An unusual case of mammary Paget’s disease in a woman with psoriasis.

Mammary Paget’s disease (MPD) is a malignant breast tumor, which is characterized by intraepidermal infiltration from malignant glandular epithelial cells. Often it may include an underlying ductal carcinoma in situ or an invasive ductal carcinoma. Clinically it appears as an erythematous patch, moist or crusted, with or without desquamation that in some cases becomes ulcerated, causing infiltration and inversion of the nipple.

The sodium-phosphate co-transporter SLC34A2, and pulmonary alveolar microlithiasis: Presentation of an inbred family and a novel truncating mutation in exon 3.

Pulmonary alveolar microlithiasis is a disorder in which many tiny fragments (microliths) of calcium phosphate gradually accumulate in alveoli. Loss of function mutations in the gene SLC34A2 coding for the sodium phosphate co-transporter (NaPi-IIb) are responsible for genetic forms of alveolar microlithiasis. We now report a consanguineous Italian family from Calabria with two affected members segregating alveolar microlithiasis in a recessive fashion.

Differential activation of signaling pathways by low-osmolar and iso-osmolar radiocontrast agents in human renal tubular cells.

Radiocontrast media (RCM)-induced nephrotoxicity (CIN) is a major clinical problem accounting for 12% of all hospital-acquired cases of acute kidney injury (AKI). The pathophysiology of AKI due to RCM is not well understood, but direct toxic effects on renal cells have been postulated as contributing to CIN. It is believed that iso-osmolar RCM (IOCM) are less nephrotoxic than low-osmolar RCM (LOCM) but clinical data have been controversial.

Whole-body MRI and PET/CT in multiple myeloma patients during staging and after treatment: personal experience in a longitudinal study.

Purpose: Diagnostic imaging plays a pivotal role in staging and prognostic assessment of multiple myeloma (MM) as well as planning and monitoring treatment. The aim of our study was to estimate the diagnostic accuracy of wholebody magnetic resonance imaging (WB-MRI) and positron emission tomography/computed tomography (PET/CT) in MM patients studied before and after treatment.

Materials And Methods: We considered 22 consecutive patients (10 males, 12 females; age range, 48-83 years) with newly diagnosed MM (NDMM group), and the same 22 patients underwent at least one re-assessment after treatment (previously treated MM, PTMM group).

Virtopsy versus autopsy in unusual case of asphyxia: case report.

We report the case of a 70-year-old woman found dead in her apartment in the South of Italy in February 2011. The detailed data showed that the victim was affected by familiar-type paranoid schizophrenia. This finding was confirmed by the discovery of antipsychotic and tricyclic antidepressant drugs in the house and the deposition of her psychiatric therapist.

Peptide imaging with somatostatin analogues: more than cancer probes.

Somastostatin (SS) scintigraphy (SRS) is an effective diagnostic tool for neuroendocrine tumours (NET). High diagnostic accuracy is based on the high affinity binding between SS and its receptors (sstr) expressed both in NET and in some non neoplastic cells. Different SS analogues have been proposed in clinical practice because of the short half-life of the native peptide.

Bone metastases radiopharmaceuticals: an overview.

The skeleton is one of the preferential sites for metastases of solid tumors, and metastatic disease is the most common malignancy of the bone. Diagnosis and evaluation of skeletal metastases require more frequently a combined approach of different diagnostic methods. Between the currently available imaging modalities, a major role is devoted to two radionuclide functional techniques namely scintigraphy and positron emission tomography (PET) imaging.

18FDG uptake in sinonasal inverted papilloma detected by positron emission tomography/computed tomography.

Inverted papilloma (IP) is a benign but locally aggressive sinonasal tumour. Aggressive surgical treatment has thus been traditionally recommended because of the risk of transformation in squamous carcinoma. CT and MRI are used to evaluate bone destruction and soft-tissue extension before surgery but may be ineffective to differentiate an inverted papilloma from squamous cell carcinoma.

Gadolinium and nephrogenic systemic fibrosis: have the alarm bells been silenced?

We review the current approach to using gadoliniumbased contrast agents taking into account data published in the literature and US Food and Drug Administration and European Medicines Evaluation Agency (EMEA) guidelines.

Pathophysiological premises to radiotracers for bone metastases.

Aim of our paper is to review the most important radio-compounds that can be successfully used to detect and/or characterize bone metastases. From a didactic point of view, we made a distinction between two main categories , the first allowing to individuate bone's reaction (osteotropic agents), the second trying to detect metastatic tumor cells (oncotropic agents). A wide description of the most diffuse Tc-99m diphosphonates , including analysis of uptake mechanisms and pharmacokinetics, is followed by a brief report on pathophysiological premises to the clinical use of F-18 fluoride and of specific (radioiodine, radiolabeled somatostatin or cathecolamine analogues) or non specific, as Tc-99m sestamibi, F-18 fluorodeoxhyglucose, F-18 choline, F-18 thymidine) oncotropic agents.

Less frequent requests for In-111 pentreotide and its brothers of endocrinological interest.

The somatostatin receptor scintigraphy (SRS), using octreotide radiolabelled with 111In (octreoscan, OCTs), is a consolidated diagnostic procedure in patients with neuroendocrine tumors. A higher accuracy has been demonstrated with single photon emission computed tomography-CT, while a further improvement has been obtained with positron emission tomography (PET)-CT, using somatostatin analogues radiolabeled with 68Ga, significantly increasing the number of detected lesions. Although the well-known presence of an OCTs uptake in many benign diseases, when in an active phase, the application of SRS in these patients did not find any clinical relevance yet.

Nuclear medicine in multiple myeloma -- more than diagnosis.

Multiple myeloma (MM) is a neoplastic monoclonal proliferation of plasma cells, mainly involving bone marrow. To properly stage and manage patients with MM the clinician needs, at first, a complete skeletal survey, being more rarely present also extra skeletal locations. Today none of the available diagnostic imaging methods is able alone to answer to all the questions regarding staging, treatment, and follow up.

Differential activation of signaling pathways involved in cell death, survival and inflammation by radiocontrast media in human renal proximal tubular cells.

Radiocontrast media (RCM) are widely used in clinical medicine but may lead to radiocontrast-induced nephropathy (RCIN). The pathogenesis of acute renal failure secondary to RCM is not fully understood, but direct toxic effects are believed to be a major cause of RCIN. We have investigated the effect of different types of RCM on signaling pathways known to play a role in cell death, survival, and inflammation.

Off-label use of intravascular iodinated organic and MR contrast media.

Unlabelled: This paper analyses off-label prescribing of the iodinated organic and magnetic resonance (MR) contrast media used in diagnostic imaging and evaluates the liability profiles and medicolegal issues associated with such use. The term off-label generally indicates the use of known drugs for which new scientific evidence suggests use in a manner and in clinical scenarios not explicitly addressed by the drug data sheet and is outside the indications for which the medication was approved. In addition, the term also indicates the use of drugs with a different route of administration and dosage from those indicated in the information leaflet.

Critical issues in radiology requests and reports.

Purpose: This study evaluated the appropriateness and accuracy of 500 radiology requests and their matched reports in order to identify recurring errors in both areas.

Materials And Methods: A randomly chosen sample consisting of 167 computed tomography (CT), 166 ultrasonography (US) and 167 radiographic examinations were collected and analysed according to national referral guidelines and to the principles of justification and optimisation (Law no. 187/2000).

Nephrogenic systemic fibrosis: the first Italian gadolinium-proven case.

Nephrogenic systemic fibrosis (NSF) is a systemic disease, recently described in patients with advanced chronic kidney disease (CKD), characterized by progressive scleromyxedema-like fibrotic involvement mainly of the skin. We describe the case of a 66-year-old woman on chronic hemodialysis for end-stage renal failure, also affected by hypothyroidism, secondary hyperparathyroidism and occluding arteriopathy, for which she underwent a contrast-enhanced magnetic resonance angiography of the lower limbs in February 2007. One month later, she began complaining of progressive, painful distal lower limb stiffness, which subsequently spread to all four limbs and to the whole trunk.

Whole-body magnetic resonance imaging for detecting bone metastases: comparison with bone scintigraphy.

Purpose: The aim of the study was to assess the reliability of whole-body magnetic resonance imaging (WB-MRI) in detecting skeletal metastasis and to compare the results with those of bone scintigraphy (BS).

Materials And Methods: Thirty-three patients (21 women, 12 men, median age 58 years, range 27-78) were enrolled. Histological proof of malignancy was obtained in all cases.

Is there a role for positron emission tomography imaging in the early evaluation of prostate cancer relapse?

The patient population with a rising prostate specific antigen (PSA) post-therapy with no evidence of disease on standard imaging studies currently represents the second largest group of prostate cancer patients. Little information is still available regarding the specificity and sensitivity of positron emission tomography (PET) tracers in the assessment of early biochemical recurrence. Ideally, PET imaging would allow one to accurately discriminate between local vs nodal vs distant relapse, thus enabling appropriate selection of patients for salvage local therapy.

The evolving role of MRI in oncohaematological disorders.

Magnetic resonance imaging (MRI) has opened new possibilities to current diagnostic radiology in the evaluation of bone marrow. Compared with other imaging modalities, MRI is the only technique able to directly visualise bone marrow with its different components of red and yellow marrow. Other advantages of MRI are high-contrast resolution and multiplanar view, as well as extensive coverage of the skeleton with whole-body MRI (WBMRI).

Current status of PET/CT for tumour volume definition in radiotherapy treatment planning for non-small cell lung cancer (NSCLC).

Target volume delineation of lung cancer is well known to be prone to large inter-observer variability. The advent of PET/CT devices, with co-registered functional and anatomical data, has opened new exciting possibilities for target volume definition in radiation oncology. PET/CT imaging is rapidly being embraced by the radiation oncology community as a tool to improve the accuracy of target volume delineation for treatment optimization in NSCLC.