Imaging decisions (Berlin, Germany)最新文献

In prostate cancer, bone metastasis is related to a poor prognosis and is one of the major causes of morbidity and mortality. Detection of metastatic bone disease is particularly important in prostate cancer patients with high probability for distant metastases before embarking on radical prostatectomy or radiation therapy. The choice of imaging modalities that best depict the metastatic bony lesions may vary depending on different patterns of bone metastases. Bone scintigraphy has been used routinely in the evaluation of prostate cancer patients in the last decades. However, it suffers from adequate specificity. Single photon emission tomography (SPECT) increases the sensitivity and specificity of planar bone scanning especially for the evaluation of the spine. Recently, positron emission tomography (PET) using F-18 Fluoride shows promising results in the detection of bone metastases especially in cancers with prominent osteoblasic pattern of bone metastases such as prostate cancer. This article reviews the value of conventional planar bone scanning, SPECT, SPECT/CT as well as F-18 Fluoride PET/CT in the assessment of bone metastases in prostate cancer patients.

Single voxel magnetic resonance spectroscopy (MRS) has been the standard in human breast tumour studies published to date. This method is hampered by the impossibility to study tissue heterogeneity or compare the metabolite signals in breast lesion directly to those in unaffected tissue. Multivoxel MRS studies, frequently referred to as spectroscopic imaging, while potentially allowing for truly quantitative tissue characterization, have up to now also been far from quantitative with, for example, the signal-to-noise ratio of the choline (Cho) signal serving as a measure of tumour activity. Demonstrated in this study is that in a standard clinical setting with a regular 1.5 T MR scanner, it is possible to perform quantitative multivoxel MRS. Using a pre-measurement to map the distributions of water and fat, and literature values for the T1 and T2 relaxation times of Cho and water in fibroglandular breast tissue and tumours, one can determine the concentrations of Cho in different tumour compartments and surrounding tissues in two brief multivoxel MRS measurements. Quantitative diagnostic and follow-up studies of focal breast pathology are now possible.

Imaging is crucial for evaluating the presence and extent of prostate cancer. This review illustrates the role of imaging tools including ultrasound, computed tomography, magnetic resonance imaging, sentinel lymph adenectomy, positron emissions tomography and ohers for optimizing diagnosis and therapeutic concept in prostate cancer patients.

Mammography is the primary imaging modality for the early detection of breast cancer. Because of the low predictive value of mammography, a large majority of patient referred for biopsy have benign disease. The question is whether magnetic resonance imaging (MRI) is a diagnostic alternative to biopsy for women with inconclusive findings at mammography or mammographic (Breast Imaging Reporting And Data System (BIRADS) 3 lesions. In this article the breast MRI and indications will be described. An overview will be given of MRI as a problem-solving modality in mammographic BIRADS 3 lesions and inconclusive mammographic findings with and without microcalcifications. The negative predictive value of breast MRI must be sufficiently high to definitively indicate a lack of need for biopsy and thus to be an effective addition to the work-up of mammographic BIRADS 3 lesions or inconclusive findings on mammography. Therefore, breast MRI should only be used for cases with proven diagnostic value.

F-18 fluorocholine [fluoromethyl-dimethyl-2-hydroxyethyl-ammonium (FCH)] is a choline analogue that shows great structural similarity to natural choline. The pathophysiological basis for the use of choline and its derivates for prostate cancer (PC) imaging are the elevation of choline levels and the up-regulation of choline kinase activity in malignant cells. In order to allow rapid tumour growth, malignant cells are able to trap choline to produce phosphatidylcholine, part of the cellular membrane. As shown in recent studies, F-18 choline PET and PET/CT might be a valuable tool in detecting the primary tumour in case of elevated prostate-specific antigen (PSA) serum levels. However, data are not consistent, and further research is necessary before general recommendations concerning F-18 choline PET and PET/CT can be given in this setting. Furthermore, some studies investigated the accuracy of F-18 choline PET and PET/CT in detecting lymph node or bone metastases and local recurrences in case of PSA relapse in patients with a history of PC.

There are many different imaging studies that can be used to evaluate breast lesions. This article will provide a brief introduction to each of the different examination modalities, including mammography, ultrasound and magnetic resonance imaging as well as image-guided invasive procedures. General guidelines for recommended use of each modality are suggested.

Magnetic resonance imaging (MRI) of the breast has become a well-established method for detection of invasive breast carcinoma. However, the role and use of breast MRI for ductal carcinoma in situ (DCIS) has remained controversial. The purpose of this study was to assess the diagnostic performance of breast MRI for detection and characterization of pure DCIS based on the currently published reports. A systematic review was performed in which studies on breast MRI for diagnosis of patients with pure DCIS were selected. A total of 26 articles were finally included, a total of 1051 patients with 1059 lesions. Sensitivity for diagnosis of pure DCIS ranged from 58% to 100%, with an overall of 84%. Sensitivity was highest for high-grade DCIS (95%). Overall specificity was 74%. The majority of DCIS lesions were characterized as non-mass-like enhancement (75%) with a segmental distribution of enhancement (50%). Suspicious kinetic curves were found in 49% of the DCIS cases. A few studies reported on size assessment. This review shows that MRI has a moderate sensitivity for detection of DCIS in general, and a good sensitivity for high-grade DCIS. The morphologic and kinetic appearance of DCIS can be very variable. Although mammography is the current standard for detection of DCIS, MRI could help improve the ability to diagnose DCIS, especially in high-grade DCIS.