Adrenal glands uptake patterns in 18F-Fluoroethylcholine PET/CT. / Patrones de captación en las glándulas suprarrenales de la PET/TC con 18F-Fluoroetilcolina.

PURPOSE: To find reasons of different radioactive choline adrenal uptake in prostate or renal cancer patients who underwent 18F-fluoroethylcholine positron emission tomography/computed tomography. METHODS: Forty-nine positron emission tomography/computed tomography studies with radioactive choline (96 adrenal glands) were analysed with respect to the adrenal glands shape, uptake pattern and maximum standardised uptake value. Fifteen other parameters were recorded, assessed or counted, ratios of chosen parameters were calculated, and checked for correlation with adrenal glands uptake. RESULTS: Adrenal glands presented a wide range of radioactive choline uptake intensities (range 2-7.9) and different uptake patterns (diffuse, focal or mixed). Maximum uptake in the right (4.3±1.2) adrenal gland positively correlated with the thickness of the parenchyma at the point of maximal uptake (5.3mm±1.5) (p=0.000). Maximum uptake in the right and left adrenal gland, as well as mean adrenal gland uptake, correlated with maximum uptake in the pituitary gland (p=0.000, p=0.000 and p=0.001, respectively) and with maximum uptake in liver (p=0.008, p=0.000 and p=0.011, respectively). Neither hormonal treatment nor patients' age significantly correlated with standardised uptake values of adrenal glands in the studied group. CONCLUSIONS: The variability of radiocholine uptake in adrenal glands depends probably on overall body metabolism and hypophyseal function expressed by statistically significant correlation with liver and pituitary gland uptake. Predominant focal or mixed with focal areas uptake patterns on positron emission tomography in normal in computed tomography adrenal glands should be assessed with caution to avoid a diagnostic mistake.

Vascular patterns in superficial lymphomatous lymph nodes: A detailed sonographic analysis().

PURPOSE: To identify the vascular patterns found in superficial lymph nodes with histologically confirmed lymphomatous involvement and to determine their value in the sonographic diagnosis of lymphadenopathy. METHODS AND MATERIALS: The study involved the prospective classification of vascular patterns observed during power Doppler and/or color Doppler studies of superficial lymph nodes scheduled for resection. Forty patients (27 men and 13 women, aged 22-84 years; mean age: 58 years) with pathologically proven lymphoma were selected for this study (26 cervical, 13 axillary and 1 inguinal). RESULTS: A longitudinal vessel with or without branches (pattern I) was found in 14 lymphomatous nodes. Six contained short vessel segments distributed in the hilum area or centrally (pattern II), five had multiple vessels, partially branching, entering the node in a few rows from its longitudinal side (pattern III), seven presented multiple vessels that branched irregularly or chaotically with avascular areas (pattern IV), and eight had a peripheral vessel distribution (pattern V). Therefore, 50% of the lymphomatous nodes had vascular patterns regarded as characteristic of reactive lymph nodes (patterns I and II), and 37.5% had patterns normally described in lymph nodes with metastatic involvement (patterns IV and V); other lymphomatous lymph nodes had ambiguous vascular patterns that have not been previously classified (pattern III). CONCLUSION: The angioarchitecture of superficial lymphomatous lymph nodes varies widely and is difficult to classify. It may resemble that reported in normal or reactive lymph nodes or patterns that are associated with metastases. The finding of a normal or benign vascular pattern in a lymph node with suspected lymphomatous involvement does not eliminate the need for a diagnostic biopsy.

3D ultrasound examination of the superficial lymph nodes--does it provide additional information?

PURPOSE: To compare the appearance of superficial lymph nodes on standard two-dimensional (2D) ultrasound examination and on three-dimensional (3D) ultrasound examination. MATERIALS AND METHODS: Fifty two lymph nodes (35 cervical, 16 axillary, 1 inguinal) in 52 patients were examined with ultrasound in 3D mode. In standard 2D grey-scale examination and on a C-plane of 3D mode (parallel to the surface of the probe), the shape of a lymph node and its hilum were assessed. Final histopathological diagnoses included 36 lymphomas, 11 reactive or inflammatory lymph nodes, 3 metastases and 2 plasmocytoma infiltrations. RESULTS: The appearance of hilums and lymph nodes as a whole changed on a C-plane of 3D mode (as compared with 2D presentation) in 28 % and 37 %, respectively. The differences in lymph node shape on 2D and 3D ultrasound were apparent in a comparable percentage of reactive lymph nodes (45 %) and lymphomatous lymph nodes (39 %). The differences in lymph node hilum shape on 2D and 3D ultrasound applied to 56 % of reactive lymph nodes and 20 % of lymphomatous lymph nodes. CONCLUSION: Three-dimensional imaging on a C-plane (parallel to the surface of the probe) may supply the examiner with different information concerning the shape of the lymph node and its hilum in comparison to standard 2D ultrasound. Changes in the shapes of hilum and lymph node occurred in reactive or inflamed lymph nodes as well as in lymphomas. Clinical significance of this fact demands further investigation.

Color-SieScape imaging of carotid and vertebral arteries.

OBJECTIVE: The aim of this study was to estimate the feasibility and limitations of Color-SieScape imaging of carotid and vertebral arteries in healthy subjects. METHODS: extended field of view procedure was applied during the examination of 80 carotid and 80 vertebral arteries in 40 healthy volunteers. RESULTS: visualisation of a common carotid artery together with a proximal segment of both an internal (ICA) and external carotid artery (ECA) in one Color-SieScape image was possible in nine cases. Clear presentation of a common carotid artery in one Color-SieScape image with a segment of an ICA or ECA of varying length was possible in 49 cases. In 22 cases, visualisation of an ICA was possible only on a minimal length, with major artefacts or completely impossible. Color-SieScape images of vertebral arteries were good or very good in 34 cases and poor or very poor in 46 cases. Artefacts arose due to the pulsatile movements of the arterial wall, especially in vessels lying close to the skin and in the proximal part of a common carotid artery. Tracing a tortuous vessel and ICA coming from common carotid artery at an angle close to 90 degrees produced significant artefacts. CONCLUSIONS: Color-SieScape images of carotid and vertebral arteries of good quality are usually possible to obtain.

Ultrasonography as the method of incidental detection of mandible lesions.

We present two cases of patients with bone cysts in which the suggestion of a bone lesion was made primarily on the basis of ultrasound examination. Examinations were performed with use of a 7.5 MHz linear probe on Siemens Elegra ultrasound scanner (Siemens, Erlangen, Germany) with application of tissue harmonic imaging (THI) and power Doppler mode. On the basis of such features as uneven and irregular bone surface, widening and distorting of the mandible shape or visualization of the mass inside the bone on ultrasound examination, the presence of the bone tumor was suggested. Ultrasound examination may be the first method suggesting the presence of the unsuspected mandible tumor in patients referred to search for underlying pathology in soft tissues. During the examination of the soft tissues of the head and neck also the surface of bones should be each time carefully evaluated.

Pleomorphic adenoma and adenolymphoma in ultrasonography.

OBJECTIVE: The aim of the study was to define ultrasonographic morphologic features characteristic of pleomorphic adenoma and adenolymphoma (Warthin's tumor). METHODS: Documentation of 31 ultrasonographic examinations of 20 pleomorphic adenomas and 10 Warthin's tumors in 28 patients was analysed. All cases were confirmed by fine needle aspiration biopsy or/and histopathological examination. Estimated ultrasound criteria were: borders (well-defined, predominantly well-defined, ill-defined), shape (lobulated, oval, irregular), echogenicity (increased, decreased), structure (homogeneous, slightly inhomogeneous, inhomogeneous) and presence of irregular anechoic areas within a tumor. RESULTS: 100% of the lesions were hypoechoic. 80.6% of all tumors were well-defined. The remaining 19.4% had predominantly well-defined borders. 55% of pleomorphic adenomas had a lobulated shape. Almost equal percentages of Warthin's tumors were lobulated, had an oval and irregular shape. Irregular echolucent areas were present in six of 11 examinations of Warthin's tumors and in one pleomorphic adenoma. CONCLUSIONS: Ultrasonography is a useful method for the evaluation of pleomorphic adenomas and Warthin's tumors and sometimes it might allow to suggest the nature of a tumor if a certain sonographic pattern is present.

US-appearance of a Küttner tumour resembling a malignant lesion: US-histopathologic correlation.

We present a case of unilateral Küttner tumour in the right submandibular gland. Its clinical course and ultrasound features inclined us to include a malignant lesion in the differential diagnosis. US-histopathologic correlation explained the ultrasound appearance of the lesion.