RESUMO
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.
Assuntos
Radioisótopos do Iodo , Iodobenzenos , Doenças Neurodegenerativas/diagnóstico por imagem , Doença de Parkinson/diagnóstico por imagem , Transtornos Parkinsonianos/diagnóstico por imagem , Compostos Radiofarmacêuticos , Tomografia Computadorizada de Emissão de Fóton Único , Adulto , Idoso , Encéfalo/diagnóstico por imagem , Corpo Estriado/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Radioisótopos do Iodo/farmacocinética , Iodobenzenos/farmacocinética , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/diagnóstico por imagem , Valor Preditivo dos Testes , Compostos Radiofarmacêuticos/farmacocinética , Receptores de Dopamina D2/análiseRESUMO
AIM: Vascular graft infection is a rare complication with a high morbidity and mortality. Early diagnosis is essential to establish an adequate treatment. We assess the accuracy of 99mTc-WBC scintigraphy with SPECT/CT in the diagnosis of vascular graft infection. MATERIALS AND METHODS: We retrospectively analyzed thirty 99mTc-WBC scintigraphies with SPECT/CT performed in thirty patients with suspicion of vascular prosthesis infection. Studies were considered positive for graft infection if the intensity of activity involving the graft was greater than the liver or bone marrow activity (spine and pelvis). RESULTS: Final diagnosis of infection was established in 10 patients, based on Fitzgerald criteria. Scintigraphy was positive in 11 patients. No false negatives were obtained. The values of sensitivity and specificity were 100% and 95%, respectively, with a PPV of 91% and a NPV of 100%. Twenty five patients had a CT performed prior to scintigraphy, in 9 cases the result was positive and in the remaining 16 was negative. CT sensitivity and specificity obtained in our study were 62.5% and 76% respectively, with a PPV of 55.6% and a NPV of 81.3%. Diagnosis of infection led to prosthesis exeresis in 8 cases (all of them had a positive microbiological study of the extracted material), while the remaining 2 patients were treated with antibiotic therapy alone due to high surgical risk. CONCLUSION: Our results suggest a high accuracy for 99mTc-WBC scintigraphy with SPECT/CT in the assessment of clinically suspected arterial graft infection.
Assuntos
Prótese Vascular/efeitos adversos , Leucócitos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Cintilografia/métodos , Compostos Radiofarmacêuticos , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tecnécio Tc 99m Exametazima , Enxerto Vascular , Vasculite/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Prótese Vascular/microbiologia , Remoção de Dispositivo , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/microbiologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Vasculite/microbiologiaRESUMO
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.
Assuntos
Apraxias/diagnóstico por imagem , Circulação Cerebrovascular , Lúpus Eritematoso Sistêmico/diagnóstico por imagem , Transtornos da Memória/diagnóstico por imagem , Transtornos do Humor/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Adolescente , Apraxias/etiologia , Apraxias/fisiopatologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Transtornos da Memória/etiologia , Transtornos da Memória/fisiopatologia , Transtornos do Humor/etiologia , Transtornos do Humor/fisiopatologia , RadiografiaRESUMO
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.
Assuntos
Diuréticos , Hidronefrose/diagnóstico por imagem , Renografia por Radioisótopo , Ultrassonografia Pré-Natal , Feminino , Humanos , Lactente , MasculinoRESUMO
48 year old man with chronic obstructive pulmonary disease (COPD) secondary to pulmonary hypertension with domiciliary non-invasive ventilation was seen. He came to the emergency department with acute exacerbation of COPD. The patient was admitted to the Cardiology Service with the diagnosis of congestive heart failure. Diagnostic imaging (chest X-ray, transthoracic Doppler-echocardiography, multidetector row spiral CT and myocardial perfusion imaging) revealed an enlarged right ventricle. ECG was consistent with right ventricular failure. The heart perfusion imaging (pharmacologic stress testing with dobutamine) showed cor pulmonale and right ventricle ischemia induced by drug stress with dobutamine. Although right ventricle myocardial chronic dysfunction rarely causes right ventricular failure, it can occur when cor pulmonale and ischemia heart disease are present.
Assuntos
Isquemia Miocárdica/complicações , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Cardiopulmonar/etiologia , Diabetes Mellitus Tipo 2/complicações , Dobutamina , Ecocardiografia Doppler , Ecocardiografia sob Estresse , Coração/diagnóstico por imagem , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Ventrículos do Coração , Humanos , Hipercolesterolemia/complicações , Hipertrofia Ventricular Direita/complicações , Hipertrofia Ventricular Direita/diagnóstico , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Doença Cardiopulmonar/diagnóstico , Cintilografia , Insuficiência Respiratória/etiologia , Fumar/efeitos adversos , Volume Sistólico , Tomografia Computadorizada EspiralAssuntos
Atlas Cervical/anormalidades , Atlas Cervical/diagnóstico por imagem , Fluordesoxiglucose F18 , Achados Incidentais , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Compostos Radiofarmacêuticos , Idoso , Humanos , Masculino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodosAssuntos
Coristoma/diagnóstico por imagem , Hiperparatireoidismo Primário/etiologia , Doenças da Boca/diagnóstico por imagem , Soalho Bucal/diagnóstico por imagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Disgenesia da Tireoide/diagnóstico por imagem , Adenoma/complicações , Adenoma/diagnóstico por imagem , Coristoma/complicações , Feminino , Humanos , Hipotireoidismo/etiologia , Achados Incidentais , Pessoa de Meia-Idade , Doenças da Boca/complicações , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/diagnóstico por imagem , Compostos Radiofarmacêuticos , Tecnécio Tc 99m SestamibiRESUMO
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.
Assuntos
Neoplasias Femorais/diagnóstico por imagem , Osteoma Osteoide/diagnóstico por imagem , Compostos Radiofarmacêuticos , Medronato de Tecnécio Tc 99m/análogos & derivados , Adolescente , Diagnóstico Diferencial , Reação a Corpo Estranho/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , CintilografiaRESUMO
Radiolabeled metaiodobenzylguanidine is an analogue of norepinephrine used to localize tumors that express the neurohormone transporters, specifically those derived from the neural crest having a neuroendocrine origin. It is also used to treat non-surgical metastases derived from them. A review of the literature revealed symptomatic improvements associated to a decrease in hormone levels in a significant percentage of patients after (131)I-MIBG treatment. However, complete tumor remission has been described only in very few cases and hardly ever when bone metastases exist. We present a case of a patient diagnosed of malignant pheochromocytoma who achieved complete hormonal and metabolic response after (131)I-MIBG treatment (600 mCi) in spite of the presence of bone metastases.
Assuntos
3-Iodobenzilguanidina/uso terapêutico , Neoplasias das Glândulas Suprarrenais/tratamento farmacológico , Antineoplásicos/uso terapêutico , Feocromocitoma/tratamento farmacológico , Neoplasias das Glândulas Suprarrenais/metabolismo , Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias Ósseas/secundário , Humanos , Masculino , Neurotransmissores/biossíntese , Feocromocitoma/metabolismo , Feocromocitoma/secundário , Indução de Remissão , Adulto JovemRESUMO
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.
Assuntos
Adenocarcinoma/diagnóstico por imagem , Neoplasias Colorretais/patologia , Radioisótopos de Flúor , Fluordesoxiglucose F18 , Imagem Multimodal , Neoplasias Pancreáticas/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/cirurgia , Quimioterapia Adjuvante , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/cirurgia , Feminino , Humanos , Leiomioma , Pessoa de Meia-Idade , Segunda Neoplasia Primária , Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias da Glândula Tireoide/tratamento farmacológico , Neoplasias da Glândula Tireoide/patologia , Neoplasias UterinasRESUMO
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.
Assuntos
Diafragma/lesões , Ruptura Esplênica/complicações , Esplenose/diagnóstico por imagem , Tórax/diagnóstico por imagem , Acidentes de Trânsito , Idoso , Doenças Assintomáticas , Eritrócitos , Humanos , Achados Incidentais , Masculino , Cintilografia , Ruptura/complicações , Esplenose/etiologia , Tecnécio , Fatores de TempoRESUMO
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.
Assuntos
Bronquiectasia/diagnóstico por imagem , Carcinoma/diagnóstico por imagem , Radioisótopos do Iodo/farmacocinética , Pulmão/diagnóstico por imagem , Compostos Radiofarmacêuticos/farmacocinética , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Imagem Corporal Total , Idoso , Antibacterianos/uso terapêutico , Biomarcadores Tumorais , Bronquiectasia/etiologia , Bronquite/complicações , Bronquite/tratamento farmacológico , Carcinoma/sangue , Carcinoma/radioterapia , Carcinoma/secundário , Carcinoma/cirurgia , Terapia Combinada , Diagnóstico Diferencial , Reações Falso-Positivas , Feminino , Humanos , Radioisótopos do Iodo/uso terapêutico , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/secundário , Cintilografia , Compostos Radiofarmacêuticos/uso terapêutico , Tireoglobulina/sangue , Neoplasias da Glândula Tireoide/sangue , Neoplasias da Glândula Tireoide/radioterapia , Neoplasias da Glândula Tireoide/secundário , Neoplasias da Glândula Tireoide/cirurgia , TireoidectomiaRESUMO
La metayodobencilguanidina radiomarcada es un análogo de la norepinefrina que se utiliza en la localización de tumores que expresan transportadores de dicha neurohormona, especialmente los derivados de la cresta neural y de origen neuroendocrino, y en el tratamiento de sus metástasis cuando estas no son quirúrgicas. En la literatura revisada se encuentran mejorías sintomáticas, asociadas a un descenso de los niveles hormonales, en un porcentaje no despreciable de casos tras el tratamiento con 131I-MIBG. Sin embargo, la remisión tumoral completa se ha descrito en muy pocas ocasiones y casi nunca en presencia de metástasis óseas. Presentamos un caso de feocromocitoma maligno que tras el tratamiento con 131I-MIBG (600 mCi) alcanzó una respuesta hormonal y metabólica completa a pesar de la existencia de metástasis óseas (AU)
Radiolabeled metaiodobenzylguanidine is an analogue of norepinephrine used to localize tumors that express the neurohormone transporters, specifically those derived from the neural crest having a neuroendocrine origin. It is also used to treat non-surgical metastases derived from them. A review of the literature revealed symptomatic improvements associated to a decrease in hormone levels in a significant percentage of patients after 131I-MIBG treatment. However, complete tumor remission has been described only in very few cases and hardly ever when bone metastases exist. We present a case of a patient diagnosed of malignant pheochromocytoma who achieved complete hormonal and metabolic response after 131I-MIBG treatment (600 mCi) in spite of the presence of bone metastases (AU)