Imaging treated prostate cancer.

In patients with a clinical suspicion of recurrence after treatment for prostate cancer, imaging can be used to distinguish between local recurrence and metastatic disease. Multiparametric magnetic resonance imaging (mpMRI) of the prostate may be a valuable imaging modality for the detection and localization of local recurrence in patients treated for prostate cancer. In mpMRI, morphological T2-weighted images are combined with functional MRI techniques including diffusion-weighted imaging, dynamic contrast-enhanced imaging, and magnetic resonance spectroscopic imaging to improve accuracy. In this paper, the current status of imaging techniques used to detect and to localize tumor recurrence in patients treated for prostate cancer will be reviewed, with emphasis on mpMRI for local prostate cancer recurrence.

Magnetic resonance imaging in diagnosis, staging and radiotherapy planning for prostate cancer.

T2-weighted magnetic resonance imaging (MRI), preferably using an endorectal coil, is able to clearly depict the normal prostatic anatomy and to identify prostate cancer with fair diagnostic accuracy. The latter can be further increased by using functional techniques such as spectroscopy (assessment of prostatic metabolism), dynamic contrast-enhanced MRI (assessment of angiogenesis) and diffusion-weighted imaging (assessment of cellular density). T2-weighted MRI is an important tool for local staging of prostate cancer in patients clinically staged as cT1 or cT2, because of its high specificity for macroscopic capsular extension or seminal vesicle invasion. Compared to CT-imaging, MRI depicts the internal prostatic anatomy, prostatic margins and the extent of prostatic tumours much more clearly. This benefit can be exploited to improve the accuracy of target delineations in radiotherapy planning.

Is there a role for sonography in breast cancer screening?

Sonography can disclose tumors that remain mammographically occult. As a result, many have suggested to perform sonography in addition to screening mammography, especially in women with dense breasts. This approach, however, should be dealt with very cautiously. First of all, the term "mammographically occult" should be used carefully, because lesions that are missed because of suboptimal mammographic image quality or bad positioning or because no attempt has been made to compare with previous mammograms must not automatically be considered as mammographically occult. Secondly, introduction of sonography in mammographic screening is not straightforward because (1) it is extremely difficult to detect small malignant lesions with sonography without concurrently causing an excess of false positive results, (2) it is unclear how sonographic screening should be organized and quality-assured, (3) it is not unreasonable to expect that the excess costs of sonographic screening would favor other prevention strategies with more favorable cost/benefit ratio to decrease overall mortality. But most importantly, no large-scale trials have unequivocally proven the validity of sonography screening so far, neither in the general population, nor in subgroups with dense mammograms and/or at increased risk of breast cancer. Therefore, mammography remains currently the only screening tool that is associated with a decrease of breast cancer specific mortality and that should be used for mass screening.

Ruptured tuboovarian abscess causing peritonitis in a postmenopausal woman. A difficult diagnosis on imaging.

Pelvic inflammatory disease with tuboovarian abscess is rare in postmenopausal women. Clinical and sonographic findings are usually sufficient to recognize pelvic inflammatory disease in premenopausal women, but in the elderly the disease may easily be overlooked, largely by unexpectedness. Computed tomography can be helpful when the clinical and sonographic findings are complex or equivocal. However, when the level of suspicion is low, it can be very difficult to interpret, especially when complicated with peritonitis, as illustrated in the present case report.

Widening of the spinal canal and dural ectasia in Marfan's syndrome: assessment by CT.

We describe a method for diagnosing dural ectasia (DE) and spinal canal widening (SCW) using CT. We examined 23 patients with Marfan's syndrome (MFS), 17 with Ehlers-Danlos syndrome (EDS) and 29 normal subjects, using six axial slices at the level of the L1-S1 pedicles. Transverse diameters of the vertebral bodies, spinal canal and dural sac were measured and indices were defined to differentiate patients with DE and SCW from normal. Statistical significance was assessed using Student's t -test, chi (2)-test and Pearson's correlation coefficient. DE and SCW occurred in 69.6 % and 60.9 % of cases of MFS and in 23.5 % and 35.3 % of EDS respectively. In MFS, prevalence was significantly higher than in the control group. DE was significantly more frequent in MFS than in EDS. A strong correlation existed between DE and SCW in MFS and the control group, but not in EDS. Our system enables quantitative assessment of SCW and DE. The latter is particularly important in subjects suspected of having MFS, in whom it is a common and characteristic sign.

Laparoscopic adjustable silicone gastric banding leakage assessed by 99mTc-pertechnetate scintigraphy.

UNLABELLED: The purpose of this study was to assess the value of 99mTc-pertechnetate scanning in the diagnosis of gastric banding leaks. METHODS: Three patients with morbid obesity received laparoscopic adjustable silicone gastric banding (ASGB), but no significant weight reduction was obtained. To exclude band leakage as the cause, four scintigraphic procedures were performed, consisting of imaging the upper abdomen 30 min and 3 h after injection of 3 mL (111 MBq) pertechnetate solution into the ASGB reservoir. In one patient, the integrity of the ASGB device was first assessed radiologically after injection of a water-soluble contrast agent into the ASGB reservoir. RESULTS: In two normally functioning ASGB devices, radiotracer was observed within the device on both early and late images. In two patients with a surgically proven small leak in the reservoir or the connecting tube, late images showed little tracer in the reservoir and the connecting tube. However, intense tracer accumulation was observed in the stomach as a result of resorption of pertechnetate in the subcutaneous or peritoneal blood vessels and subsequent gastric uptake. In one of the latter patients, radiographic assessment of the ASGB device revealed no abnormalities. CONCLUSION: 99mTc-pertechnetate scanning is a valuable technique to diagnose small leaks in an ASGB device.