¹8F-fluorocholine PET/CT compared with extended pelvic lymph node dissection in high-risk prostate cancer.

PURPOSE: To compare (18)F-fluorocholine positron-emission tomography/computed tomography (PET/CT) with extended pelvic lymph node dissection (ePLND) for the detection of lymph node metastases in a large cohort of patients with high-risk prostate cancer. MATERIALS AND METHODS: Patients with prostate-specific antigen levels between 20 and 99 ng/mL and/or Gleason score 8-10 cancers, planned for treatment with curative intent following a negative or inconclusive standard bone scan, were investigated with (18)F-fluorocholine PET/CT followed by an ePLND. None of the patients received hormonal therapy prior to these staging procedures. Results for PET/CT were compared on a per-patient basis with histopathology from ePLND. Sensitivity, specificity, positive and negative predictive values were calculated. RESULTS: PET/CT detected a total of 76 suspected lymph node metastases and four suspected bone metastases in 33 (29 %) of the 112 included patients. Of these, 35 suspected lymph node metastases, only within the anatomical template area of an ePLND, were found in 21 of the patients. Histopathology of the ePLND specimens detected 117 lymph node metastases in 48 (43 %) of the 112 patients. Per-patient sensitivity, specificity, positive and negative predictive values for (18)F-fluorocholine PET/CT for lymph node metastases within the ePLND template were 0.33, 0.92, 0.76 and 0.65, respectively. Only 11 patients had lymph nodes larger than 10 mm that would have been reported by CT alone. CONCLUSIONS: (18)F-fluorocholine PET/CT detects lymph node metastases in a significant proportion of patients with high-risk prostate cancer with a high specificity, but low sensitivity.

Intraluminal duodenal diverticulum causing pancreatitis in a patient with a polysplenia syndrome.

A 19-year-old female had recurrent bouts of pancreatitis. At endoscopy a mucosa-covered mass lesion was seen in the duodenum. A double-contrast examination of the stomach and duodenum showed an intraluminal duodenal diverticulum (IDD). Also an inversed abdominal situs and a midgut malrotation were noted. Computed tomography revealed evidence of a polysplenia syndrome. Although this syndrome is associated with various gastrointestinal abnormalities, its combination with an IDD does not seem to have been reported previously. After surgical removal of the IDD the patient has not had any further attacks of pancreatitis.

Lymph nodes in the hepato-duodenal ligament. A comparison between ultrasound and low-field MR imaging.

PURPOSE: We investigated whether a low-field MR unit (0.2 T) could demonstrate and determine the size of the lymph nodes in the hepato-duodenal ligament that were previously found on ultrasound. MATERIAL AND METHODS: Eighteen patients were examined with ultrasound, MR and liver biopsy on consecutive days. RESULTS: Two-thirds of the enlarged nodes detected by ultrasound were also detected with the low-field MR technique. However, the size of the nodes was slightly larger on ultrasound. CONCLUSION: Compared to low-field MR, ultrasound appears to be superior in the evaluation of lymph nodes in the liver hilus.

Phantom study of chest radiography with storage phosphor, selenium, and film-screen systems.

PURPOSE: Chest radiographs from 3 digital systems--2 based on luminescent phosphors and one on selenium--and a conventional film-screen system were evaluated and compared. MATERIAL AND METHODS: Computed radiography (CR) has for the past years been dominated by a single manufacturer, but now several systems have been marketed. Using a chest phantom and, as test objects, 2 simulated tumours for the lung and mediastinum, respectively, and one object simulating pulmonary lines, a total of 400 exposures were made, 100 on each system. The test objects were placed randomly with a ratio of presence/absence of each object of about 50. Six radiologists participated, 2 residents and 4 staff members. A receiver operating characteristics (ROC) analysis was performed with construction of curves, and the difference between the curves was estimated with a 2-tailed paired t-test. RESULTS AND CONCLUSION: The selenium-based system performed significantly better for pulmonary line detection than all the other systems, and better than one storage phosphor system for the lung "tumour" (p < 0.05), while one storage phosphor system was slightly better than the other in diagnosing all 3 test objects. The score for the film-screen system was only average.

Hepatic lymph nodes as follow-up factor in primary biliary cirrhosis. An ultrasound study.

BACKGROUND: The aim of this study was to investigate whether changes in lymph node size in the hepatoduodenal ligament reflect changes in biochemical and histologic markers of cholestasis, hepatocellular damage, and humoral immunoreactivity in patients with primary biliary cirrhosis (PBC). METHODS: Twenty-three consecutive patients were examined with repeated liver biopsies, laboratory tests, and ultrasonographic examinations of the hepatoduodenal ligament. The effect of treatment with ursodeoxycholic acid (UDCA) on these factors was also studied. RESULTS: A correlation was found between changes in lymph node size and changes in markers of hepatocellular damage, cholestasis, and humoral immunoreactivity and also with intralobular inflammation. In the UDCA-treated patients the node size decreased slightly during 2 years of treatment, whereas it was unchanged in the control group (p = 0.0528). CONCLUSIONS: Changes in the size of the lymph nodes in the hepatoduodenal ligament may reflect inflammation and cholestasis in PBC and thus be a valuable indicator in the follow-up of patients with this disease.

Ultrasound, hepatic lymph nodes and chronic active hepatitis.

Thirty-two consecutive patients with a histological diagnosis of chronic active hepatitis were examined with liver biopsy, laboratory tests and ultrasonography of the hepato-duodenal ligament to investigate the possible correlation between enlarged lymph nodes in the hepato-duodenal ligament and biochemical activity, histological activity and/or humoral immunoreactivity. We found a significant correlation between lymph-node size and serum alkaline phosphatase in the total material. In the hepatitis C-virus-associated group of patients a significant correlation between the size of the lymph nodes and gamma-glutamyl transpeptidase was found. In the autoimmune group there was a trend towards a negative correlation between lymph-node size and albumin.

Evaluation of the image quality of ink-jet printed paper copies of digital chest radiographs as compared with film: a receiver operating characteristic study.

Paper copies of digital radiographs printed with the continuous ink-jet technique have proved to be of a high enough quality for demonstration purposes. We present a study on the image quality of ink-jet printed paper copies of digital chest radiographs, based on receiver operating characteristic (ROC) analysis. Eighty-three digital radiographs of a chest phantom with simulated tumors in the mediastinum and right lung, derived from a computed radiography (CR) system were presented in two series of hard copies as ink-jet printed paper copies and as laser recorded film. The images, with a matrix of 1,760 x 2,140 pixels, were printed with a spatial resolution of 10 pixels/mm in the CR film recorder as well as in the ink-jet printer. On film, every image was recorded in two versions, one optimized for the mediastinum and one for the lungs. On paper, only one image was printed; this constituted an effort to optimize both the mediastinum and the lungs. The ink-jet printed images, printed on a matt coated paper, were viewed as on-sight images with reflected light. The examinations were reviewed by six radiologists, and ROC curves were constructed. No significant difference was found between the performance of film and that of ink-jet paper prints. Because the cost for a paper copy is only a tenth of that of film, remarkable cost reductions can be achieved by using the ink jet technique instead. Our results show that further quality studies of ink-jet printed images are worthwhile.

Breast imaging: a comparison of digital luminescence radiographs displayed on TV-monitor and film-screen mammography.

The purpose of this study was to compare the diagnostic accuracy of conventional film-screen mammograms with the corresponding digital luminescence mammograms saved on optical disk and viewed on a 1240-line monitor. One hundred mammograms from 100 patients, including 17 biopsy-proven cancers and one cancer confirmed by cytology, were reviewed. Five radiologists with different mammography experience served as observers, and receiver operating characteristic (ROC) curves were constructed. The result of the monitor interpretation was not inferior to the conventional mammogram interpretation. One observer with vast mammography experience obtained excellent results with a digital interpretation.

Digital luminescence radiography using a chest phantom. Comparison between radiographs displayed on monitor at a workstation and at a personal.

With the introduction of picture and archiving communicating systems an alternative image display for the wards might be a personal computer (PC). The intention with this study was to evaluate the diagnostic image quality of the monitor of a PC compared to that of a workstation. Eighty-five digital radiographs of a chest phantom with simulated tumors in the mediastinum and right lung were saved on optical discs. The examination were reviewed by 4 radiologists on a monitor at a workstation and at a PC, and receiver operating characteristic (ROC) curves were constructed. No significant difference was found between performance of the PC and the workstation.

Demonstration of digital radiographs by means of ink jet-printed paper copies: pilot study.

Different digital medical images have been printed on paper with a continuous ink jet printer, and the quality has been evaluated. The emphasis has been on digital chest radiographs from a computed radiography system. The ink jet printing technique is described as well as the handling of the image data from image source to printer. Different versions of paper prints and viewing conditions were compared to find the optimum alternative. The evaluation has been performed to maximize the quality of the paper images to make them conform with the corresponding film prints and monitor images as much as possible. The continuous ink jet technique offers high-quality prints on paper at a considerably lower cost per copy compared with the cost of a film print. With a future switch-over from diagnosing of digital images on film to diagnosing them on monitors, hard copies for demonstration purposes will occasionally be needed. This need can be filled by ink jet-printed paper copies.

Bedside chest radiography using digital luminescence. A comparison between digital radiographs reviewed on a personal computer and as hard-copies.

The introduction of picture and archiving communicating systems is currently being evaluated in several institutions. We decided, as an intermediate step, to see if image quality after transferral to a personal computer (PC) is sufficient for the diagnostic needs in an intensive care unit. Seventy-five portable digital chest radiographs were studied both as hard-copies and on a monitor after transferral to a PC. Two chest radiologists and one anesthesiologist reviewed the examinations. Our intention was to evaluate if everything that is routinely checked by the anesthesiologist is demonstrable after electronic transfer to a local workstation. We found practically no difference between the performance of monitor and film for the whole material.

Ultrasound, hepatic lymph nodes and primary biliary cirrhosis.

Thirty-five consecutive patients with primary biliary cirrhosis were examined using liver biopsy, laboratory tests and ultrasonography of the hepato-duodenal ligament to investigate the possible correlation between enlarged lymph nodes in the hepato-duodenal ligament and biochemical activity, histologic activity or stage and/or humoral immunoreactivity. We found a positive correlation between the size of the largest lymph node and laboratory values of cholestasis, hepatocellular damage and increased humoral immunoreactivity. On the other hand, we found a negative association between lymph node size and hepatocellular function. When twelve of the patients were reexamined after at least 10 months, in the majority of the patients changes in lymph node size were accompanied by similar changes in markers of cholestasis, hepatocellular damage and immunoreactivity. Prognostic index was also directly associated with lymph node size in most of these patients. No association between lymph node size and histologic stage was observed.

Digital luminescence radiography using a chest phantom. Comparison between radiographs displayed on monitor and hard-copy.

Ninety-eight digital radiographs of a chest phantom with simulated tumors in the mediastinum and left lung and a pneumothorax-simulation in the right hemithorax were compared with the corresponding examinations saved on optical disk and viewed on a 1,000-line monitor. The examinations were reviewed by 7 radiologists with different experience, and receiver operating characteristic (ROC) curves were constructed. There was no significant difference between the hard-copy and the monitor results. A significant interobserver difference was seen only with the low attenuating 6 mm "tumor" and then only between the observer with the highest and the one with the lowest scores.

Vectorcardiogram more sensitive than 12-lead ECG in the detection of inferior myocardial infarction.

The vectorcardiogram (VCG) is commonly stated to be more sensitive than the 12-lead electrocardiogram (ECG) for the diagnosis of inferior myocardial infarction. However, a recent study indicated that VCG is not superior to ECG for this diagnosis. The purpose of this study was to compare the performance of VCG and ECG criteria and to indicate possible explanations for the disagreement between earlier studies. Accordingly, we studied 65 patients with inferior myocardial infarction verified by left ventriculography or 201-TI myocardial scintigraphy and 351 normal subjects. Sensitivity was 69% (45/65) and 43% (28/65) for the VCG and ECG criteria, respectively. This difference was highly significant (P less than 0.001). Among the normal subjects there were only three with false positive ECG. We conclude that both VCG and ECG criteria for the diagnosis of inferior myocardial infarction are highly specific and that VCG criteria have greater sensitivity than ECG criteria.

Improved ECG interpretation using synthesized VCG for the diagnosis of inferior myocardial infarction.

Electrocardiographic (ECG) criteria for the diagnosis of inferior myocardial infarction (IMI) have high specificity but low sensitivity. Vectorcardiographic IMI criteria attain higher sensitivity without sacrificing specificity. One approach to improving ECG interpretation is to synthesize VCG loops from the 12-lead ECG. The performance of synthesized VCG (SVCG) was assessed, using the Frank VCG criterion of Starr et al. ECGs and SVCGs from 351 normal subjects and 65 patients with IMI verified by myocardial scintigraphy or angiocardiography were studied. The sensitivity was 14 percentage points higher for SVCG than for ECG (72% vs. 58%).

Ultrasound examination of lymph nodes in the hepatoduodenal ligament.

Ninety patients, found to have lymph nodes in the hepato-duodenal ligament (HDL) on ultrasound examination were reviewed over a one-year period in order to define the diseases in which such nodes can be found. The patients were divided into four main groups: benign liver disease (n = 31), malignant disease (n = 26), disease of the gallbladder or the biliary tree (n = 14) and a group with various benign, most inflammatory diseases (n = 19). In 40% of the patients (36/90), the lymph nodes in the HDL were the only sign of disease on ultrasound examination, and the majority of those were in the benign group.

Lung mechanics and their relationship to lung volumes in pulmonary sarcoidosis.

Pulmonary sarcoidosis was studied with respect to lung mechanical properties and to the influence of these on lung volumes. Sixty-six patients, with histological support for the diagnosis of sarcoidosis, and radiological signs of pulmonary involvement, i.e., stage II or III, were studied. The static pressure/volume (P/V) curves showed that the static elastic recoil pressure (PelL) tended to be increased at a given percentage of predicted total lung capacity (TLC). Reduction of static lung compliance (CstL) was a typical finding. At maximal inspiration PelL was abnormally low in 20 subjects, including in the main those with recent onset of the disease and older patients. The possibility of a greater inflammatory activity at the site of mechanical receptors in the lungs and airways of these patients is proposed. Pulmonary resistance, measured at a given PelL, was usually increased signifying bronchial involvement. TLC, residual volume (RV) and functional residual capacity (FRC) were lower in current smokers and ex-smokers than in lifelong nonsmokers. This may be due to synergistic effects of the inflammatory processes caused by smoking and sarcoidosis. A reduced vital capacity (VC) mainly reflected a low CstL but also obstruction with increased RV. Forced expiratory volume in one second (FEV1) reflected lung stiffness and obstruction equally. Lung mechanics revealed functional abnormalities which were not obvious from the standard tests, particularly in patients with respiratory symptoms.

Quantitative evaluation of tomographic 201-thallium myocardial scintigraphy.

Myocardial 201Tl emission computed tomography was performed on 25 normal subjects and 27 patients with angiographically significant coronary artery disease. A semi-automatic computer program was designed to define the left ventricular myocardial volume in all short axis sections. Within this volume the relative mean myocardial pixel count was calculated. This parameter was found to separate the 2 patient groups with a sensitivity of at least 81% at a specificity of 100%.

Computed tomography of the thymus gland in myasthenia gravis.

Sixteen consecutive patients with myasthenia gravis were examined by computed tomography (CT) before thymectomy. Surgical and histologic findings were compared with those obtained at CT. The results, like those of most other recent studies, indicate that CT is a reliable method for identifying thymoma. In all three patients with thymoma, and in five out of eight patients with hyperplasia, the lesion was observed at CT, giving an overall accuracy of 80 per cent. Although thymic hyperplasia is a basically histologic diagnosis an enlarged gland may give a correct diagnosis of this abnormality.