Initial Experience with Technegas —A New Ventilation Agent

Technegas is an ultra-fine dry dispersion of 99mTc-labelled carbon with particle size of ap proximately 0.005 μn. Because of this small size, penetration characteristics are gas-like and Technegas adheres to alveolar walls permitting excellent images of regional ventilation. The experience gained from the initial 150 patients studied is presented. The first 20 patients were examined with both 133Xe and Technegas ventilation scans followed by a perfusion scan. All patients readily accepted the Technegas and even in patients with moderately severe obstructive lung disease, a ventilation scan was possible. The multiple views possible with Technegas gave greater confidence in reporting, as ventilation and perfusion abnormalities could be directly compared in the same projections.     

Which patients with newly diagnosed prostate cancer need a radionuclide bone scan? An analysis based on 631 patients

Purpose: Although radionuclide bone scans are frequently recommended as part of the staging evaluation for newly diagnosed prostate cancer, most scans are negative for metastases. We hypothesized that Gleason score, prostate-specific antigen (PSA), and clinical stage could predict for a positive bone scan (BS), and that a low-risk group of patients could be identified in whom BS might be omitted.

Methods: All patients who had both pathologic review of their prostate cancer biopsies and radionuclide BS at our institution between 1/90 and 5/96 were studied. Gleason score, PSA, and clinical stage (AJCC, 4th edition) were evaluated by univariate and multivariate analyses for their ability to predict a positive BS. Groups analyzed were Gleason of 2–6 vs. 7 vs. 8–10; PSA of 0–15 vs. greater than 15–50 vs. greater than 50; and clinical stage of T1a–T2b vs. T2c–T4. Univariate analysis using χ² and multivariate analysis using logistic regression were performed.

Results: Of the 631 consecutive patients, 88 (14%) had positive BS. Multivariate analysis (64 excluded due to missing PSA and/or clinical stage) showed Gleason score, PSA, and clinical stage to be significant independent predictors for positive BS (p < 0.002, p < 0.001, p < 0.001, respectively). The odds ratios were 5.25 (confidence interval [CI], 3.43–8.04) for PSA > 50 vs. 0–15; 2.25 (CI, 1.43–3.54) for Gleason of 8–10 vs. 2–6; 2.15 (CI, 1.54–2.99) for clinical stage T2c–T4 vs. T2b or less. Three of 308 (1%) had a positive BS in patients with Gleason 2–7, PSA of 50 or less, and clinical stage of T2b or less. In the subset of the same risk group with PSA of 15 or less, all 237 had negative bone scans. In patients with PSA greater than 50, 49/99(49.5%) had positive BS.

Conclusion: Gleason score, PSA, and clinical stage were independent predictors for a positive radionuclide BS in newly diagnosed prostate cancer patients. PSA is the major predictor for positive BS. About one-half of the patients analyzed were in the low-risk group (Gleason 2–7, PSA ≤ 50, clinical stage ≤ T2b) and elimination of BS in these patients would result in considerable economic savings.     

Predictive role of positron emission tomography (PET) in the outcome of lymphoma patients

An extensive analysis of the reliability of positron emission tomography (PET) after induction treatment in patients with Hodgkin's disease (HD) or aggressive non-Hodgkin's lymphoma (NHL). In all, 75 untreated patients with HD (n=41) or aggressive NHL (n=34) were studied with both PET and CT scans following standard chemotherapy induction therapy (ABVD or MACOP-B) with/without radiotherapy. Histopathological analysis was performed when considered necessary. After treatment, four out of five (80%) patients who were PET(+)/CT(-) relapsed, as compared with zero out of 29 patients in the PET(-)/CT(-) subset. Among the 41 CT(+) patients, 10 out of 11 (91%) who were PET(+) relapsed, as compared with 0 out of 30 who were PET(-). The actuarial relapse-free survival (RFS) rates were 9 and 100% in the PET(+) and PET(-) subsets, respectively (P=0.00001). All five patients who were PET(+)/CT(-) underwent a lymph node biopsy: in four (80%) cases, persistent lymphoma and was confirmed at histopathological examination. Two HD patients who were PET(-)/CT(+) (with large residual masses in the mediastinum or lung) were submitted to biopsy, which in both cases revealed only fibrosis. In HD and aggressive NHL patients, PET positivity after induction treatment is highly predictive for the presence of residual disease, with significant differences being observable in terms of RFS. PET negativity at restaging strongly suggests the absence of active disease; histopathological verification is important in patients who show PET positivity.     

Spinal metastases from myxoid liposarcoma warrant screening with magnetic resonance imaging

BACKGROUND: Myxoid liposarcoma (MLS) has an unusual tendency for extrapulmonary metastasis, particularly to the spine and soft tissues. The objective of this study was to determine the prevalence of spinal metastasis, treatment outcomes, and optimal screening method for spinal metastasis in patients with MLS. METHODS: Data from patients with had spinal metastases were obtained from the authors' institutional soft tissue sarcoma database. The accuracy with which positron emission tomography (PET) scans and bone scans identified metastatic lesions was compared with the accuracy of magnetic resonance imaging (MRI). Clinical response to treatment was based on pain, neurologic scores, and survivorship analysis. RESULTS: There were 33 patients who developed spinal metastasis after a median 36 months of follow-up (range, from 7.5 months to 33 years). Known spinal metastases were detected by bone scans in 16% of patients and by PET scans in 14% of patients. Patients who underwent surgery had high-grade spinal cord compression more often than patients who did not undergo surgery (72% vs 19%, respectively; P = .002). Pain and neurologic function were improved or maintained in all patients who received radiation alone (n = 8 patients) and in all but 1 patient who underwent surgery (n = 18 patients). The median overall survival was 51.4 months from the time of primary diagnosis and 21.9 months from the time of first metastasis. CONCLUSIONS: Bone scans and PET scan lack sufficient sensitivity to detect spinal metastasis from MLS. Treatment of metastasis is palliative, but local treatment can yield long-term disease control in select patients. Screening with whole-spine MRI may lead to the earlier detection of spinal metastasis.     

110例鼻咽癌原发灶部位、体征和鼻咽、颅底CT关系探讨

目的：探讨鼻咽癌原发灶部位、体征与鼻咽、颅底CT关系。材料与方法：分析1993年12月至1995年10月我院收治的110例鼻咽癌之临床表现及鼻咽、颅底CT扫描。结果：茎突内侧软组织受侵率为87．3％（96／110），颈淋巴结转移率为77．3％。原发灶位于侧壁单侧颈淋巴结转移为52．9％（18／34），双侧颈淋巴结转移为35．4％（12／34）；原发灶位于顶侧壁单侧颈淋巴结转移为48．4％（17／35），双侧颈淋巴结转移为40．0％（14／35）。鼻咽癌除了直接向各壁和周围邻近组织发展蔓延外，咽旁间隙受侵和颈淋巴结转移有直接关系。鼻咽癌原发灶部位与颈淋巴结转移亦有关。本组资料还说明茎突内侧软组织受侵的侧别对颈深上淋巴结转移和前后组颅神经损害有一定关系。     

FDG-PET scanning for detection and staging of extranodal marginal zone lymphomas of the MALT type: a report of 42 cases.

BACKGROUND: Although reports have suggested that FDG-PET scans were not useful for staging of extranodal marginal zone lymphomas (MZL), experience at our center suggests otherwise. Thus we reviewed the findings of FDG-PET scans in patients with extranodal MZL seen at our center. PATIENTS AND METHODS: A database of 175 patients with histologically-confirmed diagnoses of extranodal MZL was reviewed. Forty-two patients who had had FDG-PET scans for initial staging were identified. All information was obtained by retrospective review of medical records and PET scans. RESULTS: Thirty-four (81%) patients had focal tracer uptake within verified tumor sites, six (14%) patients did not, and two (5%) patients had indeterminate uptake. Seven of the 34 (21%) patients with uptake within verified tumor sites had uptake in regional lymph nodes and four patients were upstaged due to FDG-PET findings. Eight patients also obtained post-treatment FDG-PET scans. In five of those eight, the repeated FDG-PET scan indicated a complete response, and in three there was an indeterminate or mixed response. CONCLUSION: FDG-PET scans carried out for initial staging of extranodal MZL detected disease in a high proportion of patients. This study suggests that imaging with FDG-PET scans is useful for both initial staging and follow-up of patients with extranodal MZL.     

胸部恶性淋巴瘤的影像学诊断

目的　对照分析普通Ｘ线、ＣＴ在胸部淋巴瘤的改变,以期提高对其影像学表现的认识。方法　对有病理证实的６０ 例常规摄Ｘ线正侧位胸片、肺门和纵隔分层,１６ 例行ＣＴ扫描。结果　表现为纵隔／和肺门淋巴结肿大（以前中纵隔居多）、肺浸润、胸膜和心包病变。肺浸润分间质改变为主型、结节型、肺炎肺泡型和胸膜病变型。结论　同一病例多种影像学表现为其特点,多数病例可由平片及分层确诊,ＣＴ较其更敏感。影像学对胸内淋巴瘤病理分型的确定有待进一步探讨。     

Surveillance imaging of Hodgkin lymphoma patients in first remission

BACKGROUND:

The majority of patients with Hodgkin lymphoma (HL) achieve disease remission after primary therapy. To the best of the authors' knowledge, no consensus exists for postremission surveillance imaging.

METHODS:

Retrospectively analyzed were 192 adult patients with classic HL in first remission. Events were defined as recurrent HL or secondary malignancies. Primary outcome was positive predictive value (PPV) of surveillance positron emission tomography/computed tomography (PET/CT) and CT scans in event detection. Secondary outcomes were costs and radiation exposures of surveillance scans.

RESULTS:

Sixteen events (12 recurrent HL cases and 4 secondary malignancies) were detected during a median follow‐up of 31 months. The PPV of surveillance PET/CT was 22.9% compared with 28.6% for CT (P = .73). Factors that were found to significantly improve the PPV of scans in detecting recurrent HL included PET and CT concordance, involvement of a prior disease site, or the occurrence of a radiographic abnormality within 12 months. There were too few events to determine whether event detection by PET/CT versus CT or the presence of symptoms at the time of event detection affected overall outcomes. The cost to detect a single event was approximately $100,000. Radiation exposure to detect a single event was 146.6 millisieverts per patient for each of 9 patients.

CONCLUSIONS:

For patients with HL in first disease remission, surveillance radiography appears to be expensive, with limited clinical impact. Surveillance CT is generally adequate. Cancer 2010. © 2010 American Cancer Society.     

Craniofacial Hemangiopericytoma Associated with Oncogenic Osteomalacia: Case Report

A craniofacial hemangiopericytoma associated with oncogenic osteomalacia is described and the literature is reviewed. A 46 year-old male with multiple fractures and hypophosphatemia was found to have a craniofacial mass extending from the right ethmoid sinus into the right frontal lobe. Initial detection of the tumor was made with an ¹¹¹Indium-pentreotide scan (Octreoscan). Gross total resection of the tumor was achieved and the patient received postoperative radiation therapy. One year after surgery, the patient remains free of tumor with significant increase in bone density and normal phosphate levels. This is the first report of a hemangiopericytoma invading the brain that was associated with paraneoplastic hypophosphatemia and osteomalacia. Also, this is the first reported detection of a hemangiopericytoma by an Octreoscan. Primary detection and secondary surveillance of hemangiopericytomas may be possible with serial Octreoscans.     

胆囊癌的CT诊断

报道１６例原发性胆囊癌。根据其ＣＴ表现分为：囊壁增厚型３例；腔内结节型６例；肿块型６例和混合型１例。胆囊癌多种多样的ＣＴ表现取决于它在进展中不同阶段的病理改变。ＣＴ能有效显示胆囊癌对相邻脏器的侵犯、淋巴结转移和肝转移，当出现上述征象时强烈支持胆囊癌的诊断。本文还对胆囊癌的临床特点以及鉴别诊断问题进行了讨论。     

Renal angiomyolipomas

Renal angiomyolipomas are generally benign tumors which are composed of smooth muscle, fat, and blood vessels. Classically these have been diagnosed with the use of arteriograms; however, since ultrasound and CAT scans have come into use these now are the common modalities for diagnosis. All angiomyolipomas generally can be followed conservatively, whereas larger ones have a tendency to bleed and require intervention. This paper reviews the diagnosis, treatment, and prognosis of patients with angiomyolipomas.     

New grading system of cerebral gliomas using positron emisson tomography with F-18 fluorodeoxyglucose

Summary Positron emission tomography (PET) using fluorine-18 (18F)-fluorodeoxyglucose (FDG) has been reported to be a powerful diagnostic and prognostic tool in patients with primary brain tumors. This study was undertaken to compare the prognostic value of: (1) visual grading of [18]FDG uptake in the tumor, (2) the absolute glucose metabolic rate of the tumor (TMRglc), (3) the ratio of glucose metabolism between the tumor and whole brain (T/WB) and (4) between the tumor and contralateral cerebellum (T/CBL). Each of these four parameters was correlated with the survival time in 20 patients with malignant cerebral gliomas. Excellent correlation was obtained with visual grading and reasonably good correlation was obtained with T/WB or T/CBL, but TMRglc alone was only a fair prognostic indicator. Thus, visual grading provides a qualitative analysis and T/WB provides a semi-quantitative analysis neither of which requires arterial blood sampling for quantification of absolute metabolic rates for glucose.     

CT平扫与对比增强扫描对下咽癌的诊断价值及对下咽癌侵犯周围结构的影像表现分析

目的探析下咽癌应用CT平扫与对比增强扫描的诊断价值及对其侵犯周围结构的影像表现分析。方法临床选择下咽癌患者50例,均进行喉镜检查及CT平扫与对比增强扫描。比较CT平扫与对比增强扫描的影像分期与病理分期的诊断准确情况;比较CT平扫及对比增强扫描对下咽癌诊断率与喉镜的比较情况;比较喉镜检查与CT平扫与对比增强扫描对下咽癌周围结构的显示情况。结果 CT平扫与对比增强扫描的影像分期与病理分期比较,差异无统计学意义(P>0.05);CT平扫与对比增强扫描对下咽癌诊断率与喉镜检查对比,差异无统计学意义(P>0.05);CT平扫与对比增强扫描显示淋巴结转移、环后区壁内脂肪层、杓状软骨、环状软骨、甲状软骨、喉旁间隙及会厌前间隙清晰情况显著高于喉镜检查法,差异有统计学意义(P<0.05)。结论下咽癌应用CT平扫与对比增强可清晰显示下咽癌是否出现淋巴结转移、侵犯范围、大小部位等结构,诊断准确性较高,值得临床推广。     

食管癌放疗前CT扫描的临床价值(附165例初步分析)

目的：探讨食管癌放疗前CT扫描的临床价值。材料与方法：165例食管癌放疗前作了CT扫描,对病变长度、软组织影最大宽度进行了测量,对异常肿大的淋巴结、受侵部位逐一记录。结果：表明病灶越长、软组织影最大宽度平均值比例增大。病变＜5cm,软组织影最大宽度平均值为3．12,5～7cm为4．403．1～9cm为5．09;＞9cm为5．61。淋巴结转移占35．15％,外侵占89．7％,外侵常累及的部位气管占55．15％（91／165）、隆突下占41．12％（68／165）、主动脉弓占29．70％（49／165）降主动脉占41．18％（69／165）、奇静脉窝占15．15％（25／165）、心包占10．30％（7／165）。结论：CT扫描的临床价值在于明确病灶范围,合理设计放射野,CT图像还可直接输入“T．P．S”（TreatmentPlanningSystem）进行放射治疗计划的设计、优化。     

Spontaneous regression of pulmonary bullae

The natural history of pulmonary bullae is often characterized by gradual, progressive enlargement. Spontaneous regression of bullae is, however, very rare. We report a case in which complete resolution of pulmonary bullae in the left upper lung occurred spontaneously.