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Introduction/Justification: The benefits of using 18F-FDG PET/CT for staging and managing treatment in patients with multiple myeloma (MM) are extensively documented. Recent studies indicate that 68Ga-PSMA PET/CT is also an excellent marker for MM lesions and may complement 18F-FDG due to the significant genetic heterogeneity observed in these patients' lesions. The involvement of bone tissue stands out as one of the most critical aspects of MM. To quantify this involvement, two quantitative parameters have recently been proposed: Percentage of Bone Involvement (PBI) and Intensity of Bone Involvement (IBI). Objectives: This study aims to compare PBI and IBI in 68Ga-PSMA and 18F-FDG PET/CT images for multiple myeloma patients. Materials and Methods: Fifteen patients were included in the study, 8 men (53.3%), with a mean age of 66.7 ± 10.7 years. The patients underwent 68Ga-PSMA and 18F-FDG PET/CT scans with a maximum interval of 8 days between images (median 4 days). The bone tissue was segmented in the images based on the Hounsfield scale of the CT image, followed by processing for closing of the volume of interest (VOI). Both PBI and IBI were calculated for the two radiotracers, with the liver SUV used as a reference for 18F-FDG and the left atrium as a reference for 68Ga-PSMA. Spearman's rank-order correlation assessed the relationship between PBI and IBI data. Results: On average, PBI values were higher for 68Ga-PSMA than for FDG, at 3.07% ± 2.5% and 1.96% ± 3.8%, respectively. The mean IBI values were similar for both radiotracers: 0.08 ± 0.13 for 18F-FDG and 0.08 ± 0.09 for 68Ga-PSMA. The median IBI calculated for 68Ga-PSMA was 0.05, higher than the 0.01 found for 18F-FDG. Despite the similarity in average values between 68Ga-PSMA and 18F-FDG, the maximum PBI and IBI values were found in different patients for both radiotracers. Additionally, the Spearman test did not indicate correlation between the variables: (r = 0.39; p = 0.16) for PBI and (r = 0.41; p = 0.13) for IBI. Conclusion: The average and maximum values of PBI and IBI for 68Ga-PSMA and 18F-FDG are close. However, no correlation was found between them, highlighting that the heterogeneous genetic profile of the disease results in different uptake patterns for both radiotracers.

Introduction/Justification: Static renal scintigraphy using 99mTc-DMSA is an accurate method for diagnosing and monitoring renal scars and allows for semi-quantification of relative tubular function (RTF). However, in cases of hydronephrosis, radiopharmaceutical accumulation in the pyelocaliceal system may interfere with RTF quantification. Although 24-hour images are typically requested to address this issue, they can inconvenience patients and disrupt the nuclear medicine service routine. Objectives: This study aimed to assess the impact of additional 24-hour imaging on RTF quantification in patients with hydronephrosis compared to standard 3-hour images. Materials and Methods: A retrospective analysis was conducted on patients who underwent renal scintigraphy with 99mTc-DMSA, focusing on those who received additional 24-hour imaging. Patients were divided into two groups: those aged up to 12 years (Group 1) and those over 12 years old (Group 2). Planar images were acquired 3 hours post-injection of 175 mBq of 99mTc-DMSA for adults and 1.5 MBq/kg for patients weighing up to 40 kg. Additional delayed images were obtained after 24 hours if pyelocaliceal dilation was present. RTF was calculated using both 3-hour and 24-hour images, preferably using semi-automatic regions of interest. The T-Student test was utilized for statistical analysis, considering a difference of ≤ 3% between the two values as not significantly justifying the additional 24-hour image. Results: A total of 1,205 consecutive 99mTc-DMSA scans from February 2019 to December 2023 were evaluated. Group 1 comprised 662 patients, with 62 undergoing additional 24-hour imaging, while Group 2 consisted of 543 patients, with 43 undergoing 24-hour imaging. The mean value of the difference between the 3h and 24h images is 1.95% ± 1.83% and median 2 (0 - 6) for Group 1, and 2.40% ± 2.08% and median 2 (0 - 8) for Group 2. Statistical analysis demonstrated equivalence between RTF quantifications obtained at 3-hour and 24-hour imaging for Group 1 p < 0.0001, 95% confidence interval (1.45 - 2.42). However, for Group 2, quantifications at 3-hour and 24-hour imaging were not necessarily equivalent p = 0.0714, 95% confidence interval (1.76 - 3.05). Conclusion: Additional 24-hour imaging with 99mTc-DMSA in patients under 12 years of age with pyelocaliceal dilation does not appear to impact RTF compared to 3-hour images. However, for older patients, 24-hour imaging is necessary for greater accuracy in RTF determination. Further investigations are warranted to better understand factors influencing RTF calculation, guiding the indication for additional 24-hour imaging.

Introduction/Justification: Antisynthetase syndrome is an autoimmune pathology characterized by production of autoantibodies against aminoacyl tRNA synthetase, mainly anti-Jo-1. Report: Male patient presenting a clinical picture of polyarthritis in hands and wrists, periorbital edema, myositis and interstitial lung disease. FAN 1/320 (nuclear homogeneous), reactive anti Jo-1, elevated CPK, erythrocyte sedimentation rate and CRP. MRI presenting muscle edema, electroneuromyography compatible with myopathy and chest CT scan suggesting inflammatory/infectious pattern. Patient was diagnosed with antisynthetase syndrome and prednisone introduced. Later on course cyclophosphamide was added due to lung involvement. He evolved with respiratory and joint symptom improvement but with progressive worsening of muscle symptoms, characterized by proximal weakness (difficulty getting out of bed and car, daily life activities like brushing his teeths and eating). He also presented CPK rise, persistent subfebrile temperature and signs of inflammatory activity (leukocytosis and CRP rise), without any apparent focus and isolated episodes of dysphagia. Rituximabe was introduced and PET/CT scan was performed to search for the focus of the infection. PET/CT showed a diffuse pattern of muscle hypermetabolism, specially in right lower limb, suggesting a diffuse muscle inflammation without any infectious focus. Conclusion: Antisynthetase syndrome is a rare entity with few PET/CT reports in the literature. However PET scan appears to be very useful in the investigation of fever of unknown origin, diagnosing inflammatory activity and in response assessment evaluation.

Introduction/Justification: Anorectal melanoma is a rare tumor that develops in melanin producing pigment cells of the anus and rectum. As a rare entity there is not much literature regarding the management of this pathology. It`s a difficult diagnosis and the majority of patients present metastases. Therefore we presented a case of probable anorectal melanoma submitted to 18F-FDG PET/CT. Report: 76 years old, male with history of anal pain and sporadic bleeding after bowel movement in the last 6 months. Bowel habits of 3-4 times daily and weight loss not quantified in the period. Digital rectal examination revealed a vegetative, friable and painful lesion, found 1 cm from anal verge, in the anterior wall, extending for 3 cm and presence of blood. Colonoscopy revealed an infiltrative, multilobular, friable and non stenosing lesion, measuring 5 cm and including pectineal line and anterior wall of the anus. Biopsy revealed colorectal mucosa with atypical cellular proliferation and ulceration and immunohistochemistry demonstrated markers that confirmed the diagnosis of melanoma (primary lesion or metastatic). Chest and abdominal CT scans demonstrated lung, liver and left adrenal lesions. 18F- FDG PET/CT was performed for primary staging. PET scan revealed hypermetabolism in anorectal wall thickening, that might be the primary lesion and in multiple hypermetabolic lesions in thyroid, lungs, liver, left adrenal, stomach lesser curvature, retroperitoneal and pelvic nodes, peritoneal implants and bones, suggesting metastatic involvement. Conclusion: This report shows a patient with a clinical picture, physical examination and complementary exams compatible with anorectal neoplasia. Immunohistochemistry confirms the diagnosis of melanoma. Anorectal melanomas are extremely rare and aggressive. Lymphatic dissemination of anal melanomas results in distant metastases to the liver and lungs by up to 90% of cases. These findings are in line with the FDG PET/CT reported in our study. 18F-FDG PET/CT may be useful in the primary staging of anal melanoma patients and in identifying lesions missed by other conventional radiological methods.

Introduction: Subtraction of ictal-interictal SPECT co-registered to MRI (SISCOM) is a quantification tool that can improve the sensitivity and specificity of the epileptogenic zone (EZ) localization. Commercially available image analysis software packages for SISCOM are costly, and Statistical Parametric Mapping (SPM) could be an alternative free software for the definition of the EZ. There are only a few studies that compare SISCOM using SPM (SISCOM-SPM) with visual analysis.Aim: To compare SISCOM-SPM vs. visual analysis for localization of the EZ in patients with pharmacoresistant focal epilepsies.Materials and methods: We evaluated all our patients with focal epilepsies that underwent ictal and interictal SPECT. We defined the reference standard to locate the EZ by pathology and follow-up (in patients submitted to surgery), or seizure semiology, serial EEG, long-term video-EEG, 18F-FDG PET/CT, and MRI (in patients who were not operated). We compared the location of the EZ by visual analysis of SPECT images and by SISCOM-SPM to the reference standard and classified as concordant, discordant, or partially concordant.Results: We included 23 patients. Visual analysis was concordant with the EZ reference standard in only 13 patients (56.5%), while SISCOM-SPM was concordant in 18 cases (78.3%), providing a 21.8% increase in the location of EZ. However, this difference was not significant due to the small sample size (p = 0.0856).Conclusion: Our preliminary results demonstrate that, in clinical practice, SISCOM-SPM has the potential to add information that might help localize the EZ compared to visual analysis. SISCOM-SPM has a lower cost than other commercially available SISCOM software packages, which is an advantage for developing countries. Studies with more patients are necessary to confirm our findings.

Introdução: Este trabalho consistiu no desenvolvimento de um dispositivo de baixo custo para testes e protocolos de exames de medicina nuclear in vitro. Foi desenvolvido e validado inicialmente para medir a taxa de filtração glomerular (TFG) com EDTA-51Cr usando apenas uma câmera de cintilação. O dispositivo consiste de 5 cilindros de chumbo (com tampas) fixados perpendicularmente e espaçadamente sobre uma placa de chumbo, que ao ser acoplado na câmara de cintilação torna-se equivalente a um contador-gama tipo poço, com sensibilidade de 300Bq. Esse dispositivo foi testado para as quantidades usuais de EDTA-51Cr das amostras de plasma sanguíneo de 8 pacientes (6 homens, 2 mulheres, idades de 43-68 anos, média 54 anos) que fizeram o exame de modo convencional. Resultados: Os valores de TFG obtidos com o método convencional e com o dispositivo variaram respectivamente, de 27 a 73 ml/min/1,73m2 (média 56,7±14,0) e de 31 a 82 ml/min/1,73m2 (média 60,9±14,5), expressando uma correlação de r=0,9010 e p=0,5628 (95% de confiança). Conclusão: O dispositivo proposto é uma alternativa confiável ao uso do “Contador Gama Tipo Poço” convencional para medir a TFG usando o método EDTA-51Cr. Devido ao seu custo muito baixo, tem o potencial de promover o uso deste procedimento em qualquer serviço de medicina nuclear que possua uma câmera de cintilação. Esta tecnologia foi depositada no Instituto Nacional de Propriedade Industrial (INPI) sob o processo de patente BR:10.2015.020347-0.

Introduction: To perform a head-to-head comparison of the uptake pattern of F-18 fluorodeoxyglucose in positron emission computed tomography (FDG PET/CT) in radioiodine refractory thyroid carcinomas (RAIR) in the same patient under elevated TSH levels (eTSH) and suppressed TSH levels (sTSH). Methods: FDG PET/CT studies were performed under two conditions: levothyroxine intake (sTSH) and 30 days after hormonal withdrawal (eTSH). SUVmax values and the number of lesions detected (local recurrence and metastases in cervical and distant lymph nodes, lungs and bone) where blindly evaluated. Blood serum TSH and Tg levels were obtained prior to both studies. FDG PET/CT imaging, neck ultrasound, biopsy and follow-up were considered the reference standard. Results: Fifteen patients performed both eTSH and sTSH FDG PET/CT studies. Both were positive for metastases in 80% of the patients. eTSH FDG PET/CT studies did not reveal increased uptake (p = 0.0640) and did not demonstrate a higher number of lesions (p = 0.320) when compared to sTSH FDG PET/CT studies. There was no change in the clinical management of these patients. Conclusions: eTSH FDG PET/CT in patients with RAIR did not show more metastases in comparison to sTSH FDG PET/CT and there was no impact in clinical management of patients. Elevating TSH levels (whether by hormonal withdrawal or recombinant TSH) in patients being submitted to FDG PET/CT may not be necessary.

Background: Studies have shown significant benefits of exercise therapy in heart failure (HF) with a reduced ejection fraction (HFrEF) and HF with a preserved ejection fraction (HFpEF). The mechanisms responsible for the beneficial effect of exercise in HFrEF and HFpEF are still unclear. We hypothesized that the effect of exercise on myocardial remodeling may explain its beneficial effect. Methods: IMAGING-REHAB-HF is a single-center, randomized, controlled clinical trial using cardiac magnetic resonance imaging, vasomotor endothelial function, cardiac sympathetic activity imaging and serum biomarkers to compare the effect of exercise therapy in HFpEF (LVEF ≥ 45%) and HFrEF (LVEF < 45%). Subjects will be assessed at baseline and after 4 months. The exercise program will consist of three 60-min exercise sessions/week. The primary endpoints are the effect of exercise on myocardial extracellular volume (ECV), left ventricular (LV) systolic function, LV mass, LV mass-to-volume and LV cardiomyocyte volume. Secondary endpoints include the effect of exercise on vasomotor endothelial function, cardiac sympathetic activity and plasmatic biomarkers. Patients will be allocated in a 2:1 fashion to supervised exercise program or usual care. A total sample size of 90 patients, divided into two groups according to LVEF:HFpEF group (45 patients:30 in the intervention arm and 15 in the control arm) and HFrEF group (45 patients:30 in the intervention arm and 15 in the control arm) – will be necessary to achieve adequate power. Conclusion: This will be the first study to evaluate the benefits of a rehabilitation program on cardiac remodeling in HF patients. The unique design of our study may provide unique data to further elucidate the mechanisms involved in reverse cardiac remodeling after exercise in HFpEF and HFrEF patients.

AimsTo assess the validity of an online method to quantitatively evaluate cerebral hypometabolism in patients with pharmacoresistant focal epilepsy as a complement to the visual analysis of the 18F-FDG positron emission tomography (PET)/CT exam.MethodsA total of 39 patients with pharmacoresistant epilepsy and probable focal cortical dysplasia [22 patients with frontal lobe epilepsy (FLE) and 17 with temporal lobe epilepsy (TLE)] underwent a presurgical evaluation including EEG, video-EEG, MRI, and 18F-FDG PET/CT. We conducted the automated quantification of their 18F-FDG PET/CT data and compared the results with those of the visual-PET analysis conducted by experienced nuclear medicine physicians. For each patient group, we calculated Cohen’s Kappa coefficient for the visual and quantitative analyses, as well as each method’s sensitivity, specificity, and positive and negative predictive values.ResultsFor the TLE group, both the visual and quantitative analyses showed high agreement. Thus, although the quantitative analysis could be used as a complement, the visual analysis on its own was consistent and precise. For the FLE group, on the other hand, the visual analysis categorized almost half of the cases as normal, revealing very low agreement. For those patients, the quantitative analysis proved critical to identify the focal hypometabolism characteristic of the epileptogenic zone. Our results suggest that the quantitative analysis of 18F-FDG PET/CT data is critical for patients with extratemporal epilepsies, and especially those with subtle MRI findings. Furthermore, it can easily be used during the routine clinical evaluation of 18F-FDG PET/CT exams.SignificanceOur results show that quantification of 18F-FDG PET is an informative complementary method that can be added to the routine visual evaluation of patients with subtle lesions, particularly those in the frontal lobes.

Objective: To evaluate the stage of maturation and the metabolism of neurogenic heterotopic ossification by using SPECT/CT. Methods: A total of 12 medical records of patients with spinal cord injury, all of them classified according to the ASIA protocol (disability scale from the American Spinal Injury Association) in complete lesion (A) and partial lesions (B, C and D) and registered at the Laboratory of Biomechanics and Rehabilitation of the Locomotor System, were submitted to SPECT/CT evaluation. Results: Sixteen hips with heterotopic ossification observed in X-ray were studied and only two (12.5%) had high osteoblastic activity. Five hips showed medium activity, three (18.75%) low activity and six (37.5%) did not present any activity detected by SPECT/CT. Conclusion: SPECT/CT helps to determinate which patients have a greater risk of relapse after surgical resection, proving to be a useful imaging study in preoperative evaluation that can be used to determinate the postoperative prognosis of these patients. Level of Evidence III, Investigating a Diagnostic Test.

PURPOSE: Create and validate a proposed animal model for training in sentinel lymph node biopsy of the stomach. METHODS: In thirty-two rabbits, through a laparotomy, they received a subserosal injection of 0.1 ml of phytate labeled with technetium-99m (0.2 mCi) in the anterior wall of the gastric corpus, followed by 0.2 ml of Blue Patent V® 2.5%, through the same puncture site. Suspicious lymph nodes were searched in vivo at five, ten and 20 minutes, both visually (Blue Patent stained lymph nodes) and with a manual gamma radiation detector (to detect suspected radioactive lymph nodes). After 20 minutes, was performed resection of these for further evaluation of radioactivity (ex vivo) and histological study. RESULTS: Lymph nodes were identified in 30 rabbits (Average of 2.2 lymph nodes per animal). Of the 90 suspected lymph nodes that occurred in the study, 70 cases (77.8%) were histologically confirmed for lymphoid tissue. Of these, the majority were located in the periesophageal region of the gastric fundus. The sample presented a mortality rate of 6.25% and nine complications related to the method, which interfered in the identification of the lymph nodes. CONCLUSION: The animal model for sentinel node biopsy in rabbit stomachs proved to be feasible, with low complexity and reproduced the difficulties encountered for gastric lymph node biopsy in humans, being adequate for surgical training.OBJETIVO: Criar e validar uma proposta de modelo animal para o treinamento em pesquisa de linfonodos sentinelas no estômago. MÉTODOS: Em trinta e dois coelhos, mediante laparotomia, foi injetado na subserosa da parede anterior do corpo gástrico, 0,1 ml de fitato marcado com tecnécio-99m (0,2 mCi), seguido pelo mesmo orifício, de 0,2 ml de Azul Patente V® 2,5%. A cavidade abdominal foi avaliada, in vivo, por meio de inspeção para pesquisa de suspeitas de linfonodos azuis e com detector manual de radiação gamma aos cinco, dez e 20 minutos para pesquisa de suspeitas de linfonodos radioativas. Após 20 minutos, foi realizada a ressecção dessas para posterior avaliação da radioactividade (ex vivo) e estudo histológico. RESULTADOS: Foram identificados linfonodos em 30 coelhos (Média de 2,2 linfonodos por animal). Das 90 suspeitas de linfonodos ocorridas no estudo, em 70 casos (77,8%) obteve-se confirmação histológica para tecido linfóide. Destas, a maioria estava localizada na região periesofágica do fundo gástrico. A amostra apresentou taxa de mortalidade de 6,25% e nove intercorrências relacionadas ao método, que interferiram na identificação dos linfonodos. CONCLUSÃO: O modelo animal para pesquisa de linfonodos sentinelas em estômago de coelhos mostrou-se factível, pouco complexo e reproduziu as dificuldades encontradas para a pesquisa de linfonodos gástricos em humanos, sendo adequado para o treinamento cirúrgico.

OBJECTIVE: Demonstrate brain perfusion changes due to neuronal activation after functional electrical stimulation (FES). METHOD: It was studied 14 patients with hemiplegia who were submitted to a program with FES during fourteen weeks. Brain perfusion SPECT was performed before and after FES therapy. These patients were further separated into 2 groups according to the hemiplegia cause: cranial trauma and major vascular insults. All SPECT images were analyzed using SPM. RESULTS: There was a significant statistical difference between the two groups related to patient's ages and extent of hypoperfusion in the SPECT. Patients with cranial trauma had a reduction in the hypoperfused area and patients with major vascular insult had an increase in the hypoperfused area after FES therapy. CONCLUSION: FES therapy can result in brain perfusion improvement in patients with brain lesions due to cranial trauma but probably not in patients with major vascular insults with large infarct area.

OBJECTIVE: To compare the accuracy of SPM and visual analysis of brain SPECT in patients with mesial temporal lobe epilepsy (MTLE). METHOD: Interictal and ictal SPECTs of 22 patients with MTLE were performed. Visual analysis were performed in interictal (VISUAL(inter)) and ictal (VISUAL(ictal/inter)) studies. SPM analysis consisted of comparing interictal (SPM(inter)) and ictal SPECTs (SPM(ictal)) of each patient to control group and by comparing perfusion of temporal lobes in ictal and interictal studies among themselves (SPM(ictal/inter)). RESULTS: For detection of the epileptogenic focus, the sensitivities were as follows: VISUAL(inter)=68%; VISUAL(ictal/inter)=100%; SPM(inter)=45%; SPM(ictal)=64% and SPM(ictal/inter)=77%. SPM was able to detect more areas of hyperperfusion and hypoperfusion. CONCLUSION: SPM did not improve the sensitivity to detect epileptogenic focus. However, SPM detected different regions of hypoperfusion and hyperperfusion and is therefore a helpful tool for better understand pathophysiology of seizures in MTLE.OBJETIVO: Comparar a acurácia do SPM com a análise visual na detecção do foco epileptogênico e alterações perfusionais à distância no SPECT cerebral. MÉTODO: Foram realizados os SPECTs ictal e interictal de 22 pacientes com epilepsia de lobo temporal mesial (ELTM). A análise visual foi realizada nos estudos interictal (VISUAL(inter)) e ictal (VISUAL(ictal/inter)). Na análise com SPM foi comparado o estudo interictal (SPM(inter)) e ictal (SPM(ictal)) de cada paciente com o grupo controle e comparou-se a perfusão dos lobos temporais entre os estudos ictal e interictal (SPM(ictal/inter)). RESULTADOS: Para a detecção do foco epileptogênico, as sensibilidades foram as seguintes: VISUAL(inter)=68%; VISUAL(ictal/inter)=100%; SPM(inter)=45%; SPM(ictal)=64% and SPM(ictal/inter)=77%. O SPM foi capaz de detectar mais áreas de hiperperfusão e hipoperfusão. CONCLUSÃO: O SPM não aumentou a sensibilidade na detecção do foco epileptogênico. Entretanto, o SPM detectou diferentes regiões de hipoperfusão e hiperperfusão e portanto, ele pode ser uma ferramenta de ajuda para se melhor entender a patofisiologia das crises na ELTM.

A 26 year-old female was admitted with abdominal pain, fever and weight loss. The clinical and laboratory investigations led to the diagnosis of paracoccidioidomycosis. Gallium-67 whole body images correlated well with the clinical course of the disease and with the patient's prognosis.Paciente do sexo feminino de 26 anos foi internada com dor abdominal, febre e emagrecimento. A investigação clínico-laboratorial estabeleceu o diagnóstico de paracoccidioidomicose. Os achados cintilográficos com citrato de gálio-67 correlacionaram-se com o curso clínico da paciente.

Objective. To create a ureteral obstruction experimental model that can be proved through Tc99m-DTPA renal scintigraphy and histopathological studies, without causing total renal function loss. Materials and Methods. Ten New Zealand white rabbits were submitted to a surgical experiment to create a model of unilateral obstruction to urinary flow. Surgery procedure provided unilateral ureteral obstruction (left kidney) to urinary flow and posteriorly was evaluated by Tc99m-DTPA renal scintigraphy and histopathological study. Tc99m-DTPA renal study was performed to detect and quantify signs of obstruction and to evaluate renal function. Statistical analysis was performed through the Student t-test with a significance level of P

CONTEXT: Thyroid uptake and scintigraphy using 99mTc-pertechnetate has proven to be more advantageous than with 131I-iodide, since the images have better quality, the procedure is faster and the patient is submitted to a lower radiation dose. OBJECTIVE: The purpose of this study was to standardize a simple and fast methodology for performing thyroid uptake and scintigraphy and to determine the normal values for 99mTc- pertechnetate uptake. TYPE OF STUDY: Prospective, non-randomized. SETTING: Division of Nuclear Medicine, Department of Radiology, School of Medical Sciences, Campinas State University. PARTICIPANTS: The study consisted of 47 normal individuals, 30 women and 17 men, with ages ranging from 19 to 61 years (mean of 33 years). PROCEDURES: The laboratory assessment of thyroid function consisted of serum dosages of ultra-sensitive thyroxin and thyrotrophin. Twenty minutes after an intravenous injection of 10 mCi (370 MBq) of 99mTc-pertechnetate, the images were obtained on a computerized scintillation camera equipped with a low-energy high-resolution parallel hole collimator. RESULTS: All the individuals were euthyroid both on clinical and laboratory evaluation. The baseline thyroid 99mTc-pertechnetate uptake ranged from 0.4 to 1.7%. The uptake values obtained in these normal individuals showed that 95% presented a thyroid uptake that ranged from 0.4 to 1.5% of the injected dose. CONCLUSION: The assessment of thyroid structure and function using 99mTc-pertechnetate is a simple, fast and efficient method, which could easily become a part of the routine studies in nuclear medicine laboratories.

CONTEXT AND OBJECTIVE: The diagnosis of repetitive strain injury (RSI) is subjective and solely based on clinical signs and physical examination. The aim of this paper was to assess the usefulness of three-phase bone scintigraphy (TPBS) in diagnosing RSI. DESIGN AND SETTING: Prospective study at the Division of Nuclear Medicine, Department of Radiology, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp). METHODS: Seventy-three patients (mean age 31.2 years; 47 males) with clinical suspicion of RSI in the upper limbs were studied. A total of 127 joints with suspicion of RSI were studied. The shoulders, elbows and wrists were analyzed semi-quantitatively, using the shafts of the humeri and ulnae as references. The results were compared with a control group of 40 normal individuals. The patients’ signs and symptoms were used as the "gold standard" for calculating the probabilities. RESULTS: From visual analysis, abnormalities were observed in the flow phase for four joints, in the blood pool phase for 11 joints and in the delayed images for 26 joints. Visual analysis of the joints of the control group did not show any abnormalities. Semi-quantitative analysis showed that most of the patients’ joint ratios were normal. The exceptions were the wrists of patients with left-sided RSI (p = 0.0216). However, the sensitivity (9%) and accuracy (41%) were very low. CONCLUSION: TPBS with semi-quantitative analysis has very low sensitivity and accuracy in the detection of RSI abnormalities in the upper limbs.

CONTEXT: More than 50% of patients with prostate, breast or lung cancer will develop painful bone metastases. The purpose of treating bone metastases is to relieve pain, reduce the use of steroids and to maintain motion. OBJECTIVE: To evaluate the use of samarium-153-EDTMP (153Sm-EDTMP) for the treatment of bone pain secondary to metastases that is refractory to clinical management. TYPE OF STUDY: Retrospective. SETTING: Division of Nuclear Medicine, Universidade Estadual de Campinas (Unicamp). METHODS: Fifty-eight patients were studied (34 males) with mean age 62 years; 31 patients had prostate cancer, 20 had breast cancer, three had lung cancer, one had lung hemangioendothelioma, one had parathyroid adenocarcinoma, one had osteosarcoma and one had an unknown primary tumor. All patients had multiple bone metastases demonstrated by bone scintigraphy using 99mTc-MDP,and were treated with 153Sm-EDTMP. Response to treatment was graded as good (pain reduction of 50-100%), intermediate (25-49%) and poor (0-24%). RESULTS: All patients showed good uptake of 153Sm-EDTMP by bone metastases. Among the patients with prostate cancer, intermediate or good response to therapy occurred in 80.6% (25 patients) and poor response in 19.4% (6). Among the patients with breast cancer, 85% (17) showed intermediate or good response to therapy while 15% (3) showed poor response. All three patients with lung cancer showed poor response to treatment. The lung hemangioendothelioma and unknown primary lesion patients showed intermediate response to treatment; the osteosarcoma and parathyroid adenocarcinoma patients showed good response to treatment. No significant myelotoxicity occurred. DISCUSSION: Pain control is important for improving the quality of life of patients with advanced cancers. The mechanism by which pain is relieved with the use of radionuclides is still not yet completely understood, however, the treatment is simple and provides a low risk of mielotoxicity. CONCLUSION: Treatment with 153Sm-EDTMP can control the pain secondary to bone metastases effectively in most patients with breast and prostate cancer without significant side effects.

CONTEXT AND OBJECTIVE: Studies using radionuclides are the most appropriate method for estimating renal function. Dimercaptosuccinic acid chelate labeled with technetium-99m (99mTc-DMSA) is the radiopharmaceutical of choice for high-resolution imaging of the renal cortex and estimation of the functional renal mass. The aim of this study was to evaluate a simplified method for determining the absolute renal uptake (ARU) of 99mTc-DMSA prior to nephrectomy, using the radioactivity counts of nephrectomy specimens as the gold standard. DESIGN AND SETTING: Prospective study at the Division of Nuclear Medicine, Department of Radiology, Universidade Estadual de Campinas. METHODS: Seventeen patients (12 females; range 22-82 years old; mean age 50.8 years old) underwent nephrectomy for various reasons. Renal scintigraphy was performed three to four hours after intravenous administration of a mean dose of 188.7 MBq (5.1 mCi) of 99mTc-DMSA, which was done six to 24 hours before surgery. The in vivo renal uptake of 99mTc-DMSA was determined using the radioactivity of the syringe before the injection (measured using a dose calibrator) and the images of the syringe and kidneys, obtained from a scintillation camera. After surgery, the reference value for renal uptake of 99mTc-DMSA was determined by measuring the radioactivity of the nephrectomy specimen using the same dose calibrator. RESULTS: The ARU measurements were very similar to those obtained using the reference method, as determined by linear regression (r-squared = 0.96). CONCLUSION: ARU estimation using the proposed method before nephrectomy seems to be accurate and feasible for routine use.

Abstract Background Neuropsychiatric sequelae of COVID-19 have been widely documented in patients with severe neurological symptoms during the chronic or subacute phase of the disease. However, it remains unclear whether subclinical changes in brain metabolism can occur early in the acute phase of the disease. The aim of this study was to identify and quantify changes in brain metabolism in patients hospitalized for acute respiratory syndrome due to COVID-19 with no or mild neurological symptoms. Results Twenty-three non-intubated patients (13 women; mean age 55.5 ± 12.1 years) hospitalized with positive nasopharyngeal swab test (RT-PCR) for COVID-19, requiring supplemental oxygen and no or mild neurological symptoms were studied. Serum C-reactive protein measured at admission ranged from 6.43 to 189.0 mg/L (mean: 96.9 ± 54.2 mg/L). The mean supplemental oxygen demand was 2.9 ± 1.4 L/min. [18F]FDG PET/CT images were acquired with a median of 12 (4–20) days of symptoms. After visual interpretation of the images, semiquantitative analysis of [18F]FDG uptake in multiple brain regions was evaluated using dedicated software and the standard deviation (SD) of brain uptake in each region was automatically calculated in comparison with reference values of a normal database. Evolutionarily ancient structures showed positive SD mean values of [18F]FDG uptake. Lenticular nuclei were bilaterally hypermetabolic (> 2 SD) in 21/23 (91.3%) patients, and thalamus in 16/23 (69.6%), bilaterally in 11/23 (47.8%). About half of patients showed hypermetabolism in brainstems, 40% in hippocampi, and 30% in cerebellums. In contrast, neocortical regions (frontal, parietal, temporal and occipital lobes) presented negative SD mean values of [18F]FDG uptake and hypometabolism (

Introduction/Justification: Recently, the tracer Prostate Specific Membrane Antigen (PSMA), which can be labeled with the radioisotopes 68Ga or 18F, has been commercially introduced. Theoretically, as the name suggests, it is a substance specific to the membrane of prostate cells and prostate cancer. However, several studies have shown that it is also a marker of neoangiogenesis, leading to its uptake in various other neoplasms and benign diseases. Objectives: This study aims to evaluate the utility of radiolabeled PSMA in detecting desmoid tumors, comparing it to 18F-luorodeoxyglucose (FDG). Materials and Methods: Three participants with a confirmed diagnosis of desmoid tumor underwent PET/CT examinations with 18F-PSMA and 18F-FDG, with a maximum interval of 3 days between examinations. Images were visually compared lesion by lesion and the maximum standardized uptake value (SUV) was calculated for each lesion and each radiopharmaceutical. Results: All lesions presented uptake of both 68Ga-PSMA and 18F-FDG. In the first patient, 3 lesions were identified: a mass adjacent to the pancreas measuring 5.4 cm (FDG: SUV = 2.0) (PSMA: SUV = 8.2), a mass in the right iliac fossa measuring 7.7 cm (FDG: SUV = 3.8) (PSMA: SUV = 5.7), and another involving the duodenojejunal transition measuring 4.1 cm (FDG: SUV = 1.9) (PSMA: SUV = 3.7). In the second patient, a mass was identified adjacent to the head and uncinate process of the pancreas measuring 9.2 cm (FDG: SUV = 9.8) (PSMA: SUV = 6.1). In the third patient, an irregular retroperitoneal mass was identified at the level of the aortic bifurcation (FDG: SUV = 2.3) (PSMA: SUV = 2.4). Conclusion: Desmoid tumors can demonstrate uptake of both 68Ga-PSMA and 18F-FDG. The intensity of tracer uptake in the lesions is variable, with some showing greater uptake of FDG, others of PSMA, suggesting a potential complementary role for these radiotracers in desmoid tumors.

Introduction/Justification: Lung cancer remains a major global cause of mortality. While 18F-FDG PET/CT is widely utilized for detection, staging, and monitoring, detecting increased glucose metabolism in tumor cells, it lacks theranostic potential. The prostate-specific membrane antigen (PSMA) tracer, initially linked to prostate cancer, is also recognized as a marker of neoangiogenesis, accumulating in various neoplasms and showing promising theranostic capabilities. Objectives: This study aims to compare the uptake patterns of 18F-FDG and 18F-PSMA in primary and metastatic lesions of non-small cell lung cancer. Materials and Methods: Four male patients diagnosed with non-small cell lung cancer (including two adenocarcinomas, one squamous cell carcinoma, and one unspecified type), aged between 58 and 71 years, underwent PET/CT imaging. 18F-FDG PET/CT scans were performed 60 minutes after intravenous administration of 0.1 mCi/kg of 18F-FDG, while 18F-PSMA PET/CT scans were obtained 90 minutes after intravenous injection of 0.1 mCi/kg of 18F-PSMA. Imaging data were analyzed by two nuclear medicine physicians and one radiologist. The maximum standardized uptake value (SUVmax) of each lesion was measured for both radiotracers in the primary tumor, lymph nodes, and metastatic sites identified through visual analysis, considering values obtained above the cardiac blood pool measured in the left atrium. Results: A total of 100 lesions were detected, with 82 identified using 18F-FDG and 92 using 18F-PSMA. Eight lesions were exclusively detected by 18F-FDG, while 14 were only identified by 18F-PSMA. The median SUVmax of lesions in 18F-FDG and 18F-PSMA images was 5.3 (1.7 – 25.0) and 3.7 (0.7 - 12.4), respectively. Brain lesions were more readily identified on 18F-PSMA images, whereas liver lesions were more notable on 18F-FDG images due to the intense physiological uptake of 18F-FDG and 18F-PSMA in the brain and liver, respectively. Conclusion: Both 18F-FDG-PET/CT and 18F-PSMA-PET/CT have the ability to identify most lesions of non-small cell lung cancer. Although 18F-PSMA images detected a greater number of lesions, the uptake intensity is generally higher with 18F-FDG. These findings suggest that the two radiopharmaceuticals may have complementary roles in lung cancer by independently detecting lesions with higher glycolytic activity or greater neoangiogenesis, or both simultaneously, which could contribute to a more personalized approach in managing these patients. The results also suggest a possible theranostic approach in selected patients with high uptake of PSMA. Further investigations involving a larger patient cohort are essential to validate these findings.

Introduction/Justification: Muscle-invasive bladder cancer (MIBC) presents high rates of metastasis and recurrence, making its monitoring challenging. PET/CT with 18F-FDG is relevant in evaluating this disease, although its urinary excretion makes the analysis of some cases difficult, even when diuretics are used. Prostate-specific membrane antigen (PSMA) is also expressed in neoangiogenesis of MIBC, making it a potential disease marker. In particular, the radiotracer 18F-PSMA-1007, unlike other analogs of this molecule, is predominantly excreted through the biliary tract, thereby facilitating the evaluation of the urinary tract. Objectives: The aim of this study was to compare PET/CT with 18F-FDG and with 18F-PSMA-1007 in evaluating MIBC. Materials and Methods: Four male patients (ages 57-73 years) were prospectively studied, undergoing PET/CT 60 minutes after intravenous administration of 0.11 mCi/kg 18F-FDG and 5 and 90 minutes after intravenous injection of 18F-PSMA-1007. Additional late (2h) pelvic images were obtained with both tracers after intravenous furosemide injection. Images were analyzed by 2 experienced nuclear physicians and 1 radiologist. The maximum standardized uptake value (SUVmax) of each lesion was measured for both radiotracers. Results: 18F-PSMA-1007 uptake in bladder lesions and regional lymph nodes progressively increased between 5, 90 minutes and 2 hours. A total of 11 lesions were identified in the 4 patients using 18F-PSMA-1007 and 9 using 18F-FDG. Two patients had undergone transurethral resection and had no active macroscopic lesions in the bladder. 18F-PSMA-1007 detected bladder lesions in the other 2 patients (SUVmax = 9.8 and 23.4), while FDG detected only 1 (SUVmax = 30.0), with the other lesion indistinguishable from radioactive urine, even after diuretic administration. Both tracers detected lymph node metastases in 3 patients (SUVmax = 4.1 to 15.8, and 9.5 to 18.3, respectively, for 18F-PSMA-1007 and 18F-FDG), and bone metastasis in 1 patient (SUVmax = 11.1 and 10.1 for 18F-PSMA-1007 and 18F-FDG, respectively). Two patients had pulmonary inflammatory/infectious processes that were FDG-avid but not 18F-PSMA-1007-avid. Conclusion: PET/CTs with 18F-FDG and 18F-PSMA-1007 appear to have similar sensitivities for MIBC lesions. Due to lower uptake in inflammatory processes, 18F-PSMA-1007 appears to have higher specificity and, due to significantly lower urinary excretion than 18F-FDG, may be more favorable for evaluating the primary bladder lesion. The significant uptake of 18F-PSMA-1007 in MIBC lesions raises the possibility of theranostic approach in selected patients.

Introduction/Justification: Head and neck squamous cell carcinoma (HNSCC) is a health problem worldwide. Most patients with HNSCC have locally advanced disease, and progression or relapse of the tumor after treatment are common events. Imaging exams to assess the existence and/or extent of the tumor play a crucial role in managing these patients. 18 F-FDG and 18 F-PSMA-1007 are markers of glycolytic activity and neo angiogenesis, respectively. The PET/CT images performed with 18 F-FDG (FDG PET/CT) have unequivocal contribution in HNSCC, but the importance of the images with 18 F-PSMA- 1007 (PSMA PET/CT) in tumor is still unclear. Objectives: The aim of this study was to describe the findings of FDG PET/CT and PSMA PET/CT in patients with advanced locoregional HNSCC at diagnosis or relapse with the purpose of verifying whether any of these exams is more suitable for detecting the tumor. Materials and Methods: Patients with advanced locoregional HNSCC at diagnosis or relapse of HNSCC were enrolled in study. Patients who underwent surgical resection of the tumor or treatment with radio chemotherapy in the last six months were excluded from the study. All patients were submitted to FDG PET/CT and PSMA PET/CT with a 24-hour interval between exams. Two nuclear medicine physicians and one radiologist analyzed the images. Comparisons between groups were analyzed by t-test, and differences were significant when p-values were < 0.05. Results: Five patients (three patients at diagnosis and one relapsed patient) were analyzed by both PET/CT images. The median age of patients was 60 years old (variation: 52-75), four were males and 1 was female. Most patients were smokers/ex- smokers and/or drinkers/ex-drinkers, had good performance status (ECOG 0), and presented tumors at stage IV. The primary tumor was localized in oropharynx/larynx (with lymph node isease), and relapses were seen mainly in lungs, liver, and bone. The HNSCC lesions were typically characterized by FDG uptake, but most lesions also exhibited varying degrees of PSMA uptake. In primary tumors and lymph node disease, mean ± SD and median (min-max) values of SUV found with FDG PET/CT scan at 1 hour were 21.1 ± 7.6 and 21.0 (14.0-33.1) and 9.0 ± 6.1 and 7.2 (2.7-18.8), respectively. For PSMA PET/CT scan, mean ± SD and median (min-max) values of SUV at 1 hour in primary tumors and lymph nodal disease were 4.0 ± 1.0 and 3.7 (2.9-5.3) and 9.0 ± 6.1 and 7.2 (2.7-18.8), respectively. The values of FDG uptake were higher than values of PSMA uptake in both primary tumors (p = 0.001) and lymph nodes (p = 0.02). Conclusion: HNSCC lesions were better detected by PET/CT images with 18F-FDG than with 18 F-PSMA-1007. The uptake of both markers in most tumors indicates that glycolytic activity and neoangiogenesis occur in HNSCC, enabling a more personalized approach in patient management. Nevertheless, the current study's sample size was small to draw conclusive results. Acknowledgements: The study was supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Fundação de Apoio ao Ensino e à Pesquisa do Estado de São Paulo (Cancer Theranostics Innovation Center, CancerThera, CEPID FAPESP #2021/10265-8), nd International Atomic Energy Agency (IAEA) technical cooperation projects for development of Latin American Countries (IAEA/TCLAC: EX-BRA6033-2401375).

Introduction/Justification: Crossed fused renal ectopia is a rare congenital anomaly resulting from embryological alterations, in which the ectopic kidney is contralateral to the insertion of its ureter into the bladder. This condition is generally asymptomatic, however, it is associated with renal complications and is usually found incidentally in radiological and molecular imaging studies. There are few reports in the literature demonstrating the combined results of molecular imaging and hybrid studies of this condition. This study aims to demonstrate the findings of static renal scintigraphy with 99mTc-DMSA, including SPECT/CT images, and dynamic renal scintigraphy with 99mTc-DTPA in a patient with crossed fused renal ectopia. Report: A 54-year-old female patient was diagnosed with stage IVa squamous cell carcinoma of the cervix causing right hydronephrosis due to extrinsic obstruction, requiring the placement of a double-J catheter. During the investigation, the patient was submitted to renal scintigraphy with 99mTc-DMSA, with SPECT/CT images, and dynamic renal scintigraphy with 99mTc-DTPA. Static images were obtained in the anterior, posterior, anterior and posterior obliques, and lateral abdominal projections and SPECT/CT images after 3 hours of intravenous injection of 99mTc-DMSA. A left ectopic kidney fused to the right kidney was observed, located to the right of the midline. Tubular function was normal in the left kidney and markedly decreased in the right kidney. Bilateral renal scars were detected. After 5 days, sequential images were acquired at intervals of 2 seconds for 1 minute and every 15 seconds for 25 minutes, in the anterior and posterior abdominal projections, immediately after intravenous injection of 99mTc-DTPA, with additional images after furosemide intravenous injection. Markedly decreased glomerular function was observed in the right kidney, and normal function in the left kidney, with signs of crossed fused renal ectopia (left ectopic kidney) and pyelocalyceal dilation on the right, with obstructive pattern. Conclusion: Crossed fused renal ectopia is a rare condition. Scintigraphy images with 99mTc-DMSA and 99mTc-DTPA allow accurate evaluation of the various functional alterations of the kidneys resulting from this anomaly. Obtaining SPECT/CT images with 99mTc-DMSA contributes to the good correlation between functional and anatomical changes of the disease. 99mTc-DMSA and 99mTc-DTPA images are also useful for evaluation of tubular and glomerular renal function in crossed fused renal ectopia. Additionally, the anatomical and functional correlation with the hybrid SPECT/CT method enables the evaluation of abnormalities with more precision.

ABSTRACT. Rapidly progressive dementia (RPD) is a rare neurological disorder. Drug toxicity is among the differential diagnoses, including the use of lithium, in which an overdosage might cause cognitive dysfunction. Clinical suspicion, laboratory confirmation, and drug interruption are key points in the management of lithium intoxication. We described a 66-year-old female patient under treatment with lithium who developed an RPD associated with parkinsonian symptoms. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) showed an “Alzheimer-like” pattern, while cerebrospinal fluid biomarkers for the disease were negative. There was a significant clinical and radiological improvement after lithium interruption. Lithium intoxication is a potentially reversible cause of RPD, as demonstrated in this case report. Drug discontinuation should be considered even in patients with normal levels of this metal, if cognitive impairment is detected. 18F-FDG PET/CT images may show an “Alzheimer-like” image pattern in acute intoxication and are useful for monitoring these patients.

El objetivo de este estudio fue comparar los métodos antropométricos por segmento corporal con los valores previstos por absorciometría con rayos X de doble energía (DXA) en atletas con lesión medular. En este estudio participaron ocho atletas tetrapléjicos y seis parapléjicos. Se midieron los perímetros corporales en siete lugares, el espesor del pliegue cutáneo en nueve (en el lado derecho del cuerpo) y la composición corporal por DXA. Se utilizó el análisis de regresión lineal para verificar las asociaciones entre composición corporal y mediciones antropométricas. Las medidas segmentarias que explican mejor la masa grasa obtenida por DXA fueron: una suma del espesor del pliegue cutáneo en el brazo (R2 = .66; p < .01); en los pliegues cutáneos del tronco, subescapular (R2 = .75, p < .01), medio axilar (R2 = .67 p < .01) y abdominal (R2 = .67, p < .01) y la suma del espesor del pliegue cutáneo del tronco (R2 = .83, p < .01); y en la pierna, el pliegue cutáneo de la pantorrilla y la suma de los pliegues cutáneos de la pierna (R2 = .83, p < .01; R2 = .68, p < .01). Los perímetros del brazo relajado y contraído mostraron relaciones relevantes (R2 = .52, p < .01, y R2 = .57, p < .01, respectivamente) con la masa grasa obtenida por DXA. Esto sugiere que el análisis segmentario de la composición corporal mediante los perímetros y el espesor del pliegue cutáneo podría ser una buena opción para determinar de forma precisa la composición corporal en atletas con lesión medular. La suma de los pliegues cutáneos por segmento reflejó de forma clara y significativa la masa grasa prevista por DXA.

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Abstract Molecules from animal venoms are promising candidates for the development of new drugs. Previous in vitro studies have shown that the venom of the spider Phoneutria nigriventer (PnV) is a potential source of antineoplastic components with activity in glioblastoma (GB) cell lines. In the present work, the effects of PnV on tumor development were established in vivo using a xenogeneic model. Human GB (NG97, the most responsive line in the previous study) cells were inoculated (s.c.) on the back of RAG−/− mice. PnV (100 µg/Kg) was administrated every 48 h (i.p.) for 14 days and several endpoints were evaluated: tumor growth and metabolism (by microPET/CT, using 18F-FDG), tumor weight and volume, histopathology, blood analysis, percentage and profile of macrophages, neutrophils and NK cells isolated from the spleen (by flow cytometry) and the presence of macrophages (Iba-1 positive) within/surrounding the tumor. The effect of venom was also evaluated on macrophages in vitro. Tumors from PnV-treated animals were smaller and did not uptake detectable amounts of 18F-FDG, compared to control (untreated). PnV-tumor was necrotic, lacking the histopathological characteristics typical of GB. Since in classic chemotherapies it is observed a decrease in immune response, methotrexate (MTX) was used only to compare the PnV effects on innate immune cells with a highly immunosuppressive antineoplastic drug. The venom increased monocytes, neutrophils and NK cells, and this effect was the opposite of that observed in the animals treated with MTX. PnV increased the number of macrophages in the tumor, while did not increase in the spleen, suggesting that PnV-activated macrophages were led preferentially to the tumor. Macrophages were activated in vitro by the venom, becoming more phagocytic; these results confirm that this cell is a target of PnV components. Spleen and in vitro PnV-activated macrophages were different of M1, since they did not produce pro- and anti-inflammatory cytokines. Studies in progress are selecting the venom molecules with antitumor and immunomodulatory effects and trying to better understand their mechanisms. The identification, optimization and synthesis of antineoplastic drugs from PnV molecules may lead to a new multitarget chemotherapy. Glioblastoma is associated with high morbidity and mortality; therefore, research to develop new treatments has great social relevance. Natural products and their derivatives represent over one-third of all new molecular entities approved by FDA. However, arthropod venoms are underexploited, although they are a rich source of new molecules. A recent in vitro screening of the Phoneutria nigriventer spider venom (PnV) antitumor effects by our group has shown that the venom significantly affected glioblastoma cell lines. Therefore, it would be relevant to establish the effects of PnV on tumor development in vivo, considering the complex neoplastic microenvironment. The venom was effective at impairing tumor development in murine xenogeneic model, activating the innate immune response and increasing tumor infiltrating macrophages. In addition, PnV activated macrophages in vitro for a different profile of M1. These activated PnV-macrophages have potential to fight the tumor without promoting tumorigenesis. Studies in progress are selecting the venom molecules with antitumor and immunomodulatory effects and trying to better understand their mechanisms. We aim to synthesize and carry out a formulation with these antineoplastic molecules for clinical trials. Spider venom biomolecules induced smaller and necrotic xenogeneic GB; spider venom activated the innate immune system; venom increased blood monocytes and the migration of macrophages to the tumor; activated PnV-macrophages have a profile different of M1 and have a potential to fight the tumor without promote tumorigenesis.

Radiotherapy and cisplatin lead to cell killing in head and neck squamous cell carcinoma patients, but adverse events and response to treatment are not the same in patients with similar clinicopathological aspects. The aim of this prospective study was to evaluate the roles of TP53 c.215G > C, FAS c.-671A > G, FAS c.-1378G > A, FASL c.-844 C > T, CASP3 c.-1191A > G, and CASP3 c.-182-247G > T single nucleotide variants in toxicity, response rate, and survival of cisplatin chemoradiation-treated head and neck squamous cell carcinoma patients. Genomic DNA was analyzed by polymerase chain reaction for genotyping. Differences between groups of patients were analyzed by chi-square test or Fisher’s exact test, multiple logistic regression analysis, and Cox hazards model. One hundred nine patients with head and neck squamous cell carcinoma were enrolled in study. All patients were smokers and/or alcoholics. Patients with FAS c.-671GG genotype, FAS c.-671AG or GG genotype, and FASL c.-844CC genotype had 5.52 (95% confidence interval (CI): 1.42–21.43), 4.03 (95% CI: 1.51–10.79), and 5.77 (95% CI: 1.23–27.04) more chances of presenting chemoradiation-related anemia of grades 2–4, lymphopenia of grade 3 or 4, and ototoxicity of all grades, respectively, than those with the remaining genotypes. FAS c.-671GG genotype was also seen as an independent predictor of shorter event-free survival (hazard ratio (HR): 2.05; P = 0.007) and overall survival (HR: 1.83; P = 0.02) in our head and neck squamous cell carcinoma patients. These findings present, for the first time, preliminary evidence that inherited abnormalities in apoptosis pathway, related to FAS c.-671A > G and FASL c.-844 C > T single nucleotide variants, can alter toxicity and survival of tobacco- and alcohol-related head and neck squamous cell carcinoma patients homogeneously treated with cisplatin chemoradiation.

Objective: To investigate, in a large prospective multicenter study, whether 2-[18F]-fluoro-2-deoxy-d-glucose-positron emission tomography is sufficiently accurate to identify clinically important bone marrow involvement by Hodgkin's lymphoma to replace routine bone marrow biopsy in a developing tropical country. Methods: Patients newly diagnosed with Hodgkin's lymphoma were recruited from six cancer centers in Brazil. All were staged by the results of positron emission tomography/computed tomography that were centrally reviewed and by iliac crest bone marrow biopsy. Patients were classified as having marrow disease if they had lymphoma identified by marrow biopsy histology or had focal 2-[18F]-fluoro-2-deoxy-d-glucose marrow uptake that resolved following chemotherapy. Results: A total of 246 participants were recruited from six different centers and 62 (25.2%) were judged to have Hodgkin's lymphoma in the bone marrow. Positron emission tomography and biopsies were concordant in 206 patients (83%). Positron emission tomography correctly identified marrow disease in 59/62 patients (95.1%) and marrow biopsy in 25/62 patients (40.3%). In 22/62 (35.4%) patients, the two techniques were concordant in the diagnosis of marrow involvement. Of the forty discordant results, positron emission tomography found bone marrow involvement in 37 patients, upstaging 22 to stage IV and having an impact on therapeutic decision in nine cases given their reallocation from early to advanced stage. Three false negative positron emission tomography results were obtained with bone marrow biopsy giving positive findings. All three cases were classified as stage IV regardless of bone marrow findings implying no modification in the clinical management. The sensitivity, specificity and accuracy of positron emission tomography for detecting bone marrow disease were 95%, 100% and 98% and for bone marrow biopsy they were 40%, 100% and 84%, respectively. Conclusion: We conclude that positron emission tomography can replace marrow biopsy in Brazilian patients with Hodgkin's lymphoma without compromising clinical management. Keywords: Hodgkin's lymphoma, FDG-PET, Positron-emission tomography, Bone marrow biopsy, Lymphoma staging

Multiple myeloma (MM) accounts for 10–15% of all hematologic malignancies, as well as 20% of deaths related to hematologic malignant tumors, predominantly affecting bone and bone marrow. Positron emission tomography/computed tomography with 18F-fluorodeoxyglucose (FDG-PET/CT) is an important method to assess the tumor burden of these patients. It is often challenging to classify the extent of disease involvement in the PET scans for many of these patients because both focal and diffuse bone lesions may coexist, with varying degrees of FDG uptake. Different metrics involving volumetric parameters and texture features have been proposed to objectively assess these images. Here, we review some metabolic parameters that can be extracted from FDG-PET/CT images of MM patients, including technical aspects and predicting MM outcome impact. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) are volumetric parameters known to be independent predictors of MM outcome. However, they have not been adopted in clinical practice due to the lack of measuring standards. CT-based segmentation allows automated, and therefore reproducible, calculation of bone metabolic metrics in patients with MM, such as maximum, mean and standard deviation of the standardized uptake values (SUV) for the entire skeleton. Intensity of bone involvement (IBI) is a new parameter that also takes advantage of this approach with promising results. Other indirect parameters obtained from FDG-PET/CT images, such as visceral adipose tissue glucose uptake and subcutaneous adipose tissue radiodensity, may also be useful to evaluate the prognosis of MM patients. Furthermore, the use and quantification of new radiotracers can address different metabolic aspects of MM and may have important prognostic implications.

Iodine-131 (131I) has been used for diagnosis and therapy in Nuclear Medicine Centers in Brazil for more than 50 years. The present study aims to investigate the impact of the counts density and the reconstruction parameters in the calibration factor determination and in the image quantification, considering the reality of Brazilian dosimetry studies. For this task, images were quantified using calibration images with high and low counts density and reconstructed adopting two different parameters approaches, usually employed in patients images. SPECT quantification results presented in this work follow other previous 131I SPECT studies and suggest that, due to the long time interval between the first e last image, as required by the Brazilian guideline, the image quantification accuracy can be improved if the counts density in calibration measurements is considered.

evaluate whether manual lymphatic drainage (MLD) or active exercise (AE) is associated with shoulder range of motion (ROM), wound complication and changes in the lymphatic parameters after breast cancer (BC) surgery and whether these parameters have an association with lymphedema formation in the long run.Clinical trial with 106 women undergoing radical BC surgery, in the Women's Integrated Healthcare Center-University of Campinas. Women were matched for staging, age and body mass index and were allocated to performed AE or MLD, 2 weekly sessions during one month after surgery. The wound was evaluated 2 months after surgery. ROM, upper limb circumference measurement and upper limb lymphoscintigraphy were performed before surgery, and 2 and 30 months after surgery.The incidence of seroma, dehiscence and infection did not differ between groups. Both groups showed ROM deficit of flexion and abduction in the second month postoperative and partial recovery after 30 months. Cumulative incidence of lymphedema was 23.8% and did not differ between groups (p = 0.29). Concerning the lymphoscintigraphy parameters, there was a significant convergent trend between baseline degree uptake (p = 0.003) and velocity visualization of axillary lymph nodes (p = 0.001) with lymphedema formation. A reduced marker uptake before or after surgery predicted lymphedema formation in the long run (>2 years). None of the lymphoscintigraphy parameters were shown to be associated with the study group. Age ≤39 years was the factor with the greatest association with lymphedema (p = 0.009). In women with age ≤39 years, BMI >24Kg/m2 was significantly associated with lymphedema (p = 0.017). In women over 39 years old, women treated with MLD were at a significantly higher risk of developing lymphedema (p = 0.011).Lymphatic abnormalities precede lymphedema formation in BC patients. In younger women, obesity seems to be the major player in lymphedema development and, in older women, improving muscle strength through AE can prevent lymphedema. In essence, MLD is as safe and effective as AE in rehabilitation after breast cancer surgery.

PURPOSE: To evaluate whether climacteric women undergoing liver transplantation had higher prevalence of decreased bone mass than those without any liver disease. METHODS: A cross-sectional study with 48 women receiving follow-up care at a university hospital in Southeastern Brazil, from February 4th 2009 to January 5th 2011, was conducted. Of these women, 24 were 35 years or older and had undergone liver transplantation at least one year before study entry. The remaining 24 women had no liver disease and their ages and menstrual patterns were similar to those of transplanted patients. Laboratorial tests (follicle-stimulating hormone and estradiol) and bone density measurements of the lumbar spine and femur (equipment Hologic, Discovery WI) were performed. Statistical analysis was carried out by Fisher's exact test, simple Odds Ratio (OR), and multiple logistic regression. RESULTS: Mean age of the women included in the study was 52.8 (±10.7) years-old, 27.1% were premenopausal and 72.9% were peri/postmenopausal. Approximately 14.6% of these women exhibited osteoporosis and 35.4% had low bone mass. The following items were associated with decreased bone mass: being postmenopausal (OR=71.4; 95%CI 3.8 - 1,339.7; pOBJETIVO: Avaliar se mulheres climatéricas submetidas a transplante de fígado tiveram maior prevalência de massa óssea diminuída do que aquelas sem antecedente de doença hepática. MÉTODOS: Estudo de corte transversal, com 48 mulheres em acompanhamento ambulatorial em um hospital universitário na região Sudeste do Brasil, no período de 04 de fevereiro de 2009 a 05 de janeiro de 2011. Foram incluídas 24 mulheres submetidas a transplante hepático há pelo menos um ano, com idades igual ou superior a 35 anos, e 24 sem antecedente de doença hepática, com idade (± três anos) e padrão menstrual semelhante ao das transplantadas. As mulheres foram submetidas a exames laboratoriais (hormônio folículo estimulante e estradiol) e densitometria óssea de coluna lombar e fêmur, com equipamento Hologic, Discovery WI. A análise estatística foi realizada por meio do teste exato de Fisher, por Odds Ratio (OR) simples e pela regressão logística múltipla. RESULTADOS: A média etária das mulheres incluídas no estudo foi de 52,8 (±10,7) anos, sendo que 27,1% estavam na pré-menopausa e 72,9%, na peri/pós-menopausa. Aproximadamente 14,6% dessas mulheres apresentaram osteoporose e 35,4%, baixa massa óssea. Os seguintes itens foram associados com massa óssea diminuída: estar na pós-menopausa (OR=71,4; IC95% 3,8 - 1.339,7; p

OBJECTIVES: To determine whether kidney disease and hemolysis are associated with bone mass density in a population of adult Brazilian patients with sickle cell disease. INTRODUCTION: Bone involvement is a frequent clinical manifestation of sickle cell disease, and it has multiple causes; however, there are few consistent clinical associations between bone involvement and sickle cell disease. METHODS: Patients over 20 years of age with sickle cell disease who were regularly followed at the Hematology and Hemotherapy Center of Campinas, Brazil, were sorted into three groups, including those with normal bone mass density, those with osteopenia, and those with osteoporosis, according to the World Health Organization criteria. The clinical data of the patients were compared using statistical analyses. RESULTS: In total, 65 patients were included in this study: 12 (18.5%) with normal bone mass density, 37 (57%) with osteopenia and 16 (24.5%) with osteoporosis. Overall, 53 patients (81.5%) had bone mass densities below normal standards. Osteopenia and osteoporosis patients had increased lactate dehydrogenase levels and reticulocyte counts compared to patients with normal bone mass density (p

O sistema linfático é um componente do corpo humano intimamente relacionado ao sistema venoso. Entretanto, o conhecimento científico a seu respeito é limitado. A etiologia e os fatores de risco para o desenvolvimento do linfedema no pós-operatório de câncer de mama são multifatoriais e ainda não foram completamente esclarecidos. O objetivo desta revisão da literatura foi descrever o padrão linfocintilográfico e avaliar as compensações linfáticas do membro superior no pós-operatório de câncer de mama com dissecção axilar.The lymphatic system is a component of the human body that is closely related to the venous system. However, scientific knowledge of this system is limited. The etiology and risk factors for the development of postoperative lymphedema in patients with breast cancer seem to be multifactorial and have not been fully understood yet. The objective of this review of the literature was to describe lymphoscintigraphic pattern and to evaluate upper limb lymphatic compensation following breast cancer surgery with axillary dissection.

Background. In systemic lupus erythematosus (SLE), atherosclerosis is attributed to traditional and lupus related risk factors, including metabolic syndrome (MetS), obesity, and inflammation. Objective. To evaluate the association between obesity, measures of body fat content, serum tumor necrosis factor alpha (TNF-α), and interleukin (IL)-6 and -10 levels in childhood-onset SLE (cSLE). Methods. We screened consecutive cSLE patients followed up in the Pediatric Rheumatology Outpatient Clinic of the State University of Campinas. cSLE patients were assessed for disease and damage. Obesity was definite as body mass index (BMI) ≥30 kg/m2. Serum TNF-α, IL-6, and IL-10 levels were measured by ELISA. Dual-energy X-ray absorptiometry was used to determine total fat mass, lean mass, and percent of body fat. Results. We included 52 cSLE patients and 52 controls. cSLE patients had higher serum TNF-α (P=0.004), IL-6 (P=0.002), and IL-10 (P

Abstract Objective: To report the case of a child with bilateral chylothorax due to infrequent etiology: thoracic duct injury after severe vomiting. Case description: Girl, 7 years old, with chronic facial swelling started after hyperemesis. During examination, she also presented with bilateral pleural effusion, with chylous fluid obtained during thoracentesis. After extensive clinical, laboratory, and radiological investigation of the chylothorax etiology, it was found to be secondary to thoracic duct injury by the increased intrathoracic pressure caused by the initial manifestation of vomiting, supported by lymphoscintigraphy findings. Comments: Except for the neonatal period, chylothorax is an infrequent finding of pleural effusion in children. There are various causes, including trauma, malignancy, infection, and inflammatory diseases; however, the etiology described in this study is poorly reported in the literature.