Complex imaging features of accidental cerebral intraventricular gadolinium administration.

Gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) is a contrast agent commonly used for enhancing MRI. In this paper, the authors report on 2 cases of postoperative inadvertent administration of Gd-DTPA directly into a ventriculostomy tubing side port that was mistaken for intravenous tubing. Both cases demonstrated a low signal on MRI throughout the ventricular system and dependent portions of the subarachnoid spaces, which was originally believed to be CSF with areas of T1 shortening in the nondependent portions of the subarachnoid spaces, and misinterpreted as basal leptomeningeal enhancement and meningitis. The authors propose that the appearance of profound T1 hypointensity within the ventricles and diffuse susceptibility artifact along the ependyma is pathognomonic of intraventricular Gd-DTPA and should be recognized.

Staging and follow-up of lacrimal gland carcinomas by 18F-FDG PET/CT imaging.

A 74-year-old man with right eye proptosis, diplopia, and orbital discomfort for 3 to 4 months underwent biopsy, the specimen of which showed transitional cell carcinoma of the lacrimal gland. 18F-FDG PET/CT was also performed for staging purposes. Six months after orbital exenteration, a follow-up CT scan demonstrated soft tissue thickening along the nasal bridge but could not differentiate between postsurgical changes and cancer recurrence. A concurrent PET/CT scan did not show any evidence of abnormal metabolic activity, further emphasizing the higher accuracy of PET/CT in staging and restaging of head and neck cancers. An annual follow-up scan was still negative for active disease.

Association of vascular fluoride uptake with vascular calcification and coronary artery disease.

OBJECTIVE: The feasibility of a fluoride positron emission tomography/computed tomography (PET/CT) scan for imaging atherosclerosis has not been well documented. The purpose of this study was to assess fluoride uptake of vascular calcification in various major arteries, including coronary arteries. METHODS: We retrospectively reviewed the imaging data and cardiovascular history of 61 patients who received whole-body sodium [¹8F]fluoride PET/CT studies at our institution from 2009 to 2010. Fluoride uptake and calcification in major arteries, including coronary arteries, were analyzed by both visual assessment and standardized uptake value measurement. RESULTS: Fluoride uptake in vascular walls was demonstrated in 361 sites of 54 (96%) patients, whereas calcification was observed in 317 sites of 49 (88%) patients. Significant correlation between fluoride uptake and calcification was observed in most of the arterial walls, except in those of the abdominal aorta. Fluoride uptake in coronary arteries was demonstrated in 28 (46%) patients and coronary calcifications were observed in 34 (56%) patients. There was significant correlation between history of cardiovascular events and presence of fluoride uptake in coronary arteries. The coronary fluoride uptake value in patients with cardiovascular events was significantly higher than in patients without cardiovascular events. CONCLUSION: sodium [¹8F]fluoride PET/CT might be useful in the evaluation of the atherosclerotic process in major arteries, including coronary arteries. An increased fluoride uptake in coronary arteries may be associated with an increased cardiovascular risk.

Extraosseus uptake of F-18 fluoride in the primary malignancy and cerebral metastasis in a case of non-small-cell lung cancer.

A 68-year-old man with history of heavy smoking was admitted for increasing falls during the past 4 weeks. Chest x-ray revealed a right upper lobe mass. Biopsy demonstrated poorly differentiated non-small-cell carcinoma. F-18 fluoride positron emission tomography/computer tomography (PET/CT) was performed to evaluate bone metastasis. Review of the sectional PET images demonstrated extraosseous fluoride uptake in the primary lung mass, as well as ring-shaped fluoride uptake in the cerebral metastatic lesion. Neither of these lesions demonstrated calcifications on CT images. The patient received radiation treatment of the brain metastasis after F-18 fluoride PET/CT study.

Longer-term outcomes of paclitaxel stent implantation as an initial treatment strategy for sirolimus-eluting stent restenosis.

OBJECTIVE: The goal of this study was to determine the long-term clinical outcomes after an initial strategy of paclitaxeleluting stent (PES) implantation for de novo sirolimus-eluting stent (SES) restenosis. BACKGROUND: The optimal treatment of drug-eluting stent (DES) restenosis is unknown. METHODS: Consecutive patients undergoing PES implantation for SES restenosis were identified. Patients were considered eligible for inclusion if: (1) the initial target lesion for the SES was de novo; (2) the SES restenotic lesion had not been previously treated; and (3) at least 1 year had passed since the PES implantation. RESULTS: A total of 130 consecutive patients with 142 restenotic SES lesions were treated with PES. Mean patient age was 66.4 +/- 11 years, diabetes was present in 37.1%, and the target lesion was focal in 67.8%. Over a median of 453 days (range, 365-789 days), out-ofhospital major adverse cardiac events occurred in 33 patients (25.4%). Out-of-hospital death occurred in 2 patients (due to sepsis and cancer), myocardial infarction in 1 patient (0.8%), and target lesion revascularization (TLR) in 30 patients (23.8%). There were no episodes of stent thrombosis. There was no difference in freedom from TLR between lesions with focal or non-focal pattern (log rank p = 0.52), although the time to recurrence was later in focal compared to non-focal lesions (323 +/- 26 days versus 216 +/- 17 days; p = 0.02). CONCLUSIONS: An initial treatment strategy of PES implantation for SES restenosis appears safe and provides reasonable outcomes at more than 1-year follow up.