Whole-body Examination Research Articles

A case of advanced ovarian cancer upstaged on the bases of pleural washing cytology

We encountered a case of ovarian cancer that had positive pleural washing cytology diagnosed by thoracoscopy. A 65-year-old woman was referred to our hospital with a sensation of abdominal fullness. A whole-body examination revealed a solid tumor of the ovary and accumulation of ascites. Neither pleural effusion nor lung metastasis was found at the time. Laparotomy showed extensive dissemination and we classified the stage as IIIc. As the diaphragm was thickened with dissemination, we tried to strip the diaphragm and used thoracoscopy to identify the thoracic area. No tumor or pleural effusion was detected. We performed pleural biopsy and pleural washing cytology. Finally, malignant cells were found in the pleural washing cytology. Pathological findings showed serous papillary adenocarcinoma of the ovary in this stage IV case. We suggest in this report that thoracoscopy is a useful method for making the correct surgical staging.

Fast dixon-based multisequence and multiplanar MRI for whole-body detection of cancer metastases.

To develop and demonstrate the feasibility of multisequence and multiplanar MRI for whole-body cancer detection. Two fast Dixon-based sequences and a diffusion-weighted sequence were used on a commercially available 1.5 T scanner for whole-body cancer detection. The study enrolled 19 breast cancer patients with known metastases and in multistations acquired whole-body axial diffusion-weighted, coronal T2-weighted, axial/sagittal pre- and postcontrast T1-weighted, as well as triphasic abdomen images. Three radiologists subjectively scored Dixon images of each series for overall image quality and fat suppression uniformity on a 4-point scale (1 = poor, 2 = fair, 3 = good, and 4 = excellent). Eighteen of the 19 patients completed the whole-body MRI successfully. The mean acquisition time and overall patient table time were 46 +/- 3 and 69 +/- 5 minutes, respectively. The average radiologists' scores for overall image quality and fat suppression uniformity were both 3.4 +/- 0.5. The image quality was consistent between patients and all completed whole-body examinations were diagnostically adequate. Whole-body MRI offering essentially all the most optimal tumor-imaging sequences in a typical 1-hour time slot can potentially become an appealing "one-stop-shop" for whole-body cancer imaging.

Screening for Skin Cancer: An Update of the Evidence for the U.S. Preventive Services Task Force

Skin cancer is the most commonly diagnosed cancer in the United States. The majority of skin cancer is nonmelanoma cancer, either basal cell cancer or squamous cell cancer. The incidence of both melanoma and nonmelanoma skin cancer has been increasing over the past 3 decades. In 2001, the U.S. Preventive Services Task Force (USPSTF) found insufficient evidence to recommend for or against routine screening for skin cancer by using whole-body skin examination for early detection of skin cancer. To update the evidence of benefits and harms of screening for skin cancer in the general population. MEDLINE and Cochrane Library searches from 1 June 1999 to 9 August 2005 for English-language articles; recent systematic reviews; reference lists of retrieved articles; and expert suggestions. English-language studies were selected to answer the following key question: Does screening in asymptomatic persons with whole-body examination by a primary care clinician or by self-examination reduce morbidity and mortality from skin cancer? Randomized, controlled trials and case-control studies of screening for skin cancer were selected. One author selected English-language studies to answer the following contextual questions: Can screening with whole-body examination by primary care clinicians or by self-examination accurately detect skin cancer? Does screening with whole-body examination or by self-examination detect melanomas at an earlier stage (thinner lesions)? All studies for the key question were reviewed, abstracted, and rated for quality by using predefined USPSTF criteria. No new evidence from controlled studies was found that addressed the benefit of screening for skin cancer with a whole-body examination by a physician. One article of fair quality, which reanalyzed data from a 1996 study identified for the 2001 report for the USPSTF, provides limited but insufficient evidence on the benefit of skin self-examination in the reduction of morbidity and mortality from melanoma. Direct evidence linking skin cancer screening to improved health outcomes is lacking. Information is limited on the accuracy of screening by physicians or patients using real patients and lesions. The limited evidence prevents accurate estimation of the benefits of screening for skin cancer in the general primary care population.

Screening for Skin Cancer: U.S. Preventive Services Task Force Recommendation Statement

Update of the 2001 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for skin cancer. To update its recommendation, the USPSTF reviewed evidence published since 2001 on studies on screening effectiveness, the stage of detection by screening, and the accuracy of whole-body examination by primary care clinicians and self-examination by patients. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for skin cancer by primary care clinicians or by patient skin self-examination. (I statement).

Whole-body diffusion-weighted magnetic resonance imaging in the staging of oncological patients: comparison with positron emission tomography computed tomography (PET-CT) in a pilot study

The aim of this pilot study was to compare positron emission tomography computed tomography (PET-CT) and whole-body DWIBS in staging oncological patients to determine the staging accuracy of whole-body DWIBS. We initiated a prospective, blinded investigation on 29 patients affected by oncological diseases (n=14) or lymphoma (n=15), who underwent fluorodeoxyglucose (FDG)-based PET-CT and whole-body DWIBS for restaging purposes. Magnetic resonance (MR) imaging was conducted with a multistack (n=4) DWIBS pulse sequence. Images were read independently by two experienced radiologists and one nuclear physician. Statistical analysis assessed interobserver agreement and diagnostic accuracy. Whole-body DWIBS had a room occupation time of 20 min. Mean postprocessing time was 15 min (range 10-17 min). Mean reading time was 20 min for reader 1 (range 15-25 min) and 18 min for reader 2 (range 13-22 min). Interobserver agreement was almost perfect (=0.93). Reader 1 had a sensitivity of 89.07%, a specificity of 98.5%, and an accuracy of 97.65%, with a positive predictive value (PPV) of 85.48% and a negative predictive value (NPV) of 98.91%. Reader 2 had a sensitivity of 87.39%, a specificity of 98.39% and a diagnostic accuracy of 97.8%, with a PPV of 88.13% and a NPV of 98.75%. The whole-body DWIBS protocol provided a fast whole-body examination with high specificity and NPV. One major bias of the study was the inclusion of patients with diffuse disease and advanced disease stage and the heterogeneity of the neoplastic diseases included.

Measurement of lower-leg volume change by quantitative computed tomography

Lower-leg edema is a common symptom in many diseases. A precise method with low variability for measurement of edema is warranted in order to obtain optimal conditions for investigation of treatment effects. To evaluate computed tomography for precise measurement of lower-leg muscle and adipose tissue volumes using a very low level of effective radiation dose. Eleven volunteers were examined three times during 1 day, either as two consecutive examinations in the morning and one single examination in the afternoon, or as one examination in the morning and two in the afternoon. Eleven scans with computed tomography were made at each examination, and lower-leg volumes were calculated from automatically measured scan areas and interscan distances. Volumes for muscle, adipose tissue, and bone were calculated separately. Minimal radiation dose was used. Mean difference between the repeated examinations was -0.1 ml for total volume, -1.4 ml for muscle, and 1.6 ml for adipose tissue volume. The corresponding 95% confidence intervals were -6.5 to 6.0 ml, -3.5 to 6.5 ml, and -7.0 to 4.0 ml, respectively. The resulting effective dose was 0.5 microSv to one leg. Computed tomography can be used as a precise quantitative method to measure small volume changes of the lower leg as a whole, and separately for muscle and adipose tissue. The results were obtained with a negligible effective dose, lower than that delivered by modern fan-beam dual-energy X-ray absorptiometry whole-body examinations and equal to a few hours of background radiation.

Technical principles of dual source CT

During the past years, multi-detector row CT (MDCT) has evolved into clinical practice with a rapid increase of the number of detector slices. Today's 64 slice CT systems allow whole-body examinations with sub-millimeter resolution in short scan times. As an alternative to adding even more detector slices, we describe the system concept and design of a CT scanner with two X-ray tubes and two detectors (mounted on a CT gantry with a mechanical offset of 90°) that has the potential to overcome limitations of conventional MDCT systems, such as temporal resolution for cardiac imaging. A dual source CT (DSCT) scanner provides temporal resolution equivalent to a quarter of the gantry rotation time, independent of the patient's heart rate (83 ms at 0.33 s rotation time). In addition to the benefits for cardiac scanning, it allows to go beyond conventional CT imaging by obtaining dual energy information if the two tubes are operated at different voltages. Furthermore, we discuss how both acquisition systems can be used to add the power reserve of two X-ray tubes for long scan ranges and obese patients. Finally, future advances of DSCT are highlighted.

Rapid progression of Epstein-Barr-virus-positive gastric diffuse large B-cell lymphoma during chemoradiotherapy: a case report.

A 61-year-old woman was referred to our hospital with epigastralgia and appetite loss. Barium examination and upper gastrointestinal endoscopy revealed uneven erythematous mucosa with multiple elevated lesions from the gastric fornix to the upper corpus. Abdominal computed tomography showed thickening of the wall of the fornix and swelling of perigastric lymph nodes, but whole-body gallium scintigraphy and bone marrow examination did not indicate further involvement. Biopsy specimens showed diffuse infiltration of large atypical lymphoid cells in which Epstein-Barr virus (EBV) was detected by in situ hybridization. Diffuse large B-cell lymphoma (DLBCL), stage II1, was diagnosed. Combination chemotherapy [cyclophosphamide, adriamycin, vincristine, and prednisone (CHOP)], was given, and this was followed by radiotherapy. Partial remission was achieved by chemotherapy, but the disease progressed rapidly during radiotherapy. Because the reported prognosis of EBV-positive DLBCL is unfavorable, the therapeutic strategy for EBV-positive gastric DLBCL should be considered carefully.

Prevalence of Skin Diseases in a Cohort of 48,665 Employees in Germany

Background: Epidemiological data are important for planning medical care. Thus far, only few prevalence data for skin diseases have been published in Germany, most of them not population based. Objectives: Estimation of prevalences of common skin diseases in a sample of employees of German companies. Methods: Whole-body examinations were performed by trained dermatologists in 150 companies as part of skin cancer screenings. Using a standardized and computerized data entry, all clinical dermatological findings were documented. Explicitly skin lesions requiring current treatment were noted. The retrospective evaluation of the data was descriptive, using the diagnoses defined a priori in the data entry mask. Results: 48,665 persons (52.8% male) with a mean age of 43.2 years were examined. The following frequencies of chronic and acute inflammatory skin diseases were observed: contact eczema 8.9%, acne 4.2%, seborrhoeic eczema 3.4%, rosacea 2.2%, psoriasis vulgaris 2.1%, atopic eczema 1.4% and lichen ruber 0.07%. In total, dermatological findings needing treatment were observed in 19% of the study cohort; 1.3% of the participants presented a suspicious finding requiring diagnostics for skin malignoma. Conclusions: There is a high frequency of chronic inflammatory skin diseases in the general working population and a high need for dermatological treatment.

Whole-body imaging of oncologic patients using 16-channel PET-CT

This study evaluated a MDCT protocol for contrast-enhanced 16-channel PET-CT with regard to scan range and duration of a whole-body (18)F-FDG PET-CT examination, the occurrence of contrast-material induced artefacts and quantitative assessment of CT attenuation. 205 patients (51.9+/-12.4 years) with different malignant tumours underwent whole-body PET-CT; the study protocol had been approved by the institutional review board. Contrast-enhanced MDCT (16 x 1.5 mm; 120 ml Iomeprol 3 ml/s, 50 ml saline chaser bolus, scan delay 70 s; oral contrast) was also used for attenuation correction. From MDCT data mean scan range and duration, occurrence of contrast media-induced artefacts, and mean CT densities of jugular (jv) and subclavian (scv), superior (vcs) and inferior (vci) caval, portal (pv), and bilateral external iliac veins, pulmonary (ap) and iliac arteries, descending thoracic and abdominal aorta, all cardiac chambers, as well as both liver lobes, spleen, adrenal glands and kidneys were determined. Attenuation corrected PET images were free of contrast media-related image artefacts. Homogeneous contrast enhancement was found in the mediastinal veins (right/left jv 171+/-34/171+/-35, scv 127+/-50/127+/-40, vcs 153+/-36 HU) and arteries (e.g. ap 145+/-26/151+/-26). Cardiac chambers, abdominal vessels (e.g. vci 138+/-24, pv 159+/-25 HU), and parenchymal organs revealed sufficient and homogenous contrast-enhancement in all cases. No beam-hardening artefacts occurred in the neighbourhood of the subclavian veins. The chosen whole-body (18)F-FDG 16-slice PET-CT protocol allowed for craniocaudal CT scanning with high vessel and parenchymal contrast revealing no IV contrast-media induced artefacts in attenuation-corrected PET data sets.

Positron Emission Tomography: A Real-Time Tool to Quantify Early Islet Engraftment in a Preclinical Large Animal Model

Clinical islet transplantation is currently being explored as a therapeutic option for persons with type I diabetes and hypoglycemic unawareness. Techniques to monitor graft survival are urgently needed to optimize the procedure. Therefore, the objective of the present study was to develop a technique for imaging survival of transplanted islets in the peritransplant and early posttransplant phase. Isolated porcine islets were labeled in vitro with 2-deoxy-2[F]fluoro-D-glucose ([F]FDG) and infused intraportally into anesthetized pigs (n=10). Dynamic examination was performed on a positron emission tomography/computed tomography hybrid system. More than 95% of the radioactivity was confined to the islets at the time of transplantation. The peak percentage of infused radioactivity within the liver, quantified at the end of the islet infusion, was only 54+/-5.1%. The distribution of the radioactivity in the liver was found to be heterogeneous. A whole-body examination showed no accumulation in the lungs or brain; extrahepatic radioactivity was, except urinary excretion, evenly distributed in the pig body. Our results imply that almost 50% of the islets were damaged to the extent that the FDG contained was release within minutes after intraportal transplantation. The distribution of radioactivity without accumulation in the brain indicates that the activity is released from lysed islet cells in the form of [F]FDG-6P rather than native [F]FDG. The presented technique shows promise to become a powerful and quantitative tool, readily available in the clinic, to evaluate initial islet engraftment and survival.

Fixation devices for whole-body 18F-FDG PET/CT: Patient perspectives and technical aspects

To evaluate the use of a fixation device in whole-body postiron emission tomography/computed tomography (PET/CT). Two hundred and thirty patients were prospectively included over a period of 3 months. Different single-phase and multiphase contrast-enhanced PET/CT protocols were used for whole-body examination. An unforced expiration state was applied as breathing protocol for CT examination. Patients were placed on a deflating device (1.0 m x 1.5 m) with arms elevated but supported in order to prevent full extension in shoulders and elbows providing comfortable positioning. Image quality was assessed by means of alignment of the liver quantitatively on co-registered PET/CT images. After the examination, patients were asked to complete a survey on subjective sensations such as pain in different body regions (yes/no). They were asked to give a final evaluation for the whole-body PET/CT examination (comfortable/not comfortable). Additionally, a control group (n=30) was assessed without the aid of additional devices. Examination protocols using the device showed minor misalignment of 5 mm. Different protocols did not reveal significant differences in misalignment. When comparing the control group misalignment was significantly higher with approx. 7 mm. The majority (75%) evaluated the positioning as comfortable despite 46% of the patients in this group feeling more or less severe pain in at least one body region. For controls, misalignment was slightly higher whereas only 39% found the positioning comfortable (chi(2)=13.03; P<0.0005) and 61% reported pain (NS). Both the technical aspects and patient evaluations favour the use of the vacuum device in whole-body PET/CT examinations. In particular, in time consuming protocols using multiphase CT examination the fixation device leads to excellent co-registration quality and patient compliance.

Breast MRI and18F FDG PET/CT in the management of breast cancer

Goals:18F FDG PET/CT is used for diagnosis, staging and establishing the response to therapy in various malignancies, including breast cancer (BC). Dedicated breast MRI (BMRI) is gaining a role in the management of BC patients (pts), demonstrating high sensitivity and specificity for detection of small lesions. We were therefore prompted to review our experience with PET and BMRI in BC.Methods: This is a retrospective study of 21 women with BC, 30–76 years old, who had BMRI and whole-body FDG PET/CT at our institution from Jun 2002 to May 2005. A total of 6 patients (group A) had BMRI and PET/CT in the preoperative period and 15 patients (group B) had BMRI and PET/CT after surgery. Reinterpretation of the imaging studies for accuracy and data analysis from medical records were performed.Results: For group A, BMRI identified breast lesions in 4 patients, while PET/CT was able to identify breast lesions in 5 patients. All these were proven to be malignancy on pathology examination. In group B, BMRI detected recurrent breast lesions in 8 patients, with 88.9% sensitivity and 83.3% specificity. In the same patient population, PET/CT was 33.3% sensitive and 91.7% specific. As a whole body examination, PET/CT revealed metastatic disease in 6 patients (100% sensitive and 90% specific). Overall, sensitivities and specificities for breast disease detection were 85.7% and 85.7% for BMRI, and 75% and 92.3% for18F FDG PET/CT.Conclusions: As expected, BMRI is more sensitive than PET/CT in the detection of breast lesions. However, PET/CT as a whole-body examination changed the management of disease by detection of distant lesions in 6 of the 21 patients. Our study suggests that18F FDG PET/CT and BMRI should be considered as complimentary imaging tools in the pre- and postoperative workup of patients diagnosed with breast cancer.

Full-body low-dosage X-ray instead of single X-ray series in trauma: a preliminary experience report of a modified advanced trauma life support algorithm

Patients presenting with trauma normally require resuscitation according to the advanced trauma life support (ATLS) algorithm. Techniques suggested during primary survey include X-ray of C-spine, chest and pelvis. This can be time consuming and radiation intensive. In comparison with conventional multiple radiographs, Lodox (Statscan), a full-body digital radiology device, performs a.p. and lateral whole-body examinations in 3–5 minutes with about one-third of the irradiation and without the necessity for lifting patients. This is the first device installed in Europe.

Absorbed whole-body doses from whole-body CT scan examinations: can the observations relating to screening of healthy individuals be extrapolated to the use of whole-body CT in PET/CT hybrid machines?

Absorbed whole-body doses from whole-body CT scan examinations: can the observations relating to screening of healthy individuals be extrapolated to the use of whole-body CT in PET/CT hybrid machines?

Leiomyoma of the ovary presenting with Meigs’ syndrome

Ovarian leiomyoma is a rare tumor. Ovarian leiomyoma accompanied with Meigs' syndrome is extremely rare. We report a case of ovarian leiomyoma presenting with Meigs' syndrome, which was first noted as dyspnea in a 79-year-old woman. A whole-body examination revealed a solid mass of the ovary, accumulation of ascites and pleural effusion, and elevated serum carbohydrate antigen 125. Abdominal hysterectomy and salpingo-oophorectomy were carried out. After the surgery, ascites and pleural effusion disappeared. The pathological diagnosis of the removed tumor was leiomyoma of the left ovary. The patient has been healthy for 24 months after the surgery, with no signs of recurrence. We also review the literature on this disease and the clinicopathologic characteristics of the current case are discussed.

Growing Pulmonary Nodule With Increased 18-Fluorodeoxyglucose Uptake in a Former Smoker

(CHEST 2005; 127:1848–1851) A 65-year-old white woman was evaluated for a solitary pulmonary nodule. While undergoing a commercial whole-body CT screening examination 1.5 years earlier, she was found to have a 9-mm poorly marginated lesion in the right lower lobe of her lung. A short-term follow-up and/or diagnostic evaluation was strongly recommended, but the patient deferred. During the current evaluation, a follow-up chest CT scan demonstrated the presence of a 16-mm nodule in the right lower lobe with irregular margins (Fig 1). The patient denied dyspnea, fever, cough, hemoptysis, or weight loss. Her medical history was only pertinent for type II diabetes mellitus, hypertension, and hypercholesterolemia. Two years earlier, she had undergone a total abdominal hysterectomy with bilateral salpingooophrectomy for treatment of a borderline stage IA ovarian tumor. The patient had a remote cumulative 25-pack-year smoking history. Her family history was negative for cancer or lung disease. Her physical examination showed normal vital signs. The chest, lung, cardiac, and abdominal examinations were unremarkable. She had no palpable lymphadenopathy. The results of her musculoskeletal examination were normal, and her neurologic examination did not reveal any deficits. The parameters of her laboratory test results were normal and included a CBC count, a blood chemistry profile, liver function tests, and measurement of serum calcium level. A whole-body positron emission tomography (PET) study showed an isolated focus of abnormal, increased 18-fluorodeoxyglucose (FDG) activity (standardized uptake ratio, 4.8) corresponding to the location of the pulmonary nodule visualized on the chest CT scan (Fig 2). A bronchogenic carcinoma was strongly suspected based on the history, the results of the imaging studies, and the doubling time of the nodule. The patient was scheduled for a bronchoscopy followed by a wedge resection of the nodule. The treatment plan was to proceed with a right lower lobe lobectomy and systematic lymph node dissection in the same operative setting if the intraoperative histologic examination confirmed a diagnosis of non-small cell lung cancer.

Whole-body MRI for staging patients with head and neck squamous cell carcinoma

Conclusions. Whole-body MRI is feasible for the tumor staging of patients with malignant head and neck tumors and appears to be a quick, reliable and proven alternative in general and for patients with contraindications to CT. This examination minimizes the logistical effort required compared to multimodality strategies. Its economic impact remains to be determined. Objective. To assess the performance of whole-body MRI for staging patients with squamous cell carcinoma of the head and neck region. Material and methods. This was a randomized, prospective clinical study. For tumor staging, 21 patients (mean age 56.7 years; range 43–80 years) with advanced malignant head and neck tumors underwent whole-body MRI in addition to routinely performed imaging investigations, including sonography, chest X-ray, CT of the head, neck and thorax and endoscopy. All investigations were accomplished within a period of 10±3 days in a random order. A randomized, blinded, consensus assessment of all the whole-body MRI examinations was performed by two radiologists. The localization and extent of the primary tumor and metastases were documented for whole-body MRI and compared to the standard of reference (all other imaging modalities as well as histology). Point estimates of the diagnostic accuracy of whole-body MRI were calculated. Results. In accordance with the standard of reference, the overall TNM category was correctly determined with whole-body MRI in all 21 patients. However, four patients were classified as having carcinoma of unknown primary, as the primary tumor was not found with any imaging modality. Two patients had mediastinal, pulmonary and hepatic metastases.

Can body volume be determined by PET?

To avoid dependence on body weight, the standardised uptake value (SUV) in positron emission tomography (PET) can instead be normalised to the lean body mass (LBM), which can be determined from body volume and mass. This study was designed to answer the following questions: Firstly, can the total body volume in principle be determined using PET? Secondly, is the precision of this measurement comparable to that achieved using an established standard method. Ten patients were examined during oncological whole-body PET examinations. The whole-body volume of the patients was determined from the transmission scan in PET. Air displacement plethysmography with BOD POD was used for comparison as the standard method of volume determination. In all patients, the whole-body volumes could be determined using PET and the standard method. Bland and Altman [23] analysis for agreement between the volumes determined by the two methods (presentation of differences vs means) revealed a very small difference of -0.14 l. With a mean patient volume of 71.81+/-15.93 l, the relative systematic error is only <0.1%. On this basis, equality of the volume values determined by the two methods can be assumed. PET can be used as a supplementary method for experimental determination of whole-body volume and total body fat in tumour patients. The fat content can be used to calculate the LBM and to determine body weight-independent SUVs (SUV(LBM)).

Kombinierte Positronen-Emissions-Tomographie/Computertomographie (PET/CT) für die klinische Onkologie: Technische Grundlagen und Akquisitionsprotokolle

Combined PET/CT imaging is a non-invasive means of reviewing both, the anatomy and the molecular pathways of a patient during a quasi-simultaneous examination. Since the introduction of the prototype PET/CT in 1998 a rapid development of this imaging technology is being witnessed. The incorporation of fast PET detector technology into PET/CT designs and the routine use of the CT transmission images for attenuation correction of the PET allow for anato-metabolic whole-body examinations to be completed in less than 30 min. Thus, PET/CT imaging offers a logistical advantage to both, the patient and the clinicians since the two complementary exams - whenever clinically indicated - can be performed almost at the same time and a single integrated report can be created. Nevertheless, a number of pit-falls, primarily from the use of CT-based attenuation correction, have been identified and are being addressed through optimized acquisition protocols. It is fair to say, that PET/CT has been integrated in the diagnostic imaging arena, and in many cases has led to a close collaboration between different, yet complementary diagnostic and therapeutic medical disciplines. (orig.)