Liver perfusion with dynamic multidetector-row computed tomography as an objective method to evaluate the efficacy of chemotherapy in patients with colorectal cancer.

A total of 24 liver metastases of colorectal cancer were evaluated by dynamic multiphasic CT. Under chemotherapy, follow-up examinations were performed every 3 months. The tumor marker CEA before vs. after chemotherapy correlated with the mean contrast enhancement within the margin of metastases. The total size of metastases correlated with the size of central necrosis as well as with the size of marginal contrast enhancement. CT is able to quantify perfusion and local activity of liver metastases to determine the efficacy of chemotherapy.

Assessment of disease activity in alveolar echinococcosis: a comparison of contrast enhanced ultrasound, three-phase helical CT and [(18)F] fluorodeoxyglucose positron emission tomography.

BACKGROUND: Objective of the present study was to assess activity or vascularization of focal liver lesions in alveolar echinococcosis (AE) using [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) in comparison with contrast enhanced ultrasound (CEUS) and three-phase helical computed tomography (CT). METHODS: In this prospective study, 17 patients with confirmed AE of the liver were included (6 males, 11 females; average age: 59 +/- 16 years; average duration of disease: 10.5 years) and were then examined using FDG-PET, precontrast ultrasound (US), CEUS, and three-phase helical CT. We assessed metabolic activity (FDG-PET) and vascularization (CEUS and CT) of Echinococcus multilocularis specific hepatic lesions. RESULTS: FDG-PET identified increased metabolic activity in the corresponding lesions in seven patients (41.2%). A vascularization pattern of echinococcal lesions was visualized in 9 patients (52.9%) by CEUS and in 4 patients (23.5%) by CT. All positive FDG-PET findings were also positive at CEUS. CONCLUSIONS: There was association between findings of metabolic activity in AE at FDG-PET and vascularized lesions of the liver returned by CEUS. This suggests that CEUS may represent a cost-effective tool in the decision making to perform FDG-PET examination.

Evaluating bowel wall vascularity in Crohn's disease: a comparison of dynamic MRI and wideband harmonic imaging contrast-enhanced low MI ultrasound.

This was a prospective comparison of dynamic MRI (1.5 T) and echo-signal enhanced ultrasound in evaluating vascularization in thickened bowel walls cases of Crohn's disease. Twenty-one patients with histologically confirmed Crohn's disease and bowel wall diameters >5 mm were examined by MRI and ultrasound (US). MR sequences: T1w fl2D, T2w, FLASH T1w post-contrast media (CM) applications with fat saturation were used. Dynamic Turbo-FLASH T1w sequences were acquired in the area of maximal thickening of the ileal wall every 1.5 s post-CM application for a total duration of 1 min. US was performed after the application of 1.2 ml of echo-signal enhancer. Contrast uptake was measured by the semiquantitative score and brightness analysis in regions of interest (ROI). Clinical and laboratory findings including Crohn's disease activity indices were documented; MRI and US parameters were correlated. The length of sonographically documented lesions (122+/-75 mm) correlated significantly with the length of thickened bowel segments in MRI (128+/-76 mm; r=0.466; P=0.033). The maximum percent signal enhancement in the terminal ileum at ultrasound (217.5+/-100.1%) showed a high correlation with the findings of MRI (262+/-108%; r=0.623; P=0.003). With both methods, a plateau phase was observed. US and MRI are capable of evaluating local vascularization in the bowel wall objectively.

May 2004: newborn with intracranial mass.

May 2004: We present the case of a male newborn (38th week of gestation) with a 3-week history of a sonographically detected parietal mass of 5-cm diameter. The entire mass was removed at surgery. Surprisingly, microscopy revealed an intracerebral hemorrhage and nests of glycophorin-A immunoreactive blasts and nucleated erythrocytes in the surrounding parenchyma. The final diagnosis was chronic intracerebral hemorrhage of unknown etiology with reactive changes of the surrounding brain tissue and perifocal extramedullary erythropoiesis. This case is unique because, to date, intracranial extramedullary erythropoiesis has only been described in chronic subdural hemorrhage.

F-18 NaF PET for detection of bone metastases in lung cancer: accuracy, cost-effectiveness, and impact on patient management.

UNLABELLED: As bone metastases might be present in lung cancer despite a normal bone scan, we examined various alternatives prospectively. Positron emission tomography using F-18 sodium fluoride (PET) and single photon emission tomography (SPECT) were more sensitive than a planar bone scan. PET was more accurate with a shorter examination time than SPECT but had higher incremental costs. INTRODUCTION: Previous studies have shown that vertebral bone metastases not seen on planar bone scans may be present on F-18 fluoride positron emission tomography (PET) scan or single photon emission computed tomography (SPECT). The purpose of this study was to measure the accuracy, clinical value and cost-effectiveness of tomographic bone imaging. MATERIALS AND METHODS: A total of 103 patients with initial diagnosis of lung cancer was prospectively examined with planar bone scintigraphy (BS), SPECT of the vertebral column and PET using F-18 sodium fluoride (F-18 PET). Receiver operating characteristic (ROC) curve analysis was used for determination of the diagnostic accuracy. A decision-analysis model and the national charge schedule of the German Hospital Association were used for determination of the cost-effectiveness. RESULTS: Thirteen of 33 patients with bone metastases were false negative on BS, 4 on SPECT, and 2 on F-18 PET. The area under the ROC curve was 0.771 for BS, 0.875 for SPECT, and 0.989 for F-18 PET (p < 0.05). As a result of SPECT and F-18 PET imaging, clinical management was changed in 8 (7.8%) and 10 (9.7%) patients. Compared with BS, the costs per additional correctly diagnosed patient were 1272 Euro with SPECT and 2861 Euro with F-18 PET. The threshold for the costs of F-18 PET being more cost-effective than SPECT was 345 EUR. CONCLUSION: Routine performance of tomographic bone imaging improves the therapeutic strategy because of detection of otherwise missed metastases. F-18 PET is more effective than SPECT but is associated with higher incremental costs.

Endovascular treatment of visceral artery aneurysms.

PURPOSE: To review a 10-year experience with endovascular embolization of visceral artery aneurysms. METHODS: Twenty-five patients (13 men; mean age 52.1 years, range 31-80) presented with VAAs of varying locations and etiologies: 10 splenic, 3 gastroduodenal, 2 pancreaticoduodenal, 3 hepatic, 3 superior mesenteric, 2 celiac, 1 left gastric, and 1 jejunoileal. Ten patients were asymptomatic; 7 aneurysms were ruptured. Transcatheter coil embolization was the treatment of choice in all patients. RESULTS: Coil placement was initially (<7 days) successful in 23 (92%) patients. One superior mesenteric artery aneurysm remained perfused, and recurrent bleeding occurred 2 days after intervention in 1 case, but repeated embolization excluded the aneurysm. One patient with necrotizing pancreatitis died from sepsis 10 days after endovascular treatment and surgery (4% 30-day mortality). Long-term follow-up revealed excellent results after an average 48.7 months (range 14-75) with only 1 recurrence after 12 months. CONCLUSIONS: Embolotherapy is the treatment of choice in visceral artery aneurysms, regardless of etiology, location, or clinical presentation.