Differential diagnosis of benign and malign pancreatic masses with 18F-fluordeoxyglucose-positron emission tomography recorded with a dual-head coincidence gamma camera.

INTRODUCTION: Metabolic imaging using 18F-fluordeoxyglucose and a ring-positron emission tomography camera is an established method in the differential diagnosis of pancreatic masses. Ring-positron emission tomography cameras, however, are expensive and available in only few specialized centres. The aim of this study was to investigate how far 18F-fluordeoxyglucose scan with a conventional dual-head gamma-camera could differentiate between benign and malign pancreatic masses. MATERIAL AND METHODS: Forty-one patients (male/female: 25/16; mean age: 64.0 years; range: 41-86 years) with a pancreatic mass detected by ultrasound, computed tomography or MRI were included. In all patients 18F-fluordeoxyglucose scan was performed after overnight fasting and injection of 4 mCi 18F-fluordeoxyglucose using an ADAC Vertex MCD dual head gamma-camera (ADAC; Milpitas, California, USA), equipped with a 5/8-inch NaI-crystal. Images were acquired through a 180 degrees grade rotation in the three dimensional mode. The chosen matrix was 128 x 128 x 16, a Butterworthfilter (ADAC) was used and data were transferred into visible sinograms via Fourier-Rebinning. Coronar, sagittal and transversal slices of 3.9 mm thickness each were acquired. Focal tracer enhancement was suspicious for a malignoma and therefore regarded as positive, diffuse or no tracer uptake was suspicious for a benign process and was regarded as negative for cancer. DEFINITION OF GOLD STANDARDS: A diagnosis of cancer had to be confirmed histologically by specimens obtained by 18G-needle biopsy, surgical resection or at autopsy. A diagnosis of an inflammatory mass was considered proven, if no carcinoma could be found histologically in the surgically resected mass or at autopsy, or if there was no progression of the disease during a follow-up of at least 12 months. RESULTS: In 22 patients carcinoma was diagnosed (pancreatic cancer: n=17; endocrine tumour: n=3; carcinoma of the common bile duct: n=2). 18F-fluordeoxyglucose scan showed a focal tracer enhancement in 19 of these 22 patients (sensitivity: 86.4%). False negative results were acquired in two patients with cancer of the common bile duct and in one patient with poorly controlled insulin-dependent diabetes mellitus. In 19 patients the final diagnosis was an inflammatory pancreatic mass. 18F-fluordeoxyglucose scan showed a diffuse tracer enhancement in 15 of these 19 patients (specificity: 78.9%). False positive results were acquired in three patients whose blood tests showed signs of an acute episode of chronic pancreatitis. Positive and negative predictive values of 18F-fluordeoxyglucose scan were 82.6% and 83.3%, respectively. CONCLUSION: 18F-fluordeoxyglucose scan with a conventional dual-head gamma-camera is a highly sensitive and specific method in the differential diagnosis of benign and malign pancreatic masses.

Findings at helical CT-enteroclysis in symptomatic patients with crohn disease: correlation with endoscopic and surgical findings.

PURPOSE: The purpose of our study was to assess the diagnostic potential of helical CT-enteroclysis (HCTE) and to correlate our findings to endoscopic and surgical results. METHODS: Twenty-eight consecutive patients suffering from histologic proven Crohn disease underwent HCTE and endoscopy within 4 weeks. HCTE findings were read by two observers in consensus and compared with endoscopic and surgical results. RESULTS: Morphological signs of an acute or recurrent bowel inflammation were found in 25 of 28 (89%) patients. HCTE demonstrated accurately all mural and extramural changes of the inflamed bowel walls. Moreover, in 18 of 25 (72%) patients, HCTE depicted additional pathologic changes such as fistulas, abscesses, and skip lesions, all of which could not be visualized by endoscopy. CONCLUSION: HCTE is an accurate technique to detect mural and extramural abnormalities in patients with Crohn disease. HCTE should be considered as a complementary imaging method to endoscopy, and should be the first imaging method especially when Crohn-associated complications are suspected.

[Euthanasia and the paradox in delegation of life assessment]. / Sterbehilfe and das Paradoxon der delegierten Lebensbewertung.

Active euthanasia, a question of individual existence, fundamentally concerns the concept of human society. Although legalizing voluntary euthanasia seems to be consequent in liberal democracy, delegation of the act of homicide leads to a paradox in liberalism: Generalization in the assessment of individual life--as it is necessary in such a context--undermines the fundamental right of the individual for social existence irrespective of any assessment whatsoever. This is reflected by the humanistic principle of human dignity as it has been described by Kant. Conventional jurisdiction, which permits passive and indirect euthanasia but prosecutes active homicide, avoids this fundamental problem. Nevertheless it facilitates a humane demise within the framework of adequate hospice care.