In Patients We Trust: Reliability of Self-Reported Weight and Height in Nuclear Medicine Patients.

The aim of the study was to assess the reliability of the self-reported weight and height of nuclear medicine patients in view of recommendations for weight-dependent tracer application for imaging and therapy. Methods: In total, 824 patients (334 men and 490 women) were asked to report their weight and height before imaging or therapy and their level of confidence. Subsequently, the weight and height of each patient were measured, and body mass index, body surface area, and lean body mass were calculated. Differences between reported and true values were compared for statistically significant differences. Results: The average patient age was 60 ± 14 y (range, 17-91 y). An over- or underestimation of weight by at least 10% was observed in 2% of patients, and height was overestimated by 1% by the patients. The BMI calculation was affected by incorrect self-reported values. Conclusion: Most self-reported weights and heights of nuclear medicine patients are accurate. However, since over- and underestimation of weight and height lead to incorrect body mass index, body surface area, and lean body mass values, patient weights should be measured at least for patients receiving a weight-adapted therapy or if quantification in PET/CT is needed.

Breast Lesions during Pregnancy - a Diagnostic Challenge: Case Report.

BACKGROUND: Palpable masses of the breast often occur during pregnancy and should be further investigated. The standard diagnostic during pregnancy is an ultrasound combined, if needed, with a core needle biopsy. Most lesions are benign in younger women but, nevertheless, the incidence of pregnancy-associated breast cancer is 1 in 3,000 deliveries and rising. CASE REPORT: We report the case of a 24-year-old patient diagnosed with a palpable breast lesion at 37 weeks of gestation. An ultrasound was performed and the lesion was rated BI-RADS 4. The initial core needle biopsy showed a ductal carcinoma in situ. After delivery and ablactating, a mammography, breast magnetic resonance imaging and a second ultrasound-guided biopsy was performed. Due to the inconclusive imaging and histological results, a wide excision was performed and a juvenile papillomatosis was confirmed. No further resection was necessary as the initial margins were sufficient. CONCLUSION: This case suggests that the diagnosis of masses of the breast during pregnancy and lactation can be quite difficult. Diagnosis should be confirmed by an excision biopsy and by histological examination through an experienced pathologist. As a significant proportion of papillomas contain malignant regions, an argument exists for the complete excision of all papillary tumours.

Diagnostic accuracy of abnormal galactographic and sonographic findings in the diagnosis of intraductal pathology in patients with abnormal nipple discharge.

The purpose of the study was to compare the diagnostic accuracy of the combination of galactography and ultrasound in patients with pathologic nipple discharge. Fifty-six patients with pathologic nipple discharge were included in the study. Sensitivity, specificity, and positive (PPV) and negative predictive value (NPV) for each method and the combination of both were calculated. Both methods together had a sensitivity, specificity, PPV, and NPV of 91%, 17%, 61%, and 57%. The combined sensitivity of galactography and ultrasound for intraductal pathologies is higher than either modality alone, with a low specificity. No specific signs exist to predict benign or malignant lesions.

Use of contrast-enhanced spectral mammography for intramammary cancer staging: preliminary results.

RATIONALE AND OBJECTIVES: To prospectively evaluate and compare the accuracy of contrast-enhanced spectral mammography (CESM) and ultrasound (US) in size measurement of breast cancer with histologic tumor sizes as gold standard. MATERIALS AND METHODS: Twenty women aged between 40-73 years (mean age, 57 ± 10 years) with histologically proven invasive ductal/lobular carcinomas were included in the study. Agreement between imaging tumor size (CESM and US) and histopathologic tumor size was evaluated with Bland-Altman analysis. Stereotactically guided vacuum biopsy was performed in four patients after CESM. Two independent reviewers described artifacts of CESM. RESULTS: Motion artifacts did not occur in the study. CESM-specific artifacts caused by scattered radiation mostly occurred in oblique view of CESM. Background enhancement of breast tissue was seen in four patients. Mean difference of tumor sizes was 0.3 mm (6.34%) between CESM and histology and -2.2 mm (-7.59%) between US and histology. Limits of agreement ranged from -18.9 to 19.48 mm for CESM and from -17.1 to 12.7 mm with US. Especially smaller tumors with a size <23 mm were measured more precisely with CESM. Enhancement of breast tissue around microcalcifications correlated with abnormalities. CONCLUSIONS: CESM is accurate in size measurements of small breast tumors. On average CESM leads to a slight overestimation of tumor size, whereas US tends to underestimate tumor size. Assessment of the breast tissue can be limited by the scattered radiation artifact and background enhancement of breast tissue. CESM seems to be helpful in the characterization of breast tissue around microcalcifications.

Chronic high-fat diet impairs collecting lymphatic vessel function in mice.

Lymphatic vessels play an essential role in intestinal lipid uptake, and impairment of lymphatic vessel function leads to enhanced adipose tissue accumulation in patients with lymphedema and in genetic mouse models of lymphatic dysfunction. However, the effects of obesity on lymphatic function have been poorly studied. We investigated if and how adipose tissue accumulation influences lymphatic function. Using a lymphatic specific tracer, we performed in vivo near-infrared (NIR) imaging to assess the function of collecting lymphatic vessels in mice fed normal chow or high-fat diet (HFD). Histological and whole mount analyses were performed to investigate the morphological changes in initial and the collecting lymphatic vessels. HFD was associated with impaired collecting lymphatic vessel function, as evidenced by reduced frequency of contractions and diminished response to mechanostimulation. Moreover, we found a significant negative correlation between collecting lymphatic vessel function and body weight. Whole mount analyses showed an enlargement of contractile collecting lymphatic vessels of the hind limb. In K14-VEGF-C mice, HFD resulted in a reduced spreading of the tracer within dermal lymphatic vessels. These findings indicate that adipose tissue expansion due to HFD leads to a functional impairment of the lymphatic vasculature, predominantly in collecting lymphatic vessels.

Dynamics of lymphatic regeneration and flow patterns after lymph node dissection.

Knowledge about the mechanisms of regeneration of the lymphatic vasculature after surgical trauma is essential for the development of strategies for the prevention and therapy of lymphedema. However, little is known about the alterations of lymphatic flow directly after surgical trauma. We investigated lymphatic function in mice using near-infrared imaging for a period of 4 weeks after surgeries that mimic sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND), by removal of the popliteal lymph node (LN) alone or together with the popliteal fat pad, respectively. SLNB-like surgery did not cause changes in lymphatic drainage in the majority of cases. In contrast, lymphatic drainage impairment shown by collecting vessel rupture, dermal backflow and rerouting of lymph flow via collateral vessels were observed after ALND-like surgery. All collateral vessels drained to the inguinal LN. These results indicate that less invasive surgery prevents lymphatic decompensation. They also reveal the development and maturation of collateral lymphatic vessels after extensive surgical trauma, which reroute the flow of lymph towards a different LN. These findings might be helpful for the development of strategies to prevent and/or treat post-surgical lymphedema.

Use of a PEG-conjugated bright near-infrared dye for functional imaging of rerouting of tumor lymphatic drainage after sentinel lymph node metastasis.

Tumor lymphangiogenesis promotes metastatic cancer spread to lymph nodes and beyond. However, the potential remodeling and functionality of tumor-draining lymphatic vessels has remained unclear. Thus, we aimed to develop non-invasive imaging methods for repeated quantitative imaging of lymphatic drainage and of contractile collecting lymphatic vessel function in mice, with colloidal near-infrared (NIR) tracers and a custom fluorescence stereomicroscope specially adapted for NIR sensitive imaging. Using these tools, we quantitatively determined pulse rates and valvular function of collecting lymphatic vessels with high resolution. Unexpectedly, we found that tumor-draining lymphatic vessels in a melanoma footpad model initially were dilated but remained functional, despite lower pulse rates. In two independent tumor models, impaired lymphatic function was detected once metastases were present in draining lymph nodes. Importantly, we found that lymphatic dysfunction, induced by metastatic tumor spread to sentinel lymph nodes, can lead to a rerouting of lymphatic flow away from the metastatic lymph node, via collateral lymphatic vessels, to alternate lymph nodes. These findings might have important clinical implications for the procedure of sentinel lymph node mapping that represents the standard of care for determining prognosis and treatment of melanoma and breast cancer patients.

Long-term diffusion impairment of cerebral white matter in a degenerative disease of the central and peripheral nervous system: reflection of chronic excitotoxicity?

The authors report an abnormal prolonged restricted magnetic resonance imaging (MRI) proton diffusion that persisted for more than 2 years in a 6.5-year-old boy with a progressive neurological disease characterized by developmental retardation, peripheral polyneuropathy, and bilateral optical nerve atrophy. The long-term restricted magnetic resonance imaging proton diffusion observed in diffusion-weighted magnetic resonance images indicates chronic metabolic tissue impairment in the affected white matter, whereas measurable lactate accumulation in proton magnetic resonance spectroscopy was absent, and no respiratory complex abnormality was found in muscle tissue. These findings are suggestive of a chronically disturbed regulation of energy supply triggering a "slow onset" excitotoxicity, causing chronic hypoxia and leading to slow cell death as has been postulated in certain neurodegenerative processes.

Value of quantitative analysis of routine clinical MRI sequences in ALS.

Simple morphological assessment of conventional MRI used in routine neurological diagnostic work-up lacks sensitivity and specificity for amyotrophic lateral sclerosis (ALS). Quantitative analysis of routine MRI sequences might, however, be more suitable to reveal ALS-related pathological cerebral alterations. We investigated 10 ALS patients and 10 age- and sex-matched healthy controls by MRI. Brain maps of T2 relaxation time (T2), relative proton density (PD), and apparent diffusion coefficient (ADC) were obtained. Values of these parameters were measured in 22 selected brain regions, and compared among the patients and the controls by using paired t-test with Bonferroni corrected alpha level (= 0.002). In ALS patients, increased PD was found in the pyramidal tract, corpus callosum, and white and grey matter. T2 elongation was found at the genu of corpus callosum, and at the posterior limb of the internal capsule (ICP). ADC values showed a tendency towards an increase in patients, which was only significant at the ICP. PD therefore appeared to be the most sensitive parameter for the detection of degenerative changes not only in the motor system but also in extramotor brain regions.

Wound ballistics of injuries caused by handguns with different types of projectiles.

BACKGROUND: There are considerable differences in the shape and composition of military and civilian projectiles. MATERIALS AND METHODS: Five different projectiles with the same kinetic energy were fired into the heads of freshly sacrificed pigs (n=30) through the submental region in the occipital direction. Computed tomography (CT) and 3D face scans of the animal skulls were obtained before and after firing. The image data sets were fused and provided the basis for a quantitative analysis of destruction patterns. RESULTS: As a result of the destruction of the parietal bone at the potential exit site, there were significant volume difference between the Action 4 (6.45 +/- 3.42 ml) and the Hydra-Shok projectile (12.71 +/- 2.86 ml). The partial metal-jacketed projectile showed a minor increase in volume (4.89 +/- 1.47 ml) and a partial loss of soft projectile components. Radiology showed differences between the various projectiles in fragmentation and bone and soft-tissue destruction. CONCLUSIONS: Although the projectiles had the same kinetic energy, there were considerable differences in injury patterns between full metal-jacketed projectiles, which are the only projectiles permitted for military use under the Geneva Conventions, and the other investigated projectiles. These injuries present a major medical challenge to both first responders and surgeons.

Influence of different types of guns, projectiles, and propellants on patterns of injury to the viscerocranium.

PURPOSE: Gunshot injuries to the oral and craniomaxillofacial region vary with the type of gun used. Computed tomography (CT) is the standard diagnostic tool for assessing tissue damage in patients with gunshot injuries. Cone-beam computed tomography (CBCT) is a new imaging technique that has recently become available for clinical diagnosis. The objective of this study was to characterize injury patterns with a focus on gun types and identify the imaging modality that is best suited to assessing injuries caused by different gun types. PATIENTS AND METHODS: We present the cases of 14 patients who sustained gunshot injuries to the viscerocranium during the past 10 years. The injuries were caused by 8 basic combinations of handguns or long guns with soft lead core projectiles, partial or full metal-jacketed bullets, and different propellants. Diagnosis was based on clinical and radiological findings (including CT and CBCT). RESULTS: We found a direct correlation between the gun/projectile combination on the one hand and the diameter of the wound track, tissue contamination, and tissue destruction on the other. Entrance and exit wounds are indicative of certain gun/projectile combinations. High-density projectiles cause severe artifacts in CT, unlike CBCT, making it difficult to evaluate anatomic structures in close proximity to the projectile. CONCLUSIONS: Every gun/projectile combination is associated with a typical pattern of injury. Even in the absence of the offending projectile, it is thus possible to narrow down the likely gun and/or projectile. In the diagnostic imaging of injuries caused by high-density projectiles, CBCT is more suitable than CT.

Regeneration of autotransplanted avascular lymph nodes in the rat is improved by platelet-rich plasma.

The aim of this study was to verify that subcutaneous lymph node transplantation inducing lymphatic regeneration is possible in healthy adult rats, in analogy to results obtained in other species. This rat model was used to determine the effects of lymph node fragmentation as well as sheep erythrocytes and platelet-rich plasma injection on the regeneration of the transplanted lymph nodes. The results show for the first time that the rat is an adequate model to study the regeneration of transplanted lymph nodes. Lymph node fragmentation seems to affect transplant regeneration negatively. An immune challenge by injection of sheep erythrocytes in the drainage area of the transplanted lymph nodes does not improve fragment regeneration. However, injection of syngeneic platelet-rich plasma containing several growth factors resulted in an improvement in regeneration. Lymph node fragment regeneration, although still experimental, could be relevant for lymphedema prevention. Acquired lymphedema has a high prevalence in developed countries as a consequence of the removal and/or radiotherapy of tumor-draining lymph nodes in cancer patients. This disease causes lifelong disability due to chronic swelling and increased risk of infections. It currently lacks an effective treatment.

Lymphocyte numbers and subsets in the human blood. Do they mirror the situation in all organs?

Lymphocyte numbers in the blood are used to evaluate the immune status on a daily basis in medicine. Several studies have documented the normal ranges of lymphocytes and lymphocyte subsets in the peripheral blood. A variety of techniques and criteria have revealed clear differences between the lymphocyte subsets in childhood and adolescence. Race and gender are also variables for blood lymphocytes, and even environmental factors seem to influence the numbers of some lymphocyte populations. However, do all these variations in lymphocyte subsets in the peripheral blood mirror changes in the lymphocyte populations of the whole body, or is it just a result of different migratory habits of cells? The factors influencing the distribution of lymphocytes in the peripheral blood with regard to the different abilities of T and B cells to migrate to distinct lymphoid or non-lymphoid tissue are summarized. In addition it will be described how the removal of organs (e.g. thymus, spleen, liver) influences the distribution of lymphocytes in the blood. All these parameters should be considered not only in the clinical situation when the immune status of a patient is extrapolated from the lymphocyte numbers in the blood, but also when interpreting treatment effects in patients.

Keystones in lymph node development.

New molecular markers are constantly increasing our knowledge of developmental processes. In this review article we have attempted to summarize the keystones of lymphoid tissue development in embryonic and pathological conditions. During embryonic lymph node development in the mouse, cells from the anterior cardinal vein start to bud and sprout, forming a lymph sac at defined sites. The protrusion of mesenchymal tissue into the lymph sacs forms the environment, where so-called 'lymphoid tissue inducer cells' and 'mesenchymal organizer cells' meet and interact. Defects of molecules involved in the recruitment and signalling cascades of these cells lead to primary immunodeficiency diseases. A comparison of molecules involved in the development of secondary lymphoid organs and tertiary lymphoid organs, e.g. in autoimmune diseases, shows that the same molecules are involved in both processes. This has led to the hypothesis that the development of tertiary lymphoid organs is a recapitulation of embryonic lymphoid tissue development at ectopic sites.