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Introduction/Justification: Adenoid cystic carcinoma (ACC) is a tumor of the salivary glands, characterized by insidious growth, recurrences, and distant metastases. Objectives: This study aimed to describe the findings of PET/CT images performed with 18 F-FDG (FDG PET/CT) and 18 F-PSMA-1007 (PSMA PET/CT) in patients with relapsed ACC to verify whether any of these studies are more suitable for identifying local recurrence and distant metastases. Materials and Methods: Patients were submitted to restaging PET/CT studies with 18 F-FDG and 18 F- PSMA-1007 with a 24-hour interval between exams before treatment. Two nuclear medicine physicians compared imaging findings. Results: Patient 1. P.A.C., a 29-year-old female, was diagnosed with ACC of the parotid in 2016. She underwent total parotidectomy and RT. In 2021, a chest computed tomography (CT) identified lung nodules, and the patient underwent resection of the largest lesions. In 2024, the patient was submitted to restaging images with FDG PET/CT that were negative for metastases, but PSMA PET/CT images identified mild PSMA uptake in two pulmonary nodules (0.8 cm, SUV = 2.2; 0.9 cm, SUV = 3.4) suspicious for ACC metastases. The patient remains asymptomatic under supervised follow-up. Patient 2. L.C.O., a 49-year-old male with newly diagnosed ACC in the salivary gland, underwent tumor resection and RT in 2010. The patient recurred in lungs and skull and was submitted to resection of the lung nodules and total skull radiotherapy (RT). In 2022, the patient underwent RT to a metastasis in the 5th lumbar vertebrae. In 2023, FDG PET/CT revealed hypermetabolism in multiple pulmonary nodules (the largest measuring 1.8 cm, SUV = 13.4) and in the L5 vertebrae (SUV = 8.5), consistent with metastases. The PSMA PET/CT showed only mild PSMA uptake in the pulmonary nodules (the largest nodule had a SUV = 4.7) and similar PSMA uptake (as FDG) in L5 vertebrae (SUV = 8.7). The patient is currently asymptomatic. Patient 3. P.C.S., a 46- year-old male, was diagnosed with ACC in the parapharyngeal space and underwent surgical resection followed by RT in 2008. In 2022, a chest CT identified lung metastases, the largest nodule with 3.8 cm. In 2023, a FDG PET/CT demonstrated hypermetabolic lung nodule metastases (the largest measuring 3.0 and 3.8 cm; SUV = 12.3 and SUV = 6.1, respectively). The FDG PET/CT also demonstrated multiple liver nodules (the largest measuring 2.7 cm) without FDG uptake, suspicious for metastases. A PSMA PET/CT showed PSMA uptake in the same lung nodules, however incongruent when compared to FDG uptake: the two nodules measuring 3.0 and 3.8 cm had SUVs of 5.2 and 8.8, respectively). The patient currently reports dyspnea during moderate-intensity physical activity. Conclusion: The data show heterogeneity in FDG PET/CT and PSMA PET/CT findings in relapsed ACC. Combining both PET/CT radiotracers can provide additional information for monitoring patients. PSMA PET/CT has the advantage of the possibility of a theranostic approach. 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, CEPID FAPESP #2021/10265-8), and International Atomic Energy Agency (IAEA) technical cooperation projects for development of Latin American Countries (IAEA/TCLAC: EX-BRA6033-2401375).

Introduction/Justification: Sarcomas are malignant tumors in the bone, cartilage, fat, muscles, and vessels. Sar- comas are highly heterogeneous due to the wide variety of histological subtypes and various ana- tomical locations, and thus, the diagnosis and management of these tumors are challenging. Beyond sarcomas, the musculoskeletal system is a frequent site of metastatic tumors and multiple myeloma with lesions that present difficult local control. Imaging exams such as MRI and 18F-FDG (FDG PET/CT) to assess the extent of these tumors play a crucial role in managing these patients. How- ever, PET/CT imaging with 18F-PSMA-1007 (PSMA PET/CT) may be a more interesting diagnostic marker due to the potential Theranostics implications. Objectives: This study aimed to compare the performance of FDG PET/CT and PSMA PET/CT images in patients with advanced-stage unresectable recurrent and metastatic musculoskeletal tumors. Materials and Methods: Patients underwent FDG PET/CT and PSMA PET/CT imaging with a 24-hour interval be- tween studies. Two nuclear medicine physicians compared imaging findings. Results: Eight patients underwent FDG PET/CT and PSMA PET/CT images. In five patients, PSMA uptake was higher than FDG uptake. The highest PSMA uptake occurred in a giant cell recurrent sacral tumor of a 27-year-old male patient; the SUVs for PSMA and FDG were 100 and 16, respec- tively. A 58-year-old male patient with osteolytic metastasis from renal cell carcinoma in the right scapula presented PSMA uptake higher than FDG (SUVs = 40 and 11, respectively). A recurrent spin- dle cell neural tumor in the upper limb of a 69-year-old male presented PSMA uptake also higher than FDG (SUVs = 27 and 8, respectively). A myxofibrosarcoma mass in the distal right leg of a 61- year-old female presented higher PSMA uptake slightly higher than FDG uptake (SUVs = 18 and 10, respectively). Interestingly, two patients with chordomas had heterogeneous PSMA and FDG up- take. The PSMA PET/CT of a 65-year-old male patient presenting multiple metastases from chor- doma with soft tissue invasion showed uptake higher than FDG in all lesions; the highest SUV was a lesion in the right acetabulum: PSMA SUV = 32 and FDG SUV = 19. This patient presented PSMA-avid additional sites of metastases in mediastinal lymph nodes and the right hepatic lobe, while FDG uptake was minimal in these metastases. In contrast, an FDG PET/CT of a 54-year-old male with a large recurrent chordoma (30x24 cm mass) extending from the level of L4 to the proximal left thigh presented FDG uptake higher than PSMA uptake (SUVs = 31 and 9, respectively). Also, FDG uptake of two patients (52-year-old males) with desmoid tumors in the upper limb was higher than PSMA uptake, although uptake of both radiotracers was low: PSMA SUVs of 3 and 5, and FDG SUVs of 4 and 7. Conclusion: The study results show the potential advantage of using PSMA PET/CT and FDG PET/CT to provide additional information for monitoring patients and combining therapies, especially as PSMA PET/CT demonstrated more extensive disease. PSMA PET/CT has the advantage of the possi- bility of a Theranostic approach.

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: 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: 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.

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.

Abstract Objectives: to evaluate the bone mass in prepubertal patients with Turner Syndrome (TS) according to height age (HA) and verify the influence of karyotype and adiposity. Methods: retrospective and analytical study of prepubertal TS patients. The variables analyzed were: karyotype, age at bone densitometry (BD), height, body mass index (BMI) and BD result. The result of the BD was corrected using HA. BMI and BD were calculated on Z score for chronological age (CA) and for HA. Results: thirty-seven prepubertal patients were selected and after exclusion criteria, 13 cases between 10 and 13 years old were included in the study. The BD for HA was significantly higher than for CA (0.39 ± 1.18 x −1.62 ± 1.32), without karyotype (p=0.369) and BMI (p=0.697) influence. Conclusion: prepubertal TS patients present normal BD when corrected for HA, without influence of karyotype and BMI.

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.

Objective: Evaluate the effect of radiosynovectomy of the ankle with samarium-153 and yttrium-90 in hemophilic arthropathy through the possible reduction of hemarthrosis, analyzing complications, adverse effects, and the need for complementary therapies. Methods: Radiosynovectomy of the ankle in 15 hemophilic patients was analyzed retrospectively and followed between January 2008 and December 2021. The analysis was performed through patients’ medical records and diaries to quantify hemarthrosis that occurred six months before and six months after the procedure. Clinical follow-up and evaluation of outcomes were also analyzed. Results: Eighteen radiosynovectomies of the ankle were performed in 15 patients with a mean follow-up of 124 months. A reduction in episodes of haemarthrosis has been demonstrated within six months (p

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.

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.

This study evaluated two cases of Apert's syndrome, through phonological, cognitive, and neuropsychological instruments and correlated the results to complementary exams. In short, this study reveals the necessity of application of neuropsychological, cognitive and phonological evaluation and correlation of the results with complementary testings because significant differences can be present in the Apert's syndrome.

Fibrodysplasia ossificans progressiva is a rare genetic disease characterized by widespread soft tissue ossification and congenital stigmata of the extremities. We report on a male child followed for ten years since the age of 3 years and 9 months, when the diagnosis was made. He was born with bilateral hypoplasic hallux valgus and ventricular septal defect, corrected by transsternal approach when 32 months old. Restriction of neck mobility followed and foci of ectopic ossification appeared. Four crises of disease exacerbation were treated with oral prednisone and/or other antiinflammatory drugs. Sodium etidronate 5 to 10 mg/kg/day was prescribed intermittently during about six years but was discontinued due to osteopenia. The disease course has been relentless, with severe movement restriction including the chest wall. A review showed few similar case reports in the Brazilian literature. We revisit the criteria for diagnosis and the essentials of management and treatment.

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.

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.