Thyroid nodules with initially non-diagnostic,fine-needle aspiration results: comparison of core-needle biopsy and repeated fine-needle aspiration

Objective

To evaluate the role of core-needle biopsy (CNB) by comparing the results of CNB and repeated fine-needle aspiration (FNA) for thyroid nodules with initially non-diagnostic FNA results.

Methods

From October 2008 to December 2011, 360 nodules – 180 consecutive repeated FNAs and 180 consecutive CNBs –– from 360 patients (83 men, 277 women; mean age, 54.4 years) with initially non-diagnostic FNA results were analyzed retrospectively. The incidence of non-diagnostic results, inconclusive results, diagnostic surgery, and diagnostic performance of repeated FNA and CNB were assessed, and factors affecting second non-diagnostic results were evaluated.

Results

CNB achieved a significantly lower non-diagnostic and inconclusive rate than repeated FNA (1.1 % versus 40.0 %, P?P?P?=?0.047). Multivariate logistic regression analysis showed that repeated FNA was the most important factor for second non-diagnostic results (OR?=?56.06, P?P?=?0.003).

Conclusions

CNB is more useful than repeated FNA for reducing the number of non-diagnostic and inconclusive results and for preventing unnecessary diagnostic surgery for thyroid nodules with initially non-diagnostic FNA results.

Key Points

? Core-needle biopsy achieved a lower number of non-diagnostic and inconclusive results. ? Core-needle biopsy achieved better diagnostic performance. ? Use of core-needle biopsy could prevent unnecessary diagnostic surgery. ? Repeated fine-needle aspiration was significantly associated with a second non-diagnosis.     

Effect of vascular haemoglobin concentrations on ultrasound-guided diffuse optical tomography in differentiating benign from malignant breast lesions

Objectives

Ultrasound-guided diffuse optical tomography (US-DOT) can potentially detect breast carcinomas by measuring total tumour haemoglobin concentrations (TTHC). The purpose of this study was to evaluate whether vascular haemoglobin concentrations (VHC) affect the ability of US-DOT to distinguish breast carcinomas from benign.

Materials and methods

In 85 women (97 palpable lesions) referred for core breast biopsy, we measured VHC with a complete blood count and calculated TTHCs for each lesion with US-DOT. Anaemia was defined as a VHC less than 120.0 g/L.

Results

Mean TTHCs were significantly higher in malignant lesions (n?=?53) than in benign lesions (n?=?44), regardless of whether the lesions were from women with anaemia (TTHC, 248.5 vs. 123.3 μmol/L; P?=?0.001) or from those without (TTHC, 229.7 vs. 173.9 μmol/L; P?=?0.016). A cut-off TTHC of 155.1 μmol/L provided 81.3 % sensitivity, 81.8 % specificity and 81.5 % accuracy for detecting malignant tumours in women with anaemia and 78.4 % sensitivity, 54.5 % specificity and 67.1 % accuracy for women without. There was no significant difference in sensitivity (P?=?0.813), specificity (P?=?0.108) and accuracy (P?=?0.162) between the anaemic group and the non-anaemic group.

Conclusions

Vascular haemoglobin concentrations did not affect the ability of US-DOT to differentiate breast carcinomas from benign lesions.

Key Points

? US-DOT can differentiate benign from malignant breast lesions by measuring TTHC. ? No difference in TTHC between the anaemia and non-anaemia group. ? Vascular haemoglobin concentrations do not affect the diagnostic ability of US-DOT.     

Increased signal intensity of prostate lesions on high b-value diffusion-weighted images as a predictive sign of malignancy

Objectives

The evaluation of lesions detected in prostate magnetic resonance imaging (MRI) with increased signal intensity (SI) on high b-value diffusion-weighted images as a sign of malignancy.

Methods

One hundred and three consecutive patients with prostate MRI examination and MRI-guided in-bore biopsy were retrospectively included in the study. MRI-guided in-bore biopsy histologically confirmed prostate cancer in 50 patients (n?=?92 lesions). The other 53 patients (n?=?122 lesions) had negative bioptical results.

Results

In patients with histologically confirmed prostate cancer, 46 of the 92 lesions had visually increased SI on the high b-value images compared with the peripheral zone (SI?=?+27?±?16%) or the central gland (SI?=?+37?±?19%, P?<?0.001 respectively). In patients with a negative biopsy, ten of the 122 lesions had visually increased SI (compared with the peripheral zone, SI?=?+29?±?18%, and with the central gland, SI?=?+41?±?15%, P?<?0.001 respectively). Neither the apparent diffusion coefficient (ADC) values nor the Gleason Score of lesions with increased SI were significantly different from lesions without increased SI.

Conclusions

Visually increased SI on the high b-value images of diffusion-weighted imaging using standard b-values is a sign of malignancy but can occasionally also be a feature of benign lesions. However, it does not indicate more aggressive tumours.

Key points

? Diffusion weighted magnetic resonance imaging is increasingly used to diagnose prostatic cancer ? Reduced signal intensity (SI) on apparent diffusion coefficient (ADC) mapping is characteristic ? Prostatic tumours usually exhibit increased SI on high b-value images ? But benign lesions can also yield increased SI on high b-value images     

Gadoxetic acid enhanced MRI for differentiation of FNH and HCA: a single centre experience

Objectives

Evaluation of enhancement characteristics of histopathologically confirmed focal nodular hyperplasias (FNHs) and hepatocellular adenomas (HCAs) with gadoxetic acid-enhanced MRI.

Methods

Sixty-eight patients with 115 histopathologically proven lesions (FNHs, n?=?44; HCAs, n?=?71) examined with gadoxetic acid-enhanced MRI were retrospectively enrolled (standard of reference: surgical resection, n?=?53 patients (lesions: FNHs, n?=?37; HCAs, n?=?53); biopsy, n?=?15 (lesions: FNHs, n?=?7; HCAs, n?=?18)). Two radiologists evaluated all MR images regarding morphological features as well as the vascular and hepatocyte-specific enhancement in consensus.

Results

For the hepatobiliary phase, relative enhancement of the lesions and lesion to liver enhancement were significantly lower for HCAs (mean, 48.7 (±48.4) % and 49.4 (±33.9) %) compared to FNHs (159.3 (±92.5) %; and 151.7 (±79) %; accuracy of 89 % and 90 %, respectively; P?<?0.001). Visual strong uptake of FNHs vs. hypointensity of HCAs in the hepatobiliary phase resulted in an accuracy of 92 %. This parameter was superior to all other morphological and dynamic vascular criteria alone and in combination (accuracy, 54–85 %).

Conclusions

For differentiation of FNHs and HCAs by means of MRI, gadoxetic acid uptake in the hepatobiliary phase was found to be superior to all other criteria alone and in combination.

Key Points

? EOB-MRI is well suited to differentiate FNHs and hepatocellular adenomas. ? For this purpose hepatobiliary phase is superior to unenhanced and dynamic imaging. ? Hepatobiliary phase (peripheral) hyper- or isointensity is typical for FNH. ? Hepatobiliary phase hypointensity is typical for hepatocellular adenomas. ? EOB-MRI helps to avoid misinterpretations of benign hepatocellular lesions.     

MRI of the breast in patients with DCIS to exclude the presence of invasive disease

Objectives

Core biopsy underestimates invasion in more than 20% of patients with preoperatively diagnosed ductal carcinoma in situ (DCIS) without evidence of invasion (pure DCIS). The aim of the current study was to evaluate the efficacy of preoperative magnetic resonance imaging (MRI) to discriminate between patients with DCIS who are at high risk of invasive breast cancer and patients at low risk.

Methods

One hundred and twenty-five patients, preoperatively diagnosed with pure DCIS (128 lesions; 3 bilateral) by core-needle biopsy, were prospectively included. Clinical, mammographic, histological (core biopsy) and MRI features were assessed. All patients underwent breast surgery. Analyses were performed to identify features associated with presence of invasion.

Results

Eighteen lesions (14.1%) showed invasion on final histology. Seventy-three lesions (57%) showed suspicious enhancement on MRI with a type 1 (n?=?12, 16.4%), type 2 (n?=?19, 26.0%) or type 3 curve, respectively (n?=?42, 57.5%). At multivariate analysis, the most predictive features for excluding presence of invasive disease were absence of enhancement or a type 1 curve on MRI (negative predictive value 98.5%; A_Z 0.80, P?=?0.00006).

Conclusion

Contrast medium uptake kinetics at MRI provide high negative predictive value to exclude presence of invasion and may be useful in primary surgical planning in patients with a preoperative diagnosis of pure DCIS.

Key Points

? It is important to determine invasion in breast DCIS. ? MRI contrast medium uptake kinetics can help exclude the presence of invasion. ? However, the positive predictive value for the presence of invasion is limited. ? MRI features were more accurate at predicting invasion than mammographic features alone.     

Performance of intra-procedural 18-fluorodeoxyglucose PET/CT-guided biopsies for lesions suspected of malignancy but poorly visualized with other modalities

Purpose

We sought to evaluate the safety and the diagnostic success rate of percutaneous biopsies performed under intra-procedural ¹⁸?F-deoxyglucose (FDG) positron-emission tomography/computed tomography (PET/CT) guidance for lesions difficult to see with conventional cross-sectional imaging.

Methods

From 2011 to 2013, consecutive clinically indicated percutaneous PET/CT-guided biopsies of 106 masses (mean size, 3.3 cm; range, 0.7–15.9 cm; SD, 2.9 cm) in bones (n?=?33), liver (n?=?26), soft tissues (n?=?18), lung (n?=?15) and abdomen (n?=?14) were reviewed. The biopsy procedures were performed following injection of a mean of 255 MBq (SD, 74) FDG. Mean maximal standardized uptake value (SUV) of lesions was 8.8 (SD, 6.3). A systematic review of the histopathological results and outcomes was performed.

Results

Biopsies were positive for malignancy in 76 cases (71.7 %, 76/106) and for benign tissue in 30 cases (28.3 %, 30/106). Immediate results were considered adequate for 100 PET/CT biopsies (94.3 %, 100/106) requiring no further exploration, and for the six others (5.7 %, 6/106) benign diagnoses were confirmed after surgery (n?=?4) or follow-up (n?=?2). The consequent overall sensitivity and the diagnostic success of biopsy were therefore 100 %. No significant differences in terms of detection of malignancy were observed between the different locations. Lesions > 2 cm or with SUV?>?4 were not significantly more likely to be malignant. Complications occurred after four biopsies (3.7 %, 4/106).

Conclusion

Intra-procedural PET/CT guidance appears as a safe and effective method and allows high diagnostic success of percutaneous biopsies for metabolically active lesions.     

Predictive significance of breast-specific gamma imaging for upstaging core-needle biopsy-detected ductal carcinoma in situ to invasive cancer

Objective

We evaluated the significance of breast-specific gamma imaging (BSGI) for determination of upstaging to invasive cancer from preoperative ductal carcinoma in situ (DCIS).

Methods

This study enrolled 168 patients with 175 breast lesions diagnosed as DCIS on core-needle biopsy that subsequently underwent preoperative BSGI between September 2011 and October 2017. Both qualitative and quantitative analyses using tumor-to-normal background ratio (TNR) and coefficient of variation (COV) were performed, and the predictive significance for upstaging to invasive cancer was investigated. We also sought to identify clinicopathological factors associated with upstaging and their relation to BSGI findings.

Results

Fifty-eight lesions (33.1%) were confirmed to be invasive breast cancer after the final surgical approach. On univariate analysis, tumor size based on ultrasonography (US), hormone status, histologic grade, Breast Imaging Reporting and Data System category, comedo-necrosis, Ki-67 expression, and BSGI findings were associated with upstaging to invasive cancer. Tumor size?>?2.0 cm (p?=?0.005), Ki-67 expression?>?8% (p?<?0.001), qualitative BSGI findings (p?=?0.020), and COV?>?30.44 (p?=?0.022) were independently associated with upstaging after multiple regression analysis.

Conclusion

BSGI is a useful imaging modality for predicting upstaging to invasive breast cancer from DCIS on core-needle biopsy in conjunction with US tumor size and Ki-67 expression.

     

MRI-guided percutaneous coaxial cutting needle biopsy of small pulmonary nodules: feasibility

Objectives

To prospectively evaluate the feasibility, safety and accuracy of magnetic resonance imaging (MRI)-guided percutaneous coaxial cutting needle biopsy of small (≤2.0 cm in diameter) pulmonary nodules.

Methods

Ninety-six patients (56 men and 40 women) with 96 small lung nodules underwent MRI-guided percutaneous coaxial cutting needle biopsy. These lesions were divided into two groups according to maximum nodule diameters: 0.5–1.0 cm (n?=?25) and 1.1–2.0 cm (n?=?71). The diagnostic accuracy, sensitivity and specificity were calculated, and comparison of the two groups was performed using Fisher's exact test.

Results

All specimens obtained were sufficient for diagnosis. Histological examination of needle biopsy revealed 64 malignant, 30 benign and 2 indeterminate nodules. The final diagnoses from surgery or clinical follow-up were 67 malignant nodules and 29 benign nodules. The diagnostic performance of MRI-guided percutaneous coaxial cutting needle biopsy in diagnosing malignant tumours was as follows: accuracy, 97 %; sensitivity, 96 %; specificity, 100 %; positive predictive value, 100 %; and negative predictive value, 91 %. There was no significant difference between the two groups (P?>?0.05, Fisher's exact test). No serious complications occurred.

Conclusions

MRI-guided percutaneous coaxial cutting needle biopsy is a safe and accurate diagnostic technique in the evaluation of small lung nodules.

Key Points

? MRI-guided biopsy helps clinicians to assess patients with small lung nodules. ? Differentiation of malignant and benign nodules is possible with 97?% accuracy. ? MRI guidance enables accurate lung biopsy without ionising radiation. ? No serious complications occurred in MRI-guided lung biopsy.     

The role of needle biopsy for focal bone lesions with complete fluid-fluid levels on magnetic resonance imaging

Objective

To assess the value of image-guided needle biopsy of bone lesions completely filled with fluid–fluid levels (FFLs) on magnetic resonance imaging (MRI) and the safety of primary surgical curettage.

Materials and methods

The radiology database was searched for all reports containing “fluid level” from 1998 to 2011 and the imaging was reviewed retrospectively. Inclusion criteria were patients with bone lesions completely filled with FFLs on MRI (defined as FFLs on every axial and/or sagittal T2-weighted or Short Tau Inversion Recovery (STIR) sequence). The pathology database was then reviewed for the outcome of needle biopsy (n?=?14) and for the outcome of surgical curettage, either post-biopsy or primary (n?=?52).

Results

There were 53 patients (mean age 18 years; M?=?34, F?=?19). Fourteen patients underwent percutaneous needle biopsy, which was diagnostic in five (36 %) and non-diagnostic in nine (64 %). Fifty-two patients had surgical curettage/resection, which was diagnostic in 50 (96 %) and non-diagnostic in two (4 %). All lesions were benign; 78 % were aneurysmal bone cysts (ABC), 8 % were lesions with ABC change, and 14 % were simple bone cysts.

Conclusions

Our results suggest that patients with bone lesions completely filled with FFLs on MRI are almost certain to be benign, provided that the clinical and radiological features are not atypical. Percutaneous needle biopsy in such cases is unlikely to be of value and these lesions can be safely managed with primary surgical curettage.     

Subfascial involvement in glomuvenous malformation

Objective

Glomuvenous malformation (GVM) is an inherited autosomal dominant trait. The lesions, which appear as bluish nodules or plaque-like cutaneous elevations, are usually tender and more firm than sporadic venous malformations. Conventionally, the lesions are thought to be limited to the cutaneous and subcutaneous tissue planes. The objective was to characterize the depth of involvement of GVM lesions.

Materials and Methods

Magnetic resonance imaging (MRI) findings in GVM were retrospectively evaluated by two radiologists. The signal characteristics, tissue distribution, pattern of contrast enhancement of the lesions in GVM were documented.

Results

Thirty patients (19 female) aged 1–35 years (mean 18 years) were diagnosed with GVM based on clinical features (n?=?20) and/or histopathological findings (n?=?10). The lesions were present in the lower extremity (n?=?15), upper extremity (n?=?6), cervico-facial region (n?=?6), pelvis (n?=?2), and chest wall (n?=?1). All patients had skin and subcutaneous lesions. Fifty percent of the patients (n?=?15) demonstrated subfascial intramuscular (n?=?15), intra-osseous (n?=?1), and intra-articular involvement (n?=?1).

Conclusion

Contrary to the conventional belief that GVMs are generally limited to the skin and subcutaneous tissue, deep subfascial extension of the lesions is common.     

Value of CT angiography for the detection of intracranial vascular lesions in patients with acute severe headache

Objectives

To retrospectively investigate the prevalence and characteristics of intracranial vascular lesions in patients with acute severe headache with the use of CT angiography (CTA).

Methods

We systematically searched for neurologically intact patients with acute severe headache and normal unenhanced head CT. The study group consisted of 512 patients; 251 male; mean age 46.2?±?12.4 years. All patients underwent CTA between 1 day and 2 months after the headache attack. CTA images were interpreted by two experienced neuroradiologists for the presence of vascular lesions.

Results

Thirty-four (6.6 %) of the 512 patients had intracranial vascular lesions on CTA, including 33 aneurysms (2 patients had 2 aneurysms each), 2 moyamoya disease and 1 arterial dissection. No gender- or age-related differences were found. Aneurysms arose most commonly on the internal carotid artery (n?=?12), followed by the anterior communicating artery (n?=?7), and the middle cerebral artery (n?=?7). Maximal diameters ranged from 2.0 to 13.1 mm (mean, 3.9?±?2.6 mm).

Conclusions

CTA is a feasible tool for diagnosing intracranial vascular lesions in patients with acute severe headache. The prevalence of vascular lesions in our series was 6.6 %, which is higher than that predicted in the general population.

Key Points

? Unruptured cerebral aneurysms may be a cause of acute severe headache ? CTA assesses intracranial vascular lesions in patients with acute severe headache ? The prevalence of vascular lesions in our series of patients was 6.6 %     

Endovascular Management of Iatrogenic Native Renal Arterial Pseudoaneurysms

Purpose

Our purpose was to evaluate iatrogenic renal pseudoaneurysms, endovascular treatment, and outcomes.

Methods

This retrospective study (2003–2011) reported the technical and clinical outcomes of endovascular therapy for renal pseudoaneurysms in eight patients (mean age, 46 (range 24–68) years). Renal parenchymal loss evaluation was based on digital subtraction angiography and computed tomography.

Results

We identified eight iatrogenic renal pseudoaneurysm patients with symptoms of hematuria, pain, and hematoma after renal biopsy (n?=?3), surgery (n?=?3), percutaneous nephrolithotomy (n?=?1), and endoscopic shock-wave lithotripsy (n?=?1). In six patients, the pseudoaneurysms were small-sized (<20?mm) and peripherally located and were treated solely with coil embolization (n?=?5). In one patient, coil embolization was preceded by embolization with 500–700 micron embospheres to control active bleeding. The remaining two patients had large-sized (≥50?mm), centrally located renal pseudoaneurysms treated with thrombin?±?coils. Technical success with immediate bleeding cessation was achieved in all patients. There were no procedure-related deaths or complications (mean follow-up, 23.5 (range, 1–67) months).

Conclusions

Treatment of renal pseudoaneurysms using endovascular approach is a relatively safe and viable option regardless of location (central or peripheral) and size of the lesions with minimal renal parenchymal sacrifice.     

CT perfusion technique for assessment of early kidney allograft dysfunction: preliminary results

Objectives

To assess the benefit of quantitative computed tomography (CT) perfusion for differentiating acute tubular necrosis (ATN) and acute rejection (AR) in kidney allografts.

Methods

Twenty-two patients with acute kidney allograft dysfunction caused by either AR (n?=?6) or ATN (n?=?16) were retrospectively included in the study. All patients initially underwent a multiphase CT angiography (CTA) protocol (12 phases, one phase every 3.5 s) covering the whole graft to exclude acute postoperative complications. Multiphase CT dataset and dedicated software were used to calculate renal blood flow. Renal biopsy or clinical course of disease served as the standard of reference. Mean effective radiation dose and mean amount of contrast media were calculated.

Results

Renal blood flow values were significantly lower (P?=?0.001) in allografts undergoing AR (48.3?±?21 ml/100 ml/min) compared with those with ATN (77.5?±?21 ml/100 ml/min). No significant difference (P?=?0.71) was observed regarding creatinine level with 5.65?±?3.1 mg/dl in AR and 5.3?±?1.9 mg/dl in ATN. The mean effective radiation dose of the CT perfusion protocol was 13.6?±?5.2 mSv; the mean amount of contrast media applied was 34.5?±?5.1 ml. All examinations were performed without complications.

Conclusion

CT perfusion of kidney allografts may help to differentiate between ATN and rejection.

Key points

? Quantitative CT perfusion of renal transplants is feasible. ? CT perfusion could help to non-invasively differentiate AR from ATN. ? CT perfusion might make some renal biopsies unnecessary.     

CT fluoroscopy-guided lung biopsy versus conventional CT-guided lung biopsy: a prospective controlled study to assess radiation doses and diagnostic performance

Objective

We evaluated radiation doses, complication rates, and diagnostic accuracy for CT-guided percutaneous needle aspiration biopsy (NAB) procedures of pulmonary lesions performed with or without fluoroscopic guidance.

Methods

A total of 142 patients were prospectively enrolled to receive CT-guided NAB with (Group I, n?=?72) or without (Group II, n?=?70) fluoroscopic guidance. Outcome measurements were patient and doctor radiation dose, and complication rate. Sensitivity, specificity and accuracy were calculated based on 123 NAB results.

Results

The mean estimated effective patient radiation dose was 6.53?mSv in Group I and 2.72?mSv in Group II (p?<?0.001). The mean estimated effective doctor dose was 0.054?mSv in Group I and 0.029?mSv in Group II (p < 0.001). The complication rate was significantly different between the two groups (13.4% versus 31.4%, p?=?0.012). Sensitivity, specificity and accuracy for diagnosing pulmonary lesions were 97.8%, 100% and 98.4% in group I and 95.3%, 100% and 89.5% in group II (p?>?0.05).

Conclusions

CT fluoroscopy-guided NAB of pulmonary lesions provides high diagnostic accuracy and can be performed with significantly fewer complications. However, radiation exposure to both patient and doctor were significantly higher than conventional CT-guided NAB.     

Stiffness of the surrounding tissue of breast lesions evaluated by ultrasound elastography

Objective

To evaluate the stiffness of the surrounding tissue of breast lesions using the strain ratio assessment method by ultrasound (US) elastography.

Methods

This was an institutional ethics committee approved prospective study. A total of 127 breast lesions in 118 women (mean age 48.23?±?14.32, range 20–90) were examined with conventional and elastographic US. The strain ratio assessment method was utilized to semi-quantitatively evaluate the stiffness of the breast lesions and the surrounding tissue.

Results

Fifty-five lesions were malignant and 72 were benign. The strain ratio of the surrounding tissue was significantly higher in malignant cases (1.49?±?0.67) than in benign ones (1.17?±?0.44) (P?=?0.001), and yielded an Az value of 0.669 in the diagnosis of breast lesions. There was a significant high positive correlation between the strain ratio of the lesion and the strain ratio of the surrounding tissue in the malignant group (r?=?0.740, P?<?0.001), and a significant moderate positive correlation in the benign group (r?=?0.595, P?<?0.001).

Conclusion

The stiffness of the surrounding tissue of malignant breast lesions was higher than that of benign lesions. The strain ratio of the surrounding tissue and the lesions was significantly correlated, and has potential for breast lesion diagnosis.

Key Points

? Stiffness of the surrounding tissue of malignant breast lesions was increased. ? Stiffness of the surrounding tissue correlated with stiffness of breast lesions. ? Stiffness of the surrounding tissue has potential use in diagnosis of breast lesions.     

Application of the diffusion kurtosis model for the study of breast lesions

Objectives

To evaluate diffusion-weighted imaging (DWI) and diffusion kurtosis imaging (DKI) in the differentiation and characterisation of breast lesions.

Methods

Thirty-six women underwent breast magnetic resonance imaging (MRI) including a DWI sequence with multiple b-values (50–3,000 s/mm²). Mean values for apparent diffusion coefficient (ADC), mean diffusivity (MD) and mean kurtosis (MK) were calculated by lesion type and histological subtype. Differences and correlation between parameters were determined.

Results

Forty-four lesions were found. There were significant differences between benign and malignant lesions for all parameters (ADC, p?=?0.017; MD, p?=?0.028; MK, p?=?0.017). ADC and MD were higher for benign (1.96?±?0.41?×?10^?3 and 2.17?±?0.42?×?10^?3 mm²/s, respectively) than for malignant lesions (1.33?±?0.18?×?10^?3 and 1.52?±?0.50?×?10^?3 mm²/s). MK was higher for malignant (0.61?±?0.27) than benign lesions (0.37?±?0.18). We found differences between invasive ductal carcinoma (IDC) and fibroadenoma (FA) for all parameters (ADC, MD and MK): p?=?0.016, 0.022 and 0.016, respectively. FA and fibrocystic change (FC) showed differences only in MK (p?=?0.016).

Conclusions

Diffusion in breast lesions follows a non-Gaussian distribution. MK enables differentiation and characterisation of breast lesions, providing new insights into microstructural complexity. To confirm these results, further investigation in a broader sample should be performed.

Key Points

? The diffusion kurtosis model provides new information regarding breast lesions ? MD and MK are valid parameters to characterise tissue microstructure ? MK enables improved lesion differentiation ? MK is able to differentiate lesions that display similar ADC values     

CT-guided adrenal biopsy: comparison of ipsilateral decubitus versus prone patient positioning for biopsy approach

Objectives

To compare ipsilateral decubitus and prone patient positioning for performing computed tomography guided adrenal biopsy using the requirements for out-of-plane approach (OOP) and the needle insertion time (NIT) as a surrogate for procedure complexity.

Methods

The study included 106 adrenal biopsies performed in 104 patients with lesions measuring ≤4?cm that were divided into two groups: Ipsilateral decubitus (Group I) and prone (Group II) positions. The frequency of use of an OOP biopsy path and the NIT were recorded as well as diagnostic yield, adverse events and transgression of organs to approach the target lesion.

Results

Groups I and II comprised 54 and 50 patients, respectively. The use of the OOP approach was significantly less frequent (P?n?=?4) compared to Group II (n?=?38). NIT was statistically shorter (P?Conclusion Ipsilateral adrenal biopsy approach is a less complex, equally reliable and safe compared to the prone approach based on the less frequent use of the OOP approach and the shorter NIT.

Key Points

? Ipsilateral adrenal biopsy decubitus positioning provides a direct, non-transpulmonary path for sampling ? Ipsilateral decubitus positioning reduces the need for potentially dangerous out-of-plane approaches (OOP) ? Ipsilateral decubitus and prone positioning are equally reliable and safe techniques     

Added value of FDG-PET imaging in the diagnostic workup for yttrium-90 radioembolisation in patients with colorectal cancer liver metastases

Objective

Yttrium-90 radioembolisation (Y90-RE) is recommended for unresectable, chemorefractory liver-dominant disease; however, the incidence of extrahepatic disease (EHD) is high. FDG-PET may have additional value to CT in demonstrating EHD. Our aim was to evaluate the added diagnostic value of FDG-PET to abdominal CT and study the influence of FDG-PET findings on treatment decisions.

Methods

All consecutive patients with colorectal cancer liver metastases (CRCLM) referred for Y90-RE were included. Patients who underwent both CT and FDG-PET in the diagnostic workup were selected. Imaging reports were scrutinised for documented sites of EHD, and changes of management due to FDG-PET findings were determined.

Results

A total of 42 patients were included. Findings on CT and FDG-PET matched in 20 patients (no EHD, n?=?15; identical EHD, n?=?5). In 4 patients, lesions detected on CT were not FDG-avid, and in 18 patients, FDG-PET showed more lesions than CT (P?<?0.05). In 7/42 patients (17 %) a change of management was made based on the additional FDG-PET findings, i.e. exclusion from Y90-RE treatment (n?=?6) and change in treatment plan (whole liver rather than segmental treatment, n?=?1).

Conclusions

In patients with CRCLM referred for Y90-RE, FDG-PET showed significantly more EHD and led to a considerable change of management.

Key Points

? Yttrium-90 radioembolisation is a locoregional treatment for liver tumours ? Detection of extrahepatic lesions, for which CT is widely used, is crucial ? FDG-PET shows significantly more extrahepatic lesions compared to CT ? FDG-PET findings led to a considerable change in treatment decisions     

Intravoxel incoherent motion model-based liver lesion characterisation from three b-value diffusion-weighted MRI

Objective

To evaluate intravoxel incoherent motion (IVIM) model-based liver lesion characterisation from three b-value diffusion-weighted imaging (DWI).

Methods

The 1.5-T DWI data from a respiratory gated spin-echo echo-planar magnetic resonance imaging sequence (b?=?0, 50, 800 s/mm²) were retrospectively analysed in 38 patients with different liver lesions. Conventional apparent diffusion coefficient ADC?=?ADC(0,800) as well as IVIM-based parameters D′?=?ADC(50,800), ADC_low?=?ADC(0,50), and f′ were calculated voxel-wise. Sixty-one regions of interest in hepatocellular carcinomas (HCCs, n?=?24), haemangiomas (HEMs, n?=?11), focal nodular hyperplasias (FNHs, n?=?11), and healthy liver tissue (REFs, n?=?15) were analysed. Group differences were investigated using Student’s t-test and receiver-operating characteristic (ROC) analysis.

Results

Mean values?±?standard deviations of ADC, D′, ADC_low (in 10^-5 mm²/s), and f′ (in %) for REFs/FNHs/HEMs/HCCs were 130?±?11/143?±?27/168?±?16/113?±?25, 104?±?12/123?±?25/162?±?18/102?±?23, 518?±?66/437?±?97/268?±?69/283?±?120, and 18?±?3/14?±?4/6?±?3/9?±?5, respectively. Differences between lesions and REFs were more significant for IVIM-based parameters than for conventional ADC. ROC analysis showed the best discriminability between HCCs and FNHs for ADC_low and f′ and between HEMs and FNHs or HCCs for D′.

Conclusion

Three instead of two b-value DWI enables a numerically stable and voxel-wise IVIM-based analysis for improved liver lesion characterisation with tolerable acquisition time.

Key Points

? Quantitative analysis of diffusion-weighted MRI helps liver lesion characterisation. ? Analysis of intravoxel incoherent motion is superior to apparent diffusion coefficient determination. ? Only three b-values enable separation of diffusion and microcirculation effects. ? The method presented is numerically stable, with voxel-wise results and short acquisition times.     

MR-guided vacuum-assisted breast biopsy of MRI-only lesions: a single center experience

Purpose

The purpose of this study was to compare three different biopsy devices on false-negative and underestimation rates in MR-guided, vacuum-assisted breast biopsy (VABB) of MRI-only lesions.

Methods

This retrospective, single-center study was IRB-approved. Informed consent was waived. 467 consecutive patients underwent 487 MR-guided VABB using three different 8-10-gauge-VABB devices (Atec-9-gauge,A; Mammotome-8-gauge,M; Vacora-10-gauge,V). VABB data (lesion-type, size, biopsy device, histopathology) were compared to final diagnosis (surgery, n?=?210 and follow-up, n?=?277). Chi-square, and Kruskal–Wallis tests were applied. P values?<?0.05 were considered significant.

Results

Final diagnosis was malignant in 104 (21.4 %), high risk in 64 (13.1 %) and benign in 319 (65.5 %) cases. Eleven of 328 (3.4 %) benign-rated lesions were false-negative (1/95, 1.1 %, A; 2/73, 2.7 %, M; 8/160 5.0 % V; P?=?0.095). Eleven high-risk (11/77, 14.3 %) lesions proved to be malignant (3/26, 11.5 % A; 4/12, 33.3 % M; 4/39, 10.3 % V; P?=?0.228). Five of 34 (14.7 %) DCIS were upgraded to invasive cancer (2/15, 13.3 %, A; 1/6, 16.6 % M; 2/13, 15.3 %, V; P?=?0.977). Lesion size (P?=?0.05) and type (mass vs. non-mass, P?=?0.107) did not differ significantly.

Conclusion

MR-guided VABB is an accurate method for diagnosis of MRI-only lesions. No significant differences on false-negative and underestimation rates were observed between three different biopsy devices.

Key Points

? MR-guided VABB is an accurate procedure for the diagnosis of MRI-only lesions. ? Similar false-negative and underestimation rates allow all three different MR-guided VABB devices for clinical application. ? High-risk lesions should undergo surgery due to a substantial underestimation rate. ? Agreement between MR-guided VABB and final diagnosis (benign/malignant) was 95.5% (465/487).