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Background: Breast MRI full diagnostic protocol (FDP) showed great value in detecting and characterizing non-mass enhancement (NME); however, it is costly and time-consuming. MRI abbreviated protocol (AP) showed comparable accuracy to FDP in various indications but has not been specifically tested in NME. Our study purpose is to assess the accuracy of the AP in the detection and characterization of breast NME in comparison with the FDP and to perform time analysis of the AP. Methods: Patients who demonstrated NME in dynamic contrast-enhanced MRI were included to be assessed using AP and FDP. Image analysis was performed blindly and independently. Firstly, reconstructed images from the pre- and first post-contrast T1WI (first maximum intensity projection and subtraction) were made available as AP. Later, the time/signal intensity curve and remaining images of the FDP were added to the assessment. Both protocols were compared regarding acquisition time, interpretation time, BI-RADS scores and accuracy in the detection and characterization of NME in correlation to histopathology and/or follow-up. Validity statistics, Cohen-Kappa and ROC curve were used. Results: Fifty-nine NME lesions were identified. AP acquisition and interpretation times were significantly shorter than those of the FDP (3.3 vs. 35 min) and (45 "25–75 s" vs. 108 "80–150 s") (P < 0.001), respectively. There was almost perfect agreement between the two protocols in the BIRADS grading of NME (k = 0.950, P < 0.001). In ROC curve analysis, the FDP was insignificantly more accurate than the AP (84.8% vs. 81.4%, P = 0.144). Conclusions: Breast MRI–AP is comparable to the FDP in the detection and characterization of breast NME with advantageous time saving. [ABSTRACT FROM AUTHOR]

Although area postrema syndrome (APS) is one of the core clinical features of neuromyelitis optica spectrum disorder (NMOSD), it is frequently misdiagnosed as gastrointestinal or systemic disorders. In this study, we describe the diagnostic challenges in NMOSD patients with APS and their characteristic clinical and radiological features. All patients who attended our university hospitals during the period from March 2019 to August 2020 with a diagnosis of NMOSD according to the latest diagnostic criteria were admitted and evaluated clinically, radiologically with gadolinium-enhanced brain and spinal MRI, measures of serum Anti-Aquaporin 4 (Anti-AQP4) and clinical status using the Expanded Disability Status Scale (EDSS) scores. APS was diagnosed if there was a history of intractable nausea, vomiting, or hiccups (INVH) that had lasted longer than 1 week with the exclusion of other etiologies, or less than 48 h if associated with a lesion in the dorsal medulla on MRI scan. Twenty out of 90 (22.2%) identified patients with a diagnosis of NMOSD had a history of unexplained intractable nausea, vomiting or hiccoughs lasting an average of 20 days. Seventeen patients were anti-Aquaporin 4 seropositive. Seven patients (35%) presented initially with isolated clinical features of APS and were diagnosed only after subsequent relapse. Patients with APS preceding other core clinical presentations (13 cases, 65%) were diagnosed after development of motor manifestations. All patients developed acute myelitis during the course of illness. Brain and spinal MRI scans showed that 13 had a linear lesion in the dorsal tegmentum of the medulla oblongata adjacent to the fourth ventricle. Otherwise, longitudinally extensive transverse myelitis was found in 80%, while 35% showed extension of the cord lesion to the AP. APS as a core clinical characteristic of NMOSD is not a rare presentation as was previously thought and can occur in both AQP4-seropositive and seronegative NMOSD. [ABSTRACT FROM AUTHOR]