Imaging with 18 F-FDG PET/CT is able to reveal vascular inflammation, and several studies have shown that increased 18 F-FDG uptake in carotid artery plaques can qualify the degree of atherosclerotic inflammation. However, clinical assessment of acute aortic dissection (AAD) by PET/CT remains largely unexplored. This study aimed to investigate the use of 18 F-FDG PET/ CT to predict short-and midterm outcomes in medically controlled AAD patients. Methods: A total of 28 medically treated AAD patients (2 Stanford type A and 26 type B, aged 69.5 6 11.6 y) were prospectively studied. All patients were examined by enhanced CT for diagnosis of AAD and underwent serial imaging studies during follow-up. PET/CT images were acquired 50 and 100 min after 18 F-FDG injection in all patients in the acute phase. Results: Of the 28 patients, 8 who had an unfavorable outcome due to death from rupture (n 5 2), surgical repair (n 5 4), and progression of dissection (n 5 2) were categorized as having unfavorable AAD. The remaining 20 patients were categorized as having favorable AAD. Maximum dissection diameter in the unfavorable group was significantly greater than that in the favorable group (P 5 0.0207). On 50-min images, maximal and mean standardized uptake values (SUVs) at maximum aortic dissection sites were significantly greater for the unfavorable group than for the favorable group (all P , 0.01). A stepwise-forward selection procedure demonstrated that the mean SUV at sites of maximum aortic dissection on 50-min images significantly and independently predicted an unfavorable outcome for AAD (P 5 0.0171; odds ratio, 7.72; 95% confidence interval, 1.44-41.4; R 2 5 0.2372). A mean SUV greater than 3.029 had significant predictive power, with sensitivity of 75.0%, specificity of 70.0%, a positive predictive value of 50.0%, a negative predictive value of 87.5%, and accuracy of 71.4%. Conclusion: Greater uptake of 18 F-FDG in AAD was significantly associated with an increased risk for rupture and progression. 18 F-FDG PET/CT may be used to improve AAD patient management, although more studies are still needed to clarify its role in this clinical scenario. Acut e aortic dissection (AAD) is a life-threatening condition that arises from an atherosclerotic lesion in the aorta and is a leading cause of mortality (1). Current outcomes of medical therapy for Stanford type B AAD remain poor, with early mortality ranging from 10% to 12% (2,3). Medical management for AAD, particularly for Stanford type B, poses the difficult problem of deciding on whether surgery is needed and when it should be performed. The decision should balance the surgical risk and the hazard of aortic rupture in elective cases of Stanford type B AAD and in the elderly (4). Close, long-term CT monitoring of morphologic parameters, including maximum aortic diameter and the shape of the dissection, is helpful both for preventing aortic rupture and for undertaking timely surgical or endovascular intervention (5). However, only the relative and not the individual risk of...

A 34-year-old woman with a past history of a carcinoid tumor in the right ovary presented with a right breast mass found on contrast-enhanced computed tomography (CT) of the chest. She was asymptomatic, and her blood tests were normal. The mass measured about 2 cm. Mammography showed a lobular, circumscribed, high-density mass without microcalcifications in the upper outer quadrant of the right breast. Ultrasonography showed an irregular mass with both hypoechoic and hyperechoic components with increased vascularity. The mass was well enhanced on contrast-enhanced CT and dynamic magnetic resonance imaging. At the same time, a well-enhanced small nodule was detected in the pouch of Douglas. Both of the tumors were resected, and a primary breast neuroendocrine tumor (solid neuroendocrine carcinoma) and peritoneal dissemination of the ovarian carcinoid tumor were diagnosed.

Our results show that elasticity imaging provides relatively reliable predictions for malignancy, especially in BI-RADS category 4 masses, compared with MR DWI.

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