Rodney H. Reznek

Summary: Context  Evidence regarding the accuracy of [¹²³I] metaiodobenzylguanidine (MIBG) imaging for phaeochromocytoma localization is currently limited to small series.Objective  We present the largest series of primary phaeochromocytomas in which the performance of [¹²³I]MIBG has been evaluated and correlated with cross‐sectional imaging.Design  We identified 76 patients with both preoperative [¹²³I]MIBG and cross‐sectional imaging for confirmed primary phaeochromocytoma between 1995 and 2005 at our institution. This comprised 60 adrenal tumours in 55 patients and 33 extra‐adrenal tumours in 23 patients (2 patients had both adrenal and extra‐adrenal tumours). Phaeochromocytoma metastases were not evaluated.Main outcome measure(s)  [¹²³I]MIBG studies were independently reviewed and correlated with CT and MRI examinations, as well as tumour functional status, to identify features that may predict a false negative [¹²³I]MIBG result.Results  The overall sensitivity of [¹²³I]MIBG was 75%. Tumour detection was lower for extra‐adrenal (58%) vs. adrenal (85%) phaeochromocytomas (P = 0·005). For extra‐adrenal tumours, [¹²³I]MIBG demonstrated 8 of 14 carotid body, 2 of 2 intrathoracic, 8 of 14 retroperitoneal and 2 of 3 pelvic phaeochromocytomas. Overall, MRI and CT demonstrated 68 of 68 and 72 of 74 primary phaeochromocytomas, respectively. Tumour size correlated with [¹²³I]MIBG uptake for adrenal (P = 0·009) but not extra‐adrenal tumours. When tumours were adjusted for size, no other imaging feature or functional status correlated with [¹²³I]MIBG negativity, although two large [¹²³I]MIBG negative adrenal tumours contained large areas of necrosis or haemorrhage.Conclusions  Extra‐adrenal and small adrenal phaeochromocytomas are more likely to result in false negatives on [¹²³I]MIBG. Tumoural necrosis or haemorrhage do not consistently relate to [¹²³I]MIBG uptake, although adrenal phaeochromocytomas containing minimal solid tissue due to extensive necrosis may predict a negative [¹²³I]MIBG result.

The last two decades have seen ground-shifting changes in the epidemiology, genetics, diagnosis and management of renal cancer. Advances in diagnosis have led to many tumours being identified at an asymptomatic stage. There have also been parallel advances in treatment, such as nephron sparing procedures and radiologically guided ablative procedures. However, these changes have brought with them dilemmas such as our ability to evaluate the nature and aggressiveness of early stage tumours and how best to identify those patients who will benefit most from early treatment. This practical, clinically-oriented volume focuses on these current diagnostic and clinical challenges, making it relevant to all members of the multidisciplinary cancer care team.

Malignant pleural mesothelioma (MPM) is the most common primary neoplasm of the pleura, and its incidence is expected to continue to increase over the next 10 to 20 years. Approximately 7 to 13 cases per million general population are diagnosed each year in the United States.

CT/MRI of neuroendocrine tumours - Cancer Imaging CT/MRI of neuroendocrine tumours - Neuroendocrine tumours (NETs) are often thought to be rare and rather recherche cancers which are of little concern e to the general physician, surgeon or radiologist because of their rarity and esoteric nature. In fact, while relatively uncommon, the total group of gastro-entero-pancreatic (GEP) tumours incorporates the spectrum of all types of carcinoids, incuding bronchial carcinoids, and the whole gamut of islet-cell tumours.

The aim of the present study is to compare the diagnostic performance of CT and MR imaging in detecting aldosterone-producing adenoma and to compare the interobserver variability in the detection of an aldosterone-producing adenoma on CT and MR. A retrospective study of 34 patients with primary hyperaldosteronism was performed. A total of 17 cases of aldosterone-producing adenoma and 17 cases of bilateral adrenal hyperplasia were included. The final diagnosis of an adenoma was made by surgery with histological confirmation, whereas that of bilateral adrenal hyperplasia was made on adrenal venous sampling or a good biochemical and clinical response following medical treatment alone and in the absence of a unilateral radiological abnormality. The CT (n=30) and MR (n=24) scans were reviewed independently by two radiologists experienced in adrenal imaging, who were unaware of the cause of the primary hyperaldosteronism. The diagnostic performances of both observers in detecting an aldosterone-producing adenoma on CT and MR imaging were compared. The 16 adenomatous nodules that were detected on imaging ranged from 1 to 4.75 cm in diameter. The calculated sensitivity and specificity for detecting aldosterone-producing adenoma were 87 and 93% for one observer and 85 and 82% for the other observer on CT, and 83 and 83% for one observer and 92 and 92% for the other observer on MR, respectively. Receptor operating characteristics curve analysis showed similar performances of both observers in detecting an aldosterone-producing adenoma on CT and MR imaging. There was good interobserver agreement on CT (k=0.71) and on MR (k=0.67). We have demonstrated comparable diagnostic performance and good interobserver agreement on CT and MR imaging for the detection of aldosterone-producing adenoma.

CT/MRI in staging renal cell carcinoma - Cancer Imaging CT/MRI in staging renal cell carcinoma - Renal cell carcinoma (RCC) is the eighth most common malignancy. It accounts for approximately 3% of newly diagnosed cancers and has been reported to occur in 11 out of 100 000 individuals. The incidence of RCC has increased by 40% in the USA from 1974 to 1990. There appears to be a true increase in the incidence of RCC over and above that attributable to the increased number detected by abdominal cross-sectional imaging. This increase has been accompanied by improved 5-year survival as the tumors detected by imaging are diagnosed at an earlier stage when they are still resectable.

Imaging and screening strategies in oncology - Cancer Imaging Imaging and screening strategies in oncology - This paper aims to discuss the role of diagnostic imaging in screening protocols for early detection of cancer of the breast, colon and rectum, prostate and lung. The latest attitude of scientists and public health managers towards screening programmes is mainly driven by evidence results, but randomised trials are often difficult to start due to ethical reasons, and difficult to conclude because of the merging new technologies and the long time required.