FDG-Anreicherungen im braunen Fettgewebe (ABF) erschweren die PET-Beurteilung bei Kindern und Jugendlichen. Als Präventionsmaßnahmen (PM) zur Vermeidung von ABF wurden Wärmezufuhr und/oder eine Prämedikation mit Betablockern (BB) beschrieben. Wir gingen der Frage nach, welchen Effekt diese PM auf die ABF haben.

The clinical significance of 18F-FDG-PET/CT in the follow-up of patients with differentiated thyroid carcinoma was evaluated and the results were compared with those of 18F-FDG-PET, 131I-whole-body scintigraphy including SPECT/CT (WBS) and ultrasound. In addition, it was the aim to investigate the impact of 18F-FDG-PET/CT on the therapeutic management. Patients, methods: 327 patients (209 women, 118 men; mean age 53 ± 18 years) with differentiated thyroid cancer (242 papillary, 75 follicular, 6 mixed, 1 Hurthle cell and 3 poorly differentiated tumours) were analyzed retrospectively at four tertiary referral centres. 289 18F-FDG-PET/CT and 118 18F-FDG-PET studies were performed in these patients between 2007 and 2010. In addition, an overall clinical evaluation was performed, including cytology, histology, thyroglobulin level, ultrasound, WBS, and subsequent clinical course in order to compare the molecular imaging results. Finally, the change in therapeutic management due to findings of 18F-FDG-PET/CT was investigated. Results: The sensitivity of 18F-FDG-PET/CT was 92%, the specificity was 95%. Sensitivity and specificity of 18F-FDG-PET alone were 67% and 93%, respectively. WBS showed a sensitivity of 65% and a specificity of 94%. The corresponding values of ultrasound were 37% and 94%, respectively. The sensitivity of 18F-FDG-PET/CT in the group of patients with a negative WBS (n=194) amounted to 96%. When 18F-FDG-PET/CT and WBS were considered in combination, tumour tissue was missed in only 2 out of 133 patients; when 18F-FDG-PET and WBS were combined, tumour tissue was missed in 1 out of 24 patients. 18F-FDG-PET/CT resulted in management change in 43% (n=57/133) with a decision on surgical approach in 20% (n=27/133). Conclusions: 18F-FDG-PET/CT is superior to 18F-FDG-PET alone in patients with differentiated thyroid cancer and has a direct impact on the therapeutic management of patients with suspected local recurrence or metastases, particularly in those with negative WBS.

Summary The clinical significance of 18F-FDG-PET/CT in the follow-up of patients with differentiated thyroid carcinoma was evaluated and the results were compared with those of 18F-FDGPET, 131I-whole-body scintigraphy including SPECT/CT (WBS) and ultrasound. In addition, it was the aim to investigate the impact of 18F-FDG-PET/CT on the therapeutic management. Patients, methods: 327 patients (209 women, 118 men; mean age 53 ± 18 years) with differentiated thyroid cancer (242 papillary, 75 follicular, 6 mixed, 1 Hürthle cell and 3 poorly differentiated tumours) were analyzed retrospectively at four tertiary referral centres. 289 18F-FDG-PET/CT and 118 18F-FDG-PET studies were performed in these patients between 2007 and 2010. In addition, an overall clinical evaluation was performed, including cytology, histology, thyroglobulin level, ultrasound, WBS, and subsequent clinical course in order to compare the molecular imaging results. Finally, the change in therapeutic management due to findings of 18F-FDG-PET/CT was investigated. Results: The sensitivity of 18F-FDG-PET/CT was 92%, the specificity was 95%. Sensitivity and specificity of 18F-FDG-PET alone were 67% and 93%, respectively. WBS showed a sensitivity of 65% and a specificity of 94%. The corresponding values of ultrasound were 37% and 94%, respectively. The sensitivity of 18F-FDG-PET/CT in the group of patients with a negative WBS (n=194) amounted to 96%. When 18F-FDG-PET/CT and WBS were considered in combination, tumour tissue was missed in only 2 out of 133 patients; when 18F-FDG-PET and WBS were combined, tumour tissue was missed in 1 out of 24 patients. 18F-FDG-PET/CT resulted in management change in 43% (n=57/133) with a decision on surgical approach in 20% (n=27/133). Conclusions: 18F-FDG-PET/CT is superior to 18F-FDG-PET alone in patients with differentiated thyroid cancer and has a direct impact on the therapeutic management of patients with suspected local recurrence or metastases, particularly in those with negative WBS.

Purpose: Restenosis remains a major problem in percutaneous transluminal angioplasty (PTA) of peripheral arteries. The aim of this feasibility study was to evaluate the technical feasibility and safety of a new endovascular brachytherapy (EVBT) device with Rhenium-188 in restenosis prophylaxis of infrainguinal arteries. Materials and Methods: From March 2006 to April 2009, 52 patients with 71 infrainguinal arterial lesions were treated with Re-188 to prevent restenosis after PTA. 40 patients with 53 lesions (24 de-novo lesions and 29 restenoses) were re-examined (clinic, color-coded duplex ultrasound) after a mean follow-up period of 12.7 months (2.6 to 25.1 months). The liquid beta-emitter Re-188 was introduced to the target lesion via an EVBT certified PTA balloon and a tungsten applicator. After the calculated irradiation time, Re-188 was aspirated back into the tungsten applicator. A dose of 13 Gy was applied at a depth of 2 mm into the vessel wall. Results: After a mean follow-up of 12.7 months, the overall restenosis rate after Re-PTA was 15.1% (8/53 lesions). The restenosis rate for de-novo lesions was 20.8% (5/24) and 10.3% for restenoses (3/29). In 4 patients reintervention was necessary (3 PTAs and 2 major amputations). No peri-procedural complications were observed. No elevated radiation dose for the patient or the interventionalist was measured. Conclusion: EVBT with a Re-188 filled balloon catheter was technically feasible and safe after PTA of infrainguinal arterial lesions with restenosis rates lower than expected compared to published results. Treatment of restenoses seems to be more effective than de-novo lesions.

Surgery for colorectal liver metastasis facilitates long-term survival, and neoadjuvant chemotherapy improves resectability but may also alter staging accuracy. The aim of this study was to evaluate the effects of neoadjuvant chemotherapy on the efficacy of positron emission tomography (PET), PET–computed tomography (CT), CT and intraoperative ultrasound (IUS) in the detection of liver metastasis.

Restenosis remains a major problem in percutaneous transluminal angioplasty (PTA) of peripheral arteries. The aim of this feasibility study was to evaluate the technical feasibility and safety of a new endovascular brachytherapy (EVBT) device with Rhenium-188 in restenosis prophylaxis of infrainguinal arteries.From March 2006 to April 2009, 52 patients with 71 infrainguinal arterial lesions were treated with Re-188 to prevent restenosis after PTA. 40 patients with 53 lesions (24 de-novo lesions and 29 restenoses) were reexamined (clinic, color-coded duplex ultrasound) after a mean follow-up period of 12.7 months (2.6 to 25.1 months). The liquid beta-emitter Re-188 was introduced to the target lesion via an EVBT certified PTA balloon and a tungsten applicator. After the calculated irradiation time, Re-188 was aspirated back into the tungsten applicator. A dose of 13 Gy was applied at a depth of 2 mm into the vessel wall.After a mean follow-up of 12.7 months, the overall restenosis rate after Re-PTA was 15.1 % (8 / 53 lesions). The restenosis rate for de-novo lesions was 20.8 % (5 / 24) and 10.3 % for restenoses (3 / 29). In 4 patients reintervention was necessary (3 PTAs and 2 major amputations). No periprocedural complications were observed. No elevated radiation dose for the patient or the interventionalist was measured.EVBT with a Re-188 filled balloon catheter was technically feasible and safe after PTA of infrainguinal arterial lesions with restenosis rates lower than expected compared to published results. Treatment of restenoses seems to be more effective than de-novo lesions.

Die Sentinel-Lymphnode-Technik ist geeignet, um bei lymphogen metastasierenden Tumorerkrankungen den Lymphknotenstatus minimal invasiv zu bestimmen.

Splenic haemangiomas are rare disorders (1–4). Nevertheless, they represent the most common primary neoplasm of the spleen (1–4). Splenic sclerosing haemangioma (SSH) is a very rare and an unusual tumour that features secondary changes such as fibrosis or calcinosis (5). Imaging modalities play an important role in evaluation of focal and diffuse splenic abnormalities. FDG-PET/CT has been introduced as powerful imaging modality in evaluation of splenic involvement, particularly in lymphoma (6, 7). However, this case report shows how radiological imaging modalities, including FDG-PET/CT, can occasionally lead to misdiagnosis (8, 9).

Zielsetzung: Beurteilung der endovaskulären Brachytherapie (Rhenium-PTA) nach PTA im femorocruralen Stromgebiet hinsichtlich Sicherheit, technischer Anwendbarkeit, Restenosehäufigkeit und Reinterventionsrate

Spätestens seit der letzten Fassung der Leitlinien zum Prostatakarzinom der European Association of Urology von 2009 ist die Wächterlymphknotendiagnostik auch in der Urologie eine anerkannte Methode zum Lymphknotenstaging. Die Arbeit beschreibt die Methode und die Ergebnisse der Augsburger Arbeitsgruppe und präsentiert Daten zum rezidivfreien Überleben nach SLNE.

The authors present a procedure guideline for scintigraphic detection of sentinel lymph nodes in malignant melanoma and other skin tumours, in breast cancer, in head and neck cancer, and in prostate and penile carcinoma. Important goals of sentinel lymph node scintigraphy comprise reduction of the extent of surgery, lower postoperative morbidity and optimization of histopathological examination focussing on relevant lymph nodes. Sentinel lymph node scintigraphy itself does not diagnose tumorous lymph node involvement and is not indicated when lymph node metastases have been definitely diagnosed before sentinel lymph node scintigraphy. Procedures are compiled with the aim to reliably localise sentinel lymph nodes with a high detection rate typically in early tumour stages. Radiation exposure is low so that pregnancy is not a contraindication for sentinel lymph node scintigraphy. Even with high volumes of scintigraphic sentinel lymph node procedures surgeons, theatre staff and pathologists receive a radiation exposure <1 mSv/year so that they do not require occupational radiation surveillance.

Ziele: Technische Machbarkeitsstudie und klinische Nachuntersuchung mit Bestimmung des technischen und klinischen Erfolges nach endovaskulärer Brachytherapie mit Rhenium-188 (Rhenium-PTA) im femoropoplitealen Stromgebiet. Methode: Von 03/06–08/07 wurden 17 Patienten (mittleres Alter 74,4) mit insgesamt 22 Läsionen mittels Rhenium-PTA behandelt (13 De-Novo Läsionen und 9 Rezidivstenosen). Nach erfolgreicher primärer PTA wurde dabei über einen EVBT -Ballon der flüssige ß-Strahler Rhenium -188 zur Bestrahlung eingebracht und nach Bestrahlung wieder vollständig evakuiert (Postinterventionelle Gabe von ASS und Clopidgrel über ein Jahr). Zur Evaluation wurden die Dokumentationsbögen zur Dosimetrie, der Interventionsbericht und die Patientenakte herangezogen. Das Follow-up erfolgte klinisch sowie mit einer Dopplerdruckmessung, einer FKDS der Läsion sowie einer Gehstreckenbestimmung. Bei V.a. Restenose wurde eine MRA oder CTA durchgeführt. Ergebnis: Die technische Erfolgsrate betrug 100%. Es traten keine peri- oder postinterventionellen Komplikationen auf. Es kam zu keinem Zeitpunkt zu einer erhöhten Strahlenbelastung des Personals oder zu einem Austritt von Rhenium-188 aus dem PTA Ballon. Die durchschnittliche Länge der primären PTA betrug 37,3mm (20–80mm), die Länge der Rhenium-PTA lag bei 59,1mm (40–100mm). Die durchschnittliche Aktivitätskonzentration der Rhenium-Lösung betrug 5,09 GBq/ml, die Bestrahlungsdauer lag bei 10,47 min (5,1–25min). Bei der Auswertung der 22 Läsionen zeigte sich nach einem Nachbeobachtungszeitraum von 16,2 Monaten (8,2–25,1) eine Restenoserate von 13,6% (3 Läsionen mit Restenose/Verschluss). Schlussfolgerung: Die EVBT mit flüssigem Rhenium-188 zeigte sich im Rahmen unserer Untersuchung als praktikable und sichere Technik zur Restenoseprophylaxe nach PTA im femoropoplitealen Stromgebiet mit einer guten Offenheitsraterate. Aufgrund der kleinen Fallzahl ist eine weitere Evaluation im Rahmen größerer, randomisierter Studien notwendig.

PURPOSE:Sentinel lymph node dissection (SLND) has replaced extended lymphadenectomy for nodal staging in several solid tumours. We present our results of SLND in prostate cancer in regard to detection and false-negative rate.METHODS:In a 2-day protocol about 300 MBq (99m)Tc-nanocolloid are injected into the prostate. Two hours later static scans of the pelvis are performed to get information about the number and location of radioactive lymph nodes. During surgery the radioactive nodes are excised with the help of a gamma probe and sent separately to the pathologist. The histological procedure includes haematoxylin and eosin staining, serial sections and immunohistochemistry.RESULTS:Since 1999, a total of 2,020 men underwent SLND alone or in combination with either standard or extended lymphadenectomy after radical retropubic prostatectomy. Lymph nodes positive for metastases were found in 16.7% of patients. The scintigraphic detection rate was 97.6% and the intraoperative detection rate 98%. For 187 lymph node-positive men who had either standard or extended lymphadenectomy in addition to SLND the false-negative rate could be calculated, resulting in false-negative findings in 11 of 187 patients (6%).CONCLUSION:Our results demonstrate that SLND in prostate cancer is a reliable procedure for nodal staging.

Fragestellung: In den Frühstadien des Vulvakarzinoms treten positive Lymphknoten in nur 10 bis 26% der Fälle auf, da also der überwiegende Teil dieser Patientinnen keine Metastasen aufweist, muss die inguinale Lymphonodektomie als Routinemaßnahme in Frage gestellt werden. Wir haben aber zur Zeit weder klinisch noch apparativ die Möglichkeit, prätherapeutisch den Nodalstatus mit ausreichender Genauigkeit vorherzusagen, um daraus Konsequenzen für eine individuelle Therapieentscheidung zu ziehen. Mit dieser Arbeit soll ein Beitrag dazu geleistet werden, ob wie beim malignen Melanom, dem Mammakarzinom und verschiedenen anderen Tumorentitäten auch beim Vulvakarzinom die Detektion des Sentinellymphknotens eine Möglichkeit darstellt, wie man auch hier individuell zu einer Einschränkung der Therapie kommen könnte.

Summary Aim: We investigated the influence of the injection technique on the false negative rate in identifying the sentinel lymph node in multifocal breast cancer. Patients, methods: 958 consecutive patients were divided into unifocal and multifocal breast cancer patients. The scintigrafic and intraoperative detection rate as well as the false negatives were calculated in relation to peritumoral or subareolar injection. Results: In all patients the scintigrafic and intraoperative detection rate exceeded 99%, except in patients with multifocal cancer, who were injected peritumorally. In this group the intraoperative detection rate declined to 96%. In patients with unifocal breast cancer the false negative rate was below 5%, independent of the injection technique. Multifocal breast cancer patients showed a significant dependence on the injection technique. The false negative rate was 26.3% in patients with peritumoral injection and 5.6% in those with subareolar injection. Conclusion: The results clearly demonstrate that in multifocal breast cancer a reliable detection of a SLN is impossible with the peritumoral injection technique. Subareolar injection seems to be a way to operate on multifocal breast cancer with SLNE, but the number of investigated patients is too low for statistic approval. So, prospective studies should be performed to validate these preliminary results before SLNE becomes routine in multifocal breast cancer.

Introduction The prospectively randomized HD15 multicenter trial of the German Hodgkin Study Group (GHSG) included advanced-stage Hodgkin lymphoma patients comparing 8 cycles of BEACOPP escalated with 6 cycles or 8 cycles time-condensed BEACOPP baseline . One other main study endpoint was the prognostic value of 18 F-fluorodesoxyglucose (FDG) positron emission tomography (PET) following chemotherapy. The aim was to specify the negative predictive value of PET (NPV) in patients with residual tumour mass after chemotherapy. Methods Entry criteria for the PET question were partial remission (PR) after the end of chemotherapy with at least one involved nodal site measuring more than 2.5 cm in diameter by computed tomography (CT). Exclusion criteria included diabetes, elevated blood sugar levels and skeletal involvement with risk of instability. Calculations were restricted to those cases with either progressive disease (PD) or relapse within 12 months after PET or at least 12 months of follow-up. A total of 275 patients were eligible for this analysis. The assessment was based on those patients confirmed by an expert panel as being PET-negative. CT verification was performed to identify false positive PET findings. The NPV was defined as the proportion of patients without progression or relapse within 12 months. Results 9/216 patients with PET-negative residues and 9/59 patients with PET-positive residues had PD or relapse within one year of follow-up. The NPV was 0.958% (95% CI 0.931 – 0.985%). In 244/245 cases with PET-negative residual masses, no irradiation was given. In the 62/66 cases with PET-positive residues, additional radiotherapy was performed. Progression/relapse rates were significantly different between those patients with residual mass being PET-negative or PET-positive (p=0.0053). PET-negative patients, who were assessed as partial response by CT, had a prognosis similar to those in complete remission. There was no significant difference in the progression free survival in this trial and the prior GHSG trials HD12 (arms pooled) and HD9 (arm C) for advanced-stage HL (p=0.266). Importantly, the proportion of patients receiving radiotherapy decreased from 70% (HD9-C) to 39% (HD12) and 12% (HD15). Discussion The high NPV of PET suggests that radiotherapy following 6 or 8 cycles of BEACOPP might be restricted to those patients who are PET-positive after chemotherapy.