[Indication for bone scans in early breast cancer staging]

OBJECTIVE

Evaluate the indication for bone scanning during staging of early breast cancer in the light of scientific evidence to assess the need to modify practices with scant effectiveness.

MATERIAL AND METHODS

The bone scans carried out in our Nuclear Medicine Department in 2007 on patients with primary breast cancer were reviewed retrospectively. Results were analyzed in relation to the clinical and histopathologic findings for each tumor. Bone scan results of tumors >2 cm y <or=5 cm (T2) were analyzed in two groups stratified by tumor size, <or=3 cm or >3 cm, and pre-treatment clinical stage.

RESULTS

Out of 245 bone scans of patients with breast cancer, 237 (97%) were negative for metastatic disease and 8 (3%) were positive. Lesions <2 cm (Tis and T1) were diagnosed in 131 patients (53.5%), none of which had bone metastasis at time of diagnosis. Lesions >2 cm and <or=5 cm (T2) were diagnosed in 84 patients (34%), of which 3.6% had bone metastasis. There were no differences in the rate of bone metastases in patients with stage T2 disease and lesions <or=3 cm vs. >3 cm. The bone scan findings did not modify staging in any of the 66 patients with T2 tumors stage IIA, but it did modify staging in 2 of 12 patients with stage IIB tumors. Twenty percent of 15 patients with T3 tumors and 13% of patients with T4 tumors had bone metastasis at time of diagnosis.

CONCLUSIONS

Ineffective practices should be modified and bone scanning should not be indicated in patients with early breast cancer Tis, T1 and T2 with tumor <or=2 cm, clinical stage IIA. Pre-treatment bone scanning is still indicated in T2 IIB, T3 and T4 disease.

SPECT scan in somatization disorder patients: an exploratory study of eleven cases

OBJECTIVE

There are no previous studies using single photon emission computed tomography (SPECT) scans in somatization disorder (SD) patients. The aim of this paper is to assess SPECT imaging abnormalities in SD patients and study any relation to laterality.

METHOD

Eleven SD patients from the Somatization Disorder Unit of Miguel Servet University Hospital, Zaragoza, Spain, not fulfilling criteria for any other psychiatric disorder and showing normal computed tomography (CT) and magnetic resonance imaging (MRI) images were studied with SPECT. Patients with DSM-IV axis I comorbidity were ruled out because it has been demonstrated that SPECT scans can show abnormalities in patients with depression and anxiety disorders. The technique used for SPECT was 99mTc-D,1,hexamethylpropyleneamide-oxime (99mTc-HMPAO) in four patients and 99mTc-bicisate in the other seven. The SPECT scans were evaluated without knowledge of clinical data and entirely by visual inspection.

RESULTS

Seven out of 11 (63.6%) SD patients showed hypoperfusion in SPECT imaging. In four cases there was hypoperfusion in the non-dominant hemisphere and the predominance of pain symptoms took place in the contralateral hemibody. In the other three patients hypoperfusion was bilateral. The anatomical regions affected were cerebellum (four cases), frontal and prefrontal areas (three cases), temporoparietal areas (two cases) and the complete hemisphere (one case).

CONCLUSIONS

A proportion of SD patients may present hypoperfusion in SPECT images, uni- or bilaterally, in different brain areas. Possible aetiological explanations for this finding are discussed. Controlled studies are necessary to confirm or refute this hypothesis.

[Secondary encephalopathy due to exposure to organic solvents: psychopathological, neuropsychological and neuroimaging findings]

Chronic exposure to organic solvents may cause permanent cognitive impairment. The nonspecify of neurological signs as the abnormalities of neurophysiological tests and morphological neuroimaging techniques have oblige the use of clinic neuropsychology in the monitorization of the neurotoxicity cause by these substances. The new modern functional neuroimaging techniques can contribute to the diagnosis of brain lesions caused by the exposure to organic solvents. We report a case that clearly supports this hypothesis as we emphasize the correlation found between clinical symptoms and the deficits obtained after the study of cerebral blood flow with single photon emission computed tomography (SPECT).

[Chronic schizophrenia: validity of the study of regional cerebral blood flow through cerebral SPECT]

OBJECTIVE

To check the validity of the diagnostic test in schizophrenia.

MATERIAL AND METHODS

The cerebral blood flow (CBF) characteristics were assessed by means of single photon emission tomography (SPECT) in 24 patients with schizophrenia and 20 normal control subjects. Analysis of sensitivity, specificity and the Youden rate was made of certain RCBF patterns chosen in terms of the cerebral regions between which the greatest differences were observed according to the diagnosis, schizophrenia vs control.

RESULTS

Schizophrenia vs control: sensitivity = 58.33%; specificity = 95%; positive predictive value = 93.33% and overall efficiency = 53.33%.

CONCLUSIONS

Cerebral SPECT is valid in the discrimination between patients diagnosed with schizophrenia and control subjects, taking the diagnostic judgement of the psychiatrist as the gold standard, and the RCBF pattern that displays the best coefficient is hypoperfusion, in one or several of the regions: right frontal/left frontal/right parietal/thalamus: sensitivity = 58.33%; specificity = 95%; positive predictive value = 93.33% and overall efficiency = 53.33%.

[Contribution of hepatic scintigraphy with Tc99m blood cells to the imaging diagnosis of cavernous hemangioma. Results in 48 patients]

Cavernous hemangiomas are the most common benign tumours of the liver, being the liver the most frequent organ affected by this lesions. We report 48 patients who underwent 99mTc-red blood cell (RBC) scintigraphy, after ultrasound or tomographic appearance of cavernous hemangioma. Scintigraphy findings in 29 of 48 patients (60.4%) were typical of cavernous hemangioma, hemangioma-positives, after scintigraphy (all true-positives). On clinical, ultrasound and in one case after surgery (exploratory laparotomy) the follow up was positive for hemangioma. Specificity of 100%. In the remaining 19 patients (39.6%) where hemangioma-negative lesions, 17 of 19 where true negatives and the remaining 2 where angiomas false-negatives, both of them were small lesions. The sensitivity for hemangiomas was 89.4%. To conclude with we would like to enhance the high specificity and sensitivity of 99mTc-red blood cell scintigraphy on the diagnosis of cavernous hepatic hemangioma (CHH). We highlight the utility of this specific imaging technique in the final diagnosis of CHH not requiring other invasive diagnosis tests, such as laparoscopy that in our study proved to be unnecessary.

Cavernous hemangioma of the liver. Diagnostic value of 99mTc-labeled red cell scintigraphy: results in 28 patients

Cavernous hemangioma is the most common benign tumor of the liver, the organ in which these lesions are most often present. We report on 28 patients who underwent 99mTc-labeled red cell scintigraphy after ultrasound or computerized tomography images suggesting the existence of one or more hepatic angiomas. In 16 patients (57.1%), an accumulation of red blood cells was considered to indicate the existence of hemangiomas. On the basis of subsequent clinical follow-up, ultrasound studies, and in one case laparotomy, all were eventually confirmed to be hemangiomas. The specificity as 100%. In the remaining 12 patients (42.9%), red cell uptake was not observed and the findings were considered negative; in this group, there were 10 true negatives and 2 false negatives in which scintigraphy failed to detect the existing angiomas due to their small size and deep location. The sensitivity was 88.8%. On the basis of the results, it is concluded that labeled red cell scintigraphy is a highly sensitive and specific method for the diagnosis of cavernous hemangioma of the liver. It should be considered the method of choice when this lesion is suspected, thus avoiding the use of more invasive diagnostic procedures such as laparoscopy which, in our study proved to be unnecessary.