December 01, 2012
The following are highlights from current issues of RSNA’s two peer-reviewed journals.
Performance of FDG PET/CT in the Clinical Management of Breast Cancer
PET with fluorine 18 (18F) fluorodeoxyglucose (FDG) has an important role in oncology while its role in the management of patients with breast cancer continues to evolve.
In a State-of-the-Art review in the January issue of Radiology (RSNA.org/Radiology), David Groheux, M.D., PhD., of Saint-Louis Hospital, Paris, and colleagues examine the principles of FDG PET/CT focusing on breast imaging and assess the advantages and limits of this approach at diagnosis, initial staging, follow up and evaluation of response to therapy in breast cancer. Specifically, the authors discuss the following regarding FDG PET/CT:
- Its usefulness in differentiating malignant from benign breast lesions
- Whether it can replace sentinel node biopsy for axillary staging
- Its role in initial staging of inflammatory or locally advanced breast cancer and in initial staging of clinical stage IIA and IIB and
primary operable stage IIIA breast cancer
- How it compares with conventional techniques in the restaging of cancer in patients suspected of having disease recurrence
- Its role in the assessment of early response to neoadjuvant therapy and of response to therapy for metastatic disease
Combined PET/CT is more sensitive and specific than either of its constituent imaging methods, according to the authors.
“It facilitates distinguishing normal physiologic uptake from pathologic FDG uptake, allows accurate localization of functional abnormalities and reduces the incidence of false-positive and false-negative results of imaging studies,” the authors write. “The factors that influence FDG uptake by breast tumors have an implication on how to interpret FDG PET/CT scans and who is the appropriate patient for imaging.”
Complications of Aortic Valve Surgery: Manifestations at CT and MR Imaging
Because postoperative complications of aortic valve surgery remain a substantial source of morbidity and mortality, routine surveillance of prosthetic heart valves with transthoracic echocardiography (TTE), transesophageal echocardiography (TEE) and fluoroscopy is critical.
However, MR and CT are emerging as diagnostic tools complementary to conventional imaging for detecting and monitoring complications after aortic valve replacement, according to an article in the November-December 2012 issue of RadioGraphics (RSNA.org/RadioGraphics). Along with discussing that emerging role, Nancy Pham, M.D., of the Cleveland Clinic, and colleagues present CT and MR imaging appearances of a broad spectrum of prosthetic aortic valve diseases, including:
- Paravalvular or valvular regurgitation
- Valve dehiscence
- Prosthetic valve endocarditis (PVE) and abscess formation
- Obstruction (thrombosis versus pannus)
- Structural failure
- Pseudoaneurysm formation
The choice between CT and MR imaging depends on individual patient characteristics, the type of prosthetic valve, and the acuity of the clinical situation, according to the authors.
“In general, screening with TTE followed by TEE is recommended,” the authors write. “When results of TTE and TEE are inconclusive, cardiac CT and MR imaging should be considered. The choice between these imaging techniques depends on the presence of patient-specific contraindications to CT or MR imaging.”
This article meets the critera for AMA PRA Category 1 Credit™. CME is available in print and online.
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