乳腺脂肪坏死的X线诊断

目的 评价乳腺脂肪坏死的X线征象及其病理学基础。方法 回顾性分析14例经病理证实的乳腺脂肪坏死的X线平片,对其中2例活检的病人进行了短期随访。结果 主要X线征象：（1）油脂性囊肿5例,其中2例伴囊壁钙化。（2）不对称性密度增加6例。（3）不规则肿块3例。 14例中8例伴有病灶周围结构紊乱。2例随病灶均无明显变化。结论 乳腺不死的X线表现与其病灶内纤维结缔组织的反应强度有关,在多种多样的X线表现中油脂性囊肿是特异性的X线表现。     

Diffusion weighted imaging in early prediction of neoadjuvant chemotherapy response in breast cancer

Background

Neoadjuvant chemotherapy (NAC) has clinically important outcome. Early evaluation of the treatment response is important to avoid unnecessary therapy in non-responders. MRI is the most sensitive imaging for monitoring NAC response.

Multimodal imaging findings including high-resolution 3D T2-weighted imaging for COVID-19 vaccine-associated axillary lymphadenopathy in a patient with breast cancer

COVID-19 vaccines have received authorization worldwide. Vaccines are typically administered to the deltoid muscle, and axillary swelling/tenderness at the first dose (11.6%) and the second dose (16%) have been reported as secondary effects. Regional lymphadenopathy in the axilla and supraclavicular region has also been reported with a prevalence of 1.1% and is referred to as COVID-19 vaccine-associated lymphadenopathy (VAL). COVID-19 VAL mimics lymph node (LN) metastases on magnetic resonance imaging, ultrasound, and 18F-fluoro-2-deoxy-Dglucose positron emission tomography. Although several specific findings of VAL on clinical imaging have been reported, the difficulty in differentiating between VAL and LN metastases could lead to false-positive or -negative diagnoses. Here, we report a case of breast cancer with ipsilateral VAL with multimodal imaging including 3D T2-weighted imaging, a new magnetic resonance imaging technique, and discuss the future perspective for differentiating between VAL and LN metastases.     

Detection of breast cancer with conventional mammography and contrast-enhanced MR imaging

The aim of this study was to compare the diagnostic performance of conventional mammography and dynamic contrast-enhanced fast 3D gradient-echo (GRE) MRI regarding the detection and characterization of breast lesions relative to histopathologic analysis and to assess the results of a combined evaluation of both methods. fifty consecutive patients with 63 histopathologically verified breast lesions underwent dynamic contrast-enhanced GRE MRI in addition to routine conventional mammography. All lesions were classified by both methods on a five-point scale as benign or malignant, and the results were correlated to histopathology. Conventional mammography and dynamic MRI yielded a sensitivity and specificity of 82 and 64 %, and 92 and 76 %, respectively. The difference between the results was statistically not significant (p > 0.05) with areas under the receiver-operating-characteristics curves of 0.807 for mammography and 0.906 for MR imaging. Combination of the results of both methods slightly increased the sensitivity for detection of breast cancer to 95 % but decreased specificity to 52 %. In this selected patient subset, including only patients referred for excisional biopsy, contrast-enhanced dynamic MRI proved more sensitive and specific than conventional mammography regarding the detection of malignancy. While a combination of both methods yields a slightly improved sensitivity, specificity is vastly reduced. Received 5 May 1997; Revision received 14 July 1997; Accepted 7 August 1997     

Locally advanced breast cancer: comparison of mammography,sonography and MR imaging in evaluation of residual disease in women receiving neoadjuvant chemotherapy

The accuracy of mammography, sonography and magnetic resonance imaging (MRI) in identifying residual disease after neoadjuvant chemotherapy is evaluated and imaging findings are correlated with pathologic findings. Fifteen patients enrolled in an experimental protocol of preoperative neoadjuvant chemotherapy underwent clinical examination, mammography, sonography and dynamic MRI, performed in this order, before and respectively after 2 and 4 cycles of neoadjuvant chemotherapy. Four radiologists, two for mammography, one for sonography and one for MR, examined the images, blinded to the results of the other examinations. All patients underwent radical or conservative surgery, and imaging findings were compared with pathologic findings. MRI identified 2/15 (13.3.%) clinically complete response (CR), 9/15 (60%) partial response (PR), 3/15 (20%) stable disease (SD) and 1/15 (6.7%) progressive disease. Mammography identified 1/15 (6.7%) clinically CR, 8/15 (53.3%) PR and 4/15 (27%) SD, and was not able to evaluate the disease in 2/15 (13%) cases. Sonography presented the same results as MRI. Therefore, MRI and sonography compared to mammography correctly identified residual disease in 100 vs. 86%. MRI resulted in two false-negative results because of the presence of microfoci of in situ ductal carcinoma (DCIS) and invasive lobular carcinoma (LCI). MRI was superior to mammography in cases of multifocal or multicentric disease (83 vs. 33%). Sonography performed after MRI improves the accuracy in evaluation of uncertain foci of multifocal disease seen on MR images with an increase of diagnostic accuracy from 73 to 84.5%. MRI assesses response to neoadjuvant chemotherapy better than traditional methods of physical examination and mammography.     

乳腺癌辅助化疗前后18F-FDG、99Tcm-HL91显像的临床研究

目的观察乳腺癌辅助化疗前后18^F-FDG、99^Tc^m-4，9-二氮-3，3，10，10-四甲基十二烷-2，11-二酮肟（HL91）显像的变化，探讨其在乳腺癌辅助化疗疗效评价中的价值。方法28例经细针穿刺检查确诊为原发性乳腺癌的患者在化疗前、后分别行18^F-FDG、99^Tc^m-HL91显像，根据显像结果计算病灶ROI／对侧正常乳腺组织ROI（T／N）放射性计数比值。化疗结束以WHO制定的评价标准分为有效组和无效组，并观察化疗前后病理学改变。结果辅助化疗总有效率（RR）为71．4％（20／28），有效组20例，无效组8例；病理改变可见退化变性期（Ⅰ期）、肉芽肿期（Ⅱ期）、纤维化期（Ⅲ期）。治疗前病灶摄取18^F-FDG、99^Tc^m-HL91 T／N值分别为2．98±1．09，2．55±0．80（t=2．312，P=0.026），有效和无效组分别为3．03±1．23，3．09±1．39（t=1．314，P=0．108）和253±0．76，2．63±0．97（t=1．597，P=0．875）；T／N值分布18^F-FDG为1．68～6．49（中位值2．73），99^Tc^m-HL91为1．46—5．01（中位值2．39），两者间呈直线相关（r=0．743，P=0．024）。治疗后28例18^F-FDG T／N值有所下降，为2．40±0．79（t=1．932，P=0．031）；有效和无效组分别为2．28±0．81，2．93±0．76（t=2．462，P=0．015），与治疗前比较有效组差异有统计学意义（t=2．482，P=0．012），且与治疗前呈直线相关（r=0．673，P=0．035），而无效组差异无统计学意义（t=1．562，P=0．324）。99^Tc^m-HL91 T／N值下降的病例中4例为无效，5例为有效，其余为升高；有效和无效组分别为2．59±0．71，2．61±0．99（t=1．472，P=0．096），与治疗前比较2组差异均无统计学意义（t=1．368和1．341，P值为0．127和0．878）。结论18^F-FDG显像对乳腺癌辅助化疗疗效评价具有一定的临床价值。     

多模态MRI对乳腺癌化疗相关认知功能障碍的研究进展

乳腺癌病人化疗相关认知功能障碍（CRCI）发生的重要神经基础是化疗引起的脑结构、代谢、灌注和功能的改变。多模态MRI可以通过基于体素的形态学测量、扩散张量成像、磁共振波谱、磁敏感加权成像、动脉自旋标记灌注成像和基于血氧水平依赖的功能MRI等技术从局部或全局显示脑灰质体积和密度改变、脑白质纤维损伤、脑代谢改变、脑血流灌注以及脑区激活和功能连接变化等,从而为进一步探索乳腺癌CRCI的发病机制、早期诊断和症状研究提供依据。就多模态MRI在乳腺癌CRCI中的研究进展予以综述。     

Mammographic,sonographic and MR imaging features of invasive micropapillary breast cancer

Purpose

Describe mammographic, sonographic and MRI findings of invasive micropapillary carcinoma (IMPC) of the breast.

Materials and methods

Review of the pathology database identified 43 patients (mean age, 59.3 years) with the diagnosis of breast IMPC. Three patients had no available imaging studies. Mammograms (40), breast ultrasounds (33) and MRIs (8) were retrospectively evaluated by two radiologists in consensus following the BI-RADS Lexicon. Clinical, histopathologic features, as well as hormone status were recorded.

Results

Twenty patients presented with palpable abnormality (20/40, 50%). Thirty-five patients had an abnormal mammogram (87.5%, 35/40) showing 39 lesions, 29 corresponding to masses (29/39, 74.4%), 11 associated with microcalcifications and two associated with architectural distortion. Sonography identified 41 masses (in 33 patients) displaying an irregular shape (30/41, 73.2%), appearing hypoechoic (39/41, 95%), with spiculated or angular margins (26/41, 63.4%), non-parallel orientation (26/41, 63.4%) and combined acoustic posterior pattern (18/41, 44%). MRI identified 13 lesions (in eight patients), 12 as masses (12/13, 92.3%) with irregular or spiculated margins (12/12, 100%), eight displaying an irregular or lobulated shape (8/12, 66.7%), six with homogeneous internal enhancement (6/12, 50%) and eight with type 3 enhancement curve (8/12, 61.5%). Associated non-mass like enhancement was noted in two patients. Twenty-nine patients had associated lymphovascular invasion (29/40, 72.5%) and axillary lymph node metastases were present in 22 of the 39 patients (22/39, 56%).

Conclusion

Invasive ductal carcinoma with IMPC features display imaging findings highly suspicious of malignant lesions. They are associated with high lymphovascular invasion and lymph node metastases rates.     

Comparison of breast cancer detection by diffusion-weighted magnetic resonance imaging and mammography

PURPOSE: Breast cancer-detecting ability of diffusion-weighted magnetic resonance imaging (DW-MRI) was investigated by comparing the breast cancer detection rates of DW-MRI and mammography (MMG). MATERIALS AND METHODS: The subjects were 48 women who had breast cancer (53 cancer lesions) who underwent DW-MRI before surgery. Altogether, 41 lesions were invasive ductal carcinoma (IDC), 7 were noninvasive ductal carcinoma (NIDC) and 5 were "others." RESULTS: The breast cancer detection rates by MMG and DW-MRI were 84.9% and 94.3% (P < 0.001), respectively. In each classification of histology and size, the detection rate by DW-MRI was higher than that by MMG. In relation to the mammary gland density, the detection rates of fatty, scattered, heterogeneously dense, and extremely dense mammary glands were 100%, 100%, 92.0%, and 83.3%, respectively. The mean apparent diffusion coefficient values of the histologic types were 1.07 +/- 0.17 x 10(-3), 1.50 +/- 0.24 x 10(-3), 1.12 +/- 0.25 x 10(-3), and 2.01 +/- 0.29 x 10(-3) mm(2)/s for IDC, NIDC, others, and normal breast, respectively, showing that the values of IDC and NIDC were significantly different from that of the normal breast (P < 0.001 each). A significant difference was also noted between IDC and NIDC (P < 0.001). CONCLUSION: DW-MRI may be useful for detecting breast cancer in a wide age group of women, including young women with dense mammary glands.     

Monitoring breast cancer response to neoadjuvant systemic chemotherapy using parametric contrast-enhanced MRI: a pilot study

RATIONALE AND OBJECTIVES: Neoadjuvant systemic therapy (NST) is the standard treatment for locally advanced breast cancer and a common option for primary operable disease. It is important to develop standardized imaging techniques that can monitor and quantify response to NST enabling treatment tailored to each individual patient, and facilitating surgical planning. Here we present a high spatial resolution, parametric method based on dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI), which evaluates breast cancer response to NST. MATERIALS AND METHODS: DCE-MRI examinations were performed twice on 17 breast cancer patients, before and after treatment. Seven sets of axial breast images were sequentially recorded at 1.5 Tesla applying a three-dimensional, gradient echo at a spatial resolution approximately 2 x 1.2 x 0.6 mm(3) and temporal resolution approximately 2 minutes, using gadopentate dimeglumine (0.1 mmol/kg wt). Image analysis was based on a color-coded scheme related to physiologic perfusion parameters. RESULTS: A high Pearson correlation coefficient of 0.96 (P < .0001) was found between the histopathologic estimation of viable neoplastic tissue volume and the segmented volume of all the pixels demonstrating fast and steady state washout after NST (colored in light red and green). Segmentation of these pixels before and after NST indicated response in terms of reduced tumor volume and a parallel decrease in enhancement rate which reflects diminished transcapillary transfer of the contrast agent. CONCLUSIONS: The use of a parametric MRI technique provided a means to standardize segmentation and quantify changes in the perfusion of breast neoplastic tissue in response to NST. Whether this technique can serve to predict breast cancer recurrence and survival rates requires further clinical testing.     

Let's go out of the breast: Prevalence of extra-mammary findings and their characterization on breast MRI

Purpose

The aim of this study is to assess the prevalence, the site and the nature of extra-mammary findings on breast magnetic resonance imaging (MRI) and to determine its accuracy in the characterization of the discovered lesions.

Materials and methods

A retrospective review of 308 female patients (mean age 50 ± 20) who underwent breast MRI with 1.5 T device was performed. 125 out of 308 (40.5%) had a positive personal history of breast cancer (pre-operative n = 80; follow-up n = 45), while the remaining 183 without history of breast cancer (high familiar risk for breast cancer n = 80; dense breast n = 103). All incidental findings were characterized by means of additional imaging (US; Bone scintigraphy-MRI; CT-PET-CT).

Results

59 incidental findings were found in 53/308 (17%) examined patients. 9/59 incidental findings (15%) were confirmed to be malignant while the remaining 50/59 (84%) benign. The most common site was the liver (33/59; 55.8%), followed by the lung (6/59; 10.1%), bone (6/59; 10.1%), diaphragm (6/59; 10.1%) spleen (3/59; 5%), kidney (2/59; 3.4%), gall bladder (1/5; 1.5%), ascending aorta (1/59; 1.5%), thyroid (1/59; 1.5%). The incidence of malignant incidental findings resulted to be higher in the group of patients with personal breast cancer (36%) than in the other one (8%). By comparing MRI findings with the additional definitive imaging tools, breast MRI allowed a correct diagnosis in 58/59 cases with a diagnostic accuracy value of 98%.

Conclusion

Incidental extramammary findings on breast MRI are common. Benign lesions represent the most frequent findings, however malignant ones need to be searched especially in patients with personal history of breast cancer because they could influence the clinical patient management. Breast MRI can characterize incidental findings with high accuracy value.     

应用1HMR波谱在新辅助化疗早期评估乳腺癌化疗效果的研究

目的 应用1HMRS评价化疗早期复合胆碱(tCho)浓度变化在早期评估乳腺癌新辅助化疗效果的价值.方法 搜集已确诊为乳腺癌(肿瘤T分期在T1c以上者)并进行新辅助化疗的患者20例.所有患者化疗前均进行乳腺病变穿刺活检,在化疗结束后均进行手术治疗.将手术病理切片与化疗前穿刺病理片比较,将患者分为化疗有效组和无效组.所有患者均在化疗前1周内及化疗第1疗程结束后3周内(化疗第二疗程开始前)各进行1次乳腺MRS检查.采用外参照定量法计算化疗前、后tCho浓度,并采用配对样本均数t检验比较2组统计学意义.采用秩和检验比较2组病灶大小的统计学意义.以病理作为金标准,用ROC曲线分析根据tCho浓度变化判断化疗有效的价值.结果 20例中化疗有效为16例,无效为4例.化疗有效组化疗前、后胆碱浓度分别为(4.24±3.09)、(1.13±1.14)mmol/L,两者差异有统计学意义(t=5.040,P<0.01),而无效组[(3.72±2.69)、(3.06±2.21)mmol/L]差异无统计学意义(t=1.785,P>0.05).2组间病灶大小变化值(中位数均为0 cm)差异无统计学意义(U=23.00,W=33.00,P=0.437).以病理作为金标准根据化疗前、后的tCho浓度变化评估化疗有效性的ROC曲线下而积为0.984.结论 MRS能在肿瘤大小发生改变之前即反映出肿瘤代谢的变化,从而能在新辅助化疗早期评估其疗效.     

MR imaging of testicular torsion: features of testicular hemorrhagic necrosis and clinical outcomes

PURPOSE: To determine whether emergency subtraction dynamic contrast-enhanced MR imaging (DCE-MRI) in combination with T2- and T2*-weighted imaging of the testis is useful in the evaluation of patients with testicular torsion. MATERIALS AND METHODS: Fourteen patients with surgically proven testicular torsion were examined using preoperative emergency MRI, including T2-weighted, T2*-weighted, and DCE-MRI. The affected testis was examined histologically in eight patients who underwent orchiectomy, and by postoperative follow-up MRI in six patients who underwent orchiopexy. The diagnostic criteria for testicular torsion and detection of hemorrhagic necrosis in the affected testis in emergency MRI were decreased or no perfusion in DCE-MRI and a spotty and/or streaky pattern of low or very low signal intensity in T2- and T2*-weighted images. The intraoperative findings and clinical outcomes were also compared. RESULTS: The histological findings and follow-up MR images revealed total or partial necrosis of the affected testis in 10 of the 14 patients. In the diagnosis of complete torsion, the sensitivities were 100% for DCE-MRI and 75% for T2- and T2*-weighted imaging. In the detection of testicular necrosis, T2- and T2*-weighted imaging showed the highest accuracy (100%), followed by 12-hour time from onset (93%), intraoperative findings (79%), and DCE-MRI (71%). CONCLUSION: Emergency MRI can help diagnose testicular torsion and detect testicular necrosis when DCE-MRI is used in combination with T2- and T2*-weighted images.     

Magnetic resonance imaging of metaplastic carcinoma of the breast: sonographic and pathologic correlation

Metaplastic carcinoma of the breast is a rare disease. We describe the MRI findings with the correlative sonographic and pathologic features of two cases. On MRI, T2-weighted images demonstrate a relatively well-defined mass with high signal intensity cystic components. Dynamic enhancement subtraction images showed an early enhancing and delayed washout peripheral rim and non-enhancing internal components. A microlobulated, isoechogenic mass with cystic components was seen sonographically, and was histopathology related to necrosis and cystic degeneration. Although these features are not unique, metaplastic carcinoma should be included in the differential diagnosis for breast masses.     

乳腺叶状肿瘤的MRI特征及鉴别诊断

乳腺叶状肿瘤（PT）是一类少见的乳腺肿瘤,具有上皮和间叶细胞双向分化的特点,表现多样,在临床及影像上可与纤维腺瘤、边缘光整的乳腺癌或乳腺肉瘤相似,在治疗及预后方面则明显不同。传统影像学诊断PT价值有限,而在乳腺增强MRI及功能成像上,PT的影像表现具有一定特征性,对术前诊断及活检穿刺定位有重要意义。就PT的临床表现、病理、MRI特征及鉴别诊断予以综述。     

Mucinous carcinoma in a male patient: Diagnosis and management of breast cancer in male patients

Male breast cancer is a rare but serious condition that impacts an increasing number of men each year. Due to low incidence rate, there is a current lack of established diagnostic and management practices. Here, we provide a review of the current epidemiology, classification, diagnosis, and treatment of male breast cancer. We present a rare case of mucinous breast cancer in a 74-year-old male patient detected after he presented with a retroareolar mass. The patient underwent mammography, targeted ultrasound, and ultrasound-guided core needle biopsy, which established the diagnosis. He was treated surgically with left mastectomy and sentinel lymph node biopsy with axillary lymph node dissection, followed by post-adjuvant tamoxifen and has remained free of recurrence and metastasis since.     

Computer-aided detection applied to breast MRI: assessment of CAD-generated enhancement and tumor sizes in breast cancers before and after neoadjuvant chemotherapy

RATIONALE AND OBJECTIVES: MRI has shown promise in assessing breast cancer patients undergoing neoadjuvant chemotherapy. Computer-aided detection (CAD) for MRI can automatically display tumor enhancement parameters. This study was performed to determine the utility of CAD applied to breast MRI in this patient population. MATERIALS AND METHODS: Fifteen patients with 16 newly diagnosed locally advanced breast cancers were evaluated with MRI before and after neoadjuvant chemotherapy. CAD assessments, including presence or absence of significant enhancement, enhancement profiles, and maximum sizes, were recorded. Pre-chemotherapy and post-chemotherapy enhancement profiles were compared. Sizes were compared to those measured by the radiologist and at final pathology. RESULTS: Prior to chemotherapy, all tumors demonstrated CAD-assessed significant enhancement. Following chemotherapy, 7/16 tumors showed no residual significant enhancement, but all had residual disease at pathology. In those patients with residual enhancement, comparison of the post-chemotherapy to pre-chemotherapy CAD enhancement profiles showed a significant decrease in percentage of washout enhancement (P = 0.0147) in patients with less than 5 mm of residual microscopic disease. Radiologist-measured tumor sizes demonstrated better correlation with sizes at pathology (r = 0.60) than did CAD-generated tumor sizes (r = 0.32). CONCLUSION: CAD may be helpful in assessing changes in MRI enhancement profiles of tumors following chemotherapy. However, CAD-assessed significant enhancement following chemotherapy can be falsely negative for residual malignancy, and CAD tumor sizes are less accurate than those measured by the radiologist in predicting size of residual malignancy. CAD may complement but should not replace the radiologist's assessment of tumors in this patient population.     

Imaging findings of breast augmentation with injected hydrophilic polyacrylamide gel: Patient reports and literature review

Hydrophilic polyacrylamide gel (PAAG) is a nonresorbable soft tissue filler that has been used as implant material for breast augmentation in some countries, particularly from the Asian continent. Many complications associated with hydrogel use have been reported in the clinical literature including inflammation, persistent mastodynia, formation of multiple lumps, poor cosmetic results, glandular atrophy, and significant spread of hydrogel into the surrounding tissue. Data on long-term toxicity is currently unavailable.The radiologic features of PAAG injection mammoplasty frequently constitute a diagnostic challenge for radiologists. Indeed, the imaging appearances of uncomplicated PAAG implants may mimic conventional implants on mammography, sonography and MRI, with some distinguishing features. The location and local spread of the injected PAAG, and the eventual detection of local inflammation, are best evaluated by ultrasonography and especially MRI, considered the most sensitive technique for assessment of PAAG mammoplasty. MRI clearly depicts the volume and the distribution of gel within the breast; contrast medium enhancement allows delineation of areas of inflammation and infection. It is important to be familiar with the spectrum of imaging findings in order to make an accurate diagnosis and offer proper management.This paper aims to review the normal and abnormal mammographic, sonographic, and MR imaging characteristics of PAAG augmentation mammoplasty through presented patient reviews of three women having undergone direct PAAG injection.     

Mammographic and ultrasonographic findings in bilateral breast cancer: a comparative study

To compare the results of mammographic and US examinations in unilateral and bilateral breast cancers in routine clinical work, the files of all patients with 825 preoperative mammograms and 525 preoperative US examinations operated on for primary breast cancer in the Oulu University Hospital from 1983 through 1993 were retrospectively reviewed. The only statistically significant difference noted in the mammographic findings was the false-negative rates in unilateral, bilateral and metachronous second breast cancers (6.8, 16.3 and 23.3 %, respectively). The differences were mainly due to the lower sensitivity of mammography in the detection of palpable bilateral breast cancers. The false-negative rate of US was also significantly higher in bilateral breast cancers (23 %) than in unilateral cancers (11 %), and significantly higher for nonpalpable than palpable cancers in both the bilateral and the unilateral groups. The mammographic failure rates and the difference between these two groups were most pronounced during the early study period, which underscores the importance of experience and dedicated imaging technique. The smaller tumour size at the time of diagnosis and probably the loss of the opposite breast for comparison have contributed to the higher false-negative rates in bilateral breast cancer. Received 25 April 1997; Revision received 1 September 1997; Accepted 6 October 1997