Cardiac Magnetic Resonance Versus Single-Photon Emission Computed Tomography for Detecting Coronary Artery Disease and Myocardial Ischemia: Comparison with Coronary Angiography.

BACKGROUND: This study aimed to compare the diagnostic accuracy of stress single-photon emission computed tomography (SPECT) and stress cardiac magnetic resonance (CMR) for the assessment of coronary artery disease (CAD) in the same patients, using coronary angiography as the reference standard. METHODS: Thirty patients with known or suspected CAD who were referred for exercise SPECT myocardial perfusion imaging (MPI) for the evaluation of myocardial ischemia underwent stress CMR MPI and computed tomography coronary angiography (CTCA) or selective coronary angiography (SCA). The data from the two stress modalities were compared against the data from angiography. RESULTS: In our study population, 30% of the recruited subjects had significant CAD. The CMR sensitivity for the detection of significant CAD and/or myocardial ischemia was 89% and specificity was 76%. For SPECT, the corresponding sensitivity was 78% and specificity was 52%. The negative predictive value was 92% for CMR and 83% for SPECT. The receiver-operating characteristic (ROC) analysis evaluating the presence of significant CAD, CMR (area under the curve (AUC) 0.78) outperformed SPECT (AUC 0.59) (p < 0.01). The ROC analysis evaluating the presence of myocardial ischemia was also in favor of CMR (AUC 0.82) versus SPECT (AUC 0.67) (p < 0.01). CONCLUSIONS: CMR has high diagnostic accuracy for the detection of CAD and stress-induced ischemia and appears to outperform SPECT. CMR may thus be the preferred noninvasive imaging modality to assess patients with known or suspected CAD.

Leydig cell tumour of the ovary localised with positron emission tomography/computed tomography.

Androgen-producing ovarian tumours can lead to assessment difficulties because of their small size. We present a case of virilising steroid cell ovarian tumour in a 41-year-old woman localised with Fluorine-18-Deoxyglucose Positron Emission Tomography/Computed Tomography ((18)FDG-PET/CT). Although the biochemical evaluation pointed to an ovarian source of androgen, diagnostic attempts to localise the source of hyperandrogenism with transvaginal ultrasound (US), and magnetic resonance imaging (MRI) of pelvis failed. Additional evaluation with (18)FDG-PET/CT showed an increased uptake in the right ovary. A laparoscopic right oophorectomy was performed and histopathology examination revealed a 1.2-cm Leydig cell tumour. The patient showed regression of clinical signs.

The impact of FDG-PET/CT on the management of breast cancer patients with elevated tumor markers and negative or equivocal conventional imaging modalities.

OBJECTIVE: To evaluate the clinical impact of fluorodeoxyglucose (FDG)-PET/computed tomography (CT) scan on restaging breast cancer patients with rising tumor markers and negative or equivocal findings in conventional imaging studies. METHODS: We studied 46 patients with breast cancer of an average age of 57.6 years (ranging from 38 to 68 years). All patients were referred for an FDG-PET/CT scan because of elevated tumor markers, without any other obvious clinical or laboratory sign of relapse. Conventional imaging study results were either negative (29 out of 46 patients) or inconclusive (17 out of 46 patients). All patients underwent a whole-body FDG-PET/CT scan in a combined PET/CT. The findings were confirmed by a follow-up at least 9 months later, and when it was possible, final diagnosis was obtained by histopathology. RESULTS: In 34 out of 46 patients, an FDG-PET/CT scan showed sites of increased metabolic activity, indicating active disease. In 23 out of 46 patients, the therapeutic approach and further clinical management were affected. The FDG-PET/CT scan was true-positive in 33 patients, false-positive in one patient, false-negative in five patients, and true-negative in seven patients. On the basis of our results in this population, an FDG-PET/CT scan had a sensitivity of 86.8%, a specificity of 87.5%, and an accuracy of 86.9%. The positive predictive value was 97.1% and the negative predictive value was 58.3%. Clinical management was affected in 50% of these patients. CONCLUSION: The FDG-PET/CT scan plays an important role in restaging breast cancer patients with rising tumor markers and negative or equivocal findings in conventional imaging techniques, with a consequent significant clinical impact on further management in these patients.