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.

[Radiological diagnosis of osteoporosis]. / Radiologische Diagnostik der Osteoporose.

The roentgen-morphologic findings of "osteoporosis" in the different regions of the skeleton are demonstrated. A combination of osteoporosis and osteomalacia induced by hormonal and metabolic bone diseases occur frequently. The results of sequential studies are discussed. Diagnostic informations obtained by quantitative radiology, especially by different methods like x-ray morphometry, densitometry with gamma-rays of isotopes of different energies, quantitative computed tomography, and imaging analysis with electronic methods are described. The sequential use of diagnostic imaging techniques in cases of suspected osteoporosis are explained.

[Common roentgen morphology of generalized osteopathies]. / Allgemeine Röntgenmorphologie der generalisierten Osteopathien.

The generalized macromorphological x-ray findings of the different kinds of osteopathy are discussed. These metabolic bone diseases include osteoporosis, osteomalacia, secondary hyperparathyroidism caused by renal osteopathy and all possible combinations. The complications caused by hormonal and metabolic bone disease are described. The pathomorphological significance and value of follow-up studies with regard to therapeutic procedures are explained.

[Special radiology of the hand in renal osteopathy]. / Spezielle Radiologie der Hand bei renaler Osteopathie.

The different radiographical abnormalities of the hand with renal osteodystrophy are demonstrated. The soft tissue immersion low-energy X-ray technique allows early detection of macrostructural changes of spongy and compact bone, irregularities of the cortex, defects and pseudocysts, osteosclerosis as well as calcifications in the soft tissue and arterio sclerosis of patients with chronic renal failure. Possible erroneous interpretations will be discussed.

[Measurement procedure for further radiologic analysis of bone. A review of the quantitative radiology of the skeleton]. / Die Messverfahren zur weiterführenden radiologischen Analyse des Knochens. Eine Ubersicht der quantitativen Radiologie des Skelettes.

The reasons for using measurements of bone density for further analysis of changes in metabolic bone diseases are pointed out. Besides the easy methods of visual comparison of X-ray images and "microradioscopy", the methods of quantitative radiology are discussed. The X-ray morphometry method is presented, including the new results of measurement of various bones of the skeleton. Structural analysis of spongy and compact bone tissue from the X-ray image using opto electronic image transformation is demonstrated. The techniques of X-ray photodensitometry and isotope-densitometry are explained. The importance of a reproducible calibration standard and the special value of reference systems containing a known concentration of hydroxyapatite are shown. Special information is given regarding the present status of the development of the new technique of quantitative computer tomography (QCT) or computer tomometry with the aid of a solid reference system. This new reference system is constructed from various concentrations of hydroxyapatite in "solid water" (a polyethylene mixture) and is demonstrated in detail. The results of comparing measurements of the 2nd lumbar vertebral body are shown. Finally, the clinical importance of measurements of the "apatite value" of vertebral trabecular bone tissue and of various trabecular areas of the skeleton is emphasized.

[Informational value of weak-radiation immersion radiography of the hand in hormonal and metabolic osteopathies]. / Informationswert der Weichstrahl-Immersions-Radiographie (WIR) der Hand bei hormonalen und metabolischen Osteopathien.

The early detection of changes in the bones of the hand in hormonal and metabolic osteopathies is possible with the aid of soft tissue immersion radiographic technique combined with "microradioscopy". The informational value of this special method of investigation will be demonstrated by several examples from the 286 examinations of accentuated osteoporotic and osteomalacic and hyperparathyroidism changes of the skeleton. Structural changes in the normally mineralized and poorly mineralized bone as well as the neighbouring soft tissue (joint capsule, tendons, subdermal fatty tissue) and the skin layer itself can be demonstrated. Examinations following therapy in the hospital or in private practice using this painless special method can demonstrate changes of the macrostructure and during the process of healing within the bone.

[Information value of x-ray computed tomography for the detection and control of spondylitis]. / Informationswert der Röntgen-Computer-Tomographie für den Nachweis und die Kontrolle der Spondylitis.

The information content of early bone changes in computed tomography (CT) of pyogenic non-tuberculous spondylitis and spinal tuberculosis is analysed. The CT findings are compared with conventional x-ray images including tomography. In 3 of 16 patients no indications of osteomyelitis were found by conventional x-ray images, whereas CT revealed paravertebral soft tissue swelling or abscesses and osteolysis and thus established the diagnosis of spondylitis. In one patient the process caused neurologic symptoms by extending into the epidural space. The contributions of CT to the diagnosis of spondylitis are to delineate the extent of soft tissue swelling, to detect small defects in the vertebral bodies, to exclude disc involvement, and to differentiate inflammations and other destructive changes. CT can be used for fine needle localization and aspiration of tissue or pus for histological or bacteriological investigations to establish the pathological diagnosis.

[Detection of occult fractures of the pelvic bones by roentgen computed tomography]. / Nachweis maskierter Frakturen des Beckenskelettes mit der Röntgen-Computer-Tomographie.

The informational value of C.T. concerning pelvic fractures is presented. Not all injuries to the hip joint and to the os sacrum can be seen on standard a.p.-projections, oblique views, special projections or conventional tomography. 17 typical examples have been selected from young patients with multiple injuries. C.T.-findings concerning fractures of the hip joint, of the os sacrum and of hidden pelvic fractures are described. Emphasis is placed on careful radiological analysis of fractures with special regard to the planning of conservative or operative treatment and also on the later functional results following fractures of the hip joint.

[Rare localization of Paget's osteodystrophia deformans in the skeleton]. / Seltene Lokalisationen der Osteodystrophia deformans Paget am Skelett.

Frequency of rare skeletal lesions in Paget's disease is compared with normal localisations. Radiological morphology of rare localisations of Paget's disease of the scapula, of the lower arm bones, of the hand bones, of the patella and the calcaneus are described. Thickening of trabeculae in the spongy bone and porosity of compact bone, deformation and enlargement of the bones are typical; this has to be differentiated and related to a small number of other bone diseases.

[Course of Paget's osteodystrophia deformans--exemplified by the roentgen morphology of the cranial bones]. / Die "Gangarten" der Osteodystrophia deformans Paget--am Beispiel der Röntgenmorphologie des Schädelskelettes.

The still unknown etiology and pathogenesis of Paget's disease or Osteodystrophia deformans Paget are discussed; localisation of skeletal lesions and clinical findings of the disease are described. The skull bones are used to give an example for the 4 phases of the course of the disease, shown by X-ray pictures. Typical X-ray findings of changes in structure, pattern, size, and shape of the skull bones are compared with the pathological and anatomical picture.

[Femur head necrosis in metabolic and hormonal osteopathies--a radiologic-morphologic analysis]. / Die "Hüftkopfnekrose" bei metabolischen und hormonellen Osteopathien--eine radiologisch-morphologische Analyse.

The pathogenesis of bone necrosis is discussed with special attention and with respect to metabolic, hormonal, and vascular factors. The influence of statics and dynamics of the hip joint bones for the development of aseptic necrosis are discussed. 45 patients with "idiopathic femoral head necroses" were observed, including 6 cases of renal osteopathy following renal transplantation and immune suppression therapy, 14 cases of long term corticoid therapy, and 11 cases of liver diseases of different genesis. The femoral head necrosis is understood as complication of an osteopathy. In our patients there were 31 males and 14 females - which means higher involvement of males. Plain radiological findings and CT-findings of changes of the femoral head structure in different stages of the disease are described. Early diagnosis of metabolic and hormonal osteopathies is demanded for a joint keeping therapy of the beginning femoral head necrosis.

[Significance of a new large-format image intensifier in serial examination of thoracic organs]. / Bedeutung eines neuen Grossformat-Bildverstärkers für die Reihenuntersuchung der Thoraxorgane.

At the beginning informations are given of serial radiological examinations, of lung investigations of all medical employees, and of blood donors. Very low radiations doses are claimed for all provisional care investigations. This is guaranteed by the new large format image intensifier (Siemens Optilux 57). The important technical data of this large format image intensifier are given, which lead to reduction of radiation dose and film expenses. Experiences with the new large format image intensifier of more than 1500 investigations of blood donors and medical employees are described.

[Benign disorders of soft tissue on the roentgen computer tomogram]. / Die gutartigen Erkrankungen der Weichteile im Röntgen-Computer-Tomogramm.

Diagnostic procedures of soft tissue lesions have considerably improved by the high density resolution of computed tomography. Indications for investigations by CT are described in detail and illustrated by examples. Enhancement by contrast medium enables further differentiation of the tumors. In most cases for cancer control the scar tissue can be differentiated from relapse. Comparison of both sides reveals isodense tumors. Limits of the CT method will be met in looking for discreet changes in the joints.

[Roentgen morphology of sport injuries to the pelvic apophyses]. / Röntgen-Morphologie von Sportverletzungen der Apophysen des Beckenskelettes.

Pelvic apophyses are places of insertion of strong muscles and tendons and are therefore places of least resistance at the end of skeletal growth. Avulsions and disruptions of pelvic apophyses can be caused by overstrain during different kinds of sport activity. Typical radiological findings in 8 different cases of ruptures of apophyses, osteochondropathies, and resulting conditions of sport injuries are demonstrated. The difficulties of correct diagnosis and differential diagnosis are pointed out. The significance of hormonal impairment of ossification for development and stress factor of pelvic apophyses is exposed. Questions of treatment and follow-up studies are discussed.