The added value of contrast enhanced spectral mammography in identification of multiplicity of suspicious lesions in dense breast

Objective

To evaluate the additive value of Contrast Enhanced Spectral Mammography (CESM) in the preoperative assessment of malignant lesions in dense breast parenchyma regarding multiplicity.

Role of contrast enhanced spectral mammography in predicting pathological response of locally advanced breast cancer post neo-adjuvant chemotherapy

Objective

To evaluate the accuracy of CESM technique in predicting the final pathological response and residual tumor size post NAC in LABC.

Accuracy of CESM versus conventional mammography and ultrasound in evaluation of BI-RADS 3 and 4 breast lesions with pathological correlation

Aim

Assess accuracy of contrast enhanced spectral mammography (CESM) versus conventional mammography and ultrasound in evaluation of BI-RADS 3 and 4 breast lesions with pathological correlation.

Integration of magnetic resonance imaging in characterization of inflammatory breast disorders

Objective

Assess the efficacy of using different imaging modalities aiming at proper characterization of benign and malignant inflammatory breast disorders.

Diffusion-weighted imaging in relation to morphology on dynamic contrast enhancement MRI: the diagnostic value of characterizing non-puerperal mastitis

Objectives

To demonstrate the value of diffusion-weighted imaging (DWI) in the characterisation of mastitis lesions.

Methods

Sixty-one non-puerperal patients with pathologically confirmed single benign mastitis lesions underwent preoperative examinations with conventional MRI and axial DWI. Patients were categorised into three groups: (1) periductal mastitis (PDM), (2) granulomatous lobular mastitis (GLM), and (3) infectious abscess (IAB). Apparent diffusion coefficient (ADC) values of each lesion were recorded. A one-way ANOVA with logistic analysis was performed to compare ADC values and other parameters. Discriminative abilities of DWI modalities were compared using the area under the receiver operating characteristic curve (AUC). P < 0.05 was considered statistically significant.

Results

ADC values differed significantly among the three groups (P = 0.003) as well as between PDM and IAB and between PDM and GLM. The distribution of non-mass enhancement on dynamic contrast-enhanced (DCE) MRI differed significantly among the three groups (P = 0.03) but not between any two groups specifically. There were no differences in lesion location, patient age, T₂WI or DWI signal intensity, enhancement type, non-mass internal enhancement, or mass enhancement characteristics among the three groups.

Conclusions

ADC values and the distribution of non-mass enhancement are valuable in classifying mastitis subtypes.

Key points

? Mastitis subtypes exhibit different characteristics on DWI and DCE MRI. ? ADC values are helpful in isolating PDM from other mastitis lesions. ? Distribution of non-mass enhancement also has value in comparing mastitis subtypes.

     

Contrast-enhanced spectral mammography vs. mammography and MRI – clinical performance in a multi-reader evaluation

Objectives

To compare the diagnostic performance of contrast-enhanced spectral mammography (CESM) to digital mammography (MG) and magnetic resonance imaging (MRI) in a prospective two-centre, multi-reader study.

Methods

One hundred seventy-eight women (mean age 53 years) with invasive breast cancer and/or DCIS were included after ethics board approval. MG, CESM and CESM?+?MG were evaluated by three blinded radiologists based on amended ACR BI-RADS criteria. MRI was assessed by another group of three readers. Receiver-operating characteristic (ROC) curves were compared. Size measurements for the 70 lesions detected by all readers in each modality were correlated with pathology.

Results

Reading results for 604 lesions were available (273 malignant, 4 high-risk, 327 benign). The area under the ROC curve was significantly larger for CESM alone (0.84) and CESM?+?MG (0.83) compared to MG (0.76) (largest advantage in dense breasts) while it was not significantly different from MRI (0.85). Pearson correlation coefficients for size comparison were 0.61 for MG, 0.69 for CESM, 0.70 for CESM?+?MG and 0.79 for MRI.

Conclusions

This study showed that CESM, alone and in combination with MG, is as accurate as MRI but is superior to MG for lesion detection. Patients with dense breasts benefitted most from CESM with the smallest additional dose compared to MG.

Key Points

? CESM has comparable diagnostic performance (ROC-AUC) to MRI for breast cancer diagnostics.? CESM in combination with MG does not improve diagnostic performance.? CESM has lower sensitivity but higher specificity than MRI.? Sensitivity differences are more pronounced in dense and not significant in non-dense breasts.? CESM and MRI are significantly superior to MG, particularly in dense breasts.

     

ADC value as a predictor for myelin loss/Preservation in MS plaques with different enhancement pattern in correlation with disease activity

Background

MS plaques display different pattern of enhancement with variable clinical course. The purpose is to assess the role of ADC value as a predictive for MS histologic changes with different enhancing pattern and its correlation with disease activity.

Invasive Micropapillary Carcinoma of the Breast: MR Imaging Findings

Objective

To analyze the magnetic resonance (MR) imaging findings of invasive micropapillary carcinoma of the breast.

Materials and Methods

MR images were retrospectively evaluated in 14 patients (age range: 37-67, mean age: 49 years) with pathologically confirmed invasive micropapillary carcinoma of the breast. The enhancement type (mass/non-mass), shape, margin, contrast enhancement, and time-intensity curve pattern on the dynamic study were correlated with the histopathologic features. Associated findings, such as edema, nipple change, skin change and enlarged axillary lymph nodes were also studied.

Results

The most common features of the masses were irregular shape (12 of 14 patients, 85.8%) and irregular or spiculated margin (11 of 14 patients, 78.7%). The contrast enhancement was heterogeneous in 11 patients (78.7%), rim enhancement in 2 cases (14.2%), and homogeneous in one patient (7.1%). The predominant kinetic pattern was rapid increase (14 of 14, 100%) in the initial phase and washout (11 of 14, 78.7%) in the delayed phase. Associated non-mass like enhancement was shown in 4 patients, representing ductal carcinoma in situ. MR imaging helped detect additional sites of cancer other than the index lesion in 3 patients (21.4%). Enlarged axillary lymphadenopathy was identified in 7 of the 14 patients (50%).

Conclusion

Invasive micropapillary carcinoma appears as a mass with an irregular shape, irregular or spiculated margin and heterogeneous enhancement on MR imaging. Though these findings are not specific and are also observed with other breast malignancies, invasive micropapillary carcinoma frequently showed multiple lesions, accompanying non-mass enhancement and axillary lymph node enlargement.     

Delayed post contrast magnetic resonance imaging (MRI) of the brain in multiple sclerosis (MS) patients: Is it of value?

Aim of the work

The aim of this study was to assess the rule of delayed T1 post contrast sequence in detection of active lesions in multiple sclerosis patients by comparing the early and delayed T1 post contrast images.

Contrast-enhanced spectral mammography in recalls from the Dutch breast cancer screening program: validation of results in a large multireader,multicase study

Objectives

Contrast-enhanced spectral mammography (CESM) is a promising problem-solving tool in women referred from a breast cancer screening program. We aimed to study the validity of preliminary results of CESM using a larger panel of radiologists with different levels of CESM experience.

Methods

All women referred from the Dutch breast cancer screening program were eligible for CESM. 199 consecutive cases were viewed by ten radiologists. Four had extensive CESM experience, three had no CESM experience but were experienced breast radiologists, and three were residents. All readers provided a BI-RADS score for the low-energy CESM images first, after which the score could be adjusted when viewing the entire CESM exam. BI-RADS 1-3 were considered benign and BI-RADS 4-5 malignant. With this cutoff, we calculated sensitivity, specificity and area under the ROC curve.

Results

CESM increased diagnostic accuracy in all readers. The performance for all readers using CESM was: sensitivity 96.9 % (+3.9 %), specificity 69.7 % (+33.8 %) and area under the ROC curve 0.833 (+0.188).

Conclusion

CESM is superior to conventional mammography, with excellent problem-solving capabilities in women referred from the breast cancer screening program. Previous results were confirmed even in a larger panel of readers with varying CESM experience.

Key Points

? CESM is consistently superior to conventional mammography ? CESM increases diagnostic accuracy regardless of a reader’s experience ? CESM is an excellent problem-solving tool in recalls from screening programs

     

Combined apparent diffusion coefficient value (ADC) and 1H magnetic resonance spectroscopy (MRS) in breast lesions: Benefits and limitations

Objective

This study aimed to assess the diagnostic value of a combined imaging protocol of diffusion-weighted MRI, apparent diffusion coefficient (ADC) values, and MR spectroscopy(MRS) in discriminating benign and malignant breast lesions.

Management for BI-RADS category 3 lesions detected in preoperative breast MR imaging of breast cancer patients

Objective

To retrospectively evaluate characteristics of and determine appropriate follow-up recommendations for BI-RADS category 3 lesions detected in preoperative MRI of breast cancer patients.

Methods

BI-RADS category 3 assessments were identified from the breast MRI database for 5,110 consecutive breast cancer patients who had undergone preoperative MRI and surgery. Patient and lesion characteristics, malignancy rate, and interval between lesion detection and cancer diagnosis were analysed. Histopathological results or imaging at or after 2-year follow-up were used as reference standards.

Results

Of the 626 lesions, morphological features included a single focus in 26.5% (n?=?166), multiple foci in 47.1% (n?=?295), mass in 21.7% (n?=?136) and non-mass enhancement in 4.6% (n?=?29). Cancer was found in 0.8% (5/626) at a median interval of 50 months (range, 29–66 months). Malignancy rate according to morphological feature was: 1.8% (3/166) in a single focus, 0.7% (1/136) in mass and 3.4% (1/29) in non-mass enhancement. All detected cancers were stage 0 or IA.

Conclusions

Annual follow-up might be adequate for BI-RADS category 3 lesions detected at preoperative MRI because of the 0.8% (5/626) malignancy rate, long interval between lesion detection and cancer diagnosis, and early stage of diagnosed cancers.

Key Points

? BI-RADS category 3 lesions on preoperative MRI had 0.8% malignancy rate. ? All cancer diagnoses from BI-RADS 3 occurred after 24-month follow-up. ? Annual follow-up might be adequate for BI-RADS 3 detected on preoperative MRI.

     

The diagnostic value of sonoelastographic strain ratio in discriminating malignant from benign solid breast masses

Objective

To detect the diagnostic efficiency of sono elastographic strain ratio in discriminating malignant from benign solid breast masses and compare it with the sono elastographic elasticity score method.

Incidentally Detected Enhancing Breast Lesions on Chest Computed Tomography

Objective

To evaluate the nature and imaging appearance of incidental enhancing breast lesions detected on a routine contrast-enhanced chest CT.

Materials and Methods

Twenty-three patients with incidental enhancing breast lesions on contrast-enhanced chest CT were retrospectively reviewed. The breast lesions were reviewed by unenhanced and enhanced CT, and evaluated by observing the shapes, margins, enhancement patterns and backgrounds of breast lesions. A histopathologic diagnosis or long-term follow-up served as reference standard.

Results

Sixteen (70%) patients had malignant breast lesions and seven (30%) had benign lesions. In 10 patients, the breast lesions were exclusively detected on contrast-enhanced CT. Using unenhanced CT, breast lesions with fibroglandular backgrounds were prone to be obscured (p < 0.001). Incidental primary breast cancer showed an non-significant trend of a higher percentage irregular margin (p = 0.056). All of the four incidental breast lesions with non-mass-like enhancement were proven to be malignant.

Conclusion

Routine contrast-enhanced chest CT can reveal sufficient details to allow for the detection of unsuspected breast lesions, in which some cases may be proven as malignant. An irregular margin of incidental enhancing breast lesion can be considered a suggestive sign of malignancy.     

Breast tomosynthesis: A diagnostic addition to screening digital mammography

Objectives

Comparison between digital mammography alone and with adding digital breast tomosynthesis in breast cancer screening.

The utility of DW-MRI in the diagnosis of pancreatic focal lesions

Background

Early diagnosis is crucial in management of pancreatic malignancy. DWMRI could be used in differentiating pancreatic lesions and judge about tumor aggressiveness.

The diagnostic potential of diffusion weighted and dynamic contrast enhanced MR imaging in the characterization of complex ovarian lesions

Purpose

Our aim was to evaluate the diagnostic potential of diffusion-weighted (DW) and dynamic contrast enhanced MRI (DCE-MR) in the diagnosis and characterization of complex ovarian lesions.

Homogeneously enhancing breast lesions on contrast enhanced US: differential diagnosis by conventional and contrast enhanced US findings

Objective

To clarify the details of homogeneously enhancing lesions on contrast-enhanced ultrasonography (CEUS) and also to elucidate whether their differential diagnosis is possible.

Methods

Seventy-three homogeneously enhancing lesions on CEUS were retrospectively selected. Two radiologists first assessed conventional US findings alone in consensus to differentiate malignant vs. benign lesions. Then, qualitative and quantitative CEUS findings were analyzed to determine the useful findings for the differential diagnosis. Determined CEUS findings were applied to the indeterminate lesions based on conventional US findings to see whether CEUS can improve the diagnostic performance.

Results

There were 42 cancers (58 %) out of 73. Sensitivity and specificity using conventional US findings alone were 91 and 55 %, respectively. Among the CEUS findings tested, multivariate analysis revealed only the type 3 enhancement pattern, which indicates a larger enhancing area than the precontrast hypoechoic lesion, was related to malignancy (p < 0.05). By adding this information, however, no improvement was achieved in the diagnostic performance as determined by conventional US findings.

Conclusions

Approximately half of the homogeneously enhancing lesions on CEUS are malignant, and differentiation of malignant from benign lesions may be possible, at least to some extent, by meticulous assessment of the conventional US rather than CEUS findings.