Bone mineral measurements with quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA) were compared with chemical analysis (ChA) to determine (1) the accuracy and (2) the influence of bone marrow fat. Total bone mass of 19 human femoral necks in vitro was determined with QCT and DXA before and after defatting. ChA consisted of defatting and decalcification of the femoral neck samples for determination of bone mineral mass (BmM) and amount of fat. The mean BmM was 4.49 g. Mean fat percentage was 37.2% (23.3%–48.5%). QCT, DXA and ChA before and after defatting were all highly correlated (r>0.96,p<0.0001). Before defatting the QCT values were on average 0.35 g less than BmM and the DXA values were on average 0.65 g less than BmM. After defatting, all bone mass values increased; QCT values were on average 0.30 g more than BmM and DXA values were 0.29 g less than BmM. It is concluded that bone mineral measurements of the femoral neck with QCT and DXA are highly correlated with the chemically determined bone mineral mass and that both techniques are influenced by the femoral fat content.

OBJECTIVETo assess the prevalence of vertebral deformities in men and women aged 55 years and over.DESIGNCross-sectional study.SETTINGA quarter in Rotterdam, The Netherlands.METHODSAs part of the 'Rotterdam elderly study', 750 responding men and 750 women underwent lateral radiography of the spine and subsequent morphometry of the vertebrae to detect presence of vertebral deformities. Grade 1 and grade 2 deformities were scored on the basis of the results of the morphometry. The entire vertebral column was classified as normal (no deformities), moderate spinal deformity (grade 1 deformities) or severe spinal deformity (grade 2 deformities). Dual Energy X-ray Absorptiometry (DXA) was used to assess the bone mineral density (BMD) at the femoral neck.RESULTSThe prevalence of moderate or severe spinal deformity was estimated to be 18% in men (12% moderate and 6% severe) and 22% in women (11% moderate and 11% severe) after adjustment for the present age distribution of the Dutch population. The prevalence of deformities increased with age, in particular for severe deformities in women aged 70 years and over. A decreasing BMD was observed with increasing severity of vertebral deformities. Men with severe spinal deformity had a 4% lower BMD whereas women with severe spinal deformity had a 6% lower BMD.CONCLUSIONVertebral deformities are frequently present in the general population, mostly in the higher age groups. There was an association with decreased BMD. In view of the ongoing aging of the population, a future increase in the prevalence of vertebral deformities is to be expected.

Changes which have taken place since 1983, when the Dutch consensus meeting on mammography was held, made it necessary to review the consensus statement. In 1983 only radiologists participated in the working group, in 1993 representatives from all other relevant disciplines participated as well. Much attention was paid to the indication for mammography and supplementary diagnostic methods, especially ultrasound techniques and US-guided cytology. Along the lines given by the ACR guidelines on breast cancer reporting, attention was given to better communication with referring doctors.

We describe a new technique using ultrasound guided puncture of the subclavian vein and fluoroscopic control of the guide wire and the catheter position. Using this technique we performed 70 catheter introductions in 54 patients at the radiological department of the University Hospital of Rotterdam. Long term administration of chemotherapy was the most frequent indication for introduction of the Hickman catheter. The puncture related complication rate was compared with the complications of the 'blind' percutaneous puncture method, as mentioned in literature. All the ultrasound guided punctures of the subclavian vein were successful and no puncture related complications, such as pneumothorax, haemothorax or arterial puncture, occurred. Since ultrasound guided puncture of the subclavian vein in combination with fluoroscopic control of the guide wire and catheter reduces the risk of complications of introduction of Hickman catheters, we consider this technique superior to other methods.

The use of ultrasound combined with ultrasound-guided fine-needle aspiration biopsy (UGFAB) of supraclavicular lymph nodes in the pretreatment staging of 37 patients with squamous cell carcinoma of the esophagus is described. All patients underwent computed tomography (CT) scans of the chest and the abdomen and ultrasound of the abdomen and supraclavicular regions. Supraclavicular lymph node metastases (Stage IV disease according to the tumor nodes metastasis [TNM] classification) were cytologically diagnosed in seven (18.9%) of the 37 patients. In two of these patients, no other metastases were found. In the other five patients, UGFAB replaced more invasive diagnostic procedures. Due to their superficial location, ultrasound and UGFAB of the supraclavicular lymph nodes was relatively simple to perform, and contributed to an improved staging of squamous cell carcinoma of the esophagus.

A total of 83 self-expandable metalic stents were placed percutaneously in 69 patients for palliation of malignant biliary obstruction. Stent diameter was 1 cm; length, 3.5-10.5 cm. Of the 41 patients with common bile duct obstruction, 27 died 0.2-12 months (median, 3.2 months) after stent insertion. Two patients developed recurrent jaundice and cholangitis after 6 and 12 months, respectively. One patient underwent reintervention. Fourteen patients were alive without jaundice 1-8 months (median, 6.3 months) after stent placement. Of the 28 patients with hilar lesions, 13 died 0.7-7.6 months (median, 4.3 months) after stent placement. Fifteen were alive 1-15.5 months (median, 8.1 months) afterward. Recurrent jaundice and cholangitis were seen in eight of the 28 patients (28%) after 1-6 months (median, 3.6 months). The cause of malfunction of the stent(s) was tumor ingrowth in one patient, tumor overgrowth at the proximal end in five patients, and overgrowth at the distal end in two patients. Reintervention was performed in five patients (18%). Stent-related complications were seen in four patients.

The problems encountered in draining the bile ducts endoscopically in 148 patients with malignant obstruction of the mid or distal common bile duct and/or the papilla were assessed. Endoscopically visible extrinsic invasion of the papilla by a malignancy in the pancreatic head, with or without duodenal stenosis, appeared to be the major reason for the failure to insert a stent. The larger a tumor in the pancreatic head the greater the chance of invasion of the papillary region. This appeared to be evident for tumors restricted to the non-uncinate region of the pancreatic head. We would recommend primary percutaneous biliary drainage or surgery when the size of a proven malignancy restricted to the non-uncinate region of the pancreatic head is 5 cm or more, or when diagnostic duodenoscopy reveals extrinsic invasion of the papilla of Vater, or severe duodenal involvement with stenosis.

Following the introduction of suitable radiotracers for skeletal imaging, the detection of malignant bone disease became one of the important fields of interest in nuclear medicine. In many nuclear medicine departments bone scans may account for more than half of all imaging procedures. In oncology many applications of bone scintigraphy have been mentioned, and it is recognized that the bone scan is no longer solely used for the mapping of bone metastases, but among other applications also for therapy monitoring and the localization of sites for biopsy or further diagnostic imaging. It should be emphasized that in an era of limited funds for health care it is important to understand how useful bone scanning is. It is the purpose of this chapter to explore the indications for bone scintigraphy in the evaluation of patients with osseous metastases. In addition to this survey the cost-effectiveness of bone scanning in relation to its diagnostic yield and the proper choice of bone seeking radiopharmaceuticals for the detection of skeletal metastases will be discussed.