SPECT/TC con galio-67 en los síndromes febriles sin foco conocido
2018
espanolIntroduccion y objetivo Los sindromes febriles de origen desconocido (SFOD) son procesos complejos en la practica hospitalaria. Su manejo incluye una anamnesis y exploracion clinica exhaustivas, asi como una extensa bateria de pruebas. Cuando los resultados son inciertos, las tecnicas diagnosticas de imagen como la SPECT/TC con galio-67 (67Ga-SPECT/TC) desempenan un papel importante. Pretendemos evaluar su papel en el estudio de los SFOD en nuestro medio hospitalario. Material y metodos Hemos revisado 57 pacientes con SFOD a los que se realizo una 67Ga-SPECT/TC (32 mujeres y 25 hombres, rango de edad: 32 a 83 anos) recogiendo hallazgos gammagraficos, tratamientos empiricos y diagnostico final. Se obtuvieron valores de sensibilidad, especificidad, valores predictivos positivos y negativos para la 67Ga-SPECT/TC y se compararon con los resultados descritos en la bibliografia para la PET/TC con Fluor-18-desoxiglucosa (18F-FDG PET/TC). Resultados Los diagnosticos encontrados fueron: infeccion en 27/57 (47%), enfermedad inflamatoria en el 15/57 (26%), neoplasia en 1/57 (1,75%) y pacientes sin diagnostico final en 14/57 (24%). Los valores estadisticos de la 67Ga-SPECT/TC fueron: sensibilidad, especificidad, valor predictivo positivo y negativo de 67%, 93%, 97% y 48%, respectivamente, que fueron levemente inferiores a los encontrados para la 18F-FDG PET/TC (86%, 52%, 70% y 92%, respectivamente). El rendimiento diagnostico encontrado fue superior en aquellos pacientes que carecian de tratamiento empirico. Conclusion A pesar los valores superiores del 18F-FDG PET/TC, la 67Ga-SPECT/TC es una tecnica util en el manejo de los SFOD. Es recomendable su uso si el primero no esta disponible. EnglishIntroduction and objective Febrile syndromes of unknown origin (FSUO) are complex processes in hospital practice. Their management includes an exhaustive medical history and examination, as well as an extensive number of biochemical tests. If these are inconclusive, diagnostic imaging techniques such as SPECT/CT with 67-Gallium Citrate (67Ga-SPECT/CT) could play an important role. We evaluated its role in the management of FSUO in our healthcare area. Material and methods We reviewed 57 patients who underwent a 67Ga-SPECT/CT due to a FSUO (32 women and 25 men, age range: 32-83 years old) obtaining scintigraphic findings, previous treatments and final diagnosis. Values of sensitivity, specificity, positive predictive values (VPP) and negative values (NPV) were obtained and compared with the results for PET/CT with 18Fluor-deoxy-glucose (18F-FDG PET/CT) found in the literature. Results The diagnoses found were: infection in 27/57 (47%), inflammatory disease in 15/57 (26%), neoplasm in 1/57 (1.75%) and patients without final diagnosis in 14/57 (24%). The statistical values of 67Ga-SPECT/CT were: sensitivity, specificity, PPV and NPV of 67%, 93%, 97% y 48%, respectively which were slightly lower than those found for the 18F-FDG PET/CT (86%, 52%, 70% and 92%, respectively). The diagnostic yield was 73% which increased to 80% in the patients who lacked empirical treatment. Conclusion Despite the better results of 18F-FDG PET/CT, 67Ga-SPECT/CT behaved as a useful technique in the management of FSUO. It is advisable to use it if 18F-FDG PET/CT is not available.
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