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Panda S, Nath A, Thakar A, Kumar R, Seenu V, Sikka K, Singh CA, Kumar R. In-vivo lymphoscintigraphy of sinonasal tumors identifies retropharyngeal node and level I as predominant sentinel nodes. Rev Esp Med Nucl Imagen Mol 2023; 42:374-379. [PMID: 37399973 DOI: 10.1016/j.remnie.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To evaluate by in- vivo lymphoscintigraphy and SPECT-CT imaging, the lymphatic drainage patterns of para-nasal sinus(PNS) tumors. To confirm or refute the belief of the retropharyngeal lymph node (RPLN) being the significant draining lymph node for such tumors. METHODS Prospective cohort study conducted on previously untreated PNS tumors with no clinico-radiological evidence of lymph node metastasis. Lymphoscintigraphy undertaken by nasal endoscopic assisted peritumoral injection of 99mTc Sulfur colloid. Injections were classified as anterior or posterior as per a vertical line along the maxillary sinus ostium. RESULTS 17 patients were included. Lymphoscintigraphy successfully identified 17 sentinel nodes in 15 patients and was unsuccessful (lymphoscintigraphy failure) in 2 patients. Predominant sites of sentinel lymphatic drainage were noted to be the RPLN (n = 8; 47%), and Level I (n = 7; 42%). Occasional drainage was identified at the peri-parotid node(n = 1) and at Level II (n = 1). Contralateral drainage was noted in 2 patients (level I-1 and RPLN-1). Anterior injections drained predominantly to Level I (6/8) and RPLN (2/8), while posterior injections drained predominantly to the RPLN ( 6/7). The relative risk of RPLN being identified as the sentinel node was significantly higher for posteriorly placed injections than for anteriorly placed injections (RR- 3.43; 95% CI-1.0-11.8, p = 0.05). CONCLUSION The RPLN is noted as a frequent draining node for sino-nasal tumours and merits routine attention in all sino-nasal tumors. The radio-colloid SPECT-CT technique described here offers an excellent in-vivo technique to further explore and validate the lymphatic drainage pathways of these tumours.
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Affiliation(s)
- S Panda
- Department of Otorhinolaryngology, Head, Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - A Nath
- Department of Plastic Surgery, Himalayan Institute of Medical Sciences, Dehradun, India
| | - A Thakar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - R Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - V Seenu
- Department of Surgical Discipline, All India Institute of Medical Sciences, New Delhi, India
| | - K Sikka
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - C A Singh
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - R Kumar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
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Blanco-Saiz I, Goñi-Gironés E, Ribelles-Segura MJ, Salvador-Egea P, Díaz-Tobarra M, Camarero-Salazar A, Rudic-Chipe N, Saura-López I, Alomar-Casanovas A, Rabines-Juárez A, García-Torres J, Anda-Apiñániz E. Preoperative parathyroid localization. Relevance of MIBI SPECT-CT in adverse scenarios. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 2:35-44. [PMID: 37268356 DOI: 10.1016/j.endien.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/26/2022] [Indexed: 06/04/2023]
Abstract
PURPOSE Selective parathyroidectomy, the treatment of choice for primary hyperparathyroidism, requires precise preoperative localization. Our purpose was to compare the accuracy and concordance of pre-surgical MIBI parathyroid scintigraphy and ultrasonography, as well as to assess the relevance of hybrid acquisition (SPECT/CT) in compromised circumstances: low-weight or ectopic adenomas, coexisting thyroid disease and re-interventions. METHODS The study included 223 patients with primary hyperparathyroidism operated in a single Surgical Unit from August 2016 to March 2021. Preoperative ultrasonography and double-phase MIBI were performed with early SPECT/CT acquisition. A minimally invasive surgical approach was initially attempted, except in patients with concomitant thyroid surgery or multiglandular parathyroid disease. RESULTS Selective parathyroidectomy was accomplished in 179 patients (80.2%); cervicotomy and/or thoracoscopy in 44. Removal of the parathyroid lesion was achieved in 211 patients (94.6%), corresponding 204 (96.7%) to adenomas (37 ectopic). The cure rate was 94.2%. Preoperative MIBI SPECT/CT showed higher sensitivity and accuracy (84%; 80%) compared to ultrasound (72%; 71%), being more precise in defining the exact anatomical location (75.8% vs 68.7%). These differences reached statistical significance in ectopic glands. The existence of concomitant thyroid pathology did not decrease the sensitivity of SPECT/CT (84.2%). Mean parathyroid weight was 692.2mg (95%CI: 443.5-941) in MIBI-negative cases and 1145.9mg (95%CI: 983.6-1308.3) in MIBI-positive (p=0.001). Re-intervention was successful in the 8 patients with previous surgery. CONCLUSION MIBI SPECT/CT presents greater sensitivity, accuracy and anatomical precision than ultrasound for preoperative parathyroid localization, even in the case of ectopic glands or coexisting thyroid pathology. The weight of the pathological gland is a significantly limiting factor.
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Uña-Gorospe JA. Determination of the segmental hepatic clearance rate of 99mTc-mebrofenin and its application in the functional assessment of future liver remnant after liver resection. Rev Esp Med Nucl Imagen Mol 2021; 40:385-396. [PMID: 34663555 DOI: 10.1016/j.remnie.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 12/28/2022]
Abstract
99mTc-mebrofenin hepatobiliary scintigraphy with SPECT/CT (HBS-M) has become an important quantitative method to evaluate global liver function and future liver remnant (FLR) function in patients who are candidates for resective liver surgery. The purpose of this work was to describe the method in the prediction of post-surgical liver failure. The overall liver function and that of the FLR are obtained by analysis of the initial dynamic phase of the scan. Liver volume to be preserved is expressed as a percentage of the total liver volume measured in both CT sections. HBS-M is able to accurately gauge regional liver function abnormalities that could be represented as normal liver tissue parenchyma in the CT study. This technique can provide very valuable prognostic information for the estimation of the postoperative risk of liver failure in all patients who are candidates for resective liver surgery.
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Affiliation(s)
- Jon Andoni Uña-Gorospe
- Servicio de Medicina Nuclear, Hospital Universitario Nuestra Señora de Candelaria, Carretera del Rosario 145, 38010, Santa Cruz de Tenerife, Canarias, Spain.
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Noriega-Álvarez E, Domínguez Gadea L, Sanz Viedma S, Del Prado Orduña Diez M, Minoves Font M, Peiró Valgañón V, García Jiménez R. Nuclear Medicine in the diagnosis of pathologies of the spine: role of hybrid imaging. Rev Esp Med Nucl Imagen Mol 2021; 40:37-49. [PMID: 33041242 DOI: 10.1016/j.remn.2020.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 11/24/2022]
Abstract
Clinical problems in the human spine are still common in our society, often causing pain and can also limit movement. Back pain is a very common clinical entity, although difficult to diagnose due to its multifactorial nature. There are multiple processes that can alter the structure of the spine, injure vertebrae and/or the surrounding tissue. For the study of the spine, image diagnosis is essential, and within this, molecular hybrid techniques play an important role by providing us with an image of functional and morphological fusion. Among these, SPECT/CT is key in the diagnosis of traumatic and stress pathology, allowing us to locate hidden vertebral fractures, and is also very useful in degenerative and post-surgical pathology. On the other hand, PET/CT with 18F-FDG also plays an important role in the management and monitoring of infectious and oncological processes. This review describes the application of these hybrid techniques in the different pathologies of the spine and the findings of their images, being very useful for the diagnostic assessment and therapeutic management of the patient.
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de la Rubia-Marcos M, García-Alonso P, Mena-Melgar C, Tagliatori-Nogueira B, Herrero-Muñoz A, Sandoval-Moreno C, Paniagua-Correa C, Castillejos-Rodríguez L, Ortega-Valle A, Balsa-Bretón MA. 99mTC-white blood cell scintigraphy with SPECT/CT in the diagnosis of vascular graft infection. Rev Esp Med Nucl Imagen Mol 2020; 39:347-52. [PMID: 32616455 DOI: 10.1016/j.remn.2020.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 11/20/2022]
Abstract
AIM Vascular graft infection is a rare complication with a high morbidity and mortality. Early diagnosis is essential to establish an adequate treatment. We assess the accuracy of 99mTc-WBC scintigraphy with SPECT/CT in the diagnosis of vascular graft infection. MATERIALS AND METHODS We retrospectively analyzed thirty 99mTc-WBC scintigraphies with SPECT/CT performed in thirty patients with suspicion of vascular prosthesis infection. Studies were considered positive for graft infection if the intensity of activity involving the graft was greater than the liver or bone marrow activity (spine and pelvis). RESULTS Final diagnosis of infection was established in 10 patients, based on Fitzgerald criteria. Scintigraphy was positive in 11 patients. No false negatives were obtained. The values of sensitivity and specificity were 100% and 95%, respectively, with a PPV of 91% and a NPV of 100%. Twenty five patients had a CT performed prior to scintigraphy, in 9 cases the result was positive and in the remaining 16 was negative. CT sensitivity and specificity obtained in our study were 62.5% and 76% respectively, with a PPV of 55.6% and a NPV of 81.3%. Diagnosis of infection led to prosthesis exeresis in 8 cases (all of them had a positive microbiological study of the extracted material), while the remaining 2 patients were treated with antibiotic therapy alone due to high surgical risk. CONCLUSION Our results suggest a high accuracy for 99mTc-WBC scintigraphy with SPECT/CT in the assessment of clinically suspected arterial graft infection.
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de Arcocha-Torres M, Quincoces G, Martínez-López AL, Erhard A, Collantes M, Martínez-Rodríguez I, Ecay M, Banzo I, Irache JM, Peñuelas I. Preparation, radiolabeling with 99mTc and 67Ga and biodistribution studies of albumin nanoparticles covered with polymers. Rev Esp Med Nucl Imagen Mol 2020; 39:225-232. [PMID: 32201272 DOI: 10.1016/j.remn.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/28/2020] [Accepted: 02/06/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To optimize radiolabeling with 99mTc and 67Ga of albumin nanoparticles coated with 4 differents synthetic polymers and to evaluate their stability in vivo and in vitro, as well as their biodistribution in vivo after intravenous administration. MATERIAL AND METHODS The nanoparticles were prepared using albumin and NOTA-modified albumin by the desolvation method and coated with 4 different polymers; HPMC, GMN2, GPM2 and GTM2. They were purified, lyophilized and characterized. Radiolabelling with 99mTc was perfomed with 74 MBq of 99mTc sodium pertechnetate, previously reduced with and acid solution of tin chloride at different concentrations (0.003, 0.005, 0.007, 0.01, 0.05 and 0.1mg/ml) and at different times (5, 10, 15, 30 and 60minutes) and temperatures (room temperature, 40°C and 60°C). Radiolabelling with 67Ga was perfomed by incubation of the nanoparticles with 37 MBq of 67Gallium chloride (obtained from commercial gallium-67 citrate) at different times (10 and 30minutes) and temperatures (room temperature, 30°C and 60°C), and posterior purification with microconcentrators. The radiochemical purity was evaluated by TLC. Stability studies of radiolabeled nanoparticles in physiological serum and blood plasma were perfomed. Biodistribution studies of nanoparticles coated with GPM2 polymer were carried out in Wistar rats after intravenous administration of the nanoparticles. Control animals were carried out with 99mTc sodium pertechnetate and 67Ga chloride. To do so, the animals were killed and activity in organs was measured in a gamma counter. RESULTS 99mTc labeling was carried out optimally with a tin concentration of 0.007mg/ ml for the GPM2 nanoparticles and 0.005mg / ml for the rest of the formulations, with a radiolabelling time of 10minutes at room temperature. In the case of 67Ga the label was optimized at 30° C temperature and 30minutes of incubation. In both cases the radiochemical purity obtained was greater than 97%. The nanoparticles showed high stability in vitro after 48hours of labeling (70% nanoparticles labeled with 99mTc and 90% those labeled with 67Ga). Biodistribution studies of nanoparticles 99mTc -GPM2 and 67Ga -NOTA-GPM2 showed a high accumulation of activity in the liver at 2 and 24hours after intravenous administration. CONCLUSION The labeling procedure with 99mTc and 67Ga of albumin and albumin modified with NOTA nanoparticles allows obtaining nanoparticles with high labeling yields and adequate in vitro stability, allowing their use for in vivo studies.
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Affiliation(s)
- M de Arcocha-Torres
- Servicio Medicina Nuclear, Hospital Universitario Marqués de Valdecilla, Santander, España; Grupo de investigación Imagen Molecular (IDIVAL), Universidad de Cantabria, Santander, España.
| | - G Quincoces
- Unidad de Radiofarmacia, Servicio Medicina Nuclear, Clínica Universidad de Navarra, IdiSNA, Pamplona, España
| | - A L Martínez-López
- Departamento de Tecnología y Química Farmacéutica, Universidad de Navarra, Pamplona, España
| | - A Erhard
- Unidad de Radiofarmacia, Servicio Medicina Nuclear, Clínica Universidad de Navarra, IdiSNA, Pamplona, España
| | - M Collantes
- Unidad de investigación micropet, Servicio Medicina Nuclear, Clínica Universidad de Navarra, IdiSNA, Pamplona, España
| | - I Martínez-Rodríguez
- Servicio Medicina Nuclear, Hospital Universitario Marqués de Valdecilla, Santander, España; Grupo de investigación Imagen Molecular (IDIVAL), Universidad de Cantabria, Santander, España
| | - M Ecay
- Unidad de investigación micropet, Servicio Medicina Nuclear, Clínica Universidad de Navarra, IdiSNA, Pamplona, España
| | - I Banzo
- Servicio Medicina Nuclear, Hospital Universitario Marqués de Valdecilla, Santander, España; Grupo de investigación Imagen Molecular (IDIVAL), Universidad de Cantabria, Santander, España
| | - J M Irache
- Departamento de Tecnología y Química Farmacéutica, Universidad de Navarra, Pamplona, España
| | - I Peñuelas
- Unidad de Radiofarmacia, Servicio Medicina Nuclear, Clínica Universidad de Navarra, IdiSNA, Pamplona, España
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Minoves Font M. Clinical applications of nuclear medicine in the diagnosis and assessment of musculoskeletal sports injuries. Rev Esp Med Nucl Imagen Mol 2019; 39:112-134. [PMID: 31791886 DOI: 10.1016/j.remn.2019.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/15/2019] [Accepted: 09/21/2019] [Indexed: 11/17/2022]
Abstract
Increased participation in sports and physical exercise are widely promoted as an approach to a physically active lifestyle which has a positive effect on healthy aging, in patients and athletes of all ages, beginners and experts, including amateur athletes and professional athletes. Unfortunately, this has caused a higher incidence of sports-related injuries. In the sports context, the early and accurate diagnosis of injuries is of the utmost importance in order to enable early treatment to achieve a full recovery. Imaging techniques are increasingly important for the successful diagnosis and management of the patient. The nuclear medicine techniques with bone tracers provide physiological and metabolic information in the early phases of musculoskeletal injuries, which often precede anatomical changes and they reflect changes in bone turnover. This allows early diagnosis, along with evaluation of the activity and phase of the injury. In this article, the applications of nuclear medicine techniques, focusing on bone scintigraphy, alongside the important contribution of hybrid studies (SPECT/CT), in the diagnosis of bone and soft tissue sports injuries, will be described. In addition, we explain their usefulness in the expression of the pathophysiology of these lesions and their scintigraphic patterns. The article will also describe biomechanical and physiopathological aspects, injury mechanisms and clinical presentations of bone and joint sports injuries, knowledge of this is essential for the correct diagnostic assessment of imaging studies.
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Affiliation(s)
- Montse Minoves Font
- Cetir-Ascires, Barcelona, España; Vocal del Grupo de Patología Musculoesquelética de la SEMNIM, España.
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Sengoz T, Yaylali O, Yuksel D, Demirkan F, Uluyol O. The clinical contribution of SPECT/CT with 99mTc-HMPAO-labeled leukocyte scintigraphy in hip and knee prosthetic infections. Rev Esp Med Nucl Imagen Mol 2019; 38:212-217. [PMID: 31147296 DOI: 10.1016/j.remn.2019.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/03/2019] [Accepted: 01/10/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES White blood cell scanning with 99mTc-hexamethylpropylene amine oxime (HMPAO) has proven a sensitive and specific imaging method in the diagnosis of suspected prosthesis infection. The aim of this retrospective study was to evaluate the usefulness of SPECT/CT performed simultaneously using a hybrid imaging device of prosthesis infections. MATERIALS AND METHODS 99mTc-HMPAO scintigraphy was performed on 37 patients (11 men and 26 women; age range 38-84 years; mean age±SD, 65.7±5.6 years). Planar scans were acquired 2.4 and 24hour after injection. SPECT/CT was obtained 4 h after injection, using a dual-head hybrid gama camera coupled with a low-power x-ray tube. In all patients, scintigraphic results were matched with the results of surgery, cultures and clinical follow-up. RESULTS Seventeen (45,9%) out of 37 patients had prosthesis infection and 20 (54,1%) out of 37 patients had non-infectious prosthesis pathologies with 99mTc-HMPAO scintigraphy and SPECT/CT. The 99mTc-HMPAO scintigraphy was true-positive for infection in 16 of 37 patients and true-negative in 20 of 37 patients. SPECT/CT provided an accurate anatomic localization of all positive foci. With regard to the final diagnosis, SPECT/CT added a significant clinical contribution in 22 of 37 patients (59,4%). Sensitivity, specificity, negative predictive value and positive predictive values were 100%,59.1%,100%,62.5% in planar images with 99mTc-HMPAO scintigraphy and 100%,90.1%,100%,88.2% in the planar+SPECT/CT imaging, respectively. DISCUSSION Our results indicate that SPECT/CT performed using a hybrid device can improve imaging with 99mTc-HMPAO scintigraphy in patients with suspected osteomyelitis by providing accurate anatomic localization and precise definition of the extent of infection.
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Affiliation(s)
- T Sengoz
- Pamukkale University, Medical Faculty, Department of Nuclear Medicine, Denizli, Turquía.
| | - O Yaylali
- Pamukkale University, Medical Faculty, Department of Nuclear Medicine, Denizli, Turquía
| | - D Yuksel
- Pamukkale University, Medical Faculty, Department of Nuclear Medicine, Denizli, Turquía
| | - F Demirkan
- Pamukkale University, Medical Faculty, Department of Orthopedics, Denizli, Turquía
| | - O Uluyol
- Pamukkale University, Medical Faculty, Department of Nuclear Medicine, Denizli, Turquía
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Suárez JP, Domínguez ML, Zeidán N, García ME, Lisei D, Martín N, González FM. Complications of shoulder arthroplasty: added value of SPECT/CT imaging. Rev Esp Med Nucl Imagen Mol 2019; 38:234-7. [PMID: 30692042 DOI: 10.1016/j.remn.2018.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/04/2018] [Accepted: 12/10/2018] [Indexed: 11/20/2022]
Abstract
The incidence of prosthetic shoulder replacements has increased considerably in recent years, as well as the complications derived from the procedure. The correct diagnosis of each type of complication is essential for therapeutic decision making, which is currently based on the information provided by radiological and nuclear medicine imaging. Nevertheless, both techniques have intrinsic limitations that could be mostly overcome with the advent of the hybrid SPECT/CT imaging, which is set to play a fundamental role in the evaluation of shoulder prostheses.
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Serrano Vicente J, Parras Castañera E, Infante Torre JR, Rayo Madrid JI, García Bernardo L, Caballero Moreno M, Martínez Esteve A, Muñoz Sanz A. 67-Gallium SPECT/CT in febrile syndromes of unknown origin. Rev Esp Med Nucl Imagen Mol 2018; 37:354-8. [PMID: 30473055 DOI: 10.1016/j.remn.2018.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION AND OBJECTIVE Febrile syndromes of unknown origin (FSUO) are complex processes in hospital practice. Their management includes an exhaustive medical history and examination, as well as an extensive number of biochemical tests. If these are inconclusive, diagnostic imaging techniques such as SPECT/CT with 67-Gallium Citrate (67Ga-SPECT/CT) could play an important role. We evaluated its role in the management of FSUO in our healthcare area. MATERIAL AND METHODS We reviewed 57 patients who underwent a 67Ga-SPECT/CT due to a FSUO (32 women and 25 men, age range: 32-83 years old) obtaining scintigraphic findings, previous treatments and final diagnosis. Values of sensitivity, specificity, positive predictive values (VPP) and negative values (NPV) were obtained and compared with the results for PET/CT with 18Fluor-deoxy-glucose (18F-FDG PET/CT) found in the literature. RESULTS The diagnoses found were: infection in 27/57 (47%), inflammatory disease in 15/57 (26%), neoplasm in 1/57 (1.75%) and patients without final diagnosis in 14/57 (24%). The statistical values of 67Ga-SPECT/CT were: sensitivity, specificity, PPV and NPV of 67%, 93%, 97% y 48%, respectively which were slightly lower than those found for the 18F-FDG PET/CT (86%, 52%, 70% and 92%, respectively). The diagnostic yield was 73% which increased to 80% in the patients who lacked empirical treatment. CONCLUSION Despite the better results of 18F-FDG PET/CT, 67Ga-SPECT/CT behaved as a useful technique in the management of FSUO. It is advisable to use it if 18F-FDG PET/CT is not available.
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Bonacina M, Albano D, Steimberg N, Bosio G, Camoni L, Bertagna F, Giubbini R, Mazzoleni G. Different uptake of 123I-MIBG in the two main liver lobes: A persistant unsolved mistery. Rev Esp Med Nucl Imagen Mol 2018; 37:285-9. [PMID: 29754941 DOI: 10.1016/j.remn.2018.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/12/2018] [Accepted: 01/16/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE After radiopharmaceutical injection, a heightened 123I-MIBG concentration is frequently observed in the left hepatic lobe compared to the right one, but the reason of this finding remains unknown. Our aim was to retrospectively analyze the different 123I-MIBG uptake pattern between the two hepatic lobes and correlate our results with some epidemiological/clinical features. MATERIAL AND METHODS Ninety-four 123I-MIBG scintigraphies from 71 patients were selected. Regions of interest were drawn in the right and left lobes using transverse tomographic sections and left to right activity ratios (L/R ratio) were calculated at 6 and 24h after radiotracer administration. RESULTS Twenty-seven examinations were positive for hypermetabolic lesions while the remaining 67 were negative. In all cases mean early and delayed L/R ratios were greater than 1.00; average early L/R ratio was 1.37 and delayed L/R ratio 1.52. The delayed L/R ratio was significantly higher than the early one. There was no difference in the L/R ratios with regard to age, gender, primary disease and result of scintigraphy. CONCLUSIONS 123I-MIBG uptake was higher in left hepatic lobe compared to right and this ratio did not correlate with any epidemiological or clinical feature. The reason of this metabolic is not yet explained and some biomolecular hypotheses could be tested in 3D dynamic in vitro models.
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García Jiménez R, García-Gómez FJ, Noriega Álvarez E, Calvo Morón C, Martín-Marcuartu JJ. Hybrid imaging in foot and ankle disorders. Rev Esp Med Nucl Imagen Mol 2017; 37:191-202. [PMID: 29221678 DOI: 10.1016/j.remn.2017.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/24/2017] [Accepted: 10/09/2017] [Indexed: 11/29/2022]
Abstract
Disorders of the foot and ankle are some of the most frequent ones affecting the musculoskeletal system and have a great impact on patients' quality of life. Accurate diagnosis is an important clinical challenge because of the complex anatomy and function of the foot, that make it difficult to locate the source of the pain by routine clinical examination. In the study of foot pathology, anatomical imaging (radiography, magnetic resonance imaging [MRI], ultrasound and computed tomography [CT]) and functional imaging (bone scan, positron emission tomography [PET] and MRI) techniques have been used. Hybrid imaging combines the advantages of morphological and functional studies in a synergistic way, helping the clinician manage complex problems. In this article we delve into the anatomy and biomechanics of the foot and ankle and describe the potential indications for the current hybrid techniques available for the study of foot and ankle disease.
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Affiliation(s)
- R García Jiménez
- Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España; Grupo de Patología Músculo-Esquelética de la SEMNIM
| | - F J García-Gómez
- Medicina Nuclear, Hospital Universitario Virgen Macarena, Sevilla, España; Grupo de Patología Músculo-Esquelética de la SEMNIM
| | - E Noriega Álvarez
- Medicina Nuclear, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España; Grupo de Patología Músculo-Esquelética de la SEMNIM
| | - C Calvo Morón
- Medicina Nuclear, Hospital Universitario Virgen Macarena, Sevilla, España; Grupo de Patología Músculo-Esquelética de la SEMNIM.
| | - J J Martín-Marcuartu
- Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España; Grupo de Patología Músculo-Esquelética de la SEMNIM
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Marín-Oyaga V, Gutierrez-Villamil C, García-Concha D, Arevalo-Leal S. Usefulness of scintigraphy with labelled leucocytes and SPECT/CT in vascular graft infection. Rev Esp Med Nucl Imagen Mol 2017; 36:388-391. [PMID: 28619419 DOI: 10.1016/j.remn.2017.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/28/2017] [Accepted: 05/03/2017] [Indexed: 10/19/2022]
Abstract
Vascular graft infections are a rare complication in this type of procedure. However, when they do occur, they usually have high morbidity, and even a high mortality. Proper identification and location is crucial for the appropriate and early management, whether medical or surgical, thus knowledge of the right tools is paramount. Nuclear medicine studies play an important role in this regard, either by using labelled white blood cells scintigraphy or 18F-FDG. The choice, among other factors, will depend on the experience with both techniques by the different groups, their knowledge of them, as well as their availability. Two cases are presented in which 99mTc-HMPAO-white blood cells SPECT/CT scintigraphy was very useful in the diagnosis and location of the suspected infectious compromise, which led to the subsequent appropriate and guided management. Both cases were confirmed clinically and microbiologically.
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Affiliation(s)
- V Marín-Oyaga
- Servicio de Medicina Nuclear, Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia; Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.
| | - C Gutierrez-Villamil
- Servicio de Medicina Nuclear, Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia; Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - D García-Concha
- Facultad de Medicina, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
| | - S Arevalo-Leal
- Servicio de Medicina Nuclear, Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia; Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
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14
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Milà M, Bechini J, Vázquez A, Vallejos V, Tenesa M, Espinal A, Fraile M, Monreal M. Acute pulmonary embolism detection with ventilation/perfusion SPECT combined with full dose CT: What is the best option? Rev Esp Med Nucl Imagen Mol 2017; 36:139-145. [PMID: 28185782 DOI: 10.1016/j.remn.2016.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/21/2016] [Accepted: 11/01/2016] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- M Milà
- Department of Nuclear Medicine (ICS-IDI), Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
| | - J Bechini
- Department of Radiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - A Vázquez
- Applied Statistics Service, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - V Vallejos
- Department of Nuclear Medicine (ICS-IDI), Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - M Tenesa
- Department of Radiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - A Espinal
- Applied Statistics Service, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Fraile
- Department of Nuclear Medicine (ICS-IDI), Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - M Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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15
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Wong KK, Chondrogiannis S, Bowles H, Fuster D, Sánchez N, Rampin L, Rubello D. Hybrid-fusion SPECT/CT systems in parathyroid adenoma: Technological improvements and added clinical diagnostic value. Rev Esp Med Nucl Imagen Mol 2016; 35:385-390. [PMID: 27554661 DOI: 10.1016/j.remn.2016.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/11/2016] [Accepted: 07/12/2016] [Indexed: 10/21/2022]
Abstract
Nuclear medicine traditionally employs planar and single photon emission computed tomography (SPECT) imaging techniques to depict the biodistribution of radiotracers for the diagnostic investigation of a range of disorders of endocrine gland function. The usefulness of combining functional information with anatomy derived from computed tomography (CT), magnetic resonance imaging (MRI), and high resolution ultrasound (US), has long been appreciated, either using visual side-by-side correlation, or software-based co-registration. The emergence of hybrid SPECT/CT camera technology now allows the simultaneous acquisition of combined multi-modality imaging, with seamless fusion of 3D volume datasets. Thus, it is not surprising that there is growing literature describing the many advantages that contemporary SPECT/CT technology brings to radionuclide investigation of endocrine disorders, showing potential advantages for the pre-operative locating of the parathyroid adenoma using a minimally invasive surgical approach, especially in the presence of ectopic glands and in multiglandular disease. In conclusion, hybrid SPECT/CT imaging has become an essential tool to ensure the most accurate diagnostic in the management of patients with hyperparathyroidism.
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Affiliation(s)
- K K Wong
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Nuclear Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - S Chondrogiannis
- Department of Nuclear Medicine, Radiology, Medical Physics, Clinical Pathology, Rovigo Hospital, Rovigo, Italy
| | - H Bowles
- Nuclear Medicine Department, Hospital Clinic, Barcelona University, Barcelona, Spain
| | - D Fuster
- Nuclear Medicine Department, Hospital Clinic, Barcelona University, Barcelona, Spain
| | - N Sánchez
- Nuclear Medicine Department, Hospital Clinic, Barcelona University, Barcelona, Spain
| | - L Rampin
- Department of Nuclear Medicine, Radiology, Medical Physics, Clinical Pathology, Rovigo Hospital, Rovigo, Italy
| | - D Rubello
- Department of Nuclear Medicine, Radiology, Medical Physics, Clinical Pathology, Rovigo Hospital, Rovigo, Italy.
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16
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Wong KK, Chondrogiannis S, Fuster D, Ruiz C, Marzola MC, Giammarile F, Colletti PM, Rubello D. Additional value of hybrid SPECT/CT systems in neuroendocrine tumors, adrenal tumors, pheochromocytomas and paragangliomas. Rev Esp Med Nucl Imagen Mol 2016; 36:103-109. [PMID: 27793631 DOI: 10.1016/j.remn.2016.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/15/2016] [Accepted: 09/15/2016] [Indexed: 10/20/2022]
Abstract
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.
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Affiliation(s)
- K K Wong
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Nuclear Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - S Chondrogiannis
- Department of Nuclear Medicine, Radiology, NeuroRadiology, Medical Physics, Clinical Laboratory, Molecular Laboratory, Microbiology, Pathology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - D Fuster
- Department of Nuclear Medicine, Hospital Clínic, Barcelona, Spain
| | - C Ruiz
- Department of Nuclear Medicine, Hospital Clínic, Barcelona, Spain
| | - M C Marzola
- Department of Nuclear Medicine, Radiology, NeuroRadiology, Medical Physics, Clinical Laboratory, Molecular Laboratory, Microbiology, Pathology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - F Giammarile
- Nuclear Medicine Department, University of Lyon, Lyon, France
| | - P M Colletti
- Department of Nuclear Medicine, University of Southern California, Los Angeles, CA, USA
| | - D Rubello
- Department of Nuclear Medicine, Radiology, NeuroRadiology, Medical Physics, Clinical Laboratory, Molecular Laboratory, Microbiology, Pathology, Santa Maria della Misericordia Hospital, Rovigo, Italy.
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17
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Serrano-Vicente J, Infante-Torre JR, García-Bernardo L, Moreno-Caballero M, Martínez-Esteve A, Rayo-Madrid JI. Pancreatic accessory spleen. False positive with 99mTc-Octreotide. Rev Esp Med Nucl Imagen Mol 2016; 36:53-55. [PMID: 27329561 DOI: 10.1016/j.remn.2016.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/04/2016] [Indexed: 11/28/2022]
Abstract
The case is presented on a patient with abdominal pain and suspicion of neuroendocrine tumor in the tail of the pancreas shown in the abdominal CT and MRI. Whole-body scintigraphy and abdominal SPECT/CT with 99mTc-octreotide were performed that showed a nodular lesion partially on the posterior side of the pancreas tail. This nodule showed faint tracer uptake, and was reported as probable neuroendocrine tumor. Partial pancreatectomy and splenectomy were performed, and the histological study identified the lesion as an ectopic spleen. There are similar cases in the literature that match these findings, but this lesion is still frequently diagnosed after performing unnecessary surgery. When an asymptomatic intrapancreatic mass is detected, an accessory spleen should be considered and specific diagnostic techniques should be performed, such as labeled and denatured red blood cell SPECT/CT.
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Affiliation(s)
- J Serrano-Vicente
- Nuclear Medicine Department, Infanta Cristina Hospital, Badajoz, Spain.
| | - J R Infante-Torre
- Nuclear Medicine Department, Infanta Cristina Hospital, Badajoz, Spain
| | - L García-Bernardo
- Nuclear Medicine Department, Infanta Cristina Hospital, Badajoz, Spain
| | | | - A Martínez-Esteve
- Nuclear Medicine Department, Infanta Cristina Hospital, Badajoz, Spain
| | - J I Rayo-Madrid
- Nuclear Medicine Department, Infanta Cristina Hospital, Badajoz, Spain
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18
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KleinJan GH, Brouwer OR, Mathéron HM, Rietbergen DD, Valdés Olmos RA, Wouters MW, van den Berg NS, van Leeuwen FW. Hybrid radioguided occult lesion localization (hybrid ROLL) of (18)F-FDG-avid lesions using the hybrid tracer indocyanine green-(99m)Tc-nanocolloid. Rev Esp Med Nucl Imagen Mol 2016; 35:292-7. [PMID: 27174865 DOI: 10.1016/j.remn.2016.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/31/2016] [Accepted: 04/01/2016] [Indexed: 01/31/2023]
Abstract
PURPOSE To assess if combined fluorescence- and radio-guided occult lesion localization (hybrid ROLL) is feasible in patients scheduled for surgical resection of non-palpable (18)F-FDG-avid lesions on PET/CT. METHODS Four patients with (18)F-FDG-avid lesions on follow-up PET/CT that were not palpable during physical examination but were suspected to harbor metastasis were enrolled. Guided by ultrasound, the hybrid tracer indocyanine green (ICG)-(99m)Tc-nanocolloid was injected centrally in the target lesion. SPECT/CT imaging was used to confirm tracer deposition. Intraoperatively, lesions were localized using a hand-held gamma ray detection probe, a portable gamma camera, and a fluorescence camera. After excision, the gamma camera was used to check the wound bed for residual activity. RESULTS A total of six (18)F-FDG-avid lymph nodes were identified and scheduled for hybrid ROLL. Comparison of the PET/CT images with the acquired SPECT/CT after hybrid tracer injection confirmed accurate tracer deposition. No side effects were observed. Combined radio- and fluorescence-guidance enabled localization and excision of the target lesion in all patients. Five of the six excised lesions proved tumor-positive at histopathology. CONCLUSION The hybrid ROLL approach appears to be feasible and can facilitate the intraoperative localization and excision of non-palpable lesions suspected to harbor tumor metastases. In addition to the initial radioguided detection, the fluorescence component of the hybrid tracer enables high-resolution intraoperative visualization of the target lesion. The procedure needs further evaluation in a larger cohort and wider range of malignancies to substantiate these preliminary findings.
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19
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Noriega E, Sabaté-Llobera A, Benítez A, Martínez GA, Rodríguez-Rubio J, Mora J. Numb chin syndrome as a manifestation of jaw metastasis diagnosed in a bone scan. Rev Esp Med Nucl Imagen Mol 2015; 35:34-7. [PMID: 26514319 DOI: 10.1016/j.remn.2015.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/02/2015] [Accepted: 08/03/2015] [Indexed: 11/17/2022]
Abstract
In many cases, numb chin syndrome (NCS) may represent a banal pathology. However, as it can be associated with malignant processes, its presence should alert the clinician of a possible occult disease. In patients already diagnosed with cancer, it often represents an ominous sign that indicates poor prognosis, due to the rapid progress of the disease. The case is presented of a 62-year-old man diagnosed with synchronous lung and bladder cancer, who suddenly complained of numbness in the chin. The bone scan confirmed the suspicion of metastastic bone disease, and the patient died two months after the appearance of this sign.
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Affiliation(s)
- E Noriega
- Servei de Medicina Nuclear, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España.
| | - A Sabaté-Llobera
- Servei de Medicina Nuclear, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
| | - A Benítez
- Servei de Medicina Nuclear, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
| | - G A Martínez
- Servei de Medicina Nuclear, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
| | - J Rodríguez-Rubio
- Servei de Medicina Nuclear, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
| | - J Mora
- Servei de Medicina Nuclear, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
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20
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Abstract
In general terms, one of the main objectives of sentinel lymph node (SLN) biopsy is to identify the 20-25% of patients with occult regional metastatic involvement. This technique reduces the associated morbidity from lymphadenectomy, as well as increasing the identification rate of occult lymphatic metastases by offering the pathologist those lymph nodes with the highest probability of containing metastatic cells. Pre-surgical lymphoscintigraphy is considered a "road map" to guide the surgeon towards the sentinel nodes and to ascertain unpredictable lymphatic drainages. In prostate cancer this aspect is essential due to the multidirectional character of the lymphatic drainage in the pelvis. In this context the inclusion of SPECT/CT should be mandatory in order to improve the SLN detection rate, to clarify the location when SLNs are difficult to interpret on planar images, to achieve a better definition of them in locations close to injection site, and to provide anatomical landmarks to be recognized during operation to locate SLNs. Conventional and laparoscopic hand-held gamma probes allow the SLN technique to be applied in any kind of surgery. The introduction and combination of new tracers and devices refines this technique, and the use of intraoperative images. These aspects become of vital importance due to the recent incorporation of robot-assisted procedures for SLN biopsy. In spite of these advances various aspects of SLN biopsy in prostate cancer patients still need to be discussed, and therefore their clinical application is not widely used.
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Affiliation(s)
- S Vidal-Sicart
- Nuclear Medicine Department, Hospital Clínic Barcelona, Barcelona, Spain.
| | - R A Valdés Olmos
- Interventional Molecular Imaging and Nuclear Medicine Section, Leiden University Medical Centre, Leiden, The Netherlands; Nuclear Medicine Department, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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21
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Arora S, Singh Dhull V, Karunanithi S, Kumar Parida G, Sharma A, Shamim SA. (99m)Tc-MDP SPECT/CT as the one-stop imaging modality for the diagnosis of early setting of Kienbock's disease. Rev Esp Med Nucl Imagen Mol 2015; 34:185-7. [PMID: 25824583 DOI: 10.1016/j.remn.2014.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 10/16/2014] [Accepted: 10/17/2014] [Indexed: 10/23/2022]
Abstract
(99m)Tc-Methylene diphosphonate (MDP) triple phase bone scintigraphy (BS) has a role in early diagnosis of Kienbock's disease, especially when the X-ray is negative. Early diagnosis can result in prompt management of the patient since wrist pain in older individuals due to aging may go unnoticed or be due to other diagnoses with the production of greater damage and eventually a worse prognosis. Herein, we present a case report of a 29-year-old female with Kienbock's disease in whom the X-ray was negative and MRI incorrect. The (99m)Tc-MDP SPECT/CT BS helped the diagnosis of the disease in an early stage (stage 1) and had a clinical impact on the patient's management.
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Affiliation(s)
- S Arora
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - V Singh Dhull
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - S Karunanithi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - G Kumar Parida
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - A Sharma
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - S A Shamim
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
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22
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Vidal-Sicart S, Vilalta Solsona A, Alonso Vargas MI. [Sentinel node in melanoma and breast cancer. Current considerations]. Rev Esp Med Nucl Imagen Mol 2015; 34:30-44. [PMID: 25455506 DOI: 10.1016/j.remn.2014.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 09/16/2014] [Accepted: 09/17/2014] [Indexed: 11/21/2022]
Abstract
The main objectives of sentinel node (SN) biopsy is to avoid unnecessary lymphadenectomies and to identify the 20-25% of patients with occult regional metastatic involvement. This technique reduces the associated morbidity from lymphadenectomy and increases the occult lymphatic metastases identification rate by offering the pathologist the or those lymph nodes with the highest probability of containing metastatic cells. Pre-surgical lymphoscintigraphy is considered a "road map" to guide the surgeon towards the sentinel nodes and to localize unpredictable lymphatic drainage patterns. The SPECT/CT advantages include a better SN detection rate than planar images, the ability to detect SNs in difficult to interpret studies, better SN depiction, especially in sites closer to the injection site and better anatomic localization. These advantages may result in a change in the patient's clinical management both in melanoma and breast cancer. The correct SN evaluation by pathology implies a tumoral load stratification and further prognostic implication. The use of intraoperative imaging devices allows the surgeon a better surgical approach and precise SN localization. Several studies reports the added value of such devices for more sentinel nodes excision and a complete monitoring of the whole procedure. New techniques, by using fluorescent or hybrid tracers, are currently being developed.
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