artículo de revisión rev Med chile 2010; 138: 1441-1450 PET/CT en cáncer pulmonar DAVID LADRÓN DE GUEVARA H., RAÚL PEFAUR D. PET/CT in lung cancerMetabolic imaging studies are an integral part of oncology practice, particularly with 18 fluorodeoxyglucose PET scanning. Lung cancer is one of the primary indications of a PET/CT study. It is helpful in staging, evaluating treatment response and follow-up of these patients. The recent development of PET/CT, which incorporates a multislice CT scanner to the PET detector, improves results, combining metabolic information from the PET with anatomic data obtained with CT. It reduces false positive results from PET in cases of inflammatory disease such as pneumonia or drug reactions, which are frequent in this group of patients. These conditions are easily recognized by CT. It also improves the detection of primary tumors, when they are adjacent to atelectasis or desmoplastic reactions. PET-CT studies are able to characterize the metabolism of mediastinal and hilar lymph nodes, thus obviating the need for further related imaging studies or invasive procedures. In the assessment of metastatic disease, it allows a whole body analysis in only one study, with high predictive value and optimal cost-benefit relation. The detection of a second primary tumor is not infrequent in these patients. PET-CT is useful in the evaluation of treatment response after chemotherapy, and for the long term follow-up. (Rev Med Chile 2010; 138: 1441-1450.
Frecuencia de malignidad en incidentalomas tiroideos detectados con tomografía por emisión de positrones/ tomografía computada (PET/CT) con F18-FDG de cuerpo entero DaviD LaDrón De guevara h. 1 , cLauDia munizaga m. a , naTaLia garcía s. a , caroLina LeTeLier B. 2 , aLex wash F. 1 Frequency of malignancy in thyroid incidentalomas detected by whole body 18F-FDg PEt/Ct Background: Thyroid incidentalomas detected by 18 F-Fludeoxyglucose (FDG) PET/CT are defined as an incidental and unexpected thyroid focus present in a patient studied for a non-thyroid disease. Aim: To assess the frequency of malignancy of nodular thyroid incidentalomas, and their association with 18 F-FDG avidity (standard uptake value (SUV) max). Material and Methods: Whole body PET/CT performed from December 2008 to December 2017 were reviewed selecting those that showed nodular thyroid foci. Glands with diffuse increased uptake were excluded. Thyroid ultrasonography and fine-needle aspiration cytology (FNAC) performed after PET/CT were reviewed. Bethesda score and SUVmax were correlated. Results: Of 5,100 whole body 18F-FDG PET/CT, 119 showed a thyroid nodular uptake (2.3%). Forty eight percent of these patients were studied with FNAC or surgery, 50% of which (29/58) were confirmed as malignant. Benign nodules showed significantly lower 18 F-FDG uptake (n = 20,
Cat-Scratch Disease (CSD) is a benign, self-limited illness that occurs after scratch or bite of a cat carrier of Bartonella henselae. It presents as lymphadenopathy near to the inoculation site, and affects in 80% of cases individual younger that 21 years old. Fewer than 25% of patients will have the atypical form of the disease, with involvement of organs as liver, spleen, central nervous system and retina. Osteomyelitis has been claimed in old series as rare, although more recent publications suggest a higher incidence. Axial skeleton is the most frequently involved, especially pelvis and dorsal and lumbar spine. Skeletal lesions can be only one or multiple. Lesions not always cause pain and they can appear weeks or months after the beginning of symptoms. We describe two girls with skeletal involvement, positive serology for B. henselae and complete recovery. One of them (12 yr) had fever and abdominal pain, with a hypodense lesion in liver and multifocal osteomyelitis in spine and pelvis. The other one (10 yr) had sub-maxillary adenopathy and one painless lesion in iliac crest, which was evident in bone scan (BS), without fever or worsening of general condition. We recommend the regular use of BS in patients with CSD due to poor sensitivity of radiography in detection of bone envolvement and because these lesions can be multifocal and painless in some cases.Key words: Cat-Scratch Disease; Bartonella henselae; Osseous involvement; Osteomyelitis; Bone scan. IntroducciónEl compromiso del aparato locomotor siempre significa un reto para el médico. Sus causas son diversas: desde traumáticas, infecciosas e inflamatorias, a tumorales. Sus manifestaciones clí-nicas son variables, dependiendo de la edad del paciente y su etiología. Con este espectro tan diverso, frente a un niño con síntomas y signos músculo-esqueléticos, nuestro objetivo será siempre descartar un proceso infeccioso o tumoral. Así la patología del aparato locomotor de un recién nacido o un lactante, obligará a descartar como primera posibilidad una osteo-artritis sépti-ca, la cual habitualmente se desarrollará en el contexto de un cuadro infeccioso sistémico 1 . Es diferente en el pre-escolar y escolar, donde surge una gran gama de patologías; los cuadros infecciosos en este grupo etario ya no ocupan el primer lugar y las manifestaciones pueden estar dadas tanto por focalización del microorganismo en el esqueleto, así como ser una respuesta reactiva a la presencia del mismo en el organismo. En ellos, el cuadro clínico puede expresarse como un síndrome febril, con o sin síntomas dolorosos del aparato locomotor. Actualmente, a
An update on giant cell arteritisGiant cell arteritis (GCA) is a primary granulomatous systemic vasculitis involving the aorta and its main branches that affects people aged over 50 years with a genetic predisposition. Its main phenotypes are cranial and extracranial involvement, with or without symptoms of polymyalgia rheumatica. These phenotypes can overlap. The extracranial form can be oligosymptomatic and must be sought directly. The main complications of the disease are ischemia of essential territories such as the optic nerve or cerebral circulation, and aneurysmal dilations of the aorta and its large branches. Clinicians must be aware of all the presentation forms of the disease, to start a timely treatment and avoid potentially serious or fatal consequences. To date, the diagnosis of GCA is based on clinical and pathological criteria, with the temporal artery biopsy as the "gold standard" for diagnosis, although its sensitivity is variable. This can lead to an underdiagnosis in patients with negative biopsies or predominant extra-cranial symptoms. The emergence of new and valuable imaging tools substantially improved the timely diagnosis, mainly in subclinical and oligosymptomatic forms. Among them we highlight ultrasonography of the temporal and axillary arteries, Computed Tomography Angiography, Magnetic Resonance Angiography, and PET-CT. These imaging techniques are complementary, and their use is highly recommended. GCA treatment is based on steroidal therapy, often associated with a corticosteroid-sparing immunosuppressive agent. The follow-up is eminently clinical.
Rectal cancer: diagnosis, study and stagingRectal cancer is defi ned as a tumour located between the anal verge and 15 cm within anal verge. In rectal cancer, a precise preoperative staging allows to categorize patients for different available treatments, as well as decide the best surgical treatment. Preoperative staging is performed by several radiological techniques. Currently available procedures are endorectal ultrasound (EUS), computed tomography (CT) magnetic resonance (MRI), positron emission tomography-computed tomography (PET/CT) and intraoperative ultrasound. EUS is a procedure performed by the colorrectal surgeon that allows the evaluation of the depth of tumour invasion as well as lymph node status; nevertheless its main shortcoming is the inability to assess mesorectal fascia involvement. Nowadays, MRI is the best method to assess mesorectal fascia involvement in addition to tumour invasion and lymph nodes involved. CT is a widely available procedure, and its main use is evaluation of distant metastases, with lower accuracy to assess tumour invasion and lymph node status. PET/CT is currently gaining importance, however its role in preoperative staging it's not widely accepted. IOUS allows evaluation of liver metastases during surgery, and therefore determines management and prognosis. Consequently, is necessary for surgeons to maintain an up-to-date knowledge of current methods, its advantages and limitations.
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