Diagnostics

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Open AccessReview

Contrast Enhanced MRI in the Diagnosis of HCC

by Eric Niendorf, Benjamin Spilseth, Xiao Wang and Andrew Taylor

Diagnostics 2015, 5(3), 383-398; https://doi.org/10.3390/diagnostics5030383 - 21 Sep 2015

Cited by 28 | Viewed by 10876

Hepatocellular carcinoma (HCC) is the 6th most common cancer worldwide. Imaging plays a critical role in HCC screening and diagnosis. Initial screening of patients at risk for HCC is performed with ultrasound. Confirmation of HCC can then be obtained by Computed Tomography (CT) [...] Read more.

Hepatocellular carcinoma (HCC) is the 6th most common cancer worldwide. Imaging plays a critical role in HCC screening and diagnosis. Initial screening of patients at risk for HCC is performed with ultrasound. Confirmation of HCC can then be obtained by Computed Tomography (CT) or Magnetic Resonance Imaging (MRI), due to the relatively high specificity of both techniques. This article will focus on reviewing MRI techniques for imaging HCC, felt by many to be the exam of choice for HCC diagnosis. MRI relies heavily upon the use of gadolinium-based contrast agents and while primarily extracellular gadolinium-based contrast agents are used, there is an emerging role of hepatobiliary contrast agents in HCC imaging. The use of other non-contrast enhanced MRI techniques for assessing HCC will also be discussed and these MRI strategies will be reviewed in the context of the pathophysiology of HCC to help understand the MR imaging appearance of HCC. Full article

(This article belongs to the Special Issue NMR in Medicine)

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Open AccessCase Report

Use of Molecular Imaging Markers of Glycolysis, Hypoxia and Proliferation (¹⁸F-FDG, ⁶⁴Cu-ATSM and ¹⁸F-FLT) in a Dog with Fibrosarcoma: The Importance of Individualized Treatment Planning and Monitoring

by Kamilla Westarp Zornhagen, Malene M. Clausen, Anders E. Hansen, Ian Law, Fintan J. McEvoy, Svend A. Engelholm, Andreas Kjær and Annemarie T. Kristensen

Diagnostics 2015, 5(3), 372-382; https://doi.org/10.3390/diagnostics5030372 - 11 Sep 2015

Cited by 3 | Viewed by 7264

Abstract

Glycolysis, hypoxia, and proliferation are important factors in the tumor microenvironment contributing to treatment-resistant aggressiveness. Imaging these factors using combined functional positron emission tomography and computed tomography can potentially guide diagnosis and management of cancer patients. A dog with fibrosarcoma was imaged using [...] Read more.

Glycolysis, hypoxia, and proliferation are important factors in the tumor microenvironment contributing to treatment-resistant aggressiveness. Imaging these factors using combined functional positron emission tomography and computed tomography can potentially guide diagnosis and management of cancer patients. A dog with fibrosarcoma was imaged using ¹⁸F-FDG, ⁶⁴Cu-ATSM, and ¹⁸F-FLT before, during, and after 10 fractions of 4.5 Gy radiotherapy. Uptake of all tracers decreased during treatment. Fluctuations in ¹⁸F-FDG and ¹⁸F-FLT PET uptakes and a heterogeneous spatial distribution of the three tracers were seen. Tracer distributions partially overlapped. It appears that each tracer provides distinct information about tumor heterogeneity and treatment response. Full article

(This article belongs to the Collection Feature Papers)

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Open AccessInteresting Images

Pelvic Actinomycosis Associated with an Intrauterine Contraceptive Device Demonstrated on F-18 FDG PET/CT

by Danijela Dejanović, Jan Anders Ahnlide, Cecilia Nilsson, Anne Kiil Berthelsen and Annika Loft

Diagnostics 2015, 5(3), 369-371; https://doi.org/10.3390/diagnostics5030369 - 28 Aug 2015

Cited by 3 | Viewed by 6187

Abstract

A 44-year-old woman with a history of dysmenorrhea, obstipation, and low back pain was investigated for gynecological disorder. Physical examination indicated a “frozen pelvis”. Ultrasound examination revealed the ovaries adherent to the uterus, bilateral ovarian cysts, and an intrauterine contraceptive device in situ [...] Read more.

A 44-year-old woman with a history of dysmenorrhea, obstipation, and low back pain was investigated for gynecological disorder. Physical examination indicated a “frozen pelvis”. Ultrasound examination revealed the ovaries adherent to the uterus, bilateral ovarian cysts, and an intrauterine contraceptive device in situ, which reportedly had been in place for 19 years. Prior to a scheduled laparoscopy, the patient returned with oedema of the lower abdomen and legs, fatigue, and weight loss. Laboratory findings included elevated CA-125, anemia, leucocytosis and high C-reactive protein. Pelvic actinomycosis was subsequently diagnosed. We report the PET/CT appearance of this condition. Full article

(This article belongs to the Collection Hybrid Imaging in Medicine)

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Open AccessCase Report

Evaluation of Alpha-Therapy with Radium-223-Dichloride in Castration Resistant Metastatic Prostate Cancer—the Role of Gamma Scintigraphy in Dosimetry and Pharmacokinetics

by Kalevi Kairemo, Timo Joensuu, Nigora Rasulova, Timo Kiljunen and Aki Kangasmäki

Diagnostics 2015, 5(3), 358-368; https://doi.org/10.3390/diagnostics5030358 - 30 Jul 2015

Cited by 11 | Viewed by 6200

Abstract

Radium-223-dichloride (²²³RaCl₂) is a new bone-seeking calcium analogue alpha-emitter, which has obtained marketing authorization for the treatment skeletal metastases of hormone-refractory prostate cancer. The current treatment regimen is based on six consecutive doses of ²²³RaCl₂ at 4 [...] Read more.

Radium-223-dichloride (²²³RaCl₂) is a new bone-seeking calcium analogue alpha-emitter, which has obtained marketing authorization for the treatment skeletal metastases of hormone-refractory prostate cancer. The current treatment regimen is based on six consecutive doses of ²²³RaCl₂ at 4 week intervals and the administered activity dose, 50 kBq/kg per cycle is based on patient weight. We analyzed two patients using quantitative serial gamma imaging to estimate dosimetry in tumors and see possible pharmacokinetic differences in the treatment cycles. The lesions were rather well visualized in gamma scintigraphy in spite of low gamma activity (<1.1% gamma radiation) at 0, 7 and 28 days using 30–60 min acquisition times. Both our patients analyzed in serial gamma imagings, had two lesions in the gamma imaging field, the mean counts of the relative intensity varied from 27.8 to 36.5 (patient 1), and from 37.4 to 82.2 (patient 2). The half-lives varied from 1.8 days to 4.5 days during the six cycles (patient 1), and from 1.5 days to 3.6 days (patient 2), respectively. In the lesion half-lives calculated from the imaging the maximum difference between the treatment cycles in the same lesion was 2.0-fold (1.8 vs. 3.6). Of these patients, patient 1 demonstrated a serum PSA response, whereas there was no PSA response in patient 2. From our data, there were maximally up to 4.0-fold differences (62.1 vs. 246.6 ) between the relative absorbed radiation doses between patients as calculated from the quantitative standardized imaging to be delivered in only two lesions, and in the same lesion the maximum difference in the cycles was up to 2.3-fold (107.4 vs. 246.6). Our recommendation based on statistical simulation analysis, is serial measurement at days 0–8 at least 3 times, this improve the accuracy significantly to study the lesion activities, half-lives or calculated relative absorbed radiation doses as calculated from the imaging. Both our patients had originally two metastatic sites in the imaging field; the former patient demonstrated a serum PSA response and the latter demonstrated no PSA response. In these two patients there was no significant difference in the lesion activities, half-lives or calculated relative absorbed radiation doses as calculated from the quantitative imaging. Our results, although preliminary, suggest that dose monitoring can be included as a part of this treatment modality. On the other hand, from the absorbed radiation doses, the response cannot be predicted because with very similar doses, only the former patient responded. Full article

(This article belongs to the Special Issue Prostate Cancer Diagnosis)

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Open AccessReview

PET/MRI in Oncological Imaging: State of the Art

by Usman Bashir, Andrew Mallia, James Stirling, John Joemon, Jane MacKewn, Geoff Charles-Edwards, Vicky Goh and Gary J. Cook

Diagnostics 2015, 5(3), 333-357; https://doi.org/10.3390/diagnostics5030333 - 21 Jul 2015

Cited by 37 | Viewed by 10685

Abstract

Positron emission tomography (PET) combined with magnetic resonance imaging (MRI) is a hybrid technology which has recently gained interest as a potential cancer imaging tool. Compared with CT, MRI is advantageous due to its lack of ionizing radiation, superior soft-tissue contrast resolution, and [...] Read more.

Positron emission tomography (PET) combined with magnetic resonance imaging (MRI) is a hybrid technology which has recently gained interest as a potential cancer imaging tool. Compared with CT, MRI is advantageous due to its lack of ionizing radiation, superior soft-tissue contrast resolution, and wider range of acquisition sequences. Several studies have shown PET/MRI to be equivalent to PET/CT in most oncological applications, possibly superior in certain body parts, e.g., head and neck, pelvis, and in certain situations, e.g., cancer recurrence. This review will update the readers on recent advances in PET/MRI technology and review key literature, while highlighting the strengths and weaknesses of PET/MRI in cancer imaging. Full article

(This article belongs to the Collection Hybrid Imaging in Medicine)

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Open AccessArticle

Molecular Imaging of Tumors Using a Quantitative T₁ Mapping Technique via Magnetic Resonance Imaging

by Kelsey Herrmann, Mette L. Johansen, Sonya E. Craig, Jason Vincent, Michael Howell, Ying Gao, Lan Lu, Bernadette Erokwu, Richard S. Agnes, Zheng-Rong Lu, Jonathan K. Pokorski, James Basilion, Vikas Gulani, Mark Griswold, Chris Flask and Susann M. Brady-Kalnay

Diagnostics 2015, 5(3), 318-332; https://doi.org/10.3390/diagnostics5030318 - 17 Jul 2015

Cited by 15 | Viewed by 6346

Abstract

Magnetic resonance imaging (MRI) of glioblastoma multiforme (GBM) with molecular imaging agents would allow for the specific localization of brain tumors. Prior studies using T₁-weighted MR imaging demonstrated that the SBK2-Tris-(Gd-DOTA)₃ molecular imaging agent labeled heterotopic xenograft models of brain [...] Read more.

Magnetic resonance imaging (MRI) of glioblastoma multiforme (GBM) with molecular imaging agents would allow for the specific localization of brain tumors. Prior studies using T₁-weighted MR imaging demonstrated that the SBK2-Tris-(Gd-DOTA)₃ molecular imaging agent labeled heterotopic xenograft models of brain tumors more intensely than non-specific contrast agents using conventional T₁-weighted imaging techniques. In this study, we used a dynamic quantitative T₁ mapping strategy to more objectively compare intra-tumoral retention of the SBK2-Tris-(Gd-DOTA)₃ agent over time in comparison to non-targeted control agents. Our results demonstrate that the targeted SBK2-Tris-(Gd-DOTA)₃ agent, a scrambled-Tris-(Gd-DOTA)₃ control agent, and the non-specific clinical contrast agent Optimark™ all enhanced flank tumors of human glioma cells with similar maximal changes on T₁ mapping. However, the retention of the agents differs. The non-specific agents show significant recovery within 20 min by an increase in T₁ while the specific agent SBK2-Tris-(Gd-DOTA)₃ is retained in the tumors and shows little recovery over 60 min. The retention effect is demonstrated by percent change in T₁ values and slope calculations as well as by calculations of gadolinium concentration in tumor compared to muscle. Quantitative T₁ mapping demonstrates the superior binding and retention in tumors of the SBK2-Tris-(Gd-DOTA)₃ agent over time compared to the non-specific contrast agent currently in clinical use. Full article

(This article belongs to the Special Issue NMR in Medicine)

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Open AccessReview

Hybrid Imaging for Patient-Specific Dosimetry in Radionuclide Therapy

by Michael Ljungberg and Katarina Sjögreen Gleisner

Diagnostics 2015, 5(3), 296-317; https://doi.org/10.3390/diagnostics5030296 - 10 Jul 2015

Cited by 18 | Viewed by 7686

Abstract

Radionuclide therapy aims to treat malignant diseases by systemic administration of radiopharmaceuticals, often using carrier molecules such as peptides and antibodies. The radionuclides used emit electrons or alpha particles as a consequence of radioactive decay, thus leading to local energy deposition. Administration to [...] Read more.

Radionuclide therapy aims to treat malignant diseases by systemic administration of radiopharmaceuticals, often using carrier molecules such as peptides and antibodies. The radionuclides used emit electrons or alpha particles as a consequence of radioactive decay, thus leading to local energy deposition. Administration to individual patients can be tailored with regards to the risk of toxicity in normal organs by using absorbed dose planning. The scintillation camera, employed in planar imaging or single-photon emission computed tomography (SPECT), generates images of the spatially and temporally varying activity distribution. Recent commercially available combined SPECT and computed tomography (CT) systems have dramatically increased the possibility of performing accurate dose planning by using the CT information in several steps of the dose-planning calculation chain. This paper discusses the dosimetry chain used for individual absorbed-dose planning and highlights the areas where hybrid imaging makes significant contributions. Full article

(This article belongs to the Collection Hybrid Imaging in Medicine)

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Open AccessEditorial

Introducing Interesting Images

by Andreas Kjaer

Diagnostics 2015, 5(3), 294-295; https://doi.org/10.3390/diagnostics5030294 - 09 Jul 2015

Cited by 3 | Viewed by 4292

Abstract

Since the launch of Diagnostics, a major part of contributions have been within the field of medical imaging.[...] Full article

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Open AccessInteresting Images

Brown Tumors Due to Primary Hyperparathyroidism in a Patient with Parathyroid Carcinoma Mimicking Skeletal Metastases on ¹⁸F-FDG PET/CT

by Kim Francis Andersen and Elisabeth Albrecht-Beste

Diagnostics 2015, 5(3), 290-293; https://doi.org/10.3390/diagnostics5030290 - 09 Jul 2015

Cited by 9 | Viewed by 5867

Abstract

Parathyroid carcinoma only represents <1% of all cases of primary hyperparathyroidism (PHPT). Even rare, chronic PHPT may lead to excessive osteoclast activity, and the increased resorption leads to destruction of cortical bone and formation of fibrous cysts with deposits of hemosiderin—so-called brown tumors. [...] Read more.

Parathyroid carcinoma only represents <1% of all cases of primary hyperparathyroidism (PHPT). Even rare, chronic PHPT may lead to excessive osteoclast activity, and the increased resorption leads to destruction of cortical bone and formation of fibrous cysts with deposits of hemosiderin—so-called brown tumors. These benign, osteolytic lesions may demonstrate FDG-avidity on ¹⁸F-FDG PET/CT, and as such are misinterpreted as skeletal metastases. Regression of the lesions may occur following successful treatment. We present a case demonstrating the diagnostic work-up and follow-up of a patient with PHPT due to parathyroid carcinoma and with presence of brown tumors on ¹⁸F-FDG PET/CT, visualizing the possible role of this imaging modality in the evaluation of treatment response in these patients. Full article

(This article belongs to the Collection Hybrid Imaging in Medicine)

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Open AccessInteresting Images

In Vivo Phenotyping of Tumor Metabolism in a Canine Cancer Patient with Simultaneous ¹⁸F-FDG-PET and Hyperpolarized ¹³C-Pyruvate Magnetic Resonance Spectroscopic Imaging (hyperPET): Mismatch Demonstrates that FDG may not Always Reflect the Warburg Effect

by Henrik Gutte, Adam E. Hansen, Majbrit M.E. Larsen, Sofie Rahbek, Helle H. Johannesen, Jan Ardenkjaer-Larsen, Annemarie T. Kristensen, Liselotte Højgaard and Andreas Kjaer

Diagnostics 2015, 5(3), 287-289; https://doi.org/10.3390/diagnostics5030287 - 26 Jun 2015

Cited by 9 | Viewed by 5915

Abstract

In this communication the mismatch between simultaneous ¹⁸F-FDG-PET and a ¹³C-lactate imaging (hyperPET) in a biopsy verified squamous cell carcinoma in the right tonsil of a canine cancer patient is shown. The results demonstrate that ¹⁸F-FDG-PET may not always reflect [...] Read more.

In this communication the mismatch between simultaneous ¹⁸F-FDG-PET and a ¹³C-lactate imaging (hyperPET) in a biopsy verified squamous cell carcinoma in the right tonsil of a canine cancer patient is shown. The results demonstrate that ¹⁸F-FDG-PET may not always reflect the Warburg effect in all tumors. Full article

(This article belongs to the Collection Hybrid Imaging in Medicine)

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Diagnostics, Volume 5, Issue 3 (September 2015) – 10 articles , Pages 287-398

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