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Background: The treatment of lateral epicondylitis remains unsatisfactory in certain cases. The aim of this study is to investigate the efficiency of an ultrasound-guided infiltration combined with fenestration of the extensor tendon postulating a 50% reduction in pain on exertion within 6 months. Methods: In a prospective, nonrandomized, multicenter study design, 68 patients with chronic lateral epicondylitis and symptoms lasted for at least 6 weeks were included. Each hospital has been assigned for Traumeel (A), autologous whole blood (B), or dextrose (C) in advance. Preinterventional, 6 weeks, 12 weeks, 6 and 12 months after infiltration, patient-related outcome parameter, and dorsal wrist extension strength were documented. Preinterventional (obligate) and after 6 months (optional) radiological evaluation (magnetic resonance imaging) was performed. Results: The Visual Analog Scale showed a significant reduction after 6 months in all groups (A. 4.8-2.5, B. 6.2-2.3, C. 5.8-2.4). Similar results could be observed with Subjective elbow value, Disabilities of Arm, Shoulder, and Hand Score, Mayo Elbow Performance Score, and Patient Rated Tennis Elbow Evaluation. The loss of strength could be completely compensated after about 6 months. Magnetic resonance imaging did not fully reflect clinical convalescence. Re-infiltrations were sometimes necessary for final reduction of symptoms (A = 11, B = 8, C = 4). Switching to surgical intervention was most frequently observed in group C (A = 2, B = 1, C = 5). In 14.5% of the cases, no improvement of the symptoms could be achieved with this method. Conclusion: The primary hypothesis of a significant long-term pain reduction of at least 50% could be achieved regardless of the medication chosen.

Breast pain is a common concern among women in primary care clinics. A rare cause of breast pain is Mondor’s disease (MD), which can present as an acute, painful, erythematous, cord-like induration on the breast or anterior chest wall. The disorder is caused by sclerosing superficial thrombophlebitis of the anterolateral thoracoabdominal wall veins. There does not appear to be a racial or ethnic propensity for this condition; however, it is important to understand that it may be more difficult to see in darker skin types (Fitzpatrick skin types IV-VI) and requires close attention on physical exam. The cause of MD is poorly understood but may be related to direct trauma, strenuous exercise, or hormone changes. We review a case of a 54-year-old woman who presented with an anterior chest wall palpable cord, better visualized with adequate lighting and skin traction, ultimately diagnosed as MD based on clinical findings and imaging studies. Mondor’s disease often resolves spontaneously with supportive care, as in this patient’s case; however, clinicians should be aware of this rare cause of breast pain and its association with hypercoagulable state, vasculitis, and breast cancer.

Bone involvement is relatively rare in vascular malformations. Gorham-Stout disease, also referred to as vanishing bone disease, is characterized by osteoclast activation and osteolysis caused by proliferating lymphatic endothelial cells. We present the case of a 12-year-old boy who had Gorham-Stout disease at the age of 8 years. The clinical course was complicated by pathological fractures and localized intravascular consumption coagulopathy. Sclerotherapy and embolization therapy led to normalization of the coagulation parameters and significant improvement of the clinical findings. We speculate that this effect may be attributable to the elimination of lymphatic endothelial cells. Key words: endovascular laser photocoagulation, Gorham-Stout syndrome, localized consumption coagulopathy, sclerotherapy, vanishing bone disease

In a technical development study approved by the institutional ethics committee, the feasibility of fast diffusion-weighted imaging as a replacement for conventional magnetic resonance (MR) imaging sequences (short inversion time inversion recovery [STIR] and T1-weighted spin echo [SE]) and positron emission tomography (PET)/computed tomography (CT) in the detection of skeletal metastases from prostate cancer was evaluated. MR imaging and carbon 11 ((11)C) choline PET/CT data from 11 consecutive prostate cancer patients with bone metastases were analyzed. Diffusion-weighted imaging appears to be equal, if not superior, to STIR and T1-weighted SE sequences and equally as effective as (11)C-choline PET/CT in detection of bone metastases in these patients. Diffusion-weighted imaging should be considered for further evaluation and comparisons with PET/CT for comprehensive whole-body staging and restaging in prostate and other cancers., (RSNA, 2008)

Objective: To demonstrate the possibilities, advantages and limitations of virtual bronchoscopy using data sets from positron emission tomography (PET) and computed tomography (CT)., Materials and Methods: Eight consecutive patients with non-small cell lung cancer (NSCLC) underwent PET/CT. PET was performed with a glucose analog, 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (18F-FDG), using a state-of-the-art full-ring Pico-3D PET scanner. CT was performed with a venous-dominant contrast-enhanced phase using a 16-slice CT scanner. The tracheobronchial system was segmented using the CT data set with an interactive threshold interval volume-growing segmentation algorithm. The primary tumors and lymph node metastases were segmented for virtual CT-bronchoscopy using the CT data set and for virtual hybrid bronchoscopy using the PET/CT data set. The structures of interest were visualized with a color-coded shaded-surface rendering method., Results: The use of CT and virtual CT-bronchoscopy primarily facilitates visualization of the anatomical details of the tracheobronchial system and detection of anatomical/morphologic structural changes caused by disease. PET/CT and virtual hybrid bronchoscopy, or virtual PET/CT-bronchoscopy, give superior results to virtual CT-bronchoscopy because the hybrid bronchoscopy uses both the CT information and the molecular/metabolic information about the disease obtained from PET., Conclusions: PET/CT imaging has proven to be a highly valuable oncological diagnostic modality. Virtual hybrid bronchoscopy can be performed using a low-dose CT scan or diagnostic CT. However, it is expected to improve diagnostic accuracy in identification and characterization of malignancies, verification of infections, and differentiation of viable tumor tissue from atelectases and scar tissue, as well as assessment of tumor staging and therapeutic response, and detection of early stage recurrences that are not detectable or are liable to be misjudged using virtual CT-bronchoscopy. It could also be useful as a screening examination method for patients with suspected endobronchial malignancy. Virtual hybrid bronchoscopy with a transparent color-coded shaded-surface rendering model offers a useful alternative to fiberoptic bronchoscopy, and is particularly promising for patients for whom fiberoptic bronchoscopy is not feasible, contraindicated or refused.

The purpose of the investigation was to assess positron emission tomography (PET), computed tomography (CT) and the image fusion of PET and CT (PET/CT) in the detection of metastases from gastrointestinal neuroendocrine tumors. In a prospective study, thirty-one patients were consecutively examined using a state-of-the-art PET/CT. PET was performed with a carbohydrated F-18-labeled somatostatin receptor ligand (Gluc-Lys([(18)F]FP-TOCA) from the base of the skull to the proximal thigh using a Pico-3D PET scanner. CT was performed with a noncontrast low-dose CT (LD-CT) and a venous-dominant contrast-enhanced CT (VD-CT) from the base of the skull to the proximal thigh and a hepatic arterial-dominant contrast-enhanced CT (AD-CT) from the epigastric region using a 16-slice CT. The data sets from PET and CT (LD-CT and VD-CT) were fused automatically. To assess a relative sensitivity of each imaging modality, the total number of metastases by summing the number of metastases depicted for each patient by the highest sensitive modality was used as reference standard. PET, LD-CT, AD-CT, VD-CT, PET/LD-CT and PET/VD-CT showed a lesion-by-lesion based overall detection rate for liver metastases (n=858) of 90.8% (P<0.001), 29.4% (P<0.001), 45.5% (P<0.001), 73.9% (P<0.001), 91.5% (P<0.001) and 100%. PET, LD-CT, VD-CT, PET/LD-CT and PET/VD-CT showed an overall detection rate for lymph node metastases (n=193) of 93.8% (P<0.001), 25.4% (P<0.001), 64.8% (P<0.001), 93.8% (P<0.001) and 100% and for osseous metastases (n=567) of 98.6% (P<0.005), 40.7% (P<0.001), 40.7% (P<0.001), 100% and 100%. Furthermore, PET revealed 2 (22.2%) of 9 intrapulmonal lesions seen on LD-CT, VD-CT, PET/LD-CT and PET/VD-CT. PET as single modality revealed most liver, lymph node and osseous metastases. The combination of molecular/metabolic with anatomical/morphological information improves the diagnostic accuracy for the detection of metastases in comparison to any single imaging modality. LD-CT cannot replace VD-CT in the detection of liver and lymph node metastases, but was equal in the detection of osseous metastases and identifying of pulmonary lesions.

Purpose: Evaluation of MR-guided interstitial laser thermotherapy (ILT) of colorectal liver metastases under consideration of efficacy, safety and patient survival., Materials and Methods: Sixty-six inoperable patients with a total of 117 colorectal liver metastases were treated with MR-guided laser therapy in 96 sessions. 40.9% of patients presented metastases from rectum carcinoma, 30.3% from sigmoid carcinoma and 28.8% from colon carcinoma. Inclusion criteria were < or =5 metastases < or =5 cm in greatest diameter and no extrahepatic tumor spread. Internally water-cooled 9F power-laser-applicators were placed under CT-fluoroscopy. For MR-guided ILT, a 1064 nm Nd-YAG-lasers with a beam divider with multi applicator technique was used. The energy applied was 10 watt per centimeter diffusor length, with the diffusor length ranging from 20 to 40 mm. The mean duration of the energy application was 23 minutes (range: 15 - 37 minutes). The endpoint of the laser ablation was defined as the absence of hyperintense tumor tissue in the continuously monitored T2-w fat saturated gradient-echo sequences. Follow-up included contrast-enhanced MRI using T1- and T2-weighted spin-echo and gradient-echo sequences every three months after treatment. Survival times were calculated using the Kaplan-Meier method., Results: The median follow-up was 8.7 months (mean 11.8; standard deviation 9.9; range 1 to 36). The overall median progression free survival was 6.1 months (range, 0.3 to 27+ months). Median survival was 23 months (95% CI, 17-29 months). The rate of major complications was 2.1% (n = 2) and peri-procedural mortality (30 days) was 3% (n = 2). After 3, 6, 9, and 12 months, local tumor control was 98.3%, 91.4%, 76.1%, and 69.4%, respectively. In no patient metastatic deposits along the catheter access route were found., Conclusions: In patients with colorectal liver metastases, interstitial laser thermotherapy is an effective and safe therapeutic option and therefore suitable not only in palliative situations.

The aim of this study was to demonstrate the possibilities, advantages and limitations of virtual bronchoscopy using data sets from positron emission tomography (PET) and computed tomography (CT). Twelve consecutive patients with lung cancer underwent PET/CT. PET was performed with F-18-labelled 2-[fluorine-18]-fluoro-2-deoxy-D: -glucose ((18)F-FDG). The tracheobronchial system was segmented with a volume-growing algorithm, using the CT data sets, and visualized with a shaded-surface rendering method. The primary tumours and the lymph node metastases were segmented for virtual CT-bronchoscopy using the CT data set and for virtual PET/CT-bronchoscopy using the PET/CT data set. Virtual CT-bronchoscopy using the low-dose or diagnostic CT facilitates the detection of anatomical/morphological structure changes of the tracheobronchial system. Virtual PET/CT-bronchoscopy was superior to virtual CT-bronchoscopy in the detection of lymph node metastases (P=0.001), because it uses the CT information and the molecular/metabolic information from PET. Virtual PET/CT-bronchoscopy with a transparent colour-coded shaded-surface rendering model is expected to improve the diagnostic accuracy of identification and characterization of malignancies, assessment of tumour staging, differentiation of viable tumour tissue from atelectases and scars, verification of infections, evaluation of therapeutic response and detection of an early stage of recurrence that is not detectable or is misjudged in comparison with virtual CT-bronchoscopy.

Objective: To estimate performance of MRI for differentiating malignant from benign solitary pulmonary nodules (SPN) using morphological characteristics., Material and Methods: MRI in 46 patients with SPN (mean diameter: 19 mm) was carried out on 1.0 Tesla scanner using ECG-gated, gradient echo sequence. Morphological signs of SPN were determined and compared with previously performed helical-CT, where final diagnosis served as reference with 52% frequency of malignancy. Furthermore, three observers evaluated all images., Results: Significant differences between the two groups were found for nodules shape, margin, inhomogeneity and the vessel-sign in MRI, nodules shape, margin, the vessel-sign, and presence of spicules in CT. Using these signs, AUC were 0.746 for MRI and 0.765 for CT. The mean sensitivity, specificity, and accuracy of observers for MRI/CT were 89%/95%, 42%/41%, 66%/68%, respectively., Conclusions: Despite discrepancies in morphologic appearance, no significant difference of accuracy between MRI and CT was determined. Further investigations are necessary to demonstrate the clinical use in combination with functional parameters, establishing MRI as a comprehensive diagnostic modality for SPN.

The aim of this prospective study was to assess the feasibility of a state-of-the-art clinical PET/CT scanner for in vivo tumor imaging in mice in comparison to a small animal PET scanner and a small animal CT scanner. Seventeen female NMRI nude mice bearing a subcutaneous transplanted murine mammary carcinoma (EMT6) on the right hind limb were examined using a clinical PET/CT scanner (biograph Sensation 16), a dedicated small animal PET scanner (MOSAIC system), and a dedicated small animal CT scanner (MicroCAT II). 18F-fluoroazomycin arabinoside (18F-FAZA) was used as PET tracer for imaging of regional tumor hypoxia. The examination of tumor-bearing mice using a state-of-the-art clinical PET/CT scanner, a dedicated small animal PET scanner and a dedicated small animal CT scanner revealed good image quality and allowed the evaluation and correlation of molecular/metabolic alterations of cancers with anatomical/morphological findings. The tumor lesions showed a 1.89 +/- 0.6 higher mean tumor-to-background ratio +/- SD for the dedicated small animal PET scanner than the PET from the clinical PET/CT scanner (P<0.001). The mean tumor-to-background ratio of the PET of the clinical PET/CT scanner showed a high correlation with the mean tumor-to-background ratio of the dedicated small animal PET scanner (r2 = 0.92). The tissue hypoxia in the subcutaneous transplanted EMT6 tumors did not correlate with the tumor volume. Clinical PET/CT scanners are widely available and could contribute not only to human clinical routine examinations, but also to tumor research in animals. The molecular/metabolic information is reduced when imaging small tumors of mice with clinical PET/CT scanners due to the low spatial resolution and sensitivity of the PET scanners. The examination of small tumors in mice should be reserved to research centers with small animal PET/CT scanners because they provide promising hope to achieve accurate measurement of activity concentration. For tumor research in humans and animals using clinical PET/CT scanners, PET scanners with a higher spatial resolution and a higher sensitivity will be highly promising, but will be in competition to PET/MRI.

Objective: For staging, follow-up and even screening (www.screening.info) an "all-in-one" imaging examination is desirable. In the concept of whole body MRI, lung imaging prevails as the weakest link. The purpose of our study was to determine the optimal MRI sequences for the detection of malignant lung nodules., Patients and Methods: On the basis of 6 lung cancer, 46 metastases and one tuberculoma in 13 patients eight MRI sequences--HASTE, IR-HASTE, fat saturated TrueFISP, STIR, VIBEipat = 2, and contrast-enhanced (CE) VIBE (with ipat = 2, 0, 4) performed with parallel imaging and 12 matrix coil elements--were compared in terms of contrast-to-noise ratio (CNR) and quality in the visualization of the lung nodules using multidetector CT as standard of reference. The parameters of the sequences were pragmatically selected to minimize the imaging time to allow for imaging the entire lung within one breathold interval., Results: The STIR sequence was found to be the best for detecting malignant lung nodules (p<0.01) followed by the FS TrueFISP, CE VIBE subsetipat = 0, CE VIBE subsetipat = 2, IR-HASTE, HASTE, CE VIBE subsetipat = 4, and VIBE. The STIR sequence visualized malignant nodules down to 2 mm in size and did not display the 19 mm tuberculoma., Conclusion: The STIR sequence should be included in future studies investigating if MRI can compete with CT in the early identification (detection and classification) of malignant lung nodules.

Objective: To assess the diagnostic value of whole-body positron emission tomography (PET), computed tomography (CT), magnetic resonance imaging (MRI), and the fusion of PET and CT (PET/CT) and PET and MRI (PET/MRI) in the detection of metastatic disease of gastrointestinal carcinoid tumors., Materials and Methods: This prospective study included six patients with extensive nonresectable metastases of gastrointestinal carcinoid tumors which were consecutively examined from the base of the skull to the proximal thigh using a state-of-the-art PET/CT scanner and a 1.5 Tesla whole-body MRI scanner. PET was performed with a carbohydrated F-18-labeled somatostatin-receptor ligand ([ superset18 F]FP-Gluc-TOCA) using a Pico-3D PET scanner. CT was performed with a venous-dominant contrast-enhanced phase using a 16-slice CT scanner. MRI was performed with a coronal T2-weighted Half-Fourier Acquired Single-Shot Turbo Spin Echo (HASTE) sequence, a coronal T2-weighted Turbo-Short Tau Inversion-Recovery (STIR) sequence, a coronal T1-weighted Turbo Spin Echo (TSE) sequence and a high resolution axial T2-weighted TSE sequence. The data sets from PET and CT were fused automatically. The PET and MRI data sets were fused manually. Lesions were rated as metastases if they were not clearly identified as benign lesions according to standard radiological criteria., Results: For PET, CT, MRI, PET/CT, and PET/MRI, the lesion-by-lesion based analysis showed an overall detection rate for liver metastases (n = 391) of 49.9% (P<.001), 37.1% (P<.001), 98.2%, 50.9% (P<.001) and 100%, for lymph node metastases (n = 37) of 91.9%, 83.8%, 64.9%, 100% and 97.3% and for osseous metastases (n = 12) of 100%, 8.3% (P<.005), 66.7%, 100% and 100%., Conclusions: PET as single modality revealed the most lymph node and osseous metastases. MRI as single modality revealed the most liver metastases. The combination of molecular/metabolic with anatomical/ morphological information improves the diagnostic accuracy for the detection of metastases in comparison to the single modalities. Whole-body PET/MRI is a very promising diagnostic modality for oncological imaging due to the missing radiation exposure and the high soft tissue resolution of MRI in contrast to CT.

Positron emission tomography (PET) facilitates the evaluation of molecular aspects and metabolic alterations that are fundamental in detecting of malignancies, characterization of tumor stage and assessment of therapeutical response, and tumor recurrence. The main advantage of PET is its high sensitivity in identifying of areas of cancerous involvement at an early stage. In general, the accelerated radiotracer activity occurs before anatomical structure changes. The main difficulty with PET is the lack of an anatomical reference frame. Magnetic resonance imaging (MRI) is an excellent morphological imaging modality with a high anatomical resolution. Whole-body MRI produce large amounts of image data, resulting in the possibility of overlooking subtle pathological findings. The fusion of PET with MRI can compensate for their disadvantages and therefore offers several advantages in comparison to PET or MRI alone. The combination of these two excellent diagnostic imaging modalities into a single scanner improves the diagnostic accuracy by facilitating the accurate registration of molecular aspects and metabolic alterations of the diseases with exact correlation to anatomical findings and morphological information. Whole-body PET/MRI is a very promising diagnostic modality for oncological imaging and for use in cancer screening in the decades to come due to the considerably lower radiation exposure in contrast to PET/CT and the high soft tissue resolution of MRI.

Objective: The aim of this study was to investigate image quality and diagnostic accuracy in detecting coronary artery lesions using a 16-MDCT scanner., Materials and Methods: Thirty-seven patients (28 men, nine women) underwent unenhanced helical CT and MDCT angiography of the coronary arteries. After patients received oral beta-blocker medication, CT scans were obtained during a single breath-hold with a 16-MDCT scanner using ECG-gating (0.75-mm collimation, 2.8-mm table feed/rotation, 0.42-sec rotation time). The image quality was assessed in terms of artifacts and segment visibility by two reviewers. Stenosis severity was compared with the results of conventional invasive coronary angiography., Results: The data evaluation of the image quality was based on a total of 488 segments, of which 380 segments were considered to have diagnostic image quality. One hundred eight segments (22.1%) could not be sufficiently evaluated because of severe calcifications (35 segments) and motion artifacts (73 segments). The mean calcium score (Agatston score equivalent [ASE]) was 524.3 +/- 807.6. Twenty-eight (75.7%) of the 37 patients had an ASE of less than 1,000 (mean ASE, 90.8 +/- 152.3 [SD]), and nine (24.3%) patients had an ASE of 1,000 or greater (mean ASE, 1,761.0 +/- 637.6). For detecting lesions 50% or greater (without any exclusion criteria), the overall sensitivity, specificity, positive predictive value, and negative predictive value were 59%, 87%, 61%, and 87%, respectively. When limiting the number of patients to those with a calcium score of less than 1,000 ASE, the threshold-corrected sensitivity for lesions 50% or greater was 93%; specificity, 94%; positive predictive value, 68%; and negative predictive value, 99%., Conclusion: In patients with no or moderate coronary calcification, MDCT of coronary arteries using 16-MDCT technology allows the reliable detection of coronary artery stenoses with high diagnostic accuracy. Obtaining an initial unenhanced scan was found to be mandatory to avoid performing useless examinations in patients with severe calcifications.

The aim of this study was to perform a realistic visualization of the auditory and vestibular system using volume data sets from high-resolution computed tomography (HR-CT) and high-resolution magnetic resonance imaging (HR-MRI). - In 10 patients with conductive and/or sensorineural hearing loss, vertigo and tinnitus, HR-CT and HR-MRI of the petrous bone were performed consecutively. CT was performed with a 16-slice computed tomography scanner using a high spatial resolution. MRI was performed with a 3.0 Tesla scanner using a three-dimensional-constructive interference in steady state (3D-CISS) gradient-echo, and T2-weighted, unenhanced and gadolinium (GD)-enhanced T1-weighted turbo spin-echo sequences. The middle ear structures were interactively segmented and visualized with a color-coded shaded-surface rendering method using the HR-CT volume data sets. The inner ear structures were interactively segmented and visualized with a color-coded shaded-surface rendering method using the high-resolution 3D-CISS MRI volume data sets. Finally, both shaded-surface rendered models were superimposed semi-automatically using a commercial available software program to visualize the auditory and vestibular system. - The representation of the middle and inner ear structures with image fusion of HR-CT and HR-MRI takes advantage of both the high bony contrast of HR-CT and the high soft tissue contrast discrimination and sensitivity to fluids of HR-MRI, as well as the high spatial resolution of both modalities. In comparison to the fused axial CT/MRI, the images of 3D CT/MRI fusion facilitates a clear representation and better spatial orientation. - The middle and inner ear consists of bony structures, soft tissue structures and fluid-filled spaces. For this reason, the image fusion of volume data sets from HR-CT and HR-MRI allowed an optimized and realistic visualization of the auditory and vestibular system.

Purpose: Evaluation of sensitivity and false positive findings of two fast MRI sequences for the detection of pulmonary nodules in comparison with spiral CT by two independent observers., Materials and Methods: All 30 enrolled patients had a spiral CT or MSCT as base line study. MRI was performed with a 1.5 T MR scanner (Sonata, Siemens) using a transverse 3D gradient echo sequence (3D-GRE: TR/TE/flip = 2.9 ms/1.1 ms/5 degrees ) and a half-Fourier single-shot fast spin-echo sequence (HASTE: TR/TE/flip = 800/25/150 degrees ) acquired in three planes. A separate analysis for both sequences was carried out prospectively by two independent readers (A and B) with different experience regarding pulmonary MRI. Additionally, a retrospective reading with knowledge of the CT scans was done. Results were calculated for all lesions and for lesions larger than 4 mm., Results: The sensitivities were 73 %, 70 % and 84 % for the 3D-GRE sequence (reader A, reader B, retrospective reading) and 65 %, 68 % and 81 % for the HASTE sequence. For lesions larger than 4 mm, the sensitivities were 93 %, 89 %, 96 % for the 3D-GRE sequence and 85 %, 85 %, 96 % for the HASTE sequence. The rate of false positive findings depended on the reader's experience, but was generally lower for the 3D-GRE sequence with 2 and 16 (reader A and B) false positive nodules compared to 4 and 40 false positive findings for the HASTE sequence. The 3D-GRE sequence was more accurate for both readers (reader A: p = 0.08, reader B: p = 0.00003)., Conclusion: The sensitivity of MRI for the detection of lung nodules was only acceptable for lesions larger than 4 mm. The 3D-GRE sequence is superior to the HASTE sequence due to the reduced amount of false positive findings with comparable sensitivity.

PET/CT imaging is a highly valuable oncological imaging modality. The combination of positron emission tomography (PET) and computed tomography (CT) provides the ability to accurately register molecular and metabolic aspects of cancers with anatomical and morphological findings in human clinical routine examinations and for animals in vivo research. Small animal models of mice are widely used in biomedical research for mimicking and studying the human nature, because of their genetic resemblance and the feasibility of gene transfer and gene modification. The recent generation of high performance human PET/CT scanners combines a state of the art full-ring 3D PET scanner and a high-end 16-slice CT scanner (biograph Sensation 16, Siemens AG, Erlangen, Germany). Small animals can be examined with special scanning and reconstruction protocols. The examination of tumor-bearing small animals using a modern human PET/CT revealed excellent image quality. CT can be performed with a maximum spatial resolution of 0.6 x 0.6 x 0.6 mm and PET with a maximum spatial resolution of 6.3 x 6.3 x 6.0 mm. The examination of tumor-bearing small animals using human PET/CT allowed accurate correlation and evaluation of metabolic and anatomical information and is promising for in vivo research purposes. Although image quality is limited by spatial resolution, human PET/CT is widely available and expected to contribute significantly to research with small animal imaging. The investigation of cancer in small animals with PET/CT is probably one of the most challenging tasks in nuclear medicine for the evaluation of tumor growth and growth inhibition factors; development of new anti-tumor drugs and measuring of anti-tumor effects; and cancer treatment response of immunotherapy, chemotherapy and radiation therapy.

Purpose: To determine whether dynamic contrast material-enhanced magnetic resonance (MR) imaging with use of kinetic and morphologic parameters reveals statistically significant differences between malignant and benign solitary pulmonary nodules., Materials and Methods: Fifty-eight patients met the inclusion criteria of a solitary 5-40-mm pulmonary nodule without calcification or fat at computed tomography. Fifty-one patients were examined successfully; 46 received a histologic diagnosis, and five received a diagnosis by means of observation over 2 years. Dynamic MR images were acquired every 10 seconds for a total of 4 minutes. Diagnostic characteristics for differentiation were examined by using threshold values for maximum peak enhancement, slope of enhancement, and washout. Receiver operating characteristic curves were calculated to test the usefulness of these parameters. The diagnostic performance of a combination of curve profiles and morphologic contrast material distribution were tested by using a decision tree., Results: Frequency of malignancy was 53% (27 of 51 nodules). Malignant nodules showed stronger enhancement with a higher maximum peak and a faster slope (P <.001). Significant washout (>0.1% increase in signal intensity per second) was found only in malignant lesions (14 of 27 lesions). Sensitivity, specificity, and accuracy were 96%, 88%, and 92%, respectively, for maximum peak; 96%, 75%, and 86% for slope; and 52%, 100%, and 75% for washout. When curve profiles and morphologic enhancement patterns were combined, sensitivity increased to 100%., Conclusion: Dynamic MR imaging delineates significant kinetic and morphologic differences in vascularity and perfusion between malignant and benign solitary pulmonary nodules. Washout seems to be highly specific for malignancy., (Copyright RSNA, 2004)

Whole-body positron emission tomography (PET) scanning with the radiolabeled glucose analogue 2-[fluorine-18]-fluoro-2-deoxy-D-glucose ( superset 18 F-FDG) can identify areas of cancerous involvement and distinguish malignant from benign lesions and therefore, plays an important role in the diagnosis and management of patients with cancer. PET facilitates the evaluation of metabolic and molecular characteristics of a wide variety of cancers, but it is limited in its ability to visualize anatomical structures. Whole-body magnetic resonance imaging (MRI) is a promising diagnostic modality for the diagnosis and management of patients with cancer, because of its high anatomical resolution. Whole-body PET and whole-body MRI allow to evaluate both the primary tumor and for the presence of metastasis at the same time. The combination of these two excellent diagnostic imaging modalities into a single scanner offers several advantages in comparison to PET and MRI alone. A hybrid PET/MRI facilitates the accurate registration of metabolic and molecular aspects of the diseases with exact correlation to anatomical findings, improving the diagnostic value in identifying and characterizing of malignancies and tumor staging. Thus, hybrid PET/MRI could be a very important diagnostic imaging modality in oncological applications in the decades to come, and possibly for use in cancer screening and cardiac imaging.

Mammography is the primary imaging modality for screening of breast cancer and evaluation of breast lesions (T staging). Ultrasonography is an adjunctive tool for mammographically suspicious lesions, in patients with mastopathy and as guidance for reliable histological diagnosis with percutaneous biopsy. Dynamic enhanced magnetic resonance mammography (MRM) has a high sensitivity for the detection of breast cancer, but also a high false positive diagnosis rate. In the literature, MRM is reported to have a sensitivity of 86-96%, a specificity of 64-91%, an accuracy of 79-93%, a positive predictive value (PPV) of 77-92% and a negative predictive value (NPV) of 75-94%. In unclarified cases, metabolic imaging using fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) can be performed. In the literature, FDG PET is reported to have a sensitivity of 64-96%, a specificity of 73-100%, an accuracy of 70-97%, a PPV of 81-100% and an NPV of 52-89%. Furthermore, PET or PET/CT using FDG has an important role in the assessment of N and M staging of breast cancer, the prediction of tumour response in patients with locally advanced breast cancer receiving neoadjuvant chemotherapy, and the differentiation of scar and cancer recurrence. Other functional radionuclide-based diagnostic tools, such as scintimammography with sestamibi, peptide scintigraphy or immunoscintigraphy, have a lower accuracy than FDG PET and, therefore, are appropriate only for exceptional indications.

Positron emission tomography (PET) facilitates the evaluation of metabolic and molecular characteristics of a wide variety of cancers, but is limited in its ability to visualize anatomical structures. Computed tomography (CT) facilitates the evaluation of anatomical structures of cancers, but can not visualize their metabolic and molecular aspects. Therefore, the combination of PET and CT provides the ability to accurately register metabolic and molecular aspects of disease with anatomical findings, adding further information to the diagnosis and staging of tumors. The recent generation of high performance PET/CT scanners combines a state of the art full-ring 3D PET scanner and a high-end 16-slice CT scanner. In PET/CT scanners, a CT examination is used for attenuation correction of PET images rather than standard transmission scanning using superset 68 Ge sources. This reduces the examination time, but metallic objects and contrast agents that alter the CT image quality and quantitative measurements of standardized uptake values (SUV) may lead to artifacts in the PET images. Hybrid PET/CT imaging will be very important in oncological applications in the decades to come, and possibly for use in cancer screening and cardiac imaging.

Colorectal cancer is the second leading cause of cancer-related deaths in Europe and the United States. Most colorectal cancers develop from adenomatous polyps over a number of years. Early detection of polyps eliminates the risk of subsequent carcinomas. Computed tomographic (CT) colonography is a diagnostic technique detecting colorectal neoplasms. With the introduction of multidetector-row computed tomography (MD-CT), CT colonography (CTC) has gained influence as a new diagnostic tool in early detection of colonic pathologies by acquiring volumetric CT data sets of the abdomen. This volumetric data is analyzed using CTC workstations, which provide an interactive display of 2D and 3D images of the colon. In several studies, CTC revealed a high accuracy (sensitivity/patient: 83-100% and specificity/patient: 93-100%) in detecting pathological colonic changes. Furthermore, CTC is an excellent diagnostic technique for the evaluation of patients with incomplete conventional colonoscopy and allows the assessment of extracolonic abdominal and pelvic organs. In this article, the status of CT colonography as a method of detecting colonic polyps and colorectal carcinomas using single- and multidetector-row CT will be reviewed.

Aim of the Study: To compare high resolution MRI examinations of inner ear structures at 1.5 T and at 3 T., Method: Temporal bones were measured bilaterally in 3 healthy volunteers in a 1.5 T and in a 3 T MR-scanner using the respective one channel head coil (quadrature detection) of the manufacturer. The same steady-state gradient echo sequence (3D-CISS) was employed at a voxel size of 0.4 x 0.4 x 0.4 mm(3). The signal-to-noise ratio (SNR) was determined quantitatively., Results: An SNR of 8 could be achieved for the measurements at 3 T in 7:37 min. The SNR at 3 T was, on average, a factor of 1.34 higher than that at 1.5 T despite the fact that the excitation angle had to be drastically reduced (alpha = 42 degrees instead of alpha = 70 degrees at 1.5 T) due to the limit of the specific absorption rate (SAR)., Discussion: The MR representation of the inner ear is clearly improved at 3 T. To obtain the same SNR at 1.5 T approximately the double measuring time would be required, connected with reduced patient comfort and an increased risk for a displacement of the head during the high resolution measurement.

Purpose: The aim of the study was to assess the arterial vascular system of the lower extremities in patients with peripheral arterial occlusive disease using Multislice-CT angiography (MS-CTA) and to compare the results with the standard of reference, intraarterial digital subtraction angiography (IA-DSA)., Materials and Methods: MS-CTA and IA-DSA of the lower extremities were carried out on 23 patients with peripheral arterial occlusive disease (Fontain Stage IIb: 18, III: 3, IV: 2). MS-CTA comprised a 4 x 2.5 mm collimation, 15 mm table feed/rotation, 0.5 sec rotation time and 3 mm slice thickness (1.5 mm reconstruction increment). Delay time was determined by bolus tracking. 150 ml of contrast media were injected intravenously at a flow rate of 3 ml/sec. Maximum intensity projection (MIP) reformations were performed using a semi-automatic vessel tracking program. MS-CTA (axial and MIP-reformatted images) and IA-DSA were reviewed by two radiologists. The grade of vascular stenosis as well as occlusion were rated on a scale of 0 to 3 (0=0-50% stenosis, 1 = 51-75% stenosis, 2 = 76-99% stenosis, 3 = occlusion)., Results: For MS-CTA, the mean delay time was 30.2 s (23-40 s), mean scan time was 37.4 (33-42 s). Data analysis was based upon a total of 1136 vascular segments for both methods (568 each). A comparison of all the evaluated segments in both techniques revealed a MS-CTA / IA-DSA 86.3% match. Out of 442 segments proximal the trifurcation, 386 were correctly assessed in MS-CTA (87.3%) and distal the trifurcation, 101 out of 126 segments were rated correctly (80.2%). In MS-CTA, an overall confidence interval of 95% can be achieved in 83.2% to 89.0% for correctly rated stenosis grading., Conclusions: In patients with peripheral arterial occlusive disease, MS-CTA of the lower extremity is a promising minimal-invasive method for detection of relevant arterial stenoses. However, the technique was limited to routine diagnostic purposes due to severe calcifications and time consuming reconstruction procedures.

Bourneville-Pringle disease (synonym: tuberous sclerosis, epiploia) is a neuroectodermal disorder. A characteristic clinical triad of adenoma sebaceum, mental retardartion, and seizures leads to early childhood diagnosis. Many patients show morphological changes of the visceral organs, vascular, and skeletal system. We review the computed tomographic findings of Bourneville-Pringle disease as relates to an oligosymptomatic 36-year-old woman with late onset of clinical symptoms.

The aim of this study was to compare different representation models of surface-rendered virtual bronchoscopy. 10 consecutive patients with inoperable primary lung tumors underwent thin-section spiral computed tomography. The structures of interest, the tracheobronchial system and anatomical and pathological thoracic structures were segmented using an interactive threshold interval volume-growing segmentation algorithm and visualized with the aid of a color-coded surface rendering method. For virtual bronchoscopy, the tracheobronchial system was visualized using a triangle-surface rendering model, a shaded-surface rendering model and a transparent shaded-surface rendering model. The triangle-surface rendering model allowed optimum detailed spatial representation of the dimensions of extraluminal anatomical and pathological mediastinal structures. As the lumen of the tracheobronchial system was less well defined, the rendering model was of limited use for depiction of the airway surface. The shaded-surface rendering model facilitated an optimum assessment of the airway surface, but the mediastinal structures could not be depicted. The transparent shaded-surface rendering model provides simultaneous adequate to optimum visualization and assessment of the intraluminal airway surface and the extraluminal mediastinal structures as well as a quantitative assessment of the spatial relationship between these structures. Fast data acquisition with a multi-slice detector spiral computed tomography scanner and the use of virtual bronchoscopy with the transparent shaded-surface rendering model obviate the need for time consuming detailed analysis and presentation of axial source images by providing improved the diagnostic imaging of endotracheal and endobronchial diseases and offering a useful alternative to fiberoptic bronchoscopy.

In the United States and Europe, colorectal cancer is the second leading cause of cancer-related deaths. It is well known that colorectal carcinomas may originate from preexisting adenomas. For the visualization of colorectal cancer and other pathologic changes such as polyps, two 3D methods (volume-rendering (VR) and surface-rendering (SR)) in MR colonography were compared in our study. MR colonography was carried out in 17 patients on a 1.5 T MR scanner using a 10 mmolar gadolinium water solution enema. Coronal as well as rotated VR and SR views were compared in order to examine the technical quality (TQ) of the visualization model and grade of confidence (GC) in the pathological findings. Colonoscopic findings revealed 8 colorectal carcinoma, 10 patients with polyps, 4 diverticular disease, and 2 with redundant bowel loops. Based on a total of 248 colonic segments for both visualization methods, volume rendering were significantly superior to surface rendering for both, TQ (p<0.0001) and GC (p<0.0001). Volume rendering and surface rendering were not dependent on individual colon segments (p=0.13 for TQ and p=0.18 for GC) or on image rotation (p=0.06 for TQ and p=0.062 for GC). It is also independent of the type of pathology (p=0.31 for TQ and p=0.42 for GC) and the reviewers (p=0.62 for TQ and p=0.88 for GC). This indicates, that for the purpose of interpreting the technical quality and pathological findings, volume rendering is superior to surface rendering in MR colonography. Volume rendering could be used as an 3D visualization tool, enabling MR colonography examinations to be completed sooner in cases where colon distension is sufficient, and it would also provide an overview of potential mass lesions.

Objective: To evaluate and compare two fast gradient-echo sequences (GRE) concerning the visualization of solitary pulmonary nodules with an open low-field MRI system in comparison to computed tomography., Materials and Methods: Fourteen patients with solitary pulmonary nodules detected by spiral CT ranging in size from 6 mm to 42 mm (mean 20 mm) underwent MRI on an open 0.2 T scanner using a spoiled 2D GRE (2D FLASH; TR/ TE/Flip = 100 ms/7.5 ms/30 degrees ) and a totally refocused 2D steady-state GRE (True-FISP; TR/TE/FA = 7.3 ms/3.5 ms/80 degrees ). The image quality concerning artifacts (by flow, breathing and susceptibility) and the morphologic characteristics of the nodules were scored and compared with CT by two independent radiologists. The diameters of the nodules measured by MRI were compared with CT measurements. The sequences were also evaluated with regard to the signal-to-noise ratio (SNR) of the lesion., Results: All lesions were detected with the 2D FLASH sequence. True-FISP failed to find a granuloma with a size of 6 mm. The 2D FLASH was rated significantly superior to true FISP concerning image quality artifacts by susceptibility as well as concerning to CT the presentation of nodule characteristics. In MR images, the size of lesions was significantly smaller than in CT images for both sequences: for 2D FLASH the mean difference was 0.9 mm and for true FISP 2.6 mm. The SNR of the nodules was significantly higher for the 2D FLASH than for the true FISP., Conclusion: In low field MRI, the 2D FLASH sequence is superior to the 2D true FISP sequence in imaging of pulmonary nodules. With the 2D FLASH sequence nodules of 6 mm or larger in size can be visualized.

Purpose: The aim of this study was to demonstrate the possibilities of a hybrid rendering method, the combination of a color-coded surface and volume rendering method, with the feasibility of performing surface-based virtual endoscopy with different representation models in the operative and interventional therapy control of the chest., Material and Method: In 6 consecutive patients with partial lung resection (n = 2) and lung transplantation (n = 4) a thin-section spiral computed tomography of the chest was performed. The tracheobronchial system and the introduced metallic stents were visualized using a color-coded surface rendering method. The remaining thoracic structures were visualized using a volume rendering method. For virtual bronchoscopy, the tracheobronchial system was visualized using a triangle surface model, a shaded-surface model and a transparent shaded-surface model., Results: The hybrid 3D visualization uses the advantages of both the color-coded surface and volume rendering methods and facilitates a clear representation of the tracheobronchial system and the complex topographical relationship of morphological and pathological changes without loss of diagnostic information. Performing virtual bronchoscopy with the transparent shaded-surface model facilitates a reasonable to optimal, simultaneous visualization and assessment of the surface structure of the tracheobronchial system and the surrounding mediastinal structures and lesions., Conclusions: Hybrid rendering relieve the morphological assessment of anatomical and pathological changes without the need for time-consuming detailed analysis and presentation of source images. Performing virtual bronchoscopy with a transparent shaded-surface model offers a promising alternative to flexible fiberoptic bronchoscopy.

Objective: A hybrid rendering method which combines a color-coded surface rendering method and a volume rendering method is described, which enables virtual endoscopic examinations using different representation models., Materials and Methods: 14 patients with malignancies of the lung and mediastinum (n=11) and lung transplantation (n=3) underwent thin-section spiral computed tomography. The tracheobronchial system and anatomical and pathological features of the chest were segmented using an interactive threshold interval volume-growing segmentation algorithm and visualized with a color-coded surface rendering method. The structures of interest were then superimposed on a volume rendering of the other thoracic structures. For the virtual endoscopy of the tracheobronchial system, a shaded-surface model without color coding, a transparent color-coded shaded-surface model and a triangle-surface model were tested and compared., Results: The hybrid rendering technique exploit the advantages of both rendering methods, provides an excellent overview of the tracheobronchial system and allows a clear depiction of the complex spatial relationships of anatomical and pathological features. Virtual bronchoscopy with a transparent color-coded shaded-surface model allows both a simultaneous visualization of an airway, an airway lesion and mediastinal structures and a quantitative assessment of the spatial relationship between these structures, thus improving confidence in the diagnosis of endotracheal and endobronchial diseases., Conclusions: Hybrid rendering and virtual endoscopy obviate the need for time consuming detailed analysis and presentation of axial source images. Virtual bronchoscopy with a transparent color-coded shaded-surface model offers a practical alternative to fiberoptic bronchoscopy and is particularly promising for patients in whom fiberoptic bronchoscopy is not feasible, contraindicated or refused. Furthermore, it can be used as a complementary procedure to fiberoptic bronchoscopy in evaluating airway stenosis and guiding bronchoscopic biopsy, surgical intervention and palliative therapy and is likely to be increasingly accepted as a screening method for people with suspected endobronchial malignancy and as control examination in the aftercare of patients with malignant diseases.

Surgical correction of anterior thoracic wall deformities is an extensive procedure with considerable operative trauma. The procedure can be markedly supported by means of preoperative 3D spiral-computed tomography for the purpose of improved preoperative planning in order to avoid unnecessary tissue mobilization. It is also helpful to enhance the patients' comprehension regarding the operative requirements.

Objective: To determine the dosage of gadobenate dimeglumine (Gd-BOPTA) necessary for MRI of rheumatoid arthritis of the wrist., Design and Patients: Seven wrists inflamed with rheumatoid arthritis were imaged using a dedicated 0.2-T MR unit. Four cumulative dosages of 0.0125, 0.025, 0.05 and 0.1 mmol/kg body weight (BW) Gd-BOPTA were tested. Three-dimensional T1-weighted gradient-recalled echo sequences (GRE; TR: 100 ms, TE: 18 ms, flip angle 90 degrees , 4:55 min) were acquired prior to an intravenous injection and after each additional dosage of Gd-BOPTA. Relative enhancement, signal-difference-to-noise ratios (SDNRs) and the size of the inflamed tissue were quantified. Three radiologists independently evaluated the image quality, the size and the contrast of the enhancing tissue., Results: The readers agreed on a dose of 0.05 mmol/kg BW as satisfactory for the evaluation of the size of the inflammatory tissue and for determination of bone involvement (kappa = 0.9, P < 0.001). Highly inflammatory pannus was depicted with adequate image contrast using 0.025 mmol/kg BW Gd-BOPTA. According to the SDNR and relative enhancement findings, a dose of 0.05 mmol/kg BW suffices for both off-center and centered regions of tissue inflammation (t-test, P < 0.05)., Conclusion: Gadolinium-BOPTA is an alternative contrast agent for MRI of rheumatoid disease. This study shows that a dose of 0.05 mmol/kg BW suffices at low field strength.

Thin-section spiral computed tomography was used to acquire the volume data sets of the thorax. The tracheobronchial system and pathological changes of the chest were visualized using a color-coded surface rendering method. The structures of interest were then superimposed on a volume rendering of the other thoracic structures, thus producing a hybrid rendering. The hybrid rendering technique exploit the advantages of both rendering methods and enable virtual bronchoscopic examinations using different representation models. Virtual bronchoscopic examinations with a transparent color-coded shaded-surface model enables the simultaneous visualization of both the airways and the adjacent structures behind of the tracheobronchial wall and therefore, offers a practical alternative to fiberoptic bronchoscopy. Hybrid rendering and virtual endoscopy obviate the need for time consuming detailed analysis and presentation of axial source images.

Objective: The aim of this prospective study was to summarize all of the qualitative and quantitative imaging criteria for the differentiation of solitary pulmonary lesions (SPLs) as malignant (MSPLs) or benign (BSPLs) described in the literature and to critically analyze the different characteristics in order to evaluate their clinical importance and usefulness as criteria for a discrimination during the primary diagnostic assessment of SPLs using chest radiography, spiral computed tomography (SCT) and high-resolution computed tomography (HRCT)., Materials and Methods: SPLs were examined, evaluated and then completely removed by surgery in 104 consecutive patients (MSPLs n=81, BSPLs n=23). No SPL was excluded by size. Chest radiography was performed with frontal and lateral views, SCT was carried out with a slice thickness of 8 mm and HRCT with a slice thickness of 1 mm and a 12-cm field of view., Results: All the characteristics which enabled a reliable differentiation of MSPLs from BSPLs were characteristics which were observed significantly more frequently in MSPLs than BSPLs. Useful characteristics for the differentiation of MSPLs from BSPLs (1) using chest radiography were the indistinct edge (P<0.0001) and a ground-glass opacity of the lung parenchyma adjacent to the SPL (P<0. 05); (2) using SCT the presence of spicules (P<0.0005), the vessel sign (P<0.0005), necrotic areas (P<0.001), spicules extending to the visceral pleura (P<0.005), circumscribed pleural thickening (P<0. 005), inhomogeneity (P<0.01), a ground-glass opacity of the lung parenchyma adjacent to the SPL (P<0.01), the lesion density (P<0.05), pleural retraction (P<0.05) and the bronchus sign (P<0.05); and (3) using HRCT the presence of spicules (P<0.00005), spicules extending to the visceral pleura (P<0.0005), the vessel sign (P<0.0005), pleural retraction (P<0.001), circumscribed pleural thickening (P<0. 001), the bronchus sign (P<0.005), a ground-glass opacity of the lung parenchyma adjacent to the SPL (P<0.01), the lesion density (P<0.05) and the length of spicules (P<0.05). Using any one of the characteristics with a significance level of P<0.01, the identification of MSPLs (1) using chest radiography showed a sensitivity of 64.2% and a specificity of 82.6% (accuracy of 68.3%); (2) using SCT a sensitivity of 88.9% and a specificity of 60.9% (accuracy of 82.7%); and (3) using HRCT a sensitivity of 91.4% and a specificity of 56.5% (accuracy of 83.7%)., Conclusions: Using chest radiography, SCT and HRCT, a precise morphological assessment of the periphery of the pulmonary lesion and the adjacent visceral pleura is necessary to distinguish MSPLs from BSPLs. In this respect SCT and HRCT are useful in differentiation of MSPLs from BSPLs. However, metastases strongly resembled benign lesions in terms of size and edge type and chronic inflammatory pseudotumors as a group mimic MSPLs.

Purpose: The aim of this study was to demonstrate on a complex anatomical structure the possibilities and the advantages of a superimposition of a color-coded surface and volume rendering (hybrid rendering) method with the possibility of the performance of a virtual endoscopy., Material and Method: In 6 patients with cochlear implants a high-resolution spiral computed tomography of the petrous bone was performed. The cochlear implants, the middle and inner ear structures were visualized using a color-coded surface rendering method, either shaded or as a grid. The petrous bone was visualized using a transparent volume rendering method., Results: The hybrid 3D visualization uses the advantages of both the color-coded 3D surface and volume rendering method. In comparison to the axial source images, the hybrid 3D visualization thus facilitates a clearer representation and better assessment of the complex topographical relationship without loss of diagnostic information. The virtual endoscopy facilitates an intraluminal visualization and inspection of all color-coded 3D surface- and volume rendered structures., Conclusions: The hybrid rendering and virtual endoscopy make the morphological assessment of cochlear implants easier by the simultaneous visualization of the surrounding structures and thereby support the diagnostic imaging methods. This image processing method can be used pre-operatively for the individual planning, simulation, training and further development of surgical procedures and interventions and post-operatively for the control of the position and further developments of implants.

Purpose: The aim of this prospective study was to assess the diagnostic value of the tumour markers carcinoembryonic antigen (CEA), cytokeratin 19 fragment marker (CYFRA 21-1) and neuron-specific enolase (NSE) in the differentiation of malignant (MSPLs) from benign solitary pulmonary lesions (BSPLs)., Methods: Solitary pulmonary lesions (SPLs) were diagnosed using plain radiography and spiral computed tomography (SCT) and then completely removed by surgery in 104 consecutive patients (MSPLs; n = 81, BSPLs; n = 23). The serum concentrations of the tumour markers were determined 1-3 days prior to surgery by ELISA for CEA and CYFRA 21-1 and by IRMA for NSE using commercially available assay kits. The cut-off values were set at 3 ng/ml (for non-smokers) and 5 ng/ml (for smokers) for CEA, at 3.3 ng/ml for CYFRA 21-1 and at 12.5 ng/ml for NSE., Results: MSPLs were identified with a sensitivity between 13.6 and 45.7%, a specificity between 87.0 and 100% and an accuracy between 32.7 and 54.8%. Using the tumour markers alone, the highest sensitivity (27.2%) and accuracy (40.4%) was found with CEA, the highest specificity (100%) with CYFRA 21-1 and with NSE. Primary lung cancers (n = 39) were identified with a sensitivity between 17.9 and 61.5%, a specificity between 87.0 and 100% and an accuracy between 48.4 and 71.0%. Using the tumour markers alone, the highest sensitivity (35.9%) and accuracy (59.7%) was found with CYFRA 21-1, the highest specificity (100%) with CYFRA 21-1 and with NSE. The combination of all three tumour markers resulted in a greater sensitivity and greater diagnostic accuracy but a loss in specificity compared with CYFRA 21-1 and NSE., Conclusion: The use of the tumour markers alone or in combination showed a low sensitivity and low accuracy for the diagnostic differentiation of MSPLs from BSPLs and primary lung cancers from BSPLs. However, both CYFRA 21-1 and NSE exhibited a specificity of 100% and may be useful complements to standard clinical imaging methods.

Background: The aim of this prospective study was to assess the diagnostic value of the imaging modalities (chest radiography, spiral computed tomography (SCT) and high-resolution computed tomography (HRCT)) and the tumour markers (carcinoembryonic antigen (CEA), cytokeratin marker (CYFRA 21-1) and neuron-specific enolase (NSE)) in the differentiation of malignant (MSPLs) from benign solitary pulmonary lesions (BSPLs)., Patients and Methods: Solitary pulmonary lesions (SPLs) were examined, evaluated and then completely removed by surgery in 104 consecutive patients (MSPLs n = 81, BSPLs n = 23). Chest radiography was performed with frontal and lateral views, SCT was carried out with a slice thickness of 8 mm and HRCT with a slice thickness of 1 mm and a 12-cm field of view. For the tumour marker analysis, serum concentrations were determined 1-3 days prior to surgery by ELISA for CEA and CYFRA 21-1 and by IRMA for NSE using commercially available assay kits. The cut-off values were set at 3 ng/ml (for non-smokers) and 5 ng/ml (for smokers) for CEA, at 3.3 ng/ml for CYFRA 21-1 and at 12.5 ng/ml for NSE., Results: Using any one of the characteristics with a significance level of P <0.01, the identification of MSPLs using chest radiography showed a sensitivity of 64.2% and a specificity of 82.6%, using SCT a sensitivity of 88.9% and a specificity of 60.9% and using HRCT a sensitivity of 91.4% and a specificity of 56.5%. For the identification of MSPLs using CEA a sensitivity of 27.2% and a specificity of 87.0% (accuracy of 40.4%) was observed. Using CYFRA 21-1 a sensitivity of 19.8% and a specificity of 100.0% (accuracy of 37.5%) and using NSE a sensitivity of 13.6% and a specificity of 100. 0% (accuracy of 32.7%) was found., Conclusions: Using chest radiography, SCT and HRCT, a precise morphological assessment of the periphery of the pulmonary lesion and the adjacent visceral pleura is necessary to distinguish MSPLs from BSPLs. Tumour markers used alone or in combination with the imaging methods brought no additional benefits, in terms of sensitivity and accuracy, over the diagnostic imaging methods alone. However, the tumour markers exhibited a far superior specificity (100% for CYFRA 21-1 and NSE) compared with the imaging methods.