MR imaging for detection of trampoline injuries in children.

BACKGROUND: The recreational use of trampolines is an increasingly popular activity among children and adolescents. Several studies reported about radiological findings in trampoline related injuries in children. The following publication presents our experience with MRI for detection of trampoline injuries in children. METHODS: 20 children (mean 9.2 years, range: 4-15 years) who had undergone an MRI study for detection of suspected trampoline injuries within one year were included. 9/20 (45%) children had a radiograph as the first imaging modality in conjunction with primary care. In 11/20 (55%) children MR imaging was performed as the first modality. MR imaging was performed on two 1.5 T scanners with 60 and 70 cm bore design respectively without sedation. In 9/20 (45%) children the injury mechanism was a collision with another child. 7/20 (35%) children experienced leg pain several hours to one day after using the trampoline without acute accident and 4/20 (20%) children described a fall from the trampoline to the ground. RESULTS: All plain radiographs were performed in facilities outside the study centre and all were classified as having no pathological findings. In contrast, MR imaging detected injuries in 15/20 (75%) children. Lower extremity injuries were the most common findings, observed in 12/15 (80%) children. Amongst these, injuries of the ankle and foot were diagnosed in 7/15 (47%) patients. Fractures of the proximal tibial metaphysis were observed in 3/15 children. One child had developed a thoracic vertebral fracture. The two remaining children experienced injuries to the sacrum and a soft tissue injury of the thumb respectively. Seven children described clinical symptoms without an overt accident. Here, fractures of the proximal tibia were observed in 2 children, a hip joint effusion in another 2, and an injury of the ankle and foot in 1 child. There were no associated spinal cord injuries, no fracture dislocations, no vascular injuries and no head and neck injuries. CONCLUSIONS: In the majority of children referred for MR imaging with pain after trampoline MR imaging detects injuries. These injuries are often not visible on plain radiographs. Therefore we recommend a generous use of MR imaging in these children after initial negative plain radiography.

Quantitative 2- and 3-dimensional analysis of pharmacokinetic model-derived variables for breast lesions in dynamic, contrast-enhanced MR mammography.

PURPOSE: 2- and 3-dimensional evaluation of quantitative pharmacokinetic parameters derived from the Tofts model modeling dynamic contrast enhancement of lesions in MR mammography. MATERIALS AND METHODS: In 95 patients, MR mammography revealed 127 suspicious lesions. The initial rate of enhancement was coded by color intensity, the post-initial enhancement change is coded by color hue. 2D and 3D analysis of distribution of color hue and intensity, vascular permeability and extracellular volume were performed. RESULTS: In 2D, malignant lesions showed significant higher number of bright red, medium red, dark red, bright green, medium green, dark green and bright blue pixels than benign lesions. In 3D, statistical significant differences between malignant and benign lesions was found for all this parameters. Vascular permeability was significant higher in malignant lesions than in benign lesions. Regression model using the 3D data found that the best discriminator between malignant and benign lesions was combined number of voxels and medium green pixels, with a sensitivity of 79.4% and a specificity of 83.1%. CONCLUSIONS: Quantitative analysis of pharmacokinetic variables of contrast kinetics showed significant differences between malignant and benign lesions. 3D analysis showed superior diagnostic differentiation between malignant and benign lesions than 2D analysis. The parametric analysis using a pharmacokinetic model allows objective analysis of contrast enhancement in breast lesions.

[MR Imaging of the pelvis in the diagnosis of the endometrium in breast cancer patients in tamoxifen therapy]. / Magnetresonanztomographie (MRT) des Beckens zur Beurteilung des Endometriums unter Tamoxifentherapie.

PURPOSE: The purpose of the study was to determine the value of MR imaging of the pelvis in the diagnostic work-up of the endometrium in breast cancer patients in tamoxifen therapy. MATERIALS AND METHODS: MR imaging of the pelvis was performed on 24 patients (mean: 62 years, range: 51 - 74 years) and 30 healthy women (mean: 65 years, range: 51 - 73 years). The volume of the uterus and cervix and the maximal thickness of the endometrium, junctional zone and myometrium of the uterus were determined and compared to the confidence interval of the parameters in healthy women. The Mann-Whitney U-test was used to identify differences in the volume of the uterus and cervix and in the thickness of the uterine wall layers in both groups. RESULTS: A comparison of the volume of the uterus and cervix and the thickness of the uterine wall layers in the two groups yielded no significant differences. The volume of the uterus and cervix showed no statistical differences between the two groups. The maximal height of the endometrium in the patient group showed a mean of 0.6 cm (range: 0.1 - 2.2 cm), and a mean of 0.4 cm (range: 0.1 - 1.2 cm) in the group of healthy women. The differences were not statistically significant. In all healthy women the endometrium showed homogeneous signal intensity in the sagittal T2-weighted images. In 12 of the 24 breast cancer patients, the endometrium showed inhomogeneous signal intensity. In 9 of 12 patients with an inhomogeneous endometrium with a thickness equal to or greater than 0.6 cm, histopathology confirmed polyps. In 3 patients endometrium hyperplasia was found. In one patient histopathology revealed a polyp and an endometrium carcinoma in stage T1 a N0. The endometrium carcinoma was not able to be seen via MR imaging. CONCLUSION: MR imaging might be helpful in the diagnosis of endometrium pathologies during tamoxifen therapy. Therefore, MR imaging of the pelvis could be used as a diagnostic tool in the follow-up diagnosis of the endometrium in breast cancer patients in tamoxifen therapy.

[Angiographic follow-up after carotid artery stenting of bifurcation stenosis]. / Angiographische Verlaufskontrolle nach Stentimplantation zur Behandlung der Karotisbifurkationsstenose.

PURPOSE: The purpose of this prospective study was to determine the restenosis grade, the intima hyperplasia and the stent expansion via angiographic follow-up six months after carotid artery stenting. MATERIALS AND METHODS: In 100 patients, angiographic follow-up was performed 5.9 months (range: 2.9-11.4 months) after carotid artery stenting. The restenosis grade, the intima hyperplasia and the stent expansion were measured by selective angiography of the treated carotid artery. RESULTS: The mean restenosis grade was 16 % (range: 0-78 %). In 6 of 100 patients (6 %), a restenosis grade of > 50 % was measured. In 4 patients the restenosis grade was 50-70 %. In 2 patients the restenosis grade was > 70 %. In 91 of 100 patients (91 %), the restenosis was localized in the former area of stenosis of the carotid artery, and in 9 of 100 patients (9 %), the restenosis was localized in the cranial stent end. The mean grade of intima hyperplasia was 31 % (range: 2-70 %). The mean increase in stent expansion at the time of follow-up was 10 % (range: 0-59 %). No correlation was able to be determined between the grade of stenosis and the grade of restenosis (rho = 0.017, range: - 0.180-0.213), between the grade of residual stenosis and the grade of restenosis (rho = 0.257, range: 0.064-0.431) and between intima hyperplasia and the grade of restenosis (rho = 0.476, range: 0.309-0.615). CONCLUSIONS: Carotid artery stenting is associated with a low incidence of high-grade restenosis 6 months after an intervention. The intima hyperplasia, which can be observed in each Wallstent, is partly compensated by the expansion of the self-expandable stent. Without a correlation between the grade of residual stenosis and the grade of restenosis, low-grade residual stenosis can be accepted. Therefore, we recommend undersized postdilation of the Wallstent.

Diffusion-weighted MR imaging after angioplasty or angioplasty plus stenting of arteries supplying the brain.

BACKGROUND AND PURPOSE: There has been concern regarding the safety of revascularization procedures of vessels supplying the brain vessels because of the risk of cerebral embolization during the procedure. We have observed a high incidence of hyperintense lesions on diffusion-weighted MR images of the brain after stenting at the carotid bifurcation. The hypothesis of this study is that diffusion-weighted MR imaging of the brain can reveal new diffusion abnormalities after angioplasty or angioplasty plus stenting of arteries supplying the brain, other than at the carotid bifurcation. Therefore, we prospectively obtained diffusion-weighted MR images of the brain before and after such revascularization procedures. METHODS: Thirty-seven revascularization procedures were performed in 32 patients. Eleven interventions were performed at the distal internal carotid artery, two at the external carotid artery, two at the common carotid artery, five at the innominate artery, five at the vertebral artery, and 12 at the proximal subclavian artery. Diffusion-weighted MR imaging of the brain was performed before and 24 hours after the procedures. RESULTS: After eight (22%) of 37 procedures, new hyperintensities were visible on the diffusion-weighted MR images. With six of these eight procedures, the hyperintensities occurred in the vascular territory supplied by the treated vessel. In total, 35 new cerebral lesions could be seen, 33 (94%) of which occurred in the vascular territory supplied by the treated vessel. None of the patients in whom new diffusion abnormalities were found had new neurologic symptoms or deficits. No new lesions could be seen after procedures at the subclavian artery. CONCLUSION: Revascularization procedures of arteries supplying the brain were associated with new lesions on the diffusion-weighted MR images of the brain after 22% of the procedures, provided that MR imaging could be performed, indicating the occurrence of cerebral microemboli during such procedures. Diffusion-weighted MR imaging of the brain can be used as a tool to assess the impact of modifications of procedural technique and/or the use of cerebral protection devices on the occurrence of such lesions.

[Value of pelvic MRI in the preoperative diagnosis of endometriosis]. / Wertigkeit der Magnetresonanztomographie (MRT) des Beckens in der präoperativen Diagnostik der Endometriose.

PURPOSE: To determine the value of magnetic resonance imaging (MRI) of the pelvis in the preoperative diagnosis of endometriosis. MATERIALS AND METHODS: Over a period of 8 months, preoperative MRI of the pelvis were obtained in 13 patients with suspected endometriosis (mean patient age 34.6 years; range 25 - 47 years). RESULTS: In 9 of 13 patients (69 %), the diagnosis of endometriosis was made by MRI and confirmed by laparoscopy in 8 cases. In 2 of 13 patients, endometriotic lesions were detectable by laparoscopy only. In the remaining 2 patients, no endometriosis was visible on MRI or by laparoscopy. MRI was able to visualize a total of 19 endometriotic lesions, with 14 (74 %) confirmed by histopathologic examination following laparoscopy. Five of these 19 lesions (26 %) visible on MRI were not seen by laparoscopy. Using laparoscopy and subsequent histopathologic examination, 27 endometriotic lesions were diagnosed, with 13 (48 %) not seen on the preoperative MRI. CONCLUSION: MRI and laparoscopy are complementary diagnostic tools that will best document the full extent of endometriosis when combined. MRI can visualize additional lesions inaccessible to laparoscopy. Thus, MRI of the pelvis should used preoperatively for surgical treatment planning.

[Magnetic resonance imaging in the diagnosis of benign and malignant pelvic tumors]. / Magnetresonanztomographie benigner und maligner Tumoren des weiblichen Beckens.

Magnetic resonance imaging (MRI) is an accepted imaging method for diagnosing diseases of the female pelvis. This review article describes the role of MR imaging for the diagnosis of benign and malignant pelvic tumors. Sagittal T2-weighted fast spin echo sequences can be effectively applied to diagnose leiomyomas of the uterus and provide exact pretreatment measurements of size and localization. In the diagnostic work-up of endometrial carcinoma, fat-saturated, T1-weighted gradient echo sequences make it possible to determine precisely how deep myometrial infiltration extends and what tissue should be included in preoperative treatment planning. In cervical cancer staging, MRI permits both assessment of local tumor extent and determination of tumor volume for planning and monitoring radiotherapy. The usefulness of MRI in cervical cancer staging is, however, limited since not all early-stage cancer (FIGO stage IA and small stage IB tumors) can be detected. Hence, it appears that the use of MRI as a screening method for cervical cancer cannot be recommended. MRI can distinguish between benign and malignant ovarian tumors with high sensitivity and specificity. Standard and fat-saturated T1-weighted sequences usually can diagnose teratomas with a specificity of 100 %. Axial fat-saturated, contrast enhanced T1-weighted spin echo sequences are useful in the staging of malignant ovarian tumors since they facilitate evaluation of their internal structure and will disclose peritoneal metastases. Besides staging of ovarian cancer, MRI can be applied for localization and for monitoring treatment response.

[Cerebral protection with balloon occlusion during carotid artery stent implantation--first experiences]. / Zerebrale Protektion mit Ballonokklusion bei der Stentimplantation der A. carotis--Erste Erfahrungen.

PURPOSE: To assess the technical feasibility and the results of cerebral protection with the GuardWire Plus Temporary Occlusion & Aspiration System during carotid artery stenting for high-grade stenosis. PATIENTS AND METHODS: In 20 patients 20 carotid artery stenoses were treated with stent placement under cerebral protection. A contralateral carotid occlusion was an exclusion criteria for the use of the protection device. In all cases only aspiration, but no flushing was used before deflation of the occlusion balloon. In 17 of 20 patients diffusion-weighted (DW-)MRT imaging of the brain was performed before and 24 hours after the procedure. RESULTS: The stent implantation was successfully performed in all patients. In 3 patients neurologic symptoms occurred during the occlusion time. In these 3 patients the symptoms immediately disappeared after deflation of the balloon. In one case there was dilatation of the internal carotid artery at the site of the balloon inflation. In 3 of the 17 DW-MR images new ipsilateral cerebral lesions, in one case a new contralateral lesion occurred after the procedure. CONCLUSIONS: The cerebral protection procedure is technically feasible. The occlusion of the internal carotid artery was not tolerated by all patients. The DW-MR imaging demonstrated cerebral lesions indicating the occurrence of cerebral microemboli during the procedure. Further investigations are necessary to determine if the use of the cerebral protection device will improve the results of the carotid artery stenting for high-grade stenoses.

Epidemiological Follow-up 15 Years after the Breast Cancer Scandal in Essen.

Purpose: In the years 1993-1996 a number of presumably false-positive breast cancer diagnoses were made by a pathologist in Essen. A follow-up, undertaken 15 years later, investigated how many women had tumour recurrence and/or metastasis or had died from breast cancer. Material and Methods: A total of 151 (68 %) out of 222 women could be traced. One hundred and forty-seven (66.2 %) of the 222 women were alive. The observed survival rate, number of recurrences and/or metastases, and number of deaths from breast cancer were compared with data from the Munich Tumour Registry. The number of breast cancer cases among daughters of the affected women was ascertained. Results: The total observed survival rate at follow-up after 15 years was 93 %, a much higher figure than the survival rate of 45 % given by the Munich Tumour Registry. Recurrence and/or metastasis or death from breast cancer occurred in 9/222 cases (4.1 %). The incidence for these events calculated according to data from the Munich Tumour Registry is 13 %. Two daughters (2.2 %) out of a total of 90 were diagnosed with breast cancer whereas, according to the German Cancer Research Centre, the expected rate would have been between 5 and 10 %. Conclusions: The results of our follow-up after 15 years show that more women survived than expected and that the number of recurrences and/or metastases and deaths due to breast cancer was lower than expected. Fewer daughters of affected women were diagnosed with breast cancer than expected. These results support our suspicion that not all women diagnosed with breast cancer by a pathologist in Essen actually had breast cancer.

[Magnetic resonance imaging of the pelvis in patients with polycystic ovary syndrome]. / Magnetresonanztomografie (MRT) des Beckens bei Patientinnen mit polyzystischem Ovarsyndrom.

INTRODUCTION: MRI evaluation of parameters of the ovaries for the diagnosis of polycystic ovaries in patients with polycystic ovary syndrome (PCOS). MATERIALS AND METHODS: An MRI of the pelvis was performed in 51 patients with PCOS and 50 healthy volunteers. The volume and maximum diameter of the bigger ovary, the number of follicles, and the maximum diameter and volume of the biggest follicle of the bigger ovary were determined in relation to patient age and were statistically compared. ROC analysis was performed to evaluate the prognostic quality of the parameters of the ovaries regarding the diagnosis of PCOS. RESULTS: In a cohort aged 21 - 30 a significant difference between patients with PCOS and healthy volunteers was able to be determined for all 5 parameters (p < 0.001). In the cohort aged 31 - 40 neither one of the parameters showed a significant difference. In the group of 21 - 30 year-olds the AUC was significantly different from 0.5 in all parameters. The maximum diameter, the volume and the number of follicles of the bigger ovary presented the highest AUC. The parameters needed to diagnose PCOS in MRI in a group of women aged 21 - 30 are a maximum diameter of an ovary of 30 mm, an ovarian volume of 5.6 cm(3) and at least 12 follicles. In regard to these parameters a diagnostic sensitivity of 90.32%, 90.32 % und 80.65% and a specificity of 68.42%. 63.16% und 86.42% can be reached. CONCLUSION: In the cohort aged 21 - 30 PCOS can be diagnosed in MRI with high diagnostic sensitivity.

[Magnetic resonance tomography in the diagnostics of breast implants: a survey]. / Die Magnetresonanztomographie in der Diagnostik von Brustimplantaten: Eine Ubersicht.

This review article describes the procedure of magnetic resonance (MR) mammography in patients with breast implants. The spectrum of breast implants in MR imaging and local implant complications are illustrated. MR mammography should be used for the diagnosis of implant complications and suspected malignant lesions in patients with breast implants.

[Evaluation of the results after using of the BI-RADS categories in 1,777 clinical mammograms]. / Ergebnisse nach Verwendung der BI-RADS-Kategorien an 1777 klinischen Mammographien.

PURPOSE: The purpose of our study was to evaluate the results after using the BI-RADS categories in clinical mammography, especially in the BI-RADS 0 and BI-RADS 3 categories. MATERIAL AND METHODS: During 1 year clinical mammograms were performed in 1,777 patients. The assessment reported by radiologists was based on the American College of Radiology using BI-RADS categories. In BI-RADS 0 and BI-RADS 3 categories additional examinations, histopathological results, und follow-up results were reported. RESULTS: Of 1,777 mammograms, 135 (4.1%) were classified into the BI-RADS 0 category. In 60 of 67 (90%) findings categorized as BI-RADS 0, MR mammography was performed and the results of the mammograms were ultimately classified into the BI-RADS 2 category. In 18 of 135 (13.3%) patients with BI-RADS 0 no further examinations were done. In 113 of 1,777 (3.4%) mammograms were classified into the BI-RADS 3 category. In 11 of 113 (9.7%) patients with BI-RADS 3 histopathology was done. A follow-up mammogram after 6 months was done only in 24 of 102 (23%) patients. In 21 of 102 (18.5%) patients with BI-RADS 3 follow-up mammograms were not performed. CONCLUSIONS: Not all patients with mammographic lesions in the BI-RADS 0 category avail themselves of further diagnostic work-up. Therefore in BI-RADS 0 category lesions, additional work-up should be performed directly after mammography during the same consultation. In some cases of BI-RADS 0 category, MR mammography is able to resolve the problem. Therefore the indication for MR mammography should be more commonly used.

[Quantitative parametric analysis of contrast-enhanced lesions in dynamic MR mammography]. / Quantitative parametrische Analyse der Kontrastkinetik von Läsionen in der dynamischen MR-Mammographie.

PURPOSE: The aim of the study was an evaluation of the quantitative parametric analysis of contrast-enhanced lesions in dynamic MR mammography. MATERIAL AND METHODS: In 137 patients, 183 contrast-enhanced lesions were identified in dynamic MR mammography. In 82 lesions histopathology was performed and in 101 lesions follow-up MR mammography was carried out. The contrast kinetics of lesions was analyzed quantitatively, on a pixel-by-pixel basis. The initial signal enhancement was coded by color intensity (bright, medium, dark), the post-initial signal enhancement was coded by color hue (blue, green, red). ROC analysis and logistic regression were performed. RESULTS: Malignant lesions showed a significantly higher number of bright red, medium red and dark red, bright green and medium green pixels than benign lesions. Benign lesions showed a significantly higher number of bright blue, medium blue and dark blue pixels than malignant lesions. The highest areas under the ROC curves (AUC) were found for medium red (AUC = 0.782) and medium green pixels (AUC = 0.733). A regression model with medium red and medium green pixels allows diagnosis of malignant lesions with a sensitivity of 60.7% and a specificity of 83.6%. CONCLUSIONS: The quantification of contrast-enhanced lesions allows objective analysis of the signal intensities in malignant and benign lesions. Therefore, this method might increase the specificity of MR mammography. Further developments are necessary before this method can be used for routine analysis of contrast-enhancing lesions in MR mammography.

MR-guided vacuum-assisted breast biopsy with a handheld biopsy system: clinical experience and results in postinterventional MR mammography after 24 h.

This prospective study evaluates the feasibility of the magnetic resonance (MR)-guided vacuum-assisted breast biopsy with a handheld vacuum-biopsy system and documents the biopsy results with MR mammography 24 h after the procedure. MR-guided biopsy was undertaken in 33 patients with 34 lesions on dynamic MR mammography. The interventions were performed with the handheld 10-gauge Vacora vacuum-biopsy system. In all cases, dynamic MR mammography was performed 24 h after the procedure to determine the extent of the lesion removal and to identify the lesions that were missed. In 5/34 (14.7%) lesions, biopsy was not performed because no suspicious lesion was identified on the day of biopsy. In 25/29 (86.2%) lesions, the biopsy was successfully performed with a complete removal in 4/29 (13.8%) and a partial removal of 21/29 (72.4%) lesions. In 4/29 (13.8%) interventions the lesion was missed with the biopsy. In one case, histopathology after surgical excision revealed ductal carcinoma in situ. Histopathology revealed 9/29 (31%) malignant and 20/29 (68.9%) benign lesions. MR-guided vacuum-assisted breast biopsy with the handheld Vacora vacuum-biopsy system is technically feasible in most cases. MR mammography 24 h after the biopsy should be performed in those cases in which the biopsy success is unclear immediately after the procedure.

Whole-body PET/CT-mammography for staging breast cancer: initial results.

The purpose of this study was to evaluate the feasibility and utility of a dedicated positron emission tomography (PET)/CT protocol in breast cancer patients. 40 patients with suspected recurrent breast cancer underwent whole-body PET/CT in the supine position (SP) followed by PET/CT of the breasts and axillae in the prone position (PP) using a special positioning aid. PP and SP images were compared in terms of the tumour-to-thoracic-wall distance, tumour-to-skin distance and tumour volume, diameter, density, maximal standardized uptake value (SUV(max)) and localization. The size of axillary areas, the number of intra-axillary lymph nodes, their transverse diameters, their SUV(max) and the number of distant metastases were compared between PP and SP images. Differences were tested for significance using the Student's t-test. All patients tolerated PP imaging well. Five locally recurrent breast cancers were detected, both in the SP and in the PP. Mean tumour-to-thoracic-wall distances (PP, 19 mm; SP, 8 mm; p = 0.003) and tumour-to-skin distances (PP, 10 mm; SP, 7 mm; p = 0.013) were significantly larger in the PP than in the SP. Potential thoracic wall or skin infiltration, as well as quadrant localization, were determined more easily in PP. The axillary area was wider in the PP when compared with SP (PP, 14.4 cm(2); SP, 10.6 cm(2); p<0.001). No other parameters were significantly different. In conclusion, a dedicated whole-body PET/CT examination, including PET/CT mammography, is feasible for clinical practice and may offer important information on the possible infiltration of a breast lesion into the adjacent thoracic wall and skin. Even though the axilla may be delineated more clearly in the PP, there seems to be no benefit with regard to N-staging.

[Diagnosis of vulval and vaginal neoplasms with magnetic resonance imaging]. / Verwendung der Magnetresonanztomographie in der Diagnostik von Neoplasien der Vulva und Vagina.

Magnetic resonance imaging (MRI) is widely accepted as an established method in the diagnostic imaging of diseases of the female pelvis. This review article describes the role of MRI in the diagnosis of neoplasms of the vulva and the vagina. MRI is useful in the pretherapeutic staging of vulval and vaginal neoplasms in order to assess tumor size, local tumor extent and presence of lymph node metastases. Further indications for MRI are the diagnosis of posttherapeutic changes and tumor recurrence.

[Comparison of unidimensional and bidimensional measurement to assess therapeutic response in the treatment of solid tumors]. / Vergleich uni- und bidimensionaler Messverfahren zur Beurteilung des Therapieansprechens bei der Behandlung solider Tumoren.

PURPOSE: In this prospective study we applied both the bidimensional WHO method and the unidimensional RECIST method in treatment follow-up of solid tumors. MATERIAL AND METHODS: Computed tomography was performed in 80 patients before and after one chemotherapy cycle: 20 patients each with lung cancer, lymphoma, and metastases of the lung and the liver. In 207 tumor lesions unidimensional and bidimensional measurements were performed: 36 lesions of lung cancer, 51 lesions of lymphoma, and 60 lesions of metastases of the lung and the liver, respectively. We assigned the results to the corresponding response categories. RESULTS: For tumor assessment, the kappa statistic produced a high agreement of 0.94 between the two methods for assessment of therapeutic response. CONCLUSION: The unidimensional RECIST measurement is easier to perform in order to assess tumor size during treatment follow-up in oncologic radiology.

FDG-PET/CT in restaging of patients with recurrent breast cancer: possible impact on staging and therapy.

We aimed to compare the value of combined positron emission tomography (PET)/CT, PET+CT (viewed side by side), CT alone and PET alone concerning the rTNM stage and influence on therapy in patients with recurrent breast cancer. 44 patients with suspicion of recurrent breast cancer underwent whole-body [18F]-2-fluoro-2-deoxy-d-glucose (FDG)-PET/CT. Images of combined PET/CT, PET+CT, PET alone and CT alone were evaluated by four blinded reader teams. Diagnostic accuracies and influence on therapy were compared. Histology and a mean clinical follow up of 456 days served as the standard of reference. Differences between the staging procedures were tested for statistical significance by McNemar's test. Overall TNM tumour stage was correctly determined in 40/44 patients with PET/CT, in 38/44 with PET+CT, in 36/44 with PET alone and in 36/44 patients with CT alone. No statistically significant difference was detected between all tested imaging modalities. PET/CT changed the therapy in two patients compared with PET+CT, in four patients compared with PET alone and in five patients compared with CT alone. Combined PET/CT appeared to be more accurate in assessing the rTNM and showed a moderate impact on therapy over PET and CT. Minor improvements were noted when compared with PET+CT. Experienced readers might therefore be able to provide accurate staging results for further therapy from separately acquired studies.