Incidental detection of breast cancer by 68Ga-DOTATOC-PET/CT in women suffering from neuroendocrine tumours.

AIM: Somatostatin receptor (sstr) imaging using 68Ga-DOTATOC-PET/CT in neuroendocrine tumors (NET) is promising, suggesting a more sensitive detection of lesions with a low sstr-expression. This is also important for other sstr positive tumors, especially breast cancer whose incidence and age-range is similar to that of NET. PATIENTS, METHODS: The PET/CT data of 33 consecutive women with NET (age: 33-78 years, mean 59) who underwent whole-body staging with 68Ga-DOTATOC was retrospectively analyzed for breast lesions. The data was read separately, side-by-side and as fused images. Focal tracer uptake in the breast was semiquantitatively analyzed by comparing the lesional SUVmax to normal breast tissue using Wilcoxon's rank sum test. Breast cancer lesions were compared visually to concomitant NET-lesions. RESULTS: In six of 33 patients (18%) breast lesions were observed on the CT-scans and classified in four patients (12%) as suspicious. The same lesions also showed a pathological tracer uptake on the corresponding PET-scan, visually and semiquantitatively (p<0.01). Histological reevaluation of the suspicious lesions revealed two patients with NET metastases. Two patients had primary breast cancer with lower tracer uptake than concomitant abdominal NET-lesions. Breast cancer diagnosis resulted in a change of the therapeutic regimen. CONCLUSION: 68Ga-DOTATOC-PET/CT not only improves the staging of NET-patients, but also increases the chance to detect sstr-positive breast cancer. Although these lesions may show a lower tracer uptake than NET, they must not be overlooked or misinterpreted as metastases. Further imaging and clarification by histopathology is warranted, as the confirmation of a secondary malignoma has great impact on further therapeutic proceedings.

Computed tomography of the adrenal glands.

Whole body CT opens a third dimension-in addition with the advantage of being a non-invasive method with relatively negligible risk. Both, the normal CT findings of the adrenal gland and the normal variants in shape and position are described. With help of morphometry and image processing measurements of the size of the adrenal gland of 20 healthy patients were made and are listed; not only the respective normal variants but also hypo-hyperplasia are pointed out. Some examples are suitable for the illustration of pathologic conditions, such as inflammation and benign and malignant primary and secondary neoplasis. Finally, the value of adrenal gland CT is discussed with reference to the other radiologic methods.

[New bases and theories for improving angio-cine-densitometry. III Resolution of quotient cine-densitometry (author's transl)]. / Neue Grundlagen und Theorien zur Verbesserung der Angio-Cine-Densitometrie. III. Das zeitliche Auflösungsvermögen der Quotienten-Cine-Densitometrie

In the present paper, the degree of resolution which can be achieved with quotient cine-densitometry is described. The accuracy of the procedure is illustrated. The superiority of this method over video-densitometry is pointed out.

[New bases and theories from improving angio-cine-densitometry. II Improvements in the signal-to-noise ratio by the quotient method in cine densitometry]. / Neue Grundlagen und Theorien zur Verbesserung der Angio-Cine-Densitometrie. II. Die Verbesserung des Signal-Rauschverhältnisses durch das Quotientenverfahren in der Cine-Densitometrie

In radio-cine-densitometry, random variations can be smoothed and reduced in two ways: temporal (frame to frame) and spatial (each frame). Both methods may, however, alter the signal measurements. The advantage of quotient cine-densitometry depends on the elimination of interference or random variations without changing the signal. Elimination of the variations occurs during signal recording. Amongst others the following are eliminated: variations in mains voltage, uneven development, absorption by other tissues and organs. A more suitable signal-to-noise ratio can be obtained. If an artery or a vein are opacified simultaneously it is possible, by means of quotient cine densitometry, to distinguish the arterial and venous phase and to analyse these separately from the overlying tissues.

[New principles and theories for improving angio-cinedensitometry. I. The physical principles of quotient densitometry(author's transl)]. / Neue Grundlagen und Theorien zur Verbesserung der Angio-Cine-Densitometrie. I. Das physikalische Prinzip der Quotienten-Densitometrie

The physical basis of quotient densitometry is described. All stages are discussed, beginning with the production of the x-rays, their attenuation by the patient, their effect on the radiographic film, and the evaluation of the film by projection and its measurements by a photo cell in a Wheatstone bridge. Two values were obtained, one consisting of the signal together with background fog, the other of the background alone. By an analysis of the relationships of these measurements, obtained from specially separated points on the radiograph, it is possible to eliminate artefacts to a large extent.

[Diagnostic possibilities of computed x-ray tomography in thorotrast accumulation]. / Diagnostische Möglichkeiten der Röntgencomputertomographie bei Thorotrastspeicherung.

Quantification of Thorotrastosis is easily obtained by means of computerized tomography. Th-concentration, total Th-content in an organ and the percentage of contaminated parenchyms can be evaluated. Some examples of such measurements are presented. Conventional x-ray morphology and CT-findings are demonstrated by hand of several cases of thorotrast tumors and other patients with Th-induced lesions.

[Effect and quantification of respiratory movement of abdominal organs on x-ray computer tomography (author's transl)]. / Einfluss und Quantifizierung der Atemverschieblichkeit von abdominellen Organen bei der Röntgencomputertomographie.

The effect of respiratory movement of abdominal organs on computer tomography is illustrated. Methods for an objective evaluation of the reproducibility of tomograms are presented. A procedure for the quantitative determination of the respiratory movement of abdominal organs using computer tomography is described.

[A new basis and theories for improving angio-cine-densitometry. V. The effect of the injection method of the contrast on measurements during angio-cine-densitometry (author's transl)]. / Neue Grundlagen und Theorien zur Verbesserung der Angio-Cine-Densitometrie. V. Der Einfluss des Injektionsmodus der Kontrastsubstanz auf das Messergebnis bei der Angio-Cine-Densitometrie

The theoretical basis for measuring speed of flow in vessels of conscious patients obtained by estimating dilution of injected contrast is described. Previously, measurements at two separate points had to be carried out in order to obtain a flow profile, but with the present method, a single measurement point is adequate. If contrast is distributed evenly in the circulation during its flow to the periphery, the measurement can be carried out at some distance from the point of injection. The ability to select ones point of measurement makes it possible to avoid areas covered by overlying shadows and eliminates the difficulties inherent in measurements in curved vessels.

[New basic considerations and theories for improving angio-cine-densitometry. IV. The effect of discontinuous, pulsatile flow on angio-cine-densitometric measurements (author's transl)]. / Neue Grundlagen und Theorien zur Verbesserung der Angio-Cine-Densitometrie IV. Der Einfluss einer nicht-kontinuierlichen, pulsierenden Strömung auf das Messergebnis der Angio-Cine-Densitometrie

Various expressions of the speed of flow of blood in arteries are discussed, such as instantaneous speed, integral speed, pulse wave speed (phase speed) and velocity of a moving front. The flow profile of the abdominal aorta was obtained by cine-densitometry, bearing in mind the above considerations, and the densitometric curves have been analysed. Differences of the flow velocities in different persons have been interpreted as a result of these theoretical considerations. The effects of the point of measurement, the distance over which the measurement was carried out and the pulse wave length on velocity were examined. In order to obtain a median blood stream velocity by angio-cine-densitometry, repeated injections of small volumes of contrast medium (random sampling method) are recommended.

[The information value of roentgen computerized tomography in atrial tumors of the heart]. / Informationswert der Röntgencomputertomographie bei Vorhoftumoren des Herzens.

The symptoms of intracavitary masses are usually not characteristic and are often confused with those of mitral valve disease. It is therefore necessary to employ all possible diagnostic measures. Like echo cardiography, computer tomography is a non-invasive method which provides accurate information concerning the size, position and shape of the mass. Angiocardiography can confirm these findings, but provides extra information only if there are additional abnormalities or coronary disease. Early diagnosis is important, since the patient is at risk from complications such as cardiac failure, emboli and arrhythmias, and since operative removal of the tumour carries a good prognosis.

[Coronary flow measurements, using cine densitometry. Results using a multiple detector method. I. Normal flow values in healthy and stenosed coronary arteries during rest (author's transl)]. / Koronare Flussmessungen mit der Cinedensitometrie Ergebnisse mit dem Mehrfachdetektor-Messverfahren: I. Normalwerte der Durchblutung an gesunden und stenosierten Herzkranzefässen in körperlicher Ruhe

Coronary blood flow was measured by a cine densitometric method using a newly developed system incorporating computer data analysis. The first results concerning front and wave velocity of a selectively injected contrast bolus are reported. Average absolute flow volumes in the right coronary artery are 114 ml. per minute, in the left coronary artery, 88 ml per minute (RIVA = 52 ml/min., RC = ml/min.). There is good agreement with the results of dye dilution and isotope wash out techniques, but the latter are more complicated and less easily reproduced and therefore less suitable for routine use. The results are critically evaluated.

[Coronary flow measurements with cine densitometry. II. Quantitative determinations of flow velocities and flow volumes through severe coronary stenoses during rest (author's transl)]. / Koronare Flussmessung mit der Cinedensitometrie. II. Quantitative Bestimmung von Stromgeschwindigkeiten und Durchflussmengen an hochgradigen Koronarstenosen unter truhebedingungen.

The normal flow values through healthy or moderately narrowed coronary arteries, which had been determined by a new method of cine radiography, together with a computer, were published in this Journal in 1976. In the present paper we report the results of further studies of flow velocity and flow volume through high-grade coronary artery stenosis of severity III and III--IV. Compared with the results obtained on normal and mildly stenosed arteries, measurements at rest through severely stenosed coronaries showed an almost constant flow. The first results on aorto-coronary vein graft measurement are described.