Objective:

To evaluate the significance of incidentally discovered breast lesions on 18-fludeoxyglucose ((18)F-FDG) positron emission tomography (PET)/CT.

Methods:

6050 (18)F-FDG PET/CT studies, performed between January 2009 and February 2012, were retrospectively reviewed. 55 lesions in 50 patients were identified. Additional work-up, including mammography, ultrasound, follow-up (18)F-FDG PET/CT and biopsy, was available for 39 incidental breast lesions in 36 patients. All patients were female, with mean age 61.5 years (range 36-90 years). The maximum standardised uptake value (SUVmax), CT size and CT Breast Imaging Reporting and Data System (BI-RADS®) scores were compared between the malignant and the benign subgroups, using the unpaired t-test and Fisher's exact test. Tests were two-sided and a p-value of <0.05 was considered to be significant.

Results:

Incidental breast lesions were identified in 50 (0.8%) of 6050 (18)F-FDG PET/CT studies. 21 (53.8%) of the 39 breast incidentalomas were malignant on biopsy or imaging, of which 15 (38.5%) represented a second primary breast cancer. A statistically significant difference in the mean SUVmax between malignant and benign breast lesions was observed (p=0.021). Malignancy was significantly more common in the CT BI-RADS Category 4 or greater groups (76.2%; p=0.0105).

Conclusion:

Incidental breast lesions detected at (18)F-FDG PET/CT are uncommon. When detected, however, they may represent malignancy in up to 53.8% of cases. Advances in knowledge: SUVmax and CT findings at (18)F-FDG PET/CT can assist with differentiating benign and malignant breast conditions, guiding further evaluation with dedicated breast imaging. Review of (18)F-FDG PET/CT-detected breast lesions by a breast radiologist may be helpful in determining the need for and correlation with further breast imaging. Radiologists and nuclear medicine physicians should be cognisant of breast pathology when reporting (18)F-FDG PET/CT image data sets.

This paper argues for the use of CT colonography (CTC) to investigate patients with symptoms potentially suggestive of colorectal cancer. It describes the rationale for the UK Special Interest Group in Gastrointestinal and Abdominal Radiology (SIGGAR) randomised controlled trials that compared CTC with barium enema (BE) or colonoscopy for diagnosis of colorectal cancer or large polyps in symptomatic patients. Diagnostic outcomes from the trials are detailed for both intra- and extracolonic disease, along with psychological reactions of patients to the tests, and cost-effectiveness of the different diagnostic strategies. The author concludes that BE should be replaced by CTC immediately and that CTC is a sensitive, acceptable and equally cost-effective alternative to colonoscopy in patients in whom colonoscopy is contraindicated or undesirable.

We evaluated the diagnostic role of ultrasonography-guided core needle biopsy (CNB) according to ultrasonography features of thyroid nodules that had inconclusive ultrasonography-guided fine-needle aspiration (FNA) results.A total of 88 thyroid nodules in 88 patients who underwent ultrasonography-guided CNB because of previous inconclusive FNA results were evaluated. The patients were classified into three groups based on ultrasonography findings: Group A, which was suspicious for papillary thyroid carcinoma (PTC); Group B, which was suspicious for follicular (Hurthle cell) neoplasm; and Group C, which was suspicious for lymphoma. The final diagnoses of the thyroid nodules were determined by surgical confirmation or follow-up after ultrasonography-guided CNB.Of the 88 nodules, the malignant rate was 49.1% in Group A, 12.0% in Group B and 90.0% in Group C. The rates of conclusive ultrasonography-guided CNB results after previous incomplete ultrasonography-guided FNA results were 96.2% in Group A, 64.0% in Group B and 90.0% in Group C (p=0.001). 12 cases with inconclusive ultrasonography-guided CNB results were finally diagnosed as 8 benign lesions, 3 PTCs and 1 lymphoma. The number of previous ultrasonography-guided FNA biopsies was not significantly different between the conclusive and the inconclusive result groups of ultrasonography-guided CNB (p=0.205).Ultrasonography-guided CNB has benefit for the diagnosis of thyroid nodules with inconclusive ultrasonography-guided FNA results. However, it is still not helpful for the differential diagnosis in 36% of nodules that are suspicious for follicular neoplasm seen on ultrasonography. Advances in knowledge: This study shows the diagnostic contribution of ultrasonography-guided CNB as an alternative to repeat ultrasonography-guided FNA or surgery.

To assess the palatability of iodinated oral contrast media commonly used in abdominopelvic CT and CT colonography (CTC).80 volunteers assessed the palatability of a 20-ml sample of a standard 30 mg ml(-1) dilution of Omnipaque® (iohexol; GE Healthcare, Cork, Ireland), Telebrix® (meglumine ioxithalamate; Guerbet, Aulnay-sous-Bois, France), Gastromiro® (iopamidol; Bracco, High Wycombe, UK) and Gastrografin® (sodium diatrizoate and meglumine diatrizoate; Bayer, Newbury, UK) in a computer-generated random order.Gastrografin is rated significantly less palatable than the remaining media (p<0.005). Omnipaque and Telebrix are significantly more palatable than Gastromiro. No difference existed between Omnipaque and Telebrix. 39% of participants would refuse to consume the quantities of Gastrografin required for a CTC examination compared with Telebrix (7%) and Omnipaque (9%) (p<0.05).Omnipaque and Telebrix are significantly more palatable than both Gastromiro and Gastrografin, with participants more willing to ingest them in larger quantities as well as being less expensive. Advances in knowledge: Omnipaque and Telebrix are significantly more palatable iodinated oral contrast media than both Gastromiro and Gastrografin, which has potential implications in compliance with both abdominopelvic CT and CTC.

A well-attended meeting, called "Brainstorming discussion for a possible biomedical facility at CERN", was held by the European Organization for Nuclear Research (CERN) at the European Laboratory for Particle Physics on 25 June 2012. This was concerned with adapting an existing, but little used, 78-m circumference CERN synchrotron to deliver a wide range of ion species, preferably from protons to at least neon ions, with beam specifications that match existing clinical facilities. The potential extensive research portfolio discussed included beam ballistics in humanoid phantoms, advanced dosimetry, remote imaging techniques and technical developments in beam delivery, including gantry design. In addition, a modern laboratory for biomedical characterisation of these beams would allow important radiobiological studies, such as relative biological effectiveness, in a dedicated facility with standardisation of experimental conditions and biological end points. A control photon and electron beam would be required nearby for relative biological effectiveness comparisons. Research beam time availability would far exceed that at other facilities throughout the world. This would allow more rapid progress in several biomedical areas, such as in charged hadron therapy of cancer, radioisotope production and radioprotection. The ethos of CERN, in terms of open access, peer-reviewed projects and governance has been so successful for High Energy Physics that application of the same to biomedicine would attract high-quality research, with possible contributions from Europe and beyond, along with potential new funding streams.

Determine values of pathological analysis of the canister content during a vacuum-assisted breast biopsy (VABB).Approval was obtained from the ethical committee. Prospective radiological and pathological analyses of the canister content collected during 231 VABBs performed on 231 patients were carried out. χ(2) test was used to determine predictors on canister pathology.The canister pathology was reported separately in 212 cases. It showed only blood in 78/212 (37%) cases and benign (including high-risk lesions) and malignant results in, respectively, 113/212 (53%) and 21/212 (10%) cases. Respective specimen analysis was benign, including high-risk lesions in 162/212 cases (76%) and malignant in 50/212 (24%) cases. Microcalcifications were documented on canister X-ray in 70/231 (30%) cases. There was significant association between the canister and the specimen pathology (p<0.0001). In none of the cases was microcalcifications seen exclusively in the canister content or pathological upgrading found in the canister content compared with the specimen.Small tissue fragments and microcalcifications may be lost in the canister during a VABB. Nevertheless, our results did not show any significant value for systematic analysis of the canister content. Advances in knowledge: There is no added diagnostic value to retrieval and analysis of tissue lost in the canister during a VABB.

Objective:

To compare the sensitivity of gastro-oesophageal reflux (GOR) scintigraphy at 5-s and 60-s frame acquisition rates.

Methods:

GOR scintigraphy of 50 subjects (1 month-20 years old, mean 42 months) were analysed concurrently using 5-s and 60-s acquisition frames. Reflux episodes were graded as low if activity was detected in the distal half of the oesophagus and high if activity was detected in its upper half or in the oral cavity. For comparison purposes, detected GOR in any number of 5-s frames corresponding to one 60-s frame was counted as one episode.

Results:

A total of 679 episodes of GOR to the upper oesophagus were counted using a 5-s acquisition technique. Only 183 of such episodes were detected on 60-s acquisition images. To the lower oesophagus, a total of 1749 GOR episodes were detected using a 5-s acquisition technique and only 1045 episodes using 60-s acquisition frames (these also included the high-level GOR on 5-s frames counted as low level on 60-s acquisition frames). 10 patients had high-level GOR episodes that were detected only using a 5-s acquisition technique, leading to a different diagnosis in these patients. No correlation between the number of reflux episodes and the gastric emptying rates was noted.

Conclusion:

The 5-s frame acquisition technique is more sensitive than the 60-s frame acquisition technique for detecting both high- and low-level GOR. Advances in knowledge: Brief GOR episodes with a relatively low number of radioactive counts are frequently indistinguishable from intense background activity on 60-s acquisition frames.

Objective:

Brachytherapy employing iodine-125 seeds is an established treatment for low-risk prostate cancers. Post-implant dosimetry (PID) is an important tool for identifying suboptimal implants. The aim of this work was to improve suboptimal implants by a subsequent iodine-125 seed top-up (reimplantation), based on the PID results.

Methods:

Of 255 patients treated between 2009 and 2012, 6 were identified as having received suboptimal implants and were scheduled for seed top-up. Needle configurations and the number of top-up seeds were determined based on post-implant CT images as well as a reimplantation treatment plan. An average of 14 seeds per patient were implanted during each top-up. Dosimetric outcome was assessed via target parameters and doses received by organs at risk.

Results:

All six patients had a successful top-up, with a 67% increase in the mean dose delivered to 90% of the prostate volume and a 40% increase in the volume that receives 100% of the prescribed dose. However, the final dosimetric assessment was based on the same seed activity, as the planning system does not account for the decay of the initially implanted seeds. Although physical dosimetry is not influenced by different seed activities (doses are calculated to infinity), the radiobiological implications might be slightly different from the situation when optimal implantation is achieved with one treatment only.

Conclusion:

Seed reimplantation in suboptimal prostate implants is feasible and leads to successful clinical outcomes. Advances in knowledge: Suboptimal prostate implants can occur for various reasons. This work shows that seed reimplantation as salvage therapy can lead to an optimal dosimetric outcome with manageable normal tissue effects.