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To evaluate whether the computer-aided diagnosis (CAD)-extracted kinetic heterogeneity of breast cancer on MRI and changes therein during treatment were associated with the pathological response to neoadjuvant systemic therapy (NST).Consecutive patients with invasive breast cancer, who underwent NST followed by surgery between 2014 and 2020, were retrospectively evaluated. Using a commercial CAD system, kinetic features (angiovolume, peak enhancement, delayed enhancement profiles, and kinetic heterogeneity) of breast cancer were assessed with pre- and mid-treatment MRI. Multivariate logistic regression was used to identify the associations between CAD-extracted kinetic features and pathological complete response (pCR).A total of 130 patients (mean age, 55 years) were included, 37 (28.5%) of whom achieved a pCR. When the pre- and mid-treatment MRI data were compared, the pCR group exhibited greater changes in kinetic heterogeneity (86.14 ± 32.05% vs. 8.50 ± 141.01%, p0.001) and angiovolume (95.20 ± 14.29% vs. 19.89 ± 320.16%; p0.001) than the non-pCR group. Multivariate regression analysis showed that a large change in kinetic heterogeneity (odds ratio (OR) = 1.030, p0.001), age (OR = 0.931, p = 0.005), progesterone receptor negativity (OR = 7.831, p = 0.001), and HER2 positivity (OR = 3.455, p = 0.017) were associated with pCR.A greater change in the CAD-extracted kinetic heterogeneity of breast cancer between pre- and mid-treatment MRI was associated with a pCR in patients on NST.A greater change in kinetic heterogeneity was associated with a pathological complete response. Computer-aided diagnosis-extracted kinetic heterogeneity might serve as a quantitative biomarker of therapeutic efficacy.

Background/Aim: To provide data regarding relationships between quantitative dynamic contrast enhanced magnetic resonance imaging (DCE MRI) and prognostic factors in breast cancer (BC). Patients and Methods: Data from 4 Centers (200 female patients, mean age, 51.2±11.5 years) were acquired. The following data were collected: histopathological diagnosis, tumor grade, stage, hormone receptor status, KI 67, and DCE MRI values including K(trans) (volume transfer constant), V(e) (volume of the extravascular extracellular leakage space (EES) and K(ep) (diffusion of contrast medium from the EES back to the plasma). DCE MRI values between different groups were compared using the Mann-Whitney U-test and by the Kruskal-Wallis H test. The association between DCE MRI and Ki 67 values was calculated by the Spearman’s rank correlation coefficient. Results: DCE MRI values of different tumor subtypes overlapped significantly. There were no statistically significant differences of DCE MRI values between different tumor grades. All DCE MRI parameters correlated with KI-67: K(trans), r=0.44, p=0.0001; V(e), r=0.34, p=0.0001; K(ep), r=0.28, p=0.002. ROC analysis identified a K(trans) threshold of 0.3 min(–1) for discrimination of tumors with low KI-67 expression (

BACKGROUND The associations between diffusion kurtosis imaging (DKI)-derived parameters and clinical prognostic factors of breast cancer have not been fully evaluated; this knowledge may have implications for outcome prediction and treatment strategies. PURPOSE To determine associations between quantitative diffusion parameters derived from DKI and diffusion-weighted imaging (DWI) and the prognostic factors and molecular subtypes of breast cancer. STUDY TYPE Retrospective. POPULATION A total of 383 women (mean age, 53.8 years; range, 31-82 years) with breast cancer who underwent preoperative breast MRI including DKI and DWI. FIELD STRENGTH/SEQUENCE A 3.0 T; DKI using a spin-echo echo-planar imaging (EPI) sequence (b values: 200, 500, 1000, 1500, and 2000 sec/mm2 ), DWI using a readout-segmented EPI sequence (b values: 0 and 1000 sec/mm2 ) and dynamic contrast-enhanced breast MRI. ASSESSMENT Two radiologists (J.Y.K. and H.S.K. with 9 years and 1 year of experience in MRI, respectively) independently measured kurtosis, diffusivity, and apparent diffusion coefficient (ADC) values of breast cancer by manually placing a regions of interest within the lesion. Diffusion measures were compared according to nodal status, grade, and molecular subtypes. STATISTICAL TESTS Kruskal-Wallis test, Mann-Whitney U test with Bonferroni correction, receiver operating characteristic (ROC) analysis, and multivariate logistic regression analysis. (Statistical significance level of P

To investigate whether intratumoral heterogeneity, assessed via dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI), reflects the molecular subtypes of invasive breast cancers. We retrospectively evaluated data from 248 consecutive women (mean age ± standard deviation, 54.6 ± 12.2 years) with invasive breast cancer who underwent preoperative DCE-MRI and DWI between 2019 and 2020. To evaluate intratumoral heterogeneity, kinetic heterogeneity (a measure of heterogeneity in the proportions of tumor pixels with delayed washout, plateau, and persistent components within a tumor) was assessed with DCE-MRI using a commercially available computer-aided diagnosis system. Apparent diffusion coefficients (ADCs) were obtained using a region-of-interest technique, and ADC heterogeneity was calculated using the following formula: (ADCmax−ADCmin)/ADCmean. Possible associations between imaging-based heterogeneity values and breast cancer subtypes were analyzed. Of the 248 invasive breast cancers, 61 (24.6%) were classified as luminal A, 130 (52.4%) as luminal B, 25 (10.1%) as HER2-enriched, and 32 (12.9%) as triple-negative breast cancer (TNBC). There were significant differences in the kinetic and ADC heterogeneity values among tumor subtypes (p < 0.001 and p = 0.023, respectively). The TNBC showed higher kinetic and ADC heterogeneity values, whereas the HER2-enriched subtype showed higher kinetic heterogeneity values compared to the luminal subtypes. Multivariate linear analysis showed that the HER2-enriched (p < 0.001) and TNBC subtypes (p < 0.001) were significantly associated with higher kinetic heterogeneity values. The TNBC subtype (p = 0.042) was also significantly associated with higher ADC heterogeneity values. Quantitative assessments of heterogeneity in enhancement kinetics and ADC values may provide biological clues regarding the molecular subtypes of breast cancer. • Higher kinetic heterogeneity was associated with HER2-enriched and triple-negative breast cancer. • Higher ADC heterogeneity was associated with triple-negative breast cancer. • Aggressive breast cancer subtypes exhibited higher intratumoral heterogeneity based on MRI.

OBJECTIVE. The purpose of this study was to investigate whether early kinetic parameters derived from ultrafast dynamic contrast-enhanced MRI (DCE-MRI) using compressed sensing are associated with prognostic factors for breast cancer. MATERIALS AND METHODS. We evaluated 201 consecutive women (mean age, 54.6 years) with breast cancer (168 invasive, 33 ductal carcinoma in situ) who underwent both ultrafast DCE-MRI using compressed sensing (temporal resolution, 4.7 seconds; spatial resolution, 0.8 × 1.1 × 0.9 mm) and surgery between 2018 and 2019. Early kinetic parameters (time to enhancement [TTE] and maximum slope [MS]) were measured in breast lesions by two radiologists using a software program and were correlated with histopathologic prognostic factors. The Mann-Whitney U test and linear regression analysis were used. RESULTS. The median TTE and MS values for breast cancer were 11.9 seconds and 7.7%/s, respectively. The median MS was significantly larger in invasive cancer lesions than in ductal carcinoma in situ lesions (8.4%/s vs 4.7%/s, p 2 cm) (p = .048) and estrogen receptor-negative status (p < .001) were significantly associated with a shorter TTE. A higher histologic grade (grade 3) (p = .01) was significantly associated with a larger MS. We observed excellent interobserver agreement between two readers in the measurements of TTE and MS (intraclass correlation coefficients, 0.943 and 0.890, respectively). CONCLUSION. Ultrafast MRI-derived early enhancement parameters, such as TTE and MS, are associated with histopathologic prognostic factors in women with breast cancer.

We sought factors associated with false-negative results in the diagnosis of invasive breast cancer via non-contrast breast magnetic resonance imaging (MRI) using fused high b-value diffusion-weighted imaging (DWI) and unenhanced T1-weighted images (T1WI). Between 2018 and 2019, 316 consecutive women (mean age, 54.6 years) with invasive breast cancer who underwent preoperative breast MRI, including fused high b-value DWI and unenhanced T1WI, were retrospectively evaluated. Malignancy confidence ratings of the most suspicious breast lesions evident on fused DWI were derived by two radiologists using a 6-point Likert-type scale. Both clinicopathological and imaging features were analyzed. Multivariate regression analysis was performed to identify factors associated with false-negative DWI results in the diagnosis of invasive breast cancer. Of the 316 breast cancers, fused DWI yielded 289 (91.5%) true-positive and 27 (8.5%) false-negative results. Multivariate analysis showed that small tumor size (≤ 1 cm) (odds ratio [OR], 5.95; 95% confidence interval [CI], 2.11, 16.81; p = 0.001), presence of calcifications in the tumor (OR, 3.41; 95% CI, 1.27, 9.15; p = 0.015), and a moderate/marked background diffusion signal (ORs, 4.23 and 19.18; 95% CI, 1.31, 13.67 and 6.51, 56.46; p = 0.016 and p < 0.001, respectively) were significantly associated with false-negative results. In subgroup analysis of 141 screening-detected cancers, a marked background diffusion signal (OR, 7.94; 95% CI, 2.30, 27.35; p = 0.001) remained significantly associated with false-negative results in the multivariate analysis. In addition to histopathological features, a higher background diffusion signal was associated with false-negative results in the diagnosis of invasive breast cancer via non-contrast MRI using fused high b-value DWI and unenhanced T1WI. • Subcentimeter tumors and presence of calcifications in the tumor are associated with false-negative diffusion-weighted imaging results in the diagnosis of invasive breast cancer. • A higher degree of background diffusion signal may lead to false-negative interpretation of diffusion-weighted imaging in patients with invasive breast cancer.

Objective: To determine whether shear-wave elastography (SWE)-measured tumor stiffness is associated with disease-free survival in females with early-stage invasive breast cancer. Methods: This retrospective study included 202 consecutive females (mean age, 52.9 years; range, 25–84 years) with newly diagnosed T1–two breast cancer who underwent preoperative SWE between April 2015 and January 2016. Tumor stiffness was assessed and quantitative SWE features of each breast lesion were obtained by a breast radiologist. Cox proportional hazard models were used to identify associations between SWE features and disease-free survival after adjusting for clinicopathologic factors. Results: Fifteen (7.4%) patients exhibited recurrence after a median follow-up of 56 months. Mean (Emean), minimum, and maximum elasticity values were higher in females with recurrence than in those without recurrence (184.4, 138.3, and 210.5 kPa vs 134.9, 101.7, and 159.8 kPa, respectively; p = 0.005, p = 0.005, and p = 0.012, respectively). Receiver operating characteristics curve analysis for prediction of recurrence showed that Emean yielded the largest area under the curve (0.717) among the quantitative SWE parameters, and the optimal cut-off value was 121.7 kPa. Multivariable Cox proportional hazards analysis revealed that higher Emean (>121.7 kPa) [adjusted hazard ratio (HR), 10.01; 95% CI: 1.31–76.33; p = 0.026] and lymphovascular invasion (adjusted HR, 7.72; 95% CI: 1.74–34.26; p = 0.007) were associated with worse disease-free survival outcomes. Conclusion: Higher SWE-measured Emean was associated with worse disease-free survival in females with early-stage invasive breast cancer. Advances in knowledge: Tumor stiffness assessed with shear-wave elastography might serve as a quantitative imaging biomarker of disease-free survival in females with T1–two breast cancer.

Gastrointestinal tract (GI) perforations can occur due to various causes such as trauma, iatrogenic factor, infectious condition, peptic ulcer, inflammatory disease, or a neoplasm. Because GI perforations represent an emergency and life-threatening condition, prompt diagnosis and surgical treatment are required in most cases. However, according to the underlying causes of GI perforations, additional treatment strategies may be needed. Adjuvant chemotherapy or immunotherapy may be required in various GI neoplasms such as adenocarcinoma, lymphoma or gastrointestinal stromal tumor. Inflammatory bowel disease is a chronic disease repeating cycle of intermittent, thus appropriate medical treatment and periodic follow-up are also required. Moreover, vascular intervention may have a role in some cases of mesenteric ischemia associated with mesenteric artery occlusion. Recently, computed tomography (CT) has been the first choice for patients with suspected GI perforations, because CT plays an important role in the accurate assessment of the perforation site, the pathology causing the perforation and the ensuing complications. This review will illustrate characteristic CT findings that differentiate underlying pathologies causing GI perforations to help clinicians decision-making regarding an optimal treatment plan.

To investigate the value of the whole-lesion histogram apparent diffusion coefficient (ADC) metrics for differentiating low-risk from non-low-risk ductal carcinoma in situ (DCIS). The authors identified 93 women with pure DCIS who had undergone preoperative MR imaging and diffusion-weighted imaging from 2013 to 2016. Histogram analysis of pixel-based ADC data of the whole tumour volume was performed by two radiologists using a software tool. The results were compared between low-risk and non-low-risk DCIS. Associations between quantitative ADC metrics and low-risk DCIS were evaluated by receiver operating characteristics (ROC) curve and logistic regression analyses. In whole-lesion histogram analysis, mean ADC and 5th, 50th and 95th percentiles of ADC were significantly different between low-risk and non-low-risk DCIS (1.522, 1.207, 1.536 and 1.854 × 10−3 mm2/s versus 1.270, 0.917, 1.261 and 1.657 × 10−3 mm2/s, respectively; p = .004, p = .003, p = .004 and p = .024, respectively). ROC curve analysis for differentiating low-risk DCIS revealed that 5th percentile ADC yielded the largest area under the curve (0.786) among the metrics of whole-lesion histogram, and the optimal cut-off point was 1.078 × 10−3 mm2/s (sensitivity 80%, specificity 75.9%, p = .001). Multivariate regression analysis revealed that a high 5th percentile of ADC (> 1.078× 10−3 mm2/s; odds ratio [OR] = 10.494, p = .016), small tumour size (≤ 2 cm; OR = 12.692, p = .008) and low Ki-67 status (< 14%; OR = 10.879, p = .046) were significantly associated with low-risk DCIS. Assessment with whole-lesion histogram analysis of the ADC could be helpful for identifying patients with low-risk DCIS. • Whole-lesion histogram ADC metrics could be helpful for differentiating low-risk from non-low-risk DCIS. • A high 5th percentile ADC was a significant factor associated with low-risk DCIS. • Risk stratification of DCIS is important for their management.

Background Numerous studies have analyzed associations between apparent diffusion coefficient (ADC) and histopathological features such as Ki-67 proliferation index in breast cancer (BC), with mixed results. The purpose of this study was to perform a multicenter analysis to determine relationships between ADC and expression of Ki-67 and tumor grade in BC. Methods For this study, data from six centers were acquired. The sample comprises 870 patients (all female; mean age, 52.6 ± 10.8 years). In every case, breast magnetic resonance imaging with diffusion-weighted imaging was performed. The comparison of ADC values in groups was performed by Mann-Whitney U test where the p values are adjusted for multiple testing (Bonferroni correction). The association between ADC and Ki-67 values was calculated by Spearman’s rank correlation coefficient. Sensitivity, specificity, negative and positive predictive values, accuracy, and AUC were calculated for the diagnostic procedures. ADC thresholds were chosen to maximize the Youden index. Results Overall, data of 870 patients were acquired for this study. The mean ADC value of the tumors was 0.98 ± 0.22 × 10− 3 mm2 s− 1. ROC analysis showed that it is impossible to differentiate high/moderate grade tumors from grade 1 lesions using ADC values. Youden index identified a threshold ADC value of 1.03 with a sensitivity of 56.2% and specificity of 67.9%. The positive predictive value was 18.2%, and the negative predictive value was 92.4%. The level of the Ki-67 proliferation index was available for 845 patients. The mean value was 12.33 ± 21.77%. ADC correlated with weak statistical significant with expression of Ki-67 (p = − 0.202, p

To investigate whether quantitative diffusion metrics derived from diffusion tensor imaging (DTI) are associated with histological prognostic factors in breast cancer patients. This retrospective study was approved by the institutional review board, and informed consent was waived. Between 2016 and 2017, 251 consecutive women (mean age, 53.8 years) with breast cancer (230 invasive, 21 in situ) who underwent preoperative magnetic resonance (MR) imaging with DTI were identified. Diffusion gradients were applied in 20 directions (b values, 0 and 1,000 s/mm2). DTI metrics – mean diffusivity (MD) and fractional anisotropy (FA) – were measured for breast lesions and contralateral normal breast by two radiologists and were correlated with histological findings using the Mann-Whitney U-test and linear regression analysis. MD and FA were significantly lower for breast cancers than for normal fibroglandular tissues (1.03 ± 0.25×10−3 mm2/s vs. 1.60 ± 0.19×10−3 mm2/s, p 2 cm) (p = 0.007), high histological grade (grade 3) (p = 0.045) and axillary node metastasis (p = 0.009) were significantly associated with lower MD in invasive breast cancer patients. Larger size (p < 0.001) and high histological grade (p = 0.025) were significantly associated with lower FA. DTI-derived diffusion metrics, such as MD and FA, are associated with histological prognostic factors in breast cancer patients. • MD was significantly lower for breast cancers than for normal breast tissues. • FA was significantly lower for breast cancers than for normal breast tissues. • Reduced DTI metrics were associated with poor prognostic factors of breast cancer. • DTI may provide valuable information concerning biological aggressiveness in breast cancer.

Purpose To explore associations between prognostic factors and subtypes of invasive breast cancer (IBC) and elasticity values using three-dimensional (3D) and two-dimensional (2D) shear-wave elastography (SWE). Materials and methods Mean elasticity values (kPa) of 121 IBCs were measured using both 3D and 2D SWE. Associations between these values and prognostic factors and subtypes were analyzed using linear regression model. Results In both 3D and 2D SWE, larger size and presence of lymphovascular invasion were independent factors influencing higher mean elasticity on multivariate analyses (all p values Conclusions Using either 3D or 2D SWE, higher mean elasticity values are associated with poor prognostic factors of IBC.

The purpose of this study was to analyze the clinicopathologic and immunohistochemical features of invasive breast cancers detected only with digital breast tomosynthesis (DBT), compared with those of cancers detected with both DBT and full-field digital mammography (FFDM).The medical records of 261 women (108 without and 153 with symptoms) with invasive breast cancers who underwent FFDM and DBT between April 2015 and June 2016 were retrospectively reviewed. To assess detectability, all DBT and FFDM images were reviewed independently by three radiologists blinded to clinicopathologic information. The reference standard was established by an unblinded consensus review of all images. Clinicopathologic and immunohistochemical features were analyzed according to the detectability status.Of the 261 cancers, 223 (85.4%) were detected with both DBT and FFDM (both-detected group). Twenty-four cancers (9.2%) not detected with FFDM (DBT-only group) were classified by DBT as a mass (58.3%), architectural distortion (33.3%), or asymmetry (8.3%). The remaining 14 cancers (5.4%) were not detected with either DBT or FFDM (both-occult group). On multivariate analysis, a dense breast parenchyma (p = 0.007), small tumor size (≤ 2 cm; p = 0.027), and luminal A-like subtype (estrogen receptor positive or progesterone receptor positive or both, human epidermal growth factor receptor 2 negative, and Ki-67 expression14%; p = 0.008) were significantly associated with the DBT-only group. For 108 screening-detected cancers, a dense breast parenchyma (p = 0.007) and luminal A-like subtype (p = 0.008) also maintained significance.The addition of DBT to FFDM in screening would aid in the detection of less-aggressive subtypes of invasive breast cancers in women with dense breasts.

Background Computed tomography venography (CTV) at low kVp using model-based iterative reconstruction (MBIR) can enhance vascular enhancement with noise reduction. Purpose To evaluate image qualities and radiation doses of CTV at 80 kVp using MBIR and a small iodine contrast media (CM) dose and to compare these with those of CTV performed using a conventional protocol. Material and Methods Sixty-five patients (mean age = 58.1 ± 7.2 years) that underwent CTV for the evaluation of deep vein thrombosis (DVT) and varicose veins were enrolled in this study. Patients were divided into two groups: Group A (35 patients, 80 kVp, MBIR, automatic tube current modulation, CM = 270 mg/mL, 100 mL) and Group B (30 patients, 100 kVp, filtered back projection [FBP], 120 fixed mA, CM = 370 mg/mL, 120 mL). Objective and subjective image qualities of inferior vena cava (IVC), femoral vein (FV), and popliteal vein (PV) were assessed and radiation doses were recorded. Results Mean vascular enhancement in group A was significantly lower than in group B ( P 0.05). In addition, radiation dose in group A was significantly lower than in group B ( P Conclusion CTV at 80 kVp using MBIR with small iodine contrast dose provided acceptable image quality at a lower radiation dose than conventional CTV using FBP.

Background Radiological imaging plays a central role in the diagnosis of breast cancer (BC). Some studies suggest MRI techniques like diffusion weighted imaging (DWI) may provide further prognostic value by discriminating between tumors with different biologic characteristics including receptor status and molecular subtype. However, there is much contradictory reported data regarding such associations in the literature. The purpose of the present study was to provide evident data regarding relationships between quantitative apparent diffusion coefficient (ADC) values on DWI and pathologic prognostic factors in BC. Methods Data from 5 centers (661 female patients, mean age, 51.4 ± 10.5 years) were acquired. Invasive ductal carcinoma (IDC) was diagnosed in 625 patients (94.6%) and invasive lobular carcinoma in 36 cases (5.4%). Luminal A carcinomas were diagnosed in 177 patients (28.0%), luminal B carcinomas in 279 patients (44.1%), HER 2+ carcinomas in 66 cases (10.4%), and triple negative carcinomas in 111 patients (17.5%). The identified lesions were staged as T1 in 51.3%, T2 in 43.0%, T3 in 4.2%, and as T4 in 1.5% of the cases. N0 was found in 61.3%, N1 in 33.1%, N2 in 2.9%, and N3 in 2.7%. ADC values between different groups were compared using the Mann–Whitney U test and by the Kruskal-Wallis H test. The association between ADC and Ki 67 values was calculated by Spearman’s rank correlation coefficient. Results ADC values of different tumor subtypes overlapped significantly. Luminal B carcinomas had statistically significant lower ADC values compared with luminal A (p = 0.003) and HER 2+ (p = 0.007) lesions. No significant differences of ADC values were observed between luminal A, HER 2+ and triple negative tumors. There were no statistically significant differences of ADC values between different T or N stages of the tumors. Weak statistically significant correlation between ADC and Ki 67 was observed in luminal B carcinoma (r = − 0.130, p = 0.03). In luminal A, HER 2+ and triple negative tumors there were no significant correlations between ADC and Ki 67. Conclusion ADC was not able to discriminate molecular subtypes of BC, and cannot be used as a surrogate marker for disease stage or proliferation activity.

OBJECTIVE. The purpose of this study was to evaluate and compare the diagnostic performance and image quality of low-dose CT performed with adaptive statistical iterative reconstruction (ASIR)-V wi...

Background Combined minimum apparent diffusion coefficient (ADC) and ADC difference value may improve the diagnostic performance of breast diffusion-weighted imaging (DWI) compared with mean ADC. Purpose To investigate whether ADC parameters at DWI are associated with distant metastasis-free survival in women with invasive breast cancer. Materials and Methods Between 2013 and 2014, 258 consecutive women (mean age ± standard deviation, 50.9 years ± 10.5; age range, 23-85 years) with newly diagnosed invasive breast cancer who underwent preoperative MRI with DWI were evaluated. All DWI examinations were retrospectively reviewed by two radiologists blinded to clinical information. The mean, minimum, and maximum ADCs were measured by manually placing regions of interest within the lesions, and the ADC difference value (the difference between minimum and maximum ADCs) was calculated to evaluate intratumoral heterogeneity. Cox proportional hazards models were used to determine the associations between ADC parameters and distant metastasis-free survival after adjustment for clinical-pathologic factors. Results In 25 of the 258 women (9.7%), distant metastasis developed at a median follow-up of 51 months. The ADC difference value was higher in women with distant metastasis than in those without distant metastasis (mean, 0.743 × 10-3 mm2/sec vs 0.566 × 10-3 mm2/sec, respectively; P 0.698 × 10-3 mm2/sec) (hazard ratio [HR], 4.5; 95% confidence interval [CI]: 2.0, 10.0; P < .001), presence of axillary node metastasis (HR, 3.3; 95% CI: 1.2, 9.3; P = .02), and estrogen receptor negativity (HR, 2.6; 95% CI: 1.2, 5.7; P = .02) were associated with poorer distant metastasis-free survival. Conclusion A higher apparent diffusion coefficient difference value at diffusion-weighted imaging is associated with poorer distant metastasis-free survival of women with invasive breast cancer. © RSNA, 2019 See also the editorial by Taourel in this issue.

To investigate possible associations between quantitative apparent diffusion coefficient (ADC) metrics derived from whole-lesion histogram analysis and breast cancer recurrence risk in women with estrogen receptor (ER)–positive, human epidermal growth factor receptor 2 (HER2)–negative, node-negative breast cancer who underwent the Oncotype DX assay. This retrospective study was conducted on 105 women (median age, 48 years) with ER-positive, HER2-negative, node-negative breast cancer who underwent the Oncotype DX test and preoperative diffusion-weighted imaging (DWI). Histogram analysis of pixel-based ADC data of whole tumors was performed, and various ADC histogram parameters (mean, 5th, 25th, 50th, 75th, and 95th percentiles of ADCs) were extracted. The ADC difference value (defined as the difference between the 5th and 95th percentiles of ADCs) was calculated to assess intratumoral heterogeneity. Associations between quantitative ADC metrics and the recurrence risk, stratified using the Oncotype DX recurrence score (RS), were evaluated. Whole-lesion histogram analysis showed that the ADC difference value was different between the low-risk recurrence (RS

The purpose of this study was to investigate prospectively whether the apparent diffusion coefficients (ADCs) of both breast cancer and normal fibroglandular tissue vary with the menstrual cycle and menopausal status. Institutional review board approval was obtained, and informed consent was obtained from each participant. Fifty-seven women (29 premenopausal, 28 postmenopausal) with newly diagnosed breast cancer underwent diffusion-weighted imaging twice (interval 12-20 days) before surgery. Two radiologists independently measured ADC of breast cancer and normal contralateral breast tissue, and we quantified the differences according to the phases of menstrual cycle and menopausal status. With normal fibroglandular tissue, ADC was significantly lower in postmenopausal than in premenopausal women (P = 0.035). In premenopausal women, ADC did not differ significantly between proliferative and secretory phases in either breast cancer or normal fibroglandular tissue (P = 0.969 and P = 0.519, respectively). In postmenopausal women, no significant differences were found between ADCs measured at different time intervals in either breast cancer or normal fibroglandular tissue (P = 0.948 and P = 0.961, respectively). The within-subject variability of the ADC measurements was quantified using the coefficient of variation (CV) and was small: the mean CVs of tumor ADC were 2.90 % (premenopausal) and 3.43 % (postmenopausal), and those of fibroglandular tissue ADC were 4.37 % (premenopausal) and 2.55 % (postmenopausal). Both intra- and interobserver agreements were excellent for ADC measurements, with intraclass correlation coefficients in the range of 0.834-0.974. In conclusion, the measured ADCs of breast cancer and normal fibroglandular tissue were not affected significantly by menstrual cycle, and the measurements were highly reproducible both within and between observers.

OBJECTIVE To compare the objective and subjective image quality indicators and radiation doses of computed tomography (CT) venography performed using model-based iterative reconstruction (MBIR) at 80 kVp and adaptive statistical iterative reconstruction (ASIR)-V at 70 kVp. MATERIALS AND METHODS Eighty-three patients who had undergone CT venography of the lower extremities with MBIR at 80 kVp (Group A; 21 men and 20 women; mean age, 55.5 years) or ASIR-V at 70 kVp (Group B; 18 men and 24 women; mean age, 57.3 years) were enrolled. Two radiologists retrospectively evaluated the objective (vascular enhancement, image noise, signal-to-noise ratio [SNR], contrast-to-noise ratio [CNR]) and subjective (quantum mottle, delineation of contour, venous enhancement) image quality indicators at the inferior vena cava and femoral and popliteal veins. Clinical information, radiation dose, reconstruction time, and objective and subjective image quality indicators were compared between groups A and B. RESULTS Vascular enhancement, SNR, and CNR were significantly greater in Group B than in Group A (p ≤ 0.015). Image noise was significantly lower in Group B (p ≤ 0.021), and all subjective image quality indicators, except for delineation of vein contours, were significantly better in Group B (p ≤ 0.021). Mean reconstruction time was significantly shorter in Group B than in Group A (1 min 43 s vs. 131 min 1 s; p < 0.001). Clinical information and radiation dose were not significantly different between the two groups. CONCLUSION CT venography using ASIR-V at 70 kVp was better than MBIR at 80 kVp in terms of image quality and reconstruction time at similar radiation doses.

Background Non-mass enhancements (NME) with invasive components account for 10–42% of total malignant NMEs. The factors associated with invasiveness on magnetic resonance imaging (MRI) could be useful for clinical assessment and treatment. Purpose To evaluate the clinical significances of the distributions and internal enhancement patterns (IEP) of malignant NMEs on 3-T breast MRI. Material and Methods A total of 448 consecutive women with newly diagnosed breast cancer that had undergone preoperative MRI and surgery between February 2013 and March 2016 were identified. After exclusions, 72 malignant NMEs without a mass in 72 women (mean age = 51.5 years) were included. Two readers independently assessed distributions and IEPs of NME, according to the Breast Imaging Reporting and Data System lexicon fifth edition. Collected data included the presence of invasion and histopathologic factors. Results A clustered ring IEP was significantly associated with invasive cancer (75.0%, P = 0.001, Reader1; 72.9%, P Conclusion The presence of a clustered ring IEP in patients with breast cancer was found to be significantly associated with invasive breast cancer and high Ki-67 expression.

The purpose of this study was to evaluate the association between the breast tumor strain ratio and axillary lymph node metastasis in patients with invasive breast cancer.The records of 284 patients with invasive breast cancer who underwent ultrasound elastography before surgery between March 2013 and May 2014 were reviewed retrospectively. For women with multifocal or bilateral cancer, the largest tumor was included. An experienced radiologist performed ultrasound elastography and measured the strain ratio, which is defined as the fat-to-lesion ratio and is indicative of the relative stiffness of the breast lesion, using dedicated software within the ultrasound equipment. The associations between axillary lymph node metastasis with the tumor strain ratio and clinical and biologic variables were evaluated using univariate and multivariate logistic regression analyses.Among 284 tumors, 85 (29.9%) showed axillary lymph node metastasis by surgical histopathologic analysis. The strain ratio was statistically significantly higher in tumors with axillary lymph node metastasis than in those without axillary lymph node metastasis (mean ± SD, 5.19 ± 1.28 vs 4.17 ± 1.30, respectively; p0.001). On univariate analysis, a higher strain ratio (3.89), larger tumor size (2 cm), higher histologic grade (grade 3), presence of lymphovascular invasion, palpability, and higher expression of Ki-67 (≥ 14%) were statistically significantly associated with axillary lymph node metastasis. On multivariate analysis, a higher strain ratio (3.89) (odds ratio [OR], 14.208; p0.001), presence of lymphovascular invasion (OR, 17.437; p0.001), and higher expression of Ki-67 (≥ 14%) (OR, 3.744; p = 0.002) maintained independent significance for predicting axillary lymph node metastasis.The breast tumor strain ratio on ultrasound elastography is associated independently with axillary lymph node metastasis in patients with invasive breast cancer.

Purpose To retrospectively investigate the relationship between the kinetic features of breast cancer assessed with computer-aided diagnosis (CAD) at preoperative magnetic resonance (MR) imaging and disease-free survival in patients with primary operable invasive breast cancer. Materials and Methods This retrospective study was approved by the institutional review board. The requirement to obtain informed consent was waived. The authors identified 329 consecutive women (mean age, 52.9 years; age range, 32-88 years) with newly diagnosed invasive breast cancer who had undergone preoperative MR imaging and surgery between January 2012 and February 2013. All MR images were retrospectively reviewed by using a commercially available CAD system, and the following kinetic parameters were noted for each lesion: peak enhancement (highest pixel signal intensity in the first series obtained after administration of contrast material), angio-volume (total volume of the enhancing lesion), and delayed enhancement profiles (the proportions of washout, plateau, and persistently enhancing component within a tumor). Cox proportional hazards modeling was used to identify the relationship between CAD-generated kinetics and disease-free survival after adjusting for clinical-pathologic variables. Results A total of 36 recurrences developed at a median follow-up of 50 months (range, 15-55 months). CAD-measured peak enhancement at preoperative MR imaging enabled differentiation between patients with and patients without recurrence (area under the receiver operating characteristic curve = 0.728; 95% confidence interval [CI]: 0.676, 0.775; P < .001). Multivariate Cox analysis showed that a higher peak enhancement (hazard ratio [HR] = 1.001; 95% CI: 1.000, 1.002; P = .004), a higher washout component (HR = 1.029; 95% CI: 1.005, 1.054; P = .017), and lymphovascular invasion at histopathologic examination (HR = 3.011; 95% CI: 1.302, 6.962; P = .010) were associated with poorer disease-free survival. Conclusion Higher values of CAD-measured peak enhancement and washout component at preoperative MR imaging were significantly associated with poorer disease-free survival of patients with primary operable breast cancer. © RSNA, 2017.

The purpose of this study was to retrospectively investigate whether 3D breast density changes measured using MRI were associated with recurrent cancer in patients with breast cancer who received adjuvant tamoxifen.A search of the breast MRI database (2007-2008) revealed a dataset that included 80 women (mean age, 44 years; range, 27-68 years) with breast cancer who underwent breast-conserving surgery, adjuvant tamoxifen treatment, and breast MRI before and after tamoxifen. The following clinicopathologic variables were collected: age, body mass index, menopausal status, family history, tumor stage, tumor grade, hormonal receptor status, and adjuvant chemotherapy status. MRI variables (total breast volume, fibro-glandular volume, and breast density) were measured for the contralateral untreated breast before and after tamoxifen treatment, and the percentage changes were recorded. A multivariate logistic regression analysis was performed to identify independent factors that were associated with cancer recurrence.Overall, 12 (15%) of the 80 women developed recurrence. No recurrent cancers were found in the remaining 68 patients (85%) at a median follow-up of 48 months (range, 37-60 months). Percentage reduction of breast density after tamoxifen was the only independent factor associated with recurrence (adjusted odds ratio [OR] = 0.848, 95% CI = 0.769-0.935, and p = 0.001 for observer 1; adjusted OR = 0.957, 95% CI = 0.919-0.996, and p = 0.032 for observer 2) in the multivariate analysis.Three-dimensional breast density changes measured using MRI during tamoxifen treatment were an independent factor associated with cancer recurrence in patients with breast cancer who received adjuvant tamoxifen.

Ultrasonographic (US) assessment of breast density has the potential to provide a nonionizing method. This study was to prospectively evaluate intermodality and interobserver agreements for assessment of breast density between US and mammography. Institutional review board approval was obtained. Forty-one women (mean 52.1 years; range 25-72 years) with variable breast density consented to participate. Eight radiologists blinded to mammographic information performed breast US for all participants and assessed each breast density using four categories based on the proportion of the breast occupied by the fibroglandular tissue. All participants underwent full-field digital mammography and mammographic density was independently assessed by eight radiologists 2 weeks after US using the breast imaging reporting and data system (BI-RADS) 4-category system. Intermodality agreements between US and mammographic assessments and interobserver agreements among radiologists were assessed using kappa statistics (к) and intraclass correlation coefficients (ICCs). There was substantial intermodality agreement between the US and mammographic assessments of breast density (к = 0.65 and ICC = 0.80), and 68 % (222/328) of the assessments had exact agreement. When categories were dichotomized into fatty (categories 1 and 2) and dense (categories 3 and 4), 86 % (282/328) of the assessments had exact agreement (к = 0.71). The interobserver agreement for the US assessments of breast density was substantial (average к = 0.63, ICC = 0.82) and not significantly different from that for the mammographic assessments (average к = 0.74, ICC = 0.85) (P = 0.701). US and mammography demonstrated substantial intermodality and interobserver agreement for assessment of breast density.

To explore the association between quantitative parameters derived from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) and Ki-67 proliferation status in patients with estrogen receptor (ER)-positive invasive breast cancer.We retrospectively reviewed the records of 88 patients with ER-positive invasive breast cancer who underwent preoperative DCE-MRI and DWI on a 3T scanner. Perfusion parameters (KIn the high-Ki-67 group, the mean KK4 J. Magn. Reson. Imaging 2017;45:94-102.

We compared maximal diameters of ipsilateral (IMA) and contralateral (IMA) internal mammary arteries in patients with unilateral breast cancer and analyze the implications of enlargements of ipsilateral or contralateral IMAs in relation to histopathologic factors. Of 568 women who underwent breast magnetic resonance imaging (MRI) examinations from January 2009 to May 2012, 196 had unilateral, histologically proven breast cancer. In 156 women, maximal IMA diameters in the second intercostal space were measured by two blinded radiologists in left and right sides using nonenhanced axial T2-weighted turbo spin-echo sequence images. In the 156 study patients, mean maximal diameter of ipsilateral IMAs (2.37 ± 0.60 mm) was significantly larger than that of contralateral IMAs (2.03 ± 0.58 mm) (p = 0.00). Ipsilateral IMA enlargement was present in 66.7 % of the patients (104 of 156). Furthermore, ipsilateral IMA enlargement was found to be significantly associated with human epidermal growth factor receptor-2 (HER-2) expression (p = 0.039). Maximal IMA diameter was significantly greater in ipsilateral sides in breast cancer patients. Findings suggest ipsilateral IMA enlargement detected by MRI might be a useful additional predictor of HER-2 expression in unilateral breast cancer.

Purpose To investigate the value of diffusion-weighted imaging (DWI) for differentiating gallbladder adenocarcinoma from adenoma, and predicting histologic grades of gallbladder adenocarcinoma. Materials and methods Fourty-three gallbladder adenocarcinomas and 8 adenomas were included. We compared apparent diffusion coefficient (ADC) values between adenocarcinoma and adenoma, and ADC values of gallbladder adenocarcinoma among the histologic grade. Results Gallbladder adenocarcinoma (1.041×10 −3 mm 2 /s) showed significantly lower ADC values than adenoma (2.039×10 −3 mm 2 /s) ( P −3 mm 2 /s) showed significantly higher ADC values than higher-grades (1.104×10 −3 and 0.915×10 −3 mm 2 /s in moderately- and poorly-differentiated, respectively) ( P Conclusion DWI can help to differentiate gallbladder adenocarcinoma from adenoma, and well-differentiated from higher-grade adenocarcinoma.

To evaluate any association between tumor apparent diffusion coefficient (ADC) values and axillary lymph node metastasis (ALNM) in early-stage invasive ductal carcinoma.Records of 270 invasive ductal carcinoma patients with stages T1 and T2 disease who underwent breast magnetic resonance imaging, including diffusion-weighted imaging with b values of 0 and 1000s/mm(2) were reviewed retrospectively. The tumor ADC values were analyzed for their utility in predicting ALNM using multivariate regression analysis and receiver operating characteristic (ROC) curve analysis.Of the 270 patients, 58 (21.5%) experienced ALNM. The mean tumor ADC values were significantly lower in patients with ALNM than in those without metastasis (0.880 × 10(-3) vs. 0.999 × 10(-3)mm(2)/s, P0.001). A ROC curve demonstrated a tumor ADC value of 0.991 × 10(-3)mm(2)/s to be the optimal cut-off for predicting ALNM. In a multivariate analysis, lower tumor ADC (≤ 0.991 × 10(-3)mm(2)/s; adjusted odds ratio (OR)=5.861, P0.001), large tumor size (2 cm; adjusted OR=3.156, P=0.002) and the presence of lymphovascular invasion (adjusted OR=4.125, P0.001) were independent variables associated with ALNM. When tumor ADC value was added to known risk factors (i.e., tumor size and lymphovascular invasion), a significant improvement in the accuracy of risk prediction for axillary node metastasis was shown (c-statistic=0.758 vs. 0.816, P=0.026).In early-stage invasive ductal carcinoma, lower tumor ADC values are associated with the presence of ALNM.

Background The classic magnetic resonance imaging (MRI) feature of endometriomas is the shading sign, which is characterized by T2-shortening in ovarian cystic lesions that are hyperintense on T1-weighted images. The shading sign is infrequently observed in hemorrhagic ovarian cysts. Purpose To investigate the value of MRI with diffusion-weighted imaging (DWI) for distinguishing endometriomas from hemorrhagic cysts in the ovary. Material and Methods This retrospective study included 91 patients with 98 ovarian endometriomas and 21 hemorrhagic ovarian cysts that were confirmed pathologically, who had undergone MRI with DWI. Two radiologists compared MRI features, including size, bilaterality, multilocularity, the shading sign, the ovarian lesion/muscle signal intensity ratio at T2-weighted images, and T2 dark spots, between endometriomas and hemorrhagic cysts. We also compared the mean ADC value between endometriomas and hemorrhagic cysts, and determined the optimal cutoff ADC value for differentiating endometriomas from hemorrhagic cysts. Results The size and mean ADC values were significantly different between endometriomas and hemorrhagic cysts. The mean ADC values of endometriomas and hemorrhagic cysts were 1.06 ± 0.38 × 10 −3 mm2/s and 0.73 ± 0.29 × 10−3 mm2/s, respectively ( P −3 mm2/s (sensitivity, 77.6%; specificity, 76.2%). Conclusion The addition of DWI could help in differentiating endometriomas from hemorrhagic cysts in the ovary, when conventional MRI is challenging.

The noninvasive assessment of coronary stents by coronary CT angiography (CCTA) is an attractive method. However, the radiation dose associated with CCTA remains a concern for patients. The purpose of this study is to compare the radiation doses and image qualities of CCTA performed using tube voltages of 100 or 120 kVp for the evaluation of coronary stents. After receiving institutional review board approval, 53 consecutive patients with previously implanted stents (101 stents) underwent 64-slice CCTA. Patients were divided into three different protocol groups, namely, prospective ECG triggering at 100 kVp, prospective ECG triggering at 120 kVp, or retrospective gating at 100 kVp. Two reviewers qualitatively scored the quality of the resulting images for coronary stents and determined levels of artificial lumen narrowing (ALN), stent lumen attenuation increase ratio (SAIR), image noise, and radiation dose parameters. No significant differences were found between the three protocol groups concerning qualitative image quality or SAIR. Coronary lumen attenuation and in-stent attenuation of 100 kVp prospective CCTA (P-CCTA) were higher than in the 120 kVp P-CCTA protocol (all Ps < 0.001). Mean ALN was significantly lower for 100 kVp P-CCTA than for 100 kVp retrospective CCTA (R-CCTA, P = 0.007). The mean effective radiation dose was significantly lower (P < 0.001) for 100 kVp P-CCTA (3.3 ± 0.4 mSv) than for the other two protocols (100 kVp R-CCTA 6.7 ± 1.0 mSv, 120 kVp P-CCTA 4.6 ± 1.2 mSv). We conclude that the use of 100 kVp P-CCTA can reduce radiation doses for patients while maintaining the imaging quality of 100 kVp R-CCTA and 120 kVp P-CCTA for the evaluation of coronary stents.

To evaluate the association between tumour FDG uptake on preoperative PET/CT and axillary lymph node metastasis (ALNM) according to breast cancer subtype.The records of 671 patients with invasive breast cancer who underwent (18) F-FDG PET/CT and surgery were reviewed. Using immunohistochemistry, tumours were divided into three subtypes: oestrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative, HER2-positive, and triple-negative. Tumour FDG uptake, expressed as maximum standardized uptake value (SUVmax), and clinicopathological variables were analysed.ALNM was present in 187 of 461 ER-positive/HER2-negative, 54 of 97 HER2-positive, and 38 of 113 triple-negative tumours. On multivariate analysis, high tumour SUVmax (≥4.25) (P 0.001), large tumour size (2 cm) (P = 0.003) and presence of lymphovascular invasion (P 0.001) were independent variables associated with ALNM. On subset analyses, tumour SUVmax maintained independent significance for predicting ALNM in ER-positive/HER2-negative (adjusted odds ratio: 3.277, P 0.001) and HER2-positive tumours (adjusted odds ratio: 14.637, P = 0.004). No association was found for triple-negative tumours (P = 0.161).Tumour SUVmax may be an independent prognostic factor for ALNM in patients with invasive breast cancer, especially in ER-positive/HER2-negative and HER2-positive subtypes, but not in those with triple-negative subtype.• Tumour SUVmax could be an imaging biomarker for predicting ALNM • Tumour SUVmax predicting ALNM is effective in ER-positive/HER2-negative and HER2-positive subtypes • Tumour SUVmax predicting ALNM is inaccurate in triple-negative subtypes • Accurate prognostic prediction based on molecular subtype may facilitate individualized management.

Background Previous studies have correlated the maximum standardized uptake value (SUVmax) of breast cancer lesions with histological and biological characteristics such as tumor size, histologic grade, or hormonal receptor expression status. However, controversy remains concerning the prognostic value of SUVmax in breast cancer. Purpose To determine if the SUVmax of a tumor on 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) is associated with disease-free survival in patients with primary invasive ductal breast cancer. Material and Methods The institutional review board of our hospital approved this retrospective study. From 2009 to 2011, 508 women (mean age, 53.6 years; age range, 26–85 years) with newly diagnosed invasive ductal breast cancer who had undergone preoperative 18F-FDG PET/CT followed by surgery were identified. Clinicopathological variables and FDG uptake quantified by SUVmax were analyzed. The Cox proportional hazards model was used to evaluate the association between SUVmax and disease-free survival after controlling for clinicopathological parameters. Results There were 21 recurrences at a median follow-up of 46 months. The mean SUVmax of the primary tumor was significantly higher in patients with a recurrence than those who remained disease-free (9.5 ± 3.5 vs. 6.6 ± 4.2, P max of 5.95 was the optimal cut-off value to predict disease-free survival. Multivariate analysis identified a high SUVmax (≥5.95) and high T stage as independent significant variables associated with worse disease-free survival. Conclusion A high primary tumor SUVmax on 18F-FDG PET/CT was an independent factor associated with worse disease-free survival in patients with primary invasive ductal breast cancer.

To determine whether two-view shear-wave elastography (SWE) improves the performance of radiologists in differentiating benign from malignant breast masses compared with single-view SWE.This prospective study was conducted with institutional review board approval, and written informed consent was obtained. B-mode ultrasonographic (US) and orthogonal SWE images were obtained for 219 breast masses (136 benign and 83 malignant; mean size, 14.8 mm) in 219 consecutive women (mean age, 47.9 years; range, 20-78 years). Five blinded radiologists independently assessed the likelihood of malignancy for three data sets: B-mode US alone, B-mode US and single-view SWE, and B-mode US and two-view SWE. Interobserver agreement regarding Breast Imaging Reporting and Data System (BI-RADS) category and the area under the receiver operating characteristic curve (AUC) of each data set were compared.Interobserver agreement was moderate (κ = 0.560 ± 0.015 [standard error of the mean]) for BI-RADS category assessment with B-mode US alone. When SWE was added to B-mode US, five readers showed substantial interobserver agreement (κ = 0.629 ± 0.017 for single-view SWE; κ = 0.651 ± 0.014 for two-view SWE). The mean AUC of B-mode US was 0.870 (range, 0.855-0.884). The AUC of B-mode US and two-view SWE (average, 0.928; range, 0.904-0.941) was higher than that of B-mode US and single-view SWE (average, 0.900; range, 0.890-0.920), with statistically significant differences for three readers (P ≤ .003).The performance of radiologists in differentiating benign from malignant breast masses was improved when B-mode US was combined with two-view SWE compared with that when B-mode US was combined with single-view SWE.

To determine whether a correlation exists between maximum standardized uptake value (SUVmax) on (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) and the subtypes of breast cancer.This retrospective study involved 548 patients (mean age 51.6 years, range 21-81 years) with 552 index breast cancers (mean size 2.57 cm, range 1.0-14.5 cm). The correlation between (18)F-FDG uptake in PET/CT, expressed as SUVmax, and immunohistochemically defined subtypes (luminal A, luminal B, human epidermal growth factor receptor 2 (HER2) positive and triple negative) was analyzed.The mean SUVmax value of the 552 tumours was 6.07 ± 4.63 (range 0.9-32.8). The subtypes of the 552 tumours were 334 (60%) luminal A, 66 (12%) luminal B, 60 (11%) HER2 positive and 92 (17%) triple negative, for which the mean SUVmax values were 4.69 ± 3.45, 6.51 ± 4.18, 7.44 ± 4.73 and 9.83 ± 6.03, respectively. In a multivariate regression analysis, triple-negative and HER2-positive tumours had 1.67-fold (P 0.001) and 1.27-fold (P = 0.009) higher SUVmax values, respectively, than luminal A tumours after adjustment for invasive tumour size, lymph node involvement status and histologic grade.FDG uptake was independently associated with subtypes of invasive breast cancer. Triple-negative and HER2-positive breast cancers showed higher SUVmax values than luminal A tumours.• (18) F-FDG PET demonstrates increased tissue glucose metabolism, a hallmark of cancers. • Immunohistochemically defined subtypes appear significantly associated with FDG uptake (expressed as SUV max ). • Triple-negative tumours had 1.67-fold higher SUV max values than luminal A tumours. • HER2-positive tumours had 1.27-fold higher SUV max values than luminal A tumours.

To investigate the clinical effect of a single magnetic resonance (MR) imaging screening examination of the contralateral breast at preoperative evaluation in women with unilateral breast cancer.The institutional review board approved this study and waived informed consent. Among women with unilateral breast cancer who underwent curative surgery from 2004 to 2008, 1323 women (mean age, 46.8 years; range, 18-81 years) underwent mammography and ultrasonography (US) alone (comparison group) between January 2004 and December 2006; 1771 consecutive women (mean age, 48.2 years; range, 22-85 years) underwent mammography, US, and MR imaging (contralateral MR imaging-screened group) between January 2007 and December 2008. The incidence of synchronous cancer and the incidence of metachronous cancer in the contralateral breast were compared between groups. Multivariate Cox analysis was performed. Median follow-up was 56 months (range, 13-94 months).Twenty-five synchronous contralateral cancers (13 invasive cancers, 12 ductal carcinomas in situ; mean invasive size, 14 mm [range, 1-35 mm]; 92% [12 of 13] of invasive tumors were node negative) were additionally detected with MR imaging in the MR imaging-screened group. The cumulative incidence of contralateral breast cancer at 45 months was 0.5% (nine of 1771) (95% confidence interval [CI]: 0.23%, 0.96%) for the MR imaging-screened group and 1.4% (18 of 1323) (95% CI: 0.81%, 2.14%) for the comparison group (P = .02). Contralateral MR imaging screening (hazard ratio, 0.37; 95% CI: 0.15, 0.92; P = .03) and estrogen receptor negativity (hazard ratio, 3.98; 95% CI: 1.60, 9.92; P = .003) were associated with risk of contralateral cancer diagnosis in multivariate analysis.A single MR imaging screening examination of the contralateral breast in women with unilateral breast cancer increased synchronous cancer detection and was associated with decreased diagnosis of metachronous contralateral cancer within 45 months.

To prospectively compare the diagnostic performances of two-dimensional (2D) and three-dimensional (3D) shear-wave elastography (SWE) for differentiating benign from malignant breast masses. B-mode ultrasound and SWE were performed for 134 consecutive women with 144 breast masses before biopsy. Quantitative elasticity values (maximum and mean elasticity in the stiffest portion of mass, Emax and Emean; lesion-to-fat elasticity ratio, Erat) were measured with both 2D and 3D SWE. The area under the receiver operating characteristic curve (AUC), sensitivity and specificity of B-mode, 2D, 3D SWE and combined data of B-mode and SWE were compared. Sixty-seven of the 144 breast masses (47 %) were malignant. Overall, higher elasticity values of 3D SWE than 2D SWE were noted for both benign and malignant masses. The AUC for 2D and 3D SWE were not significantly different: Emean, 0.938 vs 0.928; Emax, 0.939 vs 0.930; Erat, 0.907 vs 0.871. Either 2D or 3D SWE significantly improved the specificity of B-mode ultrasound from 29.9 % (23 of 77) up to 71.4 % (55 of 77) and 63.6 % (49 of 77) without a significant change in sensitivity. Two-dimensional and 3D SWE performed equally in distinguishing benign from malignant masses and both techniques improved the specificity of B-mode ultrasound. • Shear-wave elastography (SWE) is increasingly used during ultrasound of the breast • 2D and 3D SWE performed equally in distinguishing benign from malignant masses • Either SWE method, combined with B-mode, outperformed B-mode ultrasound alone • Quantitative elasticity was greater for 3D than 2D SWE for all masses