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Journal Cover Revista Española de Medicina Nuclear e Imagen Molecular
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   ISSN (Print) 0212-6982
   Published by Elsevier Homepage  [3041 journals]
  • Computing quantitative indicators of structural renal damage in pediatric
           DMSA scans
    • Authors: F. Sampedro; A. Domenech; S. Escalera; I. Carrio
      Pages: 72 - 77
      Abstract: Publication date: March–April 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular, Volume 36, Issue 2
      Author(s): F. Sampedro, A. Domenech, S. Escalera, I. Carrio
      Objectives The proposal and implementation of a computational framework for the quantification of structural renal damage from 99mTc-dimercaptosuccinic acid (DMSA) scans. The aim of this work is to propose, implement, and validate a computational framework for the quantification of structural renal damage from DMSA scans and in an observer-independent manner. Materials and methods From a set of 16 pediatric DMSA-positive scans and 16 matched controls and using both expert-guided and automatic approaches, a set of image-derived quantitative indicators was computed based on the relative size, intensity and histogram distribution of the lesion. A correlation analysis was conducted in order to investigate the association of these indicators with other clinical data of interest in this scenario, including C-reactive protein (CRP), white cell count, vesicoureteral reflux, fever, relative perfusion, and the presence of renal sequelae in a 6-month follow-up DMSA scan. Results A fully automatic lesion detection and segmentation system was able to successfully classify DMSA-positive from negative scans (AUC=0.92, sensitivity=81% and specificity=94%). The image-computed relative size of the lesion correlated with the presence of fever and CRP levels (p <0.05), and a measurement derived from the distribution histogram of the lesion obtained significant performance results in the detection of permanent renal damage (AUC=0.86, sensitivity=100% and specificity=75%). Conclusions The proposal and implementation of a computational framework for the quantification of structural renal damage from DMSA scans showed a promising potential to complement visual diagnosis and non-imaging indicators.

      PubDate: 2017-03-02T15:18:57Z
      DOI: 10.1016/j.remn.2016.06.010
  • Utilidad de la PET con 11C-metionina en la diferenciación precoz entre
           recurrencia tumoral y radionecrosis de pacientes tratados de glioma de
           alto grado con RM indeterminada
    • Authors: J.R. Garcia; M. Cozar; M. Baquero; J.M. Fernández Barrionuevo; A. Jaramillo; J. Rubio; G. Maida; M. Soler; E. Riera
      Pages: 85 - 90
      Abstract: Publication date: March–April 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular, Volume 36, Issue 2
      Author(s): J.R. Garcia, M. Cozar, M. Baquero, J.M. Fernández Barrionuevo, A. Jaramillo, J. Rubio, G. Maida, M. Soler, E. Riera
      Objetivo Valorar la contribución de la PET con 11C-metionina en la diferenciación precoz entre recurrencia tumoral y radionecrosis en pacientes tratados de gliomas de alto grado. Método Treinta pacientes tratados de glioma (grado iii/iv) con cirugía/radioterapia/quimioterapia (5-18 meses) con RM indeterminada. A todos se les realizó estudio de PET con 11C-metionina (<15 días tras RM) con análisis visual (grado de intensidad y morfología de captación), cuantificación (relación SUV máximo lesión/SUV medio fondo) y corregistro PET/RM (3D-Flair). El manejo de los pacientes se decidió en el comité de neurooncología: seguimiento clínico-imagen, tratamiento de segunda línea o cirugía. Resultados Veintitrés estudios de PET con 11C-metionina fueron visualmente positivos. La morfología fue: 15 focales, 4 difusos y 4 anulares. Tres de los focales fueron resecados (AP+). En 16 se realizó terapia de segunda línea (11 respuesta, 5 progresión). En los 4 de morfología anular se decidió seguimiento, con progresión en 2 (verdaderos positivos) y libres de enfermedad en 2 (6 y 7 meses después) (falsos positivos). Siete estudios de PET con 11C-metionina fueron visualmente negativos, todos ellos libres de enfermedad (3-12 meses). La relación SUV lesión/fondo en la recurrencia tumoral fue de 2,79±1,35 mientras que en la radionecrosis fue de 1,53±0,39 (p<0,05). Con umbral de corte SUV lesión/fondo de 2,35 se obtuvo una sensibilidad y especificidad del 90,5 y 100%. Conclusión La valoración de la PET con 11C-metionina, con análisis visual, cuantitativo y corregistro PET/RM muestra un papel complementario en los pacientes con RM no concluyente, permitiendo una diferenciación precoz entre recurrencia tumoral y radionecrosis, que ayuda a la individualización de la terapia. Objective To evaluate the contribution of 11C-Methionine PET in the early differentiation between tumour recurrence and radionecrosis in patients treated for a high grade glioma. Method The study included 30 patients with glioma (III/IV grade) treated with surgery/radiotherapy/chemotherapy (5-8 months) and with an indeterminate MRI. All patients underwent a 11C-Methione PET (within 15 days of MRI) and studies were visually analysed (intensity and morphology of uptake), quantified (SUV max/SUV mean background), and coregistered to MRI (3D-Flair). Patient management was decided by the neuro-oncology committee to clinical and imaging follow-up, second-line treatment, or surgery. Results There were 23 11C-Methionine PET studies visually positive. Morphology of uptake was focal in 15, diffuse in 4, and ring-shaped in 4. Three out of the focal uptake cases und...
      PubDate: 2017-03-02T15:18:57Z
      DOI: 10.1016/j.remn.2016.06.002
  • Analysis of non-conformity in continuous quality improvement in a Hospital
           Radiopharmacy Unit
    • Authors: T. Martinez; J.F. Contreras
      Pages: 99 - 102
      Abstract: Publication date: March–April 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular, Volume 36, Issue 2
      Author(s): T. Martinez, J.F. Contreras
      Aim To perform an analysis of non-conformities (NC) registered between 2012 and 2015, as a part of the review process of the Quality Management System of our Radiopharmacy Unit. Material and methods Non-conformities registered in the Radiopharmacy Unit in the period 2012–2015 are analyzed and sorted by their impact on the process (critical, major, and minor), cause/origin of the non-conformity, and nature of radiopharmaceutical (PET vs. SPECT). Results A decrease in the NC of 20% per year is observed, especially in PET radiopharmaceuticals. Non-conformities in SPECT make up about 62–84% of the total of the NC, mainly related to the high number of doses prepared and not administered, which is about 1.5–3% in the ratio of non-administered/administered per year. Conclusions Analysis of the NC can be considered as a useful indicator in assessment of quality assurance, and in our particular case, the decrease in the registration of NC indicates effectiveness in the corrective and preventive actions implemented.

      PubDate: 2017-03-02T15:18:57Z
      DOI: 10.1016/j.remn.2016.05.010
  • Additional value of hybrid SPECT/CT systems in neuroendocrine tumors,
           adrenal tumors, pheochromocytomas and paragangliomas
    • Authors: K.K. Wong; S. Chondrogiannis; D. Fuster; C. Ruiz; M.C. Marzola; F. Giammarile; P.M. Colletti; D. Rubello
      Pages: 103 - 109
      Abstract: Publication date: March–April 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular, Volume 36, Issue 2
      Author(s): K.K. Wong, S. Chondrogiannis, D. Fuster, C. Ruiz, M.C. Marzola, F. Giammarile, P.M. Colletti, D. Rubello
      The aim of this review was to evaluate the potential advantages of SPECT/CT hybrid imaging in the management of neuroendocrine tumors, adrenal tumors, pheochromocytomas and paragangliomas. From the collected data, the superiority of fused images was observed as providing both functional/molecular and morphological imaging compared to planar imaging. This provided an improvement in diagnostic imaging, with significant advantages as regards: (1) precise locating of the lesions; (2) an improvement in characterization of the findings, resulting higher specificity, improved sensitivity, and overall greater accuracy, (3) additional anatomical information derived from the CT component; (4) CT-based attenuation correction and potential for volumetric dosimetry calculations, and (5) improvement on the impact on patient management (e.g. in better defining treatment plans, in shortening surgical operating times). It can be concluded that SPECT/CT hybrid imaging provides the nuclear medicine physician with a powerful imaging modality in comparison to planar imaging, providing essential information about the location of lesions, and high quality homogeneous images.

      PubDate: 2017-03-02T15:18:57Z
      DOI: 10.1016/j.remn.2016.09.003
  • Homeopathic mistletoe adverse reaction mimics nodal involvement in 18F-FDG
           PET/CT performed for evaluation of response to chemotherapy in lymphoma
    • Authors: P. Abreu; R. Sánchez; T. Mut; D. Balaguer; I. Latorre; H. Rodríguez
      Pages: 110 - 112
      Abstract: Publication date: March–April 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular, Volume 36, Issue 2
      Author(s): P. Abreu, R. Sánchez, T. Mut, D. Balaguer, I. Latorre, H. Rodríguez
      Some patients use complementary medicine. We present a patient with Hodgkin's lymphoma, scanned with 18F-FDG PET/CT for evaluation of response after chemotherapy, who was self-administering mistletoe as a homeopathic medicine product. The careful review of the images of the entire scan and patient collaboration in anamnesis were crucial to avoid a false positive result. A review of the published scientific data on the effects of mistletoe is also presented.

      PubDate: 2017-03-02T15:18:57Z
      DOI: 10.1016/j.remn.2016.07.005
  • Uterine leiomyosarcoma metastatic to thyroid shown by 18F-FDG PET/CT
    • Authors: M. Gauthé; N. Testart Dardel; C. Nascimento; M. Trassard; A. Banal; J.-L. Alberini
      Pages: 113 - 115
      Abstract: Publication date: March–April 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular, Volume 36, Issue 2
      Author(s): M. Gauthé, N. Testart Dardel, C. Nascimento, M. Trassard, A. Banal, J.-L. Alberini
      About one third of focal thyroid uptakes in a fluorodeoxyglucose (FDG) positron emission tomography/computerized tomography (PET/CT) study are malignant, the most frequent histological type being papillary carcinoma. Metastases to the thyroid account for approximately 7.5% of thyroid malignancies and come mainly from kidney, lung, head and neck, and breast cancers. We report the case of a 64-year-old woman presenting a fast growing thyroid nodule whose primitive or metastatic origin was not obvious, for which 18F-FDG PET/CT helped in the diagnostic process and in the later management of the patient. Histopathologic findings finally revealed a metastasis of uterine leiomyosarcoma.

      PubDate: 2017-03-02T15:18:57Z
      DOI: 10.1016/j.remn.2016.09.002
  • Uso del 177Lu-DOTATATE como terapia en carcinomas de tiroides
    • Authors: P. Oliván-Sasot; M. Falgás-Lacueva; J. García-Sánchez; V. Vera-Pinto; C. Olivas-Arroyo; P. Bello-Arques
      Pages: 116 - 119
      Abstract: Publication date: March–April 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular, Volume 36, Issue 2
      Author(s): P. Oliván-Sasot, M. Falgás-Lacueva, J. García-Sánchez, V. Vera-Pinto, C. Olivas-Arroyo, P. Bello-Arques
      Ante un paciente con cáncer diferenciado de tiroides, el protocolo de tratamiento estándar a seguir es cirugía, ablación con 131Iodo (131I) de restos tiroideos y supresión de TSH. Pero en algunos casos, el tratamiento con 131I no es efectivo y deja de ser una opción terapéutica debido a la desdiferenciación celular con pérdida de la captación de 131I. Como otras opciones, se puede recurrir a tratamiento sistémico, si bien los pacientes no siempre son respondedores, pudiendo progresar la enfermedad y quedando sin opciones terapéuticas. Los tumores endocrinos pueden expresar receptores de la somatostatina, lo que se ha utilizado tanto para el diagnóstico como para su tratamiento mediante el marcaje de los análogos de la somatostatina con isótopos radiactivos. Presentamos el caso de una paciente con carcinoma folicular de tiroides yodorrefractario, con expresión de receptores de la somatostatina, tratada con 177Lu-DOTATATE, con excelente respuesta clínica y analítica. In a patient with a differentiated thyroid cancer the standard treatment protocol to be followed is surgery, ablation of thyroid remnants with 131Iodine (131I), and TSH suppression. However, the treatment with 131I is not effective in some cases, and it no longer becomes a therapeutic option due to cell de-differentiation with loss of 131I uptake. Systemic treatment can be used as other options, although patients are not always responsive; thus, the disease may progress and therapeutic options may run out. Endocrine tumours may express somatostatin receptors,and this characteristic has been used, not only for diagnosis, but also for their treatment through somatostatin analogue labelling with radioactive isotopes. This was the case of a patient suffering from iodine-refractory follicular thyroid carcinoma, with somatostatin receptors expression, treated with 177Lu-DOTATATE, showing an excellent clinical and analytical response.

      PubDate: 2017-03-02T15:18:57Z
      DOI: 10.1016/j.remn.2016.08.001
  • A rare case of dorsal-cervical spine myeloid sarcoma detected on 18F-FDG
           PET/CT scan
    • Authors: S. Annunziata; C. Caldarella
      Pages: 127 - 128
      Abstract: Publication date: March–April 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular, Volume 36, Issue 2
      Author(s): S. Annunziata, C. Caldarella

      PubDate: 2017-03-02T15:18:57Z
      DOI: 10.1016/j.remn.2016.06.006
  • Ischio-rectal mammary-type myofibroblastoma: MRI and 18F-FDG PET/CT
    • Authors: A.A. Pham; B.D. Nguyen
      Pages: 131 - 132
      Abstract: Publication date: March–April 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular, Volume 36, Issue 2
      Author(s): A.A. Pham, B.D. Nguyen

      PubDate: 2017-03-02T15:18:57Z
      DOI: 10.1016/j.remn.2016.07.006
  • Laryngeal and cardiac amyloidosis diagnosed by 18F-Florbetapir PET/CT
    • Authors: P. García-González; R. Sánchez-Jurado; M.P. Cozar-Santiago; M. Ferrando-Beltrán; P.L. Pérez-Rodriguez; J. Ferrer-Rebolleda
      Pages: 135 - 136
      Abstract: Publication date: March–April 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular, Volume 36, Issue 2
      Author(s): P. García-González, R. Sánchez-Jurado, M.P. Cozar-Santiago, M. Ferrando-Beltrán, P.L. Pérez-Rodriguez, J. Ferrer-Rebolleda

      PubDate: 2017-03-02T15:18:57Z
      DOI: 10.1016/j.remn.2016.03.006
  • Utilidad de los parámetros analíticos en el manejo de los pacientes
           pediátricos con sospecha de pielonefritis aguda. ¿Es fiable la
    • Authors: L. Bañuelos-Andrío; M. Espino-Hernández; M. Ruperez-Lucas; M.C. Villar-del Campo; C.I. Romero-Carrasco; G. Rodríguez-Caravaca
      Pages: 2 - 6
      Abstract: Publication date: January–February 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular, Volume 36, Issue 1
      Author(s): L. Bañuelos-Andrío, M. Espino-Hernández, M. Ruperez-Lucas, M.C. Villar-del Campo, C.I. Romero-Carrasco, G. Rodríguez-Caravaca
      Objetivo Valorar la utilidad de la procalcitonina (PCT) y de otros parámetros analíticos (leucocitos en sangre, proteína C reactiva [PCR]) como indicadores de daño renal agudo en niños tras su primer episodio de infección del tracto urinario febril o afebril (ITU). Material y métodos Se ha realizado un estudio retrospectivo, con obtención de medidas séricas de PCT, PCR y leucocitos en pacientes pediátricos admitidos entre enero de 2009 y diciembre de 2011, con un primer episodio de ITU, objetivando el daño renal agudo mediante gammagrafía renal con 99mTc-DMSA (DMSA) en las primeras 72h después de la admisión. Se ha llevado a cabo un estudio descriptivo de la muestra y un trazado de curvas ROC con cálculo de puntos de corte óptimos para cada parámetro. Resultados Se han incluido 101 pacientes divididos en 2 grupos en función del resultado del DMSA, 64 fueron diagnosticados de pielonefritis aguda (PNA) y 37 de ITU. Las medias de leucocitos en sangre, PCR y PCT fueron significativamente mayores en pacientes con PNA respecto a aquellos con DMSA normal. El área bajo la curva ROC fue de 0,862 para la PCR, 0,774 para leucocitos en sangre y 0,731 para la PCT. El punto de corte óptimo para la PCT fue 0,285ng/ml (sensibilidad 71,4% y especificidad 75%). Conclusión Si bien los niveles medios de fiebre, leucocitos, PCR y PCT estuvieron significativamente más elevados en pacientes con PNA que en los que tenían ITU, la sensibilidad y especificidad de estos parámetros analíticos no permiten predecir la existencia de afectación renal aguda, haciendo imprescindible la realización de una gammagrafía renal con DMSA. Objective To investigate the usefulness of procalcitonin (PCT) and other analytical parameters (white blood cell count [WBC], C-reactive protein [CRP]) as markers of acute renal damage in children after a first febrile or afebrile urinary tract infection (UTI). Methods A retrospective study was conducted on children with a first episode of UTI admitted between January 2009 to December 2011, and in whom serum PCT, CRP and white blood cell count were measured, as well as assessing the acute renal damage with renal scintigraphy with 99mTc-DMSA (DMSA) within the first 72h after referral. A descriptive study was performed and ROC curves were plotted, with optimal cut-off points calculated for each parameter. Results The 101 enrolled patients were divided into two groups according to DMSA scintigraphy results, with 64 patients being classified with acute pyelonephritis (APN), and 37 with UTI. The mean WBC, CRP and PCT values were significantly higher in patients with APN with respect to normal acute DMSA. The area under the ROC curve was 0.862 for PCR, 0.774 for WBC, and 0.731 for PCT. The optimum statistical cut-off value for PCT was 0.285ng/ml (sensitivity 71.4% and specificity 75%). Conclusion Although the mean levels of fever, WBC, CRP, and PCT were significantly increased in patients with APN than in those who had UTI, the sensitivity and specificity of these analytical parameters are unable to predict the existence of acute renal damage, making the contribution by renal D...
      PubDate: 2017-01-04T13:35:19Z
      DOI: 10.1016/j.remn.2016.05.006
  • La estimulación previa con rhTSH mejora la respuesta al tratamiento con
           radioyodo en pacientes con bocio multinodular tóxico de baja captación
    • Authors: M.J. Azorín Belda; A. Martínez Caballero; G.C. Figueroa Ardila; M. Martínez Ramírez; C.A. Gómez Jaramillo; J.I. Dolado Ardit; J. Verdú Rico
      Pages: 7 - 12
      Abstract: Publication date: January–February 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular, Volume 36, Issue 1
      Author(s): M.J. Azorín Belda, A. Martínez Caballero, G.C. Figueroa Ardila, M. Martínez Ramírez, C.A. Gómez Jaramillo, J.I. Dolado Ardit, J. Verdú Rico
      Introducción La estimulación con TSH recombinante humana (rhTSH) aumenta la captación tiroidea de yodo, ayudando al tratamiento con radioyodo en el bocio multinodular (BMN) no tóxico. Sin embargo, son escasos los estudios que utilicen rhTSH previo a terapia con radioyodo en el BMN tóxico para controlar la hiperfunción y clínica compresiva. Material y método Se llevó a cabo un estudio prospectivo en pacientes con BMN e hipertiroidismo. Los pacientes se reclutaron de forma consecutiva y se dividieron en un grupo I, estimulados con 0,3mg de rhTSH antes de recibir radioyodo, y un grupo control o grupo II, sin estimulación previa. Se midió función tiroidea, captación tiroidea de radioyodo, peso tiroideo y síntomas compresivos, y se siguió a los pacientes durante 9 meses. Resultados Un total de 16 pacientes (14 mujeres) de edad media 69,7años constituyeron el grupo I y 16 pacientes (12 mujeres) de edad media 70,7años, el grupo II. Tras el estímulo con 0,3mg rhTSH en el grupo I, la captación de 131I a las 24h aumentó un 78,4% y la dosis estimada absorbida, un 89,3%. En el grupo II, la dosis estimada absorbida fue inferior a la del grupo I tras la estimulación con rhTSH (29,8Gy vs. 56,4Gy; p=0,001). A los 9 meses, se había controlado el hipertiroidismo en un 87,5% de pacientes en el grupo I, y en un 56,2% en el grupo II (p=0,049). La reducción media de peso tiroideo fue mayor en el grupo I que en el II (39,3% vs. 26,9%; p=0,017), con una tendencia a la mejoría subjetiva de la clínica compresiva en el grupo I, aunque no significativa. Solo 2 pacientes describieron taquicardias tras la administración de rhTSH, que se resolvieron con beta-bloqueantes. Conclusiones La estimulación con rhTSH a dosis de 0,3mg previa al tratamiento con radioyodo consigue una reducción del tamaño tiroideo y mejoría funcional en pacientes con hipertiroidismo y BMN de baja captación, sin necesidad de ingreso hospitalario. Aim Stimulation with recombinant human thyrotropin (rhTSH) increases thyroid radioiodine uptake, and is an aid to 131I therapy in non-toxic multinodular goitre (MNG). However, there are not many studies using rhTSH prior to 131I in toxic multinodular goitre to improve hyperthyroidism and compressive symptoms. Material and method A prospective study was conducted on patients with MNG and hyperthyroidism. Patients were recruited consecutively and divided into group I, stimulated with 0.3mg of rhTSH before radioiodine therapy, and a control group or group II, without stimulation. Thyroid function, radioiodine thyroid uptake, thyroid weight, and compressive symptoms were measured, and patients were followed-up for 9 months. Results Group I consisted of 16 patients (14 women), with a mean age 69.7 years, and group II with 16 pa...
      PubDate: 2017-01-04T13:35:19Z
      DOI: 10.1016/j.remn.2016.05.009
  • Radioinmunoterapia en el linfoma no Hodgkin, posicionamiento, seguridad y
           eficacia de 90Y-ibritumomab. Experiencia y seguimiento a los 10 años
    • Authors: A. Martínez; M. Martínez-Ramirez; D. Martínez-Caballero; P. Beneit; J. Clavel; G. Figueroa; J. Verdú
      Pages: 13 - 19
      Abstract: Publication date: January–February 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular, Volume 36, Issue 1
      Author(s): A. Martínez, M. Martínez-Ramirez, D. Martínez-Caballero, P. Beneit, J. Clavel, G. Figueroa, J. Verdú
      Introducción La radioinmunoterapia (RIT) es uno de los tratamientos dirigidos contra dianas moleculares del linfoma no Hodgkin (LNH). Objetivo Evaluar el posicionamiento de la RIT con 90Y-ibritumomab en pacientes con LNH, así como su seguridad y efectividad. Método Estudio retrospectivo de pacientes con LNH que recibieron RIT con 90Y-ibritumomab. Se evaluaron la concordancia con las guías clínicas, la toxicidad según la clasificación Common Terminology Criteria for Adverse Events (CTCAE) y la efectividad en función de la respuesta al tratamiento y de la supervivencia global (SG) y la supervivencia libre de progresión (SLP). Resultados Se solicitó RIT en 26 pacientes, de los que 21 (11 mujeres, edad media ± desviación estándar 56±10 años) fueron incluidos en el estudio, con la siguiente distribución: LNH folicular 67%, LNH del manto 14%, LNH difuso de células B grandes 9,5% y LNH transformado 9,5%. Se trató a 12 pacientes con LNH refractario, 7 para consolidación de respuesta y 2 para acondicionamiento a trasplante. El 71% de los pacientes presentó efectos adversos, generalmente manejables y transitorios, siendo la trombocitopenia el más frecuente. A los 3-4 meses, se obtuvo una tasa de respuesta global del 76,2% (completa en 71,4% y parcial en 4,8%) y el 19% mostró progresión de su enfermedad. Con una mediana de seguimiento de 70 meses, la SG fue 96±8 y la SLP de 54±11 meses. Conclusiones La RIT presentó una moderada correlación con las guías clínicas y probablemente esté infrautilizada. Los efectos adversos fueron frecuentes, leves y manejables. Los datos muestran una alta tasa de respuesta completa y una prolongación de la SG y la SLP. Introduction Radioimmunotherapy (RIT) is one of the therapies directed against molecular targets in non-Hodgkin's lymphoma (NHL). Objective To evaluate the positioning, safety, and effectiveness of RIT with 90Y-Ibritumomab in NHL patients. Method A retrospective study was conducted on patients with NHL who received RIT with 90Y-Ibritumomab. An evaluation was made of the concordance with clinical guidelines, toxicity as rated by the Common Terminology Criteria for Adverse Events (CTCAE), and effectiveness was assessed based on response to treatment, overall survival (OS), and progression-free survival (PFS). Results RIT was requested in 26 patients, of whom 21 (11 women, mean age 56±10 years) were included in the study, with the following distribution: Follicular NHL, 67%, Mantle NHL, 14%, Diffuse large B-cell NHL, 9.5%, and Transformed NHL 9.5%. Twelve patients with refractory NHL, 7 for consolidation response, and 2 transplant conditioning, were treated. Adverse effects were observed in 71% of patients, which were usually manageable and transient, and with the most common being thrombocyt...
      PubDate: 2017-01-04T13:35:19Z
      DOI: 10.1016/j.remn.2016.05.004
  • The HURRA filter: An easy method to eliminate collimator artifacts in
           high-energy gamma camera images
    • Authors: H. Perez-Garcia; R. Barquero
      Pages: 27 - 36
      Abstract: Publication date: January–February 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular, Volume 36, Issue 1
      Author(s): H. Perez-Garcia, R. Barquero
      Purpose The correct determination and delineation of tumor/organ size is crucial in 2-D imaging in 131I therapy. These images are usually obtained using a system composed of a Gamma camera and high-energy collimator, although the system can produce artifacts in the image. This article analyses these artifacts and describes a correction filter that can eliminate those collimator artifacts. Methods Using free software, ImageJ, a central profile in the image is obtained and analyzed. Two components can be seen in the fluctuation of the profile: one associated with the stochastic nature of the radiation, plus electronic noise and the other periodically across the position in space due to the collimator. These frequencies are analytically obtained and compared with the frequencies in the Fourier transform of the profile. A specially developed filter removes the artifacts in the 2D Fourier transform of the DICOM image. This filter is tested using a 15-cm-diameter Petri dish with 131I radioactive water (big object size) image, a 131I clinical pill (small object size) image, and an image of the remainder of the lesion of two patients treated with 3.7GBq (100mCi), and 4.44GBq (120mCi) of 131I, respectively, after thyroidectomy. Results The artifact is due to the hexagonal periodic structure of the collimator. The use of the filter on large-sized images reduces the fluctuation by 5.8–3.5%. In small-sized images, the FWHM can be determined in the filtered image, while this is impossible in the unfiltered image. The definition of tumor boundary and the visualization of the activity distribution inside patient lesions improve drastically when the filter is applied to the corresponding images obtained with HE gamma camera. Conclusion The HURRA filter removes the artifact of high-energy collimator artifacts in planar images obtained with a Gamma camera without reducing the image resolution. It can be applied in any study of patient quantification because the number of counts remains invariant. The filter makes possible the definition and delimitation of small uptakes, such as those presented in treatments with 131I.

      PubDate: 2017-01-04T13:35:19Z
      DOI: 10.1016/j.remn.2016.06.003
  • Unexpected detection of non-palpable breast ductal invasive carcinoma with
           99mTc-HYNIC-TOC (Tektrotyd®)
    • Authors: S. Prado-Wohlwend; R. Sánchez-Vañó; P. Sopena-Novales; E. Uruburu-García; C. Martínez-Carsí
      Abstract: Publication date: Available online 18 March 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): S. Prado-Wohlwend, R. Sánchez-Vañó, P. Sopena-Novales, E. Uruburu-García, C. Martínez-Carsí

      PubDate: 2017-03-20T15:47:45Z
      DOI: 10.1016/j.remn.2017.02.006
  • Role of 18F-Choline PET/CT in guiding biopsy in patients with risen PSA
           levels and previous negative biopsy for prostate cancer
    • Authors: G.A. Jiménez Londoño; A.M. García Vicente; M. Amo-Salas; F. Fúnez Mayorga; M.A. López Guerrero; M.P. Talavera Rubio; P. Gutierrez Martin; B. González García; J.A. de la Torre Pérez; Á.M. Soriano Castrejón
      Abstract: Publication date: Available online 18 March 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): G.A. Jiménez Londoño, A.M. García Vicente, M. Amo-Salas, F. Fúnez Mayorga, M.A. López Guerrero, M.P. Talavera Rubio, P. Gutierrez Martin, B. González García, J.A. de la Torre Pérez, Á.M. Soriano Castrejón
      Objectives To study 18F-Choline PET/CT in the diagnosis and biopsy guide of prostate cancer (pCa) in patients with persistently high prostate-specific antigen (PSA) and previous negative prostate biopsy. To compare the clinical risk factors and metabolic variables as predictors of malignancy. Methods Patients with persistently elevated PSA in serum (total PSA >4ng/mL) and at least a previous negative or inconclusive biopsy were consecutively referred for a whole body 18F-Choline PET/CT. Patient age, PSA level, PSA doubling time (PSAdt) and PSA velocity (PSAvel) were obtained. PET images were visually (positive or negative) and semiquantitatively (SUVmax) reviewed. 18F-Choline uptake prostate patterns were defined as focal, multifocal, homogeneous or heterogeneous. Histology on biopsy using transrectal ultrasound-guided approach was the gold standard. Sensitivity (Se), specificity (Sp) and accuracy (Ac) of PET/CT for diagnosis of pCa were evaluated using per-patient and per-prostate lobe analysis. Receiver-operating-characteristic (ROC) curve analysis was used to assess the value of SUVmax to diagnose pCa. Correlation between PET/CT and biopsy results per-prostate lobe was assessed using the Chi-square test. Univariate and multivariate logistic regression analysis were applied to compare clinical risk factors and metabolic variables as predictors of malignancy. Results Thirty-six out of 43 patients with histologic confirmation were included. In 11 (30.5%) patients, pCa was diagnosed (Gleason score from 4 to 9). The mean values of patient age, PSA level, PSAdt and PSAvel were: 65.5 years, 15.6ng/ml, 28.1 months and 8.5ng/mL per year, respectively. Thirty-three patients had a positive PET/CT; 18 had a focal pattern, 7 multifocal, 4 homogeneous and 4 heterogeneous. Se, Sp and Ac of PET/CT were of 100%, 12% and 38% in the patient based analysis, and 87%, 29% and 14% in the prostate lobe based analysis, respectively. The ROC curve analysis of SUVmax showed an AUC of 0.568 (p =0.52). On a lobe analysis, poor agreement was observed between PET/CT findings and biopsy results (p =0.097). In the univariate/multivariate analysis, none of clinical and metabolic variables were statistically significant as predictor of pCa. Conclusion Choline PET/CT is a suitable procedure for the detection of pCa in highly selected patients, however, a high rate of false positive should be expected.

      PubDate: 2017-03-20T15:47:45Z
      DOI: 10.1016/j.remn.2017.01.014
  • Hibernoma intramuscular, falso positivo de recidiva tumoral en PET/TC con
    • Authors: C.M. Hernández Heredia; A. Seva Delgado; R.J. Ávila Martínez; P.C. Gálvez Diez; L.F. Villares
      Abstract: Publication date: Available online 18 March 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): C.M. Hernández Heredia, A. Seva Delgado, R.J. Ávila Martínez, P.C. Gálvez Diez, L.F. Villares

      PubDate: 2017-03-20T15:47:45Z
      DOI: 10.1016/j.remn.2017.02.001
  • La directiva ya está aquí. ¿Estamos preparados?
    • Authors: F.J. de Haro del Moral; R. Barquero
      Abstract: Publication date: Available online 18 March 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): F.J. de Haro del Moral, R. Barquero

      PubDate: 2017-03-20T15:47:45Z
      DOI: 10.1016/j.remn.2017.01.012
  • Unusual case of tumor of unknown origin found by 18F-FDG PET/CT:
           Metastatic clear cell carcinoma of the thyroid gland
    • Authors: G. Treglia; P. Trimboli; V. Zilioli; F. Fulciniti; L. Giovanella
      Abstract: Publication date: Available online 18 March 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): G. Treglia, P. Trimboli, V. Zilioli, F. Fulciniti, L. Giovanella

      PubDate: 2017-03-20T15:47:45Z
      DOI: 10.1016/j.remn.2017.02.003
  • Uncommon distant metastasis of pleural mesothelioma detected by whole-body
           18F-FDG PET/CT
    • Authors: C. Rapicetta; S. Taddei; M. Casali; R. Valli; F. Lococo; G. Treglia; M. Paci
      Abstract: Publication date: Available online 18 March 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): C. Rapicetta, S. Taddei, M. Casali, R. Valli, F. Lococo, G. Treglia, M. Paci

      PubDate: 2017-03-20T15:47:45Z
      DOI: 10.1016/j.remn.2017.02.002
  • 18F-FDG PET/CT in initial staging and treatment response evaluation in a
           patient with thymoma
    • Authors: T.F.
      Abstract: Publication date: Available online 11 March 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): L. Uslu-Beşli, Y. Akın, T.F. Çermik

      PubDate: 2017-03-16T15:41:04Z
  • PET/TC con 18F-FDG como predictor de la biología tumoral y del
           pronóstico en el cáncer epitelial ovárico
    • Authors: B. González García; A.M. García Vicente; G.A. Jiménez Londoño; F.J. Pena Pardo; M.E. Bellón Guardia; M.P. Talavera Rubio; A. Palomar Muñoz; P. Gómez Herrero; Á.M. Soriano Castrejón
      Abstract: Publication date: Available online 9 March 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): B. González García, A.M. García Vicente, G.A. Jiménez Londoño, F.J. Pena Pardo, M.E. Bellón Guardia, M.P. Talavera Rubio, A. Palomar Muñoz, P. Gómez Herrero, Á.M. Soriano Castrejón
      Objetivo Investigar la relación del valor máximo estandarizado de captación (SUVmáx) de la lesión ovárica con el subtipo histopatológico (I/II) y su implicación en la respuesta al tratamiento y en el pronóstico de las pacientes con carcinoma epitelial de ovario (CEO). Material y métodos Análisis retrospectivo de 31 pacientes con CEO y 18F-FDG-PET/TC previo al tratamiento, determinándose el SUVmáx de la lesión ovárica y realizándose diagnóstico histopatológico del tumor y seguimiento clínico-radiológico. Se estudió la relación del SUVmáx con el tipo histológico (tipos I y II) y el estadio tumoral, así como la implicación de este y otros parámetros (histología, estadio) en la evolución de las pacientes (respuesta completa [RC], supervivencia global [SG], supervivencia libre de enfermedad [SLE], estado libre de enfermedad a los 12 meses [LE12m] y a los 24 meses [LE24m]). Resultados El SUVmáx medio en lesiones tipo I fue menor que en las tipo II (6,3 y 9,3, respectivamente; p=0,03). Se obtuvo un valor de corte de SUVmáx de 7,1 en la identificación del CEO tipo II (sensibilidad: 77,8%; especificidad: 69,2%; AUC=0,748; p=0,02). No se halló relación significativa entre SUVmáx y estadio tumoral. Alcanzar RC fue más frecuente en estadios precoces; riesgo relativo (RR) de 1,64; p=0,003, en tumores tipo I y en los de menor SUVmáx. El estadio tumoral fue determinante en la SLE (p=0,04), en el LE24m (p=0,07) y en la SG (p=0,08). Observamos SLE más prolongadas y mayor porcentaje de pacientes LE24m en tumores tipo I (RR: 1,32; p=0,26). Conclusiones El SUVmáx se relacionó con el tipo histológico del CEO. No se encontró relación entre la actividad glucolítica del tumor primario con la respuesta y el pronóstico. Objective To investigate the relationship between maximum standardised uptake value (SUVmax) of ovarian lesions and histopathology subtypes, and their involvement in the response and prognosis of patients with epithelial ovarian carcinoma (EOC). Material and methods A retrospective analysis of 31 patients with EOC and 18F-FDG-PET/CT before treatment, including an assessment of the SUVmax of ovarian lesion. Histopathological diagnosis and follow-up was performed. A study was made on the relationship between the SUVmax and histological type (type I and II) and tumour stage, as well as the role of various parameters (SUVmax, histology, stage) on the patient outcomes (complete response [CR], overall survival [OS], disease-free survival [DFS], and disease-free [DF] status, at 12 and 24 months). Results
      PubDate: 2017-03-16T15:41:04Z
      DOI: 10.1016/j.remn.2017.01.004
  • Downstaging de carcinoma hepatocelular bilobar tras radioembolización con
           microesferas de 90Y como puente al trasplante hepático
    • Authors: L. Reguera-Berenguer; J. Orcajo-Rincón; A. Rotger-Regí; A.M. Matilla-Peña; M. Echenagusia-Boyra; R. Pérez-Pascual; A. Marí-Hualde; J.C. Alonso-Farto
      Abstract: Publication date: Available online 6 March 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): L. Reguera-Berenguer, J. Orcajo-Rincón, A. Rotger-Regí, A.M. Matilla-Peña, M. Echenagusia-Boyra, R. Pérez-Pascual, A. Marí-Hualde, J.C. Alonso-Farto
      La radioembolización hepática con 90Y es una terapia locorregional cada vez más ampliamente empleada en el tratamiento del carcinoma hepatocelular. Recientemente, se ha descrito su potencial beneficio como tratamiento de downstaging, logrando una disminución de la carga tumoral que permite rescatar a los pacientes para tratamientos más radicales como el trasplante hepático. Presentamos el caso de un paciente con el diagnóstico de carcinoma hepatocelular estadio intermedio de la Barcelona Clinic Liver Cancer (BCLC), multicéntrico y bilobar, en quien el tratamiento de radioembolización con 90Y consiguió una adecuada respuesta radiológica, reduciéndose de forma muy significativa la carga tumoral, permitiendo su rescate con trasplante hepático. Hepatic radioembolization with 90Y is an increasingly widely used locoregional therapy in the treatment of hepatocellular carcinoma. Its potential benefit has recently been described as a downstaging treatment, achieving a decreased tumour burden and allowing patients to be rescued for more radical treatments, such as liver transplantation. The case is presented of a patient diagnosed with multifocal bilobar hepatocellular carcinoma, Barcelona Clinic Liver Cancer (BCLC) intermediate stage, in whom treatment with 90Y achieved a satisfactory radiological response with a very significant reduction of tumour burden, allowing rescue with liver transplantation.

      PubDate: 2017-03-08T15:29:13Z
      DOI: 10.1016/j.remn.2016.12.006
  • Assessment of cardiovascular impairment in obese patients: Limitations and
           troubleshooting of available imaging tools
    • Authors: V. Gaudieri; C. Nappi; W. Acampa; R. Assante; E. Zampella; M. Magliulo; M. Petretta; A. Cuocolo
      Abstract: Publication date: Available online 3 March 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): V. Gaudieri, C. Nappi, W. Acampa, R. Assante, E. Zampella, M. Magliulo, M. Petretta, A. Cuocolo
      The prevalence and severity of obesity have increased over recent decades, reaching worldwide epidemics. Obesity is associated to coronary artery disease and other risk factors, including hypertension, heart failure and atrial fibrillation, which are all increased in the setting of obesity. Several noninvasive cardiac imaging modalities, such as echocardiography, cardiac computed tomography, magnetic resonance and cardiac gated single-photon emission computed tomography, are available in assessing coronary artery disease and myocardial dysfunction. Yet, in patients with excess adiposity the diagnostic accuracy of these techniques may be limited due to some issues. In this review, we analyze challenges and possibilities to find the optimal cardiac imaging approach to obese population.

      PubDate: 2017-03-08T15:29:13Z
      DOI: 10.1016/j.remn.2017.01.010
  • Seguimiento de pacientes pediátricos con histiocitosis de Langerhans
           mediante PET/TC con 18F-FDG
    • Authors: J.R. Garcia; E. Riera; P. Bassa; S. Mourelo; M. Soler
      Abstract: Publication date: Available online 3 March 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): J.R. Garcia, E. Riera, P. Bassa, S. Mourelo, M. Soler
      Objetivo Evaluar el impacto de la 18F-FDG PET/TC en la identificación de focos de enfermedad activa y el seguimiento terapéutico en un grupo de pacientes pediátricos con histiocitosis de células de Langerhans (HCL). Método Entre 2007-2013 se efectuaron 13 estudios 18F-FDG PET/TC de seguimiento en 7 pacientes diagnosticados de HCL (4 niñas, 3 varones; 1-12 años). Se analizaron los hallazgos PET y se correlacionaron con los de la TC y la RM, así como el seguimiento evolutivo con estas técnicas. Resultados La PET fue negativa en 4 pacientes (todos diagnosticados de lesiones óseas y afectación hipofisaria en un caso). La TC mostró persistencia de lesiones, de carácter residual, en todos los pacientes, y la RM de hipófisis mostró su normalización. La PET permaneció negativa a los 10, 14, 25 y 28 meses, sin detectar nuevas lesiones mediante TC ni RM. La PET fue positiva en 3 pacientes (uno con adenopatías cervicales y 2 con lesiones óseas y afectación hipofisaria en uno de ellos, no identificada por la PET). Los hallazgos de la TC fueron adenopatía cervical patológica (n=1) y lesiones óseas (n=2), y de la RM, lesión hipofisaria (n=1). En el paciente con adenopatía cervical la anatomía patológica mostró afectación por HCL. En los otros 2 pacientes, la PET permaneció positiva, con aumento de la captación ósea de 18F-FDG a los 17 y 19 meses. Conclusión En este estudio preliminar, la 18F-FDG PET constituye una técnica de imagen útil, junto con otras pruebas diagnósticas, para identificar lesiones activas y monitorizar la respuesta terapéutica en pacientes pediátricos con HCL. Purpose We evaluated the impact of 18F-FDG PET/CT in identifying sites of active disease and to assess therapeutic follow up in a group of pediatric patients with Langerhans cell histiocytosis (LCH). Method During 2007-2013, 13 18F-FDG PET/CT studies were performed for follow-up in 7 patients with a diagnosis of LCH (4 female, 3 male; 1-12 years-old). PET findings were analyzed and correlated with the CT and MRI. Findings were also follow-up by these techniques. Results PET was negative in 4 patients (all diagnosed with bone lesions and one with pituitary involvement also). CT findings showed residual morphological bone lesions in all patients, and hypophysis MRI study showed no abnormal signal. PET remained negative at 10, 14, 25 and 28 months, and no new lesions on CT and MRI were detected. PET was positive in 3 patients (one with cervical lymphadenopathy and 2 with bone lesions, one also with pituitary involvement not identified by PET). CT findings showed pathological cervical lymphadenopathy (n=1), bone lesions (n=2) and also a pituitary MRI lesion (n=1). In a patient with cervical lymphadenopathy histology demonstrated LCH involvement. In the other 2 patients, PET remained positive with an increase of 18F-FDG bone uptake at 17 and 19 months. Conclusion In our preliminar study, 18F-FDG PET is a useful ...
      PubDate: 2017-03-08T15:29:13Z
      DOI: 10.1016/j.remn.2017.01.007
  • Incidental meningioma detected by using 99mTc-MIBI SPECT/CT
    • Authors: D. Albano; L. Camoni; G. Bosio; F. Bertagna
      Abstract: Publication date: Available online 3 March 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): D. Albano, L. Camoni, G. Bosio, F. Bertagna

      PubDate: 2017-03-08T15:29:13Z
      DOI: 10.1016/j.remn.2017.01.011
  • Hydrothorax secondary to peritoneal dialysis detected by peritoneal
    • Authors: D. Balaguer; P. Abreu; T. Mut; M.D. Reyes; M.C. Plancha; E. Caballero
      Abstract: Publication date: Available online 3 March 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): D. Balaguer, P. Abreu, T. Mut, M.D. Reyes, M.C. Plancha, E. Caballero

      PubDate: 2017-03-08T15:29:13Z
      DOI: 10.1016/j.remn.2017.01.013
  • 18F-florbetapir uptake in a primary intraosseous haemangioma displayed in
           a cerebral PET/CT
    • Authors: Prado-Wohlwend Sopena-Novales; M.D. Monedero-Picazo
      Abstract: Publication date: Available online 2 March 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): R. Sánchez-Vañó, S. Prado-Wohlwend, P. Sopena-Novales, E. Uruburu-García, M.D. Monedero-Picazo, C. Martínez-Carsí

      PubDate: 2017-03-02T15:18:57Z
  • Tratamiento con 177Lu-DOTATATE: pasado, presente y futuro
    • Authors: Estorch
      Abstract: Publication date: March–April 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular, Volume 36, Issue 2
      Author(s): M. Estorch

      PubDate: 2017-03-02T15:18:57Z
  • The value of quantitative analysis in 18F-NaF PET/CT
    • Authors: Lapa Marques; Costa J.P. Lima
      Abstract: Publication date: March–April 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular, Volume 36, Issue 2
      Author(s): P. Lapa, M. Marques, G. Costa, J.P. Lima
      Aim To evaluate the ability of SUVmax to differentiate bone metastases from degenerative lesions, blastic from lytic metastases, as well as to determine the correlation between SUVmax with 18F-NaF and with 18F-FDG. Material and methods A review was performed on 115 18F-NaF PET/CT studies. Of the 64 patients with bone metastases, 49 (39 women, 10 men, 61±12 years (16–81)), in whom the PET/CT supported the diagnosis of bone metastases, were selected for analysis. A record was made of the SUVmax of a maximum of ten metastases in each patient (total 172: 141 blastic, 31 lytic), as well as four degenerative lesions (total 188) with the greatest 18F-NaF uptake intensity. Of the 49 patients analyzed, 43 also had a 18F-FDG PET/CT performed in which a record was made of the SUVmax values for 18F-FDG calculated in the locations corresponding to the bone metastases observed in the 18F-NaF PET/CT: 128 metastases (106 blastic, 22 lytic). Results The mean of the SUVmax values was significantly higher in metastases than in degenerative lesions, 26.8±17.3 vs. 15.3±6.3 (P <0.001) and in blastic than in lytic metastases, 27.9±18.3 vs. 22.1±11.3 (P =0.03). A SUVmax value above 42 always represented metastases, with all values above 49 representing blastic metastases. Using the SUVmax values, it was possible to predict the occurrence of metastases (AUC=0.723; P <0.001; 95% CI=0.671–0.776). The mean of the SUVmax with 18F-NaF was significantly higher in blastic metastases (27.9±18.3 vs. 22.1±11.3, P =0.03), whereas with 18F-FDG it was significantly higher in lytic ones (3.9±3.4 vs. 9.6±3.3; P <0.01). Conclusions SUVmax can contribute to the differentiation of metastases from degenerative lesions, and blastic from lytic metastases.

      PubDate: 2017-03-02T15:18:57Z
  • Comparación de resultados cualitativos vs. cuantitativos de 99mTc-MDP
           SPECT en pacientes con sospecha clínica de hiperplasia condilar
    • Authors: D.F. López Buitrago; J. Ruiz Botero; C.M. Corral; A.R. Carmona; A. Sabogal
      Abstract: Publication date: Available online 28 February 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): D.F. López Buitrago, J. Ruiz Botero, C.M. Corral, A.R. Carmona, A. Sabogal
      Objetivo Comparar el resultado de los informes cualitativos de la tomografía computarizada de emisión por fotón único (SPECT), con los resultados cuantitativos, calculados a partir del porcentaje de captación del radiofármaco 99mTc-MDP (metilendifosfonato), en cóndilos de pacientes con sospecha clínica de hiperplasia condilar. Materiales y método Estudio retrospectivo, descriptivo realizado en 51 pacientes con impresión clínica de asimetría facial y sospecha de hiperplasia condilar, remitidos a un centro de medicina nuclear para realizarles gammagrafía ósea-SPECT por el especialista en ortodoncia y/o cirugía maxilofacial. Se obtuvieron los datos cuantitativos del porcentaje de captación del radiofármaco 99mTc-MDP en ambos cóndilos, y se compararon con el informe cualitativo generado por el médico nuclear en cada uno de los sujetos. Resultados Se estableció la concordancia entre 51 informes cualitativos y sus resultados cuantitativos. Del total de la muestra, 32 eran mujeres (63%) y 19 hombres (37%). La edad de los pacientes estaba en un rango de 13-45 años (21±8 años). Según los informes cualitativos 19 pacientes fueron positivos para hiperplasia condilar derecha, 12 para izquierda, 8 bilaterales y 12 negativos. Según los resultados cuantitativos, 16 fueron positivos para hiperplasia condilar derecha, 10 izquierdos y 25 negativos. Conclusiones Las imágenes de medicina nuclear son una importante herramienta diagnóstica, pero la interpretación cualitativa de la imagen no es tan confiable como la determinación cuantitativa. Los informes cualitativos concuerdan con los resultados cuantitativos de la prueba SPECT 99mTc-MDP, en un bajo porcentaje (39,2%, kappa=0,13; p>0,2). La principal limitación del método cuantitativo es que no registra casos de hiperplasia condilar bilateral. Objective To compare qualitative vs quantitative results of Single Photon Emission Computerised Tomography (SPECT), calculated from percentage of 99mTc-MDP (methylene diphosphonate) uptake, in condyles of patients with a presumptive clinical diagnosis of condylar hyperplasia. Materials and method A retrospective, descriptive study was conducted on the 99mTc-MDP SPECT bone scintigraphy reports from 51 patients, with clinical impression of facial asymmetry related to condylar hyperplasia referred by their specialist in orthodontics or maxillofacial surgery, to a nuclear medicine department in order to take this type of test. Quantitative data from 99mTc-MDP condylar uptake of each were obtained and compared with qualitative image interpretation reported by a nuclear medicine expert. Results The concordances between the 51 qualitative and quantitative reports results was established. The total sample included 32 women (63%) and 19 men (37%). The patient age range was 13-45 years (21±8 years). According to qualitative reports, 19 patients were positive for right side condylar hyperplasia, 12 for left side condylar hyperplasia, with 8 bilateral, and 12 negative. The quantitative reports diagnosed 16 positives for right side condylar hyperplasia, 10 for left side condylar hyperplasia, and 25 negatives.
      PubDate: 2017-03-02T15:18:57Z
      DOI: 10.1016/j.remn.2017.01.003
  • Nuevos tiempos para la neuroimagen de Medicina Nuclear en España: ¿de
           dónde partimos?
    • Authors: M.A. Balsa; V. Camacho; P. Garrastachu; D. García-Solís; M. Gómez-Río; S. Rubí; X. Setoain; J. Arbizu
      Abstract: Publication date: Available online 22 February 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): M.A. Balsa, V. Camacho, P. Garrastachu, D. García-Solís, M. Gómez-Río, S. Rubí, X. Setoain, J. Arbizu
      Objetivo conocer la situación de los estudios de neuroimagen de Medicina Nuclear que se realizaron en España en el año 2013 y primer trimestre del 2014, con el fin de definir las actividades del grupo de trabajo de Neuroimagen de la Sociedad Española de Medicina Nuclear e Imagen Molecular (SEMNIM). Material y métodos Se diseñó un cuestionario de 14 preguntas dividido en 3 partes: características de los servicios (equipamiento y profesionales involucrados), tipo de exploraciones e indicaciones clínicas y métodos de evaluación. El cuestionario se remitió a los 166 servicios de Medicina Nuclear que figuraban en la secretaría de la Sociedad Española de Medicina Nuclear e Imagen Molecular. Resultados Respondieron a la encuesta un total de 54 centros distribuidos entre todas las comunidades autónomas. La mayoría de los centros realizaron entre 300 y 800 exploraciones de neuroimagen al año, representando más de 25 exploraciones al mes. La media de equipos por servicio era de 3, teniendo la mitad de ellos equipos PET/TC y SPECT/TC. Las exploraciones realizadas con más frecuencia son la SPECT cerebral con 123I-FP-CIT, seguida de la SPECT cerebral de perfusión y de la PET con 18F-FDG, siendo las indicaciones clínicas más frecuentes los estudios de deterioro cognitivo seguidos por los de trastornos del movimiento. Para la evaluación de las pruebas la mayoría de los centros utilizaron únicamente la valoración visual, en la valoración cuantitativa la cuantificación por regiones de interés fue la más utilizada. Conclusiones Los resultados reflejan cuál fue la actividad clínica del año 2013 y primer trimestre del 2014, siendo las indicaciones principales los estudios de deterioro cognitivo y trastorno del movimiento. La variabilidad en la evaluación de los estudios PET y la colaboración con los especialistas clínicos que demandan las exploraciones de neuroimagen de Medicina Nuclear son algunos de los retos que debemos afrontar en los próximos años. Objective To determine the status of neuroimaging studies of Nuclear Medicine in Spain during 2013 and first quarter of 2014, in order to define the activities of the neuroimaging group of the Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM). Material and methods A questionnaire of 14 questions was designed, divided into 3 parts: characteristics of the departments (equipment and professionals involved); type of scans and clinical indications; and evaluation methods. The questionnaire was sent to 166 Nuclear Medicine departments. Results A total of 54 departments distributed among all regions completed the questionnaire. Most departments performed between 300 and 800 neuroimaging examinations per year, representing more than 25 scans per month. The average pieces of equipment were three; half of the departments had a PET/CT scanner and SPECT/CT equipment. Scans performed more frequently were brain SPECT with 123I-FP-CIT, followed by brain perfusion SPECT and PET with 18F-FDG. The most frequent clinical indications were cognitive impairment followed by movement disorders. For evaluation of the images most sites used only visual assessment, and for the quantitative assessment the most used was quantification by region of interest.
      PubDate: 2017-02-23T15:04:37Z
      DOI: 10.1016/j.remn.2016.12.004
  • Metástasis en ciego de un cáncer lobulillar de mama
           diagnosticada con 18F-FDG PET/TC
    • Authors: D. Villasboas-Rosciolesi; C. Pérez; L. Capdevila; F. Ramos; V. Valenti; J.R. Garcia
      Abstract: Publication date: Available online 21 February 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): D. Villasboas-Rosciolesi, C. Pérez, L. Capdevila, F. Ramos, V. Valenti, J.R. Garcia

      PubDate: 2017-02-23T15:04:37Z
      DOI: 10.1016/j.remn.2016.11.002
  • Pericardial metastases due to terminal ileum primary carcinoid tumour
           detected on 111In scintigraphy
    • Authors: D.R. Ocaña; E.E. Muñoz; J.R. García; C.P. Zarzuela
      Abstract: Publication date: Available online 20 February 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): D.R. Ocaña, E.E. Muñoz, J.R. García, C.P. Zarzuela

      PubDate: 2017-02-23T15:04:37Z
      DOI: 10.1016/j.remn.2016.12.003
  • Valor de la PET/TC cerebral con 18F-fluorocolina en la detección de
           recurrencias de neoplasias primarias del sistema nervioso central
    • Authors: A. Montes; A. Fernández; V. Camacho; C. de Quintana; O. Gallego; J. Craven-Bartle; D. López; J. Molet; B. Gómez-Ansón; I. Carrió
      Abstract: Publication date: Available online 17 February 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): A. Montes, A. Fernández, V. Camacho, C. de Quintana, O. Gallego, J. Craven-Bartle, D. López, J. Molet, B. Gómez-Ansón, I. Carrió
      Objetivo Estudiar el impacto clínico en el manejo de los pacientes de la 18F-fluorocolina (18F-COL) en la recurrencia de neoplasias cerebrales primarias. Material y métodos Se estudió prospectivamente a 21 pacientes con sospecha de recidiva de neoplasia cerebral primaria mediante PET/TC cerebral con 18F-COL en uso compasivo. La distribución por patología de los pacientes estudiados fue: 3 astrocitomas grado ii, 3 astrocitomas grado iii, un oligodendroglioma grado ii, 3 oligodendrogliomas grado iii, un oligoastrocitoma grado iii, 4 glioblastomas multiformes, una gliomatosis cerebri y 5 meningiomas. Se consideraron positivos los estudios en los que había una captación visualmente significativa respecto al fondo del parénquima cerebral. Resultados Diecisiete de los pacientes fueron positivos, comprobándose dicho resultado por histología (10 de ellos) o seguimiento clínico y por neuroimagen, sin hallarse falsos positivos o negativos. El índice target to backgroud ratio medio para los positivos fue de 8,02 y para los negativos de 0,94, lo que representa una diferencia significativa (p=0,003). Conclusión La PET/TC con 18F-COL presenta resultados alentadores en la valoración de pacientes con sospecha de recidiva. Aim To study the usefulness of 18F-fluorocholine (FCH) in detecting the recurrence of primary brain tumours. Material and methods A prospective study was conducted on brain PET/CT with FCH for compassionate use in 21 patients with suspected recurrence of a primary brain tumour. The distribution by pathology was: three grade ii astrocytomas, three grade iii astrocytomas, one grade ii oligodendroglioma, three grade iii oligodendrogliomas, one grade iii oligoastrocytoma, four glioblastoma multiform, one gliomatosis cerebri, and five meningiomas. Studies in which there was a visually significant uptake in the brain parenchyma were classified as positive. Results A total of 17 patients were classified as positive, with the results being confirmed by histology (10 cases) or clinical follow-up and imaging, with no false positives or negatives. The mean SUVmax for positive patients was 8.02 and 0.94 for the negative ones, which was significantly different (P=.003) Conclusion PET/CT with FCH shows encouraging results in the evaluation of patients with suspected recurrence of primary brain neoplasms.

      PubDate: 2017-02-23T15:04:37Z
      DOI: 10.1016/j.remn.2016.11.005
  • Gammagrafía hepatobiliar con 99mTc-mebrofenina en una paciente con
           fístula bilio-pleuro-bronquial
    • Authors: V. Marín-Oyaga; K. Cohen-Castillo; C. Gutierrez-Villamil; S. Arevalo-Leal
      Abstract: Publication date: Available online 17 February 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): V. Marín-Oyaga, K. Cohen-Castillo, C. Gutierrez-Villamil, S. Arevalo-Leal

      PubDate: 2017-02-23T15:04:37Z
      DOI: 10.1016/j.remn.2016.12.002
  • 18F-FDG-PET/CT guiding to diagnosis of neurosarcoidosis
    • Authors: P. Guglielmo; C. Crivellaro; L. Marzorati; M. Patassini; S. Morzenti; C. Landoni
      Abstract: Publication date: Available online 16 February 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): P. Guglielmo, C. Crivellaro, L. Marzorati, M. Patassini, S. Morzenti, C. Landoni

      PubDate: 2017-02-23T15:04:37Z
      DOI: 10.1016/j.remn.2016.12.001
  • Carcinoma epidermoide primario de tiroides. Valoración inicial y control
           evolutivo mediante 18F-FDG PET/TC
    • Authors: L. Caballero Gullón; E. Carmona González; A. Martínez Estévez; M.P. Gómez Camarero; J.J. Corral; I. Borrego Dorado
      Abstract: Publication date: Available online 16 February 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): L. Caballero Gullón, E. Carmona González, A. Martínez Estévez, M.P. Gómez Camarero, J.J. Corral, I. Borrego Dorado
      El carcinoma epidermoide primario de tiroides es una neoplasia muy poco frecuente, con comportamiento agresivo, de mal pronóstico, con pobre respuesta al tratamiento quimioterápico y radioterápico, y cuyo tratamiento de elección es la cirugía. Suele presentarse al diagnóstico como enfermedad extendida, como una tumefacción cervical que causa la mayoría de sus síntomas por invasión o metástasis locales. Su diagnóstico requiere excluir infiltración desde un tumor adyacente, afectación metastásica a distancia desde otro carcinoma epidermoide primario y realizar estudio inmunohistoquímico, el cual refleje el patrón característico de expresión de citoqueratinas. Presentamos el caso de un paciente de 53 años con antecedentes oncológicos de hepatocarcinoma, en el que durante el seguimiento se detecta una lesión cervical, caracterizada como hipermetabólica al realizar el estudio de extensión mediante tomografía por emisión de positrones con 18F-FDG (18F-FDG PET/TC). También presentamos el control evolutivo de dicha lesión mediante esta técnica y la utilidad de esta última. Squamous cell carcinoma of thyroid is an uncommon, very aggressive neoplasm, having a poor prognosis and poor response to chemotherapy and radiotherapy. Surgery is the initial treatment of choice, although it often presents as a widespread disease at the time of diagnosis, usually with cervical swelling that causes most of the symptoms due to local infiltration or metastasis. Local infiltration from adjacent tumour and metastatic disease needs to be excluded from other primary epidermoid carcinomas, in order to make a correct diagnosis. This also requires the typical cytokeratin pattern seen in histological studies. The case is presented of a 53 year-old man with a medical history of hepatocarcinoma, with a cervical hypermetabolic lesion detected in an 18F-FDG PET/CT performed to exclude widespread disease. The follow-up of this lesion with this technique and its usefulness is also described.

      PubDate: 2017-02-23T15:04:37Z
      DOI: 10.1016/j.remn.2017.01.001
  • Incidental finding of 131I uptake in mesenteric cystic lymphangioma on
           post-therapy 131I SPECT/CT imaging
    • Authors: G. Shao; Y. Zhao; J. Song; S. Li
      Abstract: Publication date: Available online 10 February 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): G. Shao, Y. Zhao, J. Song, S. Li

      PubDate: 2017-02-16T14:46:17Z
      DOI: 10.1016/j.remn.2017.01.002
  • Acute pulmonary embolism detection with ventilation/perfusion SPECT
           combined with full dose CT: What is the best option?
    • Authors: M. Milà; J. Bechini; A. Vázquez; V. Vallejos; M. Tenesa; A. Espinal; M. Fraile; M. Monreal
      Abstract: Publication date: Available online 6 February 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): M. Milà, J. Bechini, A. Vázquez, V. Vallejos, M. Tenesa, A. Espinal, M. Fraile, M. Monreal
      Aim To compare diagnostic accuracy of Ventilation/Perfusion (V/P) single-photon emission computed tomography (SPECT) combined with simultaneous full-dose CT with a hybrid SPECT/CT scanner versus planar ventilation/perfusion (V/P) SPECT and CT angiography (CTA) in patients suspected with acute pulmonary embolism (PE). Methods Between 2009 and 2011, consecutive patients suspected of acute PE were referred for V/P SPECT/CT (reviewed board approved study). A contrast agent was administered to patients who had no contraindications. Non-contrast V/P SPECT/CT was performed on the remaining patients. All patients were followed-up for at least 3 months. Results A total of 314 patients were available during the study period, with the diagnosis of PE confirmed in 70 (22.29%) of them. The overall population sensitivity and specificity was 90.91% and 92.44%, respectively for V/P SPECT, 80% and 99.15%, respectively, for CTA, and 95.52% and 97.08% for V/P SPECT/CT. SPECT/CT performed better than V/P SPECT (AUC differences=0.0419, P =0.0043, 95% CI; 0.0131–0.0706) and CTA (AUC differences=0.0681, P =0.0208, 95% CI; 0.0103–0.1259)). Comparing imaging modalities when contrast agent could be administered, sensitivity and specificity increased and V/P SPECT/CT was significantly better than CTA (AUC differences=0.0681, P =0.0208, 95% CI; 0.0103–0.1259) and V/P SPECT (AUC differences=0.0659, P =0.0052, 95% CI; 0.0197–0.1121). In case of non-contrast enhancement, there was non-significant increase of specificity. Secondary findings on CT impacted patient management in 14.65% of cases. Conclusion Our study shows that combined V/P SPECT/CT scanning has a higher diagnostic accuracy for detecting acute PE than V/P SPECT and CTA alone. When feasible, V/P SPECT/CT with contrast enhancement is the best option.

      PubDate: 2017-02-10T14:37:16Z
      DOI: 10.1016/j.remn.2016.11.001
  • Response assessment in relapsing polychondritis with 18F-FDG PET/CT
    • Authors: T.K. Jain; A. Sood; A. Sharma; R.K. Basher; A. Bhattacharya; B.R. Mittal
      Abstract: Publication date: Available online 26 January 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): T.K. Jain, A. Sood, A. Sharma, R.K. Basher, A. Bhattacharya, B.R. Mittal

      PubDate: 2017-01-28T14:19:26Z
      DOI: 10.1016/j.remn.2016.10.004
  • Incidental detection of tracer avidity in meningioma in 68Ga-PSMA PET/CT
           during initial staging for prostate cancer
    • Authors: T.K. Jain; A.G.S. Jois; S. Kumar V; S.K. Singh; R. Kumar; B.R. Mittal
      Abstract: Publication date: Available online 26 January 2017
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): T.K. Jain, A.G.S. Jois, S. Kumar V, S.K. Singh, R. Kumar, B.R. Mittal

      PubDate: 2017-01-28T14:19:26Z
      DOI: 10.1016/j.remn.2016.10.005
  • Primary hyperparathyroidism regression associated to cinacalcet therapy
           proved by 99mTc-MIBI scintigraphy
    • Authors: A. Coloma; S. Hernández-Estrada; H. Bowles; N. Sánchez; D. Fuster; J. Torregrosa
      Abstract: Publication date: Available online 20 December 2016
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): A. Coloma, S. Hernández-Estrada, H. Bowles, N. Sánchez, D. Fuster, J. Torregrosa

      PubDate: 2016-12-27T13:24:04Z
      DOI: 10.1016/j.remn.2016.10.010
  • Unexpected primary bone lymphoma
    • Authors: S. Rodríguez Martínez de Llano; M.L. Poncet Souto; R. Álvarez Rodríguez; C. Lancha Hernández; I. Candal Casado; P. Pais Silva
      Abstract: Publication date: Available online 6 December 2016
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): S. Rodríguez Martínez de Llano, M.L. Poncet Souto, R. Álvarez Rodríguez, C. Lancha Hernández, I. Candal Casado, P. Pais Silva

      PubDate: 2016-12-12T11:02:32Z
      DOI: 10.1016/j.remn.2016.10.006
  • Nuevos tiempos para los grupos de trabajo de la SEMNIM
    • Authors: Arbizu
      Abstract: Publication date: Available online 2 December 2016
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): J. Arbizu

      PubDate: 2016-12-05T10:51:54Z
  • Tratamiento con 177LU-DOTATATE en tumores neuroendocrinos. Estudio
    • Authors: I. Hervás; P. Bello; M. Falgas; M.I. del Olmo; I. Torres; C. Olivas; V. Vera; P. Oliván; A.M. Yepes
      Abstract: Publication date: Available online 23 November 2016
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): I. Hervás, P. Bello, M. Falgas, M.I. del Olmo, I. Torres, C. Olivas, V. Vera, P. Oliván, A.M. Yepes
      La terapia con péptidos análogos de la somatostatina marcados con radionúclidos es un nuevo tratamiento prometedor para tratar tumores neuroendocrinos. El objetivo del presente estudio preliminar es presentar nuestra experiencia en la terapia con 177Lu-DOTATATE y evaluar la tolerabilidad y la eficacia a corto plazo en pacientes con tumores que expresan receptores para la somatostatina. Se han tratado 7 pacientes con tumores neuroendocrinos metastásicos, cada uno con 4 dosis de 177Lu-DOTATATE y se ha evaluado su respuesta al tratamiento en forma de respuesta bioquímica (marcadores tumorales y analítica), según métodos de imagen (gammagrafía de receptores de somatostatina, tomografía computarizada y resonancia magnética) y respuesta funcional y de calidad de vida (mediante la Escala de actividad de Karnofsky). Se ha evaluado también la toxicidad del tratamiento. Los resultados obtenidos han sido los siguientes: respuesta bioquímica: el 60% de los pacientes mostraron una normalización de sus niveles de marcadores tumorales, mientras que en el 40% disminuyeron de manera significativa; respuesta en técnicas de imagen: el 85,7% presentaron una respuesta parcial, mientras que el 14,3% mostraron enfermedad estable; mejoría de la calidad de vida: el 100% de los pacientes mostraron una mejoría significativa en la calidad de vida con un incremento de la Escala de actividad de Karnofsky, y en cuanto a la toxicidad: ningún paciente presentó toxicidad aguda o crónica, y el 42,8% de los pacientes presentaron toxicidad subaguda hematológica transitoria. A pesar de tratarse de un estudio preliminar podemos afirmar que el tratamiento con 177Lu-DOTATATE es un tratamiento seguro, con pocos efectos adversos y que consigue una respuesta objetiva en la mayoría de los pacientes. Therapy with radiolabelled somatostatin analogue peptides is a promising new therapy to treat neuroendocrine tumours. The aim of this preliminary study is to present our experience with 177Lu-DOTATATE therapy, and evaluate tolerability and short-term efficacy in patients with tumours expressing somatostatin receptors. A total of 7 patients with metastatic neuroendocrine tumours were treated, each with 4 doses of 177Lu-DOTATATE. The treatment response was evaluated in the form of biochemical response (tumour markers), imaging methods (somatostatin receptor scintigraphy, computed tomography, and magnetic resonance), and functional and quality of life responses using the Karnofsky performance status scale. Treatment toxicity was also evaluated. The results obtained were as follows: Biochemical response: 60% of patients showed tumour marker levels returning to normal, while they decreased significantly in the remaining 40%. Imaging response: 85.7% had a partial response, while 14.3% showed stable disease. All (100%) patients showed a significant improvement in quality of life, with increased Karnofsky scale scores. No patient had acute or chronic toxicity, and subacute transient haematological toxicity was observed in 42.8% of patients. Despite being a preliminary study, it was found that treatment with 177Lu-DOTATATE is a safe treatment with few side effects, and an objective response was achieved in most patients.

      PubDate: 2016-11-28T10:38:50Z
      DOI: 10.1016/j.remn.2016.10.003
  • Right atrial metastasis of GIST detected by 18F-FDG PET/CT
    • Authors: D. Albano; M. Bonacina; E. Cossalter; F. Bertagna
      Abstract: Publication date: Available online 12 November 2016
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): D. Albano, M. Bonacina, E. Cossalter, F. Bertagna

      PubDate: 2016-11-14T10:18:34Z
      DOI: 10.1016/j.remn.2016.08.003
  • “Pine tree” appearance on 18F-FDG PET/CT MIP image in spinal
    • Authors: T. Kumar Jain; A. Sood; R. Kumar Basher; A. Bhattacharya; B. Rai Mittal; A.K. Aggarwal
      Abstract: Publication date: Available online 9 November 2016
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): T. Kumar Jain, A. Sood, R. Kumar Basher, A. Bhattacharya, B. Rai Mittal, A.K. Aggarwal

      PubDate: 2016-11-14T10:18:34Z
      DOI: 10.1016/j.remn.2016.07.001
  • Gammagrafía con 75SeHCAT en la diarrea crónica por malabsorción de
           ácidos biliares
    • Authors: L.M. Mena Bares; E. Carmona Asenjo; M.V. García Sánchez; E. Moreno Ortega; F.R. Maza Muret; M.V. Guiote Moreno; A.M. Santos Bueno; E. Iglesias Flores; J.M. Benítez Cantero; J.A. Vallejo Casas
      Abstract: Publication date: Available online 17 October 2016
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): L.M. Mena Bares, E. Carmona Asenjo, M.V. García Sánchez, E. Moreno Ortega, F.R. Maza Muret, M.V. Guiote Moreno, A.M. Santos Bueno, E. Iglesias Flores, J.M. Benítez Cantero, J.A. Vallejo Casas
      La diarrea crónica es una entidad común en la práctica clínica diaria y supone un deterioro en la calidad de vida de los pacientes. Puede ser el síntoma principal de múltiples etiologías, entre las que se encuentra la malabsorción de ácidos biliares (MAB), que en la población general presenta una prevalencia comparable a la enfermedad celíaca. La MAB ocurre por una alteración en la homeostasis de los ácidos biliares en la circulación enterohepática. Puede aparecer como consecuencia de una disfunción o enfermedad ileal (MAB tipo i), por causas idiopáticas (MAB tipo ii) o asociada con otras entidades gastrointestinales (MAB tipo iii). Entre los diferentes métodos diagnósticos disponibles destacamos la gammagrafía con 75SeHCAT como gold standard debido a sus valores de sensibilidad, especificidad, seguridad y bajo coste. La principal desventaja es que no se encuentra disponible en todos los países, por lo que se han desarrollado otros métodos como la medición sérica de FGF19 y C4 que, sin embargo, presentan una mayor complejidad y coste. El tratamiento de primera línea ante un diagnóstico de MAB es con quelantes de ácidos biliares como la colestiramina, pero presenta baja tolerabilidad y efectos secundarios, que son menores con los nuevos fármacos como el colesevelam. En resumen, la MAB es una entidad común que se encuentra infradiagnosticada e infratratada, por lo que es fundamental establecer un adecuado algoritmo diagnóstico de la diarrea crónica en el que el estudio con 75SeHCAT ocuparía la primera o segunda línea en el diagnóstico diferencial de estos pacientes. Chronic diarrhoea is a common entity in daily clinical practice and it leads to a loss in these patients quality of life. It may be the main symptom of multiple ethiologies including bile acid malabsorption (BAM) which has a comparable prevalence to celiac disease. The BAM results from imbalances in the homeostasis of bile acids in the enterohepatic circulation. It can be a consequence of ileal disease or ileal dysfunction (BAM type i), it can be considered idiopathic or primary (BAM type ii) or associated with other gastrointestinal entities (BAM type iii). Among the different diagnostic methods available, 75SeHCAT study is the primary current method due to its sensitivity, specificity, safety and low cost. The main disadvantage is that it's not available in all countries, so other diagnostic methods have appeared, such as serum measurement of FGF19 and C4, however they are significantly more complex and costly. The first-line treatment of bile acid diarrhoea is bile acid sequestrant, such as cholestyramine, which can be difficult to administer due to its poor tolerability and gastrointestinal side effects. These are less prominent with newer agents such as colesevelam. In summary, the BAM is a common entity underdiagnosed and undertreated, so it is essential to establish a diagnosis algorithm of chronic diarrhoea in which the 75SeHCAT study would be first or second line in the differential diagnosis of these patients.

      PubDate: 2016-10-31T07:50:15Z
      DOI: 10.1016/j.remn.2016.08.005
  • 18F-FDG PET/CT and sentinel lymph node biopsy in the staging of patients
           with cervical and endometrial cancer. Role of dual-time-point imaging
    • Authors: M. Mayoral; P. Paredes; B. Domènech; P. Fusté; S. Vidal-Sicart; A. Tapias; A. Torné; J. Pahisa; J. Ordi; F. Pons; F. Lomeña
      Abstract: Publication date: Available online 22 September 2016
      Source:Revista Española de Medicina Nuclear e Imagen Molecular
      Author(s): M. Mayoral, P. Paredes, B. Domènech, P. Fusté, S. Vidal-Sicart, A. Tapias, A. Torné, J. Pahisa, J. Ordi, F. Pons, F. Lomeña
      Objective Definitive staging for cervical (CC) and endometrial cancer (EC) takes place once surgery is performed. The aim of this study was to evaluate the role of PET/CT in detecting lymphatic metastasis in patients with CC and EC using dual-time-point imaging (DPI), taking the histopathological results of sentinel lymph node (SLN) and lymphadenectomy as the reference. Material and methods A prospective study was conducted on 17 patients with early CC, and 13 patients with high-risk EC. The patients had a pre-operative PET/CT, MRI, SLN detection, and lymphadenectomy, when indicated. PET/CT findings were compared with histopathological results. Results In the pathology study, 4 patients with CC and 4 patients with EC had lymphatic metastasis. PET/CT showed hypermetabolic nodes in 1 patient with CC, and 5 with EC. Four of these had metastasis, one detected in the SLN biopsy. Four patients who had negative PET/CT had micrometastasis in the SLN biopsy, 1 patient with additional lymph nodes involvement. The overall patient-based sensitivity, specificity, positive and negative predictive values, and accuracy of PET/CT to detect lymphatic metastasis was 20.0%, 100.0%, 100.0%, 87.9%, and 88.2%, respectively, in CC, and 57.1%, 88.9%, 66.7%, 84.2% and 80.0%, respectively, in EC. DPI showed higher retention index in malignant than in inflammatory nodes, although no statistically significant differences were found. Conclusions PET/CT has low sensitivity in lymph node staging of CC and EC, owing to the lack of detection of micrometastasis. Thus, PET/CT cannot replace SLN biopsy. Although no statistically significant differences were found, DPI may help to differentiate between inflammatory and malignant nodes.

      PubDate: 2016-09-27T11:00:40Z
      DOI: 10.1016/j.remn.2016.07.003
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