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The purpose of this study was to evaluate the efficacy of diffusion-weighted MR imaging with background body signal suppression (DWIBS) and a conventional DWI (cDWI) sequence for the detection of breast lesions. Fifty consecutive patients with suspected breast lesions underwent DWIBS and cDWI at 1.5 T. The routine protocol consisted of a short TI inversion recovery (STIR) sequence and a dynamic contrast-enhanced T1-weighted sequence. Apparent diffusion coefficient (ADC) and exponential ADC (eADC) values of the lesions were calculated. Receiver operating characteristic (ROC) analyses and qualitative evaluation of lesion detectability and conspicuity were performed. Thirty-six lesions were detected in 30 patients by using the routine protocol. DWIBS detected 34 lesions (94%) and cDWI detected 26 lesions (72%). The conspicuity of fibroadenomas was significantly (P = 0.007) better for DWIBS. ADC and eADC values of tumour were significantly different between DWIBS and cDWI. DWIBS is superior to cDWI in the visualization of malignant and benign lesions in the breast.

Five histologically confirmed tumors of the carotid body and seven lymph node metastases in the area of the carotid bifurcation were investigated with real-time sonography. In addition, 10 patients underwent measurements of intratumorous flow by way of a pulsed Doppler system. The typically hypervascular tumors of the carotid body revealed flow signals with standardized adjustment of Doppler sonography. The hypovascularized lymph node metastases did not demonstrate flow on Doppler sonography. In all patients, either preoperative angiography or enhanced computerized tomography was done and these studies confirmed the degree of vascularization of the mass as determined by Doppler sonography. Duplex sonography permitted noninvasive demonstration of hypervascular tumors in the area of the carotid bifurcation, a finding highly suggestive of nonchromaphil paraganglioma of the carotid body.

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The aim of this study was to assess cross-sectional imaging features and the value of CT and MRI in primary hemangiopericytoma of bone. In five patients with histologically proven primary osseous hemangiopericytoma CT and MR scans were evaluated retrospectively. Both CT and MRI were available in four patients each. In three patients both imaging techniques were available. On CT primary hemangiopericytoma of bone presents as an expansive lytic lesion with bone destruction and inhomogeneous contrast enhancement. Magnetic resonance imaging depicts osseous hemangiopericytoma as hyperintense lesion on T2-weighted images with intermediate signal intensity on T1-weighted images. Curvilinear tubular structures of signal void in the tumor matrix on T1-weighted images and corresponding hyperintense structures on T2-weighted and on fat-suppressed short tau inversion recovery images were present in three patients. Although cross-sectional imaging findings are non-specific, they add to the diagnosis and provide valuable information about the extent of bone destruction and local tumor spread in patients with primary osseous hemangiopericytoma. While CT demonstrates the extent of bone destruction best, MRI better visualizes medullary and soft tissue extension of the tumor. Curvilinear signal abnormalities support the diagnosis of hemangiopericytoma of bone. This imaging pattern is best visualized on fat-suppressed or contrast enhanced T1-weighted MR images.

99m Tc-tektrotyd is a recently developed tracer for imaging neuroendocrine tumors. We report the case of a patient with a history of prostate cancer and chronic lymphocytic leukemia, who presented with a liver biopsy showing leukemic infiltration associated with chromogranin and CDX2 positivity, suggestive of metastases from an intestinal neuroendocrine tumor.While diagnostic CT did not detect the primary tumor and showed only some liver metastases, 99m Tc-tektrotyd SPECT/MRI fusion identified a pancreatic head tumor and several liver metastases.This case illustrates the feasibility and clinical value of SPECT/MRI fusion using 99m Tc-tektrotyd in neuroendocrine tumor patients. Key Words: SPECT/MRI, SPECT/CT, 99m Tc-tektrotyd, neuroendocrine tumor (Clin Nucl Med 2012;37: e84 -e85) REFERENCES 1. Hicks RJ. Use of molecular targeted agents for the diagnosis, staging and therapy of neuroendocrine malignancy. Cancer Imaging. 2010;10:83-91. 2. Parisella MG, Chianelli M, D'alessandria C, et al. Clinical indications to the use of 99mTc-EDDA/HYNIC-TOC to detect somatostatin receptor-positive neuroendocrine tumors. division (SIAPEC/ IAP). Gastroenteropancreatic neuroendocrine neoplasms: the histology report. Dig Liver Dis. 2011;43(suppl 4):356 -360. 4. Kwekkeboom DJ, Krenning EP, Lebtahi R, et al. ENETS consensus guidelines for the standards of care in neuroendocrine tumors: peptide receptor radionuclide therapy with radiolabeled somatostatin analogs. Neuroendocrinology. 2009;90:220 -226. 5. Gabriel M, Hausler F, Bale R, et al. Image fusion analysis of (99m)Tc-HYNICTyr(3)-octreotide SPECT and diagnostic CT using an immobilisation device with external markers in patients with endocrine tumours. Eur J Nucl Med Mol Imaging. 2005;32:1440 -1451. 6. Apostolova I, Riethdorf S, Buchert R, et al. SPECT/CT stabilizes the interpretation of somatostatin receptor scintigraphy findings: a retrospective analysis of inter-rater agreement. Ann Nucl Med. 2010;24:477-483. 7. Ruf J, Heuck F, Schiefer J, et al. Impact of multiphase 68Ga-DOTATOC-PET/CT on therapy management in patients with neuroendocrine tumors. Neuroendocrinology. 2010;91:101-109. 8. Gambini JP, Núñez M, Vila R, et al. Tc-99m hynic octreotide SPECT-MRI in brain metastasis of thyroid papillary-insular cancer. Clin Nucl Med. 2009;34: 920 -921.

Fascioliosis is a zoonotic disease caused by Fasciola hepatica (common liver fluke). Initial clinical symptoms are frequently non-specific. Even after the development of liver tumors, a range of different underlying disorders will have to be considered. The rare cause of a parasitosis is not always included in the differential diagnostic work up. We report on a 41-year-old truck driver from Middle East who was admitted at our hospital due to ongoing upper abdominal pain, fatigue, night sweat and nausea lasting for weeks. Diagnostic investigation showed leucocytosis, high erythrocyte sedimentation rate, elevated liver values and IgE as well as blood eosinophilia. Radiological findings of the computed tomography were bilateral pulmonary lesions 3 mm in size and multiple hepatic lesions up to 4.5 cm in diameter. Due to the suspicion of a malignant disease, a liver biopsy was planned but cancelled after parasitological serology (Western blot and ELISA) revealed IgG-antibodies against F. hepatica. Detailed history gave evidence of a recent parasitological infection during a stay in Turkey with consumption of vegetable which were grown and washed with water from the local river. Eggs of the parasite could neither be found in analysis of duodenal secretion nor in examination of fecal culture. However, confirmation for the infection with F. hepatica was proved with another positive serology. The treatment with Triclabendazole (Egaten(®)) for two days with a total dosage of 2000 mg was followed by a remarkable recovery of the patient's symptoms and decrease of eosinophilia in the blood count just one month after treatment and normalization after four months.