[en] In Germany, breast cancer is the most common cancer for women with a lifetime prevalence of 13% and 70,000 new cases annually (Krebs in Deutschland 2011/2012. RKI (Hrsg) 2015; 10: 6 - 151). Depending on the subtype, breast cancer metastasises is found in every second to fourth case. Metastases are most common in regional lymph nodes (42%), bones (23%), lungs (12%), liver (12%), pleura/peritoneum (11%), distant lymph nodes (9%) and brain (5%) (Kennecke et al. J Clin Oncol 2010; 28: 3271 - 3277). Metastases in the urinary bladder, on the other hand, are rare and have only been described in isolated cases (Ghaida RA et al. Cent European J Urol 2013; 66: 177 - 184). We report on a patient with breast carcinoma and solitary, initially asymptomatic metastasis of the urinary bladder, which was diagnosed during staging in computer tomography (CT).

[en] Gadoxetate disodium is an intracellular contrast agent for magnetic resonance imaging (MRI) of the liver. Recent publications revealed that injection of gadoxetate disodium can lead to imaging artifacts due to transient severe motion (TSM) in the arterial phase of contrast-enhanced liver MRI. In this review we present and discuss published frequencies of TSM, contrast injection and image acquisition protocols, potential risk factors, and proposed strategies to avoid or minimize the effects of TSM. Two reviewers independently searched the PubMed search engine for ''transient severe motion artifact'' and related terms. Reference lists of retrieved articles were also searched. The two reviewers selected in consensus nine studies that reported both frequencies of TSM and potential risk factors. Study data were extracted by both reviewers, and disagreement was resolved by consensus. TSM is caused by impaired breath-hold ability after gadoxetate disodium injection and occurs in 5 -22% of patients. The dose of applied contrast agent, repeated exposure to gadoxetate disodium, high BMI and pulmonary disease have been described as potential risk factors for TSM. However, there are only few concordant results on this topic and the pathophysiology of TSM has not been identified. Proposed strategies for the prevention of TSM are slow injection rates and low doses of diluted gadoxetate disodium. Accelerated and free-breathing MRI sequence protocols and breath-hold training may minimize the effects of TSM. Further prospective studies are needed to confirm these strategies and to identify the underlying mechanism of TSM.

[en] Varying frequencies (5 - 18%) of contrast-related transient severe motion (TSM) imaging artifacts during gadoxetate disodium-enhanced arterial phase liver MRI have been reported. Since previous reports originated from the United States and Japan, we aimed to determine the frequency of TSM at a German institution and to correlate it with potential risk factors and previously published results. Two age- and sex-matched groups were retrospectively selected (gadoxetate disodium n = 89; gadobenate dimeglumine n = 89) from dynamic contrast-enhanced MRI examinations in a single center. Respiratory motion-related artifacts in non-enhanced and dynamic phases were assessed independently by two readers blinded to contrast agents on a 4-point scale. Scores of ≥3 were considered as severe motion artifacts. Severe motion artifacts in arterial phases were considered as TSM if scores in all other phases were < 3. Potential risk factors for TSM were evaluated via logistic regression analysis. For gadoxetate disodium, the mean score for respiratory motion artifacts was significantly higher in the arterial phase (2.2 ± 0.9) compared to all other phases (1.6 ± 0.7) (p < 0.05). The frequency of TSM was significantly higher with gadoxetate disodium (n = 19; 21.1 %) than with gadobenate dimeglumine (n = 1; 1.1%) (p < 0.001). The frequency of TSM at our institution is similar to some, but not all previously published findings. Logistic regression analysis did not show any significant correlation between TSM and risk factors (all p>0.05). We revealed a high frequency of TSM after injection of gadoxetate disodium at a German institution, substantiating the importance of a diagnosis-limiting phenomenon that so far has only been reported from the United States and Japan. In accordance with previous studies, we did not identify associated risk factors for TSM.

[en] Imaging studies are essential for both diagnosis and initial staging of multiple myeloma, as well as for differentiation from other monoclonal plasma cell diseases. Apart from conventional radiography, a variety of newer imaging modalities including whole-body low-dose-CT, whole-body MRI and 18F-FDG PET/CT may be used for detection of osseous and extraosseous myeloma manifestations. Despite of known limitations such as limited sensitivity and specificity and the inability to detect extraosseous lesions, conventional radiography still remains the gold standard for staging newly diagnosed myeloma, partly due to its wide availability and low costs. Whole-body low-dose CT is increasingly used due to its higher sensitivity for the detection of osseous lesions and its ability to diagnose extraosseous lesions, and is replacing conventional radiography at selected centres. The highest sensitivity for both detection of bone marrow disease and extraosseous lesions can be achieved with whole-body MRI or 18F-FDG PET/CT. Diffuse bone marrow infiltration may be visualized by whole-body MRI with high sensitivity. Whole-body MRI is at least recommended in all patients with normal conventional radiography and in all patients with an apparently solitary plasmacytoma of bone. To obtain the most precise readings, optimized examination protocols and dedicated radiologists and nuclear medicine physicians familiar with the complex and variable morphologies of myeloma lesions are required. (orig.)

[en] Many scientific manuscripts submitted for publication are limited by fundamental mistakes in their preparation, leading to rejection. We describe how to write a well-organized radiological research manuscript containing all of the important ingredients for effective communication of a hypothesis-driven scientific study in the context of medical imaging.

Key Points

• Mistakes in the preparation of scientific manuscripts lead to rejection.

• Scientific writing, like any important skill, can be learned.

• A well-developed approach will improve the quality of scientific writing.

• High-quality scientific writing is essential to communicate research results.

• A well-organized manuscript effectively communicates a hypothesis-driven scientific study.

[en] Paraneoplastic neurological syndromes (PNS) constitute a challenging diagnostic problem, as the underlying tumour often remains unidentified for a long time, even with frequent conventional diagnostic procedures. For appropriate patient management timely identification of the tumour is critical. We evaluated the value of ¹⁸F-FDG-PET/CT in the investigation of PNS. The case notes of 46 consecutive patients with clinically suspected PNS who underwent ¹⁸F-FDG-PET/CT were reviewed retrospectively and the performance of PET/CT for detecting underlying tumours was assessed. PET/CT detected foci of increased ¹⁸F-FDG uptake in 10 out of 46 patients. In six of these 10 patients combined PET/CT identified the underlying disease: four patients suffered from PNS; vasculitic and local metastatic disease was detected in two other patients. Based on our results, we believe that the role of positron emission tomography in the detection of occult neoplasms in patients with PNS has been overestimated in the past. In clinical practice, PNS is far more often suspected than proven. In our study combined PET/CT identified malignancy as the underlying cause of suspected PNS in only 8.7% (4/46). We believe that combined PET/CT should be reserved for stringently selected patients with a high clinical index of suspicion for PNS and after conventional imaging techniques fail to detect a tumour. (orig.)

[en] Background Patients suffering from hereditary hyperlipidemia have a high risk for premature cardiovascular disease and death as a consequence of accelerated atherosclerosis. Purpose To prospectively and intra-individually compare image quality and detectability of stenoses in contrast enhanced whole-body MRA (WBMRA) at 1.5 and 3 Tesla (T) in patients with hereditary hyperlipidemia. Material and Methods Twenty-seven patients with hereditary hyperlipidemia received a 1.5 and 3 T gadopentetate dimeglumine contrast-enhanced WBMRA. Twenty-three defined arterial segments were analyzed regarding depiction of target vessels and image quality according to a 5-point-scale ('not evaluable' to 'excellent'). Wilcoxon matched pair test was performed for comparison. Forty-three defined arterial segments were analyzed for the degree of stenosis (0%, 1-49%, 50-99% and 100%) as well as vessel alterations such as aneurysms. Chi-square test was performed for comparison. Results 1.5 T and 3 T scans yielded WBMRA with diagnostic quality in all patients. In seven of 23 arterial segments (30.4%) image quality was rated significantly higher at 3 T, whereas there was no significant difference in the remaining 16 segments between WBMRA at 1.5 T and 3 T. All relevant stenoses (n = 5), occlusions (n = 6), and aneurysms (n = 3) were evaluated similarly at both field strengths. Conclusion WBMRA can be performed at 1.5 T and 3 T with diagnostic image quality. Image quality was significantly higher at 3 T than at 1.5 T in only 30.4% of the arterial segments. In order to effectively take advantage of the higher field strength, further optimization of sequence parameters and injection protocols for WBMRA at 3 T is necessary

[en] To compare the diagnostic performance of whole-body magnetic resonance imaging (WBMRI) versus ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) for determination of remission status in patients with multiple myeloma (MM) after stem cell transplantation (SCT). Thirty-one patients were examined by both WBMRI and PET/CT after SCT. Imaging results and clinical remission status as determined by the clinical gold standard (Uniform Response Criteria) were compared. One hundred four lesions were detected in 21 patients. PET/CT had a sensitivity of 50.0 %, a specificity of 85.7 %, a positive predictive value of 62.5 %, a negative predictive value of 78.3 %, and an overall accuracy of 74.2 % for determination of remission status. MRI had a sensitivity of 80.0 %, a specificity of 38.1 %, a positive predictive value of 38.1 %, a negative predictive value of 80 %, and an overall accuracy of 51.6 %. Concordant results were observed in only 12 (11.5 %) of the 104 lesions. In the post-treatment setting, both FDG PET/CT and WBMRI provide information about the extent of disease, allowing for a more comprehensive evaluation of persisting or recurrent myeloma. MRI may often be false positive because of persistent non-viable lesions. Therefore, PET/CT might be more suitable than MRI for determination of remission status. (orig.)

[en] Purpose: The practice of surgical staging and treatment of anal cancer has been replaced by noninvasive staging and combined modality therapy. For appropriate patient management, accurate lymph node staging is crucial. The present study evaluated the feasibility and diagnostic accuracy of contrast-enhanced [¹⁸F]fluoro-2-deoxy-D-glucose ([¹⁸F]FDG)-positron emission tomography/computed tomography (PET/CT) for staging and radiotherapy planning of anal cancer. Methods and Materials: A total of 22 consecutive patients (median age, 61 years old) with anal cancer underwent complete staging evaluation including physical examination, biopsy of the primary tumor, and contrast-enhanced (ce)-PET/CT. Patients were positioned as they would be for their subsequent radiotherapy. PET and CT images were evaluated independently for detectability and localization of the primary tumor, pelvic and inguinal lymph nodes, and distant metastasis. The stage, determined by CT or PET alone, and the proposed therapy planning were compared with the stage and management determined by ce-PET/CT. Data from ce-PET/CT were used for radiotherapy planning. Results: ce-PET/CT revealed locoregional lymph node metastasis in 11 of 22 patients (50%). After simultaneous reading of PET and CT data sets by experienced observers, 3 patients (14%) were found to have sites of disease not seen on CT that were identified on PET. Two patients had sites of disease not seen on PET that were identified on CT. In summary, 2 patients were upstaged, and 4 patients were downstaged due to ce-PET/CT. However, radiotherapy fields were changed due to the results from ce-PET/CT in 23% of cases compared to CT or PET results alone. Conclusions: ce-PET/CT is superior to PET or CT alone for staging of anal cancer, with significant impact on therapy planning.

[en] To determine the value of multidetector computed tomography (MDCT) in patients with acute spondylodiscitis. For data acquisition, we searched our radiological database for all patients who had undergone magnetic resonance imaging (MRI) for suspected spondylodiscitis between 2007 and 2015 (n = 325). For further analyses, we included all patients (n = 67) who initially underwent MDCT prior to MRI. Overall accuracy, sensitivity, specificity and positive and negative predictive values were calculated for MDCT and, separately, for contrast-enhanced CT (CECT, n = 36) and for non-enhanced CT (NECT, n = 31). MRI together with clinical evaluation served as the standard of reference. Results: In 34 of 43 patients with acute spondylodiscitis on MRI, correct diagnosis was already made by the initial MDCT scan. The specificity and positive predictive value were 100% for MDCT. The sensitivity was 79% and the negative predictive value was 72%. The overall accuracy was 87%. Accuracy was higher for CECT (89%) than for NECT (84%), however without statistical significance (p = 0.55). MDCT detected 90% of paravertebral abscesses (34/38), but only 6% of epidural abscesses (2/36). MDCT has moderate sensitivity, but high specificity for acute spondylodiscitis. Thus, if MDCT is positive for spondylodiscitis, treatment can be started without further delay. However, MRI should be added to both MDCT negative and positive cases to rule out complications such as epidural abscesses that cannot reliably be detected by MDCT. Key Points: Patients with acute spondylodiscitis are often initially suspected of having other differential diagnosis because of nonspecific symptoms. Therefore, MDCT is frequently performed prior to MRI in patients with acute spondylodiscitis. MDCT proved moderate sensitivity but high specificity for the diagnosis of acute spondylodiscitis. Paravertebral abscess is a strong indicator for the presence of spondylodiscitis on MDCT. However, MRI is crucial to rule out epidural abscesses, an important complication.