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Until now, serum tumor markers, physical examination, and conventional imaging modalities, such as CT or MRI, have been used in assessment of recurrence of cervical cancer after treatment. However, CT and MRI provide only anatomical data, which makes analysis of post-treatment change difficult. This study aims to explore the effectiveness of PET/CT, a new scanning device that combines PET and CT, in evaluation of cervical cancer lesions in patients with suspected recurrence.We studied 51 patients suspected of recurrence among those who underwent F-18 FDG PET/CT for cervical cancer follow-up at Gachon University Gil Hospital between June 2006 and August 2009. Patients were considered to be at risk for recurrence if they reported symptoms that were clinically suggestive of recurrence, or if physical examination showed abnormalities, serum tumor marker levels rose, or follow-up images revealed changes, such as new lesions or swelling of previous sites. Sensitivity, accuracy, specificity, and positive and negative predictive values of PET/CT were measured.A total of 37 patients were confirmed with recurrence or metastasis, 13 of whom were diagnosed histologically. Measured across all patients, PET/CT scored 97.3% on sensitivity, 71.4% on specificity, a positive predictive value of 90%, a negative predictive value of 90.9%, and an accuracy of 90.2%. PET/CT yielded only one false negative diagnosis and four false positives.As F-18 FDG PET/CT has high sensitivity and negative predictive value in diagnosis of recurrent cervical cancers, it is expected that it will be useful for clinical determination of recurrence and prevention of unnecessary additional treatments. The hope is that a future study on a larger scale will contribute further to determination of the efficacy of PET/CT.

It is well known that [(18)F]FDG PET has a low sensitivity in the detection of hepatocellular carcinoma (HCC). We prospectively compared [(11)C]acetate PET/CT results with those of [(18)F]FDG PET/CT in patients with HCCs. Thirteen patients (M:F=11:2, mean age of 51+/-12) with suspicious or confirmed HCCs underwent [(11)C]acetate PET/CT with or without [(18)F]FDG PET/CT (both [(11)C]acetate and [(18)F]FDG PET/CT were performed in 10 patients). HCC was confirmed by histopathology or clinical criteria in 12 patients and one benign liver lesion. Both PET/CT images were interpreted by two experienced nuclear physicians, supported by standardized uptake value (SUV). A total of 12 patients were confirmed to have initial or recurrent HCCs. [(18)F]FDG PET/CT showed markedly increased uptake in only two patients, moderately increased uptake in another two and negative in six. [(11)C]acetate PET/CT demonstrated markedly increased uptake in seven patients, moderately increased uptake in three and negative in only two. One HCC metastatic lesion was detected only by [(11)C]acetate PET/CT. For detection of HCC, [(11)C]acetate PET/CT showed a high sensitivity of 83%, whereas [(18)F]FDG PET/CT only of 40%. The study results demonstrated that [(18)F]FDG PET/CT has a limitation in detection of HCC and [(11)C]acetate PET/CT has a complementary role to [(18)F]FDG PET/CT. When primary HCC showed low [(18)F]FDG uptake, it was [(11)C]acetate-avid, and vice versa. It may be useful to combine both [(18)F]FDG and [(11)C]acetate PET/CT for detection of HCCs.

The clinical diagnosis of pelvic inflammatory disease (PID) is inexact. There are multiple potential symptoms and signs ascribable to PID as predicted by areas of inflammatory involvement. No symptoms or signs are pathognomonic for PID. The authors describe single photon emission computed tomography (SPECT) images of technetium-99m ((99m)Tc) ciprofloxacin imaging of patients with PID that showed foci of significantly increased uptake in the regions corresponding to the areas of clinical symptoms. We report two such cases of PID. We undertook physical exams, complete blood count, erythrocyte sedimentation rate, C-reactive protein, Gram stains, wet smears, cultures, Mycoplasma genetic studies, Chlamydia cultures, and SPECT before treatment. During treatment we took laparoscopies, hysteroscopies, biopsies, and cultures. After the treatment, we repeated the same exams. (99m)Tc ciprofloxacin imaging is considered valuable in persons with symptoms of PID in whom diagnosis is difficult.

To understand the role of inducible nitric oxide synthase (iNOS) in thyroid tumorigenesis, immunohistochemical staining of 36 surgical specimens of thyroid neoplasm that consisted of seven follicular adenomas, 12 papillary carcinomas, seven follicular carcinomas, five medullary carcinomas, and five anaplastic carcinomas were analyzed. In addition, 20 specimens of normal thyroid were used as control samples. Reverse transcription-polymerase chain reaction and western blot analysis were also performed using a normal thyroid and a representative papillary carcinoma case. The intensity and proportion of the immunostained tumor cells were graded semiquantitatively. The grades of the intensity and the proportion were then summed to provide an immunohistochemical score. There was a variation in the staining intensity and proportion. The iNOS expression was low in normal follicular epithelia. Inducible nitric oxide synthase is present in the majority of thyroid tumor cells, including follicular adenomas, papillary carcinomas, follicular carcinomas, medullary carcinomas, and anaplastic carcinomas. Relatively low expression was shown in follicular neoplasms. Only a few inflammatory cells in the stroma were immunoreactive. These results suggest that iNOS may have a role in tumorigenesis, and iNOS in human thyroid carcinoma is mostly derived from tumor cells not from macrophages.

The authors report myocardial perfusion imaging of a patient showing reverse redistribution (RR) and a 64-slice multidetector-row computed tomography (MDCT) with corresponding findings. The patient had subendocardial myocardial infarction (MI) with positive electrocardiogram (EKG) findings and elevated levels of cardiac isoenzymes. Experiencing this case emphasizes the importance of complementary correlation of a new diagnostic modality that helps us to understand the nature of RR.

The aim of this study is to better understand the pattern and nature of reverse redistribution (RR) in myocardial perfusion imaging. In 20 consecutive acute myocardial infarction (MI) patients, frequency of RR was correlated with that of subendocardial MI that was detected by myocardial contrast echocardiography (MCE). RR was judged to be present when there was more than one grade of worsening in perfusion on 24 hr delayed images compared with the initial rest images. MCE evaluated no opacification in the subendocardial myocardium to suggest subendocardial MI. Kendall's nonparametric correlation coefficiency was calculated. Concordant cases were 15 of 20 (75%) and correlation was statistically significant (p = 0.0285). Our results suggested that RR was correlated with MCE-detected nontransmural MI.

A 59-year-old female came to the clinic to evaluate an operation risk of knee joint arthritis. She has history of hypertension for 6 years. She complained of dyspnea on exercise before. Radionuclide imaging demonstrated large moderate perfusion defect in anterior, anteroseptal, and anterolateral regions with significant reversibility. ECG gated 64-multidetector computed tomography demonstrated the middle third of the left anterior descending coronary artery myocardial bridging. The length of tunneled artery was 23 mm and the depth of tunneled artery was 3 mm. Coronary angiogram confirmed the middle third of the left anterior descending coronary artery myocardial bridging. Multidetector computed tomography is a reliable and noninvasive tool for diagnosing coronary myocardial bridging.

Serial sections of the conus medullaris and the filum terminale of 23 randomly selected human spinal cords were studied by light and electron microscopy, and following immunoperoxidase staining for glial fibrillary acidic protein (GFAP), vimentin, neuron-specific enolase (NSE), amyloid beta protein, and S-100 protein. The intradural portion of the filum contains bundles of GFAP-positive glial fibers, scattered silver- and NSE-positive neurons, segments of peripheral nerve, blood vessels, fibrous connective tissue, and fat. Glial cell clusters varying from five to 100 cell layers thick at times constitute the bulk of the filum. The periependymal glial cells possess moderate amounts of eosinophilic cytoplasm and relatively uniform round to ovoid nuclei containing evenly distributed chromatin. They are distributed diffusely with no specific pattern of organization, although some of them showed a tendency to form acinar structures. A minority of the glial cells showed GFAP immunoreactivity, and some were immunoreactive for vimentin. Electron microscopy demonstrated the presence of periependymal cells showing cilia, microvilli, and the formation of intercellular junctional complexes, as well as cells containing bundles of glial filaments within the cytoplasm. Degenerated NSE-positive neurons and degenerated neurites resembling neuritic plaques were also demonstrated. However, immunoperoxidase staining for amyloid beta protein was negative in these structures. Thus, the filum terminale is endowed with an abundance of glial cells and neurons and is not simply a fibrovascular tag. Periependymal glial cells in the filum terminale should not be mistaken for neoplasm. The presence of neuropil with profuse astroglial and neuronal components within the filum terminale suggests a possible functional role for these structures.

Tc-99m ciprofloxacin is available for imaging infection. However, there has been no study on employing single photon emission computed tomography (SPECT) with using Tc-99m ciprofloxacin to image active pulmonary tuberculosis. Therefore, we conducted this study to assess the efficacy of Tc-99m ciprofloxacin SPECT for imaging active pulmonary tuberculosis.Twenty-one participants were enrolled in this prospective study. They were divided into two groups according to the clinical and radiological assessment. Group one (Gr. 1) consisted of five normal volunteers and six patients with inactive pulmonary tuberculosis. Group two (Gr. 2) consisted of ten patients with active pulmonary tuberculosis. SPECT was performed 3 h after injecting 555 MBq (15 mCi) of Tc-99m ciprofloxacin. The findings of Tc-99m ciprofloxacin SPECT were interpreted by a nuclear medicine specialist and then the results were analyzed according to the patients' clinical and radiological classifications.The results of Tc-99m ciprofloxacin SPECT were as follows: eight true-positive cases, ten true-negative cases, one false-positive case and two false-negative cases. The sensitivity and specificity was 80.0% and 90.9%, respectively. The positive predictive value was 88.9% and the negative predictive value was 83.3%.Tc-99m ciprofloxacin SPECT is feasible for imaging active pulmonary tuberculosis. It is a useful nuclear-imaging method for discriminating between the active and inactive tuberculosis states in patients with a past medical history of pulmonary tuberculosis.

Both breast ultrasonography (US) and scintimammography (SMM) shows limited diagnostic accuracy in the differential diagnosis of breast cancer. We investigated whether the diagnostic performance of computer-aided diagnosis (CAD) of US was improved by adding SMM results. We retrospectively reviewed 40 breast US images and corresponding SMM images from 40 patients who presented with breast masses (21 malignant and 19 benign tumors). The morphologic features of the breast lesions on US were extracted and quantitated using the automated CAD software program (So no Eye, CAD Impact, Inc., Seoul, Korea), which calculated the probability of malignancy based on the stored database. The quantitative data of SMM were obtained as the uptake ratio of lesion to contralateral normal breast on SMM SPECT. The diagnostic accuracy of CAD of US and SMM was determined using ROC curve analysis, respectively. The best discriminating function combining the CAD results of US and SMM uptake value was created using linear discriminant analysis and the diagnostic performance was compared to that using only one diagnostic modality. Both US and SMM showed a relatively good diagnostic accuracy (area under curve=0.831 and 0.846, respectively). Combining CAD results of US and SMM resulted in improved diagnostic accuracy (area under curve =0.860), but it was not statistically significant. The diagnostic performance of CAD of breast US in the differential diagnosis of the breast mass was not significantly improved by adding SMM. However, SMM SPECT may be complementary to CAD of US in differential diagnosis of breast cancer.

To investigate the value of Tc-99m ciprofloxacin imaging in the differential diagnosis of chronic bacterial prostatitis.The study included 4 normal subjects as the negative controls, 2 patients with acute prostatitis or cystourethritis as the positive controls and 59 patients diagnosed as chronic bacterial prostatitis or chronic pelvic pain syndrome by traditional laboratory tests. In every subject, the single photon emission computerized tomography images were obtained 3 h after intravenous injection of Tc-99m Ciprofloxacin. The results of the imaging were compared with those of laboratory tests.On the images, negative uptake was observed in all normal subjects, while strong hot uptake, in the whole prostate of acute prostatitis patients and in the whole urethra of acute cystourethritis patients. In 13 (68%) of 19 patients categorized as chronic bacterial prostatitis by standard laboratory tests, hot uptake with less intensity than that of acute prostatitis was observed in the prostate area around the prostatic urethra. Negative uptake in the prostate was observed in 6 of 19 patients (32%) categorized as chronic bacterial prostatitis. Interestingly, hot uptake in the prostate was exhibited in 28 (70%) of the 40 patients categorized as chronic pelvic pain syndrome.Tc-99m ciprofloxacin imaging is helpful in the differential diagnosis of prostatitis syndrome.

We report the history of a 44-year-old woman, who had four episodes of thyrotoxicosis in 4 years. The clinical findings and laboratory results were all indicative of recurrent silent thyroiditis. Because silent thyroiditis is self-limiting, treatment is usually symptomatic. In this patient radioiodine therapy was eventually prescribed to obviate further recurrences. We were unable to find reports of this number of recurrences.

The authors report brain images of 18F-FDG-PET in a case of schizophrenia. The images showed strikingly increased bilateral uptake in the locus ceruleus. The locus ceruleus is called the blue spot and known to be a center of the norepinephrinergic system.

A 35-year-old woman underwent bone imaging to evaluate progressive pain over the medial aspect of her right foot. She was a homemaker and had not sustained any recent trauma to the region. The images showed a focus of increased uptake in the right medial midfoot. Simultaneously obtained radiographs showed the accessory ossicles adjacent to the navicular bones bilaterally. This indicated that she had right inflammatory and left quiescent accessory navicular ossicles at the same time. Bone imaging functioned well as a diagnostic method in differentiating them.

A 7-year-old boy presented with an undifferentiated embryonal sarcoma of the liver (UESL), which is a rare pediatric neoplasm that originates from the mesenchyme. F-18 FDG PET/CT associated with a separately acquired contrast-enhanced CT was performed to evaluate the status of the tumor during postoperative chemotherapy, which followed the initial neoadjuvant chemotherapy (vincristine, cisplatin, adriamycin, cyclophosphamide, and actinomycin-D) and radical tumor resection. Evaluation of the F-18 FDG PET/CT demonstrated the presence of a highly metabolic lesion in the liver (primary site) and the presence of distinct foci of FDG uptake as a result of tumor metastases, with 3 foci being observed in both lungs and one being observed in the right adrenal gland. This case gives a suggestion that F-18 FDG PET/CT can be valuable method for evaluation of the status of UESL.

The author reports CT of the abdomen and quantitative analysis of renal scintigraphy that was spuriously assessed due to unwanted extrarenai uptake. The patient had a retroperitoneal abscess that was related to fistula from the right kidney. Renal scintigraphy was performed to assess split renal function as a preoperative evaluation for nephrectomy. The computer generated differential function did not appear to coincide with the visual analysis. This discrepancy was believed due to extrarenal uptake from the area of the retroperitoneal abscess.

A 20-year-old woman who was a tennis player underwent three-phase bone imaging to rule out fracture in the right foot. She complained of pain in the region of the first digit, but x-rays did not show any changes. Bone imaging showed increased bilateral uptake in the sesamoids of the great toes on blood pool and delayed images. It was thought that the findings were suggestive of sesamoiditis or stress to the sesamoids.

The authors describe Tc-99m ciprofloxacin SPECT imaging and corresponding magnetic resonance images (MRIs) of a patient with a prostatitis syndrome, in whom seminal vesiculitis was finally diagnosed. Tc-99m ciprofloxacin imaging can detect areas of active bacterial infection. It is difficult to accurately classify patients with a prostatitis syndrome, because valid diagnostic tests are rare and the treatment is often empirical. Visualization of acute seminal vesiculitis in patients with a prostatitis syndrome, made possible with Tc-99m ciprofloxacin imaging, should improve diagnostic accuracy.

There is considerable literature on the effect of pregnancy on established thyroid cancer. In contrast, there are only isolated case reports of management of thyroid cancer diagnosed de novo during pregnancy. We describe four such patients. We recommend fine-needle aspiration biopsy (FNA) of solitary thyroid nodules found early in pregnancy. When the cytopathology is diagnostic of thyroid cancer, thyroidectomy under local or general anesthesia is advised. The patient should be given levothyroxine in a dose sufficient to keep serum thyroid-stimulating hormone (TSH) low. Serum thyroglobulin is a valuable noninvasive method of evaluating completeness of this therapy. The work-up of a nodule found late in pregnancy is best deferred until after delivery.

A 38-year-old man with a history of cocaine abuse had an evaluation for chest pain. Myocardial infarction was ruled out, and he underwent an exercise thallium myocardial perfusion SPECT study that suggested myocardial ischemia in the left anterior descending (LAD) artery territory. Cardiac catheterization showed a minimal coronary disease but a coronary artery fistula communicating the LAD artery with the main pulmonary artery. Toxic screen for cocaine was negative.

Bone imaging was performed for metastatic investigation on a 68-year-old man with prostate and rectal cancer. The image showed no evidence of bony metastasis. Interestingly, however, there was linear increased uptake apparently following the course of the left ureter and ending on the right side of the urinary bladder. According to the author's search in the literature, no report was found that addressed a crossed ureter with two kidneys. The patient had a resection of a rectal tumor 4 years earlier and abdominoperitoneal resection of recurrent tumor 2 years earlier. On physical examination, the patient's surgical scar on the abdomen ran the same course as the increased uptake.

A 39-year-old man developed persistent bleeding into the ventricular system after having undergone needle biopsy of what was presumed to be a left frontal neoplasm. He subsequently developed obstructive hydrocephalus that required shunting and died in a semivegetative state some 5/12; months later. At autopsy, although no neoplasm was identified at the operative site, there was massive collagen deposition within the ventricular system that extended into the spinal subarachnoid compartment. Although we have been able to find only three cases in the literature with detailed descriptions of similar pathological findings, we believe that our observations emphasize the potential for a complication of intraventricular and subarachnoid hemorrhage that is not widely recognized.