Mammography is the mainstay for the early detection of breast abnormalities. Mammography is characterized by an elevated sensitivity but a relative low specificity in diagnosing breast cancer. The results of mammography and SMM were then classified using the pathological findings as gold standard. In the last 4 years at the Department of Nuclear Medicine of the National Cancer Institute of Naples, more than 2000 women were investigated by SMM with Tc-MDP. In the initial step of the study we have investigated large breast lesions to evaluate the sensitivity and specificity of the test. Benign and malignant calcifications may produce similar mammography patterns, and there are not specific criteria to diagnose breast cancer when isolated clusters of microcalcifications occur. The evidence that metastatic lymph nodes were visualized earlier than primary tumors suggested modifying the sequence of image acquisition during SMM with Tc-MDP by anticipating the anterior view of the chest before the two lateral views in prone position.

Objective. To investigate CT morphologic and densitometric features and 18-FDG PET findings of surgically excised lung adenocarcinomas “mixed subtype” with predominant lepidic component, appearing as solid solitary pulmonary nodules (SPNs) on CT scan. Materials and Methods. Approval for this study was given from each local institutional review board according to its retrospective nature. Nodules pathologically classified as lung adenocarcinoma mixed subtype with bronchioloalveolar otherwise lepidic predominant component, in three different Italian institutions (Napoli; Varese; Parma), were retrospectively selected. Results. 22 patients were identified. The number of SPNs with smooth margins was significantly lower with respect to the number of SPNs with spiculated margins (p: 0.033), radiating spiculations (p: 0.019), and notch sign (p: 0.011). Mean contrast enhancement (CE) was 53.34 HU (min 5.5 HU, max 112 HU); considering 15 HU as cut-off value, CE was positive in 20/22 cases. No significant correlation was found between size and CE. Mean SUVmax was 2.21, ranging from 0.2 up to 7.5 units; considering 2.5 units as cut-off, SUVmax was positive in 7/22 cases. The number of SPNs with positive CE was significantly higher than the number of SPNs with positive SUVmax (p: 0.0005). Conclusion. CT generally helps in identifying solid SPN suspicious for malignancy but 18-FDG PET may result in false-negative evaluation; when 18-FDG PET findings of a solid SPN are negative even though CT morphology and CE suggest malignancy, radiologist should consider that lepidic component may be present inside the invasive tumor, despite the absence of ground glass.

The aim of the study was to analyze possible correlations between strain echocardiography (STE) and PET myocardial perfusion in a population of heart transplantation (HTx) recipients showing preserved left ventricular (LV) ejection fraction. By STE, LV global longitudinal strain (LV GLS) was lower in HTx. PET showed no transient or chronic ischemia in 83 of 115 HTx (73%). Fixed perfusion defects were observed in 17% of HTx and reversible ischemia in 10%. Significant coronary stenosis was observed only in 10 cases. GLS was independently associated with age at HTx and fixed perfusion defects (HR 0.41; P<.001). Such relationships underline STE ability to early identify HTx pts with subclinical myocardial dysfunction during long‐term follow‐up.

A 66-year-old man who had undergone cardiac transplantation 20 years ago (in 1990) for idiopathic dilated cardiomyopathy was referred for the first time to our hospital because of palpitations and dyspnoea during moderate physical effort (especially during the last 6 months). At the admission, the patient exhibited a previous electrocardiogram (ECG) and echocardiogram, both performed in 1994. The ECG showed left ventricular (LV) hypertrophy and negative T waves on the precordial leads, the echocardiogram showed only mild LV hypertrophy, with poor LV apical endocardial definition. The patient also showed a coronary angiography performed the same year, with coronary arteries and ventriculography within normal limits. In addition, routine cardiac biopsy results were normal until 1 year after the transplantation. Physical findings were within normal limits. The ECG showed negative T waves on the precordial leads (Figure 1). Standard echocardiography showed normal LV ejection fraction and LV hypertrophy mainly located in the LV apex (Figure 2 A). Colour Doppler highlighted systolic aliasing at the level of the distal third and of the apical portions of the left ventricle (Figure 2 B). By pulsed-wave Doppler, the gradient between the apex and base of the left ventricle was higher than 30 mmHg. By 3D echocardiography, a maximal apical LV wall thickness of 20 mm was measured at end-diastole in the apical 4-chamber view (Figure 2 C). By use of intravenous contrast echocardiography, the typical “ace of spades” configuration, the hallmark diagnostic criteria for apical hypertrophic cardiomyopathy (HCM), was clearly evidenced (Figure 2 D). For further tissue characterization, late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) was performed. Steady-state free precession images and inversion recovery LGE images in the longand short-axis images showed sub-endocardial enhancement in the hypertrophied LV apex, in absence of regional wall-motion abnormalities (Figure 2 E-F). Our patient was treated with oral Beta-blocker and Ace-inhibitor after diagnosis, and symptoms improved after drug therapy. To the best of our knowledge, this is the first case of an apical HCM developing in another body of a cardiac transplant recipient patient. Even if echocardiography is the first line imaging modality for the followup of cardiac transplant patients, it is well known that the cardiac apex may be difficult to visualize since postoperative echocardiography windows are often of poor quality because of intervening air spaces around the heart. In some cases, apical hypertrophy may be confused with apical thrombus. Echocardiographic studies with intravenous contrast agents suggest that, in the majority of these cases, poor apical endocardial definition leads to false negative reports. Other noninvasive modalities such as stress perfusion scintigraphy may suggest an enhanced tracer uptake in the apical area of the left ventricle. The definite diagnosis of apical HCM with spade-like configuration was based on published criteria of both an apical wall thickness of 15 mm and a ratio >1.3 of maximum left ventricular short axis thickness at the apical level to the basal level [1-3]. CMR can image in any plane and the introduction of steady state free precession sequences has resulted in a substantial improvement in blood to myocardium contrast, which is ideal for consistent and accurate imaging of the apex [4-5]. Cardiac catheterization is frequently done in these patients due to similarity in symptoms and ECG findings with acute coronary syndromes. Ventriculography shows the classic sign of systolic obliteration of the apex and a small ventricular cavity at the base. An unusual case of apical hypertrophic cardiomyopathy in a transplanted heart

Background: Personalized cancer therapy remains a challenge. In this context, we attempted to identify correlations between tumour angiogenesis, tumour metabolism and tumour cell type. To this aim, we used single=phase multidetector computed tomography (MDCT) and hybrid positron emission tomography-computed tomography (PET/CT) to determine whether net enhancement and standardized uptake value (SUVmax) were correlated with tumour size and cytology in patients affected by non-small cell lung cancer (NSCLC).Material/Methods: Our study included 38 patients (30 men, 8 women, mean age 70) with a NSCLC measuring between 3 cm and 7 cm, using a 16-slice multidetector CT (Brilliance Philips) and with PET-CT (Biograph 16 Siemens Medical Solutions). The following lesion parameters were evaluated: maximum diameter, medium density before contrast injection (CTpre), medium density after contrast injection (CTpost average), density in the most enhanced part of the lesion after contrast (CTpost (max)), net enhancement, SUVmax, age, and cytology. Correlation coefficient and p-value were computed for each pair of variables. In addition, correlations were computed for each pair of variables, and for all combinations of tumour types. We focused on subsets of data with more than 10 observations, and with correlation r>0.500 and p<0.05.Results: A weak correlation (r=0.32; p=0.048) was found between SUVmax and tumour size; the correlation was stronger for masses larger than 31 mm (r=0.4515; p=0.0268). No other correlations were found among the variables examined.Conclusions: Our data may have prognostic significance, and could lead to more appropriate surgical treatment and better treatment outcome.

BACKGROUND:This study investigated whether the follow-up by means of positron emission tomography with computed tomography (PET/CT) is reliable when using different software packages for image reviewing.METHODOLOGY:This study explored the influence of software on patient follow up by analysing images acquired by means of PET/CT equipment. Images were analysed using three software packages. The study included two patients who underwent examinations over the course of 2 years. An expert radiologist selected the regions of interest surrounding the lesions on each slice.RESULTS:We carried out an analysis of differences among software packages on a region of interest and on a volume of interest basis, and using time-course analysis (differences among successive examinations).CONCLUSIONS:Our results suggest that within the limits of the currently available guidelines for PET evaluation, although differences exist among the standardised uptake value measurements by different software packages, they might not alter the qualitative time-course analysis (evaluation of follow-up) if the whole analysis is performed using a fixed package.

Recent data suggest that somatostatin receptors (SSTRs) are expressed on various tumor cells. High-level expression of SSTR on the tumor cell surface provides the basis for the successful clinical use of radiolabeled ligands for the in vivo localization of tumor sites. We have characterized the in vitro binding properties of the novel SSTR ligand "mTc-P829 usingP829 bound to primary tumor cells and tumor cell lines with high affinity and high capacity. The dissociation constants (A,,I ranged between 1 and 20 IIM. '"""Tc-1'829 also bound with high affinity to the transfected hSSTR2 (Ka, 2.5 nM), hSSTRS (Ad, 2 nM), and hSSTR3 (K¿,1.5 nM). Binding of "'""Tt-PH29 to hSSTR3 was found to be displaceable by unla-beled P829/([ReO]-P829), SST-14, and vasoactive intestinal peptide (VIP; IC50, 2 nM) and, less effectively, by Tyr'-octreotide (IC50, 20 nM). In contrast, the binding of 99mTc-P829 to hSSTR2 and hSSTRS could be displaced by P829/([ReO]-P829) and Tyr'-octreotide but not by VIP. 99l"Tc-P829 scintigraphy revealed in vivo binding to primary or metastatic tumor sites in seven of eight patients with breast cancer and six of six patients with melanoma. In summary, our data show that 99n>Tc-P829 binds with high affinity to many different types of primary and cloned tumor cells. Furthermore, our data identify hSS TK2. the VIP acceptor hSSTR3, and hSSTRS as the respective target receptors. Because these receptors are frequently expressed at high levels on primary tumor cells, 99mTc-P829 appears to be a promising novel peptide tracer for tumor imaging.

Lo scompenso cardiaco (SC) è una sindrome secondaria a molteplici patologie. La Risonanza Magnetica Cardiovascolare (RMC), utilizzando la gamma di sequenze a sua disposizione, si sta affermando come il gold standard fra i test non invasivi per determinare l’eziologia di fondo, aggiungere dati prognostici, guidare la terapia nel paziente con SC. Il progresso in questo campo è continuo e rapido, con nuove e promettenti tecniche sulla caratterizzazione tessutale miocardica. Questo articolo discute i diversi ruoli della RMC nello SC. Heart Failure (HF) is a common syndrome with multiple causes. Cardiovascular Magnetic Resonance (CMR), using the available range of technique, is establishing itself as the gold standard non invasive test for determining the underlying aetiology, adding prognostic value, guiding therapy. Progress is continuing and rapid with promising new techniques such as diffuse fibrosis assessment. This paper discusses the diverse roles of CMR in HF.

Introduction: Heart Failure (HF) is a common syndrome with multiple causes. Cardiovascular Magnetic Resonance (CMR), using the available range of technique, is establishing itself as the gold standard non invasive test for determining the underlying aetiology, adding prognostic value, guiding therapy. Progress is continuing and rapid with promising new techniques such as diffuse fibrosis assessment. Objectives: This paper discusses the diverse roles of CMR in HF. © 2012 Societa Italiana di Ecografia Cardiovascolare. Published by Elsevier Srl. All rights reserved.

Aim To evaluate whether the histology and grading of solitary pulmonary nodules (SPNs) correlated with the results of dynamic multiphase multidetector CT (MDCT) and the [18F]fluorodeoxyglucose standardised uptake value (SUV) in 30 patients. Methods Chest x-rays of 270 patients with incidentally detected SPNs were retrospectively evaluated. Thirty patients with histologically proven SPNs were enrolled. On MDCT and positron emission tomography (PET)/CT images, two experts measured the density of nodules in all perfusion phases and the SUV. Net enhancement (NE) was calculated by subtracting peak pre-contrast density from peak post-contrast density. The Pearson test was used to correlate nodule NE, SUV, grading, histology and diameter. Results Of the 30 malignant SPNs, six were classified as G1 (median NE, 31.5 Hounsfield units (HU); median SUV, 4.8 units), 15 were classified as G2 (median NE, 49 HU; median SUV, 6 units), and nine were classified as G3 (median NE, 32 HU; median SUV, 4.5 units). A highly negative correlation was found in G3 SPNs between NE and the corresponding diameters (r=−0.834; p=0.00524). NE increased with the increase in diameter (r=0.982; p=0.284). SUV increased as the SPN diameter increased (r=0.789; p=0.421). NE and SUV were higher in G2 than G1 SPNs, and lower in G2 than G3 SPNs (r=0.97; p=0.137). Conclusions The significant correlation in dedifferentiated (G3) SPNs between NE and diameter (r=−0.834; p=0.00524) supports the theory that stroma and neoangiogenesis are fundamental in SPN growth. The highly negative correlation between NE and diameter demonstrates a net decrease in perfusion despite an increase in dimension. The multidisciplinary approach used herein may result in a more precise prognosis and consequently a better therapeutic outcome, particularly in patients with undifferentiated lung cancer.

Background: The aim of the study was to detect if right ventricular (RV) ejection fraction assessed by real-time 3-dimensional echocardiography (RT3DE) could predict patients with dilated cardiomyopathy (DCM) with greater functional impairment in response to cardiopulmonary exercise.Methods and Results: Seventy chronic heart failure patients with DCM (55.5 +/- 9.1 years; 48 males; 30 ischemic; New York Heart Association Class III: 48) underwent both left ventricular (LV) and RV analysis by RT3DE. Postprocessing software provided data of RT3DE systolic dyssynchrony index of 16 LV segments (systolic dyssynchrony index [SDI]) and of both LV and RV ejection fraction. Cardiac magnetic resonance was performed in a subgroup of 40 DCM patients to confirm RT3DE measurements. All the patients underwent also bicycle cardiopulmonary exercise test with evaluation of oxygen consumption (VO2) peak% (percentage of the predicted value), VE/VCO2 slope, and circulatory power (CP). Mean LV ejection fraction was 29.8 +/- 4.6%. RT3DE LV SDI index was 8.4.4 +/- 4.2, and RV ejection fraction was 51.3 +/- 4.6%. By cardiopulmonary test, mean VO2 peak was 15.2 +/- 4.4 mL . kg . min, and mean CP was 2.1 +/- 0.8. By univariable analyses, significant correlations were detectable between SDI index and VO2 peak% (r = -0.56; P < .0001) and peak CP (r = -0.48; P < .0005). Also RV ejection fraction directly correlated with VO2 peak % (r = -0.58; P < .0001) and inversely with VE/VCO2 slope (r = -0.44; P < .001). By multivariable analysis. SDI index (beta coefficient = -0.46; P < .001) and 3D RV ejection fraction 63 coefficient = 0.42; P < .001) emerged as the only independent determinants of VO2 peak% during cardiopulmonary test.Conclusions: Increased LV electromechanical dyssynchrony and impaired RV function in DCM patients arc independently associated with worse ability to perform aerobic exercise. (J Cardiac Fail 20'1;17:309-317)

Man cannot predict the future, he can invent it. —Dennis Gabor The sensitivity of mammography in detecting breast abnormalities is close to 90%; the specificity in detecting breast cancer is, conversely, as low as 50%. In current clinical practice, these statistics lead to an elevated number of