Radiologia Brasileira - Publicação Científica Oficial do Colégio Brasileiro de Radiologia

ARTROPATIA HEMOFÍLICA EM PACIENTES INFANTO-JUVENIS E ADULTOS, TRATADOS COM 153Sm-HIDROXIAPATITA (153Sm-HIP).

Calegaro J.U.M.; Furtado R.G.; Landa D.C.; Paula J.C.; Cruz J.S.; Casulari L.A.; Gomes M.V.

Medicina Nuclear, Hospital de Base do Distrito Federal – Brasília, DF.

Objetivo: A idade do paciente e o tempo de evolução da artropatia são fatores relevantes na hemofilia. Por isso foi analisado o resultado da sinoviortese com 153 Sm-HIP nas populações infanto-juvenil (até 18 anos) e adulta (acima de 18 anos). Material e métodos: Foram tratados 32 pacientes (pts), somente um do sexo feminino, com dose intraarticular de 185MBq (5mCi) de 153 Sm-HIP, totalizando 75 articulações. Foram divididos em dois grupos: A - infanto-juvenil, 14 pts, 26 art, idade média = 13,8 anos, com 7 anos de evolução da doença: B - adulto, 18 pts, 49 art, idade média = 25,4 anos, com 14 anos de evolução da artropatia. Foram avaliados antes e um ano após tratamento, classificando o resultado de como: 1 – excelente (E): 2 – bom (B); 3 regular (R); 4 discreto (D); 5 – sem reposta (P). O tratamento estatístico empregou o qui quadrado e o teste de Fisher quando necessário, comparando ambas populações e individualmente joelhos, cotovelos e tornozelos. Resultados: Grupo A: 10 E; 7B; 4 R e um P.Grupo B: 25 E; 12 B; 11 R e um P. Por articulações – Joelhos – Grupo A: 3 B; um D e um P (5 art); Grupo B: 4 E; 3 B e 4 R (11 art). Cotovelos – Grupo A: 4 E; 3 B; 3 R e um D (11 art); Grupo B: 11 E; 5 B; 6 R e um P (23 art). Tornozelos – Grupo A: 6 E, um B; um R e 2 D (10 art); Grupo B: 10 E; 4 B e um R (15 art). Não houve diferença estatisticamente significante entre os grupos comparados. Conclusão: Os resultados não mostram influência da idade ou tempo de instalação da artropatia na sinoviortese com 153Sm-HIP. É necessária a continuidade desta avaliação porque o número de pacientes e articulações são reduzidos.

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POTENTIAL ROLE OF TECHNETIUM-99m SESTAMIBI IN THE EVALUATION OF PLASMA CELL MALIGNANCY.

Lima M.S.; Lopes R.W.; Borges A.C.; Ono C.R.; Watanabe T.; Costa P.A.; Sapienza M.T.; Buchpiguel C.A.; Cerri G.G.

Centro de Medicina Nuclear, HC-FMUSP.

Objective: The aims of this study were to investigate the sestamibi scintigraphy potential in identification of plasma cells malignancy lesions and its possible role in the follow-up of these patients. Methods: Twenty-six patients with established or suspected diagnosis of plasma cells malignant proliferation were enrolled at whole-body 99mTc-sestamibi scintigraphy to detect single or multiple lesions and to evaluate disease activity. The study was performed immediately after 740-1110 MBq 99mTc-MIBI intravenous injection with whole-body anterior and posterior scans. The scans were classified according to uptake pattern (focal, diffuse and focal+diffuse), intensity (relative to myocardium uptake), and site (bone or soft tissue). Results: From the 26 patients, 77 lesions were identified; 49% showing mild uptake, 39% moderate, and only 12% severe; 68 lesions were located in bone and three extramedullary. Most frequent bone lesions were observed in ribs (25%), pelvis (18%), femur (12%) and humerus (9%); 38% of the lesions were focal, 50% diffuse, and 12% had a mixed pattern. The three extramedullary lesions (locate in nasopharynx, oropharynx, and in the liver) were previously unsuspected and were confirmed by biopsy. Conclusion: This study suggests a potential role of 99mTc-sestamibi scintigraphy during the follow-up of plasma cells malignancies, in assessing suspected and unsuspected bone and soft-tissue lesions, guiding biopsy, scanning whole-body in one study, with lower dosimetry as compared to whole-body x-ray studies.

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RADIOSYNOVECTOMY WITH 153Sm-HYDROXYAPATITE (153Sm-HYP).

Calegaro J.U.M.; Furtado R.G.; Paula J.C.; Cruz J.S.; Ciccarini D.; Gomes G.

Medicina Nuclear, Hospital de Base do Distrito Federal – Brasília, DF, Brasil.

Aim: To report our experience in the treatment of haemophilic arthropaty with 153Sm-HYP. Material and methods: From 2003 to 2005, thirty one patients with ages between 8 and 34 years old (average of 21 years old), only one female, were treated with intraarticular injection of 185MBq (5mCi) of 153Sm-HYP. A total of 77 joints were treated: 15 knees, 33 elbows, 22 ankles, 2 hips and one shoulder. After the injection, precoce (1-2h) and late (24h) scintigraphic images were acquired, to analyze, respectively, articular septation / homogeneity and escape. The clinical evaluation was made before and one year after the treatment, using objective criteria (range of motion, joint tenderness, degree of joins effusion) and subjective criteria (joint pain by visual scale and joint aspect). The response was graded as follows: 1- Excellent (E); 2 - Good (D); 3 - Mild (M); 4 - Bad (B); 5 - Worse (W). Reduction in clotting factor use and haemarthroses frequency was also evaluated. Results: The improvement by joints was: E = 35 (45,4%); G = 21 (27,2%); M = 14 (18,2%); B = 4 (5,2%); W = 3 (3,9%), being less accentuated in knees. The images showed material septation in only one knee and all other had homogeneous distribution (1-2h) and no articular escape (24h). There was a reduction of 40% in the clotting factor use and 55% in the haemarthroses frequency. Conclusions: Radiosynovectomy with 153Sm-HYP presented 72,6% of clinical improvement in the articulations evaluated, with less effective results in the knees. 153Sm-HYP seems to be a safe material, without articular leakage in the haemophilic population studied.