Combined positron emission tomographic (PET)/computed tomographic (CT) scanners allow the use of CT data for attenuation correction of PET images. Eight patients with cancer underwent PET/CT scanning. Transmission scanning was performed with conventional attenuation correction and with CT scanning during maximum inspiration and normal expiration. Image quality was visually compared and fluorine 18 activities were measured in volumes of interest in the lung and myocardium. Analysis of variance for repeated measures revealed a significant decrease (P =.0001) in measured activities between PET images corrected with CT data acquired during maximum inspiration and those corrected with the conventional attenuation correction method or with CT data acquired during normal expiration. Deep inspiration during CT can result in severe deterioration in the final PET image.

Visual assessment of FDG uptake shows a significant correlation with clinical evaluation of disease activity in patients with RA undergoing antiinflammatory treatment.

Posttraumatic osteomyelitis is frequently characterized by chronicity and recurrent activation of infection. The diagnosis is usually made on the basis of clinical, laboratory, and imaging examinations. The conventional radiograph is the basic imaging study that provides important information about skeletal deformity, bone quality, identification of metallic implants, and consolidation of the former fracture site. Other imaging techniques are required to determine the grade of activity, to define the extent of infection and to delineate small sequestra, intraosseus fistula and abscesses. A variety of more sophisticated modalities, such as modern cross-sectional imaging and radionuclide studies, are available, and the decision to choose the most suitable method can be very difficult. This review gives an overview of definition, epidemiology, and pathophysiology of chronic posttraumatic osteomyelitis and discusses the value of currently used imaging modalities.

Acute activity in a chronic osteomyelitis can be excluded with high probability if the MRI findings are negative. In the first postoperative year fibrovascular scar cannot be distinguished accurately from reactivated infection on MRI and scintigraphy may improve the accuracy of diagnosis. MRI is more sensitive in low-grade infection during the later course than combined BS/IS. Scintigraphic errors due to ectopic, peripheral, haematopoietic bone marrow can be corrected by MRI.

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Activated macrophages in acute soft-tissue infection can be labeled with USPIOs and detected with MR imaging because of susceptibility effects.

Invasive pulmonary aspergillosis (IPA) is associated with a high mortality. In 27 consecutive neutropenic patients who underwent lung resection for suspected IPA, we analyzed preoperative diagnostic evaluation, operative procedure, perioperative management, histological findings, outcome concerning recurrence of aspergillosis, and survival to evaluate the morbidity and mortality of a surgical treatment of IPA. Seventeen patients with hematologic diseases had previously undergone high-dose chemotherapy and four stem cell transplantation. Six patients with aplastic anemia were treated with antilymphocyte globulin. IPA was suspected if localized infiltrates developed on thoracic CT scan, and fever persisted under antibiotic therapy in neutropenic patients. In only one case a diagnosis of IPA could be made preoperatively. Twenty patients underwent lobectomy and seven wedge resection. At day of surgery the neutrophil count was below 500 x 10(9)/L in 78% of patients, and the platelet count below in 50 x 10(9)/L in 58% of patients. Invasive fungal infection was confirmed histologically in 22 of 27 patients (81.5%); in five patients no fungal infection was documented. The median duration of surgery was 120 min. Postoperatively, patients stayed one night in the intensive care unit, and chest tubes were removed after 2 d. Within 7 d a median of four erythrocyte packs and two platelet packs per patient were replaced. Major surgical complications occurred in two patients (bronchial dehiscence; pleural aspergillosis). Minor surgical complications included prolonged chest tube drainage (recurrent pneumothorax, n = 2; air leakage, n = 1; hematothorax, n = 1), pleural effusion (n = 4), and seroma (n = 2). Postoperatively, two patients suffered from histologically proven disseminated aspergillosis (pleural aspergillosis, renal aspergilloma) and another patient from suspected orbital aspergillosis. At 30 d postoperative mortality was 11% and 3-mo survival was 77%. After lung resection, seven patients underwent stem cell transplantation without recurrence of IPA. In conclusion, we suggest lung resection is a therapeutic option for invasive pulmonary aspergillosis in neutropenic patients with hematologic diseases and is associated with a low surgery-related morbidity and mortality.

To determine bone mineral density in patients with differentiated thyroid carcinoma receiving thyroxine replacement therapy in suppressive doses, we studied 65 patients (47 women and 18 men; age 25-83 years, mean+/-SD 52.5+/-15.4 years). Patients were free of thyroid cancer in clinical and laboratory examinations at the time of the study. Bone mineral density of the lumbar spine and both hips was measured by dual-energy X-ray absorptiometry. There was no decrease in bone density in either 32 postmenopausal or 15 premenopausal women compared with an age- and sex-matched control group, nor was any decrease in bone density found in men. Our data suggest that thyroxine treatment in suppressive doses in patients with differentiated thyroid carcinoma is not a risk factor for the development of osteoporosis.