Gimeno J, Berná L, Proubasta J, Martínez-Duncker C. Exploraciones isotópicas en pacientes con tumores primitivos óseos y patología infecciosa. Radiología (España) 1988;9:563-567.
Carrió I, Berná L, M. Estorch, Martínez-Duncker C. Tratamiento del Hipertiroidismo con Radioyodo, Hoy. Rev Esp Med Nucl 1989;8(I):3-5.
M. Estorch, I. Carrió, A. Artigas, J. Rodríguez-Arias, L. Berná, C. Martínez-Duncker, M. Ginjaume. Estudio de la Contractilidad del Ventrículo Derecho mediante Ventriculografía Isotópica. Rev Lat Cardiol 1989:10(3);177-182.
Mora J, Martin-Comin J, Carrio I, Berna L, Estorch M, Martinez-Duncker C, Gomez D, Daumal J, Ramos M. Utilidad de la gammagrafía miocárdica con Metoxi-Isobutil-Isonitrilo-Tc99m en el diagnóstico de la enfermedad coronaria. Rev Esp Cardiol 1990;43(1):18-22. We have studied 24 patients (21 males and 3 females) with coronary artery disease. Stress and rest myocardial scintigraphy was performed in all cases with 15-20 mCi of Tc99m methoxy-isobutyl-isonitrile. The examination was done in 2 sessions. Usually the stress scan was obtained and within 2-4 days the rest study was obtained. All patients underwent selective coronary arteriography within a week of the scintigraphy and, in 13 cases, rest radiologic ventriculography was also performed. In 5 patients coronary arteriography and myocardial scintigraphy were normal. In 19 cases the coronary arteriography showed lesions, the myocardial scintigraphy showed ischemia or necrosis in 17 of them and was normal in two. To localize the pathologic vessel the myocardium was divided into 3 segments and segmentary analysis localized the abnormal coronary artery in 51 out of 72 cases. The best availability of the new myocardial agent and the results obtained make it a good tracer for myocardial studies.
Germá JR, Alvarez I, Carrió I, Estorch M, Berná L, Martinez-Duncker C, Marcuello E, Nogueras FM. Aplicación clínica de la Radioinmunolocalización en el Cáncer Colorrectal. Med Clínica (Barc) 1990;94(9):325-328. We present preliminary results of radioimmunolocalization (RIL) of colorectal cancer with 131I labelled F(ab')2 fragments from monoclonal anti CEA and anti CA 19.9 antibodies in 22 patients with colorectal cancer and in one patient with metastases of unknown origin and high CEA value. Positive images were obtained in 7 of 11 primary tumors from 10 patients evaluated preoperatively; in 2 of 3 recurrences; in 9 of 12 metastatic localizations and in the unknown primary tumor localized, finally in the cecum. One local recurrence was not detected by any diagnostic methods, but RIL. There was not false-positive images. Therefore, RIL appears as a promising method for the diagnosis and follow-up of colorectal cancer.
Martínez-Duncker C, Estorch M, Berná L, y cols. Perfiles Circunferenciales Versus Análisis Visual en los Estudios de Perfusión Miocárdica de Esfuerzo con Talio-201. Rev Esp Cardiol 1990;43(3):171-176. Two methods of analysis for perfusion myocardial studies with thallium are compared: the conventional visual analysis, and a quantitative method which shows results as circumferential profiles. Three hundred and ninety myocardial segments in 65 patients were studied. Visual analysis showed abnormalities in 44/65 (68%) patients, the quantitative method did it in 53/65 (81%). When localization and/or extension discrepancy between the two methods was found, angiography was always concordant with circumferential profiles findings. Total agreement between the two methods was present in 20/65 (31%) patients. The quantitative method is more sensitive than the visual analysis. It is also more precise in defining localization and extension of thallium defects.
Duncker CM, Carrió I, Berná LL, Estorch M, y cols. Radioimmune Imaging of Bone Marrow in Patients with Suspected Bone Metastases from Primary Breast Cancer. Journal of Nuclear Medicine 1990;31(9):1450-1455. Radioimmune imaging of bone marrow was performed by technetium-99m- (99mTc) labeled antigranulocyte monoclonal antibody BW 250/183 (AGMoAb) scans in 32 patients with suspected bone metastases from primary breast cancer. AGMoAb scans showed bone marrow defects in 25/32 (78%) patients; bone invasion was subsequently confirmed in 23 (72%) patients. Conventional bone scans performed within the same week detected bone metastases in 17/32 (53%) patients (p less than 0.001). AGMoAb scans detected more sites indicating metastatic disease than bone scans in 12 of these 17 patients (71%). All patients with bone metastases in the axial skeleton had bone marrow defects at least at the sites of bone metastases. Of 15 patients with normal, or indicative of, benign disease bone scans, 8 patients (53%) presented with bone marrow defects in the AGMoAb scans. Bone invasion was confirmed in six of them. AGMoAb bone marrow scans provide a method for the early detection of bone metastatic invasion in patients with breast cancer and suspected bone metastases.
Rhodes BA, Martínez-Duncker C. Direct Labeling of Antibodies with Tc-99m. American Biotechnology Laboratory 1990;8(4):50-53.
Berná L, Martínez-Duncker C, Estorch M, Segarra A, Alonso C, Ojeda B, Germá JR, Blanco R, Carrió I. Estudio gammagráfico de la médula ósea con un anticuerpo monoclonal antigranulocitos-Tc-99m: Valor complementario a la gammagrafía ósea. Rev Esp Med Nucl 1990;9:35-37.
Carrió I, Serra R, Berná Ll, Estorch M, Martínez C, Ordoñez J. Transient Alterations in Cardiac Performance After a 6 Hour Race. Am J Cardiol 1990;65(22):1471-1474. Ten long distance runners were enrolled in a 6-hour competitive race. Immediately after the race technetium-99m-albumin gated blood pool scans were performed and indium-111 antimyosin was injected. Forty-eight hours later antimyosin scans were obtained and control gated blood pool scans were performed. Left ventricular ejection fraction was higher after the race (65 +/- 5 vs 60 +/- 7%, p less than 0.01) due to a decrease in end-systolic counts. Right ventricular ejection fraction was lower after the race (42 +/- 7 vs 54 +/- 12%, p = 0.03) due to an increase in both end-diastolic and end-systolic counts. A longer systolic period was observed after the race (53 +/- 5% of the RR interval vs 39 +/- 3%, p = 0.005). No significant differences were observed in peak filling or peak emptying rates after the race. An increase in pulmonary blood volume (116% of control) was observed after the race. Antimyosin scans were normal in 7 athletes and minimal antimyosin myocardial uptake was seen in 3. Transient alterations in biventricular performance present after the race correspond to function adaptation to strenuous exercise and are not due to irreversible myocyte damage.
Estorch M, Carrió I, Berná L, Martínez-Duncker C, Alonso C, Germá JR, Ojeda B. Indium-111-Antimyosin Scintigraphy After Doxorubicin Therapy in Patients with Advanced Breast Cancer. Journal of Nuclear Medicine 1990;31(12):1965-1969. Indium-111-antimyosin (111In-antimyosin) scans were performed in 20 women with advanced breast cancer after 10 cycles of chemotherapy consisting of cyclophosphamide, 5-fluorouracil and doxorubicin (total cumulative dose of doxorubicin of 500 mg/m2). Antimyosin uptake in the myocardium was quantified by means of a heart-to-lung ratio (HLR). Antimyosin uptake in the myocardium was observed in 17/20 (85%) patients, and HLR after chemotherapy was 1.86 ± 0.25. Left ventricular ejection fraction (EF) was determined before and after chemotherapy. Patients with decreased EF (8/20, 40%) presented with more intense antimyosin uptake (HLR of 2.11 ± 0.10 versus 1.70 ± 0.16 (p = 0.01)). HLR values correlated with EF values after chemotherapy (r = –0.47, p < 0.05). Positive antimyosin studies after chemotherapy including doxorubicin, indicate the presence of myocardial damage in these patients. Antimyosin studies are a sensitive method to detect myocyte damage in patients after doxorubicin therapy.
Carrio I, Estorch M, Berna L, Germa JR, Alonso C, Ojeda B, de Andres L, Lopez-Pousa A, Martinez-Duncker C, Torres G. Assessment of anthracycline-induced myocardial damage by quantitative indium 111 myosin-specific monoclonal antibody studies. European Journal of Nuclear Medicine 1991;18(10):806-12. To assess chemotherapeutically induced myocardial damage, myosin-specific antibody scans and ejection fraction measurements were performed in 32 patients with breast cancer and in 9 patients with other tumours. All patients had received chemotherapy including anthracyclines. The ejection fraction decreased by less than or equal to 10% in 14 of 41 (34%) patients after chemotherapy. Antimyosin uptake in the myocardium was observed in 38 of 41 (92%) patients after chemotherapy. Antimyosin uptake was quantified by means of a heart-to-lung ratio, revealing a correlation between the degree of antimyosin uptake in the myocardium and the cumulative dose of anthracycline. Patients with a decreased ejection fraction showed more intense antimyosin uptake, indicating more severe myocardial damage. A higher degree of antimyosin uptake was found in 17 breast cancer patients treated with doxorubicin compared with 15 patients treated with mitoxantrone. We conclude that antimyosin studies provide a sensitive, non-invasive method to monitor myocardial damage in patients treated with anthracyclines. Antimyosin uptake in the myocardium precedes ejection fraction deterioration. This technique may be helpful in the early identification of patients at risk of congestive heart failure during chemotherapy including anthracyclines.
Martínez-Duncker C. Nuevas técnicas en Cardiología Nuclear. SPECT, PET y Antimiosina. [New techniques in nuclear cardiology: SPECT, PET and antimyosin]. Arch Inst Cardiol Mex 1991;61(6):597-601. Nuclear Cardiology offers non-invasive techniques of high reproducibility for cardiovascular assessment. These techniques have advanced enormously in the latest years. The advances in areas such as general technology and computer systems, medicine, immunology and research, allow us to obtain and interpret cardiac information with immediate or potential clinical applications unavailable few years ago. This paper describes 3 of these new techniques in nuclear cardiology: Single Photon Computed Tomography (SPECT); Positron Emission Tomography (PET) and; the use of an Antimyosin monoclonal antibody.
J. Monés, I. Carrió, M. Roca,. M. Estorch, R. Calabuig, S. Sainz, C. Martínez-Duncker, F. Vilardell. Gastric Emptying of Two Radiolabelled Antacids. Gut 1991:32(2):147-150. The rate of gastric emptying of two antacids, magaldrate and Maalox, was investigated using scintigraphy. Successful labelling of the antacids was carried out with 99mTc. The stability of the 99mTc- labelled antacids was satisfactory and there was no difference in antacid capacity between the labelled and unlabelled antacids. The studies were carried out on 15 healthy male volunteers. After an eight hour fast each subject ingested a standardised meal of 95.7 MJ (400 kcal). One hour later 10 ml of one of the two antacids previously labelled with 99mTc was administered. Serial detection by anterior and posterior projection of the amount of antacid retained in the stomach was performed to determine gastric emptying of antacid. One week later the study was repeated under the same conditions with the other antacid also labelled with 99mTc. The mean (SD) percentages of antacid retained in the stomach fit a linear model with a t1/2 of 86.6 (15.3) minutes for magaldrate and 52.3 (5.2) minutes for Maalox (p less than 0.01). When the mean percentages of retention at six time intervals were compared for both antacids, it was found that Maalox emptied much faster (p less than 0.01 at 15 and 30 minutes, p less than 0.02 at 45, 60, 75, and 90 minutes).
Serra-Grima R, Carrió I, Estorch M, Trilla E, Berná L, Martínez-Duncker C, Rodas G. The effect of prolonged physical exercise on ventricular function. Int J Sports Cardiol 1992;1:79-82. The aim of this study is to evaluate alterations of the ventricular function in long-distance runners. A radio nuclide ventriculography was recorded at rest and immediately after the athletes ran during 2 h. 30 min. There was a significant difference between basal heart rate and mean heart rate post-exercise. The systolic time was significantly longer after race (P< 0.005). There was not a difference between ejection fraction at rest and post-exercise. The etiology of this phenomenon is unknown.
Martínez-Duncker C. Cardiología Nuclear: Isquemia Miocárdica y Viabilidad Celular. Principia Cardiológica. EPOCA 2, 1992;6(2):2-7.
Torres G, Martinez-Duncker C, Pujol J, Estorch M, Berna L, Marti-Vilalta JL, Carrio I. Tomografía cerebral por emisión de fotón único. Análisis semicuantitativo de territorios vasculares en pacientes con patología vascular cerebral. [Cerebral single-photon emission-computed tomography. A semiquantitative analysis of vascular areas in patients with cerebrovascular pathology]. Med Clin (Barc) 1992;22;98(7):241-4. BACKGROUND: Brain SPECT perfusion studies in patients with cerebral stroke may be useful to evaluate distant perfusion abnormalities. METHODS: 99mTc-HMPAO brain SPECT studies were performed in 17 patients with ischemic lesions in the basal ganglia and/or internal capsule demonstrated by NMR. Regions of interest were adjusted in representative transverse slices to the vascular territories of the anterior, middle, posterior and communicating cerebral arteries. RESULTS: Patients with ischemic lesions in the right basal ganglia showed increased cerebral perfusion in the left middle artery territory (0.95 +/- 0.13 versus 0.80 +/- 0.06; p = 0.0365). Patients with ischemic lesions in the left basal ganglia showed increased perfusion in the right anterior artery territory (0.93 +/- 0.09 versus 0.82 +/- 0.09; p = 0.0464), in the left anterior artery territory (0.93 +/- 0.09 versus 0.83 +/- 0.14; p = 0.0464), in the left middle artery territory (0.92 +/- 0.09 versus 0.78 +/- 0.05; p = 0.0079) and in the left posterior artery territory (1.05 +/- 0.14 versus 0.90 +/- 0.09; p = 0.036). Patients with ischemic lesions in the right internal capsule showed increased perfusion in the right posterior artery territory (0.95 +/- 0.11 versus 1.10 +/- 0.18; p = 0.0431). CONCLUSIONS: These results show the presence of delayed luxury perfusion phenomena in regions distant from the ischemic site.
Férez S, Martínez-Duncker C, Vargas J, Vázquez G, Verdejo J, Sghaib S. Isquemia Miocárdica Asintomática. Nueva Cardiología 1993;3:6-13.
Martínez-Duncker C, Carrió I. Utilidad de un Anticuerpo Monoclonal Antigranulocitos Marcado con Tecnecio-99m en la Identificación de Enfermedad Infecciosa de Localización Osea y Extraósea. Revista de Sanidad Militar 1993;47(2):44-48.
Civelek C, Martínez-Duncker C, Becker L.C Temporarily Altered Thallium-201 Redistribution Following Acute Myocardial Infarction: An Unreported Manifestation of Stunned Myocardium. Am J Cardiac Imaging 1993;7(1):63-67.
Martínez-Duncker C, Martínez-Duncker D, Takatsu H, Civelek C, Becker LC. El tamaño de área a riesgo de infarto determina la función ventricular izquierda residual en pacientes con un primer infarto agudo de miocardio. Revista Médica del Hospital General de México 1994:57(3);110-118.
Martínez-Duncker C. Medicina Nuclear en Pediatría: Utilidad Básica de la Gammagrafía Hepática, Osea, Renal y Cerebral. Revista Mexicana de Puericultura y PEDIATRIA, 1994;1(3);73-88.
Martínez-Duncker C, Fosado-Márquez MG. Utilidad de la Medicina Nuclear Molecular en el estudio de la patología ósea más frecuente en pediatría. Bol Med Hosp Infant Mex1995:52;543-548.
Martínez-Duncker C. Definición y aplicaciones clínicas modernas de la Medicina Nuclear Molecular: Diagnóstico y tratamiento con énfasis en pediatría. Bol Med Hosp Infant Mex1995:52;731-746.
Martínez-Duncker C, Alcántara-Ramírez R, Fosado-Márquez MG, Mayén-Pérez FG, Lagarde-Campos L. Medicina Nuclear: Estudio de la función renal en pediatría. Bol Med Hosp Infant Mex 1995:52;606-613.
Martínez-Duncker C, Fosado-Márquez MG. Aspectos biológicos y Médicos básicos sobre las radiaciones ionizantes. Bol Med Hosp Infant Mex 1995:52;669-678.
Takatsu H, Duncker CM, Arai M, Becker LC. Cardiac Sympathetic nerve function assessed by I-131-MIBG after ischemia in anesthetized dogs. Journal of Nuclear Cardiology, 1997;4:35-41. Background. Accumulation of 131I-labeled metaiodobenzylguanidine ([131I]MIBG), a radiolabeled norepinephrine analog, is reduced in infarcted myocardium, suggesting loss of cardiac sympathetic nerve viability. Histopathologic studies, however, indicate that the nerve endings are morphologically intact. Experiments were therefore designed to determine the mechanism of reduced MIBG accumulation. Methods and Results. Desipramine, a specific blocker of neuronal norepinephrine reuptake, was used to separate the portions of total myocardial [131I]MIBG accumulation attributable to neuronal and nonneuronal uptake mechanisms. Sixteen dogs underwent circumflex coronary artery occlusion for 60 minutes followed by a 5-hour reperfusion. [131I]MIBG was injected intravenously 1 hour after reperfusion. The left ventricle was removed and incubated in triphenyltetrazolium chloride to identify infarcted and viable myocardium within the zone at risk. Preliminary studies in sham-operated dogs showed that pretreatment with desipramine (5 mg/kg) reduced [131I]MIBG accumulation 4 hours after injection to 38.9% of untreated controls. Chemical sympathectomy by topical phenol resulted in a similar decrease in [131I]MIBG accumulation (to 45.7% of normal), and desipramine did not produce further inhibition of [131I]MIBG accumulation over that produced by phenol alone, indicating that the inhibitory effect of desipramine on neuronal accumulation of [131I]MIBG was essentially complete. In dogs undergoing ischemia-reperfusion, myocardial samples from infarcted and viable postischemic areas showed 64.5% ± 11.8% and 84.7% ± 9.1% of normal [131I]MIBG activity, respectively (both, p < 0.01 vs normal area, n = 9). With desipramine pretreatment (n = 7), accumulation of [131I]MIBG decreased in all areas. Neuronal accumulation was reduced uniformly in infarcted, viable postischemic, and normal areas by 30% to 35% compared with sham-operated controls. In contrast, nonneuronal accumulation was only 39.3% in infarcted areas and 84.6% in viable postischemic areas compared with normal areas, and these decreases accounted entirely for the reduced total [131I]MIBG accumulation. Conclusions. Reduced [131I]MIBG accumulation in infarcted myocardium after 60 minutes of ischemia and 5 hours of reperfusion is attributable to a deficit in nonneuronal accumulation and not to decreased accumulation by sympathetic nerves.
Martínez-Duncker C. Representación tridimensional de la perfusión ventricular izquierda en estrés farmacológico y reposo en pacientes con isquemia miocárdica [Tridimensional representation of left ventricular perfusion during pharmacological stress and rest in patients with myocardial ischemia]. Gac Med Mex 1998;134(1):103-5.
Takatsu H, Duncker CM, Arai M, Becker LC. Granulocyte accumulation in ischemic/reperfused myocardium: Assessment with a technetium-99m labeled antigranulocyte monoclonal antibody in the dog. J Nucl Cardiol, 1999;6(5):641-650. This study tested the usefulness of technetium-99m—labeled antigranulocyte monoclonal antibody BW250/183 (AGMAb) for identifying granulocyte accumulation in ischemic/reperfused canine myocardium. In dogs with 90 minutes coronary artery occlusion and 180 minutes reperfusion (n = 8), ischemic/reperfused myocardial samples demonstrated 8.5 ± 2.4 times more Tc-99m—AGMAb accumulation than nonischemic samples. Dogs given Tc-99m—labeled nonspecific human immunoglobulin instead of Tc-99m—AGMAb (n = 3) had about half as much accumulation (4.5 ± 1.6, P < .05). Ex vivo myocardial imaging of Tc-99m—AGMAb demonstrated marked uptake in infarcted regions identified by absent triphenyl tetrazolium chloride staining. The amount of uptake was inversely related to the severity of ischemia (determined by radioactive microspheres) and directly correlated with tissue myeloperoxidase activity, a specific marker of granulocyte accumulation. No increase in Tc-99m—AGMAb uptake occurred in dogs with 90 minutes ischemia and no reperfusion (n = 3) or 15 minutes ischemia and 180 minutes reperfusion (n = 2). In conclusion, Tc-99m—AGMAb is taken up in reperfused infarcted myocardium by both nonspecific and specific mechanisms. Because the amount of uptake reflects myocardial granulocyte accumulation, Tc-99m—AGMAb combined with nuclear imaging techniques may be useful for studying inflammatory processes in the heart in experimental animal models and human beings.
Martínez-Duncker C, Soto-Gutiérrez S. La gammagrafía en la evaluación de pacientes pediátricos con fiebre de origen desconocido. Bol Med Hosp Infant Mex 1999:56;504-510.
Martínez-Duncker C, Soto-Gutiérrez S, Pérez- R. Renografía radioisotópica con diurético en la evaluación de los procesos obstructivos del tracto urinario superior en pacientes pediátricos. Bol Med Hosp Infant Mex 1999:56(12):667-672.
Martínez-Duncker C. Reflujo gastroesofágico. Carta al Editor. Bol Med Hosp Infant Mex 1999:56(12):686-687.
Duncker, CM. Nuclear Medicine in Latinamerica. Journal of Nuclear Medicine 2000;41(2):36N.
Martínez-Duncker C, Soto-Gutiérrez S, Pérez- R. La gammagrafía hepatobiliar en el diagnóstico diferencial de la atresia de vías biliares Bol Med Hosp Infant Mex 2000;57(9):517-521.
Cortés-Blanco A, Martínez-Lázaro R, Martínez-Duncker C. Images in Nephrology. Unusual diffuse I-131 MIBG accumulation in a kidney with renal artery stenosis. Nephrol Dial Transplant 2000;15:1885-1886.
Rivero-Escalante H, Dorantes-Álvarez LM, García-Morales L, Coyote-Estrada N, Martínez-Duncker C, Palafox-Vázquez H y Peña-Alonso R. Frecuencia de la enfermedad tiroidea autoinmune en niños con diabetes mellitus tipo 1. Bol Med Hosp Infant Mex 2001;58:627-634. Introducción. Los reportes en la literatura mundial informan una prevalencia de enfermedad tiroidea en pacientes con diabetes mellitus insulino-dependiente de 7.3 a 23.4% y se ha identificado como factor de riesgo de enfermedad tiroidea a los anticuerpos microsomales (ACM). Los objetivos de este estudio fueron determinar la frecuencia de enfermedad tiroidea en la población de pacientes diabéticos tipo 1 y la prevalencia de ACM en dichos pacientes. Material y métodos. Estudio observacional, transversal y descriptivo. Se estudiaron pacientes con diabetes mellitus tipo 1 que acudieron al Departamento de Endocrinología del Hospital Infantil de México Federico Gómez de febrero a septiembre de 1998. A todos los pacientes se les realizó palpación del cuello en búsqueda intencionada de bocio, perfil tiroideo y anticuerpos microsomales. Los resultados se evaluaron por medio de la prueba t de Student, chi cuadrada y los valores predictivos con análisis Bayesiano. Resultados. De los 108 pacientes, 41 correspondieron al género masculino y 67 al femenino. Se encontraron 13.9% de pacientes con bocio, 18.3% con disfunción tiroidea y 6.4% con ACM positivos. Predominó el bocio eutiroideo con 53.3%, seguido de bocio hipotiroideo en 33.3%. El hipotiroidismo se encontró posterior al inicio de la diabetes mellitus tipo 1 (2.76 ± 0.9 años) y el hipertiroidismo fue prácticamente concomitante (0.42 ± 0.5). Se encontró un valor predictivo positivo de 71% y un valor predictivo negativo de 86% para disfunción tiroidea con ACM, considerándose éstos como un factor de riesgo y no como un factor determinante. Conclusiones. Se encontró una frecuencia elevada de pacientes diabéticos tipo 1 con bocio y disfunción tiroidea. Se recomienda la realización de perfiles tiroideos anuales en estos pacientes.
Martínez-Duncker C, Hurtado-López LM, Martínez-Duncker I, Arellano-Montaño S, Torres-Acosta EM, Zaldivar-Ramírez FR, Guerrero-Aguirre A, Duarte-Torres R, Camarillo-Basurto C, León-García S. La ausencia de captación de Tc-99m-MIBI descarta la presencia de tejido neoplásico en pacientes con nódulo tiroideo único no funcional. Cirujano General 2002;24(3):179-183. Objetivo: Estudiar la capacidad de la gammagrafía tiroidea con Tc-99m-MIBI (MIBI) en el diagnóstico diferencial de lesiones benignas vs malignas en pacientes con nódulos tiroideos palpables resecados quirúrgicamente. Material y métodos: Entre enero de 2000 y abril de 2001 se realizó gammagrafía tiroidea con MIBI a pacientes consecutivos con nódulo tiroideo palpable que después fueron operados mediante tiroidectomía. Los pacientes se dividieron en 2 grupos dependiendo de si el nódulo tiroideo mostró captación de MIBI (MIBI positivo) o si no lo hizo (MIBI negativo). Los hallazgos gammagráficos fueron comparados con el resultado histopatológico definitivo (RHPD) de las piezas quirúrgicas. Análisis estadístico: Tablas de contingencia y Ji cuadrada. Resultados: En este análisis se incluyen los resultados obtenidos en 64 pacientes consecutivos. Los RHPD mostraron que 47/64 pacientes tuvieron lesiones benignas y 17 pacientes tuvieron lesiones malignas. De los 47 pacientes con RHPD de benignidad, 18 pacientes se catalogaron como MIBI positivo y 29 como MIBI negativo. De los 17 pacientes con RHPD de malignidad, los 17 (100%) se clasificaron como MIBI positivo. La sensibilidad y el valor predictivo de un MIBI negativo fueron del 100%. Conclusión: Nuestros resultados concuerdan con los hallazgos ya informados en la literatura, la captación de MIBI en el nódulo tiroideo no es capaz de diferenciar entre tejido maligno y tejido benigno. Sin embargo, ningún paciente con lesión tiroidea neoplásica tuvo MIBI negativo, por lo que en los pacientes con nódulo tiroideo no funcional y MIBI negativo se justifica seguimiento clínico conservador.
Hurtado-López LM, Martinez-Duncker C, Arellano-Montaño SA, Torres-Acosta EM, Zaldivar-Ramirez FR, Pulido-Cejudo A, Basurto-Kuba E, Duarte-Torres R. Evaluación metabólica del nódulo tiroideo no funcional: Comparación entre pirofosfatos y metoxi-isobutil-isonitrilo. Rev Med Hosp Gen Mex 2003;66(3):131-135. Objetivo: Conocer el valor diagnóstico de la evaluación metabólica del nódulo tiroideo no funcional con tecnecio 99 meta-estable con pirofosfatos (Tc-99m-PYP) y tecnecio 99 meta-estable con metoxi-isobutil-isonitrilo (MIBI). Material y método: Estudio prospectivo, longitudinal, ciego, analítico, con estándar de referencia diagnóstica en 40 pacientes. Las variables estudiadas: edad y sexo, capacidad de diagnosticar cáncer por el gammagrama de perfusión con Tc-99m-PYP y del metabólico con MIBI. Se determinó sensibilidad, especificidad, valores predictivos positivos y negativos, exactitud diagnóstica, prevalencia y razones de probabilidad (RP) positiva y negativa. Resultados: Se estudiaron 38 mujeres y dos hombres, edad promedio 38 años, con diagnóstico final de bocio coloide 20, tiroiditis cuatro, adenomas cuatro, bocios adenomatosos dos, cáncer papilar nueve y cáncer folicular uno. El Tc-99m-PYP tuvo sensibilidad 20% y especificidad 56.6% con una capacidad diagnóstica que impacte en la toma de decisión muy baja (RP positiva 0.45 y negativa 1.43). El valor diagnostico del MIBI tuvo una sensibilidad de 100% y especificidad de 63%, valor predictivo negativo es del 100%; por lo tanto, el impacto de la toma de decisión diagnóstica importante (RP positiva de 2.7 y negativa de 0). Conclusión: La evaluación metabólica del nódulo tiroideo no funcional deberá realizarse sólo con el gammagrama de Tc-99m-MIBI, ya que cuando el trazador no sea captado por el nódulo significa 100% de benignidad.
Martínez-Duncker C, Hurtado-López LM. Normatividad para la administración de I-131 con fines de diagnóstico y/o tratamiento en México. Rev Edocrinol Nutr 2003;11(4):179-181. En México los servicios de medicina nuclear que administren materiales radiactivos a pacientes con fines diagnósticos y/o terapéuticos deben observar los requisitos de seguridad radiológica descritos en la Norma Oficial Mexicana NOM-013-NUCL-1995. Con el propósito de divulgar el contenido de esta Norma realizamos esta breve revisión sobre los requisitos de seguridad radiológica que deben ser observados para egresar a pacientes a quienes se les ha administrado material radiactivo con fines de diagnóstico y/o tratamiento en México. Los requisitos actualmente vigentes en México fueron modificados en EUA en 1997 debido a un estudio económico realizado que calcula que con las modificaciones ahorran 9 millones de dólares anuales en hospitalización y tiempo perdido no laboral. En un medio socioeconómico como el nuestro, donde la carencia de recursos y deseo de ahorro es imperativo, sin decremento en la eficiencia de servicios, sería de gran valor iniciar la revisión, por medio de las autoridades respectivas, de la NOM-013-NUCL-1995, a fin de actualizarla y poder brindar el beneficio de la terapéutica con yodo-131 a dosis mayores de las hasta ahora permitidas, ya que eso podría repercutir en ahorros significativos y un menor costo de dichos tratamientos para el país. Mientras tanto, la NOM-013-NUCL-1995 es de observancia obligatoria en todo el territorio nacional mexicano.
Hurtado–López LM, Arellano MSA, Martínez–Duncker C y cols. Biopsia de tiroides por aspiración, con aguja fina, no diagnóstica: ¿Qué hacer? Cirujano General 2003;25(1):14-18. Introducción: La biopsia por aspiración con aguja fina de tiroides (BAAF) es una herramienta fundamental en el diagnóstico del nódulo tiroideo no funcional, sin embargo tiene límites cuando no es diagnóstica. Objetivo: Evaluar las diferentes armas diagnósticas, paralelas a la BAAF, como son la clínica, el ultrasonido (US), el gammagrama con Tc-99-Metoxi-isobutil-isonitrilo (MIBI) y el estudio transoperatorio por congelación (ETO) a fin de tratar de aclarar la conducta a seguir frente a un nódulo tiroideo no funcional con BAAF indeterminada. Material y métodos: : Clignidad por ultrasonido, diagnóstico de malignidad por gammagrafía con Tc-99-MIBI y diagnóstico de malignidad por estudio transoperatorio por congelación. Todos los pacientes fueron intervenidos quirúrgicamente. El análisis de las variables se realizó mediante la determinación de sensibilidad, especificidad, exactitud, valor predictivo positivo, valor predictivo negativo, prevalencia y razón de probabilidad positiva y negativa para cada método diagnóstico alterno comparado con el estudio histopatológico final. Resultados: De las 24 biopsias no diagnósticas, cinco BAAF fueron inadecuadas y 19 indeterminadas. Veintidos correspondieron al sexo femenino y 2 al masculino, con una edad media 38 años, rango de 16 a 62 años (DE ± 12.9 años) moda 42 y mediana de 39 años. Seis (25%) fueron cáncer. La clínica y el ultrasonido no demostraron impacto importante en la toma de decisión terapéutica, El gammagrama con MIBI proporcionó un valor predictivo negativo de 100% con Razón de probabilidad negativa de 0, el ETO demostró un valor predictivo positivo de 100% y razón de probabilidad positiva de 0. Conclusión: Los únicos estudios paralelos a la BAAF con valor diagnóstico, confiables para el manejo diagnóstico/terapéutico de nódulo tiroideo no funcional con BAAF no diagnóstica, fueron: el MIBI y el ETO.
Hurtado-López LM, Martínez-Duncker C, Arellano-Montaño Sara, Torres Acosta EM, Duarte-Torres RM. Evaluación metabólica del nódulo tiroideo quístico. Rev Edocrinol Nutr 2003;11(4):162-165. Introducción: La dificultad que plantea el enfrentarse a una tumoración tiroidea quística, consiste en saber si se trata de una lesión benigna o maligna. Por lo tanto el objetivo del presente trabajo es determinar si la evaluación metabólica de las lesiones quísticas de tiroides brindan información para tomar una conducta segura y si ésta es complementaria a la biopsia por aspiración con aguja fina (BAAF). Material y métodos: Estudio prospectivo, longitudinal, analítico, ciego en 140 nódulos tiroideos no funcionales eliminando BAAF de nódulos sólidos e incluyendo los nódulos de contenido quístico. Se determinó el valor diagnóstico de la evaluación metabólica por medio del gammagrama con Tc-99-MIBI. El análisis estadístico se realizó mediante medidas de tendencia central y la determinación de sensibilidad, especificidad, exactitud, valor predictivo positivo, valor predictivo negativo (VP), prevalencia y razón de probabilidad positiva y negativa para cada método diagnóstico alterno. Resultados: De 140 pacientes con nódulo tiroideo, 26 (18.6%) presentaron lesión quística. Veinticuatro mujeres y 2 varones con edad promedio de 43.1 años (moda de 55 años, rango de 17 a 63 años). Por BAAF sólo se hizo diagnóstico en 5 (19.23%); en cambio por MIBI (negativo) se detectaron 17 (65.38%) nódulos benignos y por MIBI (positivo) 6 (23.08%) malignos; 3 (11.54%) no fueron diagnosticados por ninguno de los dos métodos. El valor diagnóstico del MIBI fue sensibilidad 100%, especificidad 85%, VP+ 66.6% VP- 100% exactitud 88.4%, RP+ 6.6 y RP- 0. Conclusiones: Todo nódulo quístico sin diagnóstico por BAAF debe ser evaluado metabólicamente por medio de MIBI, si no capta MIBI debe ser tratado como nódulo benigno con seguridad de 100%, si capta MIBI debe ser intervenido quirúrgicamente con alta probabilidad de cáncer.
LLM Hurtado, RC Martínez-Duncker, MS Arellano, ASM. Evaluación metabólica del nódulo tiroideo no funcional: Comparación entre pirofosfatos y metoxi-isobutil-isonitrilo. Rev Med Hosp Gen Mex 2003;66(3):131-135
Meléndez-Alafort L, Rodríguez Cortés J, Ferro-Flores G, Arteaga de Murphy C, Herrera Rodríguez R, Mitsoura E, Martínez-Duncker C. Biokinetics of (99m)Tc-UBI 29-41 in humans. Nucl Med Biol 2004;31(3):373-9. Antimicrobial peptides have been proposed as new agents to distinguish between bacterial infections and sterile inflammatory processes. (99m)Tc-UBI labeled by a direct method has shown high in vitro and in vivo stability, specific uptake at the site of infection, rapid background clearance, minimal accumulation in non-target tissues and rapid detection of infection sites in mice. The aim of this study was to establish a (99m)Tc-UBI biokinetic model and evaluate its feasibility as an infection imaging agent in humans. Whole-body images from 6 children with suspected bone infection were acquired at 1, 30, 120, 240 min and 24 h after (99m)Tc-UBI administration. Regions of interest (ROIs) were drawn around source organs (heart, liver, kidneys and bladder) on each time frame. The same set of ROIs was used for all 6 scans and the cpm of each ROI were converted to activity using the conjugate view counting method. Counts were corrected by physical decay and by the background correction factor derived from preclinical phantom studies. The image sequence was used to extrapolate (99m)Tc-UBI time-activity curves in each organ and calculate the cumulated activity (A). Urine samples were used to obtain the cumulative percent of injected activity (% I.A.) versus time renal elimination. The absorbed dose in organs was evaluated according to the general equation described in the MIRD formalism. In addition, (67)Ga-citrate images were obtained from all the patients and used as a control. Biokinetic data showed a fast blood clearance with a mean residence time of 0.52 h. Approximately 85% of the injected activity was eliminated by renal clearance 24 h after (99m)Tc-UBI administration. Images showed minimal accumulation in non-target tissues with an average target/non-target ratio of 2.18 +/- 0.74 in positive lesions at 2 h. All infection positive(99m)Tc-UBI images were in agreement with those obtained with (67)Ga-citrate. The mean radiation absorbed dose calculated was 0.13 mGy/MBq for kidneys and the effective dose was 4.34 x 10(-3)mSv/MBq.
Hurtado-López LM, Arellano-Montaño S, Torres-Acosta EM, Zaldivar-Ramirez FR, Duarte-Torres RM, Alonso-de-Ruiz P, Martínez-Duncker I, Martínez-Duncker C. Combined use of Fine Needle Aspiration Biopsy, MIBI Scans and Frozen Section Biopsy Offers the Best Diagnostic Accuracy in the Assessment of the Hypofunctioning Solitary Thyroid Nodule. Eur J Nucl Med Mol Imaging 2004;31:1273-1279. PURPOSE. The probability of malignancy is increased in hypofunctioning solitary thyroid nodules (HFNs). Fine-needle aspiration biopsy (FNA), (99m)Tc-methoxyisobutylisonitrile (MIBI) and frozen section biopsy (FS) have limited independent diagnostic accuracy for the differential diagnosis of HFNs. The goal of this study was to assess the accuracy of the three independent diagnostic methods in distinguishing between benign and malignant disease. METHODS. A total of 130 patients with an HFN on the (99m)Tc-pertechnetate scan were included in this study. FNA, MIBI scans, FS, thyroidectomy and histological analysis of surgical specimens for final diagnosis were performed in all patients. RESULTS. Of the 130 patients, 80 (61.54%) had benign lesions and 50 (38.46%), malignant lesions. FNA was diagnostic in 78/130 (60%) patients and non-diagnostic in 52/130 (40%) patients. None of the patients with a negative MIBI scan had a final histological diagnosis of malignancy, and MIBI scans were negative in 38.46% of patients with non-diagnostic FNA results. FS was diagnostic in 104/130 (80%) patients and non-diagnostic in 26/130 (20%) patients. Sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios were 81.3%, 97.8%, 96%, 88%, 36.95 and 0.19 respectively for FNA; 100%, 61.3%, 61.7%, 100%, 2.58 and 0 respectively for MIBI; and 80.5%, 100%, 100%, 89%, 0 and 0.2 respectively for FS. Use of both MIBI scans and FS in patients with non-diagnostic FNA rendered a specificity and sensitivity of 100%. CONCLUSION. MIBI scans exclude malignancy in a significant proportion of patients with non-diagnostic FNAs (38% in this study). Cystic nodules with a positive MIBI scan should be further investigated even when the FNA result indicates a benign lesion. Combined use of FNA, MIBI and FS offers the best diagnostic accuracy.
Martínez-Duncker RC. Evaluaciones gammagráficas prácticas en el diagnóstico y tratamiento de enfermedades de cabeza y cuello. Cirujano General 2004;26(3):192-202. Objetivo: Análisis de las principales técnicas de gammagrafía en las enfermedades de cabeza y cuello. Sede: Hospital de tercer nivel de atención. Selección de estudios: Se revisaron 31 estudios de la literatura biomédica relacionados con el tema y se eligieron los actualizados en relación con el diagnóstico y tratamiento de las principales enfermedades de cabeza y cuello. Resultados: Entre las enfermedades de cabeza y cuello más frecuentes, en las que las evaluaciones gammagráficas proporcionan información clínica relevante para su diagnóstico y/o tratamiento y que trataremos en esta revisión, se encuentran las de la glándula tiroides (hipertiroidismo, nódulos tiroideos funcionales, nódulos tiroideos no funcionales), las lesiones malignas como el melanoma, en las que es importante conocer la localización del (de los) ganglio (s) centinela (s) para su adecuado tratamiento, las de las glándulas salivales y las de las glándulas paratiroides. Se anexan guías útiles para el diagnóstico diferencial de varias enfermedades tiroideas, tomando en cuenta los resultados obtenidos mediante la gammagrafía y los complementarios de laboratorio (perfil tiroideo). También se analiza el tratamiento de la hiperfunción tiroidea, de la incidencia del hipotiroidismo postratamiento con I-131, del cálculo racional de la dosis (actividad) de I-131, de la tirotoxicosis y el nódulo tiroideo, del cálculo de la masa tiroidea funcional y de la captación y retención tiroidea del I-131. Conclusión: La evaluación gammagráfica de los padecimientos de cabeza y cuello resultan auxiliares importantes para la labor del cirujano.
Martínez-Duncker C. Sobre el uso, desuso, mal uso y abuso de la tecnología médica. Boletín de la Academia Mexicana de Cirugía 2005;8(3):12-15.
Martínez-Duncker C, Hurtado-López LM. Pruebas diagnósticas: Lo positivo de los resultados negativos y viceversa. Editorial. Cirujano General 2006;28(2):67-71.
Martínez-Duncker C, Hurtado-López LM. 18F-FDG PET of thyroid nodules with inconclusive cytologic results. Journal of Nuclear Medicine 2006;47(9):1555.
Hurtado-Lopez LM and Martinez-Duncker C. Preoperative evaluation of thyroid nodules with 18FDG-PET/CT or MIBI scan? Surgery 2007;141(1):121.
Hurtado-Lopez LM and Martinez-Duncker C. Negative MIBI thyroid scans exclude differentiated and medullary thyroid cancer in 100% of patients with hypofunctioninal thyroid nodules. Eur J Nucl Med Mol Imaging (On-Line first. Thursday, June 21, 2007).
