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Characteristics of the cell nuclei within human breast tumors, as assayed and scored by the Scarff-Bloom-Richardson (SBR) histopathologic method, correlate with patient prognosis and long-term survival rates (1,2). We have shown previously in rodent mammary tumors that the histopathologic tumor grade correlates with quantitative magnetic resonance imaging (MRI)–derived estimates of tumor microvascular permeability obtained using a prototypic macromolecular contrast medium, albumin–(GdDTPA)30 (3). Microvessel permeability depends on functional and morphologic characteristics of cancer vessels and on physicochemical properties of the injected solute/ contrast medium molecule (4–7). In this study, we focus on specific characteristics of two contrast media and their influence on MRI-derived estimates of microvessel characteristics. The increased permeability of tumor vessels to macromolecular solutes has been demonstrated repeatedly using albumin–(Gd-DTPA)30, which is used in this study as a reference standard (8–10). Although not previously tested as probes of endothelial hyperpermeability, ultrasmall superparamagnetic iron oxide (USPIO) particles, having a mean diameter of approximately 20 nm, were compared in this study to albumin–(Gd-DTPA)30, which is approximately 20% the size of USPIO. Unlike albumin–(Gd-DTPA)30, which is incompletely eliminated and potentially immunogenic, USPIO particles have a favorable pharmacologic and tolerance profile and are now being tested clinically (11). Thus, the purpose of this study was to define the potential of USPIO (represented by NC100150 Injection [Nycomed Imaging AS, Oslo, Norway]) for the quantitative characterization of tumor microvasculature, specifically for measures of the microvessel permeability and the plasma volume. Results were compared to estimates derived with the established macromolecular contrast medium, albumin–(Gd-DTPA)30, and to the histologic tumor grade.

SUMMARY: Molecular imaging aims to visualize and quantify biological, physiological, and pathological processes at cellular and molecular levels. Recently, molecular imaging has been introduced into breast cancer imaging. In this review, we will present a survey of the molecular imaging techniques that are either clinically available or are being introduced into clinical imaging. We will discuss nuclear imaging and multiparametric magnetic resonance imaging as well as the combined application of molecular imaging in the assessment of breast lesions. In addition, we will briefly discuss other evolving molecular imaging techniques, such as phosphorus magnetic resonance spectroscopic imaging and sodium imaging.

To identify which breast lesion descriptors in the ACR BI-RADS® MRI lexicon are most strongly associated with the diagnosis of breast cancer when performing breast MR imaging at 3 T.150 patients underwent breast MR imaging at 3 T. Lesion size, morphology and enhancement kinetics were assessed according to the BI-RADS® classification. Sensitivity, specificity and diagnostic accuracy were assessed. The effects of the BI-RADS® descriptors on sensitivity and specificity were evaluated. Data were analysed using logistic regression. Histopathological diagnoses were used as the standard of reference.The sensitivity, specificity and diagnostic accuracy of breast MRI at 3 T was 99%, 81% and 93%, respectively. In univariate analysis, the final diagnosis of malignancy was positively associated with irregular shape (p 0.001), irregular margin (p 0.001), heterogeneous enhancement (p 0.001), Type 3 enhancement kinetics (p = 0.02), increasing patient age (p = 0.02) and larger lesion size (p 0.001). In multivariate analysis, significant associations with malignancy remained for mass shape (p = 0.06), mass margin (p 0.001), internal enhancement pattern (p = 0.03) and Type 3 enhancement kinetics (p = 0.06).The ACR BI-RADS® breast lesion descriptors that are mostly strongly associated with breast cancer in breast MR imaging at 3 T are lesion shape, lesion margin, internal enhancement pattern and Type 3 enhancement kinetics.• 3 Tesla breast MRI allows an accurate diagnosis of breast cancer • The BI-RADS® descriptors help provide a confident diagnosis • The shape, margin, enhancement pattern and kinetics are the most important features • An irregular shape and margin, heterogeneous enhancement and type-3 kinetics indicate malignancy.

DDS was compared to intra-arterial angiography for the diagnosis of significant (50%) stenoses of the celiac trunk and the SMA in 38 consecutive patients referred for angiographic evaluation of peripheral arterial occlusive disease. Celiac trunk occlusion was correctly identified by DDS in three of three patients. In patients with significant celiac trunk stenoses, mean peak systolic velocity was 246 (+/- 154) cm/sec and differed significantly (P0.05) from the peak systolic velocity (101 +/- 22 cm/sec) of 22 patients with no angiographic evidence of significant stenosis. Five false-negative DDS examinations in patients with50% celiac trunk stenoses were noted. Using a peak systolic velocity of160 cm/sec (mean value in normal vessels plus 3 standard deviations) to diagnose50% celiac trunk stenosis, sensitivity of DDS was 57% and specificity was 100%. However, considering celiac trunk stenoses and occlusions as a single group, the sensitivity rate of DDS in diagnosing significant stenosis and occlusion of celiac trunk was 70%.

Poster: "ECR 2011 / C-0193 / Reduced breast biopsy rates with a combined high temporal and high spatial resolution MR imaging protocol at 3 Tesla" by: "K. Pinker-Domenig1, S. Gruber1, W. Bogner2, G. Grabner1, M. B. Schernthaner1, S. Trattnig2, T. H. Helbich1; 1Vienna/AT, 2Wien/AT"

To evaluate the frequency of diagnosis of high-risk lesions at MRI-guided vacuum-assisted breast biopsy (MRgVABB) and to determine whether underestimation may be predicted. Retrospective review of the medical records of 161 patients who underwent MRgVABB was performed. The underestimation rate was defined as an upgrade of a high-risk lesion at MRgVABB to malignancy at surgery. Clinical data, MRI features of the biopsied lesions, and histological diagnosis of cases with and those without underestimation were compared. Of 161 MRgVABB, histology revealed 31 (19%) high-risk lesions. Of 26 excised high-risk lesions, 13 (50%) were upgraded to malignancy. The underestimation rates of lobular neoplasia, atypical apocrine metaplasia, atypical ductal hyperplasia, and flat epithelial atypia were 50% (4/8), 100% (5/5), 50% (3/6) and 50% (1/2) respectively. There was no underestimation in the cases of benign papilloma without atypia (0/3), and radial scar (0/2). No statistically significant differences (p > 0.1) between the cases with and those without underestimation were seen in patient age, indications for breast MRI, size of lesion on MRI, morphological and kinetic features of biopsied lesions. Imaging and clinical features cannot be used reliably to predict underestimation at MRgVABB. All high-risk lesions diagnosed at MRgVABB require surgical excision.

Proton magnetic resonance spectroscopic imaging is a non-invasive diagnostic tool for the investigation of cancer metabolism. As an adjunct to morphologic and dynamic magnetic resonance imaging, it is routinely used for the staging, assessment of treatment response, and therapy monitoring in brain, breast, and prostate cancer. Recently, its application was extended to other cancerous diseases, such as malignant soft-tissue tumours, gastrointestinal and gynecological cancers, as well as nodal metastasis. In this review, we discuss the current and evolving clinical applications of proton magnetic resonance spectroscopic imaging. In addition, we will briefly discuss other evolving techniques, such as phosphorus magnetic resonance spectroscopic imaging, sodium imaging and diffusion-weighted imaging in cancer assessment.

The use of breast magnetic resonance imaging (MRI) is rapidly increasing. EUSOMA organised a workshop in Milan on 20-21st October 2008 to evaluate the evidence currently available on clinical value and indications for breast MRI. Twenty-three experts from the disciplines involved in breast disease management - including epidemiologists, geneticists, oncologists, radiologists, radiation oncologists, and surgeons - discussed the evidence for the use of this technology in plenary and focused sessions. This paper presents the consensus reached by this working group. General recommendations, technical requirements, methodology, and interpretation were firstly considered. For the following ten indications, an overview of the evidence, a list of recommendations, and a number of research issues were defined: staging before treatment planning; screening of high-risk women; evaluation of response to neoadjuvant chemotherapy; patients with breast augmentation or reconstruction; occult primary breast cancer; breast cancer recurrence; nipple discharge; characterisation of equivocal findings at conventional imaging; inflammatory breast cancer; and male breast. The working group strongly suggests that all breast cancer specialists cooperate for an optimal clinical use of this emerging technology and for future research, focusing on patient outcome as primary end-point.

In 101 consecutive patients with renal allograft dysfunction a correlation of Duplex Doppler sonography (DDS) with histopathologic reports of simultaneously performed biopsies was made. Renal vascular impedance was estimated by calculating the resistive index (RI). A total of 290 different specific histologic diagnoses (mean 2.1 ± 0.84 diagnoses/biopsy) was noted. with increasing time interval to transplantation, single diagnoses as cause of allograft dysfunction decreased. DDS could not reliably differentiate, exclude, or grade any of the common causes of renal allograft dysfunction like vascular and/or cellular rejection, chronic rejection, acute tubular necrosis, cyclosporin nephrotoxicity, relapse of glomerulonephritis and infection. Follow-up studies after established histologic diagnosis in 19 patients with persisting allograft dysfunction demonstrated a lack of sensitivity of DDS to significant superimposed causes of transplant malfunction. We conclude that biopsy is still necessary to direct prope...

To compare the diagnostic quality of diffusion-weighted (DW) imaging schemes with regard to apparent diffusion coefficient (ADC) accuracy, ADC precision, and DW imaging contrast-to-noise ratio (CNR) for different types of lesions and breast tissue.Institutional review board approval and written, informed consent were obtained. Fifty-one patients with histopathologic correlation or follow-up performed with a 3.0-T MR imager were included in this study. There were 112 regions of interest drawn in 24 malignant, 17 benign, 20 cystic, and 51 normal tissue regions. ADC maps were calculated for combinations of 10 b values (range, 0-1250 sec/mm(2)). Differences in ADC among tissue types were evaluated. The CNRs of lesions at DW imaging were compared for all b values. A repeated-measures analysis of variance was used to assess lesion differentiation.ADCs calculated from b values of 50 and 850 sec/mm(2) were 0.99 x 10(-3) mm(2)/sec +/- 0.18 (standard deviation), 1.47 x 10(-3) mm(2)/sec +/- 0.21, 1.85 x 10(-3) mm(2)/sec +/- 0.22, and 2.64 x 10(-3) mm(2)/sec +/- 0.30 for malignant, benign, normal, and cystic tissues, respectively. An ADC threshold level of 1.25 x 10(-3) mm(2)/sec allowed discrimination between malignant and benign lesions with a diagnostic accuracy of 95% (P.001). ADC calculations performed with multiple b values were not significantly more precise than those performed with only two. We found an overestimation of ADC for maximum b values of up to 1000 sec/mm(2). The best CNR for tumors was identified at 850 sec/mm(2).Optimum ADC determination and DW imaging quality at 3.0 T was found with a combined b value protocol of 50 and 850 sec/mm(2). This provided a high accuracy for differentiation of benign and malignant breast tumors.

Purpose To determine the frequency with which stereotactic 11-g vacuum-assisted breast biopsy (11-g SVAB) obviates an open surgical biopsy (OSB), to compare the costs of these two biopsy methods, and to estimate the potential cost savings attributable to 11-g SVAB in the diagnosis of suspicious breast lesions in patients in Austria. Materials and methods We retrospectively reviewed 318 consecutive breast lesions of BI-RADS categories IV and V (microcalcifications n = 166; masses n = 152) on which 11-g SVAB and OSB were performed. Cost savings were calculated using nationally allowed flat rates and patient charges. Costs were measured from a hospital and a socioeconomic perspective. Common clinical scenarios and sensitivity analyses assessed the extent of achievable cost savings. Results 11-g SVAB obviated the need for an OSB in 93 (29%) of 318 women. Overall cost savings per 11-g SVAB over OSB were € 242 per case from a hospital perspective, and € 422 per case from a socioeconomic perspective. The use of 11-g SVAB decreased the cost of diagnosis by 7% from a hospital perspective, and by 10% from a socioeconomic perspective. Conclusion In Austria, annual national savings of over 5 million Euro could be realized with the use of 11-g SVAB for the diagnosis of suspicious breast lesions. Although savings per case are modest, the national health care system realizes significant cost reduction as women benefit from a faster and less invasive approach to diagnosis.

The aim of this retrospective study was to evaluate performance of computer-aided detection (CAD) with full-field digital mammography (FFDM) in detection of breast cancers.CAD was retrospectively applied to standard mammographic views of 127 cases with biopsy proven breast cancers detected with FFDM (Senographe 2000, GE Medical Systems). CAD sensitivity was assessed in total group of 127 cases and for subgroups based on breast density, mammographic lesion type, mammographic lesion size, histopathology and mode of presentation.Overall CAD sensitivity was 91% (115 of 127 cases). There were no statistical differences (p0.1) in CAD detection of cancers in dense breasts 90% (53/59) versus non-dense breasts 91% (62/68). There was statistical difference (p0.05) in CAD detection of cancers that appeared mammographically as microcalcifications only versus other mammographic manifestations. CAD detected 100% (44/44) of cancers manifesting as microcalcifications, 89% (47/53) as no-calcified masses or asymmetries, 88% (14/16) as masses with associated calcifications, and 71% (10/14) as architectural distortions. CAD sensitivity for cancers 1-10mm was 84% (38/45); 11-20mm 93% (55/59); and20mm 97% (22/23).CAD applied to FFDM showed 100% sensitivity in identifying cancers manifesting as microcalcifications only and high sensitivity 86% (71/83) for other mammographic appearances of cancer. Sensitivity is influenced by lesion size. CAD in FFDM is an adjunct helping radiologist in early detection of breast cancers.

Die Roue des„Women’s imager“ ist die eines Konsolenten, der durch die adaquate Wahl des bildgebenden Verfahrens eine optimale Diagnose bzw. Therapie ermoglicht. So stellt Women’s Imaging einen integralen Bestandteil in der Gesundheitsvorsorge/versorgung der Frau dar. Ein spezielles Wissen der verschiedensten Erkrankungen von Brustdruse, Herz, gynakologischen Organen, Schwangerschaft und Osteoporose ist fur das Management dieser Patientinnen notwendigem praxisrelevante bildgebende Verfahren effizient einzusetzen. In diesem Kapitel sollen die praxisrelevanten bildgebenden Verfahren in der Diagnose von Brusttumoren, Tumoren des weiblichen Genitaltrakts, der Osteoporose und der koronaren Herzerkrankung dargestellt werden. Die betreffenden Erkrankungen sind genderspezifisch, kommen also beim mannlichen Geschlecht nicht vor oder weisen geschlechtsspezifische Symptome auf, welche die Diagnose erschweren konnen.

Purpose To examine the budget impact of ultrasound-guided 14-g large core breast biopsy (US-guided LCBB) by comparing the costs of US-guided LCBB and open surgical biopsy (OSB); to calculate the cost savings attributable to US-guided LCBB; and to assess the frequency with which US-guided LCBB obviates the need for an OSB. Materials and methods In a retrospective study, we reviewed 399 suspicious breast lesions on which US-guided LCBB and OSB or, in cases of benign histology, clinical follow-up, were performed. Cost savings were calculated using nationally allowed flat rates (A-drg) and patient charges. Costs were measured from both, a hospital and a socioeconomic perspective. Deterministic sensitivity analyses were simulated to assess the extent of achievable cost savings. Results Overall cost savings for US-guided LCBB over OSB were €977 (€2,337/€3,314) per case from a hospital perspective, resulting in a total cost decrease of 30% for the diagnosis of suspicious breast lesions. From a socioeconomic perspective, cost savings were €1,542 (€2,600/€4,142) per case, resulting in a 37% reduction in biopsy cost. US-guided LCBB obviated the need for a surgical procedure in 240 (60%) of 399 women. In all four sensitivity analyses, costs of US-guided LCBB remained lower than that of OSB. Conclusion From an economic perspective, US-guided LCBB is highly recommended for the diagnosis of suspicious breast lesions, as this procedure reduces the cost of diagnosis substantially. In Austria, annual cost savings would be €18.5 million.

Breast cancer is the leading malignant disease in women in the Western world. It affects 9–12% of women during their lifetime (Heywang-Kobrunner and Schreer 2003). In the United States breast cancer causes more than 43,000 deaths per year, in the countries of the European Union more than 74,000 (Eurostat Datenbank Newcronos, unpublished data). Early detection and effective treatment of breast cancer are the major factors contributing to the decline in the mortality rate. At present, mammography is the gold standard for the detection of breast cancer. Despite recent technical advances, mammography may miss as many as 10–25% of carcinomas, particularly in radiographically dense breasts. Furthermore, the high rate of false-positive mammograms (60–70%) results in a correspondingly high rate of biopsies that impose a heavy psychological burden on women and a heavy financial cost on the healthcare system (Heywang-Kobrunner and Schreer 2003; Elmore et al. 1998). Various additional modalities such as ultrasound (US) or magnetic resonance imaging (MRI) have been introduced to adjunctively either increase cancer detection or to improve discrimination between malignant and benign lesions. Despite complementary use of these imaging modalities, breast cancer is missed in a considerable number of cases (Heywang-Kobrunner and Schreer 2003; Elmore et al. 1998). Over time, substantial insight into the pathophysiology of breast carcinomas and other breast diseases has been gained. This knowledge should be included in breast imaging strategies of the future. Researchers expect to gain more, and particularly more precise and specific, information about breast lesions in the future, leading to earlier diagnosis of breast cancer and a more precise discrimination between benign and malignant tumors.

Purpose: To assess the diagnostic accuracy of mammography, ultrasound, and magnetic resonance imaging (MRI) of the breast in the surveillance of women at high risk for breast cancer. Experimental Design: In this prospective comparison study, women at high risk for breast cancer were offered annual surveillance examinations, consisting of mammography, ultrasound, and MRI, at a single tertiary care breast center. The sensitivity and specificity of each modality was based on the histopathologic evaluation of suspicious findings from all modalities plus the detected interval cancers. Results: Three hundred and twenty-seven women underwent 672 complete imaging rounds. Of a total of 28 detected cancers, 14 were detected by mammography, 12 by ultrasound, and 24 by MRI, which resulted in sensitivities of 50%, 42.9%, and 85.7%, respectively (P < 0.01). MRI detected not only significantly more invasive but also significantly more preinvasive cancers (ductal carcinoma in situ). Mammography, ultrasound, and MRI led to 25, 26, and 101 false-positive findings, which resulted in specificities of 98%, 98%, and 92%, respectively (P < 0.05). Thirty-five (35%) of these false-positive findings were atypical ductal hyperplasias, lesions considered to be of premalignant character. Nine (26%) of those were detected by mammography, 2 (6%) with ultrasound, and 32 (91%) with MRI (P < 0.01). Conclusion: Our results show that MRI of the breast improves the detection of invasive cancers, preinvasive cancers, and premalignant lesions in a high-risk population and should therefore become an integral part of breast cancer surveillance in these patients.

To compare image quality, the lesion detection, and the diagnostic efficacy of full-field digital mammography (FFDM) and computed radiography-based mammography using digital storage phosphor plates (DSPM) in the evaluation of breast lesions.In this prospective study, 150 patients with suspicious breast lesions underwent FFDM and DSPM. Nine aspects of image quality (brightness, contrast, sharpness, noise, artifacts, and the detection of anatomic structures, i.e., skin, retromamillary space, glandular tissue, and calcifications) were evaluated by five radiologists. In addition, the detection of breast lesions and the diagnostic efficacy, based on the BI-RADS classification, were evaluated with histologic and follow-up correlation.For contrast, sharpness, and the detection of all anatomic structures, FFDM was rated significantly better (p0.05). Mass lesions were equally detected, whereas FFDM detected more lesions consisting of calcifications (85 versus 75). DSPM yielded two false-negative results. Both lesions were rated BI-RADS 4 with FFDM, but BI-RADS 2 with DSPM. Both were invasive carcinoma at histology. The sensitivity, specificity, PPV, NPV, and accuracy of FFDM were 1.0, 0.397, 0.636, 1.0, and 0.707, compared to 0.974, 0.397, 0.630, 0.935, and 0.693 of DSPM.Based on image quality parameters, FFDM is, in part, significantly better than DSPM. Furthermore, the detection of breast lesions with calcifications is favorable with FFDM. However, the diagnostic efficacy of FFDM and DSPM was equal. The interpretation of the false-negative results suggests that the perception and characterization of breast lesions is not defined solely by the digital mammography system but is strongly influenced by the radiologist, who is one of the determinants in the interpretation of breast imaging.

5597 Background: To investigate molecular imaging of cervix cancer with combined multiparametric positron emission tomography - magnetic resonance imaging (3T MP PET-MRI) using multiple MRI techniq...

1061 Background: Skin sparing mastectomy (SSM) and nipple sparing mastectomy (NSM) and immediate reconstruction by an implant are widely used in patients with breast cancer and in high risk patient...

Purpose: To determine the difference in anxiety reactions in patients undergoing standard (non-breast) magnetic resonance imaging (MRI) compared to breast magnetic resonance imaging (MRM) and to evaluate the influence of patient information before the breast imaging examination on the rate of premature termination of the procedure. Materials and Methods: Over 2 years, 5837 non-breast and 336 breast magnetic resonance examinations were performed at our institution. One group of breast MRM patients (n = 144) received detailed information and a second group (n = 189) received only routine information before MRI. The rates of premature termination were recorded for all groups. Results: In 0.5% (27/5837) of patients undergoing standard MRI examinations the study had to be stopped prematurely. Of the breast MRM patients, those who had received only routine information had a significantly higher rate of premature termination when compared to the better-informed patients and those undergoing standard MRI (5.5%, 10/189, P = 0.01). A significantly lower rate of premature termination occurred in the better-informed breast group (0%, 0/144). Conclusion: MRM is associated with an increase in patient anxiety and higher rates of incomplete examination than other MR procedures. We recommend careful patient preparation including detailed verbal information before MRM and support during the procedure to obtain optimal patient compliance.

P ulmonary alveolar microlithiasis (PAM) is an uncommon, chronic lung disease [1] characterized by deposits of calcium within the alveoli of both lungs [2-4]. The etiology and pathogenesis are still unknown [2, 4]. The disease is an autosomal recessive derivation predominantly affecting females [ 1 , 2]. PAM is usually diagnosed with the help of a chest radiograph. Its appearance on a chest radiograph has been adequately described and is pathognomonic in children and in adults [1, 2, 5, 6]. The clinical findings are less apparent in children, and chest radiograph findings are subtle [I, 2, 6]. High-resolution CT has proven superior to chest radiography in diagnosing several lung diseases in adults and in children [6-9]. In adults, high-resolution CT showed better the extent and the severity of PAM [7, 8]; however, to our knowledge, the high-resolution CT characteristics of PAM in children have not been reported adequately. The aim of this report was to describe the radiographic findings of this rare disorder with particular attention to the features provided by high-resolution CT. Case Reports A 31-year-old woman diagnosed with PAM was the index case for our study [8]. Because the disease is an autosomal recessive derivation [2, 6], to determine whether there were unknown cases in the patient’s family, clinical examinations and chest radiographs were obtained of her relatives. Thirty-four members of this family were evaluated (22 females, 12 males; age range, 1 .5-83 years old). In addition to the index case [8], two more asymptomatic patients with PAM were detected: case 1, a 13-yearold boy, and case 2, a 6-year-old girl. In case 1 , the diagnosis of PAM was based on an open lung biopsy. Because of the positive family history and characteristic features of PAM on the chest radiograph and on highresolution CT, no open lung biopsy was required to confirm the diagnosis in case 2. In both cases, pulmonary function tests, blood gas analysis, echocardiography, and high-resolution CT were performed within 2 weeks. A CT scan was performed on both children with the patients in supine position: a Somatom Plus (Siemens, Erlangen, Germany) was used for the first patient and a Tomoscan (Philips, Best, The Netherlands) was used for the second. Imaging parameters were as follows: scan time, 1 see; section thickness, 1.5 mm; and intervals, 15 mm. Images were reconstructed with a high-spatial-frequency algorithm for pulmonary analysis. In both patients, chest radiographs revealed diffuse, ground-glass opacifications as described previously [1, 2, 5, 6] in both lungs fields and faint sandlike opacities at the lung bases that partially obscured cardiac and diaphragmatic silhouettes (Figs. 1A and 2A). In case 2, the left cardiac outline was visible as a fine radiodense line indicative of pleural calcification (Fig. 2A). On chest radiographs, neither of the two patients showed evidence of a black pleura line described in the literature [2, 8]. High-resolution CT revealed diffuse, ground-glass opacities throughout both lungs with scattered micronodular calcific densities in both cases. In case 1, the calcific densities were more pronounced than in case 2. These densities in case 1 were sometimes confluent in the posterior and inferior areas of the mid

To retrospectively determine the lesion miss rate and false-negative rate of needle-localized open breast biopsy (NLOBB) with stereotactic guidance in a large study population.The ethical review board approved the study; the need for informed consent was waived. A total of 1115 stereotactic NLOBBs performed in 1068 women aged 22-90 years (mean age, 54 years) were tracked to determine outcomes. In cases of malignancy, NLOBB was considered to be diagnostically successful. The mammographic outcomes in all patients with benign results at NLOBB were tracked for at least 2 years. Cases without such mammographic follow-up were cross-referenced with a tumor registry after at least 54 months. The lesion miss rate was based on all malignant lesions and all lesions with long-term mammographic follow-up. Results from all 1115 NLOBBs were used to report the false-negative rate.Of 1115 NLOBBs, 472 (42%) had malignant results. Mammographic follow-up data were available for 535 (83%) of 643 NLOBBs with benign results. Mammographic follow-up revealed 11 lesions that were missed with NLOBB, of which five were malignant and six benign. Thus, the lesion miss rate with NLOBB was 1.1% (11/[472 + 535]). Among the 643 cases, in 108 of them without mammographic follow-up (17%), cross-referencing with a tumor registry did not reveal missed cases of breast carcinoma. The false-negative rate was therefore 1.0% (5/[472 + 5]).On the basis of the results of long-term follow-up, the authors noted a lesion miss rate of 1.1% and a false-negative rate of 1.0%, which indicate that NLOBB with stereotactic guidance is an accurate method for diagnosing breast lesions.

Purpose: To compare magnetic resonance imaging (MRI) findings at different stages of cervix cancer treatment and to define the potential of MRI to delineate the gross tumor volume (GTV), clinical target volume (CTV), pathoanatomic structures, and organs at risk (OAR) in brachytherapy. Methods and Materials: Forty-nine patients underwent MRI at diagnosis and at brachytherapy. The ability to discriminate anatomic structures on MRI was assessed (quality factor: 0 = inability to discriminate; 1 = fair discrimination; 2 = good discrimination; 3 = excellent discrimination). The overall ability to visualize (percentage of patients with quality factors greater than 0) and the overall discrimination quality score (mean quality factors of all patients) were estimated for the applicator, GTV at diagnosis (GTVD), GTV at brachytherapy (GTVBT)/“gray zones,” cervix rim/uterine corpus, OAR, vaginal wall, and parametria. Results: The overall ability to visualize the applicator on MRI at brachytherapy was 100%; for the GTVBT/“gray zones,” cervix rim/uterine corpus, OAR, and vaginal wall, visualization was 98% (overall discrimination quality factors: 1.2, 2.9, 2.1, 1.9, 1.7, and 2.6). Three of 4 borders of parametrial space were defined in more than 98% (discrimination quality factors: 2.9, 2.1, and 1.2). Conclusion: Magnetic resonance imaging provides appropriate information for definition of the applicator, GTV, CTV, pathoanatomic structures, and OAR that enables precise delineation for cervix cancer brachytherapy.

Aim: To determine whether the resistance index (RI) contributes to the differential diagnosis of breast masses. Patients and methods: In 56 breast tumours colour-coded Doppler sonography was performed and their resistance indices calculated from their spectral Doppler tracings. Histologic evaluation was obtained by excision biopsy. Results: In seven of 28 benign tumours (25%) no lesion was seen on ultrasound. In another seven benign tumours, no intratumoral vessels were demonstrated. The resistance index of the remaining 14 lesions (50%) varied between 0.5 and 0.75 with a mean value of 0.62 (standard deviation 0.08). Ultrasound missed one of 28 carcinomas (3.5%) and in one other tumour (3.5%) no flow was demonstrable. The resistance index of 26 malignant tumours varied between 0.56 and 0.9 with a mean value of 0.7 (standard deviation 0.08). Conclusion: Breast malignancies have higher resistance indices with a wider range as assessed by colour-coded Doppler ultrasound (81% exceed 0.6) than do benign lesions. Due to the considerable overlap of the range of the resistance index, the measurements in any single patient may not be diagnostic. The absence of flow does not definitively exclude malignancy.

Nipple discharge may be a symptom of a variety of diseases. The importance of nipple discharge is its possible association with breast carcinoma. Not only the precise clinical evaluation but also particularly imaging evaluation by mammography, ultrasound, galactography or MR-galactography is necessary to establish the exact diagnosis and plan proper treatment. Depending on the underlying pathology--most commonly intraductal papilloma, fibrocystic changes or breast carcinoma--the optimal therapeutic regimen, such as single lactiferous duct excision on the one end and modified radical mastectomy on the other end of the spectra may be chosen.

To determine whether palpable noncalcified solid breast masses with benign morphology at mammography and ultrasonography (US) can be managed similarly to nonpalpable probably benign lesions (Breast Imaging Reporting and Data System [BI-RADS] category 3)-that is, with periodic imaging surveillance-and to determine whether biopsy can be averted in these lesions.No institutional review board approval or patient consent was required. This retrospective analysis, based on final imaging reports, included 152 patients (age range, 28-77 years; mean age, 48.3 years) with 157 palpable noncalcified solid masses that were classified as probably benign at initial mammography and US. Of 152 patients, 108 underwent follow-up with mammography and US (6-month intervals for 2 years, then 12-month intervals). The remaining 44 patients underwent surgical or needle biopsy after initial imaging. Lesions were analyzed at initial and follow-up examinations. Statistical analysis included Student t test and corresponding exact 95% confidence intervals.In 108 patients who underwent follow-up only, 112 lesions were palpable. In 102 (94.4%) of 108 patients, masses remained stable during follow-up. Lesions were followed for at least 2 years (mean, 4.1 years; range, 2-7 years). In six (5.6%) patients, palpable lesions increased in size during follow-up; these lesions were benign at subsequent open biopsy. No breast carcinoma was diagnosed in the 44 patients with 45 palpable lesions who underwent biopsy after initial imaging. Of 157 lesions, no malignant tumors were observed (exact one-sided 95% confidence interval: 0%, 1.95%).The data strongly suggest that palpable noncalcified solid breast masses with benign morphology at mammography and US can be managed similarly to nonpalpable BI-RADS category 3 lesions, with short-term follow-up (6-month intervals for 2 years). More data, based on a larger series, are required to determine whether this conclusion is correct.

To investigate use of the macromolecular contrast agent feruglose for differentiating and grading of human benign and malignant breast tumors on the basis of their microvascular characteristics.Sixty-three women with 63 primary breast lesions were examined with dynamic T1-weighted gradient-echo magnetic resonance (MR) imaging after intravenous injection of feruglose. A two-compartment unidirectional kinetic model applied to the dynamic data yielded estimates of the endothelial transfer coefficient, KPS, and the fractional plasma volume of the tumors. These MR imaging-derived parameters were correlated with the histologic tumor grade and quantified according to the Scarff-Bloom-Richardson (SBR) score by means of Pearson product moment correlation analyses. Differences between malignant and nonmalignant breast lesions with respect to KPS for feruglose were evaluated by means of the chi2 test and by calculating the sensitivity, specificity, and positive and negative predictive values.Histologic analysis revealed 26 benign and 37 malignant tumors. A moderate yet statistically significant correlation between KPS and SBR score was found (R = 0.496, P.001). No significant correlation was observed between fractional plasma volume and SBR score (R = 0.085, P =.507). The KPS values were zero for 19 (73%) of the 26 benign tumors and were greater than zero for 27 (73%) of the 37 carcinomas. This distribution was significantly different (chi2 = 13.035, P =.001). With the criterion KPS0 in carcinomas, sensitivity was 0.73, specificity was 0.73, and the positive predictive value was 0.79.Quantitative measures of tumor microvascular permeability can be used for breast tumor characterization. The probability of breast tumor microvascular hyperpermeability to be associated with malignancy is 79%.

Percutaneous imaging-guided needle biopsy has increasingly become an alternative to surgical biopsy for the histologic assessment of breast lesions. Percutaneous biopsy is faster, less invasive, and less expensive than surgical biopsy. Tissue acquisition is performed with automated core needles or directional vacuum-assisted biopsy probes. Guidance for percutaneous biopsy is usually provided by stereotaxis, ultrasound, and, more recently, under the guidance of MR imaging. Imaging guidance depends on lesion type and the results of diagnostic imaging studies. This article reviews indications, advantages, limitations, and controversial issues in percutaneous imaging-guided biopsy of breast lesions under stereotactic and ultrasound guidance. The potential for new research opportunities and directions is also discussed.

The objective of our study was to describe the functional and differential uptake features of atypical focal nodular hyperplasia using different MR contrast agents and to evaluate their potential role in the diagnosis and characterization of focal nodular hyperplasia.Contrast-enhanced MR images of 45 patients with 85 focal nodular hyperplasia lesions were retrospectively reviewed. In these patients, sonographic findings were nonspecific (n = 37), or CT features were inconclusive (n = 8). Non-liver specific gadolinium chelates were used in 18 patients (48 lesions) suspected of having either focal nodular hyperplasia or hemangioma. The following liver-specific agents were used in patients with suspected focal nodular hyperplasia or metastases: mangafodipir trisodium, 30 patients (55 lesions); ferumoxides, six patients (16 lesions); and SHU 555 A, six patients (six lesions). Individual lesions were quantified by signal intensity and assessed qualitatively by homogeneity, contrast enhancement, and presence of a central scar.At unenhanced MR imaging, the triad of homogeneity, isointensity, and central scar was found in 22% of the focal nodular hyperplasia lesions. On mangafodipir trisodium-enhanced T1-weighted images, all focal nodular hyperplasia lesions showed contrast uptake: in 64% of the lesions, uptake was equal to parenchyma; 25%, greater than the parenchyma; and 11%, less than the parenchyma. On iron oxide-enhanced T2-weighted images, all focal nodular hyperplasia lesions showed uptake of the contrast agent, but contrast uptake in the lesions was less than in the surrounding parenchyma. Dynamic gadolinium chelate-enhanced MR imaging showed early and vigorous enhancement of focal nodular hyperplasia lesions with rapid washout in 88%. Atypical imaging features of the lesions included hyperintensity on T1-weighted images, necrosis and hemorrhage, and inhomogeneous or only minimal contrast uptake.For patients in whom the diagnosis of focal nodular hyperplasia cannot be established on unenhanced or gadolinium-enhanced MR imaging, homogeneous uptake of liver-specific contrast agent with better delineation of central scar may help to make a confident diagnosis of focal nodular hyperplasia.

Comparison of the accuracy of 3D and 2D ultrasound in assessing the volume of human cadaver kidneys.Before autopsy the volume of 22 kidneys was assessed from a 3D data set after manually tracing organ contours (3D volumetry) and by applying a 3D ellipsoid formula both on a 3D data set and 2D images. Measurements by water-displacement served as the gold standard.3D volumetry showed a mean absolute deviation of 31 mL (18.5%) compared with the mean gold standard measurement (168 mL), yielding a concordance correlation (Lin's rho(c) ) of 0.71. Calculation based on the ellipsoid formula revealed a mean absolute deviation of 37 mL (22.0%) when applied on the 3D data set (rho(c) = 0.65) and of 42 mL (25.0%) when applied on 2D images (rho(c) = 0.61).3D volumetry showed a satisfactory concordance correlation and is superior to volume calculation based on the ellipsoid formula either applied to a 3D data set or to conventional 2D images in assessing the volume of human cadaver kidneys.

The negative influence of obesity on the detection rate of the appendix for US in adults has been reported. It has been assumed that obesity is a limiting factor in the detection of the appendix with US in children as well, but this has not yet been proven. The aim of our study was to evaluate whether nutritional condition (defined by the body mass index-for-age percentiles: BMI-FAP) influences the detection of the appendix in children on US. One hundred twenty-six children (65 girls and 61 boys) with a mean age of 11.4 years with clinically suspected acute appendicitis underwent ultrasound on a commercially available high-end machine (HDI 5000, ATL, Bothell, Wash.). The BMI was calculated, and children were divided in three weight groups in accordance with the BMI-FAP, and were correlated with US findings. Evaluation of the three weight groups in accordance with the BMI-FAP demonstrated significant differences ( p=0.04) in the detection of the appendix. There was no statistical significance for the BMI, weight, height, and age solely for the detection of the appendix. In children there is a correlation between the nutritional condition as defined by the BMI-FAP and the detection of the appendix.

Angiogenesis is a process by which new vessels grow toward and into the tissue (1,2) and is a critical component of the wound-healing process. During this process, angiogenesis leads to increased endothelial permeability of the microvasculature, which is triggered by plasma proteins such as the vascular endothelial growth factor (1,2). Based on physiologic data, there are similarities between wounds and tumors (1). Previous studies demonstrated that macromolecular contrast material–enhanced magnetic resonance imaging (MRI) is able to quantify microvascular permeability and plasma volume, representatives of angiogenesis, in tumors (3,4). The purpose of this study was twofold: (a) to quantitatively assess the time course of microvascular permeability and fractional plasma volume (fPV), representatives of angiogenesis, in an established wound-healing model induced in rodents; and (b) to correlate the MRI parameters with histologic and physiologic data of the wound-healing process.

Nicole Lindenblatt,1 Karem El-Rabadi,2 Thomas H Helbich,2 Heinrich Czembirek,3 Maria Deutinger,4 Heike Benditte-Klepetko5 1Division of Plastic and Hand Surgery, Department of Surgery, University Hospital Zurich, Zurich, Switzerland; 2Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna - General Hospital Vienna, 3Department of Radiology, Hospital Wiener Privatklinik, 4Department of Plastic and Reconstructive Surgery, Hospital Rudolfstiftung, Vienna, Austria; 5Department of Plastic and Reconstructive Surgery, Erasmus Medical Center, Rotterdam, the Netherlands Background: Silicone gel breast implants may silently rupture without detection. This has been the main reason for magnetic resonance imaging (MRI) of the augmented or reconstructed breast. The aim of the present study was to investigate the accuracy of MRI for implant rupture. Methods: Fifty consecutive patients with 85 silicone gel implants were included in the study. The mean age of the patients was 51 (range 21–72) years, with a mean duration of implantation of 3.8 (range 1–28) years. All patients underwent clinical examination and breast MRI. Intraoperative implant rupture was diagnosed by the operating surgeon. Results: Nineteen of the 50 patients suffered from clinical symptoms. An implant rupture was diagnosed by MRI in 22 of 85 implants (26%). In seven of 17 removed implants (41%), the intraoperative diagnosis corresponded with the positive MRI result. However, only 57% of these patients were symptomatic. Ultrasound imaging of the harvested implants showed signs of interrupted inner layers of the implant despite integrity of the outer shell. By microsurgical separation of the different layers of the implant shell, we were able to reproduce this phenomenon and to produce signs of implant rupture on MRI. Conclusion: Our results show that rupture of only the inner layers of the implant shell with integrity of the outer shell leads to a misdiagnosis on MRI. Correlation with clinical symptoms and the specific wishes of the patient should guide the indication for implant removal. Keywords: breast implant, rupture, silicone gel, magnetic resonance imaging, linguine, keyhole

11009 Background: Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) of the breast has been the mainstay of breast MRI with an excellent sensitivity but limited specificity. Available d...