Purpose . To compare rigid rectoscopy with three different MRI measurement techniques for rectal cancer height determination, all starting at the anal verge, in order to evaluate whether MRI measurements starting from the anal verge could be an alternative to rigid rectoscopy. Moreover, potential cut-off values for MRI in categorizing tumor height measurements were evaluated. Methods . In this retrospective study, 106 patients (75 men, 31 female, mean age 64±11.59 years) with primary rectal cancer underwent rigid rectoscopy as well as MR imaging. Three different measurements (MRI1–3) in T2w sagittal scans were used to evaluate the exact distance from the anal verge (AV) to the distal ending of the tumor (MRI1: two unbowed lines, AV to the upper ending of the anal canal and upper ending of the anal canal to the lower border of the tumor; MRI2: one straight line from the AV to the lower boarder of the tumor; MRI3: a curved line beginning at the AV and following the course of the rectum wall ending at the lower border of the tumor). Furthermore, agreement between the gold standard rigid rectoscopy (UICC classification: low part, 0-6 cm; mid part, 6-12 cm; and high part, >12 cm) and each MRI measuring technique was analyzed. Results . Only a fair correlation in terms of individual measures between rectoscopy and all 3 MRI measurement techniques was shown. The proposed new cut-off values utilizing ROC analysis for the three different MRI beginning at the anal verge were low 0-7.7 cm, mid 7.7-13.3 cm, and high>13.3 cm (MRI1); low 0-7.4 cm, mid 7.4-11.2 cm, and high>11.2 cm (MRI2); and low 0-7.1 cm, mid 7.1-13.7 cm, and high>13.7 cm (MRI3). For MRI1 and MRI3, the agreement to the gold standard was substantial (r=0.66, r=0.67, respectively). Conclusion . This study illustrates that MRI1 and MRI3 measures can be interchangeably used as a valid method to determine tumor height compared to the gold standard rigid rectoscopy.

PURPOSE:The purpose of this study is two-fold. First, to evaluate, whether functional rectal MRI techniques can be analyzed in a reproducible manner by different readers and second, to assess whether different clinical and pathologic T and N stages can be differentiated by functional MRI measurements. MATERIALS AND METHODS:54 patients (38 men, 16 female; mean age 63.2 ± 12.2 years) with pathologically proven rectal cancer were included in this retrospective IRB-approved study. All patients were referred for a multi-parametric MRI protocol on a 3 Tesla MR-system, consisting of a high-resolution, axial T2 TSE sequence, DWI and perfusion imaging (plasma flow -s PFTumor) prior to any treatment. Two experienced radiologists evaluated the MRI measurements, blinded to clinical data and outcome. Inter-reader correlation and the association of functional MRI parameters with c- and p-staging were analyzed. RESULTS:The inter-reader correlation for lymph node (ρ 0.76-0.94; p<0.0002) and primary tumor (ρ 0.78-0.92; p<0.0001) apparent diffusion coefficient and plasma flow (PF) values was good to very good. PFTumor values decreased with cT stage with significant differences identified between cT2 and cT3 tumors (229 versus 107.6 ml/100ml/min; p=0.05). ADCTumor values did not differ significantly. No substantial discrepancies in lymph node ADCLn values or short axis diameter were found among cN1-3 stages, whereas PFLn values were distinct between cN1 versus cN2 stages (p=0.03). In the patients without neoadjuvant RCT no statistically significant differences in the assessed functional parameters on the basis of pathologic stage were found. CONCLUSION:This study illustrates that ADC as well as MR perfusion values can be analyzed with good interobserver agreement in patients with rectal cancer. Moreover, MR perfusion parameters may allow accurate differentiation of tumor stages. Both findings suggest that functional MRI parameters may help to discriminate T and N stages for clinical decision making.

Objectives: Dual-energy CT (DECT) allows quantification of intravenously injected iodinated contrast media in tumors, and therefore may be considered as a surrogate marker for perfusion and tumor vascularity. This study evaluated whether newly developed DECT response criteria allow better correlation with survival than established response criteria.Methods: Seventeen patients with advanced GIST treated with tyrosine-kinase-inhibitors were assessed by contrast-enhanced DECT 2 and 6 months after beginning of treatment. Response to treatment of 165 tumor lesions was evaluated according to RECIST, Choi criteria and newly developed DECT criteria, defining non-responders as an increase of both tumor size >20% and iodine related attenuation or either a >50% increase of tumor size or iodine related attenuation. All other patients were classified as responders. Progression-free survival (PFS) and overall survival (OS) were calculated by Kaplan-Meier analysis.Results: Choi criteria and DECT showed a significantly longer median PFS of patients rated as responders than patients rated as non-responders (9-29 months vs. 2-6 months; p < 0.02) at follow-up. Only DECT analysis at 6 months follow-up allowed a valid prediction of OS.Conclusion: This study indicates that DECT allows a better prediction of therapeutic benefit in advanced GIST patients treated with tyrosine-kinase-inhibitors than established response criteria. However, the most important predictive biomarker of therapeutic benefit was absence of progression, no matter which response evaluation criteria were applied. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

Ziele: Evaluation des Einflusses von TOF auf die Bildqualität, die Läsionsdetektionsrate, das Läsionsvolumen und die quantitative Nuklidanreicherung (SUVmax) der 18-F Cholin PET/CT bei Prostatakarzinompatienten mit biochemischem Rezidiv. Die Bildqualität der PET kann in voluminösen Körperregionen herabgesetzt sein, was die Abgrenzbarkeit kleiner metastatischer Läsionen beeinträchtigt. TOF könnte das Bildrauschen, die Ortsauflösung und damit die Abgrenzbarkeit kleiner Läsionen verbessern. Methode: In einem Zeitraum von 9 Monaten wurden 32 Prostatakarzinompatienten mit biochemischem Rezidiv (PSA>0,4 ng/ml) in die Studie eingeschlossen. Bei diesen Patienten (PSA: 8,87 ng/ml ± 17; 71 Jahre ± 7,8) wurden 76 Läsionen von zwei Nuklearmedizinern und einem Assistenzarzt beurteilt. Die Patienten wurden in Abhängigkeit vom PSA (>= 5 mg/nl versus <5mg/nl)in unterschiedliche Gruppen eingeteilt. Die Läsionsvolumina und der SUVmax des Lokalrezidivs, der metastasensuspekten Lymphknoten und der Organmetastasen wurden gemesssen und verglichen. Die Bildqualität und die Abgrenzbarkeit von Läsionen wurden anhand einer Likert-Skala (5 Punkte) bewertet. Ergebnis: 8 zusätzliche Läsionen konnten mithilfe von TOF abgegrenzt werden (SUVmax 3,64 ± 0,95, Volumen 0,58cm3 ± 0,5). Die Bildqualität war bei den mit TOF-software berechneten Bildern beeinträchtigt, die Abgrenzbarkeit von Läsionen wurde hingegen besser bewertet. SUVmax unter Verwendung von TOF war signifikant höher als das der Standarduntersuchung (Standard: 6,9 ± 4,1; TOF 8,1 ± 4,1; p<0.01), das Läsionsvolumen jedoch war nicht signifikant unterschiedlich (Standard: 5,3 cm3 ± 10,4; TOF 5,4 ± 10,3; p=0,41). Schlussfolgerung: Die Verwendung von TOF scheint von zusätzlichem diagnostischen Wert für die Detektion kleiner metastatischer Läsionen zu sein, was klinische Implikationen für die bildgestützte Bestrahlung einzelner Läsionen haben könnte. Andererseits geht mit der Verwendung von TOF ein Verlust an Spezifität bei der Läsionsbeurteilung einher.

INTRODUCTION:Magnetic resonance imaging (MRI) is the standard of reference for the non-invasive evaluation of ligament injuries of the knee. The development of dual-energy CT (DE-CT) made it possible to differentiate between tissues of different density by two simultaneous CT measurements with different tube voltages. This approach enables DE-CT to discriminate ligament structures without intra-articular contrast media injection. The aims of this study were on the one hand to determine the delineation of the anterior cruciate ligament (ACL) and on the other hand to assess the diagnostic value of DE-CT and MRI in the detection of iatrogenically induced injury of the ACL in a porcine knee joint model.MATERIALS AND METHODS:Twenty porcine hind legs, which were placed in a preformed cast in order to achieve a standardized position, were scanned using DE-CT. Thereafter, a 1.5-T MRI using a standard protocol was performed. The imaging procedures were repeated with the same parameters after inducing defined lesions (total or partial incision) on the ACL arthroscopically. After post-processing, two radiologists and two orthopedic surgeons first analyzed the delineation of the ACL and then, using a consensus approach, the iatrogenically induced lesions. The result of the arthrotomy was defined as the standard of reference.RESULTS:The ACL could be visualized both on DE-CT and MRI in 100% of the cases. As for the MRI, the sensitivity and specificity of detecting the cruciate ligament lesion respectively compared with the defined arthrotomy was 66.7% and 78.6% for intact cruciate ligaments, 100% and 75% in the case of a complete lesion, 33.3% and 78.6% for lesions of the anteromedial bundle, and 0% and 100% for lesions of the posterolateral bundle. In comparison, DE-CT demonstrated a sensitivity and specificity of 66.7% and 71.4% in the case of intact cruciate ligaments, 75% and 68.8% in the case of completely discontinued ACLs, 0% and 92.9% in the case of lesions of the anteromedial bundle, and 25% and 87.5% in the case of lesions of the posterolateral bundle.CONCLUSIONS:The present ex vivo experiment shows that both study modalities (DE-CT and MRI) are equal with regard to the delineation of the ACL, while MRI achieved higher sensitivity and specificity regarding iatrogenically induced complete ACL lesions. DE-CT could be a possible alternative to MRI for certain indications in the diagnosis of a knee ligament injury.

ABSTRACT Background and aim The liver is the typical location of metastases from gastrointestinal stromal tumors (GIST). Usually, metastases of GIST are treated by tyrosine kinase inhibitors (imatinib, sunitinib or others). In patients with multiple metastases resistant to drugs and not amenable to surgical resection interventional ablation techniques are considered. Selective internal radiation therapy (SIRT), delivering 90Y-loaded particles to liver metastases might offer a new treatment option. Material/methods We evaluated nine patients with liver metastases of GIST being progressive under drug (TKI) treatment and referred for SIRT. Five patients had liver metastases only, in another four patients extrahepatic disease was present but controlled by TKI therapy. One patient had to be excluded from treatment due to a hepato-pulmonary shunt volume exceeding 20 %. Depending on intrahepatic tumor distribution, either both liver lobes or one lobe were treated using 90Y spheres. Follow-up was done via dynamic MRI, contrast-enhanced (CE)-CT and 18F-FDG-PET-CT using modified RECIST criteria at 3 months intervals. All patients with targetable mutations in KIT or PD continued with drug to control extrahepatic tumor spread. Results In the eight patients, fourteen liver lobes were treated with a mean activity of 1.07GBq per lobe. No severe side effects occured in 7/8 patients, while one male developed an ulcer of the stomach not responding to high dose antacid therapy. Radiation induced liver disease (RILD) was not observed. Three patients showed a complete remission (CR) whereas four other patients developed a partial remission (PR) and two patients had to be classified as stable disease (SD). Median follow-up interval is 16 months (range, 4 - 52 months). The mean progression free interval regarding hepatic disease was 9,6 months. Conclusion SIRT offers a safe and effective treatment option in patients with liver metastases from GIST being progressive under TKI treatment. Disclosure All authors have declared no conflicts of interest.

Diese Übersichtsarbeit befasst sich mit der Diagnostik der beiden Großgefäßvaskulitiden Takayasu-Arteriitis und Riesenzellarteriitis mit Hauptaugenmerk auf das nuklearmedizinische Verfahren der Positronen-Emissions-Tomographie mit 18F-Fluordeoxyglykose (18F-FDG-PET) und die Kombination mit der Computertomographie (18F-FDG-PET/CT). Trotz der technischen Weiterentwicklungen spielt die klinische Diagnostik bzw. die Duplexsonographie bei der Abklärung der Großgefäßvaskulitiden weiterhin eine wesentliche Rolle. Allerdings kann die 18F-FDG-PET bzw. 18F-FDG-PET/CT für spezielle Fragestellungen, wie der Ausbreitungsdiagnostik und der Darstellung des Befallsmusters der Arteriitis, einen wichtigen Beitrag liefern. Dieser Artikel gibt einen Einblick in die aktuelle Wertigkeit und in potenzielle Einsatzmöglichkeiten der 18F-FDG-PET/CT.

Für Patienten mit Prostatakarzinom stellt die Radiatio eine potenziell kurative lokale Therapieoption dar. Im Rahmen der Nachsorge nach lokal kurativ intendierter Therapie wird aktuell der Verlauf des PSA-Werts (PSA prostataspezifisches Antigen) kontrolliert, der Einsatz bildgebender Verfahren wird lediglich bei symptomatischen Patienten und/oder zur Planung einer Salvagetherapie empfohlen.

Ultrasound is of great importance in the diagnosis of acute and chronic diseases in urology, such as kidney colic, testicular torsion, low-grade kidney trauma or for follow-up of vesicoureteral reflux, evaluation of infertility, measurement of residual urinary volume and the detection of cancer. An ultrasound examination is time and cost-effective without exposure to ionizing radiation and is routinely performed by practitioners as well as in the clinical daily routine. With technical innovations, such as contrast-enhanced ultrasound or real time elastography, it would for instance be possible to extend the application field of ultrasound. However, in some fields of investigation ultrasound still lacks accuracy and despite its many advantages the validity of ultrasound findings sometimes has to be verified with computed tomography (CT) or magnetic resonance imaging (MRI).

The successful treatment of retroperitoneal soft tissue sarcomas requires an experienced team consisting of not only surgeons but also pathologists and radiologists with a high case load in these tumours. The decisive step in the preoperative work-up of these, often late detected, tumours is their reliable grading as well as, if necessary, recognition of the sarcoma subtype as a basis for determining the direction of treatment. Imaging methods provide essential information with regard to the detection of infiltration of neighbouring structures and organs. Magnetic resonance imaging (MRI) is the most suitable method for this purpose. Punch needle biopsy is to be preferred over fine-needle biopsy in all cases for histological confirmation. The surgical standard procedure for the majority of the patients comprises multivisceral resection as principle, with additional colon resection, nephrectomy, and resection of abdominal wall musculature or, respectively, the psoas muscle in order to achieve an R0 resection of the retroperitoneal compartment. If only small margins of clearance are to be expected, a preoperative (neoadjuvant) treatment with radiation and/or chemotherapy even in combination with deep wave hyperthermia for high grade sarcomas should be strongly considered. Adjuvant postoperative radiation therapy often cannot be adequately applied due to the occupation of the former tumour bed by abdominal organs that were displaced by the mass effect, especially the radiation-sensitive small bowel. The optimal treatment strategy for these patients must be discussed in a multidisciplinary tumour board prior to any diagnostic or therapeutic procedure.

Ziele: Vergleich des diagnostischen Potentials der DCE-MRT zur Differenzierung zwischen malignem, normalem Prostatagewebe und Prostatitis bei 1,5T vs. 3T. Methode: 68 Patienten mit Biopsie/Prostatektomie gesichertem Prostatakarzinom wurden ausgewertet. 22 Patienten mit histologisch gesichertem Prostatakarzinom und 8 Patienten mit Prostatitis wurden bei 1,5 T und weitere 27 Patienten (Prostatakarzinom) bzw. 11 Patienten (Prostatitis) wurden bei 3 Tesla untersucht. Alle Patienten erhielten im Rahmen der multiparametrischen Untersuchung für die Perfusionsauswertung eine axiale 2D TurboFLASH T1W GRE Sequenz unter Verwendung einer Kombination von Endorektal- und Oberflächenspule. Insgesamt 30 (bei 1,5T)/38 (bei 3 T) Areale mit normalem Prostatagewebe, 22/27 Prostatakarzinom- und 8/11 Prostatitisareale wurden markiert und die mittlere Transitzeit (MTT) bzw. Plasmafluss-Werte (PF) berechnet. Ergebnis: Im Vergleich zum normalen Gewebe zeigten die Prostatakarzinombefunde einen statistisch signifikant erhöhten PF und einen signifikant erniedrigten MTT Wert bei beiden Feldstärken (1,5 T; p<0.0001 für PF und p=0.0016 für MTT, 3 T; p<0.0001 für PF und MTT). Im Vergleich zur Prostatitis zeigten die Areale mit Prostatakarzinom statistisch signifikant erhöhte PF (p=0.0018) und erniedrigte MTT Werte (p=0.0006) bei 3 T und nur erniedrigte MTT (p=0.0034) Werte bei 1,5 T. Im Vergleich zum normalen Prostatagewebe zeigten die Areale mit Prostatitis signifikant erhöhte PF Werte bei 1,5 T (p=0.0156) ohne korrelierend erniedrigte MTT Werte. Es zeigten sich keine signifikante Unterschiede der PF und MTT Werte zwischen Prostatitis und normalem Prostatagewebe bei 3 T. Schlussfolgerung: Mithilfe der MR Perfusion können Prostatakarzinome von normalem Prostatagewebe unterschieden werden. Bei 3 T ist die Differenzierung zwischen Prostatitis und Prostatakarzinom besser als bei 1,5 T. Allerdings sind die Ergebnisse der Perfusionsauswertung nicht signifikant für die Differenzierung von Prostatitis vs. normalem Prostatagewebe.

Der Ultraschall nimmt in der primären Diagnostik in der Urologie einen wichtigen Stellenwert ein – sei es als orientierende Untersuchung bei akuten Erkrankungen wie z. B. Nierenkolik, Hodentorsion oder geringgradigen Nierentraumata oder als Verlaufskontrolle bei chronischen Erkrankungen wie z. B. vesikoureteralem Reflux, Restharnbestimmung bei benignem Prostatasyndrom (BPS), Fertilitätsabklärung oder Karzinomdetektion. Die Untersuchung kann schnell, kostengünstig und v. a. ohne Strahlenbelastung sowohl im niedergelassenen Bereich als auch im stationären klinischen Alltag durchgeführt werden. Der Einsatz innovativer Techniken wie z. B. dem kontrastverstärkten Ultraschall (CEUS) oder der Echtzeitelastographie (RTE) könnte dazu führen, dass das Anwendungsgebiet der Sonographie erweitert wird. Trotz der breiten Verfügbarkeit und der genannten Vorteile bleibt die diagnostische Aussagekraft der Sonographie in manchen Bereichen eingeschränkt, sodass der Verifizierung der sonographischen Befunde und der umfassenden Abklärung mit einer weiteren Bildgebung wie z. B. CT oder MRT eine wichtige Rolle zukommt.

To investigate the correlation between maximum standardized uptake value (SUVmax) of 18FDG PET-CT and iodine-related attenuation (IRA) of dual energy CT (DECT) of primary tumours and 18FDG PET-CT positive thoracic lymph nodes (LN) in patients with lung cancer.

Radiation therapy is a therapeutic option with curative intent for patients with prostate cancer. Monitoring of prostate-specific antigen (PSA) values is the current standard of care in the follow-up. Imaging is recommended only for symptomatic patients and/or for further therapeutic options.For detection of local recurrence magnetic resonance imaging (MRI) of the prostate is acknowledged as the method of choice.Good results for primary diagnosis were found especially in combination with functional techniques, whereas in recurrent prostate cancer only few studies with heterogeneous study design are available for prostate MRI. Furthermore, changes in different MRI modalities due to radiation therapy have been insufficiently investigated to date.As the initial results were promising prostate MRI and available therapeutic options for detection of local recurrence should be considered in patients with increased PSA.

Einleitung: Das Staging eines neu diagnostizierten Rektumkarzinoms erfolgt durch die rektale Endosonografie sowie die Magnetresonanztomografie (MRT). Neben der Tumorstadieneinteilung ist der Lymphknoten (LK)-Status für die Entscheidung zu einer neoadjuvanten Radiochemotherapie mit ausschlaggebend.

JDDG: Journal der Deutschen Dermatologischen GesellschaftVolume 9, Issue 3 p. 212-222 Vergleich der diagnostischen Genauigkeit der Ganzkörper-MRT und Ganzkörper-CT bei malignem Melanom im Stadium III/IV Daniel Hausmann, Daniel Hausmann Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität HeidelbergSearch for more papers by this authorSusanne Jochum, Susanne Jochum Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg Institut für Radiologie, Westpfalz-Klinikum GmbH, KaiserslauternSearch for more papers by this authorJochen Utikal, Jochen Utikal Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität HeidelbergSearch for more papers by this authorRichard Christian Hoffmann, Richard Christian Hoffmann Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität HeidelbergSearch for more papers by this authorChristian Zechmann, Christian Zechmann Radiologische Klinik, Universitätsklinikum der Universität HeidelbergSearch for more papers by this authorKurt Wolfgang Neff, Kurt Wolfgang Neff Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität HeidelbergSearch for more papers by this authorSergij Goerdt, Sergij Goerdt Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität HeidelbergSearch for more papers by this authorStefan Oswald Schoenberg, Stefan Oswald Schoenberg Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität HeidelbergSearch for more papers by this authorDietmar Jörg Dinter, Dietmar Jörg Dinter Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität HeidelbergSearch for more papers by this author Daniel Hausmann, Daniel Hausmann Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität HeidelbergSearch for more papers by this authorSusanne Jochum, Susanne Jochum Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg Institut für Radiologie, Westpfalz-Klinikum GmbH, KaiserslauternSearch for more papers by this authorJochen Utikal, Jochen Utikal Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität HeidelbergSearch for more papers by this authorRichard Christian Hoffmann, Richard Christian Hoffmann Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität HeidelbergSearch for more papers by this authorChristian Zechmann, Christian Zechmann Radiologische Klinik, Universitätsklinikum der Universität HeidelbergSearch for more papers by this authorKurt Wolfgang Neff, Kurt Wolfgang Neff Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität HeidelbergSearch for more papers by this authorSergij Goerdt, Sergij Goerdt Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität HeidelbergSearch for more papers by this authorStefan Oswald Schoenberg, Stefan Oswald Schoenberg Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität HeidelbergSearch for more papers by this authorDietmar Jörg Dinter, Dietmar Jörg Dinter Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität HeidelbergSearch for more papers by this author First published: 24 February 2011 https://doi.org/10.1111/j.1610-0387.2011.07614_suppl.xCitations: 3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume9, Issue3March 2011Pages 212-222 RelatedInformation

BACKGROUND:Malignant melanoma (MM) is dramatically increasing in light-skinned populations worldwide. Staging and regular follow-up examinations are essential. The purpose of this study was to compare the diagnostic accuracy of whole-body MRI with the standard diagnostic algorithm (whole-body CT and brain MRI) in patients with stage III/IV MM.PATIENTS AND METHODS:A group of 50 consecutively admitted patients with stage III/IV MM were included in the study. Whole-body CT and brain MRI scans were performed. Additionally, all patients underwent a whole-body MRI (1.5 Tesla Magnetom Avanto, Siemens Healthcare Sector, Erlangen). The findings were compared on a lesion-by-lesion basis as part of clinical routine follow-up.RESULTS:33 patients received a follow-up CT and were evaluated. Overall, 824 lesions were detected. The sensitivity of whole-body MRI was observer-dependent. MRI was slightly less sensitive than CT according to the findings of the two most experienced observers (73.4 % vs. 78.2 %, p = 0.0744). CT was significantly more sensitive in the detection of small (1-5 mm) pulmonary nodules (2.9 % vs. 66.9 %, p < 0.0001). Yet overall, MRI was significantly more specific than CT (83.4 % vs. 50.4 %, p < 0.0001).CONCLUSIONS:Whole-body MRI in compliance with standard requirements for the observers (high level of experience) should be considered as an appropriate alternative to CT without ionizing radiation, particularly for young patients with advanced MM.

The main objectives of the study described below were of two-fold nature: (1) to examine if rhBMP-2-biocoated implants in a pig model could lead to ectopic bone formation and (2) if quantitative and/or qualitative differences could be found between adhesively and covalently bonded BMP II using the scintigraphic method. In order to examine these central questions, 26 Göttingen minipigs were allocated to three groups with a control group (n = 7) and two study groups (n = 9 each) receiving one of three implant types: (a) chromosulfuric acid treated titanium surface as control, (b) non-covalently bonded BMP-2, and (c) covalently bonded and immobilized rhBMP-2. Each animal received four barbell-shaped implants, one in the proximal and distal metaphysis of each femur. The scintigraphic analyses were conducted after four, eight, and 12 weeks postoperatively. The visual (qualitative) analysis failed to show ectopic bone formation in any of the three groups. The statistical analysis of the relative values for bone formation yielded no significant differences between the groups, although the limitation in the applied methods do not enable one to draw conclusions regarding the histomophometric results.