Diagnostic Value of 18F-FDG-PET/CT in Patients with FUO.

Conventional diagnostic imaging is often ineffective in revealing the underlying cause in a considerable proportion of patients with fever of unknown origin (FUO). The aim of this study was to assess the diagnostic value of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) in patients with FUO. We retrospectively reviewed 18F-FDG-PET/CT scans performed on 50 consecutive adult patients referred to our department for further investigation of classic FUO. Final diagnosis was based on histopathological and microbiological findings, clinical criteria, or clinical follow-up. Final diagnosis was established in 39/50 (78%) of the patients. The cause of FUO was infection in 20/50 (40%), noninfectious inflammatory diseases in 11/50 (22%), and malignancy in 8/50 (16%) patients. Fever remained unexplained in 11/50 (22%) patients. 18F-FDG-PET/CT scan substantially contributed to the diagnosis in 70% of the patients, either by identifying the underlying cause of FUO or by directing to the most appropriate site for biopsy. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of 18F-FDG-PET/CT for active disease detection in patients with FUO were 94.7%, 50.0%, 84.0%, 85.7%, and 75.0%, respectively. In conclusion, whole-body 18F-FDG-PET/CT is a highly sensitive method for detection of the underlining cause of FUO or for correctly targeting suspicious lesions for further evaluation.

Traumatic pulmonary pseudocysts: CT findings.

Traumatic pulmonary pseudocyst constitutes an uncommon, though well recognized, manifestation of closed chest trauma. It is usually encountered in young patients, whose compliant chest wall permits the transmission of great compressive forces to the lung parenchyma and the laceration of the latter. Traumatic pulmonary pseudocyst is usually detected during the imaging evaluation of multi-injured patients with the use of computed tomography, as it is often not apparent in the initial supine anteroposterior chest radiographs. We present 5 cases of trauma patients, in whom we detected the presence of multiple traumatic pulmonary pseudocysts during the imaging evaluation of blunt chest trauma with the use of computed tomography.

Bone mineral density in survivors of childhood acute lymphoblastic leukemia.

The aim of our study was to evaluate bone metabolism with measurement of bone mineral density (BMD) after management (chemo-, radiotherapy) for childhood acute lymphoblastic leukemia (ALL). Bone mineral density (g/cm2) of lumbar spine was measured by dual energy X-ray absorptiometry (Norland bone densitometer) in 18 children with ALL and a median of 34 months' post-diagnosis with no history of relapse, secondary malignancy, or transplantation. In addition, patients' BMDs were correlated with particular attention to age, sex and time (years) from completion of chemotherapy. The results were compared with healthy age- and sex-matched controls of the same population and expressed as standard deviation scores (SDS). Mean age of children was 9.8 +/- 3.7 years. Of 18 children (10 boys and 8 girls), 13 were grouped as standard and 5 as high-risk, respectively. Based on z-score values, 9 were classified as normal (z-score <1 SD), 7 as osteopenic (z-score 1-2.5 SD) and 2 as osteoporotic (z-score >2.5 SD). Children with ALL had reduced lumbar BMDs (z score -0.99) in comparison to healthy controls (z score -0.14) (p=0.011), which is indicative of relative osteopenia. Moreover, the reduced BMD was associated with patient age (z score -0.14 and -1.52 for ages <10 and >10 years, respectively, p=0.016). Reduced BMD was not correlated with time from completion of chemotherapy (p=0.33), risk group (p=0.9) and sex (p=0.3). We conclude that children's BMDs are reduced after completion of chemotherapy for ALL. The causes are multifactorial and mainly related to antineoplastic treatments, such as corticosteroids and methotrexate, physical inactivity and cranial irradiation. We suggest that further studies are needed to evaluate the long-term effect on BMD in these children and to prevent pathological fractures later in life.

MR cholangiography in the evaluation of patients with duodenal periampullary diverticulum.

OBJECTIVE: This retrospective study evaluates the relationship between periampullary duodenal diverticula and the common bile duct (CBD). MATERIALS AND METHODS: The patients were examined with HASTE breath hold MR cholangiography (MRC) using a 1 T Siemens Expert Plus Scanner. Axial T2-weighted images were also obtained in all patients. RESULTS: From the 66 patients, only 23 clearly depicted to have deverticula, while 31 patients were suspected to have diverticula and for the rest 12 patients, the MRC results were negative. From these 66 patients, the 18 patients proved to have stones in the CBD. CONCLUSION: MRC has very low sensitivity in the detection of duodenum diverticula, but is the method of choice to evaluate their relationship with the distal part of the CBD.

Arachnoid cyst of the frontal part of the temporal lobe producing exopthtalmos CT and MRI evaluation.

Twenty-three patients with an arachnoid cyst in the frontal part of the temporal bone, which produced exopthtalmos, were evaluated with CT and MRI. The majority of the patients had the peak of the bowing of the bony orbit wall in the posterior third (20/23) and only three in the middle. Arachnoid cyst are classified as small (13/23), medium (5/23) or large (5/20) size. Exopthtalmos are also classified as mild, moderate or large. CT and MRI clearly revealed the exopthtalmos, the bone remodelling process and the relationship of the orbit muscles, optic nerve and posterior bony wall of the orbit.