Precise Anatomical Localization Research Articles

Contribution of 111In-pentetreotide SPECT/CT imaging to conventional somatostatin receptor scintigraphy in the detection of neuroendocrine tumours

The aim of the study was to assess the contribution of 111In-pentetreotide single-photon emission computed tomography/computed tomography (SPECT/CT) imaging to conventional somatostatin receptor scintigraphy (SRS) in terms of lesion characterization and localization in the detection of neuroendocrine tumours (NETs). A total of 107 patients with suspected or confirmed NET underwent SRS and SPECT/CT after the injection of 148-222 MBq of 111In-pentetreotide. SRS and SPECT/CT images were interpreted independently. Each site of abnormal tracer uptake was recorded according to the anatomical localization, and as being consistent or not with NET. The findings were confirmed with pathological and/or clinical/imaging follow-up data. A final diagnosis of NET was achieved in 49/107 patients (45.8%). No evidence of NET was found in the rest. SPECT/CT resulted in a significant reduction of indeterminate cases [14/107 (13.1%) vs. 1/107 (0.9%); P<0.001] and correctly reclassified one patient as negative for NET and another as positive for NET. SPECT/CT had 87.8% sensitivity and 96.6% specificity on a patient-based analysis, statistically higher than SRS (P<0.001). A total of 160 foci were detected (108 NETs and 52 physiological/benign tumours). SRS correctly classified 105/160 foci (65.6%) and remained inaccurate for 55 lesions. These 55 included 31 indeterminate lesions, 12 lesions detected only by SPECT/CT and 12 false-positive lesions. The number of foci correctly classified on the SPECT/CT images was 151/160 (94.4%), whereas two remained indeterminate and seven were false-positive findings. SPECT/CT provides incremental diagnostic value over SRS, mainly because of a precise anatomical localization that helps discriminate between tumour lesions and physiological uptake. SPECT/CT may detect unsuspected lesions in a small proportion of patients.

Imagerie des métastases cérébrales

The therapeutic management of brain metastases depends upon their diagnosis and characteristics. It is therefore imperative that imaging provides accurate diagnosis, identification, size and localization information of intracranial lesions in patients with presumed cerebral metastatic disease. MRI exhibits superior sensitivity to CT for small lesions identification and to evaluate their precise anatomical location. The CT-scan will be made only in case of MRI's contraindication or if MRI cannot be obtained in an acceptable delay for the management of the patient. In clinical practice, the radiologic metastasis evaluation is based on visual image analyses. Thus, a particular attention is paid to the imaging protocol with the aim to optimize the diagnosis of small lesions and to evaluate their evolution. The MRI protocol must include: 1) non-contrast T1, 2) diffusion, 3) T2* or susceptibility-weighted imaging, 4) dynamic susceptibility contrast perfusion, 5) FLAIR with contrast injection, 6) T1 with contrast injection preferentially using the 3D spin echo images. The role of the nuclear medicine imaging is still limited in the diagnosis of brain metastasis. The Tc-sestamibi brain imaging or PET with amino acid tracers can differentiate local brain metastasis recurrence from radionecrosis but still to be evaluated.

Does radiographic location ensure precise anatomic location of the femoral fixation site in medial patellofemoral ligament surgery?

To correlate the location of the medial patellofemoral ligament femoral fixation site in knees suffering a chronic lateral patellar instability, by using radiographic references and by using the most important anatomic reference point (i.e. the adductor tubercle) identified by means of 3-dimensional (3D) surface reconstructions by computed tomography (CT) imaging. Thirty consecutive knee 3D-CT examinations at 0º of knee extension were obtained from patients (20 females, 10 males; median age of 23.5years; range, 14-48years) treated for chronic lateral patellar instability with at least two documented patellar dislocations. For each knee, three virtual 7-mm-diameter femoral tunnels were created. One of the tunnels used an anatomic fixation landmark (anatomic fixation), while the other two used established radiologic methods. We calculated the percentage of the anatomic tunnel covered by the tunnel created according to the method described by Schoettle, and the percentage of the anatomic tunnel covered by the tunnel created according to the method described by Stephen. These percentages were compared using paired Student's t test. The percentage of anatomic tunnel area covered by the femoral tunnel created using Schoettle's method was 36.7±25.2%. When using Stephen's method, the percentage of overlap with the anatomic femoral tunnel was 25.5±21.5%. There were no significant differences between the two radiographic methods (n.s.). None of the standard radiographic methods allowed a precise anatomic femoral placement. Conventional radiographic identification of the femoral graft placement site is only an approximation and should not be the sole basis for femoral attachment location. IV.

3-phase dual-energy CT scan as a feasible salvage imaging modality for the identification of non-localizing parathyroid adenomas: a prospective study.

ObjectivesAccurate pre-operative imaging of parathyroid adenomas (PAs) is essential for successful minimally invasive surgery; however, rates of non-localizing PAs can be as high as 18 %. Multiphasic dual-energy CT (DECT) has the potential to increase accuracy of PA detection by enabling creation of paired material maps and spectral tissue characterization. This study prospectively evaluated the utility of 3-phase DECT for PA identification in patients with failed localizatio n via standard imaging.MethodsPatients with primary hyperparathyroidism and non-localizing PAs underwent a 3 phase post-contrast DECT scan acquired at 25, 55, and 85 s. The scans were prospectively evaluated by two head and neck radiologists. Pre-operative localization was compared to intraoperative localization and final histopathology. A post-hoc DECT spectral density characterization was performed on pathologically-proven PAs.ResultsOut of 29 patients with primary hyperparathyroidism and non-localized PAs, DECT identified candidates in 26. Of the 23 patients who underwent parathyroidectomy, DECT provided precise anatomic localization in 20 patients (PPV = 87.0 %), one with multi-gland disease. The virtual unenhanced images were not found to be useful for diagnosis but successful diagnosis was made without an unenhanced phase regardless. Spectral analysis demonstrated a distinct spectral Hounsfield attenuation curve for PAs compared to lymph nodes on arterial phase images.Conclusion3-phase DECT without an unenhanced phase is a feasible salvage imaging modality for previously non-localizing parathyroid adenomas. Optimal interpretation is achieved based on a combination of perfusion characteristics and other morphologic features. Advanced spectral DECT analysis has the potential for further increasing accuracy of PA identification in the future.

Who is who after spinal cord injury and repair? Can the brain stem descending motor pathways take control of skilled hand motor function?

Over the last years, anatomical, electrophysiological and genetic studies have carefully dissected the pathways connecting the brain and the spinal cord. Lawrence and Kuypers (1968) described the organization of the descending motor pathways in the non-human primate spinal cord. Although there are some differences between species regarding the precise anatomical location of each spinal pathway and the selective connectivity onto spinal interneurons and motoneurons, the pattern of organization described is conserved among the mammalian spinal cord (Courtine et al., 2007). Based on their description, the major descending motor pathways are grouped depending on their anatomical origin and their terminal distribution pattern in the spinal grey matter. The motor cortex projects corticospinal axons to the spinal cord, which mostly run in the contralateral cord and innervate the mid and dorsal grey matter neurons. On the other hand, the spinal pathways originating in the brain stem are subdivided in the lateral and ventromedial systems. The ventromedial system fibers originate in the reticular formation and the vestibular complex, and terminate in the ventral and medial parts of the ventral horn grey matter. In contrast, the lateral system fibers originate in the red nucleus and preferentially terminate in the dorsal and lateral parts of the dorsal and medial grey matter (Figure 1). Together with the corticospinal fibers, the lateral brain-stem system contacts interneurons related to motorneurons of distal muscles, whereas on the other hand, the ventromedial system pathways contact interneurons related to motoneurons of proximal muscles. Functionally, the corticospinal and lateral brain stem pathways are involved in the control of distal arm and hand muscles involved in skilled forelimb movements. The ventral brainstem pathways are mostly involved in the control of the proximal musculature of the trunk and limbs involved in posture and locomotion. Behavioral and electrophysiological studies mostly performed in cats and non-human primates corroborate these anatomical findings (Lemon, 2012). Furthermore, rodents with injuries in discrete areas of the spinal cord selectively impair specific motor functions, evidencing the functional specificity of each spinal pathway and the spinal networks that they innervate (Schucht et al., 2002; Anderson et al., 2007)

Abstract 12852: The Incremental Value of Three-Dimensional Transesophageal Echocardiography for the Diagnostic Assessment of Infective Endocarditis

Two-dimensional transesophageal echocardiography (2D TEE) may fail to detect signs of infective endocarditis (IE) or to delineate complex anatomic lesions due to suboptimal visualization of the infected area. Three-dimensional (3D) TEE may have additional value; however, data are scarce. In 124 consecutive patients (85 M; Mean age 63 ± 14 years) with definite IE involving the aortic (36), mitral (35), tricuspid (5), ≤ 1 valve (6), and prosthetic valves (30),or pace-maker/ICD leads (12) the comparative analysis between 2D and 3D imaging focused on: 1) Presence and maximal dimension of vegetations; 2) Prediction of embolic events; 3) Location and dimension of valve perforation; 3) Prediction of successful mitral valve repair; 4) Identification and morphologic assessment of perivalvular complications.3D TEE detected more vegetations per patient (1.9 ± 2.1 vs 1.7± 1.6; p= 0.06), but this difference was significant only for vegetations on prosthetic valves and PM/ICD leads (2.2 ± 1.7 vs 1.1 ± 1.5; p=0.03). TomTec Software was used to crop the 3D volume to obtain the largest value for vegetations and perforation area. The 3D TEE maximal vegetation dimension was larger with a mean difference of 2.9 mm (95% CI, 1.9-4.52 mm) vs 2DTEE. The best cut-off value for prediction of embolic events was ≥18 mm with 3D TEE and ≥14 mm with 2D TEE. The positive predictive value for 3D TEE was not statistically higher (58% vs 52%). Valve perforation was identified in 10/19 patients with 2D TEE and in 18/19 patients with 3D TEE (p&lt; 0.007) with subsequent surgical confirmation. Successful mitral valve repair was associated with a distance of the perforation &gt; 3 mm from the leaflet tip and from commisures. This information was provided only by 3D TEE. Finally, 2D TEE missed 2/20 peri-annular extensions. After addition of 3D TEE all peri-annular extensions (20/20) were detected, without adding false positives.In 5 patients contrast 3D TEE provided visualization of the full extent of the defect and its precise anatomical location, prior to successful surgical resection. In conclusion 3D TEE is a feasible technique for the analysis of vegetation size and complex cardiac lesions caused by IE that may overcome the limitations of 2D TEE, providing incremental information useful for surgery

Meyer’s Loop Anatomy Demonstrated Using Diffusion Tensor MR Imaging and Fiber Tractography at 3T

Abstract Objective: The ultimate anatomy of the Meyer’s loop continues to elude us. Diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) may be able to demonstrate, in vivo, the anatomy of the complex network of white matter fibers surrounding the Meyer’s loop and the optic radiations. This study aims at exploring the anatomy of the Meyer’s loop by using DTI and fiber tractography. Methods: Ten healthy subjects underwent magnetic resonance imaging (MRI) with DTI at 3 T. Using a region-of-interest (ROI) based diffusion tensor imaging and fiber tracking software (Release 2.6, Achieva, Philips), sequential ROI were placed to reconstruct visual fibers and neighboring projection fibers involved in the formation of Meyer’s loop. The 3-dimensional (3D) reconstructed fibers were visualized by superimposition on 3-planar MRI brain images to enhance their precise anatomical localization and relationship with other anatomical structures. Results: Several projection fiber including the optic radiation, occipitopontine/parietopontine fibers and posterior thalamic peduncle participated in the formation of Meyer’s loop. Two patterns of angulation of the Meyer’s loop were found. Conclusions: DTI with DTT provides a complimentary, in vivo, method to study the details of the anatomy of the Meyer’s loop.

Contribution of "en face" SD‐OCT in retinal toxicity

AbstractPURPOSE: To assess retinal and choroidal changes in drug‐induced retinal toxicity using "en‐face" and BScan OCT images. METHODS: All patients underwent complete ophthalmologic examination, including fundus examination and autofluorescence, color photography, fluorescein and indocyanin green angiography. Type, amount and time of drug intake was precisely assessed. RESULTS: 8 patients were analysed and included retrospectively. Retinal toxicity was induced by tamoxifen in 2 cases, by synthetic antimalarial (SAM) drug in 3 cases and by inhaled amyl nitrite ("poppers") in 3 cases. The angiographic features, B‐Scan and "en‐face" OCT scans findings were correlated. In all cases, "en‐face" OCT provided precise anatomic location of the retinal layers involved, the extend of retinal damage, as well as follow‐up of these changes. CONCLUSION: "En‐face" OCT allows full imaging and better understanding of retinal toxicity induced by tamoxifen, SAM drugs and amyl nitrite.

The logical operator map identifies novel candidate markers for critical sites in patients with atrial fibrillation

The identification of suitable markers for critical patterns during atrial fibrillation (AF) may be crucial to guide an effective ablation treatment. Single parameter maps, based on dominant frequency and complex fractionated electrograms, have been proposed as a tool for electrogram-guided ablation, however the specificity of these markers is debated. Experimental studies suggest that AF critical patterns may be identified on the basis of specific rate and organization features, where rapid organized and rapid fragmented activities characterize respectively localized sources and critical substrates. In this paper we introduce the logical operator map, a novel mapping tool for a point-by-point identification and localization of AF critical sites. Based on advanced signal and image processing techniques, the approach combines in a single map electrogram-derived rate and organization features with tomographic anatomical detail. The construction of the anatomically-detailed logical operator map is based on the time-domain estimation of atrial rate and organization in terms of cycle length and wave-similarity, the logical combination of these indexes to obtain suitable markers of critical sites, and the multimodal integration of electrophysiological and anatomical information by segmentation and registration techniques. Logical operator maps were constructed in 14 patients with persistent AF, showing the capability of the combined rate and organization markers to identify with high selectivity the subset of electrograms associated with localized sources and critical substrates. The precise anatomical localization of these critical sites revealed the confinement of rapid organized sources in the left atrium with organization and rate gradients towards the surrounding tissue, and the presence of rapid fragmented electrograms in proximity of the sources. By merging in a single map the most relevant electrophysiological and anatomical features of the AF process, the logical operator map may have significant clinical impact as a direct, comprehensive tool to understand arrhythmia mechanisms in the single patient and guide more conservative, step-wise ablation.

Synchronous Ileocecal Neuroendocrine Tumor and Carotid Chemodectoma

We report a case of carotid chemodectoma diagnosed by In pentetreotide SPECT/CT. A 72-year-old woman with an ileocecal neuroendocrine tumor underwent whole-body In pentetreotide scintigraphy for exclusion of distant metastases. Planar scintigraphy demonstrated marked tracer uptake in the ileocecal region and intense focal tracer accumulation within the neck. SPECT/CT demonstrated a space-occupying lesion at the carotid bifurcation. Histopathological evaluation revealed carotid chemodectoma. SPECT/CT is a valuable tool for the evaluation and precise anatomical localization of tracer uptake. In addition, other benign or malignant pathologies accumulating In pentetreotide may mimic neuroendocrine tumor metastases and should be considered particularly in unusual localizations.

Recent Advances in Hybrid Molecular Imaging Systems

Nuclear medicine imaging methods that use radionuclides, such as positron emission tomography (PET) and single-photon emission computed tomography (SPECT), offer highly sensitive and quantitative tools for the detection and localization of the biochemical and functional abnormalities associated with various diseases. The introduction of dual-modality PET/CT and SPECT/CT systems to the clinical environment in the late 1990s is regarded as a revolutionary advance in modern diagnostic imaging, bringing precise anatomical localization to conventional PET and SPECT imaging techniques and enhancing the quantitation capabilities of these modalities. The great success of PET/CT has also revived interest in the combination of PET and MR scanners, leading to commercially available clinical PET/MR systems. In this article, we review the recent improvements made in these hybrid molecular imaging systems, which have been dramatic in terms of both hardware and software over the past decade. We focus primarily on the hybrid imaging systems that are currently used in clinical practice and the technologies applied in those systems, with emphasis on the efforts to improve their diagnostic performances for musculoskeletal diseases.

Dual imaging-guided photothermal/photodynamic therapy using micelles

We report a type of photosensitizer (PS)-loaded micelles integrating cyanine dye as potential theranostic micelles for precise anatomical tumor localization via dual photoacoustic (PA)/near-infrared fluorescent (NIRF) imaging modalities, and simultaneously superior cancer therapy via sequential synergistic photothermal therapy (PTT)/photodynamic therapy (PDT). The micelles exhibit enhanced photostability, cell internalization and tumor accumulation. The dual NIRF/PA imaging modalities of the micelles cause the high imaging contrast and spatial resolution of tumors, which provide precise anatomical localization of the tumor and its inner vasculature for guiding PTT/PDT treatments. Moreover, the micelles can generate severe photothermal damage on cancer cells and destabilization of the lysosomes upon PTT photoirradiation, which subsequently facilitate synergistic photodynamic injury via PS under PDT treatment. The sequential treatments of PTT/PDT trigger the enhanced cytoplasmic delivery of PS, which contributes to the synergistic anticancer efficacy of PS. Our strategy provides a dual-modal cancer imaging with high imaging contrast and spatial resolution, and subsequent therapeutic synergy of PTT/PDT for potential multimodal theranostic application.

Detection of Infected Liver Cysts by 111In WBC SPECT/CT in Polycystic Liver Disease

SPECT/CT imaging can provide improved diagnostic information over traditional planar scintigraphy and SPECT, with more precise anatomic localization and observer confidence. We present 2 patients with polycystic liver disease (PCLD), both with constitutional symptoms and bacteremia. In WBC SPECT/CT images revealed increased WBC localization within a single liver cyst in each case, subsequently drained under imaging guidance. Cultures confirmed the presence of infection, allowing for appropriately directed antibiotic therapy and successful treatment outcomes. These cases illustrate the incremental value of In WBC SPECT/CT fusion imaging for the evaluation of bacteremia in complicated patients.

Esophageal Metastasis From Papillary Thyroid Cancer

We report a case of esophageal metastasis from papillary thyroid cancer diagnosed by I SPECT/CT. A 70-year-old man presented with increasing thyroglobulin levels 13 years after thyroidectomy and ablation with I for thyroid cancer. The whole-body radioiodine scan demonstrated marked tracer uptake in the mediastinum, and SPECT/CT could clearly localize the activity to the esophagus. Subsequent surgical resection with histopathologic evaluation revealed an esophageal metastasis from papillary thyroid cancer. I SPECT/CT is a valuable tool for evaluation and precise anatomical localization of the foci of radionuclide activity in thyroid cancer, enabling adequate treatment.

Molecular imaging agents for SPECT (and SPECT/CT)

The development of hybrid single photon emission computed tomography/computed tomography (SPECT/CT) cameras has increased the diagnostic value of many existing single photon radiopharmaceuticals. Precise anatomical localization of lesions greatly increases diagnostic confidence in bone imaging of the extremities, infection imaging, sentinel lymph node localization, and imaging in other areas. Accurate anatomical localization is particularly important prior to surgery, especially involving the parathyroid glands and sentinel lymph node procedures. SPECT/CT plays a role in characterization of lesions, particularly in bone scintigraphy and radioiodine imaging of metastatic thyroid cancer. In the development of novel tracers, SPECT/CT is particularly important in monitoring response to therapies that do not result in an early change in lesion size. Preclinical SPECT/CT devices, which actually have spatial resolution superior to PET/CT devices, have become essential in characterization of the biodistribution and tissue kinetics of novel tracers, allowing coregistration of serial studies within the same animals, which serves both to reduce biological variability and reduce the number of animals required. In conclusion, SPECT/CT increases the utility of existing radiopharmaceuticals and plays a pivotal role in the evaluation of novel tracers.

The Diagnostic Efficiency of 99mTc-EDDA/HYNIC-Octreotate SPECT-CT in Comparison with 111In-Pentetrotide in the Detection of Neuroendocrine Tumours

Objective: The aim of this study was to assess the diagnostic efficiency of 99mTc-EDDA/HYNIC-Octreotate in comparison with 111Inpentetrotide scintigraphy in the detection of neuroendocrine tumors. This study also evaluates the impact of SPECT-CT hybrid imaging on somatostatin receptor scintigraphy (SRS) interpretation and clinical management of these tumors. Methods: Fourteen patients were included in the study. All patients underwent a whole body and SPECT-CT imaging with both 99mTc- EDDA/HYNIC-octreotate and 111In-pentetrotide. Images were evaluated both visually and semiquantitatively. Results: On patient basis, the diagnostic results of both studies were similar. The number of lesions detected by 99mTc- EDDA/HYNICOctreotate were higher than the number of lesions detected by 111In-pentetrotide however the difference was not significant (40/43( 93%), 36/43 (83%) p=0.109). Semiquantitative analysis showed higher tumor/organ count ratios for both whole-body and SPECT 99mTc- EDDA/HYNIC-Octreotate scans. Conclusion: The results of this study suggested that, 99mTc- EDDA/HYNIC-Octreotate may be a better alternative to 111In- pentetrotide due to high image quality and lower radiation dose. SPECT/CT is a valuable tool for the assessment of neuroendocrine tumors by providing the precise anatomic localization of scintigraphic findings thus improving lesion detectability and characterization.Conflict of interest:None declared.

English

Cystic masses of neck consist of a variety of pathologic entities. The precise anatomical location and imaging appearances are important for accurate diagnosis and formulating the differential diagnoses. The age of presentation and clinical examination narrow down the differential diagnosis. US is useful in differentiating solid from cystic neck lesions. Ultrasound is often used for pre-treatment assessment. AIM&OBJECTIVE: To use readily available, relatively inexpensive, and non-ionizing radiological imaging technique for pre-treatment assessment of cystic lesions of neck. MATERIAL & METHODS: This study is conducted in department of Radio-diagnosis of TMMC &RC, TMU, Moradabad, in which we included patients of all age groups and both sexes. Imaging of neck lesions was done by Ultrasound using Scanners with 7-10 MHz transducers on MEDISON Diagnostic ultrasound system installed in department of Radio-diagnosis, TMMC&RC, Moradabad. Analytical Test: “t”-test. RESULT: 7.5% of cases were diagnosed of having cystic lesions of the neck, having approximately same occurrence in both male and females (p>.005). CONCLUSION: Cystic lesions of the neck are commonly seen as palpable neck masses. Clinical presentation along with imaging features, anatomical location, extent, internal composition,as assessed by US(Ultrasound) help in pre-treatment assessment.

Location and Tension of the Medial Palpebral Ligament

The aim of this study was to elucidate the precise anatomic location and tension of the medial palpebral ligament (MPL). Eleven hemifaces of 10 fresh Korean adult cadavers were used in this study. Nine specimens were used for measurement of dissection and tension, and 2 were used for histologic study. Measurements of tensile strength of each part of the MPL and Horner muscle were performed using a force gauge.The MPL consisted of 2 layers in all specimens dissected. The superficial layer of the palpebral ligament (SMPL) was observed from the anterior lacrimal crest to the upper and lower tarsal plates. The deep layer of the palpebral ligament (DMPL) lay from the anterior lacrimal crest to the posterior lacrimal crest, covering the lacrimal sac. The Horner muscle was observed at the posterior lacrimal crest just lateral to the attachment of the DMPL and ran laterally to the tarsal plate deep to the SMPL. The SMPL began at 4.5 ± 2.3 mm lateral to the nasomaxillary suture line to the upper and lower tarsal plates. Its transverse length was 9.6 ± 1.5 mm, and vertical width was 2.4 ± 0.7 mm, and its thickness was 4.5 ± 2.3 mm. The transverse length of the DMPL was 3.7 ± 0.4 mm, and its vertical width was 2.9 ± 1.3 mm, with a thickness of 0.3 ± 0.1 mm. The transverse length of the Horner muscle was 7.6 ± 1.9 mm, and its vertical width was 4.06 ± 1.5 mm, with a thickness of 0.4 ± 0.1 mm. The tensile strength of the SMPL was 13.4 ± 3.2 N, that of the DMPL was 4.1 ± 1.7 N, and that for Horner muscle was 9.0 ± 3.1 N. The tensile strength of the SMPL was significantly higher than that of the DMPL (P = 0.003).We reconfirmed that the MPL consisted of 2 layers: superficial layer and deep layer. Our results might be of use in surgeries of the medial canthi.

English

There is wide range of pathological neck masses from benign inflammatory conditions to frankly malignant lesions, which may be congenital or acquired. These neck mass may be an incidental finding on the general physical examination. The close proximity of various structures in the neck creates a diagnostic problem. The precise anatomical location and imaging appearances are important for accurate diagnosis and formulating the differential diagnoses of neck masses. Ultrasonography (US) and computed tomography (CT) enable radiological characterization of normal and diseased structures in the neck in ways that were previously not possible. With the advent of high frequency ultrasound (US) probes, superficial structures are visualized very conveniently and with great spatial solution. Ability of CT to give tissue attenuation values gives a fair insight into the nature of the lesion. AIMS & OBJECTIVE: In this study we planned to evaluate palpable neck masses with US and CT, and comparing their efficacy. MATERIAL & METHOD: The present study was conducted in the Department of Radio-diagnosis, TMMC & RC, TMU, Moradabad. Patients under study were referred from the department of Surgery, ENT, Medicine and Pediatrics. Patients included for study were evaluated by Clinical and Radiological examination .The age range in the present study was from 3 to 80 years and total number of patients were 40 (including both male and females). RESULT: 1. On examination distribution of lesions was found to be Inflamatory- 17.5%, Developmental- 7.5%, Thyroid masses-30%, Mesenchymal-10%, Neural 5%, Vascular-5%, Bone5%, Lymph nodes-10%, & Salivary gland mass-10%. 2. The Male to Female ratio in the present study = 1.22:1 CONCLUSION: Ultrasound complimented coupled with Computed Tomography is of immense help in the diagnosis and better management of palpable neck masses.

SPECT/CT and tumour imaging

Scintigraphic techniques are sensitive imaging modalities in the diagnosis and follow-up of cancer patients providing the functional and metabolic activity characteristics of the tumour. Hybrid SPECT/CT improves the diagnostic accuracy of these well-established imaging techniques by precise anatomical localization and characterization of morphological findings, differentiation between foci of physiological and pathological tracer uptake, resulting in a significant impact on patient management and more definitive interpretations. The use of SPECT/CT has been studied in a variety of applications in tumour imaging which are reviewed in this article. By combining functional and anatomical information in a single imaging session, SPECT/CT has become a one-stop cancer imaging modality.