Bilateral Gigantomastia, Multiple Synchronous Nodular Pseudoangiomatous Stromal Hyperplasia Involving Breast and Bilateral Axillary Accessory Breast Tissue, and Perianal Mammary-Type Hamartoma of Anogenital Mammary-Like Glands: A Case Report.

Mammary-type fibroepithelial lesions involving ectopic breast and anogenital region are rare and usually coexist with normal orthotopic breast. We present what we believe to be a unique case of synchronous bilateral gestational gigantomastia resembling fibrous mastopathy, synchronous rapidly growing pregnancy-associated nodular pseudoangiomatous stromal hyperplasia involving right breast and bilateral axillary ectopic breast tissue, and metachronous perianal mammary-type hamartoma involving anogenital mammary-like glands occurring in a 34-year-old patient with facioscapulohumeral muscular dystrophy. Also, we review the literature concerning these lesions.

Three-tesla MRI biphasic angiography: a method for preoperative assessment of the vascular supply in renal tumours: a surgical perspective.

PURPOSE: The new generation of 3TMRI has improved spatial and time resolutions, which are favourable in imaging of the renal vasculature. In this study, we have compared the imaging findings of the renal blood vessels using 3TMRI and CT with intraoperative assessment of the renal vasculature as gold standard. METHODS: This prospective study was approved by the local ethical committee. Between 4/2011 and 12/2011, 80 patients with renal tumours underwent 3TMRA (angiography) (Magnetom SKYRA 3T, Siemens). Twenty of the patients were also examined with CT AG. The results of the CTA- and MRA-imaging studies were correlated with the intraoperative assessment of the renal vessels. RESULTS: Seventy patients (87.5 %) had a detailed intraoperative assessment of the renal vessels. The sensitivities for CTA and MRA were 88.2 and 88.6 %, respectively. All discrepancies between imaging studies and intraoperative findings were due to inability to identify small polar vessels. The results of MRA were concordant with CTA in 85.0 % of cases. The (three) discrepancies between MRI and CT were due to failure of MRI in identifying small polar vessels. CONCLUSIONS: (1) 3TMRA gives detailed information about the renal vasculature including its topographical anatomy. (2) With MRI, small aberrant vessels are more frequently missed than with CTA. (3) CTA remains the gold standard. However, MRA may be used for planning of laparoscopic operations. (4) The quality of the 3D reconstruction is highly depending on the skills of the radiologist.

Hybrid peripheral nerve sheath tumors, including a malignant variant in type 1 neurofibromatosis.

The authors report a small case series of hybrid nerve sheath tumors occurring in the setting of type 1 neurofibromatosis. Four lesions were benign and consisted of plexiform neurofibromas with considerable areas of perineuriomatous differentiation in patients with type 1 neurofibromatosis. In these lesions, biphasic (Schwannian and perineuriomatous) differentiation was apparent on immunohistochemistry, with the perineuriomatous areas staining for epithelial membrane antigen, glut-1, and claudin-1 and being negative for S-100 protein. Three patients were members of a single family, with a history of various malignant neoplasms. Included in the series is 1 hybrid lesion in which neurofibromatous and perineuriomatous areas were clearly visible on hematoxylin- and eosin-stained slides. The lesion was unique in that it manifested malignant change in the S-100 protein-positive component, which was classified as malignant peripheral nerve sheath tumor. The malignant component showed areas with an epithelioid cell morphology.

Prognostic value of the number and volume of liver tumours on portal vein embolization outcomes.

BACKGROUND/AIMS: Portal vein embolization (PVE) extends the resecability of liver tumours.The issue of PVE is an insufficient growth of the liver parenchyma or a tumour progression in some patients. We evaluated the effect of the volume and the number of liver tumours on the effect of PVE. METHODOLOGY: PVE was performed in 40 patients with liver tumours due to an insufficient future remnant liver volume. The number and the volume of the tumours were evaluated and compared with the final PVE effect. RESULTS: In patients without any increase of the liver volume after PVE (n=3) the number and the volume of the tumours before PVE were 2.7±2.1 and 2205.1±2432.7mm3, respectively. In patients with sufficient growth of the liver (n=22) it was 3.8±2.2 (NS) and 1164.9±1392.1mm3 (NS), respectively. In patients with tumour progression (n=11) it was 5.6±2.2 and 6971.4±5189.5mm3, respectively (p<0.04 and p<0.005, respectively). Four patients were treated by radiofrequency ablation only due to worsening of their health state. Patients with >4 foci (OR 4.7) and a tumour volume >400mm3 (OR=13.0) had a higher probability of cancer progression or insufficient growth of the liver tissue. Patients with <6 foci and a tumour volume <3100mm3 had an 87.5% probability of a successful liver hypertrophy after PVE. CONCLUSIONS: The tumour number and volume were crucial for progression of a malignant disease and growth of the liver parenchyma after PVE.

Tubulocystic renal carcinoma: a clinical perspective.

INTRODUCTION: Tubulocystic renal carcinoma (TCRC) is a recently described neoplastic entity. To date, clinicopathological features on less than hundred cases of these rare tumours have been characterized exclusively in the pathological literature. Herein, we present five additional cases emphasizing clinical aspects on these rare renal neoplasms. MATERIAL AND METHOD: Cases diagnosed as TCRC were retrieved and reviewed from the routine and consultation files of the Pilsen tumour registry comprising over 20,000 cases of renal tumours. RESULTS: All patients were men, mean age 56 years (range 29-70). Features on computed tomography (CT) were in two cases Bosniak III, one IV and two were solid tumours. In four patients, nephrectomy was performed, and one patient underwent resection. At the time of surgery, two patients had metastases. In one case, both primary tumour and metastases were active on FDG positron emission tomography (PET)/CT. Both patients with metastatic disease were treated with sunitinib with partial response. One patient died 26 months postoperatively and the other patient is alive 5 months after surgery. Three patients with localized tumours are without evidence of disease 31, 28 and 7 months after surgery. In one case, the resected tumour was histologically combined with a papillary renal cell carcinoma (PRCC). CONCLUSION: TCRC occurs predominantly in men with a wide age range. TCRC frequently displays a cystic component which may render a radiological classification of Bosniak III or IV. FDG PET/CT is helpful in the detection of metastases. TCRC has definitive malignant potential. Our findings support a possible relationship to PRCC. The tyrosine kinase inhibitor sunitinib may be used a therapeutical agent with partial response and temporary effect.

The assessment of intracranial bleeding with virtual unenhanced imaging by means of dual-energy CT angiography.

The purpose of this study was to assess virtual unenhanced brain computed tomography (CT) images obtained by dual-energy CT angiography (CTA) for the detection of intracranial bleeding. In total, 25 patients were included in the study (average age 53.2 years, range 25-75 years, 14 male, 11 female), all with intracranial bleeding on unenhanced brain CT and who underwent additional CTA performed on a dual-source CT in a dual-energy acquisition mode. The two X-ray tubes were operated at 140 and 80 kV, respectively. Data were analyzed using dual-energy evaluation software. Virtual unenhanced images were calculated by removing the relative iodine content from each voxel. The virtual unenhanced images were evaluated by a radiologist blinded to the findings of the conventional images related to the presence of intracranial bleeding. The image quality and contrast-to-noise ratio (CNR) between bleeding and brain tissue were assessed. The virtual image quality was found to be sufficient in 96%. The agreement in detection of intracranial bleeding on virtual and conventional unenhanced images reached 96% in per-lesion analysis and 100% in per-patient analysis. The averaged CNR reached 2.63 in virtual unenhanced images and 3.27 in conventional. Virtual unenhanced images are sufficient for the detection of intracranial bleeding.

Crystal-deficient alveolar soft-part sarcoma with cutaneous involvement: a case report.

Alveolar soft-part sarcoma (ASPS) is a rare distinctive sarcoma, in most cases involving deep soft tissues of the extremities. It is associated with a specific unbalanced translocation, der(17)t(X;17)(p11;q25) that results in the formation of an ASPL-TFE3 fusion gene. Microscopically, it is typified by an alveolar growth of large cells containing typical periodic acid-Schiff-positive rod-shaped crystals, often serving as a diagnostic clue. Other distinctive features include nuclear immunoreactivity for transcription factor 3 (TFE3) protein and a typical ultrastructural finding of large crystals with a rectangular or rhomboid shape. The authors present an unusual case of ASPS with cutaneous involvement, which did not exhibit typical large crystals; there were striking round granules. Molecular genetic study revealed fusion transcript ASPL-TFE3, type 2. To the best of our knowledge, cutaneous involvement of a crystal-deficient ASPS has not been reported.

TSC2/PKD1 contiguous gene syndrome: a report of 2 cases with emphasis on dermatopathologic findings.

The association of tuberous sclerosis complex (TSC) and autosomal dominant polycystic kidney disease (ADPKD), termed TSC2/PKD1 contiguous gene syndrome, is a result of molecular defect demonstrating by deletion disrupting TSC2 and PKD1. Dermatopathology of this syndrome has never been addressed. We report 2 sporadic cases form of TSC2/PKD1 contiguous gene syndrome, with emphasis on dermatopathologic findings. Both patients presented with a typical phenotype of TSC and early-onset renal polycystic requiring kidney transplantation in one of the patients. Of a total of 13 cutaneous lesions studied, there were 7 facial angiofibromas, 2 shagreen patches, 1 periungual fibroma, 1 hypopigmented macule, 1 epidermoid cyst, and 1 intradermal melanocytic nevus. The histological features were basically similar to those occurring in TSC, but some unusual features were identified. In both patients, deletions in the region of TSC2 and PKD1 were revealed performing by multiplex ligation probe amplification test. It is concluded that the histopathological features of skin lesions in this syndrome are similar to those encountered in TSC. Clinical awareness and appropriate molecular investigation of TSC2/PKD1 contiguous gene syndrome is necessary in all patients with a typical phenotype of TSC in infancy, adolescence, or adult age, because of severity of the renal alterations.

Acral calcified vascular leiomyoma of the skin: a rare clinicopathological variant of cutaneous vascular leiomyomas: report of 3 cases.

BACKGROUND: Several histopathologic variants of cutaneous leiomyomas have been recognized. In our consultation dermatopathology practice, we encountered a variant of cutaneous leiomyoma which, to our knowledge, has not been reported. OBJECTIVE: We report 3 cases of vascular leiomyomas, all of them manifesting prominent intratumoral calcifications dominating over the residuum of the tumors and occurring on the acral sites. METHODS: We conducted a clinicopathological and immunohistochemical study, which is complemented by a literature review. RESULTS: All 3 patients were women ranging in age from 57 to 72 years. Each presented clinically with a slowly growing, firm mass. The lesion was painful in two cases. None of the patients had renal disease or endocrine abnormalities. Microscopically, the lesions were a well-circumscribed, non-encapsulated neoplasm composed of mature smooth muscle cells and vascular pattern, which was inconspicuous, but focally dilated blood vessels were present. In all cases, prominent calcifications were present. Immunohistochemically the spindle cells were positive for alpha-smooth muscle actin. LIMITATIONS: This study utilizes tissue specimens that all came as consultations; therefore, some inherent selection bias exists. CONCLUSION: Acral calcified vascular leiomyoma is a rare clinicopathological variant of leiomyoma which has predilection for acral sites and shows massive calcifications prevailing over the tumor itself.

Assessment of the kidney tumor vascular supply by two-phase MDCT-angiography.

PURPOSE: Current kidney surgery uses less invasive laparoscopic and nephron-sparring procedures. Thus, perfect imaging of the renal vasculature is essential for surgery planning. The aim of our retrospective study was to evaluate the accuracy of 16-detector-row CT-angiography in assessing the vascular anatomy of the kidney with a tumor. SUBJECTS AND METHODS: Referred for computed tomography (CT) because of a suspected renal tumor, 50 consecutive patients (mean age 58.6 years; range 43-82) were enrolled into our retrospective study. All examinations were performed with 16x0.75 mm collimation after the intravenous application of 80 ml of a non-ionic contrast material. The imaging protocol contained two-phase scanning in the arterial and then in the venous phase. The vascular anatomy of the kidney with tumor was evaluated using volume rendered (VRT) and maximum intensity images (MIP). Findings were compared with the anatomy found during surgery. RESULTS: Forty-seven patients underwent nephrectomy, with an advanced clinical stage (IV) found in the three remaining ones. Correct topography of the renal hilus, including a number of arteries and veins, and the anatomy of their branching, was described in 46 patients. A very small upper polar artery was overlooked in one patient. The accuracy for the only-arterial was 97.9% and only-venous anatomy was 100%. The parasitic vasculature of the tumor was discovered in 10 cases and all of them were confirmed by surgery (100% accuracy). Macroscopic intravenous spread of the tumor was discovered in two cases, but microscopic intravenous invasion was confirmed during histology of the kidney specimens in another two cases, the overall tumor staging accuracy reaching 95.7%. CONCLUSION: Two-phase multidetector CT is a valuable tool for assessing vascular supply of the kidney before surgery due to the tumor and can fully replace catheter-based angiography.

Computed tomography of renal cell carcinoma in patients with terminal renal impairment.

PURPOSE: An increased incidence of renal tumors has been observed in patients with end-stage-renal-disease (ESRD). The very strong association with acquired renal cystic disease (ACRD) and increased incidence of the renal tumors (conventional renal cell carcinoma (CRCC), papillary renal cell carcinoma (PRCC) or papillary renal cell adenoma (PRCA)) was reported. This study discusses the role of computed tomography (CT) in detecting renal tumors in patients with renal impairment: pre-dialysis, those receiving dialysis or with renal allograft transplants. MATERIALS AND METHODS: Ten patients (nine male, one female) with renal cell tumors were enrolled into a retrospective study; two were new dialysis patients, three on long-term dialysis, and five were renal transplant recipients with history of dialysis. All patients underwent helical CT, a total of 11 procedures were performed. Sixteen-row detector system was used five times, and a 64-row detector system for the six examinations. All patients underwent nephrectomy of kidney with suspected tumor, 15 nephrectomies were performed, and 1 kidney was assessed during autopsy. CT findings were compared with macroscopic and microscopic assessments of the kidney specimen in 16 cases. RESULTS: Very advanced renal parenchyma atrophy with small cysts corresponding to ESRD was found in nine patients, chronic pyelonephritis in remained one. A spontaneously ruptured tumor was detected incidentally in one case, patient died 2 years later. In the present study, 6.25% (1/16) were multiple PRCA, 12.5% (2/16) were solitary PRCC, 12.5% tumors (2/16) were solitary conventional renal cell carcinomas (CRCC's), 12.5% tumors (2/16) were multiple conventional renal cell carcinomas (CRCC's), 25% (4/16) were CRCC's combined with multiple papillary renal cell carcinomas with adenomas (PRCC's and PRCA's), and 25% (4/16) of the tumors were multiple PRCC's combined with PRCA's without coexisting CRCC's. Bilateral renal tumors were found in our study in 60% (6/10) confirmed in six cases, one kidney left on follow-up due to the small tumors. CONCLUSIONS: With the use of a multi-detector row system, it is possible to detect smaller foci suspected to originate in multiple tumors, especially when up to 3-mm thin multi-planar reconstructions are used. Two cases demonstrated the possibility the development of RCC in impaired kidneys may start before dialysis initiation.

PET/MRI: Multiparametric imaging of brain tumors.

A combination of morphological imaging of the brain with microstructural and functional imaging provides a comprehensive overview of the properties of individual tissues. While diffusion weighted imaging provides information about tissue cellularity, spectroscopic imaging allows us to evaluate the integrity of neurons and possible anaerobic glycolysis during tumor hypoxia, in addition to the presence of accelerated synthesis or degradation of cellular membranes; on the other hand, PET metabolic imaging is used to evaluate major metabolic pathways, determining the overall extent of the tumor (18F-FET, 18F-FDOPA, 18F-FCH) or the degree of differentiation (18F-FDG, 18F-FLT, 18F-FDOPA and 18F-FET). Multi-parameter analysis of tissue characteristics and determination of the phenotype of the tumor tissue is a natural advantage of PET/MRI scanning. The disadvantages are higher cost and limited availability in all centers with neuro-oncology surgery. PET/MRI scanning of brain tumors is one of the most promising indications since the earliest experiments with integrated PET/MRI imaging systems, and along with hybrid imaging of neurodegenerative diseases, represent a new direction in the development of neuroradiology on the path towards comprehensive imaging at the molecular level.

Extensively cystic renal neoplasms in adults (Bosniak classification II or III)--possible "common" histological diagnoses: multilocular cystic renal cell carcinoma, cystic nephroma, and mixed epithelial and stromal tumor of the kidney.

OBJECTIVE(S): To give an algorithm for resolution of extensively cystic renal neoplasms, preoperatively classified in the Bosniak classification as a category II and III. METHODS: From 1991 to 6/2004, 701 patients with 727 renal tumours were surgically treated at our hospital. Extensively cystic tumours were found in 10 cases. Extensively cystic tumours were defined as multicystic tumours without any solid nodules visible neither on CT, nor grossly in the specimen at operation (the Bosniak classification type II or III). RESULTS: Seven multilocular cystic renal cell carcinomas, three mixed epithelial and stromal tumour of the kidney and one cystic nephroma were diagnosed on histology. CONCLUSION(S): Extensively cystic renal tumours classified as the Bosniak type II or III correspond histologically to the entities mentioned above (multilocular cystic renal cell carcinoma, cystic nephroma, mixed epithelial and stromal tumour of the kidney). These entities cannot be distinguished one from another on preoperative imaging studies. A preoperative biopsy and intra-operative frozen-section analysis do not lead to a correct diagnosis in many cases. Fortunately, the operative strategy is the same for all these tumours. In such cases, the nephron sparing surgery is indicated, whenever technically feasible, as almost all extensively cystic renal tumours have a good prognosis.

The role of 18F-FDG accumulation and arterial enhancement as biomarkers in the assessment of typing, grading and staging of hepatocellular carcinoma using 18F-FDG-PET/CT with integrated dual-phase CT angiography.

AIM: The purpose of the present study was to evaluate the possibility of detection, staging and differentiation assessment of hepatocellular carcinoma (HCC) using a combination of dual-phase computed tomography (CT)-angiography in the arterial and portal phase with positron emission tomography (PET) imaging using (18)F-fluorodeoxyglucose ((18)FDG). PATIENTS AND METHODS: From a set of 10,000 patients who underwent (18)FDG-PET/CT, we examined a total of 65 patients (52 males, 13 females; mean age=61.7 years, ranging from 35-82 years) with HCC. The imaging included CT data acquisition after intravenous application of iodinated contrast material in arterial and portal phases, allowed to obtain data in CT angiography quality. Histological diagnosis of the resection sample (21), biopsy (37) or necropsy (7), including the evaluation of the hepatocytary origin of the tumor and the grade of its differentiation, was determined in all patients. RESULTS: The most sensitive sign in the detection of HCC was the alternative presence of hypervascularity or hyperaccumulation of (18)F FDG that reached 93.8%. The high level of (18)F-FDG accumulation showed sensitivity of 84.1% and specificity of 75.0% for distinguishing between well- and poorly differentiated HCC. CONCLUSION: The combination of the dual-phase CT angiography with (18)FDG PET helps in the assessment of staging and differentiation of HCC and has an important role in treatment decision-making.

18F-FDG-PET/CT in potentially advanced renal cell carcinoma: a role in treatment decisions and prognosis estimation.

AIM: to assess the influence of positron emission tomography/computed tomography with (18)F-fluorodeoxyglucose ((18)F-FDG-PET/CT) on the treatment decision in renal cell carcinoma and to assess the prognostic value of the (18)F-FDG accumulation assessments. PATIENTS AND METHODS: Data from 60 patients were included. The cohort consisted of 43 males, 17 females, mean age 66.2 years (range=49-86 years). All patients underwent (18)F-FDG-PET/CT including two-phase CT-angiography of the kidneys. Locally advanced or generalized renal cell carcinoma was suspected in all patients. The level of the (18)F-FDG accumulation within the tumor was compared with the histological grading and the development of the disease was assessed 12 months after (18)F-FDG-PET/CT. RESULTS: Overall mortality reached 46.7%, the highest (18)F-FDG accumulation showed tumor of grade 4 (mean SUV(max)=10.7, range=5-23), the highest mortality was found for tumors exceeding SUV(max) value of 10 (mortality 62.5%). New information was brought by (18)F-FDG-PET/CT in 85% of cases. CONCLUSION: (18)F-FDG-PET/CT has the potential to estimate the patient's survival according to the (18)F-FDG accumulation measured in SUV(max). Depiction of occult metastatic disease has an emerging role in decision making regarding surgery.

A role of multifactorial evaluation of prostatic 3T MRI in patients with elevated prostatic-specific antigen levels: prospective comparison with ultrasound-guided transrectal biopsy.

AIM: To assess the role of multiparametric 3T magnetic resonance (3TMRI) of the prostate in detection of the prostatic carcinoma in a male population with elevated prostatic-specific antigen (PSA) and to compare the results with those of transrectal biopsies. MATERIALS AND METHODS: A prospectively collected cohort of 191 men underwent 3T MRI before transrectal biopsy. The evaluation consisted of the assessment of T2-weighted images, diffusion-weighted images, MR spectroscopy and the pharmacokinetic evaluation of the data obtained during the dynamic post-contrast T1 imaging. The assessment included the calculation of the blood volume and transfer constant evaluations. The diagnosis of prostate carcinoma was based on a minimum of three positive signs obtained from MR studies--hypointensive T2 lesion, diffusion restriction, elevated choline/creatine peak in spectrum and malignant type of saturation by contrast agents. All biopsies were evaluated by a specialist in uropathology. RESULTS: 164 patients underwent biopsy, in 27 the biopsy was omitted due to a lack or low probability of carcinoma: Overall, 84 carcinomas were found. Based on the comparison of biopsy results, 3T MRI reached a sensitivity of 97.6%, specificity of 85.0%, positive predictive value of 74.6% and negative predictive value of 96,3% respectively. There were only three false negative findings. In three patients with very suspicious MRI findings and PSA levels over 30 ng/ml, the biopsy did not confirm carcinoma, even though it was highly suspected. CONCLUSION: The implementation of 3T MRI in routine assessment of patients with elevated PSA should reduce the number of biopsies performed and improve the number of tumors detected due to better targeted biopsies.

Pulmonary imaging using dual-energy CT, a role of the assessment of iodine and air distribution.

AIM: The aim of the study is to present the feasibility of using dual-energy CT and the evaluation of iodine and air distribution in differentiation of pathological conditions. MATERIAL AND METHOD: We used the data of 50 CT examinations performed due to suspected pulmonary embolism with any pathological finding except consolidation of the parenchyma. The patients underwent CT angiography of the pulmonary arteries on a dual-source CT (DSCT), with the two tubes independently operated at 140 and 80 kV. By exploiting the dual-energy information, iodine distribution maps were obtained in addition to the conventional CT images which served as a marker of pulmonary perfusion. Minimum intensity projections (MinIP) were used as a marker of air content. RESULTS: By comparing the iodine distribution maps and MinIP images, it was possible to differentiate between the following templates of lung parenchyma: A--normal iodine and air distribution; B--iodine content deficit with minimal or with no redistribution of air; C--reduced iodine content and increased content of air; D--deficit of iodine content and increased content of air; E--increased iodine content and normal content of air; F--increased iodine content and reduced content of air; G--reduced perfusion and reduced content of air. The type A (five cases) was typical for the pulmonary embolism with preserved normal conditions of perfusion and ventilation. Type B (18 cases) occurred in pulmonary embolism; type C was found in case of inflammation of small respiratory airways (five cases); emphysema was typical for type D (nine cases); increased perfusion was observed in the parenchyma preserved from emphysema or preserved from embolism in cases of emphysema or pulmonary embolism; type F occurred in pulmonary interstitial edema (four cases) both with pulmonary infection; finally type G was found in interstitial lung diseases (five cases). CONCLUSION: Imaging of the pulmonary circulation by means of dual-energy CT opens the potential to study pathological changes of circulatory and pulmonary perfusion impairments, our presented work signs the important relations between iodine and air distribution which have to be thought in the interpretation of dual-energy perfusion imaging of the lungs.

Predictive value of serum biomarkers in patients after portal vein embolization (PVE): a pilot study.

BACKGROUND/AIM: Insufficient growth of the liver or tumor progression is an important issue of portal vein embolization (PVE) in some patients. This study evaluated the predictive value of serum biomarkers for liver hypertrophy and tumor progression after PVE. PATIENTS AND METHODS: Serum levels of tumor markers, growth factors and cytokines were determined in 40 patients with malignant liver tumors in the pre- and post-PVE period. The values were compared with contralateral liver hypertrophy and tumor progression. RESULTS: Liver tissue hypertrophy occurred in 26 (65%), tumor progression in 11 (27.5%) and insufficient liver hypertrophy in 3 (7.5%) of the patients. The significant predictive biomarkers of PVE included serum TPA levels, monototal, IGF-BP3, IGF1, TGF-α, EGF, HGF, VEGF, TNFa and IL-10 before PVE; and TK, TPA, monototal, IGF-BP3, TGFa and IL-8 over the course of 28 days after PVE. CONCLUSION: Certain serum biomarkers have an important predictive value for the result of PVE.

Fever of unknown origin: a value of (18)F-FDG-PET/CT with integrated full diagnostic isotropic CT imaging.

AIM: The aim of presented work is to evaluate the clinical value of (18)F-FDG-PET/CT in patients with fever of unknown origin (FUO) and to compare PET/CT finding with the results of the following investigation. MATERIAL AND METHOD: 48 patients (24 men, 24 women, mean age 57.6 years with range 15-89 years) underwent (18)F-FDG-PET/CT due to the fever of unknown origin. All examinations were performed using complex PET/CT protocol combined PET and whole diagnostic contrast enhanced CT with sub-millimeter spatial resolution (except patient with history of iodine hypersensitivity or sever renal impairment). CT data contained diagnostic images reconstructed with soft tissue and high-resolution algorithm. PET/CT finding were compared with results of biopsies, immunology, microbiology or autopsy. RESULTS: The cause of FUO was explained according to the PET/CT findings and followed investigations in 44 of 48 cases-18 cases of microbial infections, nine cases of autoimmune inflammations, four cases of non-infectious granulomatous diseases, eight cases of malignancies and five cases of proved immunity disorders were found. In 46 cases, the PET/CT interpretation was correct. Only in one case, the cause was overlooked and the uptake in atherosclerotic changes of arteries was misinterpreted as vasculitis in the other. The reached sensitivity was 97% (43/44), and specificity 75% (3/4) respectively. CONCLUSION: In patients with fever of unknown origin, (18)F-FDG-PET/CT might enable the detection of its cause.