto , Feminino , Humanos , Rim/cirurgia , Transplante de Rim/efeitos adversos , Fígado/diagnóstico por imagem , Fígado/fisiopatologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Reprodutibilidade dos Testes , Baço/fisiopatologia , Esplenopatias/etiologia , Esplenopatias/fisiopatologia , Ultrassonografia/métodos
15.
Skeletal Radiol ; 46(9): 1249-1258, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28623409

RESUMO

PURPOSE: To test the diagnostic performance of bone SPECT/CT and MRI for the evaluation of bone viability in patients after girdlestone-arthroplasty with histopathology used as gold standard. MATERIALS AND METHODS: In this cross-sectional study, patients after girdlestone-arthroplasty were imaged with single-photon-emission-computed-tomography/computed-tomography (SPECT/CT) bone-scans using 99mTc-DPD. Additionally, 1.5 T MRI was performed with turbo-inversion-recovery-magnitude (TIRM), contrast-enhanced T1-fat sat (FS) and T1-mapping. All imaging was performed within 24 h prior to revision total-hip-arthroplasty in patients with a girdlestone-arthroplasty. In each patient, four standardized bone-tissue-biopsies (14 patients) were taken intraoperatively at the remaining acetabulum superior/inferior and trochanter major/minor. Histopathological evaluation of bone samples regarding bone viability was used as gold standard. RESULTS: A total of 56 bone-segments were analysed and classified as vital (n = 39) or nonvital (n = 17) by histopathology. Mineral/late-phase SPECT/CT showed a high sensitivity (90%) and specificity (94%) to distinguish viable and nonviable bone tissue. TIRM (sensitivity 87%, specificity 88%) and contrast-enhanced T1-FS (sensitivity 90%, specificity 88%) also achieved a high sensitivity and specificity. T1-mapping achieved the lowest values (sensitivity 82%, specificity 82%). False positive results in SPECT/CT and MRI resulted from small bone fragments close to metal artefacts. CONCLUSIONS: Both bone SPECT/CT and MRI allow a reliable differentiation between viable and nonviable bone tissue in patients after girdlestone arthroplasty. The findings of this study could also be relevant for the evaluation of bone viability in the context of avascular bone necrosis.


Assuntos
Artroplastia de Quadril/métodos , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Imagem Multimodal , Idoso , Artefatos , Biópsia , Meios de Contraste , Estudos Transversais , Difosfonatos , Feminino , Articulação do Quadril/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Compostos Radiofarmacêuticos , Sensibilidade e Especificidade , Compostos de Tecnécio , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X
16.
BMC Neurol ; 17(1): 78, 2017 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-28424054

RESUMO

BACKGROUND: Dementia with Lewy bodies (DLB) is the second most frequent diagnosis of progressive degenerative dementia in older people. Delusions are common features in DLB and, among them, Capgras syndrome represents the most frequent disturbance, characterized by the recurrent and transient belief that a familiar person, often a close family member or caregiver, has been replaced by an identical-looking imposter. However, other delusional conditions near to misidentification syndromes can occur in DLB patients and may represent a major psychiatric disorder, although rarely studied systematically. CASE PRESENTATION: We reported on a female patient affected by DLB who presented with an unusual delusion of duplication. Referring to the female professional caregiver engaged by her relatives for her care, the patient constantly described the presence of two different female persons, with a disorder framed in the context of a delusion of duplication. A brain 99Tc-hexamethylpropyleneamineoxime SPECT was performed showing moderate hypoperfusion in both occipital lobes, and associated with marked decreased perfusion in parieto-fronto-temporal lobes bilaterally. CONCLUSIONS: An occipital hypoperfusion was identified, although in association with a marked global decrease of perfusion in the remaining lobes. The role of posterior lobes is certainly important in all misidentification syndromes where a natural dissociation between recognition and identification is present. Moreover, the concomitant presence of severe attentional and executive deficits evocative for a frontal syndrome and the marked global decrease of perfusion in the remaining lobes at the SPECT scan also suggest a possible dysfunction in an abnormal connectivity between anterior and posterior areas.


Assuntos
Síndrome de Capgras/complicações , Doença por Corpos de Lewy/psicologia , Idoso , Córtex Cerebral/irrigação sanguínea , Feminino , Humanos , Doença por Corpos de Lewy/complicações , Neuroimagem , Oximas/metabolismo , Compostos de Tecnécio/metabolismo , Tomografia Computadorizada de Emissão de Fóton Único
17.
Chem Biol Drug Des ; 89(2): 277-284, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28205404

RESUMO

[99m Tc(CO)3 (H2 O)3 ]+ has attracted great attention among 99m Tc-labeling techniques, due to its ease of preparation, readily substituted water molecules of the precursor fac-[99m Tc(CO)3 (H2 O)3 ]+ by a variety of functional groups, small size and inertness. Bifunctional chelator based on a macrocyclic polyamine framework shows easy complexation with [99m Tc(CO)3 (H2 O)3 ]+ to produce stable complex. In this study, two novel 1, 5, 9-triazacyclododecane derivatives containing a glucose group (6 and 7) were successfully synthesized by reacting different glucose-azides with alkyne-[12]aneN3 via the so-called click chemistry and radiolabeled with [99m Tc(CO)3 (H2 O)3 ]+ to form 99m Tc(CO)3 -6 (C-1-substituted complex) and 99m Tc(CO)3 -7 (C-2-substituted complex) in high yields. The complexes were stable in vitro over 6 h when incubated in saline at room temperature and in mouse serum at 37 °C. The partition coefficient results showed that they were hydrophilic. The biodistribution studies in Kunming mice bearing S 180 tumor showed both complexes showed accumulation in the tumor. Between them, 99m Tc(CO)3 -7 had the advantages of much higher tumor uptake and tumor/muscle ratio. Compared with other reported 99m Tc-radiolabeled glucose derivatives, 99m Tc(CO)3 -7 also showed a higher tumor uptake and tumor/muscle ratio, suggesting it would be a potential candidate for further development as a tumor-imaging agent.


Assuntos
Meios de Contraste/química , Glucose/análogos & derivados , Glucose/química , Compostos Macrocíclicos/química , Neoplasias/diagnóstico por imagem , Compostos de Tecnécio/química , Animais , Química Click , Interações Hidrofóbicas e Hidrofílicas , Compostos Macrocíclicos/síntese química , Camundongos , Albumina Sérica/química , Distribuição Tecidual
18.
Magn Reson Med ; 77(4): 1665-1670, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27090199

RESUMO

PURPOSE: This study investigated a fundamentally new type of responsive MRI contrast agent for molecular imaging that alters T2 exchange (T2ex ) properties after interacting with a molecular biomarker. METHODS: The contrast agent Tm-DO3A-oAA was treated with nitric oxide (NO) and O2 . The R1 and R2 relaxation rates of the reactant and product were measured with respect to concentration, temperature, and pH. Chemical exchange saturation transfer (CEST) spectra of the reactant and product were acquired using a 7 Tesla (T) MRI scanner and analyzed to estimate the chemical exchange rates and r2ex relaxivities. RESULTS: The reaction of Tm-DO3A-oAA with NO and O2 caused a 6.4-fold increase in the r2 relaxivity of the agent, whereas r1 relaxivity remained unchanged, which demonstrated that Tm-DO3A-oAA is a responsive T2ex agent. The effects of pH and temperature on the r2 relaxivities of the reactant and product supported the conclusion that the product's benzimidazole ligand caused the agent to have a fast chemical exchange rate relative to the slow exchange rate of the reactant's ortho-aminoanilide ligand. CONCLUSIONS: T2ex MRI contrast agents are a new type of responsive agent that have good detection sensitivity and specificity for detecting a biomarker, which can serve as a new tool for molecular imaging. Magn Reson Med 77:1665-1670, 2017. © 2016 International Society for Magnetic Resonance in Medicine.


Assuntos
Meios de Contraste/química , Compostos Heterocíclicos com 1 Anel/química , Imageamento por Ressonância Magnética/métodos , Imagem Molecular/métodos , Óxido Nítrico/química , Oxigênio/química , Compostos de Tecnécio/química , Anilidas/química , Meios de Contraste/análise , Compostos Heterocíclicos com 1 Anel/análise , Concentração de Íons de Hidrogênio , Técnicas de Sonda Molecular , Sondas Moleculares/química , Óxido Nítrico/análise , Oxigênio/análise , Tecnécio , Temperatura
19.
Clin Genitourin Cancer ; 15(3): e405-e409, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28007368

RESUMO

INTRODUCTION: The aim of the study was to compare 2 methods of the sentinel lymph node biopsy (SLNB) procedure in bladder cancer: we applied technetium radiocolloid (RadCol) detected by a gamma ray detection probe, and indocyanine green (ICG) detected by a near-infrared fluorescent (NIRF) camera. MATERIAL AND METHODS: The SLNB was performed on 50 patients using the RadCol and the ICG, followed by a lymphadenectomy and a pathologic examination. RESULTS: In the analyzed group of 47 patients (3 patients were excluded owing to the lack of lymphatic drainage from the tumor), the SLNB was performed using the 2 methods. The ICG with a NIRF-guided camera detected all sentinel lymph nodes (SLNs) in 46 cases, whereas RadCol detected them in 45 cases. In 12 (25.6%) of 47 patients, the ICG-fluorescent method revealed more SLNs than the RadCol method. In 8 (17%) patients, the SLNs revealed in the ICG fluorescence were metastatic. In 3 (6.4%) patients, we found SLNs outside the standard lymphadenectomy template, but a histopathologic examination showed they were negative for cancer. In 3 (6.4%) patients, the SLNs detected by both methods were negative for cancer, but other resected lymph nodes revealed metastases. CONCLUSION: Our study shows that SLNB procedure with the RadCol or the ICG method is useful for the evaluation of lymph nodes in bladder cancer. The new ICG fluorescent technique with a NIRF camera system is safe, enables live view of the results of the procedure, and does not create additional costs. However, it highlights more lymph nodes than the radioactive method.


Assuntos
Corantes Fluorescentes/metabolismo , Linfonodos/diagnóstico por imagem , Compostos Radiofarmacêuticos/metabolismo , Biópsia de Linfonodo Sentinela/métodos , Neoplasias da Bexiga Urinária/patologia , Idoso , Feminino , Humanos , Verde de Indocianina/metabolismo , Excisão de Linfonodo , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade , Compostos de Tecnécio/metabolismo , Neoplasias da Bexiga Urinária/cirurgia
20.
J Gynecol Oncol ; 28(2): e13, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27894166

RESUMO

OBJECTIVE: Our objective was to determine the feasibility and detection rates and clarify the most effective combination of injected tracer types for sentinel lymph node (SLN) mapping in uterine cervical cancer in patients who have undergone laparoscopic surgery or neoadjuvant chemotherapy (NAC). METHODS: A total of 119 patients with cervical cancer underwent SLN biopsy at radical hysterectomy using three types of tracers. The various factors related to side-specific detection rate, sensitivity, and false negative (FN) rate were analyzed. RESULTS: The SLN detection rates using 99m-technetium ((99m)Tc)-tin colloid, indigo carmine, and indocyanine green (ICG) were 85.8%, 20.2%, and 61.6%, respectively. The patients with ≥2-cm-diameter tumors and those who received NAC had lower detection rates than those with <2-cm-diameter tumors (75.7% vs. 91.5%, p<0.01) and those who did not receive NAC (67.9% vs. 86.3%, p<0.01), respectively. Laparoscopic procedures had a higher detection rate than laparotomy (100.0% vs. 77.1%, p<0.01). No factors significantly affected the sensitivity; however, the patients with ≥2-cm-diameter tumors (86.0% vs. 1.4%, p<0.01), NAC (19.4% vs. 2.2%, p<0.01), and those who underwent laparotomy (7.4% vs. 0%, p<0.01) had an unfavorable FN rate. CONCLUSION: Among the examined tracers, (99m)Tc had the highest detection of SLN mapping in patients with uterine cervical cancer. Patients with local advanced cervical cancer with/without NAC treatment might be unsuited for SLN mapping. SLN mapping is feasible and results in an excellent detection rate in patients with <2-cm-diameter cervical cancer. Laparoscopic surgery is the best procedure for SLN detection in patients with early-stage disease.


Assuntos
Carcinoma de Células Escamosas/patologia , Verde de Indocianina , Compostos Radiofarmacêuticos , Biópsia de Linfonodo Sentinela/métodos , Linfonodo Sentinela/patologia , Compostos de Tecnécio , Compostos de Estanho , Neoplasias do Colo do Útero/patologia , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Adulto , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/cirurgia , Corantes , Feminino , Humanos , Laparoscopia , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Linfonodo Sentinela/diagnóstico por imagem , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/cirurgia
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