The interrenicular junction: a mimic of renal scarring on normal pediatric sonograms

A triangular, echogenic focus of perirenal tissue in the anterosuperior or posteroinferior margin of the kidney, the junctional parenchymal defect (JPD), and an oblique echogenic line, the interrenicular septum (IRS), connecting the JPD to the renal hilum are normal sonographic findings in the pediatric age group. They are manifestations of an oblique interface between the two parts (reniculi) of one kidney. They should not be mistaken for renal scars. Prospectively, in a group of 100 children, either the JPD or IRS was seen in 46% of right kidneys and 19% of left kidneys. Retrospectively, the JPD was seen in 47% of right kidneys and 18% of left kidneys, and the IRS was seen in 39% of right kidneys and 12% of left kidneys.     

Quality assurance of mammograms in the Norwegian Breast Cancer Screening Program

This study compared the proportion of mammograms classified as perfect, good, moderately good or inadequate by a radiographer specially trained for doing such a classification at a breast centre (local-PGMI radiographer) with the proportion similarly assessed by an expert-PGMI radiographer. The results were compared with the recommendations given in the quality assurance manual of the Norwegian Breast Cancer Screening Programme. The reasons for classifying the mammograms into other than perfect, such as good, moderately good or inadequate were investigated.The quality of the mammograms was measured by using the PGMI system, which is a quality-review model that classifies the images into the four categories according to positioning, compression, exposure, noise, artefacts, and movement. A total of 1280 mammograms from all 16 breast centres in the screening programme were classified.The distribution of perfect, good, moderately good, and inadequate mammograms differed between the local-PGMI radiographers and the expert radiographer, for both the cranio-caudal (CC) and mediolateral-oblique (MLO) mammograms (P < 0.001 for both). The expert radiographer classified a higher proportion of both CC (28%) and MLO (14%) mammograms as inadequate than did the local-PGMI radiographers (7% and 3%, respectively; P < 0.001 for both). The guidelines recommend ≤3% of the mammograms to be inadequate. The reason given for the inadequate classifications by the expert radiographer was predominantly “parts of the breast missing” for both the CC and the MLO mammograms.There is room to improve the quality of the mammograms in the screening programme in Norway. Attention should be given to positioning and the use of standardized terms in the PGMI classification.     

Breast lesions on sonograms: computer-aided diagnosis with nearly setting-independent features and artificial neural networks

PURPOSE: To develop a computer-aided diagnosis (CAD) algorithm with setting-independent features and artificial neural networks to differentiate benign from malignant breast lesions. MATERIALS AND METHODS: Two sets of breast sonograms were evaluated. The first set contained 160 lesions and was stored directly on the magnetic optic disks from the ultrasonographic (US) system. Four different boundaries were delineated by four persons for each lesion in the first set. The second set comprised 111 lesions that were extracted from the hard-copy images. Seven morphologic features were used, five of which were newly developed. A multilayer feed-forward neural network was used as the classifier. Reliability, extendability, and robustness of the proposed CAD algorithm were evaluated. Results with the proposed algorithm were compared with those with two previous CAD algorithms. All performance comparisons were based on paired-samples t tests. RESULTS: The area under the receiver operating characteristic curve (A(z)) was 0.952 +/- 0.014 for the first set, 0.982 +/- 0.004 for the first set as the training set and the second set as the prediction set, 0.954 +/- 0.016 for the second set as the training set and the first set as the prediction set, and 0.950 +/- 0.005 for all 271 lesions. At the 5% significance level, the performance of the proposed CAD algorithm was shown to be extendible from one set of US images to the other set and robust for both small and large sample sizes. Moreover, the proposed CAD algorithm was shown to outperform the two previous CAD algorithms in terms of the A(z) value. CONCLUSION: The proposed CAD algorithm could effectively and reliably differentiate benign and malignant lesions. The proposed morphologic features were nearly setting independent and could tolerate reasonable variation in boundary delineation.     

乳腺X线摄片中微小钙化的诊断价值

目的:探讨乳腺X线摄片中乳腺微小钙化对乳腺疾病诊断的价值.方法:对乳腺x线摄片中发现乳腺微小钙化并经病理组织学证实的60例病例进行观察.分析微小钙化的密度、大小形态与数量,并与病理结果进行对照分析.结果:乳腺X线摄片中见微小钙化灶97个,60例中乳腺癌41例(68.3%),良性病变19例(31.7%).良恶性肿瘤微小钙...     

Imaging of the congenitally absent cervical pedicle: avoidance of misdiagnosis in a setting of trauma

An enlarged neuroforamen may be due to a congenitally absent cervical pedicle. We report a case initially misdiagnosed as a cervical fracture. CT and MRI are recommended for correct diagnosis and prevention of unwarranted treatment.     

Percutaneous biopsy of renal masses: sensitivity and negative predictive value stratified by clinical setting and size of masses

OBJECTIVE: The purpose of our retrospective study was to evaluate the sensitivity and negative predictive value of percutaneous biopsy of renal masses stratified by clinical setting and the size of the mass. MATERIALS AND METHODS: We categorized 115 consecutive percutaneous biopsies of renal masses in 113 patients into four clinical settings and three groups of mass sizes. The sensitivity and negative predictive value were computed (with 95% confidence intervals [CI]) for each clinical setting and for each size group. RESULTS: For all procedures (n = 115), the sensitivity and negative predictive value were 90% (95% CI, 81-95%) and 64% (95% CI, 44-81%), respectively. For patients with a known malignancy who presented with a renal mass (n = 55), the sensitivity and negative predictive value were 90% (95% CI, 78-96%) and 38% (95% CI, 10-74%), respectively. For patients with no known malignancy and suspected unresectable tumor (n = 36), the sensitivity and negative predictive value were 92% (95% CI, 76-98%) and 0%, respectively. For patients with no known malignancy who presented with a cystic mass (n = 16), the sensitivity and negative predictive value were 33% (95% CI, 2-87%) and 87% (95% CI, 58-98%), respectively. For patients who were not surgical candidates with a renal cell carcinoma (n = 8) that was thought to be resectable, both the sensitivity and negative predictive value were 100%. For masses 3 cm and less (n = 31), the sensitivity and negative predictive value were 84% (95% CI, 63-95%) and 60% (95% CI, 27-86%), respectively. For masses between 4 and 6 cm (n = 42), the sensitivity and negative predictive value were 97% (95% CI, 83-100%) and 89% (95% CI, 51-99%), respectively. For masses greater than 6 cm (n = 42), the sensitivity and negative predictive value were 87% (95% CI, 71-95%) and 44% (95% CI, 15-77%), respectively. CONCLUSION: Percutaneous renal mass biopsy has a high sensitivity in three clinical settings: patients with a known malignancy, patients with no known malignancy and suspected unresectable tumor, and nonsurgical patients with a mass suspected to be a resectable renal cell carcinoma. Negative results in small (< or = 3 cm) and large (> 6 cm) masses should be viewed with caution.     

Breast imaging in a military setting: a comparison with civilian breast imaging

A retrospective study was performed to evaluate breast imaging in the Wilford Hall Medical Center, the largest medical facility in the U.S. Air Force, from the time period of October 1997 to October 2000, in comparison with its civilian counterparts. The results demonstrate that although Wilford Hall Medical Center breast imaging is faced with unique difficulties in having a relatively mobile patient and physician population, military breast imaging corresponds with civilian breast imaging in the following aspects: screening the eligible population according to age and risk factors, cancer and precancerous abnormality detection rate, and biopsy techniques, including stereotactic-guided vacuum-assisted, automated gun biopsy, ultrasound-guided biopsy, and needle localization-assisted excision biopsy. Positive predictive value based on biopsy recommendations are lower than in civilian practice, likely because military radiologists are keenly aware of the mobile status of their population and are more aggressive in recommending biopsy for a definitive diagnosis rather than mammographic follow up. In our practice, cancer diagnosed at stage 0 or 1 is 85%, 4.3% of patients have positive lymph nodes, the overall cancer detection rate per 1,000 population is 3.97, the recall rate is 8.8%, sensitivity is 100%, and specificity is 98.1%. All of these aspects are comparable with those of civilian practice.     

Core biopsy of the bowel wall: efficacy and safety in the clinical setting

OBJECTIVE: The purpose of this study was to evaluate the efficacy and complications of percutaneous 18-gauge core biopsies of lesions of the bowel wall using CT and sonographic guidance. A retrospective study was made of 15 biopsy procedures performed on 12 patients with suspected neoplasia of the gastrointestinal tract. The biopsies were performed when there were no sites of metastatic disease more readily accessible to biopsy and the lesion was inaccessible to endoscopic techniques or when the endoscopic biopsy findings were negative. CONCLUSION: Three biopsy procedures provided inadequate samples and the biopsies were repeated, giving a total of 15 biopsy procedures. A tissue diagnosis was made in all 12 patients. All procedures were well tolerated, and no immediate or delayed complications occurred. Percutaneous core biopsy of bowel wall masses is a safe technique that allows a histologic diagnosis to be obtained in difficult cases when other methods cannot provide an adequate tissue sample.     

Breast cancer: effectiveness of computer-aided diagnosis observer study with independent database of mammograms

PURPOSE: To evaluate the effectiveness of a computerized classification method as an aid to radiologists reviewing clinical mammograms for which the diagnoses were unknown to both the radiologists and the computer. MATERIALS AND METHODS: Six mammographers and six community radiologists participated in an observer study. These 12 radiologists interpreted, with and without the computer aid, 110 cases that were unknown to both the 12 radiologist observers and the trained computer classification scheme. The radiologists' performances in differentiating between benign and malignant masses without and with the computer aid were evaluated with receiver operating characteristic (ROC) analysis. Two-tailed P values were calculated for the Student t test to indicate the statistical significance of the differences in performances with and without the computer aid. RESULTS: When the computer aid was used, the average performance of the 12 radiologists improved, as indicated by an increase in the area under the ROC curve (A(z)) from 0.93 to 0.96 (P <.001), by an increase in partial area under the ROC curve ((0.90)A(')(z)) from 0.56 to 0.72 (P <.001), and by an increase in sensitivity from 94% to 98% (P =.022). No statistically significant difference in specificity was found between readings with and those without computer aid (Delta = -0.014; P =.46; 95% CI: -0.054, 0.026), where Delta is difference in specificity. When we analyzed results from the mammographers and community radiologists as separate groups, a larger improvement was demonstrated for the community radiologists. CONCLUSION: Computer-aided diagnosis can potentially help radiologists improve their diagnostic accuracy in the task of differentiating between benign and malignant masses seen on mammograms.     

计算机数字化立体定位穿刺活检术在乳腺微小病变中的应用

目的 :评价X线立体定位对乳腺微小病变的诊断价值。方法 :用美国洛爱德公司生产的高频钼靶摄像机及配套的定位仪对 2 80 0例病人行双乳轴位、斜位摄片 ,根据影像表现对可疑病灶进行定位穿刺活检。结果 :对31例微小病变进行定位穿刺 ,查出乳腺癌 2 5例 ,与手术活检病理符合率为 96 %。结论 :本方法技术先进 ,定位准确 ,操作简单 ,手术范围和组织损伤小 ,克服了反复寻找病区给患者带来的痛苦。提高了术中定位切除的准确性、可靠性 ,为更早发现乳腺癌提供了必要的技术保证。     

Prostate biopsy after ano-rectal resection: value of CT-guided trans-gluteal biopsy

We describe our single-institutional experience with computed tomography (CT)-guided percutaneous transgluteal biopsy of the prostate in patients in whom transrectal ultrasound-guided biopsy is precluded by prior ano-rectal resection. Between March 1995 and April 2007, 22 patients had 34 prostate biopsies (mean age 68; mean PSA 29 ng/ml; mean follow-up 6.1 years). The charts of patients who had transgluteal biopsy were reviewed for demographic, complications and pathology. Ninety-five percent (21/22) of primary biopsies were diagnostic. Of the 21 diagnostic biopsies, 11 were positive for prostate cancer and ten were definitive benign samples. Seventy-three percent (8/11) of the patients had progressive PSA elevation that mandated 11 further prostate biopsies. Six patients had a second biopsy, one patient had a third and one patient had a fourth biopsy. Among patients who had serial biopsies, 38% (3/8) had prostate cancer. No complications or death occurred. A malignant biopsy was not significantly associated with core number (P = 0.58) or a high PSA level (P = 0.15). CT-guided transgluteal biopsy of the prostate is safe and effective.     

Diagnostic value of ultrasonography in patients with palpable mammographically noncalcified breast tumors

PURPOSE: To analyze the diagnostic accuracy of mammography, ultrasonography (US), and both methods combined in evaluation of palpable noncalcified breast tumors. MATERIAL AND METHODS: Mammograms and sonograms of 200 patients with palpable noncalcified breast masses were retrospectively analyzed independently by four experienced radiologists in 3 sessions: Mammography or US interpretations in the first two and combined reading in the last session. Nonneoplastic abnormalities and mammographically obvious cancers were excluded. Receiver operating characteristic (ROC) analyses were performed for 115 (60 benign and 55 malignant) tumors and subgroups according to tissue density and tumor size. A single ROC curve for each diagnostic test was obtained by pooling the individual ratings. The area under the ROC curve was used as a measure of diagnostic performance. RESULTS: US revealed significantly higher diagnostic performance than mammography for tumors larger than 2 cm. Combined reading showed significantly higher performance than mammography except for tumors smaller than 2 cm. The performance of all three tests was reduced in dense parenchyma, and significantly so for mammographic and combined interpretation. CONCLUSION: The accuracy of US in patients with palpable mammographically noncalcified and not obviously malignant breast tumors is lower than reported for mixed sample populations. The accuracy of US may be influenced by breast parenchyma density. Combined reading offers the highest diagnostic accuracy.     

全数字化乳腺X线摄影应用于未触及肿块乳癌诊断的应用价值分析

乳腺癌的发病率逐年上升[1],在女性恶性肿瘤发病所占的比率非常高,其中未触及肿块隐匿性乳腺癌一直是乳腺癌诊断中最棘手的问题。目前,乳腺X线摄影作为其检测主要手段[2],尤其全数字化乳腺X线摄影检查对诊断未触及肿块乳癌具有重要的临床价值[3～5],本文对32例未触及肿块乳癌患者临床资料进行总结分析,探讨全数字化乳腺X线摄影的临床价值。