Fibroelastic pseudotumor elastofibroma dorsi detected by 18F-FDG PET/CT scan and by postherapy radioiodine SPECT/CT. / Seudotumor fibroelástico elastofibroma dorsi detectado por 18F-FDG PET/TC y por 131I SPECT/TC posterapia.

Radioiodine uptake in the thyroid tissue, metastasis of differentiated thyroid cancer (DTC), and in other tissues, depends on the expression of sodium-iodide symporter (NIS). Vascular permeability, effusions, inflammation, and other mechanisms may also play a role in the accumulation of radioactive iodine. A 63-year-old woman underwent radioiodine therapy, as well as a post-therapy whole-body scan, as she was suspected of having lung metastasis from thyroid carcinoma. The scan not only showed uptake at the lung metastasis but also a faint diffuse bilateral uptake in the posterior thorax. On SPECT/CT this uptake was located in a known Elastofibroma Dorsi (ED) previously diagnosed by contrast CT and viewed in a FDG PET/CT. The radioiodine uptake in ED, especially if typical, is not a diagnostic problem in SPECT/CT study, but can be misleading in a study limited to a few planar images, particularly if the uptake occurs asymmetrically, or ED is located in a unsuspected area.

Spectral optimization of chest CT angiography with reduced iodine load: experience in 80 patients evaluated with dual-source, dual-energy CT.

PURPOSE: To determine the energy levels that provide optimal imaging of thoracic circulation at dual-energy computed tomographic (CT) angiography with reduced iodine load in comparison with a standard technique. MATERIALS AND METHODS: The institutional review board approved the study with waiver of patient consent. Eighty patients underwent a dual-source, dual-energy CT examination after administration of low-concentration contrast material (170 mg of iodine per milliliter), and eight series of images were reconstructed, including the original polychromatic images at 80 and 140 kV and six series of virtual monochromatic spectral images at 50, 60, 70, 80, 90, and 100 keV. For each vascular compartment, the energy level that provided optimal evaluation on virtual monochromatic spectral images was determined, and these series were compared with the polychromatic dual-energy images and with standard chest CT images that were used as controls. Comparisons between groups were performed by using the paired Student t test for continuous variables and the McNemar test for categorical variables. Comparisons between dual-energy and standard CT images were performed by using the unpaired Student t test for continuous variables and the χ(2) test for categorical variables. RESULTS: For the aorta, pulmonary arteries, and veins, the reconstruction at 60 keV provided adequate attenuation without marked beam-hardening artifacts in 90% of patients, with the highest contrast-to-noise and signal-to-noise ratios, the lowest level of subjective noise, and no significant differences with images at 80 kV (mean energy, 54 keV). For the superior vena cava and brachiocephalic veins, the reconstructions at 100 keV enabled artifact-free analysis of the perivascular anatomic zone without a significant difference with images at 140 kV (mean energy, 92 keV). Compared with standard CT images acquired after administration of a 35% iodinated contrast agent, there was a statistically significant reduction in the frequency of artifacts around systemic veins at 100 keV (P < .001) and similar overall image quality for central vessels at 60 keV (P > .05). CONCLUSION: An optimal analysis of thoracic circulation can be achieved on virtual monochromatic spectral images at 60 keV and 100 keV and on the original polychromatic images at 80 kV and 140 kV. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12120195/-/DC1.

Surveillance after surgical treatment of melanoma: futility of routine chest radiography.

BACKGROUND: Current recommendations by the National Comprehensive Cancer Network and other groups suggest that follow-up of cutaneous melanoma may include chest radiography (CXR) at 6- to 12-month intervals. The aim of this study was to determine the clinical efficacy of routine CXR for recurrence surveillance in melanoma. METHODS: Post hoc analysis was performed on data from a prospective, randomized, multi-institutional study on melanoma ≥1.0 mm in Breslow thickness. All patients underwent excision of the primary melanoma and sentinel node biopsy with completion lymphadenectomy for positive sentinel nodes. Yearly CXR and clinical assessments were obtained during follow-up. Results of routine CXR were compared with clinical disease states over the course of the study. RESULTS: A total of 1,235 patients were included in the analysis over a median follow-up of 74 months (range, 12-138). Overall, 210 patients (17.0%) had a recurrence, most commonly local or in-transit. Review of CXR results showed that 4,218 CXR were obtained in 1,235 patients either before, or in the absence of, initial recurrence. To date, 88% (n = 3,722) CXR are associated with no evidence of recurrence. Of CXR associated with recurrence, only 7.7% (n = 38) of surveillance CXR were read as "abnormal." Overall, 99% (n = 4,180) of CXR were read as either "normal" or found to be falsely positive (read as "abnormal," but without evidence of recurrence on investigation). Only 0.9% (n = 38) of all CXR obtained were true positives ("abnormal" CXR, with confirmed first known recurrence). Among these 38 patients with true positive CXR, 35 revealed widely disseminated disease (multiorgan or bilateral pulmonary metastases); only 3 (0.2%) had isolated pulmonary metastases amenable to resection. Sensitivity and specificity for surveillance CXR in detecting initial recurrence were 7.7% and 96.5%, respectively. CONCLUSION: The routine use of surveillance CXR provides no clinically useful information in the follow-up of patients with melanoma. CXR does not detect recurrence at levels sufficient to justify its routine use and, therefore, cannot be recommended as part of the standard surveillance regimen for these patients.

Image-guided percutaneous thermal ablation for the palliative treatment of chest wall masses.

OBJECTIVES: To evaluate the palliative benefits of image-guided thermal ablation for the treatment of painful tumors affecting the chest wall. METHODS: Thirty-nine patients, median age 65 years, underwent percutaneous thermal ablation of 44 chest wall masses. Thirty-eight radiofrequency ablations (RFAs), 3 microwave ablations (MWAs), and 3 cryoablations were performed. Subjective pain reports at 1 week and 1 month postablation were scored from 0 to 4 based on a standard Likert pain relief scale, with 2 or higher representing clinically significant pain relief. RESULTS: Patients were followed for a median of 6 months. Overall, 31 of 44 procedures (70.5%) resulted in significant pain relief. Improvement followed 15 of 15 (100%) of ablations that were performed within 90 days of treatment with palliative external-beam radiation therapy (XRT), compared with 16 of 29 (55.2%) of the remaining procedures. Mean pain relief score at 1 month was 3.86 for the 15 combined procedures versus 1.96 for the 29 remaining procedures (P < 0.001). Local pain recurred after 5 of 31 positive responses (16.1%). Median survival was 11.2 +/- 2.3 months for patients with significant pain relief and 4.3 +/- 1.4 months for nonresponders (P < 0.001). Adverse events included a transient symptom "flare" (n = 5, 11.4%) and the exacerbation of a preexisting brachial plexopathy. CONCLUSIONS: Thermal ablation results in significant pain relief for the majority of patients and shows evidence of synergistic benefit when temporally combined with XRT. This minimally invasive technique appears to be a safe and durable alternative for the palliation of chest wall masses.

Transcatheter arterial embolization for tumor seeding in the chest wall after radiofrequency ablation for hepatocellular carcinoma.

Tumor seeding in the chest wall was depicted at follow-up CT obtained 9 months after radiofrequency ablation for hepatocellular carcinoma. Transcatheter arterial embolization was successfully performed, injecting emulsion of 10 mg of epirubicin and 1 ml of iodized oil followed by gelatin sponge particles via the microcatheter placed in the right eleventh intercostal artery. The patient died of tumor growth in the liver one year after the embolization, but no progression of the tumor seeding was noted during the follow-up period. We conclude that transcatheter arterial embolization was effective for the control of tumor seeding after radiofrequency ablation for hepatocellular carcinoma.

Edge-element based finite element analysis of microwave hyperthermia treatments for superficial tumours on the chest wall.

Several three-dimensional hyperthermia treatment planning systems for deep regional hyperthermia have been successfully utilized for improving the performance of applicators such as the BSD Sigma 60. Treatment planning systems for superficial heating in contrast have been less utilized. This paper presents a study of the applicability of the finite element method that has been developed for modelling hyperthermia treatments of recurrent chest wall cancer using a patient geometry. The patient model was created by reconstructing the tissue geometry of a patient using a series of axial CT scans. Tetrahedral grids were generated from this geometry for use in finite element simulations of the SAR profile using edge-elements and in finite element simulations of the steady-state temperature profile using scalar elements. The predicted temperature profile was well correlated with thermometry readings taken after 30 min of heating during a hyperthermia treatment. The model predicted the presence of hot-spots in regions that were not monitored. Simulations also showed that the hot-spots can be manipulated by rotating the applicator by 90 degrees. This study demonstrates the ability of the model to provide detailed and accurate heating profiles in a patient specific model for superficial microwave hyperthermia of the chest wall.

Digital chest radiography with a selenium-based flat-panel detector versus a storage phosphor system: comparison of soft-copy images.

OBJECTIVE: We compared the soft-copy images produced by a digital chest radiography system that uses a flat-panel X-ray detector based on amorphous selenium with images produced by a storage phosphor radiography system for the visualization of anatomic regions of the chest. MATERIALS AND METHODS: Two chest radiologists and two residents analyzed 46 pairs of posteroanterior chest radiographs on high-resolution video monitors (2560 x 2048 x 8 bits). In each pair, one radiograph was obtained with a storage phosphor radiography system, and the other radiograph was obtained with a selenium-based flat-panel detector radiography system. Each pair of radiographs was obtained at the same exposure settings. The interpreter rated the visibility and radiographic quality of 11 different anatomic regions. Each pair of images was ranked on a five-point scale (1 = prefer image A, 3 = no preference, 5 = prefer image B) for preference of technique. Statistical significance of preference was determined using the Wilcoxon's signed rank test. RESULTS: The interpreters had a statistically significant preference for the selenium-based radiography system in six (unobscured lung, hilum, rib, minor fissure, heart border, and overall appearance) of 11 anatomic regions (p<0.001) and for the storage phosphor system in two regions (proximal airway and thoracic spine) (p<0.05). Chest radiologists strongly preferred selenium-based images in eight regions, and they did not prefer storage phosphor images in any region. CONCLUSION: The soft-copy images produced by the selenium-based radiography system were perceived as equal or superior to those produced by the storage phosphor system in most but not all anatomic regions.

Surgical resection combined with intrathoracic hyperthermic perfusion for thymic carcinoma with an intrathoracic disseminated lesion: a case report.

Thymic undifferentiated carcinoma has a poor prognosis. We encountered a patient with thymic carcinoma associated with an intrathoracic disseminated lesion, who underwent surgery combined with intrathoracic hyperthermic perfusion after systemic chemotherapy and showed good results. The 45-year-old man was diagnosed as having a thymoma with an intrathoracic disseminated lesion. After he underwent three courses of systemic chemotherapy, he was admitted to our hospital. An anterior mediastinal tumor and an intrathoracic disseminated lesion remained, and were treated by surgical resection combined with intrathoracic hyperthermic perfusion. The tumors were histopathologically diagnosed as thymic undifferentiated carcinomas with pleural dissemination. At present, approximately 16 months after surgery, the patient is alive without recurrence.

[PET-FDG in thyroid cancer with high thyroglobulin levels and negative 131-I scan. A case report]. / La PET-FDG en el cáncer de tiroides ante niveles altos de tiroglobulina y rastro 131-I negativo. A Propósito de un caso.

The value of whole body PET-FDG in the evaluation of metastases has been demonstrated in a wide variety of tumors. In this report, we present the case of a patient with antecedent of papillary thyroid carcinoma, who was operated twelve years ago, and submitted to an ablative dose of residual thyroid tissue through 131I, being the levels of thyroglobulin normals. After twelve years of evolution, the patient refers bag pain and respiratory trouble, appearing in the CT image suspicious of metastases in right pulmonary base. The levels of thyroglobulin were shown increased, being the 131I scan negative. A whole body PET-FDG study was performed in order to exclude metastases of his malignant process, showed multiple high FDG uptake focus in brain, cerebellum, neck, chest, lymphatic nodes and bone, suggestive of dedifferentiated disease These findings were confirmed subsequently in the clinic evolution. Therefore, whole-body PET-FDG is a complementary diagnostic technique for study patients with CDT (Thyroid Differentiated Carcinoma) with 131I scan negative and rising thyroglobulin levels.

[Can digital selenium-based radiography in thoracic diagnosis replace the analog x-ray imaging technic?]. / Kann die digitale Selenradiographie in der Thoraxdiagnostik die analoge Röntgenaufnahmetechnik ersetzen?

PURPOSE: To find out the diagnostic value of digital selenium radiography, we compared the image quality of chest x-ray images from 50 patients who had been examined via conventional chest x-ray and digital selenium radiography of the chest. METHOD: 50 patients with a malignant melanoma underwent chest x-ray within 3 months in conventional technique and with digital selenium radiography (Thoravision: Philips Medical Systems, Hamburg, Germany). In this period none of the patients showed a difference in respect of clinical status or radiological diagnosis. Simultaneous examinations on the same day were not performed to avoid unnecessary exposure to x-rays. The digital and conventional images were compared by 4 radiologists with regard to image quality by the detection of defined anatomic structures. RESULTS: Image quality of digital selenium radiography was considered superior to that of conventional chest x-rays in the mediastinum, the retrocardiac and retrodiaphragmatic areas, the superior and inferior lobes of the lung especially near the parietal pleura, and the chest wall. CONCLUSIONS: Compared to analogous techniques there is no loss of image information when employing digital selenium radiography in chest x-rays. On the contrary, new assessment criteria may be gained. We conclude that digital selenium radiography offers diagnostic advantages in chest x-ray examination.

I-131 MIBG scintigraphy of neuroectodermal tumors. Comparison between I-131 MIBG and In-111 DTPA-octreotide.

An account is given of the results observed with I-131 MIBG scintigraphy in four patients (1 bladder pheochromocytoma, 3 neuroblastomas) chosen on account of their particular clinical and diagnostic interest from a series of 41 apudoma patients examined by means of this technique. In the first patient, the unusual site of the tumor in the posterior wall of the bladder meant that its detection by I-131 MIBG was only possible after catheterization of the bladder. In the second patient, uptake in the metastasis was only evident after removal of the primary tumor. In the third patient, the scintiscan revealed several metastases (some in bone) not detected by CT. In the fourth patient (congenital neuroblastoma), enhanced uptake accompanied the appearance of high plasma catecholamine and urinary vanillylhandelic acid values, suggesting a functional switch from a nonsecreting to a secreting form. a supplementary In-111 DTPA-Octreotide (OCT) scintiscan of this patient demonstrated the presence of somatostatin receptors on the neuroblasts. Thus, this examination would seem particularly useful for the differentiation of nonsecreting neuroblastomas. Its employment in assessment of the therapeutic capacity of OCT itself is also suggested.

[Treatment of recurrent neuroblastoma in childhood with whole body thermochemotherapy]. / Die Behandlung eines Neuroblastomrezidives im Kindesalter mit Ganzkörper-Thermochemotherapie.

More than 30% of the children suffering from an advanced solid tumour disease or tumour recurrence cannot be cured despite intensive oncological treatment. A new possible therapy is the application of whole-body hyperthermia in childhood in combination with chemotherapy and radiation treatment. The fundamental principles and the method of the whole-body thermochemotherapy are briefly explained. The treatment of one patient with a neuroblastoma recurrence is reported as a clinical example for the effectiveness of whole-body thermochemotherapy in childhood and the course of therapy is discussed.

Optimization of hyperthermia with CT scanning.

In a prospective study CT scanning was used to evaluate the precision of thermometry catheter placement in tumours in the head and neck or on the chest wall in 30 consecutive patients prior to hyperthermia treatment. Patients had variable-sized tumours from several primary sites. Thermometry catheter placement was guided by palpation with or without a prior CT scan. Catheter placement was confirmed by CT. All lesions were less than 8 x 8 x 6 cm (L x W x D) in size. A mean of 4.2 +/- 0.2 (+/- 1 SEM, range 2-7) closed-end polyurethane catheters were inserted orthogonally by the same experienced radiation oncologist. Horizontal thermometry catheters were intended to traverse the centre and base of the tumour mass, and a vertical catheter was often inserted to intersect a horizontal catheter. After catheter placement, wire cables with 1 cm spacings were inserted into the catheters and positions determined using orthogonal films and CT scans. The success of catheter placement was judged on the following criteria: (1) catheter distribution factor (CDF = proportion of tumour CT slices transected by at least one catheter); (2) catheter hit ratio (CHR = average number of catheters in tumour per CT slice); (3) catheter miss factor (CMF = average number of catheters out of tumour per CT slice); (4) catheter placement index, CPI = [(CHR)(CDF)]-CMF; and (5) distance of nearest catheter from the visually estimated centre of tumour in the most central tumour CT scan. In the first seven lesions with 3-6 cm depth catheter insertion was guided by palpation only. In the next 23 lesions catheter insertion was guided by a prior CT scan. In the latter group, 15 lesions had depth 3-6 cm while eight lesions had depth < or = 3 cm. Catheter placement by palpation only, without the benefit of CT scan, was much less accurate in terms of the nearest catheter to the centre of the tumour (p = .001), the proportion of CT slices with catheter in tumour (CDF, p = 0.04) and the probability of a catheter being outside the tumour (CMF, p = 0.01). The catheter placement index (CPI) was a good measure of the accuracy and adequacy of catheter placement in large tumours (p = 0.04). Displacement of normal tissue structures by tumour precluded accurate catheter placement and led to a low CPI. It was difficult to accurately instrument lesions < or = 3 cm depth even with the benefit of a prior CT scan.(ABSTRACT TRUNCATED AT 400 WORDS)