[Selective internal radioembolization in nonresectable hepatocellular carcinoma]. / Selektive interne Radioembolisation beim nichtresektablen hepatozellulären Karzinom.

INTRODUCTION: The role of selective internal radioembolization (SIRT) in the treatment of hepatocellular carcinoma (HCC) is currently unclear. MATERIALS AND METHODS: We investigated 52 patients with nonresectable HCC in cirrhosis who underwent SIRT at the Department of General, Visceral and Vascular Surgery in co-operation with the Department of Nuclear Medicine and the Institute of Diagnostic and Interventional Radiology between April 2011 and October 2015. RESULTS: In five patients, SIRT was employed for bridging to liver transplantation. In patients who had undergone pre-treatment with SIRT, histological examination of the explanted livers showed extensive tumor necrosis in the targeted areas with only minor remnant vital tissue at the margins. Four of the patients who underwent SIRT as local bridging treatment are tumor-free after transplantation. In the 47 palliatively treated patients, a total of 76 radioembolizations were performed. The observed 1­ and 2­year survival rates in these patients were 58 and 29 %, respectively, after the first SIRT. In the multivariate analysis of the observed survival, AFP before the first SIRT >30ng/ml, time interval of <12 months between the initial diagnosis and the first SIRT, largest tumor diameter >5 cm and portal vein thrombosis were independent negative prognostic factors. In the multi-variate analysis, the time to progression was independently influenced only by the AFP level before the first SIRT. In addition to standard treatment with transarterial chemoembolization (TACE), SIRT is feasible in nonresectable HCC, in particular with portal vein thrombosis, with identical results, less interventions and few side effects.

Early dynamic 18F-FDG PET/CT to diagnose chronic osteomyelitis following lower extremity fractures. A pilot study.

AIM: The study investigates whether early dynamic PET/CT (edPET/CT) using 18F-fluorodeoxyglucose (FDG) discriminates between affected versus non-affected sites in patients with complicated, protracted fracture healing and suspected COM in the lower extremities. PATIENTS, METHODS: In nine consecutive patients (1 woman, 8 men; age 54 ± 13 years), before standard late FDG-PET/CT, altogether 10 edFDG-PET/CT examinations were performed in list mode over 5 min starting with radiopharmaceutical injection. Eight consecutive time intervals (frames), four 15-s, then four 60-s, were reconstructed. For every patient, several volumes-of-interest were selected. To measure early FDG influx and accumulation, maximum and mean ed standardized uptake values (respectively, edSUVmax, edSUVmean) were calculated in each volume-of-interest during each frame. Results were compared between affected and non-affected (contralateral) bone. RESULTS: Starting in the 31-45s frame, the affected bone area showed significantly higher edSUVmax and edSUVmean than did the healthy contralateral region. In conventional PET/CT, affected bone areas also significantly differed from non-affected contralateral regions. CONCLUSION: This pilot study suggests that edFDG-PET may offer a less time consuming add on to standard FDG-PET/CT while being equally accurate. The results should be validated prospectively in larger trials.

3D ultrasound DICOM data of the thyroid gland. First experiences in exporting, archiving, second reading and 3D processing.

PURPOSE: It has recently become possible to generate and archive three-dimensional ultrasound (3D-US) volume data with the DICOM standard Enhanced Ultrasound Volume Storage (EUVS). The objective of this study was to examine the application of the EUVS standard based on the example of thyroid ultrasound. PATIENTS, METHODS: 32 patients, who were referred for thyroid diagnosis, were given a 3D-US examination of the thyroid gland (GE Voluson E8, convex 3D probe RAB4-8-D). The 3D data sets were exported to EUVS. Necessary additions to DICOM entries and transformation into an established DICOM standard were carried out. The visual assessment and volume measurements were performed by two experts on nuclear medicine using standard software in our hospital. RESULTS: In 24/32 (75%) of the patients, the whole organ was successfully recorded in a single 3D scan; in 8/32 (25%), only part of organ could be covered. In all cases, 3D-US data could be exported and archived. After supplementing the DICOM entry Patient Orientation and transformation into the DICOM PET format, 3D-US data could be displayed in the correct orientation and size at any viewing workstation and any web browser-based PACS viewer. Afterwards, 3D processing such as multiplanar reformation, volumetric measurements and image fusion with data of other cross sectional modalities could be performed. The intraclass correlation of the volume measurements was 0,94 and the interobserver variability was 5.7%. CONCLUSION: EUVS allows the generation, distribution and archiving of 3D-US data of the thyroid, facilitates a second reading by another physician and creates conditions for advanced 3D processing using routine software.