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The development and subsequent adaptation of mass cytometry for the histological analysis of tissue sections has allowed the simultaneous spatial characterization of multiple components. This is useful to find the correlation between the genotypic and phenotypic profile of tumor cells and their environment in clinical-translational studies. In this revision, we provide an overview of the most relevant hallmarks in the development, implementation and application of multiplexed imaging in the study of cancer and other conditions. A special focus is placed on studies based on imaging mass cytometry (IMC) and multiplexed ion beam imaging (MIBI). The purpose of this review is to help our readers become familiar with the verification techniques employed on this tool and outline the multiple applications reported in the literature. This review will also provide guidance on the use of IMC or MIBI in any field of biomedical research.

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The tissue response to acute myocardial infarction (AMI) is key to avoiding heart complications due to inflammation, mitochondrial dysfunction, and oxidative stress. Antioxidant and anti-inflammatory agents can minimize the effects of AMI. This study investigated the role of 2-methoxy-isobutyl-isonitrile (MIBI)-associated gold nanoparticles (AuNP) on reperfusion injury after ischemia and its effect on cardiac remodeling in an experimental AMI model. Three-month-old Wistar rats were subjected to a temporary blockade of the anterior descending artery for 30 min followed by reperfusion after 24 h and 7 days by intraventricularly administering 0.4, 1.3, and 3 mg/kg AuNP-MIBI. The cardiac toxicity and renal and hepatic function levels were determined, and the infarct and peri-infarct regions were surgically removed for histopathology, analysis of inflammation from oxidative stress, and echocardiography. MIBI-conjugated AuNP promoted changes in oxidative stress and inflammation depending on the concentrations used, suggesting promising applicability for therapeutic purposes.

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RESUMEN El hiperparatiroidismo terciario es una complicación presentada en pacientes con enfermedad renal crónica llevados a trasplante renal cuyo manejo quirúrgico requiere de la ubicación mediante imágenes diagnosticas para garantizar el éxito de esta intervención. Se presenta caso de mujer en hemodiálisis crónica que presentó hiperparatiroidismo terciario por hiperplasia paratiroidea confirmada con Tc-99m MIBI SPECT.

ABSTRACT Tertiary hyperparathyroidism is a complication presented in patients with chronic kidney disease subjected to renal transplantation whose surgical management requires location through diagnostic images to guarantee the success of this intervention. We present the case of a woman on chronic hemodialysis who presented tertiary hyperparathyroidism due to parathyroid hyperplasia confirmed by Tc-99m MIBI SPECT.

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BACKGROUND: Osteosarcoma, a malignant tumor characterized by bone or osteoid formation, is the second most common primary bone neoplasm. Clinical symptoms include local and surrounding pain, unrelieved by rest or anesthesia. Osteosarcoma has a poor chemotherapeutic response with prognosis dependent on complete tumor excision. Therefore, for inoperable osteosarcoma new therapeutic strategies are needed. The present study aimed to develop murine models of cranial and vertebral osteosarcoma that facilitate simple clinical monitoring and real-time imaging to evaluate the outcome of photodynamic therapy based on a previously developed photosensitizer. METHODS: Balb/c nude mice were divided into two groups: the cranial and vertebral osteosarcoma groups. Each group was further subdivided into the photodynamic therapy-treated and untreated groups. Images were obtained by scintigraphy with 99mTc-MIBI and radiography. Tumor growth, necrotic area, osteoid matrix area, and inflammatory infiltration were analyzed. RESULTS: Cranial and vertebral tumors could be macroscopically observed and measured. Radiographic and scintigraphic images showed tumor cells present at the inoculation sites. After photodynamic therapy, scintigraphy showed lower tumoral radiopharmaceutical uptake, which correlated histologically with increased necrosis. Osteoid matrix volume increased, and tumor size decreased in all photodynamic therapy-treated animals. CONCLUSION: Cranial and vertebral osteosarcoma models in athymic mice are feasible and facilitate in vivo monitoring for the development of new therapies. Photodynamic therapy is a potential antitumoral treatment for surgically inoperable osteosarcoma.

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Objective: Show our experience performing the minimally invasive video-assisted parathyroidectomy with central approach for the treatment of patients with primary hyperparathyroidism without using intraoperative parathyroid hormone monitoring (IPTHM) based solely on the concordance of two preoperative localization studies. Material and methods: An informed consent for the accomplishment of a minimally invasive approach was performed on 27 selected patients diagnosed with primary hyperparathyroidism who underwent pre-operative cervical ultrasound and sesta-MIBI scintigraphy studies, which were consistent across them. None had a family history that might indicate a multiple endocrine neoplasia (MEN), known thyroid disease, previous neck incision, or suspicion of carcinoma. Surgery was performed through a 1.5 cm central cervical incision and the use of harmonic scalpel. IPTHM was not performed in either case. Results: In all cases the topographic location of the adenoma was confirmed. No signs of hyperparathyroidism persistence or recurrence were registered after a follow-up period of 42 months. There were no recurrent nerve lesions. The average operative time was 24.5 minutes and all patients were discharged within 24 hours. The analgesic requirement was minimal and the cosmetic result satisfactory. Conclusion: The minimally invasive unilateral exploration of the parathyroids with video-assisted magnification without IPTHM, under the guidance of two concordant localization studies is safe and feasible, with comparable results to those of standard technique as well as aesthetic advantages, less postoperative pain and reduced hospitalization.

Objetivo: Mostrar nuestra experiencia realizando la paratiroidectomía miniinvasiva video-asistida con abordaje central para el tratamiento de pacientes con hiperparatiroidismo primario, sin utilizar el monitoreo intraoperatorio de paratohormona (mipth), basados únicamente en la concordancia de dos estudios de localización preoperatorios. Material y métodos: Se seleccionaron 27 pacientes con diagnóstico de hiperparatiroidismo primario, a los cuales se les realizó previo su consentimiento para la realización de un abordaje miniinvasivo, una ecografía cervical y una centellografía sesta-MIBI como estudios de localización pre-operatorios, los cuales fueron concordantes en todo ellos. Ninguno presentó antecedentes familiares que hicieran sospechar una neoplasia endócrina múltiple (NEM), enfermedad tiroidea conocida, cervicotomía previa, ni sospecha de carcinoma. La cirugía se realizó a través de una incisión cervical central de 1,5 cm. con el empleo del bisturí harmónico. El mipth no se realizó en ninguno de los casos. Resultados: En todos los casos se confirmó la ubicación topográfica del adenoma. No registramos persistencias del hiperparatiroidismo ni recidivas después de un período de seguimiento de 42 meses. No hubo lesiones recurrenciales. El tiempo quirúrgico promedio fue de 24,5 minutos y todos los pacientes se fueron de alta antes de las 24 horas. El requerimiento analgésico fue mínimo, y el resultado estético satisfactorio. Conclusión: La exploración unilateral miniinvasiva de las paratiroides con magnificación videoasistida sin mipth, bajo la guía de dos estudios de localización concordantes, es un procedimiento seguro y factible, con resultados comparables a los de la técnica estándar y con ventajas en lo estético, menor dolor postoperatorio y hospitalización reducida.

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La diferenciación entre abscesos y metástasis cerebrales en pacientes con algún grado de inmunosupresión y con neoplasias hematológicas resulta en ocasiones difícil. Los estudios funcionales como la tomografía de emisión de fotón único (SPECT) y la tomografía por emisión de positrones (PET) son herramientas diagnósticas eficaces para este propósito. Presentamos el caso de una paciente con diagnóstico de leucemia mieloide crónica en crisis blástica a quien se le informó múltiples abscesos cerebrales; diagnóstico basado en que no existió captación de 99mTc - MIBI en SPECT cerebral y en la buena respuesta al tratamiento antimicrobiano en ocasión en que los estudios de tomografía computarizada (TC) cerebral y resonancia magnética (RM) cerebral no fueron concluyentes. Teniendo en cuenta los resultados de la SPECT se decidió postergar el esquema de quimioterapia, ya que esta podría desencadenar complicaciones probablemente fatales en la paciente.

The differentiation between brain abscess and brain metastasis in patients with some grade of immune suppression and hematological neoplasm is difficult in some situations. Functional studies like Single-Photon Emission Tomography (SPECT) and Positron Emission Tomography (PET) are useful for this purpose. We present the case of a patient with diagnosis of chronic myelogenous leukemia in blast crisis that a diagnosis of brain abscess was made. The diagnosis had a base in 99mTc - MIBI brain SPECT did not show MIBI uptake and the good treatment response to antibiotics when brain CT scan and MRI were not conclusive. Attending to the SPECT result, chemotherapy was postponed because of probably fatal complications in this patient with brain abscess.

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Introducción: la gammagrafía con 99mTc-MIBI permite la localización preoperatoria no invasiva y facilita el acceso mínimamente invasivo en pacientes con hiperparatiroidismo primario (HPTP). Objetivos: describir los resultados iniciales de la gammagrafía paratiroidea con 99mTc-MIBI en pacientes con HPTP. Métodos: entre mayo de 2007 y febrero de 2010 fueron operados 10 pacientes por HPTP. Se excluyó una paciente con un síndrome de neoplasia endocrina múltiple. La edad media fue 46,3 años (32-70 años). Predominó el sexo femenino (6). Los síntomas principales fueron dolores óseos, debilidad, cefalea y cólico nefrítico. Un paciente presentaba tumores pardos múltiples. La enfermedad asociada más frecuente fue la hipertensión arterial. Los pacientes fueron seguidos entre 25 y 58 meses (promedio 45,3 meses). Resultados: uno de dos enfermos reintervenidos por HPTP persistente presentó hipoparatiroidismo posoperatorio (ambos tenían enfermedad tiroidea multinodular). De un total de 12 glándulas enfermas, 11 eran inferiores (9 izquierdas y 2 derechas) y una superior izquierda. La sensibilidad para la gammagrafía fue del 83 por ciento y la especificidad del 100 por ciento y, para la ecografía, estos valores fueron del 34,6 por ciento y del 96 por ciento, respectivamente. No hubo complicaciones ni muertes. Con un seguimiento promedio de 45,3 meses (25-58 meses), todos los pacientes se encontraban eucalcémicos. Conclusiones: La sensibilidad de la gammagrafía preoperatoria con 99mTc-MIBI permite obtener resultados satisfactorios en pacientes con HPTP tratados mediante técnicas de mínima invasión. Los pacientes con enfermedad nodular tiroidea deben ser evaluados cuidadosamente por el riesgo de falsos positivos(AU)

Introduction: 99mTc-MIBI scanning allows the non-invasive preoperative location and facilitates the minimally invasive access to patients with primary hyperparathyroidism. Objectives: to describe the initial results of 99mTc-MIBI parathyroid scanning in patients suffering primary hyperparathyroidism. Methods: from May 2007 through February 2010, ten patients with hyperparathyroidism were operated on. A female patient with multiple endocrine neoplasia syndrome was excluded from the study. The mean age was 46.3 years (32-70 years). Females predominated (6). The main symptoms were bone aches, weakness, headache and nephric colic. One patient presented with multiple brown tumors. The most common associated disease was blood hypertension. These patients were followed-up for 25 to 28 months (average 45.3 months). Results: one of the two patients undergoing resurgery for persistent hyperparathyroidism presented with hypoparathyroidsm posoperatively (both suffered multinodular thyroid disease). Of a total of 12 sick glands, 11 were lower glands (9 left and 2 right) and one upper left gland. The scanning sensitivity was 83percent and the specificity was 100 percent whereas the echography values were 34.6 percent and 96 percent, respectively. Neither complications nor deaths were observed. With the average follow-up of 45.3 months (25-28 months), all the patients were eucalcemic. Conclusions: preoperative 99mTc-MIBI scanning sensitivity allows achieving satisfactory results in patients with hyperparathyroidism and treated with minimally invasive techniques. The patients with nodular thyroid disease should be carefully evaluated due to positive false risk(AU)

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Se presenta el caso de una paciente sometida satisfactoriamente a hemitiroidectomía izquierda por diagnóstico de bocio nodular. El estudio anátomo-patológico de la pieza operatoria informó que el aumento de tamaño del lóbulo tiroideo izquierdo se debía a glándula paratiroides hiperplásica intratiroidea. Con este resultado se solicitó gammagrafía paratiroidea, en la que se encontró un área de captación en la región torácica derecha. Se concluyó que se trató de hiperplasia paratiroidea ectópica de doble localización, intratiroidea e intratorácica.

The case of a patient who satisfactorily underwent left hemithyroidectomy for nodular goiter is reported. Pathology study of the specimen stated enlarged left thyroid gland lobe due to hyperplasic intrathyroidal parathyroid. With this result parathyroid gammagraphy was obtained and a right thoracic capture area was reported. Final diagnosis was ectopic parathyroid hyperplasia of double localization, intrathoracic and intrathyroidal.

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In this report, we describe a rare case of brown tumor and mediastinal parathyroid adenoma. This report emphasizes the value of radionuclide scintigraphy in the setting of persistent disease following parathyroid surgery.

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El objetivo consistió en evaluar la utilidad del 99mTc-MIBI como marcador para diagnóstico y seguimiento de la progresión tumoral del NMSC en un modelo de carcinogénesis completa en ratones. Los animales en estudio fueron inyectados con 99mTc-MIBI a diferentes tiempos y eutanasiados. Se disecaron muestras de tumor y piel sana para evaluar la captación del radiofármaco y realizar el diagnóstico histológico. En animales con 22 semanas de progresión tumoral se observó una diferencia significativa en la captación del 99mTc-MIBI entre piel sana y NMSC. El protocolo que mejor se adapta al uso del 99mTc-MIBI como marcador para el diagnóstico y seguimiento de la progresión tumoral en ratones portadores de NMSC inducidos es la administración i.v de 1 mCi de 99mTc-MIBI con adquisición de datos a los 30 minutos post inyección. Se observó que a medida que los tumores progresan, la captación de 99mTc-MIBI disminuye respecto a la piel normal.

The aim of the work was to evaluate the usefulness of 99mTc-MIBI as a tracer for the tumor diagnosis and progression of NMSC in a chemically induced model in mice. After administration of 99mTc-MIBI animals were sacrificed at different times. Samples of tumor and healthy skin were dissected in order to perform histological analysis and to evaluate 99mTc-MIBI uptake. Animals under 22 weeks of tumor evolution showed a statistically difference in 99mTc-MIBI uptake between healthy skin and NMSC. Our results showed that the better protocol for the study of the tumor diagnosis and progression of NMSC in mice is the administration of 1 mCi of 99mTc-MIBI and acquisition of images 30 minutes post injection. Results showed that, as tumor progresses, the uptake of 99mTc-MIBI is significantly lower than healthy skin.

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OBJECTIVES: The proper nodal staging of non-small cell lung cancer is important for choosing the best treatment modality. Although computed tomography remains the first-line imaging test for the primary staging of lung cancer, its limitations for mediastinum nodal staging are well known. The aim of this study is to evaluate the accuracy of hybrid single-photon emission computed tomography and computed tomography using 99mTc-sestamibi in the nodal staging of patients with non-small cell lung cancer and to identify potential candidates for surgical treatment. METHODS: Prospective data were collected for 41 patients from December 2006 to February 2009. The patients underwent chest computed tomography and single-photon emission computed tomography/computed tomography examinations with 99mTc-sestamibi within a 30-day time period before surgery. Single-photon emission computed tomography/computed tomography was considered positive when there was focal uptake of sestamibi in the mediastinum, and computed tomography scan when there was lymph nodes larger than 10 mm in short axis. The results of single-photon emission computed tomography and computed tomography were correlated with pathology findings after surgery. RESULTS: Single-photon emission computed tomography/computed tomography correctly identified six out of 19 cases involving hilar lymph nodes and one out of seven cases involving nodal metastases in the mediastinum. The sensitivity, specificity, positive predictive value, and negative predictive value for 99mTc-sestamibi single-photon emission computed tomography/computed tomography in the hilum assessment were 31.6 percent, 95.5 percent, 85.7 percent, and 61.8 percent, respectively. The same values for the mediastinum were 14.3 percent, 97.1 percent, 50 percent, and 84.6 percent, respectively. For the hilar and mediastinal lymph nodes, chest tomography showed sensitivity values of 47.4 percent and 57.1 percent, specificity values of 95.5 percent and 91.2 percent, positive predictive values of 90 percent and 57.1 percent and negative predictive values of 67.7 percent and 91.2 percent, respectively. CONCLUSION: Single-photon emission computed tomography/computed tomography with 99mTc-sestamibi showed very low sensitivity and accuracy for the nodal staging of patients with non-small cell lung cancer, despite its high level of specificity. In addition, the performance of single-photon emission computed tomography/computed tomography added no relevant information compared to computed tomography that would justify its use in the routine preoperative staging of non-small cell lung carcinoma.

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OBJETIVO: Diante de um paciente portador de hiperparatiroidismo primário com indicação de tratamento cirúrgico, a localização pré-operatória da paratiroide é de fundamental importância para definir a melhor abordagem cirúrgica. MATERIAIS E MÉTODOS: A realização adicional de imagens SPECT e da cintilografia com 99mTc durante a cintilografia das paratiroides com Setamibi não é rotina em nosso meio, sendo comum a aquisição apenas das imagens planas − precoce (15 minutos) e tardia (2 horas). RESULTADOS: Na nossa experiência, tem-se percebido que a realização do protocolo completo contribui de maneira decisiva na sensibilidade da localização pré-operatória da paratiroide. CONCLUSÃO: A aplicação completa de todos os métodos cintilográficos disponíveis (SPECT e 99mTc) e a análise cuidadosa das imagens em um contexto multidisciplinar podem aumentar a acurácia da cintilografia das paratiroides.

OBJECTIVE: In patients with primary hyperparathyroidism, candidates for surgical intervention, the parathyroid pre-operative localization is of fundamental importance in planning the appropriate surgical approach. MATERIALS AND METHODS: The additional acquisition of SPECT and Technetium-99m images, during parathyroid scintigraphy with Sestamibi, is not common practice. Usually, only planar image acquisition, 15 minutes prior and 2 hours after radiopharmaceutical administration, is performed. RESULTS: In our experience, the complete protocol in parathyroid scintigraphy increases the accuracy of pre-operative parathyroid localization. CONCLUSION: The complete utilization of all available nuclear medicine methods (SPECT e 99mTc) and image interpretation in a multidisciplinary context can improve the accuracy of parathyroid scintigraphy.

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Parathyroid scintigraphies have been used to detect pathological parathyroid glands either before as well as after the parathyroid resection surgery in patients with hyperparathyroidism. One of the most utilized techniques to perform the studies is the double-phase images with Tc-99m sestamibi, which has been shown to be very accurate in the localization of enlarged parathyroid glands. Similar to Tc-99m sestamibi, Tc-99m tetrofosmin is a radiopharmaceutical initially developed to perform myocardial perfusion study that has been used to perform parathyroid scintigraphies. Although most of the papers suggest that the overall sensitivities of both radiopharmaceuticals are similar, there are some papers questioning the accuracy of Tc-99m tetrofosmin to detect abnormal parathyroid glands. In the present article, we report a case with discordant results by both methods.

A cintilografia das paratireóides tem sido utilizada para detectar glândulas paratireóides patológicas tanto antes quanto após (em caso de insucesso) a cirurgia de ressecção em pacientes com hiperparatireoidismo. Uma das técnicas mais utilizadas para realizar este exame é a de duas fases utilizando como radiofármaco o sestamibi-99mTc, a qual tem se mostrado acurada na localização de glândulas paratireóides aumentadas. Similarmente ao sestamibi-99mTc, o tetrofosmin-99mTc é um radiofármaco que foi inicialmente desenvolvido para a realização de cintilografia de perfusão do miocárdio e que tem sido utilizado para a realização de cintilografia das paratireóides. Apesar de muitos artigos sugerirem que as sensibilidades dos dois radiofármacos são idênticas, alguns poucos trabalhos questionam a acurácia do tetrofosmin-99mTc para a localização de glândulas paratireóides anômalas. No presente artigo, relatamos um caso em que foi observado resultado discordante pelos dois métodos.

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A cintilografia das paratireóides tem sido utilizada para detectar glândulas patológicas em pacientes com hiperparatireoidismo, tanto antes quanto após a cirurgia de paratireoidectomia. Apesar da elevada especificidade, a cintilografia das paratireóides pode apresentar resultados falso-positivos. Neste artigo, relatamos o caso de uma paciente transplantada renal, com múltiplas lesões osteolíticas na bacia, interpretadas como tumores marrons, que à cintilografia das paratireóides com sestamibi-99mTc apresentou hipercaptação focal do radiofármaco em topografia de porção anterior do mediastino superior. Esta área hipercaptante foi inicialmente interpretada como glândula paratireóide ectópica, porém, após realização de outros exames de imagem e análise mais detalhada, mostrou-se corresponder a tumor marrom em esterno.

Parathyroid scintigraphies have been used to detect pathological parathyroid glands either before as well as after the parathyroid resection surgery in patients with hyperparathyroidism. Although this test presents high specificity for detection of increased parathyroid glands, there exist causes of false positive results. In the present article, we report a case of a renal transplanted patient, with multiple lytic lesions on pelvic bones reported as brown tumors, who presented a focal uptake in the anterior portion of the superior mediastinum on Tc-99m sestamibi scintigraphy. This focal uptake, initially thought to be an ectopic parathyroid gland, after a more detailed analysis and the performance of other imaging diagnostic tests was demonstrated to be a brown tumor of the sternum.

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Nuclear Endocrinology was the first clinical use of radionuclides, five decades ago. From those days to the present, nuclear medicine has a definitive role in the diagnosis of a great variety of clinical situations, from the very frequent thyroid nodule to the unusual neuroendocrine tumors, including parathyroid hyperfunctioning tissue. Radioiodine I131 still remains a very effective treatment for differentiated thyroid cancer and whole body scan with I131 in conjunction with seric Tyroglobulin level are the main follow-up strategies for these tumors. New techniques, like positron emission tomography (PET) and newer radiolabeled peptides, among others, will offer a molecular approach to the 21st century clinical nuclear medicine.

Se presentan las principales indicaciones actuales de los estudios radioisotópicos en endocrinología clínica, y su situación relativa con el resto de las técnicas de imagen no invasivas disponibles en nuestro medio. Se discuten brevemente las nuevas aplicaciones terapéuticas y su potencial desarrollo.

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PURPOSE--Evaluation of the incidence and clinical implications of perfusion defects that appear worse in the rest than the stress myocardial perfusion imaging with technetium-99m isonitrile (MIBI), similar to the reverse redistribution described with thallium-201. METHODS--The studies of 730 consecutive patients with known or suspected coronary artery disease who underwent either diagnostic or prognostic (after myocardial infarction) technetium-99mMIBI planar scans were reviewed. Usual planar images were subjective and semi-quantitative analyzed. Patients were divided in two groups according to the indication of the test. The incidence of the reverse reperfusion pattern, the correlative findings with the angiographic coronary anatomy, when available, and its clinical implications were assessed. RESULTS--Three in the 540 (0.55 per cent ) patients of the diagnostic group and 6 out of the 190 (3.15 per cent ) patients of the myocardial infarction group have shown the reverse reperfusion pattern, with an overall incidence of 1.23 per cent . Perfusion defects were anterior in 2 and inferior in 1 patient of the diagnostic group, compared to 4 anterior and 2 inferior within the prognostic population patients. One patient of the diagnostic group and 4 of the prognostic group showed ST-T changes on the exercise ECG. All of them achieved at least 85 per cent of the maximum predicted heart rate during the stress test. The only patient with the reverse reperfusion pattern in the diagnostic group had no coronary disease at angiography, while the 6 patients in the post myocardial infarction group have shown either an occluded (2 cases) or recanalized infarct related artery (2 cases) and remote coronary disease (2 cases). Three of them underwent successful coronary angioplasty based on clinical and laboratory evidences of ischemia. CONCLUSION--The reverse reperfusion with technetium 99-m MIBI is an uncommon finding and may be associated with jeopardized myocardium after infarction, although its predictive value for recanalized infarct related artery seems to be very low. It seems to provide no added value towards coronary artery disease diagnosis. Additional experience is required in selected subgroups of patients in order to clarify the clinical value of the reverse reperfusion pattern with the technetium-99m MIBI

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