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Purpose: The aim of this study was to assess compliance with guidelines recommendations in the follow-up of patients with breast cancer. In this setting of patients we analyzed the appropriateness of the imaging exams recommended by different specialists in the management of follow-up., Materials and Methods: From January 2019 to December 2019 we analyzed the clinical data and the results of the imaging exams of 146 asymptomatic patients followed for follow-up in different regional radiotherapy centers. A logistic regression analysis was performed taking into account the advanced pathological stage, the absence of surgical staging of the lymph nodes, the dubious results from previous basic imaging tests, correlating them to the excessive use of advanced imaging. The association was expressed in terms of odds ratio (OR) together with their 95% confidence intervals (CI)., Results: For 96% of patients, a frequent prescription of at least one basic imaging exam (complete abdomen ETG and chest X-ray 2p) was observed in contrast to the guidelines. A finding of a large number of bone scans suggested their use as routine surveillance A positive correlation with advanced imaging (OR <1) was seen in patients with borderline basic imaging., Conclusions: Follow-up with intensive imaging is poorly effective both for the early diagnosis of relapses and for any remote localizations.

Aim: We aimed to evaluate the role of 18F-FDG PET/CT in the TNM staging of esophageal cancer in comparison with contrast-enhancement computed-tomography (CECT). Futhermore we set out to determine the role of semiquantitative PET parameters., Methods: 55 patients performed 18F-FDG PET/CT and CECT. Values of Sensitivity (Se), specificity (Sp), accuracy and predictability (PPV and NPV) were evaluated. McNemar test was applied for comparison. Cohen's K was calculated to measure the agreement. 18F-FDG PET/CT semiquantitative parameters (SUVmax, SUVmean, MTV and TLG) in relation to site and histotype, were assessed by ANOVA test and post-hoc test., Results: About T parameter, Se, Sp, accuracy, PPV and NPV of CECT and 18F-FDG PET/CT were respectively 82.35%, 94.48%, 85.00%, 93.33% and 76% for both the tecniques; the agreement resulted substantial. There were no statistically significant relationships between 18F-FDG PET/CT parameters and sites; MTV value differs in histotypes. About N parameter, Se, Sp, accuracy, PPV and NPV of CECT were respectively 82.35%, 57.89%, 65.00%, 46.67%, 88%; for 18F-FDG PET/CT were 88.23%, 60.53%, 61%, 50% and 92%; the agreement resulted fair. About M parameter, Se, Sp, accuracy, PPV and NPV PET/CT were equal for both techniques: 76.92%, 52.38%, 58.33%, 33%, 88%; the agreement resulted moderate. No statistical difference was observed in any comparison., Conclusion: 18F-FDG PET/CT is a useful tool for whole-body evaluation of patients with esophageal cancer, allowing an effective clinical TNM staging. In particular 18F-FDG PET/CT's ability in detecting distant metastases suggest its routinary performance as a second level of investigation.

Unlabelled: The aim of the study was to assess the diagnostic contribution of hybrid SPECT/CT lymphoscintigraphy compared to planar imaging for the correct identification of sentinel lymph nodes (SLN) in breast cancer (BC) patients., Materials and Methods: 73 planar and SPECT/CT lymphoscintigraphies were performed in 70 consecutive patients with BC (70 women, mean age 55.7±12.0 years, range 26-84) for pre-surgical SLNs research. Cohen'K was performed to evaluate the agreement between both techniques; their diagnostic capability was evaluated by the Student's t-test for paired data., Results: In 54/73 (73.9%) lymphoscintigraphies, SLNs were detected both on planar and SPECT/CT images. In 19/73 (26.1%) discordant cases, planar technique showed a higher number of SLNs in 4/19 lymphoscintigraphies, while SPECT/CT in 15/19. Radio-guided surgery confirmed SPECT/CT findings. Concordance between the two techniques was poor (K=-0.095). Overall, SPECT/CT detected 13 SLNs more than planar imaging (p=0.07). Furthermore, in 17/73 (23.2%) lymphoscintigraphies, SPECT/CT defined the exact SLNs anatomical localization, equivocal on planar images., Conclusions: SPECT/CT demonstrated added value over planar imaging, providing more information for the best surgical approach. It is useful especially in patients with negative or doubt planar imaging.

Unlabelled: Orbital and ocular neoplasms are rare tumors that could be benign or malign, primary or metastatic. Abnormalities within the orbit present a challenge in evaluation for imaging, both for morphologic examinations (ME) as weel as computed tomography (CT) and magnetic resonance (MR) and [18F]-2-deoxy-D-glucose Positron emission tomography/computed tomography (18F-FDG PET/CT). The aim of our study was evaluate 18F-FDG PET/CT role in orbital abnormalities, comparing it with CT and MR., Materials and Methods: A retrospective analysis of 67 patients (pts) (34 males and 33 females; mean age 59.91 years old) who performed 18F-FDG PET/CT for orbital and ocular abnormalities was performed. Comparison between 18F-FDG PET/CT and ME was performed by Cohen's K also within the most representative hystologic subtypes., Results: 18F-FDG PET/CT resulted positive in 19/67 pts. 47/67 pts performed ME (27/47 performed CT and 20/27 MR) within 20 days before 18F-FDG PET/CT and concordance was very poor (K=0.154). Considering 27/47 pts who performed CT, concordance was very poor (K=0.100). Considering the 20/47 pts who performed MR concordance was poor (K=0.266). Considering 19/47 pts with primary ocular NHL concordance resulted poor (K=0.269). Considering 6/47 pts with primary ocular melanoma concordance resulted very poor (K=0.182). In 9/47 pts with metastases diagnosis, concordance was absent (K=-0.189)., Conclusions: CT and MR are ME that permit the evaluation of the orbital region even with limits related to the difficulties of the region. 18F-FDG PET/CT is a sensitive tecnique for several malignancies. The low concordance among 18F-FDG PET/CT and ME suggests their complementary role, then to associate 18F-FDG PET/CT even for the whole-body evaluation.

Intestinal endometriosis represents a common condition that occurs particularly in women of reproductive age. The gastrointestinal tract is the third most common localization of endometriosis, after the ovaries and the peritoneum, and recto-sigmoid tract is involved in 70% of cases. Recto-sigmoid endometriosis has to be differentiated from other diseases of large bowel, especially in patients without a history of endometriosis. We report a case of sigmoid endometriosis which represented a diagnostic dilemma on multidetector computed tomography.

Congenital malformations are an heterogeneous group of disorders that can lead changes in pulmonary perfusion and then can be evaluated with lung perfusion scintigraphy. We selected five patients in which the role of lung perfusion scintigraphy emerges as a reliable and non-invasive imaging technique. Lung perfusion scintigraphy is a useful tool in pediatric patients with congenital malformations allowing an accurate evaluation of the best therapeutic strategy and its results.

We report the case of a 72 year old man with clinical suspicion of giant cell arteritis (GCA); in this case 18F-FDG PET/CT has been useful from the diagnosis to the control of the response to therapy. He performed the first 18F-FDG PET/CT that showed increased uptake of 18F-FDG in the aortic arch, brachial artery, common iliac and femoral arteries and in the temporal cerebral sites bilaterally. The patient then began a cortisonic therapy that led straight to the improvement of clinical symptoms, and repeated 18F-FDG PET/CT 3 months later the beginning of therapy that showed reduced uptake in the same sites of the first 18F-FDG PET/CT. This patient continued the cortisonic therapy, progressively reducing it until the definitive ending.

Cognitive impairment is frequent in patients with Parkinson's disease (PD), and can range from mild deterioration to dementia. Recently a contribution of Alzheimer's disease for the cognitive dysfunction in PD has been proposed, whereas the presence of tau protein and amyloid was recognized. Clusterin/ApoJ is a protein involved in the deposition of beta-amyloid and in its neurotoxicity. In this study we aimed to investigate the clusterin/ApoJ's plasma levels in patients with PD to assess its potential role in fisiopathogenetic cognitive impairment.

The prognosis for hepatobiliary malignancies is dismal. Surgery remains the primary curative option. The positron emission tomography/computed tomography (PET/CT) provides simultaneous metabolic and anatomic information on tumors in the same imaging session. The role of PET/CT in detecting hepatobiliary malignancies has not yet been established. The purpose of this review was to examine the literature on the use of PET/CT in cholangiocarcinomas, also in order to improve the preoperative staging and the restaging, for a proper oncology management of patients.

Lymphoscintigraphy and radio-guided research of the sentinel lymph node is the most important investigation in the staging of patients with cutaneous melanoma, because it allows the identification of the lymphatic drainage pathways, not always predictable, and locate the sentinel node in classic basins and in "unexpected" regions. The aim of this study was to evaluate the incidence of cases of unusual sentinel nodes detected by lymphoscintigraphy and their prognostic significance in patients with cutaneous melanoma.

The purpose of this study was to evaluate the diagnostic potential of multi-planar and volumetric reconstructions obtained from isotropic data by using 16-slice computed tomography (CT) in the diagnosis and staging of chronic pancreatitis. In a group of 42 patients CT images were evaluated searching for alterations in morphology and structure of the pancreas, alterations of the Wirsung duct, dilatation of the bile ducts, fluid collections, and vascular involvement of the digestive tract. The disease was then staged in mild, moderate and severe and correlated with the clinical staging. CT allowed the recognition of chronic pancreatitis in all cases. The staging was correct in 25/42 patients, with an accuracy rate of 59.5%. In the staging of moderate and severe forms, CT correlation with clinical and laboratory data was valid, but in mild forms it appeared less significant. Multi-detector CT is accurate in the recognition of moderate, advanced forms of chronic pancreatitis and in the identification of its complications, while it is poorly correlated with the clinical staging in mild forms of the disease.

In a patient with cerebral gliomatosis type II MRI revealed a large area of altered signal in the temporal region, parietal and occipital lobes associated with a single nodule with perilesional contrast enhancement, which showed increased uptake on PET/CT with 18F-FCH, characterizing heterogeneous cellularity of the tumor.

We report the case of a 62-year-old male with a history of primary testicular non-Hodgkin's lymphoma, treated with orchidectomy. After 14 months, the patient developed left leg swelling and pain, and was diagnosed and treated as having leg vein thrombosis. 18F-FDG-PET/CT showed a relapse of testicular lymphoma in the cutaneous muscle tissue of the left leg.

REM sleep Behaviour Disorder (RBD) is a sleep disorder that can precedes the development of motor signs of Parkinson's disease by years. The aim of this study was to assess the functional integrity of nigrostriatal dopaminergic system in RBD patients using 123I-2b-carbomethoxy-3b-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (123I-FP-CIT) Single-Photon Emission Computed Tomography (SPECT). 5 patients with RBD and 5 normal healthy controls were included in the study and underwent SPECT imaging 3 hours after injection of 111-185 MBq of 123I-FP-CIT. All RBD patients showed reduced 123I-FP-CIT striatal binding. 123I-FP-CIT SPECT is a useful diagnostic tool in RBD patients.

The purpose of this study was to evaluate the contribution of 18F-FDG-PET/CT in highlighting the peritoneal involvement in patients with ovarian cancer, also in relation to the biomarker CA125. We retrospectively analyzed 64 female patients with histological diagnosis of ovarian cancer who underwent 18F-FDG-PET/CT and CA125 measurement. Sensitivity and specificity of 18F-FDG-PET/CT were both 90.63% (95% CI: 80-100%). Sensitivity and specificity of CA125 were 93.33% (95% CI: 80-100%) and 33.33% (95% CI: 25-64%), respectively. In patients with peritoneal carcinomatosis from ovarian cancer, it is recommended to perform 18F-FDG-PET/CT, in particular when elevated CA125 levels are detected.

Assessment of the complex anatomy of the groin region using different imaging modalities is important to identify those pathological conditions that may present with atypical symptoms. In obese patients or in the presence of complications, physical examination may be unremarkable and instrumental studies based on non-invasive techniques (e.g., ultrasounds) do not allow accurate assessment of this region. Multidetector CT scanning and reconstruction can provide useful information on inguinal canal anatomy and its related diseases, contributing to timely therapeutic interventions.

We report the case of a pregnant patient who developed the typical pattern of tako-tsubo syndrome after delivery (i.e., electrocardiographic changes, elevated cardiac enzymes, and no evidence of coronary stenosis). SPECT imaging showed myocardial perfusion defects and altered motility, which reversed 6 months later.

Perineural tumor spread of head and neck malignancies is a well known form of metastatic disease in which a lesion can migrate away from the primary site along the cranial nerves. Nerve function can be preserved even in advanced stages of the disease, making neuroradiological assessment of perineural tumor location and extension of utmost importance, as radiological or pathological examination may reveal normal or nonspecific nerve function. Computed Tomography is useful in detecting foraminal enlargement or more destructive bone patterns. Magnetic Resonance imaging is the modality of choice because it can provide direct (nerve enlargement and enhancement) and indirect evidence of the disease (neuropathic muscular atrophy, obliteration of fat planes) owing to its superior soft-tissue contrast resolution, its multiplanar imaging and the decreased amount artifacts from dental hardware. Fat suppression images after contrast injection are mandatory to better detect nerve enhancement. We report the case of a female patient with perineural diffusion along the ophthalmic branch. This clinical picture is very rare, compared to those involving the mandibular and maxillary branches of the fifth cranial nerve.

In the last twenty years, the study of gastroenteric disorders underwent a radical change as a result of rapid advances in diagnostic imaging, with the introduction of more sophisticated and better performing techniques. Although this evolution has significantly contributed to improve diagnostic accuracy, also allowing assessment of different areas of the gastroenteric tract that could not be well evaluated in the past, clinicians may feel confused about deciding the most appropriate diagnostic approach according to lesion type and site. The aim of this paper is to provide an overview of available imaging techniques to guide the diagnostic approach to gastroenteric diseases.

Nuclear medicine images are difficult to interpret because they do not include anatomical details. The aim of this study was to obtain lymphoscintigrams with anatomical landmarks that could be easily interpreted by General Physicians. Traditional lymphoscintigrams were processed with Adobe© Photoshop® CS6 and converted into vector images created by Illustrator®. The combination with a silhouette vector improved image interpretation, without resulting in longer radiation exposure or acquisition times.

CT enteroclysis is an imaging technique that allows better visualization of the small bowel than standard abdomino-pelvic CT. It is more accurate than CT enterography and provides complementary diagnostic information to digestive endoscopy. Multiplanar reconstruction allows better evaluation of the diseases arising from the small bowel wall, or from surrounding organs, resulting in increased accuracy and effectiveness of this imaging technique. CT enteroclysis often enables a comprehensive assessment of small bowel disease, allowing a definite diagnosis and characterization of intestinal bowel disease, or of other related pathological conditions.

Computed tomography (CT) and magnetic resonance imaging (MRI) are important diagnostic tools for evaluating gastrointestinal disorders. A rigorous examination protocol is needed to achieve the best results. This paper describes the technical issues of CT and MRI for the study of gastrointestinal tracts (esophagus, stomach, small and large bowel).

The aim of the study was to assess the accuracy of multidetector CT (MDCT) with MPR reformation in the evaluation of large bowel obstruction. Thirty-one patients were evaluated retrospectively in a blinded fashion by two radiologists. All patients underwent MDCT with multiplanar reformation (MPR). The two radiologists interpreted independently the axial images and then the reconstructions. Each patient received a score from 1 (absent occlusion) to 5 (confirmed occlusion). The results were compared with surgical findings. Both axial and MPR images showed a very high accuracy in the diagnosis of bowel obstruction with a significant advantage of MPRs over native images and without any difference between the two radiologists. MDCT is an accurate technique in the evaluation of large bowel obstruction and use of MPRs facilitates the interpretation of imaging findings.

The aim of this study was to determine the role of 18F-FDG-PET/CT in the evaluation of carotid plaques and its relationship with cardiovascular risk factors. 18F-FDG-PET/CT scan was performed in 25 patients with ultrasound diagnosis of carotid atherosclerosis and ≥70% stenosis, who were scheduled for carotid endoarterectomy. 18F-FDG uptake was measured by ROIs drawn on PET/CT carotid artery slices. A statistically significant difference in 18F-FDG uptake was observed in relation to body mass index values between 25 and 29 kg/m2. Our results suggest that PET/CT imaging has utility in risk stratification of atherosclerotic patients.

Technical advances in computed tomography (CT), including helical CT and multidetector CT, have resulted in an improved ability to evaluate the small intestine. CT examination of the small bowel requires the use of dedicated techniques for optimal evaluation of inflammatory bowel disease in order to select the most appropriate therapeutic strategy for the individual patient and to monitor disease progression over time.Although intraluminal contrast media combined with intravenous iodinated contrast agents with a biphasic injection protocol provide good visualization of the typical lesions of the disease, accurate estimation of the degree of disease activity can only be achieved with nuclear imaging. Owing to continuous technical improvements, magnetic resonance imaging is expected to play an increasing role in the near future. However, in selected patients, three-dimensional endoanal ultrasonography remains the gold standard technique for assessing the anal sphincter and the recto-anal junction.

Lymphoscintigraphy is a first-line imaging technique for the assessment of abnormal lymphatic drainage in chyluria. It can provide information about the site of origin of chyluria, and may be helpful in selecting patients for surgery and assessing treatment efficacy. We report the case of a 59-year-old male with chyluria correctly diagnosed with lymphoscintigraphy.

Pneumatosis intestinalis may be caused by bowel ischemia and may display different patterns of appearance. We report a case of pneumatosis intestinalis with an atypical target pattern, detected by multidetector computed tomography (CT) in a 66-year-old male presenting with acute abdominal syndrome. Abdominal CT scan showed a double gas collection within the wall of a jejunal segment, with a characteristic target air distribution. The patient was surgically treated and successfully discharged from our hospital with the diagnosis of acute bowel ischemia. The target air sign can be an initial CT finding of the typical pneumatosis intestinalis and it can be useful in the early diagnosis of bowel ischemia.

We report the case of a patient with abdominal aortic aneurysm who underwent serial 18F-FDG PET/CT examinations to evaluate the risk of rupture and to guide appropriate surgical or medical management.