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Aim: Systemic inflammatory factors have been validated as indicators of ongoing systemic inflammation that could be predictive markers of poor prognosis for oncological outcomes. However, the prognostic impact of systemic inflammation markers is unknown in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) treated with peptide receptor radionuclide therapy (PRRT)., Methods: We conducted an observational, retrospective, multicentric study of 40 patients with GEP or unknown origin NETs treated with PRRT between 2016 and 2020. The systemic inflammatory markers were calculated as follows: neutrophil to lymphocyte ratio (NLR)=neutrophil count/lymphocyte count, monocyte to lymphocyte ratio (MLR)=monocyte count/lymphocyte count, platelet to lymphocyte ratio (PLR)=platelet count/lymphocyte count, albumin to lymphocyte ratio (ALR)=albumin levels/lymphocyte count and derived Neutrophil to Lymphocyte ratio (dNLR)=neutrophil count/(leucocytes count - neutrophils count). Baseline analysis and after the second dose were used for the calculation of different ratios., Results: The median age was 63 years (range 41-85), 55% were male. The baseline cut-off values for NLR were 2.61, for MLR 0.31, for PLR 110.14, for ALR 2.39 and for dNLR 1.71. The cut-off values after the 2° dose were, for NLR 2.3, for MLR 0.3, for PLR 131.61, ALR 4.16, and dNLR 1.48. Median progression-free survival (PFS) was 21.7 months (95% CI 10.7-32.8 months) and overall survival (OS) was 32.1 months (95% CI 19.6-44.7 months), PFS was shorter in patients with elevated NLR (p=0.001), ALR (0.03), and dNLR (p=0.001) in baseline analysis. DCR was 81% and ORR 18%., Conclusions: In GEP or unknown origin NETs treated with PRRT, we have identified the predictive and prognostic impact of baseline systemic inflammatory factors., (Copyright © 2022 Sociedad Española de Medicina Nuclear e Imagen Molecular. Published by Elsevier España, S.L.U. All rights reserved.)

Background: To study the possible relation between immunohistochemical expression of vascular endothelial growth factor receptor 1 (VEGFR1) and the maximum standardised uptake value (SUV max) of 18 F-FDG PET in patients with non small cell lung cancer (NSCLC)., Material and Methods: The study included 39 patients with NSCLC (24 squamous cell carcinomas and 15 adenocarcinomas). According to the clinical stage, the patients were distributed as follows: 8 stage I, 7 stage II, 15 stage III and 9 stage IV. Immunohistochemical expression of VEGFR1 was studied through the technique of tissue-matrix using Tissue Arrayer Device (Beecher Instruments, Sun Prairie, WI), using the polyclonal antibody against VEGFR1 (Santa Cruz Biotechnology, California, USA)., Results: Positive VEGFR1 immunohistochemical expression was noted in 23 cases (59%). The number of positive tumours was not related with clinical stage but there was a different statistically significant association (p:0,0009) between VEGFR1 positivity and histological type, corresponding the greater percentages of positive results to adenocarcinomas (93,3%) versus in squamous cell carcinomas (37,5%). Likewise, SUV max values were higher (p: 0,039) in negative VEGFR1 carcinomas than in positive VEGFR1 tumors (r: 4-32,1; 16,4+/-6,4 (median 16,1) vs r: 3-47; 14,5+/-8,6 (12,8))., Conclusions: Our results led us to consider that in NSCLC, the negative VEGFR1 immunohistochemical expression is associated significantly with squamous cell carcinomas subtype and with higher SUV max values in 18 F-FDG-PET., (Copyright © 2021 Sociedad Española de Medicina Nuclear e Imagen Molecular. Published by Elsevier España, S.L.U. All rights reserved.)

Background: To study the possible relation between immunohistochemical expression of vascular endothelial growth factor receptor 1 (VEGFR1) and the maximum standardised uptake value (maxSUV) of 18 F-FDG PET in patients with non small cell lung cancer., Material and Methods: The study included 39 patients with NSCLC (24 squamous cell carcinomas and 15 adenocarcinomas). According to the clinical stage, the patients were distributed as follows: 8 stage I, 7 stage II, 15 stage III and 9 stage IV. Immunohistochemical expression of VEGFR1 was studied through the technique of tissue-matrix using tissue arrayer device (Beecher Instruments, Sun Prairie, WI), using the polyclonal antibody against VEGFR1 (Santa Cruz Biotechnology, California, USA)., Results: Positive VEGFR1 immunohistochemical expression was noted in 23 cases (59%). The number of positive tumours was not related with clinical stage but there was a different statistically significant association (p:.0009) between VEGFR1 positivity and histological type, corresponding the greater percentages of positive results to adenocarcinomas (93.3%) versus in squamous cell carcinomas (37.5%). Likewise, maxSUV values were higher (p: .039) in negative VEGFR1 carcinomas than in positive VEGFR1 tumors (r: 4-32.1; 16.4+/-6.4 [median 16.1] vs. r: 3-47; 14.5+/-8.6 [12.8])., Conclusions: Our results led us to consider that in NSCLC, the negative VEGFR1 immunohistochemical expression is associated significantly with squamous cell carcinomas subtype and with higher maxSUV values in 18 F-FDG-PET., (Copyright © 2021 Sociedad Española de Medicina Nuclear e Imagen Molecular. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: The early diagnosis of infective endocarditis (IE) is a medical challenge and a multidisciplinary approach is essential to improve its frequently fatal prognosis. Our goal was to evaluate the usefulness of [ 18 F]2-fluoro-2-deoxy-d-glucose positron emission tomography ( 18 F-FDG PET) in the diagnosis of this disease., Materials and Methods: We prospectively assessed 43 patients (five female and 38 male) with clinical suspicion of IE between 2014 and 2017. All patients underwent transesophageal echocardiography (TEE) and an 18 F-FDG PET scan, and the results were compared. A positive PET finding was defined as increased FDG uptake on cardiac valves or intracardiac devices., Results: Out of 43 patients with suspected IE, the diagnosis was confirmed in 30 cases (79.7%). 18 F-FDG PET was positive in 24 patients, with 19 showing FDG uptake on cardiac valves (two native and 17 prosthetic) and five on cardiac devices, being concordant with echocardiographic findings in 11 cases. 18 F-FDG PET sensitivity was 80%, specificity 92%, positive predictive value (PPV) 96% and negative predictive value (NPV) 66%. Echocardiography presented sensitivity, specificity, PPV and NPV of 36%, 84%, 84% and 36%, respectively., Conclusions: 18 F-FDG PET proved to be a sensitive technique with a high diagnostic value in patients with prosthetic valves and intracardiac devices and suspected IE. Its utility decreased dramatically in patients with suspected IE on native valves, in which TEE presented higher sensitivity and thus better diagnostic value., (Copyright © 2019 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: The aim of the present study was to determine the long-term prognostic value provided by the exercise electrocardiographic (ECG) response to nuclear myocardial perfusion imaging (MPI) in the evaluation of patients with chest pain, focusing on patients with a discrepancy between the two tests., Methods: A total of 1460 consecutive patients (777 female; 62.6 ± 11.4 years) undergoing exercise myocardial single-photon emission computed tomography (SPECT) were included. The endpoint was the occurrence of acute coronary syndrome, heart failure or cardiac death during follow-up., Results: Ischemic ECG changes were observed during stress testing in 271 patients (18.5%) and 362 patients (24.7%) had positive (abnormal) exercise MPI results. There was a discrepancy between ECG and SPECT findings in 471 patients (32.2%). During the follow-up period (14.0-39.6 months), 224 patients (15.3%) presented cardiac events. The hazard ratios (HR) of ECG and MPI results to predict events were 1.506 (95% CI: 1.113-2.039) and 10.481 (95% CI: 7.799-14.080), respectively. In patients with negative MPI, the ECG response did not predict events (HR 1.214 [95% CI: 0.646-2.282]), the same as in patients with positive MPI (HR 1.203 [95% CI: 0.848-1.705]). Only in hypertensive patients with positive SPECT did the ECG show significant prognostic value (HR 1.937 [95% CI: 1.030-3.642]). In multivariate analysis, positive MPI proved an independent long-term prognostic factor (HR 10.536 [95% CI: 7.759-14.308]), but not ECG (HR 1.356 [95% CI: 0.994-1.850])., Conclusion: MPI results (normal vs. abnormal) had strong predictive value and discrepant ECG results had no significant additive prognostic value., (Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.)

Cancer stem cells play an important role in carcinogenesis and resistance to treatment and may lead to metastasis. The isolation of circulating stem cells involves cell sorting based on the presence of cell surface markers. Many surface markers such as CD133, c-Kit, SOX, OCT4 and TWIST have been reported. In the present study, we determined the expression of different stem cell markers and their variation in expression at different stages of the treatment process. Samples of EDTA blood were collected from metastatic colorectal cancer patients, and circulating cancer stem cells were isolated for the analysis of the expression of stem cell markers using RT-PCR. These findings were correlated with the response to therapy. All statistical analyses were performed using the GraphPad Prism 5.03 software. Significant differences were found in the expression levels of the markers CD133, SOX2, OCT4 and TWIST1. No differences were found in c-Kit expression. Correlation in the expression levels of most of the markers was observed. Expression of CD133, OCT4, SOX2 and TWIST1 had a predictive value for colon cancer behavior. Evaluation of this stem cell gene expression panel may be useful for predicting the response during the process of treatment, and the relative easy access to samples facilitates this method. Moreover the correlation between CD133 and TWIST1 expression may be associated with tumor regrowth and metastatic relapse.

Poorly differentiated follicular thyroid carcinoma (PDFC) is a tumor of follicular cell origin with intermediate attributes between well-differentiated carcinomas and anaplastic carcinomas. The majority of patients presenting with distant metastases have locally advanced tumors, being lungs and bones the most common sites affected. We present a case of a patient with a painful bulky mass at the left thorax-abdominal wall as an uncommon distant metastasis of a PDFC. After thyroidectomy, a pre-ablative 131I whole-body scan showed distant metastases on the neck, both lungs, and lateral chest-abdominal wall, so the administration of I for thyroid remnant ablation stimulated with RH-TSH was decided.

Premature atherosclerosis and its consequent heart disease play a crucial role in patients with systemic lupus erythematosus, even in premenopausal women. It is one of the leading causes of death in long evolution lupus. We present the case of a 42-year-old premenopausal woman, smoker, with a history of hypertension, cholecystectomy and lupus for 23 years, treated with NSAID, steroids and antimalarial drugs. The patient consulted due to chest pain on moderate efforts. Due to the suspicion of ischemic heart disease, a cardiology study was initiated, performing a myocardial perfusion SPECT. This revealed an intense and extensive anterolateral perfusion defect, with very light reperfusion in rest images, consistent with the diagnosis of acute infarction in the apical region and ischemia in the territory of the left anterior descending artery, which was confirmed later by cardiac catheterization., (Copyright © 2010 Elsevier España, S.L. y SEMNIM. All rights reserved.)

New oncologic procedures are currently more focused on the biological features of tumors. The ideal objective is the administration of personalized effective treatments for each patient that affects not just the location and spread of disease but also special metabolic characteristics of tumoral cells. Radiologic diagnostic methods are extremely important in the management of the patient for staging, restaging, and evaluation of treatment response, and clinicians are avid for some additional functional and metabolic information. Further, they need more dynamic methods for follow-up. Nuclear Medicine and positron emission tomography (PET) in many cases can meet this requirement, although it is not perfect, at least at the present time. Currently 2-((18)F)fluoro-2-desoxi-D: -glucose positron emission tomography is being widely used for oncologic purposes. Its information can be very useful in abdominal diseases and must be taken into account with the results of radiologic imaging. Thus, many changes in the choice of treatment are seen. However, it is very important to know that sometimes there is a lack of specificity that has to be considered.

Introduction: Spontaneous intracranial hypotension (SIH) is an infrequent clinical entity that is found predominantly in young adults and is characterised by the presence of acute or subacute headaches that appear on standing up and subsides on lying down., Case Report: A 35-year-old female with a three-month history of holocranial headaches, accompanied by dizziness and gait instability, which increase on standing up and diminish to a certain extent on lying down, associated to bilateral tinnitus. The patient's history included a slight strain made 4 months earlier, with a sudden non-irradiated pain in the back of the neck that got better spontaneously. On the basis of the clinical and radiological findings from an MRI scan of the head and neck, our service was asked to perform a cisternoscintigraphy., Conclusions: Isotope cisternoscintigraphy using 99mTc-DTPA confirmed the diagnosis of the process and enabled us to locate the CSF leak. We therefore think it advisable to highlight its value in the diagnosis of SIH syndrome so as to be able to avoid the use of other invasive complementary explorations that entail a certain degree of morbidity and mortality.

Objective: To describe the articles published in "Revista Española de Medicina Nuclear" (REMN) from 1991 through 2000., Material and Methods: Five hundred and forty-two articles (originals, reviews, editorials, letters, clinical notes and images of interest) published in REMN during the past 10 years (1991-2000) were gathered. The following variables were assessed: topic, procedure, type of article, number of authors, Spanish region affiliation, country, number of pages and number of references. The results for the five year periods 1991-1995 and 1996-2000 were also presented., Results: Excluding the editorial contributions, the most dealt with topic was the osteoarticular system (14.9%), followed by the heart (14.2%), endocrinology (12.1%), gastroenterology (11.3%) and neurology (10,3%). One hundred and thirty articles were linked to oncology. Madrid (23.7%), Catalonia (22.5%), Andalucia (10.6%) and Aragon (10.1%) were the Spanish regions that made the most contributions. Conventional planar scintigraphic studies were the most used procedure (49.1%), followed by SPECT (16.6%). The countries that were represented most were Spain and Cuba, with 410 and 36 works, respectively. The global trend underwent little change in the above variables in the decade. The pages/paper index was 6.1 +/- 1.7 for original papers and 6.5 +/- 4.3 for reviews. The authors/paper index was 6.3 +/- 2.3 for original papers and 2.7 +/- 2.1 for reviews. The references/paper index was 21.9 +/- 11.4 for original papers and 3+/- 1.1 39.6 for reviews. These three indexes increased in all sections between the periods 1991-1995 and 1996-2000., Conclusions: This survey shows subtle qualitative changes throughout the period analyzed. A quantitative increase in the scientific production in the REMN seems to exist. However, many factors must be considered in the final evaluation of these results and this remains beyond the scope of this descriptive work.

Objective: Cytosolic cathepsin D is a recognized predictor in breast cancer. This study was conducted to determine its behaviour in benign prostatic hyperplasia (BPH) and prostate cancer. The changes according to prostate volume, its relation with other serum markers (PSA, PAP, etc.) in regard to tumor grade, stage and survival were analyzed., Methods: The study was carried out on 376 patients with prostatic disease that had been diagnosed from 1991-1996. Determination of cytosolic cathepsin D levels was performed on all samples of prostate tissue according to the CIS BioInternational Immunoradiometric study., Results: Cathepsin D values ranged from 0.2 to 86.5 pmol/mg (mean 14.9) in patients with BPH and higher values were found for prostates with a larger volume (p = 0.004). A significant difference was found between patients with and those without a bladder catheter (p = 0.024); values were higher in the former group of patients. Cathepsin D values ranged from 0.5 to 74 pmol/mg (mean 18.13) in patients with prostate cancer. A statistically significant difference was found between the mean values of patients with prostate cancer and those with BPH (p = 0.047). In patients with prostate cancer, a significant difference was also found between patients with and those without a catheter (p = 0.04). No relationship was found between cathepsin D and the other parameters analyzed., Conclusions: As in most of the literature reviewed, cytosolic cathepsin D was not found to be a predictor in prostate cancer. Furthermore, no correlation was found between cathepsin D and the other markers analyzed. The foregoing may be due to the small number of tumor samples and short follow-up.

Objective: Gastric carcinoma can be divided into two main histological and clinical types: diffuse and intestinal. The aim of this study was to investigate the expression of neu/c-erbB-2 oncoprotein, epidermal growth factor receptor (EGFR), cathepsin D (catD), progesterone receptor (PR) and tumor-associated glycoprotein-72 (TAG-72) in gastric carcinoma of these histological types., Method: In this randomized, prospective study we analyzed 85 biopsy samples from patients with gastric adenocarcinoma. The control group consisted of 40 specimens from normal gastric mucosa. Neu oncoprotein and PR were determined by ELISA. CatD and TAG-72 were quantified with immunoradiometric (IRMA) methods, and EGFR were studied by radioimmunoassay (RIA)., Results: Neu, EGFR, catD and TAG-72 concentrations were higher in the tumoral group (p = 0.02, p = 0.00001, p = 0.002 and p = 0.007, respectively). In diffuse adenocarcinomas, catD and PR expression was increased (p = 0.01 and p = 0.04 respectively), whereas TAG-72 concentration, which correlated with neu (r = 0.57), was higher in the intestinal type (p = 0.04). No significant differences in EGFR and neu concentrations were seen between the two histological types., Conclusions: The higher PR and catD concentrations in diffuse adenocarcinomas, and the overexpression of TAG-72 in the intestinal type, support the existence of two modes of gastric carcinogenesis.

Various authors have proposed the use of hyaluronic acid (HA) as a tumor marker. In order to analyze its usefulness as a marker in bronchogenic carcinoma, the most common carcinoma in men, we determined the HA values in serum and bronchoalveolar lavage fluid (BAL). We performed prospective studies on two groups of patients: 81 diagnosed as having bronchial carcinoma and 34 with benign respiratory diseases. HA values were higher in patients with cancer than in those with benign diseases (serum: 79.8 ng/ml vs 63.7 ng/ml; BAL: 927 ng/mg vs 522 ng/mg). Also, the percentage of patients with levels exceeding the established cutoff was greater in the group with cancer than in the group with benign disease (serum: 24.6 vs 17.6; BAL: 25.3 vs 3). Statistically significant differences in these percentages were found in BAL (p<0.01). Patients with extended small cell carcinoma had higher HA values (p =0.04) than those with limited disease, and the percentage of patients with abnormal HA values was larger in the group with extended disease than in the group with limited disease (p = 0.004). The serial determinations of HA values in serum reflected the clinical evolution after treatment in 73% of the small cell carcinomas. Most of the patients with benign diseases whose HA values exceeded the cutoff level suffered from acute infectious dis-eases. Once these cases were excluded, the specificity of HA value determination in the diagnosis of carcinoma was very high (serum 96%, BAL 100%). The determination of HA levels in serum or BAL did not have any prognostic value in this study. We conclude that the HA levels in serum and BAL could be of interest as a tumor marker, especially in patients with small cell carcinoma.

Several non-neoplastic conditions, i.e., acute and chronic inflammations, benign tumors, renal or hepatic insufficiency, are associated with elevated plasma levels of Carcinoembryonic Antigen (CEA). Usually, CEA elevation in these pathologies is less than 10 ng/ml. CEA values in non-malignant disease can be affected by many factors, which can be classified into five main categories: a) tissular, b) physiological, c) metabolic, d) circulating and e) methodological factors. Synthesis, expression and release are the most important tissular factors. Among the metabolic ones liver, biliary and renal functions play a primary role in the determination of CEA concentrations. In addition, other factors such as the presence of circulating CEA-like substances, autoantibodies and immunocomplexes or the characteristics of the assay method can influence the diagnostic value of the CEA test. All these factors must be carefully considered when the marker is used in clinical practice.

We assayed prostatic specific antigen (PSA) and prostatic acid phosphatase (PAP) serum levels in 1383 patients using a double antibody radioimmunoassay (RIA) I125. Establishing the upper normal limit in 10 ng/ml PSA and 2.5 ng/ml for PAP, the false positive results were only 1.9 and 5.1 percent in men with non-prostatic benign or malignant pathology and respectively 0 and 2.2 percent in women. We detected false positive levels for these two tumoral markers in 3.5 and 4.7 percent of patients with non-complicated benign prostatic hypertrophy, 64.8 and 19.2 percent in complicated benign prostatic hypertrophy, 24 and 16 percent in acute prostatitis and 3.3 percent in chronic prostatitis. The sensitivity in patients with prostate cancer was 87.2 percent for PSA and 64.1 percent for PAP, and there was a better correlation with PSA than PAP for tumoral spread and histological grading. Finally, clinical efficacy was higher with PSA and was no better when both markers were assayed.

We assayed prostatic specific antigen and prostatic acid phosphatase serum levels in 1,383 patients using a double antibody radioimmunoassay (RIA) 125I. Establishing the upper normal limit in 10 ng/ml for prostatic specific antigen and 2.5 ng/ml for prostatic acid phosphatase, the false positive results were only 1.9 and 5.1% in men with nonprostatic benign or malignant pathology and 0 and 2.2% in women, respectively. We detected false positive levels in 3.5 and 4.7% of the patients with noncomplicated benign prostatic hypertrophy, 64.8 and 19.2% in complicated benign prostatic hypertrophy, 24 and 16% in acute prostatitis and 3.3% in chronic prostatitis for both tumoral markers. The sensibility in patients with prostate cancer was 87.2 and 64.1%, respectively, and there was better correlation with prostatic specific antigen than prostatic acid phosphatase levels on tumoral spread and histologic grading. Finally, the clinical efficacy was higher with prostatic specific antigen and it did not increase with the quantification of both tumoral markers.