ABSTRACT
Background: Routine CT scans may increasingly be used to document normal aortic size and to detect incidental abdominal aortic aneurysms. Purpose: To determine whether ultra-low-dose non-contrast CT (ULDNC-CT) can be used instead of the gold standard CT angiography (CTA) for assessment of maximal abdominal aortic diameter. Materials and Methods: This retrospective study included 50 patients who underwent CTA and a normal-dose non-contrast CT for suspected renal artery stenosis. ULDNC-CT datasets were generated from the normal-dose non-contrast CT datasets using a simulation technique. Using the centerline technique, radiology consultants (n = 4) and residents (n = 3) determined maximal abdominal aortic diameter. The limits of agreement with the mean (LOAM) was used to access observer agreement. LOAM represents how much a measurement by a single observer may plausibly deviate from the mean of all observers on the specific subject. Results: Observers completed 1400 measurements encompassing repeated CTA and ULDNC-CT measurements. The mean diameter was 24.0 and 25.0 mm for CTA and ULDNC-CT, respectively, yielding a significant but minor mean difference of 1.0 mm. The 95% LOAM reproducibility was similar for CTA and ULDNC-CT (2.3 vs 2.3 mm). In addition, the 95% LOAM and mean diameters were similar for CTA and ULDNC-CT when observers were grouped as consultants and residents. Conclusions: Ultra-low-dose non-contrast CT exhibited similar accuracy and reproducibility of measurements compared with CTA for assessing maximal abdominal aortic diameter supporting that ULDNC-CT can be used interchangeably with CTA in the lower range of aortic sizes.
ABSTRACT
A 76-year-old man with newly diagnosed high-risk prostate cancer was referred for primary staging with F-18-PSMA-1007 PET/CT. The PET/CT scan showed no lymph node or bone metastases, only localized disease within the prostate gland. Additionally, the F-18-PSMA PET/CT scan showed a PSMA-positive lesion correlating to a polyp located in the body of the stomach on the greater curvature. A prior F-18-FDG PET/CT showed low FDG uptake in the polyp, but this was not reported initially in the written report. The patient had no upper gastrointestinal symptoms. A gastroscopy with biopsies was performed, and the histopathology results showed chronic unspecific inflammation with no granulomas, dysplastic or malignant changes in three out of three biopsies. A repeated gastroscopy with biopsy showed an epithelioid variant of a gastrointestinal stromal tumor (Ki-67 index 2%). A laparoscopic tumor extirpation was planned after radiation treatment in combination with endocrine therapy of the localized prostate cancer. To our knowledge, this is one of very few reported cases of a PSMA-positive gastrointestinal stromal tumor (GIST), and can be added to the list of malignant pitfalls of PSMA PET/CT in prostate cancer patients.
