Interreader variability and predictive value of US descriptions of solid breast masses: pilot study

RATIONALE AND OBJECTIVES: This study evaluated the specificity of ultrasound (US) characteristics of solid breast lesions and the interreader variability in their interpretation. MATERIALS AND METHODS: In 61 patients, 70 sonographically visible solid masses, scheduled for biopsy because of findings from conventional imaging, were prospectively and sequentially accrued for evaluation. Three readers interpreted the sonograms and described the solid masses in terms of established US characteristics. The specificity and positive predictive value (PPV) for each characteristic were calculated by comparing US findings with biopsy findings, and interreader variability was evaluated. Five assessment categories were developed to guide recommendations for patient care. The relative performance of each reader was assessed by measuring the PPV for each assessment category and by measuring the area under the receiver operating characteristic curve. RESULTS: The specificity and PPV were calculated for all characteristics and for each reader. The average specificities of the three readers for the most frequently used six characteristics were as follows: spiculation, 97%+/-5 (standard deviation); taller than wide, 91%+/-4; central shadowing, 77%+/-1; markedly hypoechoic, 86%+/-5; duct extension, 95%+/-5; and microlobulation, 84%+/-3 (overall average specificity, 88.5%). The average PPVs for categories II-V were 5%, 10%, 63%, and 94%, respectively. The readers' interpretations were similar and correlated well. CONCLUSION: The proposed US recommendation system is an accurate predictor of histologic findings. A sonographic classification lexicon should prove valuable.     

Ultrasonic detection of nonopaque renal calculi

Four patients with 5 nonopaque renal calculi composed of uric acid were examined by ultrasound. The calculi varied in size from a 1.5 X 1.5-cm intrapelvic stone to a staghorn calculus measuring 4 cm. All stones were satisfactorily imaged by ultrasound, allowing a diagnosis of nephrolithiasis to be made with confidence in each case. In 2 patients with poor excretion on urography, the diagnosis was not suspected prior to the ultrasound examination. The authors feel that ultrasound has great potential value in the investigation of nonopaque filling defects of the renal pelvis and in patients with urographic nonvisualization who have a high risk of uric acid lithiasis.     

Avascular necrosis of the femoral head: morphologic assessment by MR imaging, with CT correlation

To better understand the morphologic appearance of avascular necrosis (AVN) of the femoral head on magnetic resonance (MR) images (1.5 T) and computed tomographic (CT) scans, the records of 21 lesions were reviewed retrospectively. All MR imaging studies included T1-weighted images (T1WI) (repetition times [TR] of 400-1,000 msec, and echo times [TE] of 20-25 msec), and 15 included T2-weighted images (T2WI) (TR = 2,000-2,500 msec; TE = 60-80 msec). MR signal features of the lesions were compared with features on the corresponding CT scans. Abnormalities in the superoanterior aspect of the femoral head were noted on both image types in all 21 lesions but were more obvious on MR images in two. A characteristic margin of peripheral sclerosis seen on CT scans in 95% (20 of 21) of lesions corresponded to a line of low intensity on MR images. Fractures complicating AVN were seen in eight lesions at CT scanning. On T1WI, fractures were not clearly delineated. On T2WI, fractures were of high intensity but were depicted less clearly than on CT scans. Central signal intensity of the lesions on T1WI correlated with the presence or absence of fracture: 88% (seven of eight) of the lesions with fractures appeared less intense than fat, compared with only 8% (one of 13) of lesions without fractures (P less than .005). While MR imaging is a sensitive method for early diagnosis of AVN, CT scanning can more accurately identify fractures and is thus important for staging.     

Using sonography to examine adult patients at an academic medical center: have usage patterns changed with the expansion of managed care?

OBJECTIVE: The purpose of this study was to determine the radiologic and pathologic findings associated with pulmonary aspergillosis in immunocompetent hosts without underlying lesions of the lung. CONCLUSION: In immunocompetent hosts without preexisting lesions of the lung, pulmonary aspergillosis may manifest on CT primarily as a single nodule or mass with or without an air crescent or as a localized consolidation.     

CT features of an unusual hypervascular lung carcinoma complicating chronic asbestosis related pleural disease

The CT appearance of a hypervascular lung carcinoma occurring in a patient with long-standing extensive changes of asbestosis is reported. The diagnostic difficulties that may arise when bronchogenic carcinoma develops in an area of atelectasis is discussed.     

Cystic renal mass evaluation: real-time versus static imaging

Fifty consecutive cystic renal masses in 43 patients were evaluated by both static scanning and real-time scanning techniques. Various parameters were evaluated and compared to ascertain whether the strict static scan cystic criteria were always present in comparable real-time evaluations. Four (8%) of the 50 masses were not classic cysts on real-time examinations, although the criteria were present on the static scans. Two had minimal acoustic enhancement and two had low-intensity internal echoes. Possible reasons for this difference were detailed and discussed. The potential problems in this observation were enumerated. Based on these observations, in certain cases when a cystic renal mass demonstrates poor acoustic enhancement or low-level internal echoes in real-time examination, static scanning may be helpful and may obviate the need for further studies.     

Sonographic assessment of the endometrium in patients undergoing in vitro fertilization

Sonography has an important role in the care of infertile patients undergoing in vitro fertilization. Unlike the ovarian follicle, sonographic changes in the endometrium during induction have not been extensively investigated. To determine whether changes in endometrial thickness or changes in endometrial texture would predict subsequent pregnancy, a randomized, double-blind review of 320 studies was performed. None of the endometrial patterns nor any particular change from one pattern to another during induction was predictive of subsequent pregnancy. Although differences in endometrial thickness between non-pregnant and subsequently pregnant patients were noted, on an individual basis, endometrial thickness was not a useful predictor.