Ultrasound examination of lymph nodes in the hepato-duodenal ligament with special emphasis on patients with chronic liver diseases

The significance of finding lymph nodes in the hepato-duodenal ligament on ultrasound, with special emphasis on patients with inflammatory liver disease, has been evaluated. In one study a comparison was made with magnetic resonance imaging (MRI), which is another non-invasive imaging modality without the hazards of ionizing radiation. Lymph nodes in the hepato-duodenal ligament were found in benign as well as in malignant disease. In patients with abnormal biochemical test results regarding liver function, enlarged lymph nodes as the only pathological finding on ultrasound examination indicate the presence of chronic inflammatory liver disease and indicate the need for a liver biopsy. In patients with primary biliary cirrhosis, lymph node size, as well as changes in node size at a follow-up examination after two years, correlated with laboratory values reflecting cholestasis, hepatocellular damage and immunoreactivity. Changes in node size also correlated with changes in intralobular inflammation, as seen in the liver biopsies. In patients with chronic active hepatitis, a tendency towards a positive correlation between the size of the lymph nodes and laboratory values reflecting cholestasis and humoral immunoreactivity was seen, as well as a tendency towards an association with liver inflammation in the liver biopsies. These findings support our hypothesis that size and change in size of the hepatic nodes are valuable diagnostic parameters in patients with chronic liver diseases. Compared with basic low-field MRI (0.2 T), ultrasound seems superior for evaluation of lymph nodes in the liver hilus

Quantitative evaluation of tomographic 201-thallium myocardial scintigraphy

Myocardial 201Tl emission computed tomography was performed on 25 normal subjects and 27 patients with angiographically significant coronary artery disease. A semi-automatic computer program was designed to define the left ventricular myocardial volume in all short axis sections. Within this volume the relative mean myocardial pixel count was calculated. This parameter was found to separate the 2 patient groups with a sensitivity of at least 81% at a specificity of 100%

A population-based study of the clinical utility of 18F–choline PET/CT for primary metastasis staging of high-risk prostate cancer

Abstract Background The clinical utility of 18F–choline positron emission tomography fused with computed tomography (PET/CT) in all men with high-risk prostate cancer is still uncertain, because of selection of patients in previous studies. Prohibitive costs are one reason for PET/CT not being recommended for primary metastasis staging in European or American guidelines. The purpose of this retrospective study was to assess the clinical utility of in for primary metastasis staging in as complete a population as possible of men with high-risk prostate cancer. A secondary purpose was to evaluate whether a subgroup of these men could omit metastasis staging. Results In total 410 men were identified with high-risk prostate cancer. After exclusions, 317 men were initially considered for curative treatment; 213 (67%) had a choline PET/CT, with 43 men (20%) having positive findings. The risk of lymph node metastasis according to the Briganti nomogram showed a good discrimination between men with low and high risk of positive scans. Among the 35% of men with <20% risk according to the nomogram, only 1% had a positive scan, compared to 30% positive scans among the men who had higher risk. Conclusion 18F–choline PET/CT detects suspected metastases in one fifth of men with high-risk prostate cancer and should be considered for routine use. For men with <20% risk of metastasis according to the Briganti nomogram, imaging for metastasis staging might be omitted

Pre-treatment 18F-choline PET/CT is prognostic for biochemical recurrence, development of bone metastasis, and cancer specific mortality following radical local therapy of high-risk prostate cancer

Abstract Background The aim of this study was to determine whether lymph node metastasis on pre-treatment 18F-choline PET/CT is an independent prognostic factor for biochemical recurrence (BCR), skeletal metastasis, and cancer specific mortality (CSM), after radical local treatment (radical prostatectomy and/or radiotherapy) in men with high-risk prostate cancer. Medical records were reviewed for men with newly diagnosed high-risk prostate cancer who had pre-treatment 18F-choline positron emission tomography fused with computed tomography (PET/CT) scan for primary metastasis staging. Results Of 174 eligible men, 124 met the criteria for inclusion. The PET/CT scan was negative for metastasis in 97 (78%) men, inconclusive in 15 (12%), and positive in 12 (10%). The men with a positive PET/CT scan had significantly shorter time to BCR (p = 0.02), time to skeletal metastasis (p = 0.002), and time to prostate cancer specific death (p < 0.001). On multivariable Cox regression analysis, including also tumour stage, Gleason score, and PSA, a non-negative PET/CT scan was the only significant covariate for time to BCR (HR 2.6, 95% CI 1.3–5.5) and time to skeletal metastasis (HR 2.7, 95% CI 1.3–5.9). Conclusions In men with a newly diagnosed high-risk prostate cancer and a negative or inconclusive bone scan, 18F-choline uptake on PET/CT suggestive metastasis was associated with recurrence, progression to distant metastasis, and prostate cancer death. This strongly indicates that the choline uptakes represented metastasis and not false positive findings

Demonstration of digital radiographs by means of ink jet-printed paper copies : Pilot study

Different digital medical images have been printed on paper with a continuous ink jet printer, and the quality has been evaluated. The emphasis has been on digital chest radiographs from a computed radiography system. The ink jet printing technique is described as well as the handling of the image data from image source to printer. Different versions of paper prints and viewing conditions were compared to find the optimum alternative. The evaluation has been performed to maximize the quality of the paper images to make them conform with the corresponding film prints and monitor images as much as possible. The continuous ink jet technique offers high-quality prints on paper at a considerably lower cost per copy compared with the cost of a film print. With a future switch-over from diagnosing of digital images on film to diagnosing them on monitors, hard copies for demonstration purposes will occasionally be needed. This need can be filled by ink jetprinted paper copies

(18)F-choline PET/CT for early detection of metastases in biochemical recurrence following radical prostatectomy.

Salvage radiotherapy (SRT) for biochemical recurrence (BCR) following radical prostatectomy (RP) should if possible be added at a prostate-specific antigen (PSA) level of <1-2 ng/mL. The value of positron emission tomography combined with computed tomography (PET/CT) at such low PSA values is not defined. The purpose was to determine what proportion of a well-defined cohort of hormone-naïve patients who were candidates for early salvage radiotherapy had (18)F-choline PET/CT findings suggesting metastases

Combined (18) F-fluorocholine and (18) F-fluoride positron emission tomography/computed tomography imaging for staging of high-risk prostate cancer.

Study Type - Diagnosis (cohort) Level of Evidence 2a What's known on the subject? and What does the study add? Positron emission tomography/computed tomography (PET/CT) with choline and fluoride for the detection of metastases in patients with prostate cancer have each been evaluated, with mixed results. Choline PET/CT has been evaluated against pelvic lymphadenectomy, generally with a low sensitivity but a high specificity; however, the study populations have been heterogenous. Fluoride PET/CT has been evaluated against other imaging methods, such as bone scan, single photon emission CT and MRI, and has been shown to have high specificity as well as sensitivity for bone metastases, but there are no studies with biopsy verification. This is the first study that evaluates the clinical use of both choline and fluoride PET/CT on the same patients in a well-defined population of patients with high-risk prostate cancer. OBJECTIVE: • To investigate how often positron emission tomography/computed tomography (PET/CT) scans, with both (18) F-fluorocholine and (18) F-fluoride as markers, add clinically relevant information for patients with prostate cancer who have high-risk tumours and a normal or inconclusive planar bone scan. PATIENTS AND METHODS: • Patients with prostate cancer with prostate specific antigen (PSA) levels between 20 and 99 ng/mL and/or Gleason score 8-10 tumours, planned for treatment with curative intent based on routine staging with a negative or inconclusive bone scan, were further investigated with a (18) F-fluorocholine and a (18) F-fluoride PET/CT. • None of the patients received hormonal therapy before the staging procedures were completed. RESULTS: • For 50 of the 90 included patients (56%) one or both PET/CT scans indicated metastases. • (18) F-fluorocholine PET/CT indicated lymph node metastases and/or bone metastases in 35 patients (39%). • (18) F-fluoride PET/CT was suggestive for bone metastases in 37 patients (41%). • In 18 patients (20%) the PET/CT scans indicated widespread metastases, leading to a change in therapy intent from curative to non-curative. • Of the patients with positive scans, 74% had Gleason score 8-10 tumours. Of the patients with Gleason score 8-10 tumours, 64% had positive scans. CONCLUSIONS: • PET/CT scans with (18) F-fluorocholine and (18) F-fluoride commonly detect metastases in patients with high-risk prostate cancer and a negative or inconclusive bone scan. • For 20% of the patients the results of the PET/CT scans changed the treatment plan