[Meta-analysis of the diagnostic efficacy of FDG-PET in patients with suspected ovarian cancer recurrence]. / Meta-análisis de la eficacia diagnóstica de la PET-FDG en pacientes con sospecha de recurrencia por cáncer de ovario.

AIM: The aim of this paper was to perform a meta-analysis of the literature to evaluate the accuracy of FDG-PET in recurrence detection in patients with ovarian cancer. METHODS: The search strategy consisted in identifying papers published between November 1972 and October 2003 indexed in MEDLINE and CANCERLITE. Inclusion criteria were publications that evaluated recurrence with FDG-PET in patients with ovarian carcinoma. Exclusion criteria were duplicated papers or those outdated by subsequent ones. The statistical analysis included 95 % confidence intervals (CI) of sensitivity (S), specificity (Sp) and natural logarithm of the odds ratio (Ln OR). RESULTS: Seventeen publications fulfilled the inclusion criteria and were analyzed. The S and Sp were 0.94 (95% CI, 0.93-0.96) and 0.65 (95% CI, 0.46-0.85), respectively. The Ln OR presented global homogeneity and significant values in > 75% of the studies. CONCLUSION: According to our meta-analysis, FDG-PET has high S and intermediate Sp, with few false negative results. These preliminary findings suggest that FDG-PET may be an effective means of identifying patients with recurrent ovarian cancer.

[Recurrent signet-ring cell gastric carcinoma evidenced by FDG-PET]. / Recurrencia de un carcinoma gástrico de células en anillo de sello demostrada por PET-FDG.

OBJECTIVE: To present the case report of a patient with undifferentiated and diffuse signet-ring cell gastric carcinoma in which FDG-PET evidenced recurrent disease. MATERIALS AND METHODS: The patient was diagnosed of a stage III gastric carcinoma in 1994 and was treated with a subtotal gastrectomy. In February 2003, recurrent disease was detected in mediastinal and left supraclavicular lymph nodes. The patient was treated with chemotherapy and radiotherapy, reaching a complete response. After 6 months free of disease, he presented an elevation of the tumor markers with negative results in conventional imaging methods (upper digestive endoscopy, bone scintigraphy, and CT). An FDG-PET scan was performed to rule out recurrent disease. RESULTS: FDG-PET detected pathologic findings suggestive of malignant disease in right supraclavicular and mediastinal lymph nodes. These findings were confirmed by clinical follow-up and with another CT scan performed 4 months later. CONCLUSIONS: In this case report we stress the importance of early recurrence by FDG-PET in a non-intestinal gastric carcinoma. This is of interest given the greater difficulty to detect mucous secreting and/or producing carcinomas with the PET-FDG.

[Impact of positron emission tomography with FDG-PET in treatment of patients with suspected recurrent ovarian cancer]. / Impacto de la tomografía por emisión de positrones mediante 18-Fluoro-2-Desoxi-D-Glucosa (PET-FDG) en el manejo terapéutico de pacientes con recurrencia secundaria a cáncer de ovario.

AIM: Recurrent ovarian cancer is a major problem and an accurate diagnosis can often change patients' management. This study aimed to assess the impact on management of FDG-PET in recurrent ovarian cancer. MATERIAL AND METHODS: Forty-three patients in whom FDG-PET scan was performed due to suspected recurrent ovarian cancer were included. FDG-PET results were confirmed by histopathology and clinical follow-up of at least 12 months. To assess impact on management the treatment plan based on conventional imaging methods was compared with the treatment plan based on inclusion of PET findings, classifying FDG-PET impact on management as high, medium, low or no impact. Management changes, when present, were classified as intermodality or intramodality. RESULTS: FDG-PET had a high impact on therapeutic management in 28 patients (65.1 %), medium impact in 2 patients (4.6 %), low impact in 9 patients (20.9 %), and no impact in 4 patients (9.3 %). FDG-PET induced an intermodality change in management in 27 patients (62,8 %); intramodality changes were induced in 3 patients (7 %). Finally, it produced no treatment changes in 13 patients (30.2 %). CONCLUSION: FDG-PET supplied additional information when compared to conventional diagnostic procedures and allowed adequate management changes in most patients.

Focal pulmonary uptake of gallium-67 due to radiation pneumonitis: the case for a misdiagnosis of Hodgkin's disease progression.

Gallium-67 scan is usually performed in patients with Hodgkin's disease and high-grade non-Hodgkin lymphoma for evaluation of disease status after treatment. We present a case of an asymptomatic woman in complete remission of Hodgkin's disease after treatment with chemotherapy and radiotherapy where a focal uptake of Gallium-67 was discovered two months after finishing treatment. As classical radiation pneumonitis can appear one to three months after finishing radiotherapy and normally has an asymptomatic course, this possibility should be considered in these cases, especially when prior chemotherapy was administered.

Rhabdomyolysis in DOMS.

A 26-year-old man with a previous history of external twin bursitis was remitted to our Department for a bone scintigraphy. Before the study, the patient performed an elevated number of intense sprints. Bone scintigraphy showed a bilaterally increased activity in both anterior rectum muscles suggesting rhabdomyolysis. Biochemical studies and MRT confirmed the diagnosis.

Cold metastases detected by bone scintigraphy in aggressive lung cancer.

A case of a 55-year-old man was remitted to Traumatology Department to present back pain of two weeks of evolution. The results of bone scintigraphy and the patient's evolution allowed the diagnosis. This case report and a literature review showed the importance of using a routine bone scan in diagnosis of bone metastases.

Panhypopituitarism as a consequence of metastase of breast cancer in sella turcica.

A 49-year-old female with breast cancer after mastectomy and chemotherapy was found suffering from diabetes insipidus and panhypopituitarism syndrome. Whole body bone scan showed hyperfixation in sella turcica. This site is extremely rare, especially in breast cancer metastases.

Hodgkin's disease: internal mammary lymph nodes relapse diagnosed by gallium-67 scintigraphy.

This article presents the case of a 62-year-old man with treated Hodgkin's disease who had internal mammary lymph nodes relapse after a complete initial response. These masses were gallium avid. These findings were explained by histologically documented Hodgkin's relapse, the first such case reported in that localization without chest wall involvement. The literature on mediastinal Hodgkin's disease and diagnostic procedures are reviewed.

Adrenocortical scintigraphy with 131I-6-beta-iodomethyl-norcholesterol (NP 59) in bilateral adrenocortical carcinoma.

A case of a 49-year-old man suffering from bilateral adrenocortical carcinoma with local and secondary rapid progression is reported. The results of adrenocortical scintigraphy (NP 59) and histological findings allowed the diagnosis. This case report and a literature review showed the importance of using adrenocortical scintigraphy as a complementary imaging procedure of CT or MR images.

Pelvic and lumbar metastasis detected by bone scintigraphy in malignant pleural mesothelioma.

A case of a 43-year-old man suffering from pleural mesothelioma with distant bone metastasis is reported. The results of bone scintigraphy and NMR findings allowed the diagnosis. The current case describes a hematogenous metastasis to the pelvis and vertebral column from a malignant pleural mesothelioma that was detected initially by bone scintigraphy.

[Bone metastasis secondary to renal carcinoma diagnosed with bone scintigraphy]. / Metástasis óseas secundarias a carcinoma renal diagnosticadas mediante gammagrafía ósea.

We reported the case of a 35-y-old man with renal cell carcinoma and cold lesions detected by bone scintigraphy, related to metastatic involvement. Conventional X-Ray did not show any pathological findings, being confirmed by axial computed tomography (CT) the scintigraphic bone lesions. We have accomplished a discussion of the role of bone scintigraphy and complementary techniques (radiography, alkaline phosphatase levels) in the diagnosis of bone metastases in renal cell carcinoma.

[Value of the detection of serum thyroglobin and I-131 scintigraphy in the follow-up of differentiated thyroid cancer]. / Valor de la determinación de la tiroglobulina sérica y de la gammagrafía mediante I-131 en el seguimiento del cáncer diferenciado de tiroides.

OBJECTIVES: The objective of this work has been to know the sensitivity of serum thyroglobulin and I-131 scintigraphy in the detection of thyroid remnants or metastases, and to evaluate the predictive value of serum thyroglobulin in the follow-up of differentiated thyroid cancer patients. METHODS: We have carried out a retrospective study of 218 patients with differentiated thyroid cancer, with detection of serum thyroglobulin levels and I-131 scintigraphy in clinical status of hypothyroidism, after to perform thyroidectomy and between six and nine months later. We have rejected 16 and 14 patients who have had presented high serum levels of thyroglobulin, or an incomplete follow-up. RESULTS: Our results showed a good correlation of both parameters (92%). The sensitivity of TG and I-131 scan was 85% and 90% respectively, and superior to 90% for both procedures in the diagnosis of the osseous and lung metastases. The sensitivity of I-131 scan and TG was 100% and less to 70% in the detection of thyroid remnants and regional lymphatic nodes. The positive and negative value of TG was 99% and 91%, respectively, with a total of 24 false negative results. CONCLUSIONS: Considering this study, we believe that both techniques are complementary, with a lower sensitivity of serum TG in the detection of thyroid remnants and regional lymphatic involvement, and a negative predictive value that does not permit to accomplish the follow-up of differentiated thyroid cancer patients, considering exclusively the results of this tumoral marker.

[Positron emission tomography using 18-FDG-PET in radiologically indeterminate pulmonary lesions]. / Tomografía por emisión de positrones mediante PET-18FDG en lesiones pulmonares radiológicamente indeterminadas.

OBJECTIVE: Fluorine-18 deoxyglucose Positron Emission Tomography (FDG-PET) is a non-invasive technique that offers the possibility to define if the radiologically indetermined pulmonary lesions are benign or malignant with high positive and negative predictive values. Considering the indexed literature we can observe that there are few original studies performed with the diagnostic possibilities of our means. For this reason, our main objective is to evaluate the diagnostic accuracy of positron emission tomography in sixty-seven radiologically indetermined pulmonary nodular lesions. MATERIAL AND METHOD: Retrospectively, we evaluated the diagnostic ability of FDG-PET globally (by means of visual and semiquantitative analysis) and partially (only considering the Standardized Uptake Value (SUV)), in sixty-seven patients confirmed by pathology or clinical and radiological monitoring, in a time interval superior to one year. RESULTS: Globally, FDG-PET had a sensitivity (S) of 92%, specificity (SP) of 86.6%, positive predictive value (PPV) of 89.4%, negative predictive value (NPV) of 89.6% and diagnostic accuracy (DA) of 89%. The best results were obtained for an SUV equal or superior to 2.5. With this value, the clinical efficacy parameters were: S 0.92, SP 0.90, PPV 0.92, NPV 0.90 and DA 0.91. CONCLUSIONS: We can characterize most of the radiologically indetermined pulmonary lesions by FDG-PET. The additional use of SUV facilitates an increase in the positive predictive value and specificity of FDG-PET.

[Value of ventilation scintigraphy in the diagnosis of pulmonary thromboembolism]. / Valor de la gammagrafía de ventilación en el diagnóstico del tromboembolismo pulmonar.

OBJECTIVES: The objective of this work has been to know if to all patients with diagnostic suspected of acute pulmonary embolism and pathologic perfusion scanning, ventilation scintigraphy were performed in the assistance context, analyzing etiopathogenic, clinic and diagnostic factors related with the non prescription of the ventilation scintigraphic study. METHODS: In 1992 we have carried out a retrospective and random study of 50 patients with perfusion scintigraphy for diagnostic suspected of acute pulmonary embolism (APE). RESULTS: A diagnosis of acute pulmonary embolism and deep vein thrombosis was made respectively in 35 (70%) and 22 (44%) of a total of 50 patients. In twenty patients ventilation scintigraphic study were not performed, six of them with normal perfusion scanning and fourteen patients with pathologic scintigraphic perfusion and acute pulmonary embolism diagnosis (78.5% with high probability scintigraphic scans). In this work we find a total of 14 patients with perfusion scanning without ventilation study. The presence of high probability scintigraphic scans or the acute pulmonary embolism were significant statistically related with the non prescription of the ventilation study. CONCLUSIONS: In our opinion, none of these factors can explain the non realization of the ventilation scanning, considering this study indispensable before the presence of patient with scintigraphic perfusion defects and suspected of pulmonary embolus.

[Scientigraphic hot lesions secondary to osseous metastases in a patient with multiple myeloma]. / Lesiones gammagráficas hipercaptadoras secundarias a metástasis óseas en paciente con mieloma múltiple.

The myeloma bone deposits may be normal or may also appear as areas of a low uptake on the bone scintigraphy; the presence of multiple hot lesions with negative X-ray and minimal CT findings in patients with multiple myeloma being very uncommon. We reported the case of a 68 year old woman suffering from a multiple myeloma with multiple and hot metastatic lesions in bone scintigraphy. The X-ray was negative and the CT-findings only demonstrated a lytic femoral lesion, the spinal osseous dissemination being confirmed by MRI. We believe that this is an interesting work due to the rarity of the scintigraphic pattern as well as the discussion carried out on the radionuclide imaging methods in the diagnosis of myeloma-related bone lesions.

[Incidence of pulmonary scintigraphic changes in women irradiated for breast cancer]. / Incidencia de alteraciones gammagráficas pulmonares en mujeres irradiadas por cáncer de mama.

OBJECTIVE: To determine the incidence of respiratory function changes on quantified ventilation-perfusion scintigraphy produced by breast cancer radiation therapy and its correlation with irradiated lung volume. MATERIAL AND METHODS: Prospective study on 43 patients with breast cancer who received adjuvant radiotherapy. Quantified ventilation-perfusion scintigraphy was carried out before and after radiotherapy (3 and 9 months). The differences of ventilation and perfusion were calculated subtracting the irradiated lung values from the contralateral lung values, and their correlations with the irradiated lung volume were analyzed. RESULTS: The scintigraphic parameter means of the irradiated lung were significantly lower than those of the contralateral lung, after radiotherapy. The incidence of patients with a total perfusion and ventilation decrease over 10 % was 21 %, except for the three-month ventilation, which was 23 %. The total ventilation difference was significantly correlated with the lung volume, presenting decreases over 10 % for volumes of 100 cm3 or more. All patients remained asymptomatic. CONCLUSIONS: The pulmonary scintigraphy changes derived from the breast cancer radiotherapy produced no clinical symptomatology. Regarding scintigraphy, ventilation decreases when the irradiated lung volume increases, so a follow-up of these patients' pulmonary function should be performed when the lung volume irradiation cannot be lower than 100 cm3.

[Diagnostic usefulness of radioisotope study of nasal mucociliary transport in patients with recurrent respiratory infections]. / Utilidad diagnóstica del estudio del transporte mucociliar nasal con isótopos en pacientes con infecciones respiratorias recidivantes.

Mucociliary transport system is thee most primitive and essential airway defense mechanisms. Primary ciliary dyskinesia syndrome (PCDS), an inherited recessive autosomal disease, produces an absence of mucociliary transport, therefore chronic upper and lower airways infections since birth. The study of nasal mucociliary transport by Seroalbumin-Tc99m method is very useful in the diagnosis of this syndrome. According to our experience, mucociliary stasis in a patient with chronic respiratory airways infections is a typical condition of PCDS. Normal nasal mucociliary transport velocity discards the PCDS.

[Splenic and bone marrow increased 18F-FDG uptake in a PET scan performed following treatment with G-CSF]. / Hipercaptación esplénica secundaria a factor estimulador de colonias granulocitarias (G-CSF) en el estudio PET-FDG.

We present the case of an 11 year-old Caucasian girl who presented chest pain of 12 weeks evolution, with no other symptoms and a negative physical examination. Lactate dehydrogenase levels were increased to 797 U/l, whereas beta-2-microglobulin (BM2) levels were normal. The thoracic CT showed a bulky mediastinal mass that occupied the pretracheal, paratracheal and right prevascular regions. The gallium scintigraphy showed high uptake in the mediastinic region; the bone scintigraphy was negative. Biopsy of the mediastinal mass revealed the presence of diffuse large B-cell non-Hodgkin's lymphoma. Treatment included 4 cycles of chemotherapy followed by 7 days of subcutaneous granulocyte colony-stimulating factor (G-CSF, Lenogastrim) at a dose of 5 mg/Kg/day. Following treatment, a CT scan was performed to evaluate response, finding a calcification of the mass without significant reduction of the overall size. Because CT was inconclusive in the assessment of response to therapy, a 18F-FDG PET scan was performed. The 18F-FDG PET scan did not show any pathological uptake in the mediastinum but revealed a splenic and bone marrow diffusely increased 18F-FDG uptake. The differential diagnosis included a secondary effect induced by G-CSF therapy as one of the main possibilities, but other possibilities such as a malignant infiltration by lymphoma could not be discarded. Therefore, a second 18F-FDG PET scan was performed 3 months later. This study showed no pathological findings, with a normal 18F-FDG uptake in the spleen and bone marrow. Thus, the benign and reactive nature of the splenic and bone marrow 18F-FDG increased uptake found in the previous study was confirmed. We consider that the stimulating effect that G-CSF therapy has on the spleen and bone marrow must be taken into account when performing a 18F-FDG PET scan, as it can be an important source of false-positive results.

[Is it useful to perform a (67)gallium scintigraphy in the follow-up of patients with gastric lymphoma?]. / ¿Es útil realizar gammagrafía con galio-67 en el seguimiento de pacientes con linfoma gástrico?

Gastric (67)gallium uptake in patients with peptic ulcer has been described in many publications literature. We present the case of a jejunal (67)gallium uptake in a patient with a background of total gastrectomy due to a diffuse large B cell gastric lymphoma, associated to benign peptic ulcer which had been identified by endoscopy. We have not found any similar cases in regards to (67)gallium reported in the literature. This study aims to present a review of the causes of gastrointestinal uptake of (67)gallium and of the utility of the radiotracer in patients with gastric lymphoma.

[Periarticular heterotopic ossification secondary to central neurogenic dysfunction]. / Osificación heterotópica periarticular secundaria a disfunción neurogénica central.

A case of a 48 year old woman with a medical background of tetraparesis related to a right lobectomy and periarticular ossification development (that included both knee joints) is presented. Bone scintigraphy was performed to evaluate the metabolism of the bone lesions. The scintigraphic pattern showed an important involvement of the medial and lateral left knee and medial right knee compartments, initially attributed to degenerative osteoarthritis. We believe that the presentation of this case report is interesting for two reasons: 1) the rareness of knee involvement in periarticular heterotopic ossification related to cerebral dysfunction, and 2) the possibility of a false positive diagnosis: osteoarthritic involvement versus juxta-articular ossification. This paper reviews the role of diagnostic imaging methods in the assessment of periarticular heterotopic ossification and the differential scintigraphic diagnosis regarding to osteoarticular disorders (more frequent among the general population).