MR assessment of Müllerian duct anomalies: Does it help?

Purpose

To evaluate the role of magnetic resonance imaging in diagnosis of Müllerian duct anomalies.

Patients and methods

A prospective study included 48 female patients suspected to have Müllerian duct anomalies. All patients underwent trans-abdominal and/or trans-vaginal real time ultrasonography. MRI was performed for all patients. Cases were classified according to American Society of Infertility classification. Outcome information reviewed in comparison with final hystroscopic and labaroscopic data.

Results

This study included 48 patients suspected to have Müllerian duct anomalies according to ultrasonography. MRI final diagnosis was classified according to American Fertility Society as follows: Class I, 15 patients representing 31%, class II, 7 patients representing 15%, class III, 2 patients representing 4%, class IV, 6 patients representing 13%, class V, 15 patients representing 31% and class VI, 3 patients representing 6%.

Conclusion

MRI of the pelvis proved to be highly efficient in the diagnosis of Müllerian duct anomalies and can be considered a corner stone for diagnosis. It proved to be a non invasive, accurate, method for diagnosis and can predict outcome of the condition.     

Septate or bicornuate uterus: Accuracy of three-dimensional trans-vaginal ultrasonography and pelvic magnetic resonance imaging

Objective

To estimate the accuracy of 3-dimensional transvaginal ultrasonography (3D-TVUS), hysterosalpingography (HSG) and pelvic magnetic resonance imaging (MRI) in the differentiation between septate and bicornuate uterus.

Patients and methods

Thirty-six patients with suspected septate or bicornuate uterus on 2D ultrasound or hysterosalpingography (HSG) underwent 3D-TVUS examination, MR imaging, diagnostic laparoscopy and hysteroscopy. HSG was performed only for those patients who did not undergo the procedure before (21 patients), we retrospectively revised the hysterosalpingography of 15 patients performed outside our hospital with acceptable quality.

Results

HSG showed sensitivity of 77.4%, specificity of 60% and overall accuracy of 75% in the differentiation between the septate and bicornuate uterus. MRI showed sensitivity of 93.5%, specificity of 80%, PPV of 96.6% and negative predicative value of 66.6%, with overall accuracy of 91.6%. The 3D ultrasound showed the highest diagnostic parameters, with sensitivity of 96.7%, specificity of 100%, PPV of 100% and negative predicative value of 83.3%, with overall accuracy of 97.2%.

Conclusions

Transvaginal 3-D ultrasonography is accurate for diagnosis and differentiation between septate uterus and bicornuate uterus. We recommend 3-D transvaginal ultrasonography as the first and only mandatory step in the assessment of the uterine cavity in patients with a suspected septate or bicornuate uterus, especially before planning surgery. MRI should be preserved for patients in whom 3D TVS is not possible like virgins.     

Magnetic resonance imaging versus Ultrasound examination in detection of prenatal fetal brain anomalies

Purpose

Evaluation of the role of MR Imaging in detection of fetal brain anomalies versus 2D and 4D Ultrasound examination.

Study design

This study included 23 pregnant females who were suspected to have fetus with congenital brain anomalies over a period of one year using ultrasound. MRI was done within one week following 2D and 4D US examination. The maternal age ranged from 18 to 39 years. The gestational age ranged from 16 to 36 weeks (mean age = 26 weeks). Antenatal Ultrasound and magnetic resonance findings were compared with postnatal MRI findings.

Results

We reported different types of congenital brain anomalies including eight cases of isolated central nervous system anomalies. MRI and ultrasound showed concordant findings in six cases. MRI changed the diagnosis in 14 cases and provided additional information in two cases. Ultrasound was superior to magnetic resonance imaging in one case at second trimester due to fetal motion.

Conclusion

Our results showed that fetal MR imaging is useful in detection of fetal central nervous system anomalies as well as a complementary modality to 2D/4D Ultrasound in diagnosis of fetal central nervous system anomalies.     

Comparison of foetal US and MRI in the characterisation of congenital lung anomalies

Objectives

To compare the accuracy of prenatal ultrasonography (US) to magnetic resonance imaging (MRI) in the characterisation of congenital lung anomalies, and to assess their agreement with final diagnosis. To evaluate the influence of additional MRI information on therapeutic management.

Methods

26 prenatal congenital lung anomalies detected consecutively between 2006 and 2012 were retrospectively evaluated. Lesions were initially observed at prenatal US and further investigated with MRI. Prenatal US and MRI imaging findings, and suggested diagnosis were compared with the final diagnosis, obtained from autopsies (4), pathological evaluation following surgical resection (15) and postnatal imaging studies (7).

Results

Postnatal diagnoses included 7 congenital pulmonary airway malformations, 8 complex lesions, 7 overinflations, 1 sequestration, 1 bronchogenic cyst, 1 blastoma and 1 bilateral lymphangioma. Suggested prenatal US and MRI diagnosis was correct in 34.6% and 46.2% of patients, respectively, mainly isolated lung lesions with typical imaging findings. Nonspecific imaging findings at US and MRI studies were observed in 38.4% of cases. In 42% of the operated anomalies, pathological dissection revealed the presence of complex anomalies. MRI changed the US diagnosis, but not the further management in 9.7% of the lesions.

Conclusions

Prenatal US and MRI showed a high accuracy in the diagnosis of isolated congenital lung lesions with typical imaging findings. However, overall characterisation rates were low, because of both a high percentage of complex lesions and of lesions with nonspecific imaging findings. MRI was better than US in characterising complex lesions, but its additional information did not influence therapy decisions.     

Müllerian duct anomalies: from diagnosis to intervention

The purpose of this study was to review the embryology, classification, imaging features and treatment options of Müllerian duct anomalies. The three embryological phases will be described and the appearance of the seven classes of Müllerian duct anomalies will be illustrated using hysterosalpingography, ultrasound and MRI. This exhibit will also review the treatment options, including interventional therapy. The role of imaging is to help detect, classify and guide surgical management. At this time, MRI is the modality of choice because of its high accuracy in detecting and accurately characterising Müllerian duct anomalies. In conclusion, radiologists should be familiar with the imaging features of the seven classes of Müllerian duct anomalies, as the appropriate course of treatment relies upon the correct diagnosis and categorisation of each anomaly.Müllerian duct anomalies (MDA) are uncommon but can be a treatable form of infertility [1]. Patients with MDA are known to have higher incidences of infertility, repeated first trimester spontaneous abortions, fetal intra-uterine growth retardation, fetal malposition, pre-term labour and retained placenta [1]. The role of imaging is to detect and classify these MDA so that appropriate treatment is undertaken.     

Magnetic resonance imaging in fetal anomalies: What does it add to 3D and 4D US?

Objective

The objective of our study is to evaluate the contribution of adding MRI findings to sonographic data when assessing fetal anomalies and to determine how this addition may affect the management of pregnancy.

Study design

We prospectively examined 26 fetuses who had sonographically suspected congenital anomalies over a period of 1 year. 2D/3D and 4D ultrasound, Doppler and magnetic resonant imaging was done for all patients. MRI was done within 1 week following US examination. The maternal age range was 18-39 years. The gestational age range was 15-38 weeks (mean age = 29 weeks). Ultrasound and magnetic resonance findings were compared together.

Results

We reported different types of congenital anomalies including eight cases of isolated central nervous system anomalies, four abdominal, five musculoskeletal anomalies, seven cases of renal anomalies and two cases of Meckel Gruber syndrome. MRI and sonography showed concordant findings in 18 cases. MRI changed the diagnosis in five cases and provided additional information in three cases. Ultrasound was superior to magnetic resonance imaging in three cases.

Conclusion

Our results showed that fetal MR imaging can be used as a complementary modality to US in diagnosing fetal abnormality in which US findings are inconclusive or equivocal.     

Situs anomalies on prenatal MRI

Objective

Situs anomalies refer to an abnormal organ arrangement, which may be associated with severe errors of development. Due regard being given to prenatal magnetic resonance imaging (MRI) as an adjunct to ultrasonography (US), this study sought to demonstrate the in utero visualization of situs anomalies on MRI, compared to US.

Materials and methods

This retrospective study included 12 fetuses with situs anomalies depicted on fetal MRI using prenatal US as a comparison modality. With an MRI standard protocol, the whole fetus was assessed for anomalies, with regard to the position and morphology of the following structures: heart; venous drainage and aorta; stomach and intestines; liver and gallbladder; and the presence and number of spleens.

Results

Situs inversus totalis was found in 3/12 fetuses; situs inversus with levocardia in 1/12 fetuses; situs inversus abdominis in 2/12 fetuses; situs ambiguous with polysplenia in 3/12 fetuses, and with asplenia in 2/12 fetuses; and isolated dextrocardia in 1/12 fetuses. Congenital heart defects (CHDs), vascular anomalies, and intestinal malrotations were the most frequent associated malformations. In 5/12 cases, the US and MRI diagnoses were concordant. Compared to US, in 7/12 cases, additional MRI findings specified the situs anomaly, but CHDs were only partially visualized in six cases.

Conclusions

Our initial MRI results demonstrate the visualization of situs anomalies and associated malformations in utero, which may provide important information for perinatal management. Using a standard protocol, MRI may identify additional findings, compared to US, which confirm and specify the situs anomaly, but, with limited MRI visualization of fetal CHDs.     

Subtraction images: A really helpful tool in non-vascular MRI

Background

Subtraction imaging is a technique whereby an unenhanced T1-weighted sequence is digitally subtracted from the identical sequence performed after gadolinium administration.

Aim of the work

This study will highlight the role of subtraction imaging for non-vascular MRI applications.

Subjects and methods

The study included 40 patients presenting with lesions in different parts of the body, that are initially hyperintense on T1W sequences.We used post-processing software (Osirix) to digitally subtract the pre-enhancement from the post enhancement sequences.

Results

Based on subtraction imaging findings 5 patients were diagnosed with intraocular melanomas, two patients were diagnosed with hemorrhagic cysts in the masseter muscle , two patients were diagnosed with hemorrhagic cysts in the parotid gland, two patients were diagnosed with dysplastic hepatic nodules, 5 patients were diagnosed with post-ablation necrosis following hepatocellular carcinoma (HCC) treatment, two patients showed recurrent HCC after chemoembolisation, 3 patients showed chemoembolised HCC without recurrence, 4 patients showed intraluminal gall bladder sludge, 4 patients showed hemorrhagic renal cysts, one patient showed solid papillary neoplasm of the pancreas, 6 patients showed chocolate ovarian cysts, two patient showed ovarian cystadenoma and two patients showed ovarian cystadenocarcinoma.

Conclusion

Subtraction MRI is very helpful tool in non-vascular MRI applications.     

Hepatic artery stenosis in liver transplantation: imaging and interventional treatment

Introduction

Main purpose of our study is to demonstrate the spectral and color Doppler ultrasonography (DUS) findings that would indicate hepatic artery stenosis (HAS) after liver transplantation and to report our single center results. Moreover we want to establish role and limits of the different imaging techniques in detecting HAS, proposing a non invasive diagnostic approach and to depict indications and feasibility of endovascular treatment in the single patient.

Materials and methods

Our study consisted of 222 patients who underwent liver transplantation between January 1999 and December 2009. DUS findings were correlated with multidetector computed tomography angiography (MDCTA) and angiographic results.

Results

HAS occurred in 21 cases (9.5%). In all cases diagnosis was performed by DUS. MDCTA quantified stenosis and showed an overall picture of splanchnic vascularization. Based on DUS and MDCTA data integration, in 9 cases we adopted the “wait and see” strategy. Moreover in 12 cases treatment was considered necessary. For hepatic artery stenosis, use of DUS criteria resulted in a sensitivity of 100% (20/20), a specificity of 99.5% (201/202), a positive predictive value (PPV) of 95% (20/21), and negative predictive value (NPV) of 100% (201/201), and an overall accuracy of 99.5% (221/222).

Conclusion

Our study underline the role of DUS in early diagnosis of HAS: repeated evaluation of both direct and indirect signs increases NPV and sensitivity of DUS.     

MRI of persistent cloaca: Can it substitute conventional imaging?

Purpose

To define the role of MRI in the preoperative assessment of patients with persistent cloaca and whether it can substitute other imaging modalities.

Methods

We prospectively examined eleven patients with persistent cloaca between July 2007 and March 2012. Non contrast MRI examinations were performed on 1.5 T magnet using head coil. Multiple pulse sequences (T1WI, T2WI, fat suppression) were obtained in axial, sagittal and coronal planes of the pelvis, abdomen, and spine. The scans were reviewed for the following: the level and type of rectal termination, the developmental state of striated muscle complex (SMC), associated genitourinary and spinal anomalies. MRI findings were compared to conventional fluoroscopic imaging, operative and endoscopic findings. We applied novel MRI parameters (urethral length, relative hiatal distance and vaginal volume). The relation between different parameters was tested statistically using Pearson correlation test.

Results

MRI could accurately demonstrate the level of bowel termination in patients with persistent cloaca, in addition to its high sensitivity for detection of mullerian anomalies which were present in 73% of patients. Furthermore, MRI could disclose associating renal and spinal anomalies, and assess the developmental state of SMC.The shorter the urethra (higher urogenital confluence), the narrower the pelvic hiatus, and the more was the obstruction (vaginal distension).

Conclusion

MRI is a valuable tool in exploring the different internal anatomical features of the cloacal anomaly; and when combined with endoscopy, MRI can make other preoperative conventional imaging unnecessary.     

MRI as complementary tool added to ultrasound in the diagnosis of fetal renal abnormalities – any added value?

Purpose

To assess the potential role of magnetic resonance imaging (MRI) as a complementary diagnostic tool to ultrasonography (US) in the diagnosis of fetal renal anomalies in pregnant women with oligohydramnios in the absence of amniotic membrane rupture.

Methods

Ninety pregnant women, with oligohydramnios were prospectively evaluated using both US and MRI. Prenatal findings were correlated with the babies’ outcome.

Results

MRI studies of diagnostic quality were obtained in all fetuses. The US and MRI findings were concordant in 79 (87.8%) of the fetuses. MRI modified and changed the diagnosis in 11 fetuses (12.2%), these were five fetuses in which US diagnosis was inconclusive, five cases in which the diagnosis changed from bilateral renal agenesis to unilateral agenesis with the other kidney multicystic dysplastic kidney (MCDK), and in the remaining fetuses the modification was from bilateral renal agenesis to unilateral agenesis with the other kidney structurally normal.Concordant findings for the prenatal US and MRI scans were seen in 100% of the autosomal recessive polycystic kidney disease (APCKD), 96% of MCDK, and 92.9% of bilateral normal kidneys.

Conclusion

MRI is of value in cases of oligohydramnios in limited circumstance when US findings were inconclusive.     

Magnetic resonance cholangiopancreatography in conjunction with 3D for assessment of different biliary obstruction causes

Objective

To assess the diagnostic value of magnetic resonance imaging in conjunction with 3D-MRCP, with maximum intensity projections and volume rendered images in different biliary obstruction causes.

Patient and methods

This study retrospectively reviewed the radiology records of 29 patients (18 females and 11 males) suffering from obstructive jaundice. All patients were subjected to magnetic resonance imaging (MRI), 3D-MRCP with maximum intensity projection (MIP) and volume rendered (VR) reformatted images for biliary obstruction diseases in Zagazig University Hospitals between November 2008 and January 2010. MR studies were performed with 1.5-T superconductive magnet (Philips Achieva, class II a). The patient ages were ranging from 23 to 66 years (mean age: 34 years). This study was done to evaluate the diagnostic value and accuracy of the new MRI techniques as a non-invasive tool to diagnose and differentiate between benign and malignant variants of biliary obstruction diseases and to facilitate the management planning. All cases were evaluated by clinical examination, laboratory values, grey and colored scale ultrasonography, conventional MRI, three-dimensional (3D-MRCP), MIP, and VR images. Our results were correlated with the histology of the resected specimen, operative (ERCP) or image-guided biopsy in inoperable patients.

Results

The mean age of benign patients was 30 years compared with 54 years in malignant biliary obstruction. Seventeen patients had benign cases 58.6% (6 cases of benign stricture and 11 cases with choledocholithiasis). The other 12 cases had malignant aetiology. Twenty-three patients were subjected to operative procedures, while the remaining six had ERCP/PTC and stenting. The MRI/MRCP images were of good quality in all patients. The intra- and extra-hepatic biliary radicals were visualized completely including the proximal and distal extent of the stricture. Regarding the benign cases (16/17) were satisfactorily diagnosed, however, one case was false negative, due to missed small stone at the MIP reconstructions. The 12 malignant biliary obstruction cases were as follows: five cases were cholangiocarcinoma (one peripheral type, one perihilar position, one Klatskin’s type, and two cases of the distal type), three pancreatic neoplastic lesions, two ampullary carcinoma, and two malignant lymph nodes. Regarding the benign cases 3D-MRCP had 94.1% diagnostic accuracy, otherwise more accuracy reported in malignant causes 100%.

Conclusion

3D-MRCP with MIP creates global images for pancreatico-biliary system. It is as effective as ERCP in detection of biliary obstruction and can precisely determine its level as well. Furthermore, it can provide a road map for management planning. By avoiding the flow artifacts, the false negative results that previously reported in past studies can be reduced.     

The role of multidetector CT virtual hysterosalpingography in the evaluation of female infertility

Purpose

To assess the role of 64-row multidetector computed tomography virtual hysterosalpingography (MDCT VHSG) in the evaluation of the female reproductive tract in infertile patients and compare it with conventional X-ray hysterosalpingography (HSG).

Methods and material

The studied group included 25 patients with infertility. All patients were evaluated with 64-row MDCT VHSG and X-ray HSG. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of both examinations for uterine pathology, fallopian tube pathology and per lesion pathology were calculated. The duration for both examinations, patient discomfort and patient effective dose were documented.

Results

The mean duration for MDCT VHSG and X-ray HSG was 6.5 ± 1.9 and 26.9 ± 2.9 min respectively, MDCT VHSG has a significantly less median patient discomfort and mean patient effective dose. Sensitivity, specificity, PPV and NPV for uterine pathology were 100%, 100%, 100% and 100% respectively for MDCT VHSG and 90%, 93.3%, 90% and 93.3% respectively for X-ray HSG, the inter-method agreement for uterine pathology was k = 0.83. Sensitivity, specificity, PPV and NPV for the detection of fallopian tube pathology were 100%, 93%, 91 and 100% respectively for MDCT VHSG and 100%, 86%, 85% and 100% respectively for X-ray HSG and k = 0.76. Sensitivity, specificity, PPV and NPV for per patient pathology were 100%, 91%, 93% and 100% respectively for MDCT VHSG and 87%, 80%, 87% and 80% respectively for X-ray HSG and k = 0.75.

Conclusion

MDCT VHSG could be an excellent new alternative diagnostic procedure in the infertility assessment workup.     

Superior orbital fissure syndrome and its mimics: What the radiologist should know?

Aim of this study

The aim of this study was to assess the rule of imaging in the superior orbital fissure syndrome (SOFS) and to identify the rule of the radiologist in guidance of the management.

Material and methods

This study was conducted on 7 patients with clinical diagnosis of SOFS. Contrast enhanced MRI was used in examination of all patients. With exception of metastatic lesions, follow up MRI study was performed to all lesions. Final diagnosis was reached either by dramatic response to cortico-steroid therapy, tissue biopsy or by correlation with clinical and other imaging data.

Results

In all patients enhancing abnormal T1 and T2 intermediate intensities are seen localized to the anatomical site of the superior orbital fissure (SOF). Four patients presented with sheet like enhancement casting the SOF. Nodular enhancement is noted along the medial aspect of the SOF in one case. Two patients presented with sizable destructive space occupying lesions at SOF.

Conclusion

In management of SOFS, if there is a dramatic clinical and radiological response to corticosteroid therapy, we recommend MRI follow-up study after 6 week interval. As the symptoms were resolving, the potential risks associated with tissue biopsy from that area will be unacceptable.     

Evaluation of tumor extent in breast cancer patients using real-time MR navigated ultrasound: Preliminary study

Objectives

To evaluate the accuracy of real-time MR navigated ultrasound (MRnav US) for tumor extent measurements in breast cancer and to investigate variables influencing the accuracy of MRnav US in comparison with US alone.

Methods

Fifty-three patients with 60 malignancies underwent preoperative breast MRI and US with or without MRI navigation. Maximum lesion sizes based on MRnav US and US alone were measured, and their relationship with the pathology was analyzed considering the differences in the clinicopathologic variables of the patients.

Results

Among 60 breast cancers, mean lesion size at initial breast US without MRI navigation and at MRI-navigated US was 19 mm and 24 mm, respectively, compared with 28 mm on the histopathology. Overall, the tumor size estimated with MRnav US was more strongly correlated with the histologic tumor size than with US alone. Accurate measurements by MRnav US were significantly more frequent in the lesions that were presented as a mass type on MRI. In addition, the accurate measurement of mass extent was improved with MRnav US in patients who had non-mass type lesions on MRI and who had undergone neoadjuvant systemic chemotherapy when compared with US alone.

Conclusion

MRnav US was more accurate for tumor extent estimation than US alone, and specific clinicopathologic variables can affect the accuracy of MRnav US.     

The role of advanced MRI techniques in differentiating typical,from atypical and malignant meningiomas

Background

Meningiomas are the commonest primary, non-glial intracranial tumors. The diagnosis is often correctly predicted from characteristic imaging appearances. Some meningiomas have atypical imaging appearance that may cause diagnostic confusion.

Aim

Is to evaluate the role of advanced MR imaging techniques in differentiating typical from atypical and malignant meningiomas before surgery.

Patient

Thirty patients were retrospectively included in this study. They were referred from Neurosurgery Department and all of them suspected to have intracranial meningioma according to the contrast enhanced CT.

Methods

All patients were subjected to conventional magnetic resonance imaging followed by advanced magnetic resonance imaging in the form of diffusion weighted imaging, perfusion weighted imaging and MR spectroscopy by single-voxel techniques.

Results

The overall results based on differentiation of typical from atypical and malignant meningiomas by advanced MRI techniques. Twenty four patients had typical meningioma and 6 patients had atypical and malignant Meningiomas by advanced MRI techniques.

Conclusion

Appearance of meningiomas on DWIs and the calculation of ADC values could be correlated with their histopathological grading. On MRS, alanine was not found to be increased in all meningiomas, so MRS cannot reliably differentiate typical intracranial meningomas from atypical meningiomas.     

The role of MRI in the diagnosis of endometriosis

Aim

The aim of this study is to evaluate the accuracy of the magnetic resonance imaging in diagnosis of endometriosis especially in non-apparent types as tubal and cul de sac endometriosis.

Patients and methods

MRI obtained between January 2007 and June 2009 for 34 premenopausal women complaining of dysmenorrhea, menorrhagia and infertility and the diagnosis of endometriosis were included in the differential diagnosis. T1 weighted fat saturated and T2 weighted images were done for every patient, we evaluated the MR images for the presence of T1 bright signal suggesting endometriosis. Transvaginal US was performed in two perpendicular planes for the detection of focal areas with ill defined borders or abnormal echo texture. Suspicious cases which become negative by laparoscopy were excluded from the study.

Results

MRI diagnosed endometriosis in the uterus in 18 patients, ovarian endometriosis in 13 patients, tubal in two patients, and cul de sac in one patient.

Conclusion

It is concluded that MRI is superior in the diagnosis of endometriosis than transvaginal ultrasound.     

Primary adrenal lymphoma: radiological; pathological, clinical correlation

Objective

The purpose of this study was to analyze CT and MR imaging (MRI) manifestation of primary adrenal lymphoma in order to better understand of this rare disease.

Materials and methods

Six patients (4 men, 2 women; median age, 65.5 years) with pathologically proven primary adrenal lymphoma were retrospectively reviewed. Imaging findings (CT&;MRI, n = 3; only CT, n = 3) were analyzed and correlated with clinical and pathologic findings.

Results

All cases were pathologically proven primary adrenal diffuse large B-cell lymphoma with bilateral lesions in 3 cases respectively. Maximum diameters of the 9 lesions were 6.1–14.8 cm, median 10.5 cm. Seven lesions were round, oval or oblong, and 2 lesions irregular. Seven lesions were well-defined and 2 had ill-defined margins. Unenhanced CT density of 9 lesions and MR signal intensity of T1 weighted images of 6 lesions were similar to that of muscle, and all 6 lesions were hyperintense on T2-weighted MR images. Following intravenous injection of contrast media, 6 lesions had mild enhancement and 3 lesions had moderate enhancement on parenchymal phase imaging. Enhancement was homogenous in three, slightly inhomogeneous in four, and heterogeneous in two. Seven lesions, in 5 cases, infiltrated the adjacent tissues or organs in patients with large tumors.

Conclusion

Primary adrenal lymphoma usually manifests as large, well-defined, soft-tissue masses replacing the adrenal gland with homogeneous or slightly inhomogeneous enhancement. Large tumors especially tend to infiltrate adjacent structures.     

The value of dynamic MRI in the evaluation of the breast following conservative surgery and radiotherapy

Objective

To assess the value of dynamic contrast-enhanced magnetic resonance mammography (DCE-MRM) in breast cancer patients treated by conservation breast surgery and radiotherapy.

Materials and methods

This prospective study were performed on 20 consecutive female patients, from January 2008 till January 2010 at Zagazig university hospitals. All cases had undergone breast conservative therapy (BCT) at least 9–12 months since the end of radiation therapy up to 5 years. All cases were suspected for either recurrence or post-operative complications by clinical examination in conjunction with mammography or/and US. DCE-MRM was performed at 1.5 T. The findings were correlated with the histopathology in all cases.

Results

We found that DCE-MRM accurately revealed the presence or absence, location, and extent of recurrent tumor more accurately than mammography or US. US had high sensitivity and specificity (85.7% and 76.8%) compared to mammography (71.4% and 38.4%, respectively). Seven recurrent cases were found, two of them were multifocal. False-positive contrast enhancement was seen in only one patient pathologically proved as granuloma. MRI showed 95% accuracy, 100% sensitivity, 92.3% specificity with 83% positive predictive value and 100% negative predictive value.

Conclusion

The conventional imaging was insufficient to detect the recurrent lesions after BCT, so DCE-MRI should be the imaging modality of choice in detection of the tumoral recurrence, and differentiating it from other complications. One limitation of the DCE-MRM is the persistent false-positive enhancement due to granulation tissue.     

The role of second-look ultrasound of BIRADS-3 mammary lesions detected by breast MR imaging

Objective

To asses the value of second-look ultrasound (US) for identifying BIRADS 3 (Breast Imaging Reporting Data System) mammary lesions detected by breast Magnetic Resonance imaging (MRI).

Materials and methods

From April 2008 to May 2009 330 breast MRI were performed of which 60 patients are classified as BIRADS 3. 84 lesions underwent second-look US and percutaneous vacuum biopsy Vacora system US-guided. Statistical analysis: lesions were stratified into two groups: visible on US (Group 1) and not visible on US (Group 2).The clinical impact of second-look US was studied in terms of negative predictive value (NPV).

Results

The positive predictive value (PPV) of category 3 BIRADS MRI was found to be 89%. Second look-US results detected lesions in 51% of the MRI enhancing lesions. The second look-US showed a NPV of 97%. The NPV of second look-US was significantly greater than the NPV of MRI BIRADS 3 (97% vs 89%, p < 0.05). The logistic regression analysis showed a higher number of malignant lesions in group 1 than in group 2 (7vs 2, OR 3.7, p < 0.05).

Conclusions

The second-look US permitted the correct management of subcentimetric MRI BIRADS 3 lesions not visible with conventional imaging tecniques.