Purpose: The pretherapeutic assessment of prostate cancer is challenging and still holds the risk of overor undertreatment. This prospective trial investigates positron emission tomography (PET) with [ 18 F]fluoroethylcholine (FEC) combined with endorectal magnetic resonance imaging (MRI) for the assessment of primary prostate cancer.Experimental design: Patients with prostate cancer based on needle biopsy findings, scheduled for radical prostatectomy, were assessed by FEC-PET and MRI in identical positioning. After prostatectomy, imaging results were compared with histologic whole-mount sections, and the PET/MRI lesion-based semiquantitative FEC uptake was compared with biopsy Gleason scores and postoperative histology.Results: PET/MRI showed a patient-based sensitivity of 95% (36/38; 95% confidence interval (CI), 82%-99%). The analysis of 128 prostate lesions demonstrated a sensitivity/specificity/positive predictive value/ negative predictive value/accuracy of 67%/35%/59%/44%/54% (P ¼ 0.8295) for MRI and 85%/45%/68%/ 69%/68% (P ¼ 0.0021) for PET, which increased to 84%/80%/85%/78%/82% (P < 0.0001) by combined FEC-PET/MRI in lesions >5 mm (n ¼ 98). For lesions in patients with Gleason >6 tumors (n ¼ 43), MRI and PET achieved 73%/31%/71%/33%/60% (P ¼ 1.0000) and 90%/62%/84%/73%/81% (P ¼ 0.0010), which were improved to 87%/92%/96%/75%/88% (P < 0.0001) by combined PET/MRI. Applying semiquantitative PET analysis, carcinomas with Gleason scores >6 were distinguished from those with Gleason 6 with a specificity of 90% and a positive predictive value of 83% (P ¼ 0.0011; needle biopsy 71%/60%, P ¼ 0.1071).Conclusions: In a prospective diagnostic trial setting, combined FEC-PET/MRI achieved very high sensitivity in the detection of the dominant malignant lesion of the prostate, and markedly improved upon PET or MRI alone. Noninvasive Gleason score assessment was more precise than needle biopsy in this patient cohort. Hence, FEC-PET/MRI merits further investigation in trials of randomized, multiarm design.

Germany has a long history of insufficient iodine supply and thyroid nodules occur in over 30 % of the adult population, the vast majority of which are benign. Non-invasive diagnostics remain challenging, and ultrasound-based risk stratification systems are essential for selecting lesions requiring further clarification. However, no recommendation can yet be made about which system performs the best for iodine deficiency areas. In a German multicenter approach, 1211 thyroid nodules from 849 consecutive patients with cytological or histopathological results were enrolled. Scintigraphically hyperfunctioning lesions were excluded. Ultrasound features were prospectively recorded, and the resulting classifications according to five risk stratification systems were retrospectively determined. Observations determined 1022 benign and 189 malignant lesions. The diagnostic accuracies were 0.79, 0.78, 0.70, 0.82, and 0.79 for Kwak Thyroid Imaging Reporting and Data System (Kwak-TIRADS), American College of Radiology (ACR) TI-RADS, European Thyroid Association (EU)-TIRADS, Korean-TIRADS, and American Thyroid Association (ATA) Guidelines, respectively. Receiver Operating Curves revealed Areas Under the Curve of 0.803, 0.795, 0.800, 0.805, and 0.801, respectively. According to the ATA Guidelines, 135 thyroid nodules (11.1%) could not be classified. Kwak-TIRADS, ACR TI-RADS, and Korean-TIRADS outperformed EU-TIRADS and ATA Guidelines and therefore can be primarily recommended for non-autonomously functioning lesions in areas with a history of iodine deficiency.

The use of radiation is an essential part of both modern cancer diagnostic assessment and treatment. Next-generation imaging devices create 3D visualizations, allowing for better diagnoses and improved planning of precision treatment. This is particularly important for primary brain cancers such as diffuse intrinsic pontine glioma or the most common primary brain tumor, glioblastoma, because radiotherapy is often the only treatment modality that offers a significant improvement in survival and quality of life. In this review, we give an overview of the different imaging techniques and the historic role of radiotherapy and its place in modern cancer therapy. Finally, we discuss three key areas of risks associated with the use of ionizing radiation: (1) brain tumor induction mainly as a consequence of the diagnostic use of radiation; (2) cognitive decline as a consequence of treating childhood brain tumors as an example of long term consequences often neglected in favor of highlighting secondary primary cancers; and (3) pro-proliferative and pro-invasive alterations that occur in tumor cells that survive radiotherapy. Throughout the discussion, we highlight areas of potential future research.

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This prospective study evaluated the effects of different amounts of fluid intake on the bone-to-soft tissue (B:ST) ratio and image quality of bone scans performed using Tc-99m MDP. One hundred sixty patients with no renal disease were divided into three groups with different degrees of hydration in liters (group 1, 0.25 I; group 2, 1 I; group 3, 1.5 I), and image quality was assessed with a semiquantitative score. The B:ST ratio was calculated over the femoral diaphysis and adductor area, respectively. No significant differences in the B:ST ratio or image quality were demonstrated in all three patient groups with median values of 1.90 (group 1), 1.93 (group 2), and 1.84 (group 3). A filled urinary bladder was associated with greater fluid intake. The B:ST and image quality were correlated directly with the postinjection time interval and inversely with age. When patients drink a large volume of fluid, B:ST ratios do not necessarily increase and bone scintigraphy image quality does not improve.