Background: Cutaneous malignant melanoma (CMM) is a highly aggressive tumor with high tendency of return despite complete surgical removal. It has a high risk of dissemination to regional lymph nodes and visceral organs. The prognosis is highly dependent on lymph node involvement and distant metastases. Positron Emission Tomography with Computed Tomography (PET/CT) is a valuable non-invasive tool for the diagnosis and staging of patients with MM. The purpose of the present study was to evaluate the role of integrated (PET/CT) in staging, restaging, prognosis, and prediction of recurrence in patients with malignant melanoma. Results: Fifty malignant melanoma patients with age ranged from 28 to74 years (mean age 55.94 + 13.40 years) were 28 males (mean age 56.71 + 12.82) and 22 females (mean age 54.95 + 14.34). All our patients were histopathologically proven to have malignant melanoma. Twenty-one patients came for initial staging by 18F-FDG PET/CT. Their findings were compared with the reference standards and showed the sensitivity of 93.33%, specificity of 60%, and accuracy of 85.71% for primary staging. 18F-FDG PET/CT scan in 11 clinical suspicion patients of relapse after treatment showed the sensitivity of 100%, specificity of 66.66%, positive predictive value of 88.88%; negative predictive value of 100%; and accuracy of 90.90%. FDG-PET/CT of whole body scan in 18 cases of stage IV melanoma showed sensitivity of 100%, specificity of 66.66%, and overall accuracy of 94.44% for detection of distant metastases. SUVmean and SUVmax in all studied groups were significantly higher in true positive more than true negative or false-positive patients diagnosed by PET/CT with high sensitivity (82.88-100%). Conclusion: PET/CT imaging enhanced diagnostic performance in detection of the primary malignancy, in followup of high-risk patients and patients with suspected or known local or distant recurrence, and in restaging of patients with known distant metastatic disease to assess tumor response.

Background T2 mapping and DWI are newly quantitated method for disk degeneration assessment; they were used in the determination of an early stage of intervertebral disk degeneration. T2 mapping was quantitatively sensitive for detecting the early stage and aging-related changes in intervertebral disk degeneration. Furthermore, T2 mapping and apparent diffusion coefficient values (ADC) in lumbar intervertebral disks indirectly correlated with the Pfirrmann grades in IVDD and age-related disk degeneration. The aim of this study is to evaluate the sensitivity of T2 mapping and apparent diffusion coefficient in the determination of an early stage of intervertebral disk degeneration. Results T2 relaxometry values were found to decrease with the increased disk degeneration except in grade V where it was found to be increased again. There was a negative correlation between T2 values and semi-quantitative grading (Pfirrmann Grading) of disk degeneration and T2 values were significantly different when comparing grade I to V. A T2 value of nucleus pulposus (NP) was more sensitive than annulus fibrosus (AF) and entire of the disk. ADC values were found to decrease with the increased degree of disk degeneration; there was a weakly significant negative correlation between age and T2 mapping values, ADC values of nucleus pulposus, and entire of disk. Conclusion T2 mapping was significantly different when comparing grade I to V while ADC value had a significant weak negative correlation with age, so T2 mapping and to a little extent ADC can be used for quantitative analysis of early disk generation seeking for early diagnosis and better management.

Background: Differentiation between malignant and benign masses is essential for treatment planning and helps in improving the prognosis of malignant tumors; the aim of this work is to determine the role of diffusionweighted magnetic resonance imaging (DW-MRI) and the apparent diffusion coefficient (ADC) in the differentiation between benign and malignant solid head and neck masses by comparing diagnostic performance of low b values (0.50 and 400 s/mm 2) versus high b values (800 and 1000 s/mm 2) and comparing the result with histopathological finding. Results: The study included 60 patients (34 male and 26 female) with solid head and neck masses > 1 cm who referred to radiodiagnosis department for MRI evaluation. Multiple b values were used 50, 400, 800, and 1000 s/mm 2 (at least 2 b values). DWI and ADC value of all 60 patients were acquired. Mean ADC values of both malignant and benign masses were statistically measured and compared, and cut off value was determined. Solid head and neck masses in our study DWI with the use of high b value 800 and 1000 s/mm 2 were of higher significance (P value 0.001*). There was a significant difference in the mean ADC value between benign and malignant masses (P < 0.01); solid masses were divided into 2 categories: (a) malignant lesions 46.7% (n = 28) with mean ADC value (0.82 ± 0.19) × 10 −3 s/mm 2 and (b) benign lesions 53.3% (n = 32) with mean ADC value (2.05 ± 0.46) × 10 −3 s/mm 2) with ADC cutoff value of 1.0 × 10 −3 s/mm 2 and 94% sensitivity, 93% specificity, negative predictive value (NPV) = 94%, positive predictive value (PPV) 93%, and an accuracy of 93.5%. Conclusion: The DWI with ADC mapping were valuable as non-invasive tools in differentiating between benign and malignant solid head and neck masses. The use of high b value 800 and 1000 s/mm 2 was of higher significance (P value 0.001*) in differentiation between benign and malignant lesion than that with low b values 0, 50, and 400 s/mm 2 (0.01). The mean ADC values were significantly lower in malignant solid masses. Attention had to be paid to the choice of b values in MRI-DWI in the head and neck region.

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Background: Pancreatic malignancy is a rapidly growing cause of death in the world. Its survival rate is months even if discovered early. Aim of Study:We evaluated the correlations between PET/SUVs (Standard Uptake Values), clinical characteristics and cancer stem-like cells named aldehyde dehydrogenase 1 (ALDH1) in pancreatic cancer. We evaluated the diagnostic performance of SUV and its correlation with overall survival.Patients and Methods: Thirty-nine patients with pancreatic cancer were evaluated by PET/CT. The expression of ALDH1 was detected immunohistochemically in their cancer specimens. Results of PET/SUV were correlated with clinicpathological character, ALDH1 and overall survival.Results: PET/SUV was associated significantly with tumor size (p=0.027). No significant correlation with other clinicalpathological characteristics. PET/CT showed sensitivity= 81%, specificity=78% and accuracy=82%. PET/SUV reflected the expression level of ALDH1 with significant correlation (p=0.001). Patients with high SUV and high expression of ALDH1 had a worse median overall. Conclusion:PET-CT was a non-invasive imaging modality that helped in pancreatic cancer especially in doubtful tumors. PET/CT was helpful tool to detect lymph nodes invasion and distant metastasis. It was associated with the expression level of ALDH1. High SUV and high expression of ALDH1were significantly correlated with a worse clinical outcome. PET/SUV and Cancer stem cells may serve as significant prognostic factors in predicting outcomes in pancreatic cancer patients.