UROLOGICAL SURVEY
Imaging
Issues, controversies, and clinical utility of combined PET/CT imaging: what is the interpreting physician facing?
Blodgett TM, Casagranda B, Townsend DW, Meltzer CC
Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
AJR Am J Roentgenol. 2005; 184 (5 Suppl): S138-45
OBJECTIVE: This article identifies the most commonly encountered issues of combined PET/CT and shows the wide variability in perceived possible solutions to these issues. This article will serve as a catalyst to stimulate discussion between experts in both radiology and nuclear medicine.
CONCLUSION:Combining a PET tomography and CT scanner into a single unit amounts to advantages that are not merely additive, but synergistic. Even PET/CT skeptics will embrace the technology after becoming acquainted with the possibilities and will accept the reality that there is no return to PET only.
Editorial Comment
Combined PET/CT scanners are rapidly becoming the new standard in oncologic imaging because provides information on the morphology and function of tumors in one examination. This technology incorporates a multislice helical CT (16 or more channels) and high-resolution PET scanners. The information offered by this method has superior diagnostic capabilities and are very useful for staging neoplasms and radiation therapy planning. This an excellent article that discusses with clarity all very important issues related to the application of this new technology. Several interesting issues are discussed such as protocols of examination, how and by whom the scans are interpreted, the variability in reporting methods, where is the best place for the equipment and many other operational, educational and legal issues. The authors emphasizes that at this stage, the best indications of PET/CT are for staging patients with lymphoma, lung and colorectal cancer and for restaging patients who have undergone extensive surgery or who have had significant levels of radiation, both of which tend to distort normal anatomy and cause inflammatory changes (head and neck, colorectal, thyroid and ovarian cancer, and lymphoma). Although at this stage the role of PET/CT in the evaluation of urological malignancies is limited (detection of metastases and recurrences of renal cell cancer, identification of vital tumor tissue after chemotherapy of seminomatous germ cell tumors and detection of nodal metastases from bladder cancer), we still b recommend the reading of this manuscript which will help the urologist to understand the several complex issues related to the application of this technology.
Dr. Adilson Prando
Chief, Department of Radiology
Vera Cruz Hospital
Campinas, São Paulo, Brazil
Radiologic findings of segmental testicular infarction
Fernandez-Perez GC, Tardaguila FM, Velasco M, Rivas C, Dos Santos J, Cambronero J, Trinidad C, San Miguel P
Radiology Department, Povisa Medical Center, Vigo (Pontevedra), Spain
AJR Am J Roentgenol. 2005; 184: 1587-93
OBJECTIVE: Our objective was to describe the radiologic findings of segmental testicular infarction and to establish a proper diagnosis that can avoid orchiectomy.
CONCLUSION: The presence of a triangular-shaped avascular intratesticular lesion on sonography or MRI and enhancement of the surrounding borders on enhanced MR images may suggest a presurgical diagnosis of segmental testicular infarction and therefore avoid a total orchiectomy in these patients.
Editorial Comment
The authors present interesting imaging findings observed in 12 patients with a relatively rare testicular disorder such is segmental testicular infarction. This condition which usually presents as an acute scrotum and may be associated with epididymoorchitis, hematologic disorders, vasculitis and postoperative changes, is usually diagnosed only after orchiectomy. In this series, an acute scrotum was the most frequent clinical presentation, being observed in 8 of 12 patients (67%). Ultrasound findings were very suggestive of this entity (solid and wedge shaped avascular area on color Doppler examination, with the vertex at the testicular mediastinum). Occasionally, however, a small rounded solid mass simulating an intratesticular tumor was observed. On contrast enhanced T1-weighted MR images, segmental testicular infarction showed an enhanced rim surrounding the lesion in 92 % of patients. This paper is very important for calling the attention of the radiologist and urologist in order to recognize segmental testicular infarction and thus to avoid unnecessary orchiectomy. The authors concluded that these imaging findings (ultrasound and complimentary MRI in difficult cases), associated with the negative tumoral markers and short follow-up, should allow confidence in the diagnosis and thus avoid orchiectomy.
Dr. Adilson Prando
Chief, Department of Radiology
Vera Cruz Hospital
Campinas, São Paulo, Brazil
Publication Dates
-
Publication in this collection
19 Aug 2005 -
Date of issue
June 2005
