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  • Journal Highlights

    December 01, 2012

    The following are highlights from current issues of RSNA’s two peer-reviewed journals.

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    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.”

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    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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    PET/CT image of invasive ductal carcinoma of the left breast
    Invasive ductal carcinoma of the left breast in a 61-year-old woman who had undergone aesthetic breast surgery, with bilateral breast prosthesis, 10 years earlier. Before PET/CT, the tumor was classified as a T2N2 lesion (primary tumor of 45 mm with ipsilateral matted level I axillary lymph node metastases). (a) PET/CT image shows high FDG uptake in the primary tumor (SUVmax, 15.7).
    PET/CT image show FDG uptake also in asilla
    (b) PET/CT image shows FDG uptake also in axilla, level I (arrowhead), as well as in infraclavicular nodes (axilla, level III [long arrow]), medial to the pectoralis minor muscle (short arrow). With PET/CT results, the tumor was classified as a T2N3a lesion. (Radiology 2012;266;1 (In Press) ©RSNA, 2012. All rights reserved. Printed with permission.
    Perigraft pseudoaneurysms in a 71-year-old woman with a prosthetic aortic valve. Sagittal oblique (b) maximum intensity projection CT images show two contained collections (white arrows) associated wi
    Perigraft pseudoaneurysms in a 71-year-old woman with a prosthetic aortic valve. Sagittal oblique (b) maximum intensity projection CT images show two contained collections (white arrows) associated with the prosthesis (black arrow in b). These findings are consistent with pseudoaneurysms. Ao = aorta. (RadioGraphics 2012;32;7:1873-1892) ©RSNA, 2012. All rights reserved. Printed with permission.
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