Share
array:24 [ "pii" => "S2253808915000750" "issn" => "22538089" "doi" => "10.1016/j.remnie.2015.07.001" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "684" "copyright" => "Elsevier España, S.L.U. and SEMNIM" "copyrightAnyo" => "2014" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Esp Med Nucl Imagen Mol. 2015;34:321-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 204 "formatos" => array:2 [ "HTML" => 39 "PDF" => 165 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S2253654X1500027X" "issn" => "2253654X" "doi" => "10.1016/j.remn.2015.02.007" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "684" "copyright" => "Elsevier España, S.L.U. y SEMNIM" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Esp Med Nucl Imagen Mol. 2015;34:321-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1146 "formatos" => array:3 [ "EPUB" => 8 "HTML" => 768 "PDF" => 370 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Nota clínica</span>" "titulo" => "SPECT-TC con <span class="elsevierStyleSup">111</span>In-octreotide en paragangliomas de cabeza y cuello" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "321" "paginaFinal" => "324" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "<span class="elsevierStyleSup">111</span>In-octreotide SPECT-CT in head and neck paragangliomas" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 525 "Ancho" => 1500 "Tamanyo" => 72061 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Caso clínico 1. Sección a nivel del conducto auditivo. A): Lesión nodular derecha en tomografía de transmisión (TC); B) Corte SPECT con <span class="elsevierStyleSup">111</span>In-octreotide a dicho nivel, demuestra elevada expresión de RSS; C) Imagen de fusión SPECT-TC. Equipo multimodal SPECT-TC. Paraganglioma yugular derecho: caracterización tisular de la lesión morfológica.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Castillo-Berrio, M. Castrillón, F. Zelaya, D. Ruíz, F. Loira, J.M. Nogueiras, A. López, R. Guitián, J. Outomuro, A. Serena, L.M. Campos" "autores" => array:11 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Castillo-Berrio" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Castrillón" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Zelaya" ] 3 => array:2 [ "nombre" => "D." "apellidos" => "Ruíz" ] 4 => array:2 [ "nombre" => "F." "apellidos" => "Loira" ] 5 => array:2 [ "nombre" => "J.M." "apellidos" => "Nogueiras" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "López" ] 7 => array:2 [ "nombre" => "R." "apellidos" => "Guitián" ] 8 => array:2 [ "nombre" => "J." "apellidos" => "Outomuro" ] 9 => array:2 [ "nombre" => "A." "apellidos" => "Serena" ] 10 => array:2 [ "nombre" => "L.M." "apellidos" => "Campos" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2253808915000750" "doi" => "10.1016/j.remnie.2015.07.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808915000750?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X1500027X?idApp=UINPBA00004N" "url" => "/2253654X/0000003400000005/v1_201508090007/S2253654X1500027X/v1_201508090007/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2253808915000841" "issn" => "22538089" "doi" => "10.1016/j.remnie.2015.07.010" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "667" "copyright" => "Elsevier España, S.L.U. and SEMNIM" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Esp Med Nucl Imagen Mol. 2015;34:325-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 100 "formatos" => array:2 [ "HTML" => 20 "PDF" => 80 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting image</span>" "titulo" => "Pulmonary tumor embolus with high <span class="elsevierStyleSup">18</span>FDG uptake mimicking lung metastasis from renal-cell cancer" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "325" "paginaFinal" => "326" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Embolia pulmonar tumoral con alta captación de <span class="elsevierStyleSup">18</span>FDG imitando metástasis pulmonar de cáncer de células renales" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1246 "Ancho" => 1660 "Tamanyo" => 490579 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Intraoperative findings: after arteriotomy of the lower pulmonary artery, an attempt to remove the thrombus was performed. Due to macroscopic infiltration of the arterial posterior wall, a left lower lobectomy was carried out in order to obtain a radical resection. Final pathology was consistent with tumor embolus from RCC.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Giovanni Leuzzi, Enrico Melis, Daniele Forcella, Francesco Facciolo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Giovanni" "apellidos" => "Leuzzi" ] 1 => array:2 [ "nombre" => "Enrico" "apellidos" => "Melis" ] 2 => array:2 [ "nombre" => "Daniele" "apellidos" => "Forcella" ] 3 => array:2 [ "nombre" => "Francesco" "apellidos" => "Facciolo" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808915000841?idApp=UINPBA00004N" "url" => "/22538089/0000003400000005/v1_201508130058/S2253808915000841/v1_201508130058/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2253808915000774" "issn" => "22538089" "doi" => "10.1016/j.remnie.2015.07.003" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "664" "copyright" => "Elsevier España, S.L.U. and SEMNIM" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Esp Med Nucl Imagen Mol. 2015;34:317-20" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 128 "formatos" => array:2 [ "HTML" => 21 "PDF" => 107 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical note</span>" "titulo" => "Sentinel lymph node biopsy in pediatric melanoma. A case series" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "317" "paginaFinal" => "320" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Biopsia selectiva de ganglio centinela de melanoma en niños. Serie de casos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1465 "Ancho" => 2167 "Tamanyo" => 60296 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Anterior and posterior projections of sectorial images of the pelvic girdle of the presurgical lymphoscintigraphic study with <span class="elsevierStyleSup">99m</span>Tc-nanocolloid in the 4-year-old patient showing the injection site on the outer side of the right thigh and drainage to two lymph nodes in the right inguinal region at 30<span class="elsevierStyleHsp" style=""></span>min after radiotracer injection. The right panel shows an MIP image of the PET/CT study with no significant pathological findings.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Sánchez Aguilar, R.M. Álvarez Pérez, F.J. García Gómez, P. Fernández Ortega, I. Borrego Dorado" "autores" => array:5 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Sánchez Aguilar" ] 1 => array:2 [ "nombre" => "R.M." "apellidos" => "Álvarez Pérez" ] 2 => array:2 [ "nombre" => "F.J." "apellidos" => "García Gómez" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Fernández Ortega" ] 4 => array:2 [ "nombre" => "I." "apellidos" => "Borrego Dorado" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X14002133" "doi" => "10.1016/j.remn.2014.11.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X14002133?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808915000774?idApp=UINPBA00004N" "url" => "/22538089/0000003400000005/v1_201508130058/S2253808915000774/v1_201508130058/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical note</span>" "titulo" => "<span class="elsevierStyleSup">111</span>In-octreotide SPECT–CT in head and neck paragangliomas" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "321" "paginaFinal" => "324" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "C. Castillo-Berrio, M. Castrillón, F. Zelaya, D. Ruíz, F. Loira, J.M. Nogueiras, A. López, R. Guitián, J. Outomuro, A. Serena, L.M. Campos" "autores" => array:11 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "Castillo-Berrio" "email" => array:1 [ 0 => "caritocas541@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Castrillón" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Zelaya" ] 3 => array:2 [ "nombre" => "D." "apellidos" => "Ruíz" ] 4 => array:2 [ "nombre" => "F." "apellidos" => "Loira" ] 5 => array:2 [ "nombre" => "J.M." "apellidos" => "Nogueiras" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "López" ] 7 => array:2 [ "nombre" => "R." "apellidos" => "Guitián" ] 8 => array:2 [ "nombre" => "J." "apellidos" => "Outomuro" ] 9 => array:2 [ "nombre" => "A." "apellidos" => "Serena" ] 10 => array:2 [ "nombre" => "L.M." "apellidos" => "Campos" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Nuclear, Hospital Meixoeiro, Vigo, Pontevedra, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "SPECT-TC con <span class="elsevierStyleSup">111</span>In-octreotide en paragangliomas de cabeza y cuello" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 857 "Ancho" => 2500 "Tamanyo" => 108767 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Clinical case 2. Resected paraganglioma in left mastoid lesion. (A) SPECT with <span class="elsevierStyleSup">111</span>In-octreotide showing left nodular lesion with high expression of SSR; (B) MR: lesion in the anterior wall of the tympanic cavity which does not differentiate between residual tissue, recurrence or scar tissue; (C) fused images of SPECT-MR. Characterization of persistent post-surgical tumour tissue.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Paragangliomas are tumours of the autonomic nervous system derived from the neural crest. They are classified into adrenal (pheochromocytomas) and extra-adrenal: carotid, jugular, vagal, aortic, and autonomous visceral tumours, etc.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Paragangliomas in the head and neck can be found from the base of the skull to the aortic arch. The most common form is tumour of the carotid glomus or chemodectoma (78%).<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">They are usually benign, slowly growing tumours, although they can invade structures causing local destruction and damage to cranial nerves.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1,2</span></a> The diagnosis of malignant paraganglioma is often made late, and is only based on the appearance of the first metastasis.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1,2,4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">There are familial cases linked to hereditary syndromes such as multiple endocrine neoplasia (MEN), neurofibromatosis type 1 (Von Recklinghausen), Von Hippel-Lindau disease and hereditary pheochromocytoma/paraganglioma syndromes. Some of these tumours are bilateral and multicentric and can present metastasis.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The diagnosis is often made by conventional imaging procedures, such as magnetic resonance (MR), computed tomography and angiography; however, there are cases in which the functional imaging of nuclear medicine in its various forms combined with somatostatin analogue tracers gives a significant improvement.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Thus, we have cases of doubtful histologic diagnosis, which require a differential diagnosis with other types of malignancies. This is especially true if it is not possible to take a biopsy due to difficult access or high risk of complications, as well as in the initial staging and monitoring to detect possible post-surgical remnants, relapses or, in exceptional cases, metastasis.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We selected three cases, from a series of patients with paragangliomas of the head and neck in our centre. The cases illustrate these particular circumstances, where functional imaging based on the detection of SSR complements conventional techniques of morphological imaging.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical case 1</span><p id="par0035" class="elsevierStylePara elsevierViewall">We examined a 49-year-old male presented with hearing loss and tinnitus in the right ear. The onset of symptoms was one month earlier. We performed a MR study of the petrous portion revealing a mass in the jugular region, which was immediately anterior to the right jugular vein. The mass was of 27<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>19<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>16<span class="elsevierStyleHsp" style=""></span>mm, and could correspond to a paraganglioma.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Angiography of the aortic trunks revealed a 2.6<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1.8<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1.6<span class="elsevierStyleHsp" style=""></span>cm mass with enhancement after contrast, which was located anterior to the right jugular vein and posterior to the internal carotid, and which stood adjacent to the right middle ear with extension into the tympanic cavity. This finding was compatible with jugulotympanic paraganglioma.</p><p id="par0045" class="elsevierStylePara elsevierViewall">SPECT/CT <span class="elsevierStyleSup">111</span>In-Octreotide revealed a lesion that expressed receptors for somatostatin in the mastoid region, anterior to the right jugular vein, and which was compatible with paraganglioma. This finding allowed a histological characterization of the lesion, which was confirmed by histological analysis of the surgical specimen (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Clinical case 2</span><p id="par0050" class="elsevierStylePara elsevierViewall">We present a 64-year-old woman with a history of resected paraganglioma in the left mastoid region. The anatomical study using MR revealed that a single focus remained on the anterior wall of the tympanic cavity and left ear canal in relation to the ipsilateral mastoid region. This did not permit the differential diagnosis between residual tissues, recurrent tumour, or scar tissue. We performed a SPECT/CT study with <span class="elsevierStyleSup">111</span>In-Octreotide, which revealed a lesion with expression of SSR in the posterior-inferior wall of the tympanic cavity and the left outer ear canal. This, given the clinical evolution, was suggestive of residual tumour tissue after surgery (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Clinical case 3</span><p id="par0055" class="elsevierStylePara elsevierViewall">We present a 56-year-old woman that was seen for bilateral cervical masses. She had a family history of sisters with intrathoracic paraganglioma and recurrent carotid paraganglioma. There was no sign of hormone production, and she had normal serum metanephrine levels. The genetic study was positive for SDHD.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The anatomic CT scan revealed bilateral, relatively symmetrical, masses measuring a maximum of about 2.8<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm in diameter. These were located at the bifurcation of both carotid arteries, and had well-defined edges and multiple pinpoint images of vascular density that corresponded to afferent arteries and drainage veins. This finding was compatible with glomus tumours in the bilateral carotid space, which extended from the bifurcation of the common carotid until about 3<span class="elsevierStyleHsp" style=""></span>cm above it.</p><p id="par0065" class="elsevierStylePara elsevierViewall">MR revealed heterogeneous lesions with cystic foci in both carotid forks, which was compatible with bilateral paraganglioma.</p><p id="par0070" class="elsevierStylePara elsevierViewall">We then performed a whole-body scan and thoracic-abdominal SPEC/CT scan with <span class="elsevierStyleSup">111</span>In-Octreotide as an extension study. This revealed lesions with expression of SSR at the cervical bilateral carotid, prevascular mediastinal, and right paratracheal levels. This finding was compatible with carotid paraganglioma and metastatic paragangliomas (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">Paragangliomas of the head and neck are rare tumours with an incidence of 1:30,000–1:100,000 inhabitants. They represent 0.6% of head and neck tumours, and are mainly associated with the parasympathetic nervous system, which is present throughout the cranial nerves. Their clinical presentation, given their slow growth and insignificant hormone production, may be late and manifested mainly as cervical masses, compressive symptoms and dysfunction of cranial nerves or hearing loss.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The initial diagnosis consists of estimation by biochemical parameters and anatomical imaging. Nevertheless, whole-body scan with <span class="elsevierStyleSup">111</span>In-Octreotide and SPECT/CT is a well-established study for the diagnosis and follow-up in patients with suspected paragangliomas of the head and neck. It is highly sensitive (82%) and specific (97%). It is described by Bustillo and Telische<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> in their retrospective study with 74 patients with suspicion of paraganglioma of the head and neck, which proved that it is a precise diagnostic technique for the detection of this type of injury.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1,5</span></a> Various scientific papers reported greater diagnostic efficacy with respect to <span class="elsevierStyleSup">123/131</span>I-MIBG in these tumours. The latter is a useful technique to detect pheochromocytomas and neuroblastomas, but with less than 50% sensitivity to detect paragangliomas in the head and neck.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1,6</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Nuclear medicine imaging allows a simultaneous study of co-registration SPECT/CT after the planar acquisition with the same dose of radioisotope. This obtains both information for the functional characterization (SPECT) and structural (CT) for a precise anatomical localization of the lesion responsible for the alteration. This helps clarifying the diagnosis or reaching a differential diagnosis.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The possibility of performing a whole-body scan provides information for the initial staging and detecting foci in other locations; and in the cases of genetic mutations (SDHB, SDHC and SDHD), it serves as screening for the siblings and offspring of the patient.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1,6</span></a> Kwekkeboom et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> compared the scintigraphic results using <span class="elsevierStyleSup">111</span>In-pentetreotide with those of MR and CT in 25 patients with paragangliomas. These imaging techniques detected 53 known paragangliomas, while scintigraphy only detected 50 lesions (94%). Nevertheless, scintography, as it is a whole-body scan, detected unexpected lesions in 9 of the 25 patients (36%).</p><p id="par0095" class="elsevierStylePara elsevierViewall">On many occasions the anatomical studies alone do not allow us to identify or differentiate between residual tumour/recurrence and scar tissue. The bibliography shows that after surgical treatment of paragangliomas, recurrence/residual tumour rates are between 15 and 30%. In these cases the nuclear medicine studies with metabolic tracers have shown superior performance over anatomic imaging studies. This helps assess the extent of the process and the differential diagnosis between persistence of tumour activity versus the presence of fibrocicatricial tissue, based on the expression of SSR.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">In PET scans, <span class="elsevierStyleSup">68</span>Ga-DOTATOC/DOTATATE has great affinity for SSR, especially type 2. This is even ten times greater than that of <span class="elsevierStyleSup">111</span>In-Octreotide. Its bio-distribution is similar, but its blood clearance is much faster. This allows good detection of lesions as it improves the tumour/background gradient; various series have reported that the maximum value of the SUV in the lesions is reached with these radiotracers at 60<span class="elsevierStyleHsp" style=""></span>min post-injection. The main advantages of PET studies over conventional ones are: higher resolution (2–3× higher), shorter scan protocols (3<span class="elsevierStyleHsp" style=""></span>h, compared to 3 days in the case of <span class="elsevierStyleSup">111</span>In-Octreotide), and less radiation for patients and the medical team. It is also better in the detection of small tumours or tumours that have a low density of SSTR.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In units with the possibility for performing PET–CT studies, <span class="elsevierStyleSup">18</span>F-FDG must be considered as a useful diagnostic tool, when <span class="elsevierStyleSup">111</span>In-Octreotide studies are negative, and especially in the case of undifferentiated tumours, and in patients with mutation of the succinate dehydrogenase gene (SDHx).<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> PET tracers such as <span class="elsevierStyleSup">68</span>Ga-DOTATOC and DOTATATE, which are better than <span class="elsevierStyleSup">18</span>F-DOPA in the location of metastatic and multifocal disease foci (sensitivity 100% versus 56%),<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> are not yet available for diagnostic use in Spain. Nonetheless, in the near future, due to their affinity and bio-distribution characteristics, they will become the image study method of choice.</p><p id="par0110" class="elsevierStylePara elsevierViewall">We describe three cases, which demonstrate the utility of nuclear medicine and SPECT/CT studies with <span class="elsevierStyleSup">111</span>In-Octreotide in the diagnosis and monitoring of this type of tumour. The first case confirms the suspected diagnosis with tissue characterization of the morphological injury. The second case was carried out as a follow-up study where it is possible to differentiate between residual/recurrent tissue and scar tissue. Finally, we presented a patient with a family history of paragangliomas, SDHD (+), identifying bilateral cervical lesions compatible with paragangliomas and at the same time metastatic lesions in the mediastinum.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres540859" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec560328" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres540860" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec560329" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical case 1" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Clinical case 2" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Clinical case 3" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-11-26" "fechaAceptado" => "2015-02-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec560328" "palabras" => array:5 [ 0 => "Paraganglioma" 1 => "Scintigraphy" 2 => "SPECT–CT" 3 => "<span class="elsevierStyleSup">111</span>In-octreotide" 4 => "Somatostatin" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec560329" "palabras" => array:5 [ 0 => "Paraganglioma" 1 => "Gammagrafía" 2 => "SPECT-TC" 3 => "<span class="elsevierStyleSup">111</span>In-octreotide" 4 => "Somatostatina" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Head and neck paragangliomas are rare neuroendocrine tumours expressing somatostatin receptors on their cell surface, particularly subtype 2. Due to this distinctive feature, images can be obtained in Nuclear Medicine using synthetic analogues of somatostatin, mainly octreotide, which allow selective display by planar scintigraphy, SPECT–CT or PET–CT imaging after radiolabeling with <span class="elsevierStyleSup">111</span>In or <span class="elsevierStyleSup">68</span>Ga.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Three cases have been selected and presented from a series of patients that illustrate the utility of SPECT–CT studies with <span class="elsevierStyleSup">111</span>In-octreotide in the diagnosis and monitoring of this type of tumour. These are characterization at initial diagnosis, staging, and detection of local recurrence or metastasis, with added value with respect to anatomical images (nuclear magnetic resonance, computed axial tomography, angiography), for example in the differentiation between functional tissue or scar in patients who had previously undergone surgery.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Los paragangliomas de cabeza y cuello son tumores neuroendocrinos poco frecuentes, que expresan receptores para la somatostatina (RSS) en su superficie celular, particularmente el subtipo 2. Por esta particularidad, en la Medicina Nuclear es posible obtener imágenes de los mismos mediante la utilización de análogos sintéticos de la somatostatina, principalmente el octreotide, el cual tras su radiomarcaje con <span class="elsevierStyleSup">111</span>In o <span class="elsevierStyleSup">68</span>Ga, permiten su visualización selectiva, bien por imágenes gammagráficas planares, SPECT-TC o PET-TC.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">De una serie de pacientes se seleccionan y presentan 3 casos que ilustran la utilidad de los estudios SPECT-TC con <span class="elsevierStyleSup">111</span>In-octreotide en el diagnóstico y seguimiento de este tipo de tumour: caracterización y diagnóstico inicial, estadificación y detección de recurrencia local o metástasis, y su valour añadido respecto a las imágenes anatómicas (resonancia magnética, tomografía computarizada, angiografía), por ejemplo en la diferenciación entre tejido funcional o cicatricial en los pacientes sometidos previamente a cirugía.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Castillo-Berrio C, Castrillón M, Zelaya F, Ruíz D, Loira F, Nogueiras JM, et al. SPECT-TC con <span class="elsevierStyleSup">111</span>In-octreotide en paragangliomas de cabeza y cuello. Rev Esp Med Nucl Imagen Mol. 2015;34:321–324.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 875 "Ancho" => 2500 "Tamanyo" => 100750 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Clinical case 1. Slice through the ear canal. (A): Right nodular lesion on transmission tomography (CT); (B) SPECT slice with <span class="elsevierStyleSup">111</span>In-octreotide at this level shows high expression of SSR; (C) SPECT/CT fusion image. SPECT/CT multimodal equipment. Right jugular paraganglioma: tissue characterization of the morphological injury.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 857 "Ancho" => 2500 "Tamanyo" => 108767 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Clinical case 2. Resected paraganglioma in left mastoid lesion. (A) SPECT with <span class="elsevierStyleSup">111</span>In-octreotide showing left nodular lesion with high expression of SSR; (B) MR: lesion in the anterior wall of the tympanic cavity which does not differentiate between residual tissue, recurrence or scar tissue; (C) fused images of SPECT-MR. Characterization of persistent post-surgical tumour tissue.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1850 "Ancho" => 2327 "Tamanyo" => 234093 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Clinical case 3. Woman with a family history of paraganglioma, positivity for SDHD in the genetic study and bilateral cervical masses. (A) Axial slices: bilateral carotidal paraganglioma with high expression of SSR; (B) axial and coronal slices at the thoracic-mediastinal level. Lymph node metastasis at the level of the prevascular and right paratracheal lymph nodes. Study of familial paraganglioma. Characterization of lesions, staging.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnóstico y control evolutivo de los paragangliomas de cabeza y cuello. Aportaciones de la medicina nuclear" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Tamayo" 1 => "R. Ruano" 2 => "A. Muñoz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Acta Otorrinolaringol Esp" "fecha" => "2009" "volumen" => "60" "paginaInicial" => "68" "paginaFinal" => "75" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19245777" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673699800403" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0055" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumores del cuerpo carotídeo. Experiencia en 22 años y protocolo de seguimiento y despistaje familiar" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Feijoo" 1 => "J.M. Carranza" 2 => "M.I. Rivera" 3 => "I. Vázquez" 4 => "M. Herrando" 5 => "M.A. Marco" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Angiologia" "fecha" => "2012" "volumen" => "64" "paginaInicial" => "155" "paginaFinal" => "160" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0060" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pheochromocytoma and paraganglioma: current functional and future molecular imaging" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E.M. Blanchet" 1 => "V. Martucci" 2 => "K. Pacak" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3389/fonc.2011.00058" "Revista" => array:5 [ "tituloSerie" => "Front Oncol" "fecha" => "2012" "volumen" => "1" "paginaInicial" => "58" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22655253" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0065" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Familial paragangliomas of the head and neck" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T.V. McCaffrey" 1 => "F.B. Meyer" 2 => "V.V. Michels" 3 => "D.G. Piepgras" 4 => "M.S. Marion" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Otolaryngol Head Neck Surg" "fecha" => "1994" "volumen" => "120" "paginaInicial" => "1211" "paginaFinal" => "1216" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7917204" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0070" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Octreotide scintigraphy in the head and neck" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Bustillo" 1 => "F. Telisci" 2 => "D. Weed" 3 => "F. Civantos" 4 => "S. Angeli" 5 => "A. Serafini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00005537-200403000-00010" "Revista" => array:6 [ "tituloSerie" => "Laryngoscope" "fecha" => "2004" "volumen" => "114" "paginaInicial" => "434" "paginaFinal" => "440" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15091215" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0075" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Octreotide scintigraphy for the detection of paragangliomas" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.J. Kwekkeboom" 1 => "H. Van Urk" 2 => "B.K.H. Pauw" 3 => "S.W. Lamberts" 4 => "P.P. Kooij" 5 => "R.P. Hoogma" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Nucl Med" "fecha" => "1993" "volumen" => "34" "paginaInicial" => "873" "paginaFinal" => "878" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8389841" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0080" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of positron emission tomography imaging using [<span class="elsevierStyleSup">68</span>Ga]-DOTA-D Phe(1)-Tyr(3)-octreotide in comparison to [<span class="elsevierStyleSup">111</span>In]-DTPAOC SPECT first results in patients with neuroendocrine tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Kowalski" 1 => "M. Henze" 2 => "J. Schuhmacher" 3 => "H.R. Mäcke" 4 => "M. Hofmann" 5 => "U. Haberkorn" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Mol Imaging Biol" "fecha" => "2003" "volumen" => "5" "paginaInicial" => "42" "paginaFinal" => "48" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14499161" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0085" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pheochromocytoma-update on disease management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Därr" 1 => "J.W.M. Lenders" 2 => "L.C. Hofbauer" 3 => "B. Naumann" 4 => "S.R. Bornstein" 5 => "G. Eisenhofer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/2042018812437356" "Revista" => array:6 [ "tituloSerie" => "Ther Adv Endocrinol Metab" "fecha" => "2012" "volumen" => "3" "paginaInicial" => "11" "paginaFinal" => "26" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23148191" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0090" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A retrospective comparison between <span class="elsevierStyleSup">68</span>Ga-DOTA-TOC PET/CT and <span class="elsevierStyleSup">18</span>F-DOPA PET/CT in patients with extra-adrenal paraganglioma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Kroiss" 1 => "D. Putzer" 2 => "A. Frech" 3 => "C. Decristoforo" 4 => "C. Uprimny" 5 => "R.W. Gasser" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00259-013-2548-y" "Revista" => array:6 [ "tituloSerie" => "Eur J Nucl Med Mol Imaging" "fecha" => "2013" "volumen" => "40" "paginaInicial" => "1800" "paginaFinal" => "1808" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24072345" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22538089/0000003400000005/v1_201508130058/S2253808915000750/v1_201508130058/en/main.assets" "Apartado" => array:4 [ "identificador" => "7928" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Clinical notes" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22538089/0000003400000005/v1_201508130058/S2253808915000750/v1_201508130058/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808915000750?idApp=UINPBA00004N" ]
