Skeletal Survey in Multiple Myeloma: Role of Imaging.

Bone disease is the hallmark of multiple myeloma. Skeletal lesions are evaluated to establish the diagnosis, to choose the therapies and also to assess the response to treatments. Due to this, imaging procedures play a key role in the management of multiple myeloma. For decades, conventional radiography has been the standard imaging modality. Subsequently, advances in the treatment of multiple myeloma have increased the need for an accurate evaluation of skeletal disease. The introduction of new high performant imaging tools, such as whole-body lowdose computed tomography, different types of magnetic resonance imaging studies, and 18F-fluorodeoxyglucose positron emission tomography, replaced the conventional radiography. In this review, we analyze the diagnostic potentials, indications of use, and applications of the imaging tools nowadays available. Whole-body low-dose CT should be considered as the imaging modality of choice for the initial assessment of multiple myeloma lytic bone lesions. MRI is the gold-standard for the detection of bone marrow involvement, while PET/CT is the preferred technique in the assessment of response to therapy. Both MRI and PET/CT are able to provide prognostic information.

Prognostic Impact of Pretreatment Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography SUVmax in Patients With Locally Advanced Cervical Cancer.

OBJECTIVE: The aim of this study was to investigate the impact of SUVmax fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) measured in the primary tumor, pelvic and para-aortic node with disease-free survival (DFS) and overall survival (OS) in patients with locally advanced cervical cancer. METHODS AND MATERIALS: A total of 92 patients with histological diagnosis of locally advanced cervical cancer are treated with radiochemotherapy plus brachytherapy boost from January 2008 to April 2014 in our Institution. A pretreatment FDG-PET/CT for staging and radiotherapy planning was performed, and the value of SUVmax measured in primary tumor and positive nodes was related to DFS and OS. RESULTS: Univariate analysis showed that DFS is related to FDG-PET/CT positive para-aortic nodes (P = 0.01), International Federation of Gynecology and Obstetrics (FIGO) stage of disease (P = 0.01), and primary tumor SUVmax (P = 0.02), and OS is related to positive para-aortic nodes (P = 0.01) and primary tumor SUVmax (P = 0.02).In multivariate analysis, DFS is modified by FDG-PET/CT positive para-aortic lymph nodes, stage and high T SUVmax (P = 0.02; P = 0.003; P = 0.04), but the only worse prognostic factor of OS is the high SUVmax in the primary tumor (P = 0.01). CONCLUSIONS: We found that T SUVmax, stage, and para-aortic lymph node status assessed by FDG-PET were independent prognostic factors of DFS, whereas only T SUVmax correlated with OS.

A Comparison of Different Staging Systems for Multiple Myeloma: Can the MRI Pattern Play a Prognostic Role?

OBJECTIVE: The objective of this study is to compare the most recent systems for the staging of multiple myeloma (MM), the Durie-Salmon PLUS system and the International Staging System, according to patients' survival rates and response to therapy. Another objective is to verify whether patterns of bone marrow alteration on MRI (i.e., focal, diffuse, or variegated patterns) can provide prognostic information for patients with MM. MATERIALS AND METHODS: We retrospectively enrolled 85 patients with MM who were monitored for a minimum of 6 years and who underwent contrast-enhanced spinal and pelvic MRI at 1.5 T and whole-body FDG PET/CT at the time of diagnosis. Patients underwent MM staging performed using both staging systems and were divided into groups on the basis of their MRI patterns. These patient groups were then compared in terms of survival, response to therapy, and duration of response. RESULTS: Both staging systems showed great capability in differentiating patients with a worse prognosis from patients with a better outcome, with the capability of both systems found to be statistically significant, albeit less statistically significant for the Durie-Salmon PLUS system (p = 0.010 vs p = 0.046, respectively). Patients with a focal pattern on MRI had a worse survival rate than did the patients with other MRI patterns (p = 0.032). CONCLUSION: These data indicate that both the International Staging System and the Durie-Salmon PLUS system have great potential for characterizing and stratifying MM to determine the survival outcome and therapy response of patients. Observation of a focal pattern on MRI seems to be associated with poorer survival.

A 360-degree overview of body composition in healthy people: relationships among anthropometry, ultrasonography, and dual-energy x-ray absorptiometry.

OBJECTIVE: The aim of this study was to test the relationship between anthropometry, ultrasonography, and dual-energy x-ray absorptiometry (DXA) for the assessment of body composition in clinical practice. METHODS: The study was carried out in Italian blood donor volunteers belonging to five different age groups (18-70 y old; 25 men and 25 women per group; N = 250 participants; n = 125 men, n = 125 women). A complete history was collected and routine blood analyses were performed to confirm healthy status. All participants were submitted to whole-body DXA (tricompartmental analysis, regional, and total body), ultrasonography (abdominal adiposity evaluation), and anthropometric measurements. DXA was used as gold standard and its biomarkers were taken as reference for fat-lean mass balance, central-peripheral fat distribution, central or visceral fat, and subcutaneous fat. RESULTS: Anthropometric and ultrasound parameters were closely associated with most of DXA parameters. Composite markers representative of central and abdominal visceral fat compartments were significantly correlated with waist circumference, waist-to-hip ratio, and intra-abdominal fat thickness by ultrasound, in both men and women (P < 0.025). As expected, subcutaneous depots were significantly correlated with maximum subcutaneous fat thickness measured by ultrasonography (P < 0.025). CONCLUSIONS: Both anthropometry and ultrasonography provide a reliable estimate of visceral adipose tissue in a non-obese population compared with DXA, whereas anthropometry prediction of subcutaneous adiposity is weak. Physicians should be aware of the limits of these techniques for the assessment of body composition.

The role of ultrasonography in the evaluation of abdominal fat: analysis of technical and methodological issues.

RATIONALE AND OBJECTIVES: Ultrasonography (US) is becoming popular for the assessment of adiposity, but no one has studied this tool in the light of its potential limitations. Our purpose was to investigate the impact of technical conditions on the evaluation of abdominal fat by US. MATERIALS AND METHODS: Forty-five healthy males and 45 healthy females were consecutively enrolled in the study, randomly assigned to three groups equally distributed by sex, and examined accordingly to three technical points: fasting state (before and after meal [A]), breathing (expiration and inspiration [B]), and US equipment from different generations: 2003 and 1998 (C). Two blinded radiologists performed US in the these opposite conditions, acquiring five parameters representative of subcutaneous and visceral adiposity in two times. Student's t-test and Lin's correlation coefficient were used for statistical analysis to assess differences in the measures as well as in inter- and intra-observer agreements. RESULTS: The maximum and the only statistically significant changes were observed for intra-abdominal fat thickness regarding fasting state and breathing (Δ% = 24.1 ± 21.3 and Δ% = 9.2 ± 20.4, respectively; P < .0001). Reproducibility and repeatability, especially for visceral fat, were proved more stable in the following conditions: fasting state, expiration, and newer machine (2003). CONCLUSION: This article provides essential information and "range of confidence" for variations that can be expected from using different conditions in the measurement of abdominal adiposity by US to be carefully addressed as well as considered by US users and by researchers involving this technique in the field of body composition.

Intradural extramedullary Ewing's sarcoma. Recurrence with acute clinical presentation and literature review.

The intradural extramedullary space is an extremely unusual site for the onset of Ewing's sarcoma. We describe a case of recurrence of intradural extramedullary Ewing's sarcoma and review the literature available on this topic.

[Accuracy of endorectal Magnetic Resonance Imaging (MRI) and Dynamic Contrast Enhanced-MRI (DCE-MRI) in the preoperative local staging of prostate cancer]. / Accuratezza della RMN 1,5 T con bobina endorettale e della RMN dinamica (DCE MRI) nella stadiazione preoperatoria dei pazienti affetti da carcinoma prostatico.

BACKGROUND: The proper management of newly diagnosed prostate cancer (PCa) requires the choice of the appropriate treatment plan. A crucial factor is the accurate evaluation of the tumor local extension. The Magnetic Resonance Imaging (MRI) plays an important role in the local staging of prostate cancer, although its use in clinical practice is widely debated. Therefore, the purpose of our study was to evaluate the diagnostic accuracy of T2-weighted MR imaging in association with DCE-MRI, performed using an endorectal coil, in preoperative local staging of patients with prostate cancer, by using the histopathologic findings as the reference standard. MATERIALS AND METHODS: From April 2010 to May 2011, 65 patients (mean age, 65 years; range, 51-77 years) with clinical localized PCa, underwent radical prostatectomy at our institution, performed by 2 experienced surgeons. All patients were prospectively evaluated with eMRI in association with DCE-MRI prior to radical prostatectomy. In all patients MRI was performed at least 6 weeks after biopsy and within 2 weeks before Radical Prostatectomy (RP). Histologic analysis was our diagnostic "gold standard". To ensure that the histopathological findings matched with MR images, the assessment of radiological images and the RP specimens were performed dividing the prostate in 14 regions. RESULTS: First, we performed a "per-patient" analysis, considering the entire prostate as a single region. Then, we performed a "per-emigland" analysis, finally a "per-region" analysis. The sensitivity, specificity, PPV, NPV and AUC in predicting ECE in the analysis "per-emigland" were respectively 66.7, 95.7, 66.7, 95.7, 0.824. The evaluation of SVI reported similar results: 62.5, 97.5, 62.5, 97.5, 0.797. DCE-MRI did not improve the diagnostic accuracy of T1-T2-weighted MR images in the evaluation of ECE or SVI. CONCLUSIONS: T1-, T2-weighted MRI adds important information regarding the preoperative local staging of PCa. DCE-MRI does not improve the diagnostic accuracy of MRI in the local staging of PCa.

Vertebral fracture assessment by new dual-energy X-ray absorptiometry.

The aim of this study was to investigate the diagnostic performance of new dual-energy X-ray absorptiometry (DXA) technologies in the detection of vertebral fractures (VFs). Sixty-eight patients were submitted to DXA and conventional radiography (XR) on the same day. Lateral images of the spine were independently evaluated by three radiologists with different experience in skeletal imaging, in two sessions with 7 days between evaluations of the same anonymous images. The most expert physician repeated the analysis in a subsequent reading session after further 7 days. Results from expert XR evaluation were considered as gold standard. A semiquantitative approach was used to interpret images and morphometric analysis was performed when a VF was suspected. Seventy vertebrae (70/884, 7.9%) were excluded from the lesion-based analysis, as not evaluable: 11/70 (15.7%) missed by XR only, 56/70 (80.0%) missed by DXA only, 3/70 (4.3%) missed by both techniques (upper thoracic spine). Forty "true" fractures were detected (4.9% out of 814 vertebrae) in 26 patients (38.2% of the 68 studied patients). Twenty-five (62.5%) were mild fractures. DXA sensitivity and specificity were 70.0% and 98.3% on a lesion-based analysis, 73.1% and 90.5% on a patient-based analysis. Intra-observer agreement was excellent with no significant difference between the two techniques. Inter-observer agreement among the 3 observers was higher for XR (k=0.824 versus 0.720 in the detection of VFs, p=0.011). DXA accuracy was not influenced by radiologist experience; T4-L4 assessability as well as reproducibility and repeatability of the two techniques and accuracy of DXA were independent from sex, age, body mass index, grade of arthrosis. However DXA sensitivity was affected by mild VFs. Vertebral level did not affect the diagnostic performance with exception of vertebral body assessability. Latest improvements make VFs assessment by DXA competitive with traditional radiographic gold standard, providing consistent advantages and attractions. Few limitations still affect DXA performance and need to be overcome.

Accuracy, reproducibility and repeatability of ultrasonography in the assessment of abdominal adiposity.

RATIONALE AND OBJECTIVES: Despite improvements in the methods used in body composition analysis, some goals remain far from clinical practice. Among them, the most important is the quantification of intra-abdominal adipose tissue. Fat distribution is a key point in the assessment of cardiovascular and metabolic risk status. The aim of this study was to define the accuracy, reproducibility, and repeatability of ultrasonography in the evaluation of abdominal adiposity. MATERIALS AND METHODS: Twenty-six nonobese patients (group A) who underwent computed tomographic (CT) abdominal imaging and 29 obese patients (group B) were enrolled. Patients from both groups were independently evaluated using ultrasound by three radiologists; computed tomography-like conditions were reproduced, and six main parameters of subcutaneous and internal adiposity were measured (as well as three derived indexes) with both linear and convex probes. In group A, the same measurements were also obtained on CT images. Time spent for every ultrasound session was recorded. Results were analyzed using Lin's concordance correlation (ρ), intraclass correlation, and linear regression analysis (and analysis of variance). RESULTS: Three patients were excluded from group A after CT scans because of technical problems. Mesenteric fat thickness did not show significant correlations and reliability. Strong correlations between ultrasound and CT measurements were observed for all other visceral and subcutaneous parameters (ρ = 0.85-0.96). Intraobserver and interobserver agreement was excellent in both groups (repeatability: ρ = 0.83-0.99 for group A, ρ = 0.90-0.99 for group B; reproducibility: intraclass correlation coefficient = 0.90-0.99 for groups A and B). The mean time spent was 95 ± 21 seconds for group A (mean body mass index, 27.4 ± 2.4 kg/m(2)) and 129 ± 33 seconds for group B (mean body mass index, 37.3 ± 11.9 kg/m(2)). CONCLUSIONS: Ultrasound is accurate, reproducible, and fast in the analysis of abdominal adiposity. It offers a regional, easy, and close-at-hand evaluation of subcutaneous and visceral fat compartments. This should be taken into consideration when clinical routine examinations are performed or to evaluate patients with specific metabolic diseases before and after treatment.

Accuracy of MRI/MRSI-based transrectal ultrasound biopsy in peripheral and transition zones of the prostate gland in patients with prior negative biopsy.

The purpose of the study was to evaluate the accuracy of transrectal ultrasound biopsy (TRUS-biopsy) performed on regions with abnormal MRI and/or MRSI for both the transition (TZ) and the peripheral (PZ) zones in patients with suspected prostate cancer with prior negative biopsy, and to analyze the relationship between MRSI and histopathological findings. MRI and MRSI were performed in 54 patients (mean age: 63.9 years, mean PSA value: 11.4 ng/mL) and the ability of MRI/MRSI-directed TRUS biopsy was evaluated. A three-point score system was used for both techniques to distinguish healthy from malignant regions. Descriptive statistics and ROC analyses were performed to evaluate the accuracy and the best cut-off in the three-point score system. Twenty-two out of 54 patients presented cancer at MRI/MRSI-directed TRUS biopsy, nine presented cancer only in PZ, eight both in PZ and TZ, and five exclusively in TZ. On a patient basis the highest accuracy was obtained by assigning malignancy on a positive finding with MRSI and MRI even though it was not significantly greater than that obtained using MRI alone (area under the ROC curve, AUC: 0.723 vs 0.676). On a regional (n = 648) basis the best accuracy was also obtained by considering positive both MRSI and MRI for PZ (0.768) and TZ (0.822). MRSI was false positive in 11.9% of the regions. Twenty-eight percent of cores with prostatitis were false positive findings on MRSI, whereas only 2.7% of benign prostatic hyperplasia was false positive. In conclusion, the accuracy of MRI/MRSI-directed biopsies in localization of prostate cancer is good in patient (0.723) and region analyses (0.768). The combination of both MRI and MRSI results makes TRUS-biopsy more accurate, particularly in the TZ (0.822) for patients with prior negative biopsies. Histopathological analysis showed that the main limitation of MRSI is the percentage of false positive findings due to prostatitis.

Magnetic resonance cholangiopancreatography in asymptomatic pancreatic hyperenzymemia.

OBJECTIVES: To determine the type and frequency of pancreatic lesions detected by magnetic resonance cholangiopancreatography (MRCP) in subjects with asymptomatic pancreatic hyperenzymemia and to assess for a possible relationship between these lesions and the hyperenzymemia. METHODS: From January 2005 to May 2008, 63 subjects with asymptomatic pancreatic hyperenzymemia were studied by MRCP. In addition, amylase, pancreatic isoamylase, and lipase were determined for 5 consecutive days. RESULTS: In most subjects (n = 57, 90.5%), MRCP showed a normal pancreas. In the remaining 6 subjects (9.5%), the following alterations were found: pancreas divisum in 2, small intrapancreatic cyst in 2, anatomic variant of the Wirsung in 1, and mild dilatation of 3 secondary ducts in 1. In these 6 subjects, hyperenzymemia was highly variable from day to day, with frequent normalizations, as was also true for the 30 subjects with no MRCP alterations in whom diurnal enzyme determinations were made. CONCLUSIONS: Most of the subjects with asymptomatic pancreatic hyperenzymemia did not have pancreatic lesions detectable by MRCP. In the few subjects in whom a lesion was found, the great variability and the frequent transient normalization of serum enzyme levels tend to exclude a relation between the lesion and the hyperenzymemia.

Muscle circulation contributes to hyperdynamic circulatory syndrome in advanced cirrhosis.

BACKGROUND/AIMS: Muscle wasting likely influences blood flow to muscle districts in advanced cirrhosis. Thus, we assessed systemic hemodynamics and femoral artery blood flow corrected by muscle mass of the lower limb in 13 patients (Child-Pugh classes B and C) and 11 healthy controls. METHODS: Systemic hemodynamics were assessed by transthoracic electrical bioimpedance, femoral artery blood flow by duplex-Doppler and muscle mass by magnetic resonance imaging. RESULTS: As expected, patients exhibited increased cardiac index and reduced peripheral vascular resistance. Femoral artery blood flow did not differ between patients and controls. However, when this parameter was indicized by the muscle mass of the lower limb, which was reduced in patients (median: 3391; range: [2546-4793] vs 5118 [3562-7077]cm3, p=0.0006), it proved almost doubled in patients (91.1 [59.9-119.4] vs 50.5 [38.6-69.8]microl/min cm3; p=0.0001). Patient femoral blood flow indicized by muscle mass correlated inversely with peripheral vascular resistance (r= -0.65; p=0.017) and directly with cardiac index (r=0.57; p=0.042). CONCLUSIONS: Vasodilation of muscle districts contributes to the reduced peripheral vascular resistance in advanced cirrhosis. Our findings provide a stronger rationale for the use of non-selective vasoconstrictors to treat hemodynamic-dependent complications of cirrhosis, such as hepatorenal syndrome.

Prostate cancer: sextant localization with MR imaging, MR spectroscopy, and 11C-choline PET/CT.

PURPOSE: To retrospectively compare sensitivity and specificity of magnetic resonance (MR) imaging, three-dimensional (3D) MR spectroscopy, combined MR imaging and 3D MR spectroscopy, and carbon 11 (11C)-choline positron emission tomography (PET)/computed tomography (CT) for intraprostatic tumor sextant localization, with histologic findings as reference standard. MATERIALS AND METHODS: The local ethics committee on human research provided approval and a waiver of informed consent for the retrospective study. MR imaging, 3D MR spectroscopy, and 11C-choline PET/CT results were retrospectively reviewed in 26 men with biopsy-proved prostate cancer (mean age, 64 years; range, 51-75 years) who underwent radical prostatectomy. Cancer was identified as areas of nodular low signal intensity on T2-weighted MR images. At 3D MR spectroscopy, choline-plus-creatine-to-citrate and choline-to-creatine ratios were used to distinguish healthy from malignant voxels. At PET/CT, focal uptake was visually assessed, and maximum standardized uptake values (SUVs) were recorded. Agreement between 3D MR spectroscopic and PET/CT results was calculated, and ability of maximum SUV to help localize cancer was assessed with receiver operating characteristic analysis. Significant differences between positive and negative sextants with respect to mean maximum SUV were calculated with a paired t test. RESULTS: Sensitivity, specificity, and accuracy were, respectively, 55%, 86%, and 67% at PET/CT; 54%, 75%, and 61% at MR imaging; and 81%, 67%, and 76% at 3D MR spectroscopy. The highest sensitivity was obtained when either 3D MR spectroscopic or MR imaging results were positive (88%) at the expense of specificity (53%), while the highest specificity was obtained when results with both techniques were positive (90%) at the expense of sensitivity (48%). Concordance between 3D MR spectroscopic and PET/CT findings was slight (kappa=0.139). CONCLUSION: In localizing cancer within the prostate, comparable specificity was obtained with either 3D MR spectroscopy and MR imaging or PET/CT; however, PET/CT had lower sensitivity relative to 3D MR spectroscopy alone or combined with MR imaging.

A prospective comparison of 18F-fluorodeoxyglucose positron emission tomography-computed tomography, magnetic resonance imaging and whole-body planar radiographs in the assessment of bone disease in newly diagnosed multiple myeloma.

BACKGROUND AND OBJECTIVES: Bone lesions in multiple myeloma (MM) have been traditionally detected by whole body X-ray (WBXR) survey although magnetic resonance imaging (MRI) has become the gold standard for detecting MM involvement of the spine and pelvis. The aim of this study was to compare a new technique, positron emission tomography (PET) with 18F fluorodeoxyglucose (FDG) integrated with computed tomography (18F-FDG PET-CT), with MRI and WBXR for baseline assessment of bone disease in MM. DESIGN AND METHODS: We prospectively compared 18F-FDG PET-CT, MRI of the spine-pelvis and WBXR in a series of 46 patients with newly diagnosed MM. In 23 patients who received up front autologous transplantation, we also compared post-treatment PET-CT scans with MR images of the spine and pelvis. RESULTS: Overall, PET-CT was superior to planar radiographs in 46% of patients, including 19% with negative WBXR. In 30% of patients, PET-CT scans of the spine and pelvis failed to show abnormal findings in areas in which MRI revealed an abnormal pattern of bone marrow involvement, more frequently of diffuse type. In contrast, in 35% of patients PET-CT enabled the detection of myelomatous lesions in areas which were out of the field of view of MRI. By combining MRI of the spine- pelvis and 18F-FDG PET-CT, the ability to detect sites of active MM, both medullary and extramedullary, was as high as 92%. Following transplantation, 15 patients had negative PET-CT scans (including 13 with a very good partial response or at least a near complete response), but only 8 had normal MRI. INTERPRETATION AND CONCLUSIONS: MRI of the spine and pelvis still remains the gold standard imaging technique for the detection of bone marrow involvement in MM. 18F-FDG PET-CT provides additional and valuable information for the assessment of myeloma bone disease in areas not covered by MRI.

Can pancreatic steatosis explain the finding of pancreatic hyperenzymemia in subjects with dyslipidemia?

OBJECTIVE: It has been proposed by some investigators that benign pancreatic hyperenzymemia could result from pancreatic steatosis that they believe would have been caused by dyslipidemia; their diagnosis of steatosis was based on the finding of a hyperechogenic pancreas at ultrasound. The aim of this study was to assess the validity of this proposed model. METHODS: The study group was composed of 18 subjects with benign pancreatic hyperenzymemia, 12 men and 6 women; mean age, 55 years; range, 38 to 68 years. All 18 had dyslipidemia and 9 had hyperechogenic pancreas at ultrasound. In addition, 6 subjects with benign pancreatic hyperenzymemia but who did not have dyslipidemia or hyperechogenic pancreas and 10 healthy subjects with none of these conditions were also studied as controls. In each of these subjects, magnetic resonance imaging of the pancreas was performed to assess the presence of pancreatic steatosis. RESULTS: Magnetic resonance imaging showed normal pancreas with no signs of fatty infiltration in all 18 subjects with dyslipidemia, including those with both dyslipidemia and hyperechogenic pancreas at ultrasound. A similar result was found in all control subjects. CONCLUSION: The finding of a completely normal pancreas at magnetic resonance imaging does not support the proposed model in which pancreatic hyperenzymemia in subjects with dyslipidemia is attributed to pancreatic steatosis.

Role of 18F-FDG PET/CT in the assessment of bone involvement in newly diagnosed multiple myeloma: preliminary results.

PURPOSE: Multiple myeloma (MM) is a malignant B cell and plasma cell disorder which involves the skeleton in more than 80% of patients at diagnosis. The aim of this study was to compare whole-body X-ray (WBXR), MRI and (18)F-FDG PET/CT in patients with MM. METHODS: The study population comprised 28 newly diagnosed MM patients. Findings of (18)F-FDG PET/CT were compared with those of WBXR and MRI with regard to the number and site of lesions detected. RESULTS: Comparing (18)F-FDG PET/CT and WBXR, it was found that in 16/28 pts (57%) (18)F-FDG PET/CT detected more lesions, all of which were located in the skeleton. Nine of these 16 patients had a completely negative WBXR survey. In 12/28 pts (43%) the two methods yielded equivalent findings. Comparing (18)F-FDG PET/CT and MRI, it was found that in 7/28 pts (25%), (18)F-FDG PET/CT detected more lytic bone lesions, all of which were located outside the field of view of MRI (bone lesions in six cases and a soft tissue lesion in one). In 14/28 pts (50%), (18)F-FDG PET/CT and MRI detected the same number of lesions in the spine and pelvis, while in 7/28 pts (25%) MRI detected an infiltrative pattern in the spine whereas (18)F-FDG PET/CT was negative. CONCLUSION: (18)F-FDG PET/CT appears to be more sensitive than WBXR for the detection of small lytic bone lesions, whereas it has the same sensitivity as MRI in detecting bone disease of the spine and pelvis. On the other hand, MRI may be superior to (18)F-FDG PET/CT in diagnosing an infiltrative pattern in the spine. Therefore, careful evaluation of MM bone disease at diagnosis should include both MRI of the spine and (18)F-FDG PET/CT.

Detection and localization of prostate cancer: correlation of (11)C-choline PET/CT with histopathologic step-section analysis.

UNLABELLED: This study evaluated the potential usefulness of (11)C-choline PET/CT for detection and localization of tumors within the prostate. We used the results of step-section histopathologic examination as the standard of reference. METHODS: The results were analyzed on a sextant basis. We reviewed the results of the (11)C-choline PET/CT scans of 36 patients with prostate cancer and of 5 control subjects with bladder cancer. All patients underwent (11)C-choline PET/CT and, subsequently, radical prostatectomy with lymph node dissection within 1 mo. (11)C-Choline PET/CT scans were obtained 5-10 min after intravenous injection of 370-555 MBq of (11)C-choline. Images were reviewed visually and semiquantitatively using maximum SUV and tumor-to-background ratio. RESULTS: On a sextant basis, histopathologic analysis detected cancer foci in 143 of 216 sextants; high-grade prostate intraepithelial neoplasm foci were detected in 89 of 216 sextants (in 59 sextants in association with carcinoma, in 30 sextants alone), acute prostatitis was detected in 7 of 216 sextants (in 3 sextants in association with carcinoma, in 4 sextants alone), and 39 of 216 sextants were normal. PET/CT demonstrated focal (11)C-choline uptake in 108 sextants (94 of which involved tumor), and 108 sextants showed no abnormal (11)C-choline uptake (49 of which were false negative). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of PET/CT were 66%, 81%, 71%, 87%, and 55%, respectively. In the 5 control subjects, high-grade prostate intraepithelial neoplasm was detected at histologic examination in 16 of 30 sextants. PET/CT showed increased (11)C-choline uptake in 5 of 16 sextants. CONCLUSION: This study demonstrated the feasibility of using (11)C-choline PET/CT to identify cancer foci within the prostate. However, we also found that (11)C-choline PET/CT has a relative high rate of false-negative results on a sextant basis and that prostatic disorders other than cancer may accumulate (11)C-choline. Therefore, our data do not support the routine use of PET/CT with (11)C-choline as a first-line screening procedure for prostate cancer in men at high risk.