Interesting images
Role of nuclear medicine in staging and management in a case of Merkel cell carcinoma
Papel de la medicina nuclear en la estadificación y manejo en un caso de carcinoma de células de Merkel
M.A. Ochoa-Figueroaa,
, J. Uña-Gorospeb, A. Allende-Rierab, J. Muñoz-Iglesiasb, C. Cárdenas-Negrob, B. González-Delgadoc
Corresponding author
a Servicio de Medicina Nuclear, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
b Servicio de Medicina Nuclear, Hospital Universitario de Nuestra Señora de La Candelaria, Santa Cruz de Tenerife, Spain
c Servicio de Cirugía Plástica, Hospital Universitario de Nuestra Señora de La Candelaria, Santa Cruz de Tenerife, Spain
Read
1013
Timeswas read the article
224
Total PDF
789
Total HTML
Share statistics
array:24 [ "pii" => "S2253808912000584" "issn" => "22538089" "doi" => "10.1016/j.remnie.2012.06.001" "estado" => "S300" "fechaPublicacion" => "2012-11-01" "aid" => "348" "copyright" => "Elsevier España, S.L. and SEMNIM" "copyrightAnyo" => "2011" "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Rev Esp Med Nucl Imagen Mol. 2012;31:354-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1012 "formatos" => array:2 [ "HTML" => 788 "PDF" => 224 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0212698211002771" "issn" => "2253654X" "doi" => "10.1016/j.remn.2011.10.008" "estado" => "S300" "fechaPublicacion" => "2012-11-01" "aid" => "348" "copyright" => "Elsevier España, S.L. y SEMNIM" "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Rev Esp Med Nucl Imagen Mol. 2012;31:354-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1867 "formatos" => array:2 [ "HTML" => 1623 "PDF" => 244 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Imágenes de interés</span>" "titulo" => "Papel de la medicina nuclear en la estadificación y manejo en un caso de carcinoma de células de Merkel" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "354" "paginaFinal" => "356" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Role of nuclear medicine in staging and management in a case of Merkel cell carcinoma" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1035 "Ancho" => 2501 "Tamanyo" => 167790 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Imágenes de fusión del ganglio centinela en cortes axial, sagital y coronal. Se visualiza el sitio de las inyecciones perilesionales en la nalga izquierda, observando su drenaje a la zona inguinal izquierda.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.A. Ochoa-Figueroa, J. Uña-Gorospe, A. Allende-Riera, J. Muñoz-Iglesias, C. Cárdenas-Negro, B. González-Delgado" "autores" => array:6 [ 0 => array:2 [ "nombre" => "M.A." "apellidos" => "Ochoa-Figueroa" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Uña-Gorospe" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Allende-Riera" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Muñoz-Iglesias" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Cárdenas-Negro" ] 5 => array:2 [ "nombre" => "B." "apellidos" => "González-Delgado" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2253808912000584" "doi" => "10.1016/j.remnie.2012.06.001" "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/S2253808912000584?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0212698211002771?idApp=UINPBA00004N" "url" => "/2253654X/0000003100000006/v1_201305061116/S0212698211002771/v1_201305061116/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2253808912001334" "issn" => "22538089" "doi" => "10.1016/j.remnie.2012.10.005" "estado" => "S300" "fechaPublicacion" => "2012-11-01" "aid" => "29" "copyright" => "Elsevier España, S.L. and SEMNIM" "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Rev Esp Med Nucl Imagen Mol. 2012;31:357-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 589 "formatos" => array:2 [ "HTML" => 449 "PDF" => 140 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting images</span>" "titulo" => "Simultaneous visualization of FDG avid and non-avid metastases in renal cell cancer" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "357" "paginaFinal" => "358" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Visualización simultánea de metástasis con y sin captación de FDG en carcinoma de células renales" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1085 "Ancho" => 1600 "Tamanyo" => 184053 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The PET/CT scan was performed 70<span class="elsevierStyleHsp" style=""></span>min after intravenous injection of 363<span class="elsevierStyleHsp" style=""></span>MBq (9.8<span class="elsevierStyleHsp" style=""></span>mCi) of <span class="elsevierStyleSup">18</span>F-FDG. Maximum intensity projection (A), axial PET (B, E), PET/CT fusion (C, F) and CT (D, G) at level of upper abdominal and thoracic images showed a large right adrenal mass (60<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>45<span class="elsevierStyleHsp" style=""></span>mm dimensions, 44 HU) without any significant FDG uptake (SUVmax: 1.8) (open arrows) and increased FDG uptake in a mass (20<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>21<span class="elsevierStyleHsp" style=""></span>mm dimensions, 43 HU) at the upper lobe of right lung (arrows) with SUVmax of 4.2. The distribution of FDG in the other sides of the body was normal.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A.F. Yapar" "autores" => array:1 [ 0 => array:2 [ "nombre" => "A.F." "apellidos" => "Yapar" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808912001334?idApp=UINPBA00004N" "url" => "/22538089/0000003100000006/v1_201305061136/S2253808912001334/v1_201305061136/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2253808912000894" "issn" => "22538089" "doi" => "10.1016/j.remnie.2012.04.003" "estado" => "S300" "fechaPublicacion" => "2012-11-01" "aid" => "38" "copyright" => "Elsevier España, S.L. and SEMNIM" "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Rev Esp Med Nucl Imagen Mol. 2012;31:352-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1061 "formatos" => array:2 [ "HTML" => 822 "PDF" => 239 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting images</span>" "titulo" => "Findings in the Gerstmann–Sträussler–Scheinker syndrome in an <span class="elsevierStyleSup">18</span>F-FDG PET-CT study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "352" "paginaFinal" => "353" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hallazgos en el síndrome de Gerstmann-Sträussler-Scheinker en un estudio de PET-TC con <span class="elsevierStyleSup">18</span>F-FDG" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 1958 "Ancho" => 1667 "Tamanyo" => 144532 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">PET/CT study with <span class="elsevierStyleSup">18</span>F-FDG (axial slices) showing severe decrease of glycidic metabolism in both basal ganglia and both thalamus (A) as well as marked hypometabolism in the cerebellum and encephalic trunk (B).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Achury, V. Camacho, A. Fernández, B. Gómez-Ansón, R. Jaller, I. Carrió" "autores" => array:6 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Achury" ] 1 => array:2 [ "nombre" => "V." "apellidos" => "Camacho" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Fernández" ] 3 => array:2 [ "nombre" => "B." "apellidos" => "Gómez-Ansón" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Jaller" ] 5 => array:2 [ "nombre" => "I." "apellidos" => "Carrió" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X12001102" "doi" => "10.1016/j.remn.2012.04.002" "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/S2253654X12001102?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808912000894?idApp=UINPBA00004N" "url" => "/22538089/0000003100000006/v1_201305061136/S2253808912000894/v1_201305061136/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting images</span>" "titulo" => "Role of nuclear medicine in staging and management in a case of Merkel cell carcinoma" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "354" "paginaFinal" => "356" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M.A. Ochoa-Figueroa, J. Uña-Gorospe, A. Allende-Riera, J. Muñoz-Iglesias, C. Cárdenas-Negro, B. González-Delgado" "autores" => array:6 [ 0 => array:4 [ "nombre" => "M.A." "apellidos" => "Ochoa-Figueroa" "email" => array:1 [ 0 => "migue8a@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Uña-Gorospe" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Allende-Riera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Muñoz-Iglesias" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "C." "apellidos" => "Cárdenas-Negro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "B." "apellidos" => "González-Delgado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Nuclear, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Nuclear, Hospital Universitario de Nuestra Señora de La Candelaria, Santa Cruz de Tenerife, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Cirugía Plástica, Hospital Universitario de Nuestra Señora de La Candelaria, Santa Cruz de Tenerife, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Papel de la medicina nuclear en la estadificación y manejo en un caso de carcinoma de células de Merkel" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1250 "Ancho" => 1665 "Tamanyo" => 160484 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Dermic lesion in the left buttock.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Merkel cell carcinoma (MCC) is a rare, aggressive, cutaneous neuroendocrine neoplasm, the presentation of which varies. Histologically it is a dermic lesion. Differentiation of the cells is difficult to distinguish from cutaneous metastases of neuroendocrine carcinomas, melanoma and angiosarcoma. The immunohistochemical profile of MCC and its ultrastructural characteristics help to differentiate this carcinoma from other neoplasms. The pathogenesis of MCC is uncertain. Despite having been associated with different chromosomic abnormalities and apoptotic mechanisms, solar exposure and immunosuppression have been included among the causes of this disease.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Compared to other imaging techniques, <span class="elsevierStyleSup">18</span>F-FDG PET is a good diagnostic tool for the staging of patients with MCC mainly because a whole body image may be obtained with only one scan. However, a negative PET does not exclude the absence of disease.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> On the other hand, it seems that the use of selective biopsy of the sentinel lymph node (SLN) in these patients has great potential applicability. Nonetheless, few cases using this technique have been described in the literature.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 71-year-old woman with cutaneous lesions suspected of MCC in the left buttock (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) was referred for study. Taking into account that the tumor is predisposed to lymph node and hematogenous dissemination, whole body <span class="elsevierStyleSup">18</span>F-FDG PET-CT was considered to be the best strategy to rule out disseminated disease which contraindicates determined therapeutic approaches. If negative, surgery would be performed with extraction of the SLN. The <span class="elsevierStyleSup">18</span>F-FDG PET-CT study only demonstrated the presence of a primary lesion in the left buttock with a low metabolic rate and no distant tumoral involvement (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). Tumor resection was carried out with biopsy of the SLN in the left inguinal region. The technique used was the injection of 4 subcutaneous perilesional injections of <span class="elsevierStyleSup">99m</span>Tc-Nanocoll© (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Histopathological analysis showed MCC of the lesion as well as macrometastasis of MCC in the two lymph nodes removed. At 13 and 17 months (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B) the asymptomatic patient underwent a control <span class="elsevierStyleSup">18</span>F-FDG PET-CT study demonstrating persistent absence of tumoral lesions.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">We present the case of a patient with MCC who underwent a scintigraphic study for the localization of the SLN and studies with <span class="elsevierStyleSup">18</span>F-FDG PET-CT for the initial staging and follow-up. The sequence and evolution demonstrate that both the PET-CT study with <span class="elsevierStyleSup">18</span>F-FDG and the localization of the SLN are techniques which may aid in the initial staging of patients with MCC and contribute to better patient management by differentiating patients with local disease from those with disseminated disease.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-09-20" "fechaAceptado" => "2011-10-13" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Ochoa-Figueroa MA, et al. Papel de la medicina nuclear en la estadificación y manejo en un caso de carcinoma de células de Merkel. Rev Esp Med Nucl. 2012;<span class="elsevierStyleBold">31(6)</span>:354–6.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1250 "Ancho" => 1665 "Tamanyo" => 160484 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Dermic lesion in the left buttock.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3145 "Ancho" => 2500 "Tamanyo" => 412385 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Maximum intensity projection (MIP) PET and coronal fusion PET-CT slices. (A) Primary lesion in the left buttock with a low rate of metabolism (arrow), with no other lesion suggestive of distant macroscopic tumoral involvement with avidity by the FDG. (B) Control at 17 months showing an absence of lesions suggestive of recurrence as well as the absence of the primary lesion in the left buttock.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1032 "Ancho" => 2498 "Tamanyo" => 132549 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Fusion images of the sentinel lymph node in axial, sagittal and coronal slices. The site of the perilesional injections in the left buttock is shown, observing their drainage to the left inguinal zone.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carcinoma de células de Merkel: leucemia linfática crónica y tomografía por emission de positrones" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "I. Cervigón" 1 => "A.B. Gargallo" 2 => "C. Bahillo" 3 => "J.L. Martínez-Amo" 4 => "J.L. Orradre" 5 => "V. Muñóz-Madero" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2006" "volumen" => "97" "paginaInicial" => "264" "paginaFinal" => "266" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16801021" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnostic imaging in Merkel cell carcinoma: lessons to learn from 16 cases with correlation of sonography, CT, MRI and PET" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Peloschek" 1 => "C. Novotny" 2 => "C. Mueller-Mang" 3 => "M. Weber" 4 => "J. Sailer" 5 => "M. Dawid" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejrad.2008.10.032" "Revista" => array:6 [ "tituloSerie" => "Eur J Radiol" "fecha" => "2010" "volumen" => "73" "paginaInicial" => "317" "paginaFinal" => "323" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19108971" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Biopsia selectiva del ganglio sentinela en tumores cutáneos no melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.P. Cózar" 1 => "J. Ferrer-Rebolleda" 2 => "M.C. Redal" 3 => "A. Moreno" 4 => "L. Tortajada" 5 => "I. Casáns" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Med Nucl" "fecha" => "2006" "volumen" => "25" "paginaInicial" => "10" "paginaFinal" => "14" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16540005" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22538089/0000003100000006/v1_201305061136/S2253808912000584/v1_201305061136/en/main.assets" "Apartado" => array:4 [ "identificador" => "7927" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Interesting images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22538089/0000003100000006/v1_201305061136/S2253808912000584/v1_201305061136/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808912000584?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 0 | 1 |
| 2019 December | 3 | 0 | 3 |
| 2018 February | 4 | 2 | 6 |
| 2018 January | 11 | 1 | 12 |
| 2017 December | 7 | 0 | 7 |
| 2017 November | 13 | 1 | 14 |
| 2017 October | 7 | 3 | 10 |
| 2017 September | 17 | 3 | 20 |
| 2017 August | 6 | 3 | 9 |
| 2017 July | 7 | 2 | 9 |
| 2017 June | 12 | 3 | 15 |
| 2017 May | 7 | 2 | 9 |
| 2017 April | 12 | 3 | 15 |
| 2017 March | 6 | 39 | 45 |
| 2017 February | 7 | 0 | 7 |
| 2017 January | 8 | 0 | 8 |
| 2016 December | 9 | 5 | 14 |
| 2016 November | 15 | 2 | 17 |
| 2016 October | 26 | 0 | 26 |
| 2016 September | 13 | 1 | 14 |
| 2016 August | 12 | 3 | 15 |
| 2016 July | 10 | 1 | 11 |
| 2016 June | 12 | 4 | 16 |
| 2016 May | 23 | 9 | 32 |
| 2016 April | 21 | 10 | 31 |
| 2016 March | 16 | 13 | 29 |
| 2016 February | 20 | 9 | 29 |
| 2016 January | 26 | 10 | 36 |
| 2015 December | 11 | 14 | 25 |
| 2015 November | 17 | 8 | 25 |
| 2015 October | 24 | 10 | 34 |
| 2015 September | 23 | 7 | 30 |
| 2015 August | 22 | 1 | 23 |
| 2015 July | 11 | 2 | 13 |
| 2015 June | 4 | 1 | 5 |
| 2015 May | 9 | 4 | 13 |
| 2015 April | 11 | 2 | 13 |
| 2015 March | 20 | 7 | 27 |
| 2015 February | 23 | 1 | 24 |
| 2015 January | 39 | 5 | 44 |
| 2014 December | 32 | 5 | 37 |
| 2014 November | 15 | 2 | 17 |
| 2014 October | 19 | 1 | 20 |
| 2014 September | 16 | 1 | 17 |
| 2014 August | 14 | 3 | 17 |
| 2014 July | 23 | 2 | 25 |
| 2014 June | 23 | 2 | 25 |
| 2014 May | 20 | 1 | 21 |
| 2014 April | 14 | 2 | 16 |
| 2014 March | 7 | 2 | 9 |
| 2014 February | 9 | 3 | 12 |
| 2014 January | 13 | 2 | 15 |
| 2013 December | 20 | 4 | 24 |
| 2013 November | 16 | 3 | 19 |
| 2013 September | 1 | 0 | 1 |
| 2013 May | 2 | 0 | 2 |
Show all
