Recurrence detection in differentiated thyroid cancer patients with elevated serum level of antithyroglobulin antibody: special emphasis on using 18F‐FDG PET/CT

Objective A clinical challenge is presented by differentiated thyroid cancer (DTC) patients who show increased serum antithyroglobulin antibody (TgAb) level with undetectable thyroglobulin (Tg) and negative radioiodine whole body scan (I‐WBS). The aim of this study is to investigate the recurrence in DTC patients with elevated TgAb by using ¹⁸F‐FDG PET/CT (PET/CT) in addition to I‐WBS and neck ultrasonography (USG). Subjects and design A total of 276 TgAb+ patients were enrolled. Recurrence was assessed and compared between TgAb+ and TgAb‐ patients. TgAb+ patients were further categorized into two groups of 35–140 U/ml (Group A) and 140 U/ml or greater (Group B), according to receiver operating characteristic (ROC) curve analysis. Tumoural status was evaluated regarding the TgAb positivity and the degree of increase of TgAb. Results Thirty‐seven (13·4%) of 276 TgAb+ patients were finally diagnosed with recurrence, compared with 21 (13·5%) of 156 TgAb‐ patients (P = 0·987). There was a correlation between TgAb level and recurrence (P = 0·032). Recurrence was more common in Group B than Group A (27·8% and 9·9%, respectively, P = 0·001). Recurrence was found in 37·5% of 24 TgAb+/Tg‐ patients who showed a gradually increasing tendency in serial measurements of TgAb. Sixteen cervical foci (21·1%) missed on neck USG and 17 lesions (22·4%) located outside the neck were additionally detected with PET/CT in TgAb+ patients. Conclusions TgAb plays a complementary role to Tg in the detection of recurrence of DTC. Tumour recurrence was more frequent in patients with elevated TgAb level over 140 U/ml or a trend toward increasing levels. PET/CT could provide additional information to I‐WBS and neck USG in detecting tumour recurrence in patients with elevated TgAb.     

FDG Whole-Body PET/MRI in Oncology: a Systematic Review

The recent advance in hybrid imaging techniques enables offering simultaneous positron emission tomography (PET)/magnetic resonance imaging (MRI) in various clinical fields. ¹⁸F-fluorodeoxyglucose (FDG) PET has been widely used for diagnosis and evaluation of oncologic patients. The growing evidence from research and clinical experiences demonstrated that PET/MRI with FDG can provide comparable or superior diagnostic performance more than conventional radiological imaging such as computed tomography (CT), MRI or PET/CT in various cancers. Combined analysis using structural information and functional/molecular information of tumors can draw additional diagnostic information based on PET/MRI. Further studies including determination of the diagnostic efficacy, optimizing the examination protocol, and analysis of the hybrid imaging results is necessary for extending the FDG PET/MRI application in clinical oncology.     

Leiomyosarcoma of the epididymis: 2 cases and review of the literature

Paratesticular leiomyosarcomas are rare. We report two cases of leiomyosarcoma of the epididymis diagnosed and treated in a regional community hospital in Canada in 2009 and 2010. Both patients were males of ages 58 and 75, respectively. They presented with painless masses which, on ultrasonography, appeared to be solid masses demonstrating blood flow. Each patient underwent trans-scrotal resection of the affected epididymis. Pathological examination of trans-scrotal epididymectomy specimens confirmed the diagnosis of high-grade leiomyosarcoma. Leiomyosarcoma is an important differential diagnosis for paratesticular masses in the elderly male; the primary treatment is radical inguinal orchiectomy with high ligation of the spermatic cord.     

Quality of Life and Disease Severity Are Correlated in Patients with Atopic Dermatitis

Quantification of quality of life (QOL) related to disease severity is important in patients with atopic dermatitis (AD), because the assessment provides additional information to the traditional objective clinical scoring systems. To document the impact of AD on QOL for both children and adults as well as to quantify the relationship with disease severity, QOL assessments were performed over a 6-month period on 415 patients with AD. A questionnaire derived from the Infants'' Dermatitis Quality of Life Index (IDQOL), the Children''s Dermatology Life Quality Index (CDLQI) and the Dermatology Life Quality Index (DLQI) was used to determine the QOL for 71 infants, 197 children and 147 adults, respectively. To measure AD severity, both the Rajka & Langeland scoring system and the Scoring of Atopic Dermatitis (SCORAD) index were used. The mean scores were as follows: 7.7 ± 5.5 for IDQOL, 6.6 ± 6.3 for CDLQI, and 10.7 ± 7.9 for DLQI. In conclusion, these QOL scores are correlated with AD severity scores as estimated by the Rajka & Langeland severity score and the SCORAD. The outcome of the QOL instruments in this study demonstrates that atopic dermatitis of both children and adults affects their QOL.     

Neuroimaging in Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is a motor neuron disease characterized by progressive degeneration of upper motor neurons (UMN) and lower motor neurons (LMN). While LMN dysfunction can be confirmed by electromyography (EMG) and muscle biopsy, UMN involvement is more difficult to detect, particularly in the early phase. Objective and sensitive measures of UMN dysfunction are needed for early diagnosis and monitoring of disease progression and therapeutic efficacy. Advanced magnetic resonance imaging (MRI) techniques, such as diffusion, perfusion, magnetization transfer imaging, functional MRI, and MR spectroscopy, provide insight into the pathophysiological processes of ALS and may have a role in the identification and monitoring of UMN pathology. This article provides an overview of these neuroimaging techniques and their potential roles in ALS.