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OBJECTIVE: Extracardiac activity (ECA) may affect interpretation of gated SPECT myocardial perfusion studies (MPSs). To solve this problem, available softwares include myocardial edge delimitation. PURPOSE: To evaluate the influence of ECA in automatic myocardial edge detection under normal conditions and with abnormal perfusion and also evaluate the reproducibility of semi-automatic processing. METHODS: A total of 100 MPSs, 50 with ECA, were analyzed. Each subgroup included 25 cases with perfusion abnormalities. The cases were processed automatically and by 4 independent operators with different levels of experience. Commercial QGS and QPS softwares were used with tools to mask and relocate the left ventricle area. Functional parameters (final diastolic and systolic volumes and ejection fraction) and perfusion parameters such as the reversibility perfusion score and rest perfusion defect extension were analyzed. The data were compared with Pearson's correlation and Student's test. RESULTS: Interobserver correlation significantly worsened with the presence of ECA and was moderately affected by perfusion abnormalities. More experienced observers presented better correlation. Reproducibility was greater for the functional perfusion parameters, independently of the observer's experience. CONCLUSIONS: ECA significantly affects automatic edging delimitation, affecting the MPS values. Interobserver reproducibility with manual processing was more altered regarding functional parameters than in the perfusion scores. Perfusion abnormalities did not interfere with software reproducibility, and when present, better correlation was found. If ECA is not present, manual intervention should be avoided.
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Artefatos , Tomografia Computadorizada por Emissão de Fóton Único de Sincronização Cardíaca , Isquemia Miocárdica/diagnóstico por imagem , Imagem de Perfusão do Miocárdio , Variações Dependentes do Observador , Compostos Radiofarmacêuticos , Tecnécio Tc 99m Sestamibi , Idoso , Automação , Feminino , Humanos , Intestinos/diagnóstico por imagem , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/patologia , Compostos Radiofarmacêuticos/farmacocinética , Reprodutibilidade dos Testes , Software , Volume Sistólico , Tecnécio Tc 99m Sestamibi/farmacocinética , Radioisótopos de Tálio/farmacocinética , Distribuição TecidualRESUMO
UNLABELLED: Coronary artery disease (CAD) is the leading cause of death in many countries. Stress electrocardiogram (ECG) is able to detect myocardial ischemia and also has prognostic value, which may be impaired in presence of electrical baseline abnormalities. Stress myocardial single photon emission tomography (SPECT) has recognized utility yield in assessment of CAD, requiring independent interpretation of ECG and myocardial images. PURPOSE: To analyze stress ECG interpretation reproducibility among observers with different training level, including pre- and post-graduate medical students, compared to an experienced cardiologist and also with SPECT. METHOD: We studied 95 patients under CAD evaluation, mean age 61+/-9.3 years (range: 42-85), 56% male. Interobserver correlation kappa (k) between perfusion gated (99m)Tc-Sestamibi SPECT and exercise ECG were calculated as normal/abnormal, presence of necrosis, ischemia or mixed pattern. Interobserver kappa (k) analysis was made. RESULTS: 49.5% stress ECG and 45% SPECT studies were abnormal at the initial report with 62.1% concordance (k: 0.24) for normal/abnormal and 58.9% for ischemia (k: 0.14). Agreement between stress ECG initial report and independent cardiologist was 89.5% (k: 0.78). The correlation between independent observers and the initial report ranged between 62.1% and 48.4%, for baseline ECG between 41.1% and 90.5% considering normal/abnormal, and between 80% and 93.7% (k: 0.59-0.87) for the presence of ischemia. CONCLUSION: Stress ECG interpretation presented adequate interobserver reproducibility with greater agreement in the most experienced observers, confirming the importance of training.
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Doença das Coronárias/diagnóstico por imagem , Teste de Esforço , Imagem de Perfusão do Miocárdio , Variações Dependentes do Observador , Tomografia Computadorizada de Emissão de Fóton Único , Adulto , Idoso , Idoso de 80 Anos ou mais , Cardiologia/educação , Competência Clínica , Eletrocardiografia , Feminino , Imagem do Acúmulo Cardíaco de Comporta , Humanos , Masculino , Pessoa de Meia-Idade , Medicina Nuclear/educação , Médicos/psicologia , Reprodutibilidade dos Testes , Método Simples-Cego , Estudantes de Medicina/psicologiaRESUMO
INTRODUCTION AND OBJECTIVES: The correct interpretation of myocardial perfusion single photon emission computed tomography (SPECT) requires knowledge of the technique reproducibility. The objective was analyze the interobserver correlation of different experience in the interpretation of myocardial perfusion SPECT in patients following acute myocardial infarction (AMI) in order to improve the quality of our site. METHODS: Sixty cases (56 +/- 11 years, 87 % men) with transmural AMI who had recently undergone successful thrombolysis were included. Resting perfusion with (99m)Tc-sestamibi was performed at one week post-AMI. ANALYSIS: Semiquantitative interpretation using 17 segment-model by 2 independent specialists and 5 observers, was performed blindly. Left ventricular ejection fraction (LVEF) was measured with isotopic ventriculography one month after AMI, with a mean of 38 %. RESULTS: Using independent and then agreed on perfusion analysis, average involved segments/patient was 9.3 +/- 4 and the sum of severity 25 +/- 13. Readings of other observers ranged from 7 +/- 3.7 to 9.4 +/- 3.9 and 16.7 +/- 9.7 to 24.6 +/- 13, respectively, consistent with the reading of the specialists of between 0.779-0.871 (kappa: 0.565-0.741). There was no significant difference when the number of segments were analyzed in 40 % of the cases and for intensity in 60 % of them in more experienced observers. Correlation with consensus reading for the number of segments ranged from 0.84 to 0.94 and for severity from 0.79 to 0.89. Identification of culprit arteries was acceptable, with r values between 0.612 and 0.683 and kappas between 0.629 and 0.656. Correlation of the number of involved segments and severity with LVEF performed one month after AMI was 0.73 and 0.74, respectively. CONCLUSIONS: There was good correlation in the interpretation of myocardial perfusion SPECT, with a significantly better fit in more experienced observers. This academic exercise was also helpful in improving our residents' skills in cardiology.
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Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/cirurgia , Compostos Radiofarmacêuticos , Tecnécio Tc 99m Sestamibi , Tomografia Computadorizada de Emissão de Fóton Único , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reperfusão Miocárdica , Variações Dependentes do ObservadorRESUMO
Está establecida en la literatura la utilidad de la tomografía por emisión de positrones (PET) con 18F-flúordeoxiglucosa (FDG) en la etapificación, reetapificación y seguimiento del melanoma maligno. Objetivo: Evaluar los resultados del PET FDG en melanoma maligno en nuestro centro. Material y Método: Entre febrero 2003 y julio 2004, se estudiaron 33 pacientes (edad 49±14 años, 52% sexo masculino) referidos para etapificación y reetapificación de melanoma maligno. El examen fue realizado en equipo de alta resolución Siemens Ecat Exact HR+ con dosis de 13±3 mCi de FDG y glicemias en ayunas preinyección de 96±16 mg/dL. Se adquirieron imágenes de cuerpo entero, incluyendo cabeza y extremidades inferiores. El informe se basó en el análisis visual e índice cuantitativo de captación (SUV). Se comparó con otros estudios de imágenes e histología cuando estaban disponibles y se realizó seguimiento clínico. Resultados: Nueve pacientes fueron derivados para etapificación y 24 para reetapificación. En 29 casos, la localización inicial del primario era conocida y en 4 la enfermedad se diagnosticó por la presencia de metástasis ganglionares. Respecto de la localización tumoral, 6 fueron en cabeza y cuello (2 metástasis ganglionares), 5 en coroides, 5 en tronco, 5 en extremidades superiores, 11 en extremidades inferiores y 1 en mucosa (rectal). En 13 pacientes, el PET fue positivo para presencia de actividad tumoral hipermetabólica, 7 en ubicación próxima al primario y 6 alejados de éste, correspondiendo uno de estos últimos a un segundo primario (carcinoma rectal confirmado con histología). De este grupo, en 11 pacientes se confirmó tumor: en 7 hubo confirmación histológica postcirugía y en los restantes, hubo concordancia con imágenes anatómicas y clínica (1 paciente falleció); además, el PET demostró lesiones no sospechadas por otros estudios, las que no han sido confirmadas con histología. Dos fueron falsos positivos, uno por hematoma y otro por ...
Background: The usefulness of positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) for the staging and follow up of malignant melanoma, is well established. Aim: To assess the results of PET FDG in patients with malignant melanoma. Patients and Methods: Thirty three patients with malignant melanoma (aged 49 ± 14 years, 17 males), referred for staging and restaging, were studied. The tomography was performed using a Siemens Ecat Exat high resolution equipment. The dose of FDG was 13 ± 3 mCi and the blood glucose levels prior to injection were 96 ± 16 mg/dl. Whole body images, including the head and legs were acquired. The report was based on the visual analysis and standardized uptake value (SUV). Results: Nine patients were referred for staging and 24 for restaging. The location of the primary tumor was known in 29 cases and in four, the disease was diagnosed due to the presence of lymph node metastases. The tumor was located in the head and neck in six patients (including two lymph node metastases), in the choroid in five, in the trunk in five, in the superior limbs in five, in the inferior limbs in 11 and in the rectal mucosa in one. In 13 patients, PET was positive for the presence of hypermetabolic tumor activity. In seven, the location was near the primary tumor and in six, it was distant. In seven patients the presence of tumor was confirmed by surgery and in four, there was concordance between the anatomical imaging and clinical outcome. Two false positive images were detected, one hematoma and one due to the presence of lymph node inflammation. In 16 cases, PET was negative and in four it was not conclusive, all these patients do not have evidence of tumor in the clinical follow up. The primary location of the tumor was not identified in patients referred for lymph node metastases. Conclusions: FDG PET is useful for the staging and re staging of patients with malignant melanoma.
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Introducción: El diagnóstico y etapificación de pacientes portadores de lesiones pulmonares con PET-FDG permite optimizar el manejo y seleccionar la terapia más adecuada para cada uno. Objetivo: Analizar nuestra experiencia preliminar con PET-FDG en la caracterización metabólica de nódulos o masas pulmonares, correlacionándolo con histología cuando estaba disponible y evaluando el impacto en la conducta terapéutica. Material y Método: Se analizaron 58 pacientes referidos para evaluación de nódulo o masa pulmonar (62±7 años de edad; 48% sexo masculino; 40% fumadores). Los PET se realizaron en ayunas, utilizando 13 mCi de FDG-F18, con glicemia preinyección de 101± 5 mg/dl. Se adquirieron imágenes de cuerpo entero con análisis visual de cortes coronales, sagitales y transaxiales e imágenes 3D, así como análisis cuantitativo del índice de captación estandarizada SUV. Los estudios se compararon con histología y seguimiento clínico. Resultados: En 22 pacientes (38%), las lesiones pulmonares fueron hipermetabólicas y en 64%, no hubo evidencias de actividad tumoral. En 24% de los pacientes, se encontraron además lesiones extrapulmonares no sospechadas por otras técnicas de imágenes. El rango de tamaño de los nódulos/masas pulmonares era de 0,5 a 7 cm; en el grupo de PET positivo, el tamaño era mayor a 0,8 cm. Se obtuvo histología en 16/58: en 12 de ellos, se confirmó la presencia de neoplasia (75%), correspondiendo la mayoría a adenocarcinoma. Dos pacientes fueron falsos positivos, demostrándose en uno, un schwanoma abscedado y en el otro, un hamartoma. En 2 pacientes con nódulos sin actividad hipermetabólica al PET (estudio normal), sometidos a cirugía por las características del nódulo al TC, se corroboraron lesiones benignas. En los restantes pacientes con lesiones negativas, el seguimiento clínico no ha demostrado eventos hasta la fecha. Un paciente referido por nódulo pulmonar no fue incluido en el análisis debido a que en el PET presentaba ...
Background: The diagnosis and staging of pulmonary lesions with positron emission tomography (PET) with 18fluorodeoxyglucose (FDG) helps in the selection of the optimal therapy. Aim: To analyze the usefulness of FDG PET in the characterization of pulmonary nodules. Patients and Methods: Fifty eight patients referred for the assessment of a pulmonary nodule or mass (aged 62 ± 7 years, 28 males, 40% smokers), were studied. The imaging study was perfomed in the fasting state injecting 13 mCi of 18FDG. Pre injection blood glucose was 101 ± 5 mg/dl. Whole body images were acquired with visual analysis of coronal, sagittal and trans axial slices and three dimensional images. The standardized uptake value (SUV) was also calculated. Results: Pulmonary lesions were hypermetabolic in 22 patients (38%) and in the rest, there was no evidence of tumor activity. Extrapulmonary lesions were detected in 24% of patients. The size of the nodules ranged from 0.5 to 7 cm. in diameter. Those with positive PET had lesions over 0.8 cm diameter. In 12 of 16 patients with pathological study, the presence of cancer was confirmed. Two patients had false positive images. One had an abscessed Schwanoma and the other, a hamartoma. Two patients with PET images not suspicious of tumor, were operated and the pathology confirmed the absence of cancer. In the rest of patients with a negative study, the clinical follow up has been uneventful. In one patient with multiple hypermetabolic lesions with a pattern suggestive of sarcoidosis, the diagnosis was pathologically confirmed. Conclusions: FDG PET is useful for the characterization of pulmonary lesions and nodules.
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UNLABELLED: Coronary angiography is the "gold standard" for the diagnosis of coronary artery disease (CAD). The aim of this work was to compare 201Thallium SPECT with different coronary angiographic cutoff values. METHODS: Data pertaining to 145 patients were tabulated. All patients underwent stress ECG, 201Thallium SPECT and coronary angiography. To assess the cutoff impact, two criteria for coronary angiography diagnosis were used: a) > or = 50% and b) > or = 75% stenosis, and applied to data from patients and vessels. RESULTS: On a patient basis, 201Thallium SPECT sensitivity, specificity and accuracy were 87%, 57% and 81% with > or = 50% cutoff and 93%, 51% and 79% with > or = 75% cutoff, respectively (NS). When performing individual vessel analysis, sensitivity, specificity and accuracy were 59%, 78% and 68% for > or = 50% cutoff and 70%, 75% and 74% for > or = 75% cutoff, respectively (p < 0.029 for sensitivity). As expected, the severer the stenosis the higher the detection rate. There were 19 patients who had stenosis between 50% and 74%. Of these, 21% had abnormal stress ECG and 58% abnormal Thallium-201 SPECT. CONCLUSION: 201Thallium SPECT results support the use of > or = 50% stenosis cutoff criteria for CAD diagnosis and evaluation. Combined with coronary angiography, myocardial SPECT offers an excellent management strategy to patients.
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Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Radioisótopos de Tálio , Tomografia Computadorizada de Emissão de Fóton Único , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
La pesquisa adecuada del tromboembolismo pulmonar (TEP) tiene importancia en el manejo terapéutico y en el pronóstico de los pacientes. El cintigrama de ventilación y perfusión (VQ) es un método bien establecido en la evaluación de esta patología. La concordancia interobservador puede ser bastante variable y debieran minimizarse las discordancias dentro de un mismo grupo. Objetivo: Conocer la concordancia entre observadores formados en nuestro centro y correlacionarlos con el informe oficial emitido con los antecedentes clínicos y radiológicos. Método: Se analizaron retrospectivamente 401 estudios de 382 pacientes con sospecha de TEP de diferente probabilidad clínica, informados por 6 observadores independientes con distinta experiencia. Se realizó lectura en forma ciega informando como alta, baja o intermedia probabilidad de TEP, basado en la experiencia individual y en criterios PIOPED modificados. Se aplicó kappa ponderado. Resultados: En los informes existió 27.2 por ciento de alta probabilidad de TEP, 5.5 por ciento fueron intermedia o indeterminada y 67.3 por ciento de baja probabilidad, casi normal o normal. La concordancia entre los observadores varió entre 72.6 y 86 por ciento con variación de índice kappa entre 0.582 y 0.743. La correlación con el informe emitido varió entre 74.3 y 81.8 por ciento y (k: 0.582 y 0.675). Hubo mayor concordancia entre los observadores con mayor experiencia. Conclusión: En nuestro centro existe una excelente concordancia interobservador con buenos índices kappa en la interpretación ciega de los VQ solicitados por TEP. Este ejercicio además, sirvió como entrenamiento práctico para los residentes del centro.
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Humanos , Masculino , Adolescente , Adulto , Feminino , Pré-Escolar , Criança , Pessoa de Meia-Idade , Circulação Pulmonar , Embolia Pulmonar , Relação Ventilação-Perfusão , Interpretação Estatística de Dados , Embolia Pulmonar/fisiopatologia , Estudos Retrospectivos , Método Simples-Cego , Probabilidade , Compostos Radiofarmacêuticos , Sensibilidade e Especificidade , Variações Dependentes do ObservadorRESUMO
UNLABELLED: The aim of this trial was to evaluate in developing countries from different regions the diagnostic performance of (99m)Tc-sestamibi scintimammography (SM) in palpable breast lesions and to verify the clinical usefulness of a joint evaluation with mammography and SM. METHODS: From 10 countries, a total of 238 patients with palpable breast masses (n = 245) were included in this prospective multicenter trial. Prone SM was performed 10 min and 60-90 min (157 patients) after injection using an isotime acquisition of 10 min. Mammography was assessed by the same dedicated imaging radiologist according to breast imaging reporting and data system (BI-RADS) categories for malignancy and breast density. Masked SM findings and mammography findings were checked for a correlation with histopathology findings for excisional biopsy samples. Diagnostic values for breast cancer detection were calculated per lesion. RESULTS: Histopathology revealed 189 cancerous lesions and 56 benign lesions. The sensitivity and specificity of SM were 0.83 and 0.77, respectively. SM diagnostic values did not depend on the incidence of breast cancer in the country of origin or on the timing of imaging (early vs. delayed scans). On mammography, the technique yielded a sensitivity and specificity of 0.85 and 0.66, with 27 mammograms classified as BI-RADS category 1, 33 as category 2, 5 as category 3, 56 as category 4, and 124 as category 5. Thirty-seven lesions were considered to show increased radiologic density. No significant difference was found in SM diagnostic values among different BI-RADS categories or between the groups with low and high breast density. A sensitivity of 96% was calculated when SM and mammography results were combined, with 75% of all false-negative mammography findings classified as true-positive results by SM. CONCLUSION: SM complements mammography in patients with palpable masses and negative mammography findings.
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Neoplasias da Mama/diagnóstico por imagem , Mamografia , Compostos Radiofarmacêuticos , Tecnécio Tc 99m Sestamibi , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , CintilografiaRESUMO
BACKGROUND: Radio-iodine is a definite therapy for Graves disease hyperthyroidism. However, the optimal dosage is still debatable. AIM: To assess the effects of different radioiodine doses on thyroid function and complications in patients with hyperthyroidism. MATERIAL AND METHODS: A retrospective analysis of 139 patients with hyperthyroidism, treated with ratio-iodine between 1988 and 1998. Radio iodine dose used was classified as low (< 10 mCi), intermediate (10-14.9 mCi) or high (> or = 15 mCi). RESULTS: Thirty-five patients were treated with low doses, 33 with intermediate doses and 71 with high doses. There were no differences between these patients in age, disease severity, frequency of post treatment euthyroidism or complications. Patients treated with low doses had a higher frequency of persistent hyperthyroidism than patients treated with high doses (25.7 and 4.2% respectively, p < 0.001). Likewise, the frequency of subsequent hypothyroidism was 60% in patients treated with low doses and 84.5% of those with high doses, in whom it also appeared earlier. Associated complications were clinically irrelevant. In seven patients, Graves ophthalmopathy progressed after treatment, but this progression was not associated with the dose used. CONCLUSIONS: Radio iodine in high doses is useful, safe and effective for the treatment of Graves hyperthyroidism.
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Hipertireoidismo/radioterapia , Radioisótopos do Iodo/administração & dosagem , Glândula Tireoide/efeitos da radiação , Adolescente , Adulto , Idoso , Criança , Feminino , Seguimentos , Doença de Graves/radioterapia , Humanos , Radioisótopos do Iodo/efeitos adversos , Masculino , Pessoa de Meia-Idade , Dosagem Radioterapêutica , Estudos Retrospectivos , Glândula Tireoide/fisiopatologiaRESUMO
We report a 50-year-old woman with a recent myocardial infarction in whom a myocardial perfusion single photon emission computed tomography (SPECT) with Thallium201 was done simultaneously with a F18-fluorodeoxyglucose (FDG) SPECT to study glucose metabolism. Myocardial infarction was located in the anteroseptal and apical regions and an echocardiography, done at the second day of evolution, showed a septo-apical hypokinesia. On the tenth day, a coronary angiography showed a critical lesion of the anterior descending coronary artery and an angioplasty with stent placement was performed on the next day. On the twelfth day, a resting, redistribution 201Tl SPECT to study viability and a FDG-SPECT with a dual head high-energy collimator camera were done. Images, acquired 45 min after injection, were analyzed visually. In anterior and medial apical sectors, discordance between flux and metabolism, considered a classical mismatch, was observed. Echocardiographic hypokinesia disappeared three month after revascularization.
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Fluordesoxiglucose F18 , Infarto do Miocárdio/diagnóstico por imagem , Compostos Radiofarmacêuticos , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Feminino , Glucose/metabolismo , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/cirurgia , Radioisótopos de Tálio , UltrassonografiaRESUMO
PURPOSE: Double-phase scintigraphy with Tc-99m sestamibi is a good method to detect hyperfunctioning parathyroid glands. This study tried to determine the best time for delayed images: 2 or 4 hours. METHODS: Fifty-six patients were studied, and 35 of them had primary hyperparathyroidism (mean age, 53 +/- 13 years; 54% were women). Cervical ultrasonography was performed on 29 of 56 (52%) patients and surgery in 16 of 56 (29%) patients. The dose was 740 MBq (20 mCi) given intravenously, and the acquisition was performed at 10 minutes, 2 h, and 4 h using anterior views, including the mediastinum. Studies that had positive results were analyzed blindly by two independent observers, who selected the best definition for abnormal activity. RESULTS: Nineteen of 56 (34%) studies were negative and 37 of 56 (66%) were positive, 25 of them with one focus and 12 with two or more parathyroid foci. Analysis revealed 76% agreement between the observers (the rest was classified by consensus). In 70% of the cases, the best delayed image was obtained at 2 hours, in 16% at 4 hours (P < 0.00001), and in 14% both images were similar. In those cases with better images at 4 hours, the 2-hour images also showed the lesions. In two patients, lesions were seen only at 2 hours. These results could be explained by tracer decay, washout of parathyroid activity, or both. CONCLUSIONS: The best protocol should include the early 10-minute image and the 2-hour delayed view. Further controls do not appear necessary. This may be important for patient throughput.
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Glândulas Paratireoides/diagnóstico por imagem , Compostos Radiofarmacêuticos , Tecnécio Tc 99m Sestamibi , Feminino , Humanos , Hiperparatireoidismo/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , CintilografiaRESUMO
BACKGROUND: Samarium153 EDTMP, a beta and gamma emitter, is used in the palliative therapy of painful bone metastases. AIM: To evaluate the analgesic effects and myelotoxicity of Samarium153 EDTMP in patients with prostate, breast and renal carcinoma. PATIENTS AND METHODS: Twenty patients with bone metastases (11 males), aged 65 years old as a mean, received a 1 to 2 mCi/kg intravenous dose of Samarium153 EDTMP, produced in Chile. Patients were followed thereafter during 4 to 40 weeks. Pain was assessed using a visual analogue scale. RESULTS: Pain decreased from a score of 6.4 prior to treatment, to 2.7 at the fourth week of therapy and the effect lasted a mean of 12.5 weeks. Myelotoxicity was observed in 68% of cases (WHO stage I in 21%, stage II in 37%, stage III in 11% and no patients in stage IV). Platelets were the most affected series and neutrophils the least affected. Cell counts returned to normal between the sixth and eighth week. Seventy nine percent of patients decreased their basal analgesic therapy at the sixth week and 88% did so at the eighth week. Forty one percent of these patients discontinued all analgesics. CONCLUSIONS: Samarium153 EDTMP is effective in the treatment of pain in patients with bone metastases and its myelotoxicity is low to moderate. It should be considered as a therapy for this type of pain, with the precaution of performing periodical bood counts.
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Analgésicos não Narcóticos/uso terapêutico , Medula Óssea/efeitos da radiação , Neoplasias Ósseas/secundário , Compostos Organometálicos/uso terapêutico , Compostos Organofosforados/uso terapêutico , Dor/radioterapia , Cuidados Paliativos , Radioisótopos/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/complicações , Neoplasias Ósseas/diagnóstico por imagem , Relação Dose-Resposta à Radiação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , CintilografiaRESUMO
BACKGROUND: Exercise EKG is used as the test of choice in the diagnosis of coronary artery disease. Classical parameters are angor and ST depression representing myocardial ischemia. AIM: To correlate exercise EKG parameters with SPECT 201Thallium to know their likelihood ratios for ischemia. PATIENTS AND METHODS: Two hundred seventy four patients (171 men), aged 58 years old as a mean, were studied. Of these, 23% had a prior myocardial infarction. The likelihood ratios for the presence of ischemia of ST depression, failure to increase blood systolic pressure, the presence of angor and its duration during stress testing were calculated according to the results of SPECT 201Thallium. Seventy one patients were also subjected to a coronary angiography. RESULTS: Among men, likelihood ratios for the presence of angor, failure to increase systolic pressure, ST alterations and duration of angor were 6.9, 6.15, 1.77 and 1.27 respectively. Among women, the figures were 5.45, 1.77, 0.58 and 1.4 respectively. The diagnostic accuracy of SPECT 201Thallium, when correlated with the results of coronary angiography, was 85%. CONCLUSIONS: Among men, the best exercise EKG predictors for myocardial ischemia were the failure to increase systolic blood pressure and the presence of angor. Among women the only significant predictor was the presence of angor.
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Eletrocardiografia , Coração/diagnóstico por imagem , Isquemia Miocárdica/diagnóstico por imagem , Radioisótopos de Tálio , Angiografia Coronária , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Valor Preditivo dos Testes , Cintilografia , Distribuição por SexoRESUMO
The case of a 49 yr old alcoholic women with clinical and laboratory findings that suggested a Cushing syndrome is presented. The functional tests showed cortisol suppression greater than 50% of the basal value with 8 mg of dexamethasone and no response in the combined dexamethasone/desmopressin test. Pituitary Nuclear Magnetic Resonance (NMR) was negative, Abdominal Computed Axial Tomography suggested hyperplastic adrenal glands; adrenal nodules were not found in the NMR. Pituitary or hipothalamic Cushing with secondary autonomous micronodular adrenal hyperplasia was suspected. Norcholesterol-I131 SPECT scintigraphy under dexamethasone suppression demonstrated a functional adrenal hyperplasia which was hystologically confirmed.
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19-Iodocolesterol/análogos & derivados , Córtex Suprarrenal/diagnóstico por imagem , Síndrome de Cushing/diagnóstico por imagem , Glândulas Suprarrenais , Síndrome de Cushing/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Hipófise , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
The most frequently used non invasive tests in the diagnosis of renovascular hypertension are the measurement of peripheral blood renin before and after captopril administration, intravenous pyelogram, renal Doppler examination and radionuclide renography without and with angiotensin converting enzyme inhibitor administration. Measurement of renal vein renin levels and renal angiography are invasive tests commonly used. The latter allows an anatomical diagnosis of renal vein stenosis but does not give information about the functional consequences of such lesion and thus, does not predict the response of blood pressure to revascularization. Radionuclide renography has become the most useful non invasive diagnostic test, with a sensitivity and specificity of 83-94 and 85-97% respectively. It also predicts clinical response to revascularization and is useful for follow up after surgery or angioplasty. It also has good results in patients with renal failure, bilateral stenosis or stenosis in a solitary kidney and in transplanted patients.
Assuntos
Hipertensão Renovascular/diagnóstico por imagem , Adulto , Inibidores da Enzima Conversora de Angiotensina , Captopril , Feminino , Humanos , Hipertensão Renovascular/etiologia , Hipertensão Renovascular/fisiopatologia , Hipertensão Renovascular/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico , Renografia por Radioisótopo , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/fisiopatologia , Fatores de Risco , Sensibilidade e EspecificidadeRESUMO
We studied left ventricular perfusion and motility in 37 patients with coronary artery disease and disturbances of parietal motility, aged 57 +/- 9 years old, before and after revascularization. Perfusion was assessed with dipyridamole-tc99m MIBI SPECT and motility was assessed with two dimensional echocardiography with amrinone. Myocardial segments were defined as normal, viable or necrotic in both studies. Eighteen subjects were subjected to angioplasty and 19 to coronary bypass surgery. Submitted SPECT and echocardiography were repeated 64 +/- 15 and 69 +/- 23 days after revascularization respectively. The concordance between SPECT and echocardiographic pre-revascularization diagnosis was 60.1% Eighty one percent of segments considered viable with SPECT and 71% thus considered with echocardiography improved after revascularization. Likewise, 50% of segments considered necrotic with SPECT and 68% of segment thus considered with echocardiography did not improve. It is concluded that although there is a good concordance between both methods, they have limitations on the study of myocardial viability and should be considered as second choice.
Assuntos
Amrinona , Doença das Coronárias/diagnóstico por imagem , Dipiridamol , Revascularização Miocárdica , Tecnécio Tc 99m Sestamibi , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Tomografia Computadorizada de Emissão de Fóton Único , UltrassonografiaRESUMO
We report two male patients aged 50 and 55 years old with coronary artery disease who were treated with surgical revascularization and angioplasty respectively. To assess viable and ischemic myocardial territories, they were studied before and after revascularization with radionuclide perfusion SPECT with Tc99m-Sestamibi under Dipyridamole and with 2-D echocardiography at baseline and after the use of amrinone. Improvement in relative perfusion on SPECT and wall motion on 2-D echocardiography indicated tissue recovery.
Assuntos
Amrinona , Doença das Coronárias/diagnóstico por imagem , Dipiridamol , Ecocardiografia/métodos , Tecnécio Tc 99m Sestamibi , Tomografia Computadorizada de Emissão de Fóton Único , Angiografia Coronária , Doença das Coronárias/cirurgia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico por imagem , Revascularização Miocárdica , Função Ventricular EsquerdaRESUMO
In this study the antireflux effect of Antacid/Alginic Acid compound (Batynid (R)) was prospectively evaluated assessed by radionuclide technique. Patients were divided in 2 groups: mild esophagitis 13 patients and severe esophagitis 13 patients. The radionuclide study was done before and posterior ingestion of the compound evaluating duration, severity and number of the reflux episodes. The results show no significant differences comparing gastroesophageal reflux pre and post Batynid, in both group of patients, considering all parameters studied.
Assuntos
Alginatos/uso terapêutico , Antiácidos/uso terapêutico , Refluxo Gastroesofágico/prevenção & controle , Esofagite/complicações , Refluxo Gastroesofágico/diagnóstico por imagem , Ácido Glucurônico , Ácidos Hexurônicos , Humanos , Estudos Prospectivos , CintilografiaRESUMO
In this study the antireflux effect of Antacid/Alginic Acid compound (Batynid (R)) was prospectively evaluated assessed by radionuclide technique. Patients were divided in 2 groups: mild esophagitis 13 patients and severe esophagitis 13 patients. The radionuclide study was done before and posterior ingestion of the compound evaluating duration, severity and number of the reflux episodes. The results show no significant differences comparing gastroesophageal reflux pre and post Batynid, in both group of patients, considering all parameters studied.
RESUMO
Normal heart contraction was studied in 20 healthy subjects (14 males and 6 female, mean age 33 years). Rest radioventriculography and phase analysis were used. Ejection fraction was 66 +/- 7% for the LV and 53 +/- 7% for the RV (p < 0.0001). Peak filling rates in the first third of diastole were 1.6 +/- 0.6 EDV/sec for the LV and 0.7 +/- 0.3 EDV/sec for RV (p < 0.0001). Time to peak filling rate normalized for heart rate was 180 +/- 52 ms for the LV and 203 +/- 60 ms for the RV (p = 0.05). Filling fractions were 23 +/- 10% and 9 +/- 3%, respectively (p < 0.0001). Segmental motility was normal in all subjects. Phase analysis revealed faster emptying of the left atrium with phase angles of 171 +/- 13 degrees in the LA and 185 +/- 12 degrees in the RA (p = 0.00007). This difference may be related to faster diastolic events in the left ventricle. Phase angles for the LV and RV were -8.75 +/- 3 and -9.44 +/- 5 degrees, respectively (NS). We conclude that activation occurs earlier in the left atrium, proceeds through the septum and then synchronically over both ventricles.