RESUMO
The tools currently used to evaluate the extent of paracoccidioidomycosis (PCM) may be of limited value in detecting subclinical lesions. The aim of this study was to verify the role of gallium-67 whole-body scan in evaluating the extent of disease of 65 patients with active PCM. The (67)Ga scan findings were compared with the results of clinical evaluation, chest radiography and/or high-resolution computed tomography (CT), abdominal ultrasound (US) or CT, laryngoscopy, CT or magnetic resonance imaging (MRI) of the head, and technetium-99m methylene diphosphonate bone scan, obtained before treatment. Clinically unsuspected lesions were detected by imaging procedures in 21 patients (32%), mainly in the lungs (n=11), adrenals (n=6), and superficial (n=3) and deep lymph nodes (n=14). (67)Ga scan detected 100% of the cases with subclinical involvement in the lungs. Scintigraphy was superior to chest radiography in demonstrating lung disease (94% vs 81%). The lymphatic lesions were demonstrated by (67)Ga scan in all the clinically suspected cases and in nearly all unsuspected cases, and also revealed more extensive involvement than was clinically suspected in many of them. There was good agreement between (67)Ga scan and the other imaging procedures for the initial detection of thoracic and abdominal lymph nodes and bone involvement. (67)Ga imaging detected most cases of laryngopharyngeal disease with active inflammatory lesions found at indirect laryngoscopy. On the other hand, (67)Ga scan failed to demonstrate most of the adrenal and CNS lesions detected by abdominal US/CT and head CT/MRI. In conclusion, (67)Ga imaging is a useful tool for evaluating the location and extent of suspected and unsuspected lesions in PCM. It could serve as a screening method before the use of other diagnostic procedures, particularly in the detection of lung, superficial and deep lymph node and bone involvement.
Assuntos
Radioisótopos de Gálio , Micoses/diagnóstico por imagem , Paracoccidioidomicose/diagnóstico por imagem , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/microbiologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cintilografia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios XRESUMO
The aim of this study was to compare the accuracy of computed tomography (CT) and single photon emission computerized tomography (SPECT) in the diagnosis of dementia. Fifty-two patients with clinical diagnosis of dementia and 11 controls were studied. The scans were interpreted by one experienced neuroradiologist and one nuclear radiologist, both blinded to the clinical data. In the diagnosis of dementia, CT and SPECT showed equal sensitivity (82.7%) and statistically similar specificity (63.8 and 81.8%, respectively). The specificity of SPECT in diagnosing Alzheimer's disease (100%) was statistically superior to CT (69%). However, both methods showed similar sensitivity in detecting Alzheimer's disease. In conclusion, SPECT and CT showed similar accuracy in the diagnosis of dementia. The quite high specificity of SPECT in Alzheimer's disease may be useful for confirming that diagnosis, particularly for patients with presenile onset of the disease.
Assuntos
Demência/diagnóstico , Tomografia Computadorizada de Emissão , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico , Demência Vascular/diagnóstico , Diagnóstico Diferencial , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e EspecificidadeRESUMO
To determine the role of scintigraphy in the detection of skeletal and cardiac involvement in dermato- and polymyositis (DM/PM), we studied 30 patients with a confirmed diagnosis of DM/PM (23 females, 7 males; mean age: 35 years). Technetium-99m pyrophosphate (99mTc-PYP) and gallium-67 scans showed similar sensitivity, specificity and accuracy in the detection of skeletal muscle involvement when compared with serum enzymes (70%, 100% and 80%, respectively). Compared with the clinical parameters, 99mTc-PYP showed 70% and 67Ga 65% accuracy. Abnormal PYP cardiac uptake was observed in 57% of patients, whereas abnormal 67Ga cardiac uptake was seen in only 15%. Electrocardiography was abnormal in 40%, rest gated blood pool study in 23%, and chest X-ray in 13%. In conclusion, both 99mTc-PYP and 67Ga can be useful in the detection of the active phase of muscle disease. However, 99mTc-PYP seems to be more effective than 67Ga in the early diagnosis of cardiac involvement.
Assuntos
Dermatomiosite/diagnóstico por imagem , Coração/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Polimiosite/diagnóstico por imagem , Adolescente , Adulto , Criança , Ensaios Enzimáticos Clínicos , Dermatomiosite/diagnóstico , Eletrocardiografia , Feminino , Radioisótopos de Gálio , Imagem do Acúmulo Cardíaco de Comporta , Humanos , Masculino , Pessoa de Meia-Idade , Polimiosite/diagnóstico , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Pirofosfato de Tecnécio Tc 99mRESUMO
Pre-surgical evaluation of epileptic patients consists of neurological examination, intensive electroencephalographic (EEG) monitoring and anatomical studies (CT and MRI). Functional methods such as PET and SPECT imaging are now used more frequently. We have studied pre-operatively 15 adult epileptic patients (8 female, 7 male) using a rotational scintillation camera interfaced to a dedicated computer. The tomographic images were obtained 15 minutes after intravenous injection of 99mTc-HMPAO. All had MRI scanning and intensive EEG monitoring which generally included seizure recording. Five patients had progressive lesions (3 meningiomas, 2 astrocytomas). In 10 patients, neuroradiological studies did not show the presence of progressive lesions (2 normal scans and 8 cases with inactive lesions). Two patients with meningioma showed hypoperfusion at the lesion site while the third patient had a marked hyperperfusion which might correlate with the clinical diagnosis of epilepsia partialis continua. In the astrocytoma patients SPECT scans showed hypoperfusion at the lesion site. Data obtained from the 10 patients without progressive CNS lesions showed: (a) in 4, SPECT findings correlated well with the anatomical findings; (b) in 5 instances, SPECT was able to disclose additional functional deficits; (c) in one case, there was no SPECT correlate of a discrete anatomical lesion. In 5 of these cases with no progressive lesions (n = 10) SPECT findings were useful as a complementary tool in determining the clinical or surgical management of these patients. Despite the small number and heterogenicity of the present sample, SPECT seems to be an useful tool as part of the clinical workup of epileptic patients who are candidates for epilepsy surgery.
Assuntos
Epilepsia/diagnóstico por imagem , Cuidados Pré-Operatórios , Tomografia Computadorizada de Emissão de Fóton Único , Adulto , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Circulação Cerebrovascular , Epilepsia/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , MasculinoRESUMO
99mTc-pyrophosphate musculoskeletal imaging and 99mTc-red blood cell gated blood pool imaging were performed on 10 patients with documented polymyositis/dermatomyositis. Abnormal 99mTc-pyrophosphate uptake by peripheral muscles was found in 8 patients (6 mild, 2 marked). Cardiac uptake occurred in 5 patients and was 3+ in 2 with cardiovascular symptoms. These 2 patients also had abnormal EF on gated blood pool imaging. Patients without myocardial 99mTc-pyrophosphate uptake had normal EF. Patients with myocardial 99mTc-pyrophosphate uptake had abnormal wall motion, in proportion to the degree of uptake. Response to therapy and outcome were poorer in patients with marked scintigraphic changes. These findings suggest that the magnitude of 99mTc-pyrophosphate myocardial uptake may have prognostic implications in these patients.
Assuntos
Cardiomiopatias/fisiopatologia , Dermatomiosite/fisiopatologia , Coração/fisiopatologia , Miosite/fisiopatologia , Músculos Papilares/fisiopatologia , Adolescente , Adulto , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/patologia , Criança , Dermatomiosite/diagnóstico , Dermatomiosite/patologia , Feminino , Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Sistema Musculoesquelético/diagnóstico por imagem , Sistema Musculoesquelético/metabolismo , Miosite/diagnóstico , Miosite/patologia , Músculos Papilares/diagnóstico por imagem , Músculos Papilares/patologia , Cintilografia , Pirofosfato de Tecnécio Tc 99mRESUMO
Os autores apresentam um caso de feocromocitoma intratorácico demonstrado e localizado através da cintilografia com MIBG-131, e sua correlaçäo com a radiografia convencional e tomografia computadorizada
Assuntos
Humanos , Feminino , Adulto , Neoplasias das Glândulas Suprarrenais/análise , Medicina Nuclear , Feocromocitoma/diagnóstico , BrasilRESUMO
Endomyocardial biopsy seems to be the most accurate method to use for diagnosis and follow-up of acute rejection of the transplanted heart. This investigation compared a noninvasive procedure, gallium-67 imaging, with endomyocardial biopsy in the detection of acute rejection in heart transplantation. Seven male patients (aged 41 to 54 years) sequentially had 46 gallium-67 scintigrams and 46 endomyocardial biopsies between 1 week and 8 months after transplantation. Both studies were obtained in the same day, 48 hours after the administration of an intravenous injection of gallium-67 citrate. Cardiac uptake was graded as negative, mild, moderate, and marked according to an increasing count ratio with rib and sternal uptakes. Histologic findings were graded as negative, mild acute rejection, moderate acute rejection, severe acute rejection, resolving rejection, and nonspecific reaction. Negative biopsies were not found with moderate uptake, and neither moderate nor severe acute rejection were found with negative scintigrams. Imaging sensitivity was 83% with 17% false negatives and 9% false positives. Of seven studies with moderate uptake, five showed moderate acute rejection, and the patients had specific therapy with a decline in uptake, which correlated with resolving rejection. It is conceivable that in the future this technique may be used as a screening procedure for sequential endomyocardial biopsies in the follow-up of heart transplant patients.
Assuntos
Endocárdio/patologia , Radioisótopos de Gálio , Transplante de Coração , Miocárdio/patologia , Adulto , Biópsia , Rejeição de Enxerto , Coração/diagnóstico por imagem , Humanos , Recém-Nascido , Masculino , Pessoa de Meia-Idade , CintilografiaAssuntos
Cateterismo/efeitos adversos , Cetoacidose Diabética/complicações , Endocardite Bacteriana/etiologia , Infecções por Enterobacteriaceae/etiologia , Doença Aguda , Adulto , Eletrocardiografia , Enterobacter/isolamento & purificação , Feminino , Humanos , Pulmão/patologia , Miocárdio/patologiaRESUMO
Os autores apresentam o caso de uma paciente de 42 anos de idade, portadora de diabete melito insulino-dependente, sem evidencia de cardiopatia previa, que desenvolveu cetoacidose diabetica severa, seguindo-se endocardite aguda por Enterobacter sp, relacionada a presenca de cateter venoso central. A paciente faleceu, sem que as manifestacoes clinicas permitissem aclarar o diagnostico, que foi feito a necropsia. Os autores discutem a endocardite como complicacao, sua etiologia, os fatores facilitadores da infeccao e os diagnosticos precoce e diferencial