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Background: Pathologic nipple discharge, which is a common reason for referral to the breast imaging service, refers to spontaneous or bloody nipple discharge that arises from a single duct. The most common cause of nipple discharge is benign breast lesions, such as solitary intraductal papilloma and papillomatosis. Nevertheless, in rare cases, a malignant cause of nipple discharge can be found. Aims: To study the diagnostic value of ultrasonography, magnetic resonance imaging, and ductoscopy in patients with pathologic nipple discharge, compare their efficacy, and investigate the importance of magnetic resonance imaging in the diagnosis of intraductal pathologies. Study Design: Diagnostic accuracy study. Methods: Fifty patients with pathologic nipple discharge were evaluated by ultrasonography and magnetic resonance imaging. Of these, 44 ductoscopic investigations were made. The patients were classified according to magnetic resonance imaging, ultrasonography, and ductoscopy findings. A total of 25 patients, whose findings were reported as intraductal masses, underwent surgery oincluding endoscopic excision for two endoscopic excision. Findings were compared with the pathology results that were accepted as the gold standard in the description of the aetiology of nipple discharge. In addition, magnetic resonance imaging, ultrasonography and ductoscopy findings were analysed comparatively in patients who had no surgery. Results: Intraductal masses were reported in 26 patients, 20 of whom operated and established accurate diagnosis of 18 patients on magnetic resonance imaging. According to the ultrasonography, intraductal masses were identified in 22 patients, 17 of whom underwent surgery. Ultrasonography established accurate diagnoses in 15 patients. Intraductal mass was identified in 22 patients and ductoscopy established accurate diagnoses based on histopathologic results in 16 patients. The sensitivities of methods were 75% in ultrasonography, 90% in magnetic resonance imaging, and 94.6% in ductoscopy. The specificities were 66.7% in ultrasonography, 66.7% in magnetic resonance imaging, and 40% in ductoscopy. Intraductal papillomas were mostly observed as oval nodules with well-circumscribed smooth margins within dilated ducts and persistant in the dynamic analysis. Lesions that protruded into the lumen of the ducts, either solitary or multiple, were characteristic ductoscopy findings of our patients who were diagnosed as having papilloma/papillomatosis. Conclusion: Magnetic resonance imaging and ductoscopy had no statistical superiority over each other, however they were superior to ultrasonography in the diagnosis of pathologic nipple discharge. Magnetic resonance imaging may be highly sensitive for diagnosing nipple discharge with new techniques and sequences and a non-invasive method that more advantageous for showing ductal tree visualization and is able to detect completely obstructed intraductal lesions.

This study was done to determine mammographic, sonographic and magnetic resonance imaging (MRI) appearances of idiopathic granulomatous mastitis, an entity clinically and radiographically resembling breast carcinoma. A total of 36 women (mean age 37 years, range 21–51 years) with histopathological diagnosis of idiopathic granulomatous mastitis were enrolled in the study. The Breast Imaging Reporting and Data System (BI-RADS) was used to categorise the levels of suspicion of malignancy on mammography. Mammography findings were classified also according to density, margin, architectural distortion and number of lesions. Lesions were classified according to number, heterogeneity and echogenic features on sonography. Dynamic MRI findings were categorised as enhancing mass lesion, nonmass lesion or both mass lesions and nonmass lesions together. Subclassification criteria for MRI included lesion shape, margin, border and internal enhancement pattern. The most common mammographic finding was either focal or diffuse asymmetric density (n=15, 44%). The most common sonographic findings were solitary or multiple circumscribed heterogeneous hypoechoic masses (n=19, 52%). Among other sonographic findings were diffuse abscess formation with fistulae and massive parenchymal heterogeneity and hypoechogenicity in 12 (33%) and five (13%) women, respectively. On MRI, enhancing mass lesions were detected in 24 patients, whereas enhancing nonmass lesions were observed in 28. Sixteen patients had both enhancing mass lesions and nonmass lesions together. Although not characteristic for this entity, asymmetric density on mammography, solitary or multiple clustered heterogeneous hypoechogenicity with a tubular configuration on sonography and round, smooth-contoured masslike lesion with rim enhancement or segmental non-mass-like lesion on MRI are the most common features of the disease.

Introduction The role of sentinel lymph node biopsy (SLNB) in patients with locally advanced breast cancer (LABC) with potentially sterilized axillary lymph nodes after neoadjuvant chemotherapy (NAC) remains unclear. Patients and methods Between 2002 and 2008, SLNB with both blue-dye and radioisotope injection was performed in 77 patients with LABC whose cytopathologically confirmed positive axillary node(s) became clinically negative after NAC. Factors associated with SLN identification and false-negative rates, presence of non-sentinel lymph node (non-SLN) metastasis were analyzed retrospectively. Results SLNB was successful in 92% of the patients. Axillary status was predicted with 90% accuracy and a false-negative rate of 13.7%. Patients with residual tumor size >2 cm had a decreased SLN identification rate ( p = 0.002). Axillary nodal status before NAC (N2 versus N1) was associated with higher false-negative rates ( p = 0.04). Positive non-SLN(s) were more frequent in patients with multifocal/multicentric tumors (versus unifocal; p = 0.003) and positive lymphovascular invasion (versus negative; p = 0.0001). SLN(s) positive patients with pathologic tumor size >2 cm (versus ≤2 cm; p = 0.004), positive extra-sentinel lymph node extension (versus negative; p = 0.002) were more likely to have metastatic non-SLN(s). Conclusions SLNB has a high identification rate and modest false-negative rate in LABC patients who became clinically axillary node negative after NAC. Residual tumor size and nodal status before NAC affect SLNB accuracy. Additional involvement of non-SLN(s) increases with the presence of multifocal/multicentric tumors, lymphovascular invasion, residual tumor size >2 cm, and extra-sentinel node extension.

Purpose To assess the accuracy of magnetic resonance imaging with pelvic phased-array and endorectal coils prospectively, and evaluate if endorectal coil provides any additional information to high resolution pelvic MR imaging in rectal carcinoma staging. Materials and methods Preoperative MRI of 25 patients with rectal carcinoma was performed with pelvic phased-array coil alone, and with both phased-array coil and endorectal coil placed. Staging was made by evaluating images obtained by using both coils prospectively, and correlated with histopathologic staging. The images were then assessed separately, and compared to each other retrospectively. Results Two and 3 of the 5 histopathologically proved T1 tumors were staged correctly on MRI with pelvic phased-array coil alone and after the endorectal coil placement, respectively. Histopathologically identified five T2 tumors were staged correctly as T2 in 4 of the cases, 1 was understaged and 10 of 14 patients who had T3 tumor were staged as T3, 4 of them were understaged as T2 on both techniques. Specificity, sensitivity and accuracy rates for staging of T3 tumors were found as 71%, 100% and 84%, respectively, for each technique. Sensitivity and positive predictive value of N staging were both 88% on both techniques. Conclusion Pelvic MR imaging after the placement of endorectal coil in addition to the phase-array coil was not superior to the imaging with phased-array coil alone in T staging of rectal carcinomas and the latter achieved better visualization of the lymph nodes by means of larger field of view.

PubMed ID: 17854795 A novel fully automated system is introduced to facilitate lesion detection in dynamic contrast-enhanced, magnetic resonance mammography (DCE-MRM). The system extracts breast regions from pre-contrast images using a cellular neural network, generates normalized maximum intensity-time ratio (nMITR) maps and performs 3D template matching with three layers of 12 × 12 cells to detect lesions. A breast is considered to be properly segmented when relative overlap > 0.85 and misclassification rate < 0.10. Sensitivity, false-positive rate per slice and per lesion are used to assess detection performance. The system was tested with a dataset of 2064 breast MR images (344 slices × 6 acquisitions over time) from 19 women containing 39 marked lesions. Ninety-seven percent of the breasts were segmented properly and all the lesions were detected correctly (detection sensitivity = 100 %), however, there were some false-positive detections (31%/lesion, 10%/slice). © 2007 Elsevier Ltd. All rights reserved.

Cellular neural networks(CNNs) are massively parallel cellular structures with learning abilities. They can be used to realize complex image processing applications efficiently and in almost real time. In this preliminary study, we propose a novel, robust, and fully automated system based on CNNs to facilitate lesion localization in contrast-enhanced MRmammography, a difficult task requiring the processing of a large number of images with attention paid to minute details. The data set consists of 1170 slices containing one precontrast and five postcontrast bilateral axial MRmammograms from 39 patients with 37 malignant and 39 benign mass lesions acquired using a 1.5 Tesla MRscanner with the following parameters: 3D FLASH sequence, TR/TE 9.80/4.76 ms, flip angle 25 ° , slice thickness 2.5 mm, and 0.625 × 0.625 mm 2 in-plane resolution. Six hundred slices with 21 benign and 25 malignant lesions of this set are used for training the CNNs; the remaining data are used for test purposes. The breast region of interest is first segmented from precontrast images using four 2D CNNs connected in cascade, specially designed to minimize false detections due to muscles, heart, lungs, and thoracic cavity. To identify deceptively enhancing regions, a 3D nMITR map of the segmented breast is computed and converted into binary form. During this process tissues that have low degrees of enhancements are discarded. To boost lesions, this binary image is processed by a 3D CNN with a control template consisting of three layers of 11 × 11 cells and a fuzzy c -partitioning output function. A set of decision rules extracted empirically from the training data set based on volume and 3D eccentricity features is used to make final decisions and localize lesions. The segmentation algorithm performs well with high average precision, high true positive volume fraction, and low false positive volume fraction with an overall performance of 0.93 ± 0.05 , 0.96 ± 0.04 , and 0.03 ± 0.05 , respectively (training: 0.93 ± 0.04 , 0.94 ± 0.04 , and 0.02 ± 0.03 ; test: 0.93 ± 0.05 , 0.97 ± 0.03 , and 0.05 ± 0.06 ). The lesion detection performance of the system is quite satisfactory; for the training data set the maximum detection sensitivity is 100 % with false-positive detections of 0.28/lesion, 0.09/slice, and 0.65/case; for the test data set the maximum detection sensitivity is 97 % with false-positive detections of 0.43/lesion, 0.11/slice, and 0.68/case. On the average, for a detection sensitivity of 99 % , the overall performance of the system is 0.34/lesion, 0.10/slice, and 0.67/case. The system introduced does not require prior information concerning breast anatomy; it is robust and exceptionally effective for detecting breast lesions. The use of CNNs, fuzzy c -partitioning, volume, and 3D eccentricity criteria reduces false-positive detections due to artifacts caused by highly enhanced blood vessels, nipples, and normal parenchyma and artifacts from vascularized tissues in the chest wall due to oversegmentation. We hope that this system will facilitate breast examinations, improve the localization of lesions, and reduce unnecessary mastectomies, especially due to missed multicentric lesions and that almost real-time processing speeds achievable by direct hardware implementations will open up new clinical applications, such as making feasible quasi-automated MR-guided biopsies and acquisition of additional postcontrast lesion images to improve morphological characterizations.

Although the sensitivity of imaging studies is high in solitary parathyroid adenomas, negative results are inevitable. The aims of this prospective clinical study are to evaluate the impact of the presence of thyroid disease on the sensitivity and positive predictive value (PPV) of ultrasonography (US), sestamibi (MIBI), and parathyroid fine needle aspiration and parathormone assay (PTH-FNA).The patients were divided into 4 groups according to preoperative imaging studies: group A (n = 62) with US, group B (n = 62) with MIBI, group C (n = 62) with US + MIBI, and group D (n = 62) with PTH-FNA. These 4 groups were subdivided according to the presence (group 1) or absence (group 2) of thyroid nodule.In the overall patients, the sensitivity and PPV of PTH-FNA to localize parathyroid adenoma was higher compared with US, MIBI, and US + MIBI (100% and 100% versus 96% and 91% versus 92% and 87% versus 95% and 94%, respectively, P.05). The sensitivity and PPV of US, MIBI, and US + MIBI in the patients without thyroid nodule was higher compared with the patients with thyroid nodule (100% and 100%, 100% and 96%, 100% and 100% versus 93% and 84%, 85% and 80%, 96% and 86%, respectively, P.05). The sensitivity and PPV of the PTH-FNA was 100% in the patients with and without a thyroid nodule.PTH-FNA can be performed safely for the confirmation of parathyroid adenoma localized by preoperative imaging studies. In patients with a concomitant thyroid nodule, PTH-FNA was more accurate to detect the parathyroid adenoma than the other imaging studies.

Rationale and Objectives The objective of this work was to develop a quantitative method for improving lesion detection in dynamic contrast-enhanced magnetic resonance mammography (DCEMRM). For this purpose, we segmented and analyzed suspicious regions according to their contrast enhancement dynamics, generated a normalized maximum intensity–time ratio (nMITR) projection, and explored it to extract important features, to improve accuracy and reproducibility of detection. Materials and Methods A novel automated method is introduced to segment and analyze lesions in three dimensions. It consists of four consecutive stages: volume of interest selection, nMITR projection generation using a voxel sampling method based on a moving 3 × 3 mask, three-dimensional lesion segmentation, and feature extraction. The nMITR projection of the detected lesion is used to extract six features: mean, maximum, standard deviation, kurtosis, skewness, and entropy, and their diagnostic significance is studied in detail. High-resolution MR images of 52 breast masses from 46 women are analyzed using the technique developed. Results Entropy, standard deviation, and the maximum and mean value features were found to have high significance ( P Conclusion The lesion detection method described is efficient and leads to improved, accurate, reproducible diagnoses. It is reliable in terms of observer variability and may allow for a better standardization of clinical evaluations. The findings demonstrate the usefulness of nMITR based features; nMITR-entropy shows the best performance for quantitative diagnosis.

Objectives: Primary hyperparathyroidism (pHPT) is a common endocrine disease. The aim of this study was to assess the effect of the presence of thyroid nodules, adenoma weight, and ectopic localization on the sensitivity of different imaging studies in patients with hyperparathyroidism. Study Design: A series of 125 patients with pHPT who underwent low-frequency ultrasonography, high-frequency ultrasonography, Thallium-Technetium scintigraphy, sestamibi scintigraphy, and combined technique was reviewed retrospectively. Patients were divided in two groups depending on the presence or absence of thyroid nodules. Results: The overall sensitivity of low-frequency ultrasonography, high-frequency ultrasonography, Thallium-Technetium scintigraphy, sestamibi scintigraphy, and combined technique was 69%, 89%, 71%, 86%, and 98%, respectively. The sensitivity of these imaging studies was 94%, 100%, 94%, 96%, and 100%, respectively, in our patients with no thyroid nodules but decreased to 54%, 84%, 54%, 81%, and 79%, respectively, in the presence of thyroid nodules. The parathyroid adenoma weight in true-positive imaging studies was significantly higher than those in false-positive and false-negative imaging studies. The numbers of ectopic parathyroid adenomas were found to be higher in the group of parathyroid adenomas undetected with ultrasonography when compared with ultrasonographically detected adenomas. Conclusion: In patients with parathyroid adenoma, the sensitivity of imaging studies correlates with the presence of thyroid nodules, adenoma weight, and ectopic localization.

Granulomatous mastitis (GM) is a rare inflammatory breast disease of unknown etiology. Although it usually presents with sinus formation and abscesses, it may mimic the clinical characteristics of breast cancer. The aim of this study was to identify the clinical, radiologic, and pathologic characteristics of patients with GM and to show the results of surgical treatment in these patients. A chart review was performed for patients that were treated with a diagnosis of GM at the Breast Unit, Department of Surgery, Istanbul Medical Faculty, University of Istanbul, between September 1998 and January 2003. Eighteen patients were eligible for this study. The median age was 41.5 years (range 16–80 years). Seventeen patients were evaluated by both ultrasonography and mammography; whereas one young patient only had ultrasonography. Three patients were further examined with color Doppler ultrasonography and magnetic resonance imaging (MRI). Fourteen patients (78%) presented with a mass as the chief symptom, with a median size of 3.9 cm (range 1–8 cm), whereas four patients presented with fistula in their breasts. None of the radiologic techniques distinguished benign disease from cancer in any of the 14 patients that presented with a mass except one patient with normal mammography findings. Ultrasonography was only helpful to localize the abscess associated with a fistula tract in one patient. Therefore fine-needle aspiration biopsy (FNAB) was performed in six patients, followed by surgical excisional biopsy. The remaining eight patients with a clinical suspicion of malignancy underwent wide surgical excision with frozen section analysis under general anesthesia. All of the FNAB and frozen section evaluations revealed benign findings. All of the 18 patients underwent a wide excisional biopsy and had a definitive histopathologic diagnosis of GM. The median follow-up was 36 months (range 6–60 months). Only one patient had a recurrent disease, which was diagnosed at 12 months. GM is a rare breast disease that mimics cancer in terms of clinical findings. Preoperative radiologic diagnosis might be difficult. Complete surgical excision is the treatment of choice.

Multidetector CT (MDCT) has gained a great role in clinical imaging practice in a short time. Its major advantages are faster image acquisition and improved z-axis resolution. In spite of the advent of other imaging modalities CT is still the gold standard for the evaluation of pancreatic pathology. In this article, a review of the utility of MDCT in pancreatic applications is given with emphasis on acquisition techniques tailored to contrast material pharmacokinetics to improve lesion detection and characterization.

Endometriosis, an important gynecological disorder of reproductive women, affects most commonly the ovaries and less frequently the gastrointestinal tract, chest, urinary tract, and soft tissues. Endometriosis classically appears on MRI as a mass with a large cystic component and variable signal intensities on T1- and T2-weighted images due to the presence of variable degradation of hemorrhagic products. Endometriosis in an atypical location, an infiltrative appearance and without cystic-hemorrhagic components has rarely been described. We report on a 33-year-old woman with cyclic sciatica due to histologically documented infiltrative endometriosis involving the area of the left sciatic notch.

Gastric carcinoma is one of the leading causes of cancer mortality worldwide. Accurate preoperative staging of gastric cancer is important in planning the most effective therapy toward cure or palliation. This article reviews the radiologic diagnosis and staging of gastric cancer.

Diagnosis of extrapulmonary tuberculosis is often difficult. Although positive chest radiographic findings or a positive tuberculin skin test supports the diagnosis, negative results do not exclude extrapulmonary tuberculosis. However, recognition and understanding of the radiologic findings of extrapulmonary tuberculosis can help in diagnosis. The spine is the most common site of skeletal involvement. The femur, tibia, and small bones of the hands and feet are most commonly involved by tuberculous osteomyelitis. Tuberculosis of the joints is characteristically monoarticular; the knee and hip are most frequently affected. Central nervous system tuberculosis takes various forms, including meningitis, tuberculoma, abscess, cerebritis, and miliary tuberculosis. Ileocecal involvement is seen in 80%-90% of patients with abdominal tuberculosis. The most common manifestation of abdominal tuberculosis is lymphadenopathy. Genitourinary tuberculosis is the most common manifestation of extrapulmonary tuberculosis. Lymphatic tuberculosis is more common among children, with cervical or supraclavicular nodes most frequently involved. Tuberculosis of the breast is extremely rare and occurs most often in young, multiparous, lactating women. The radiologic features of extrapulmonary tuberculosis mimic those of many diseases. A high level of suspicion is required, especially in high-risk populations. A positive culture or histologic analysis of biopsy specimens is still required in many patients for definitive diagnosis.

Thalassemia is a kind of chronic, inherited, microcytic anemia characterized by defective hemoglobin synthesis and ineffective erythropoiesis. In all thalassemias clinical features that result from anemia, transfusional, and absorptive iron overload are similar but vary in severity. The radiographic features of beta-thalassemia are due in large part to marrow hyperplasia. Markedly expanded marrow space lead to various skeletal manifestations including spine, skull, facial bones, and ribs. Extramedullary hematopoiesis (ExmH), hemosiderosis, and cholelithiasis are among the non-skeletal manifestations of thalassemia. The skeletal X-ray findings show characteristics of chronic overactivity of the marrow. In this article both skeletal and non-skeletal manifestations of thalassemia are discussed with an overview of X-ray findings, including MRI and CT findings.

The purpose of this study was to evaluate the CT findings of pulmonary artery aneurysms in patients being treated for Behçet's disease.Thirteen patients with Behçet's disease who had a total of 46 aneurysms were included in the study. All patients underwent helical CT before and after treatment. Both initial and follow-up CT scans were evaluated for location, number, and size of aneurysms and for thrombosis and pulmonary parenchyma changes.Thirty-five (76%) of the 46 aneurysms completely disappeared during the 3-42 months of treatment (mean, 21 months), and the remaining 11 aneurysms (24%) became smaller. Both disappearance and regression of aneurysms were preceded by thrombus formation. In 15 initially thrombosed aneurysms (33%), the thrombus increased in size during treatment. After treatment, the thrombus regressed and the pulmonary artery aneurysms disappeared. Thirty-one initially nonthrombosed aneurysms (67%) first became thrombosed during treatment; later, the thrombus regressed and the aneurysm decreased in size. Perianeurysmal consolidation and air-space nodules detected in seven patients disappeared in the early stages of treatment. Mosaic attenuation areas were seen in eight patients and disappeared in seven (88%) after treatment.Pulmonary artery aneurysms in Behçet's disease may become smaller or disappear with medical treatment. Mural thrombotic changes may be observed during the regression of pulmonary artery aneurysms. Helical CT is helpful in the diagnosis and follow-up of aneurysms and thrombosis in Behçet's disease.

Skeletal abnormalities such as hypertrophic callus formation and "popcorn" calcifications are rare radiological findings of osteogenesis imperfecta, causing tumor-like appearances on imaging. We report on a 7-year-old girl with osteogenesis imperfecta presenting with hepatomegaly and palpable lymphadenopathy in the left inguinal region on physical examination. Computed tomography examination revealed a high-density mass-like lesion of the manubrium sterni. Ultrasonography and a lateral roentgenogram of the chest verified that this was a pseudomass caused by a bowed sternal manubrium.

INTRODUCTION The primary aim of this study is to investigate the effect of change in the expression levels of survivin, glutathione-S-transferase P1 (GSTP1), and topoisomerase 2α (TOP2A) on the response to antracyclin-based and taxane-based neoadjuvant chemotherapy. METHODS This study included 32 locally advanced breast cancer patients. Tumoral expressions of survivin, TOP2A, and GSTP1 in serial biopsy specimens obtained before treatment, after sequential 4 cycles of doxorubicin+cyclophosphomide, and 4 cycles of docetaxel were analyzed by real-time polymerase chain reaction. Survivin expressions were additionally analyzed in serial blood samples. RESULTS The pathologic complete response (pCR) rate and the overall response rate (clinical complete and partial) were 28% (n=9) and 91% (n=29), respectively. There were no statistically significant correlations between serial TOP2A expression levels and response. There was a nonsignificant trend toward an improved response rate with decreased survivin expression. A significant decrease in the GSTP1 expression level throughout treatment (P=0.014), which was also shown to be significantly correlated with a pCR (P=0.0001), was seen. Downregulation of GSTP1 after 4 cycles of anthracycline-based combination was independently associated with improved progression-free survival (P=0.01). CONCLUSIONS Downregulation of GSTP1 is a significant predictor of pCR and improved progression-free survival during anthracycline-based and taxane-based neoadjuvant chemotherapy in patients with locally advanced breast cancer.

The aim of this study was to evaluate the effect of breast magnetic resonance imaging (MRI) on preoperative or intraoperative surgical planning.One hundred and sixty females with breast cancer were enrolled in the study. The contribution of MRI compared to MMG and USG, their histopathological concordance, and their impact on surgical treatment were evaluated prospectively.In 48 (30.0%) of the patients, MRI identified suspicious lesions that were not detected by MMG and USG. The diagnosis by MRI was accurate in 17 (10.6%) of them, while in remaining 31 patients (19.4%) the additional lesions found by MRI and interpreted as malignant were found not to be malignant. The pathological accordance of MRI and MMG compared with USG were 69.3 and 70.0%, respectively, whereas individually, MMG and USG were in accordance with the pathological examination in 52.9 and 67.9% of the cases, respectively.Assessment of the tumor size, multifocality, multicentricity, and presence of ductal carcinoma in situ by MRI may lead to misinterpretations in the majority of patients. The surgical approach should not be changed based solely on MRI findings. An accurately interpreted MMG combined with USG may be sufficient in most cases.

We aimed to compare the diagnostic value of fine-needle aspiration cytology (FNAC) and fine-needle aspiration thyroglobulin measurements (FNA-Tg) for detecting cervical lymph node metastases from differentiated thyroid carcinomas.This prospective study included 225 patients with neck node metastases or recurrences of papillary thyroid carcinoma. From the 225 patients, 255 lymph nodes were evaluated by FNAC and FNA-Tg. Final diagnoses confirmed by histological examination were compared to preoperative FNAC and FNA-Tg results.FNAC correctly diagnosed 212 metastatic lymph nodes but failed to diagnose 43 of them. FNA-Tg correctly diagnosed 253 metastatic lymph nodes but failed to diagnose two of them. FNA-Tg levels showed 100% sensitivity, 96% specificity, 99% diagnostic accuracy, a 99% positive predictive value (PPV) and a 100% negative predictive value (NPV) with a threshold level of FNA-Tg with a diagnostic accuracy 28.5 ng/ml. The specificity, diagnostic accuracy, PPV and NPV of FNA-Tg were significantly higher than those of FNAC.FNA-Tg measurement can be performed safely for the detection of lymph node metastasis in patients with differentiated thyroid carcinomas.

Cerebral alveolar echinococcosis is rare. We report a case with multiple intracranial masses which show cauliflower-like contrast enhancement pattern on MRI. The lesions originated from hepatic involvement with invasion of the inferior vena cava.

To assess the role of magnetic resonance imaging (MRI), particularly signal intensity changes, in predicting the dedifferentiation of parosteal osteosarcoma, and to evaluate other factors that may affect grading on MRI.MRI of 12 patients with parosteal osteosarcoma diagnosed on plain radiography were reviewed with regard to size, location, extent, soft tissue component, intramedullary invasion, and signal characteristics. The findings are correlated with histopathologic results.By histopathological examination there were 6 Grade I, 3 Grade II, and 3 Grade III tumors. Average size was 11 cm. All cases had a soft tissue component. Intramedullary extension was evident in 3/6 of the Grade I cases, 2/3 of the Grade II cases, and all (3/3) of the Grade III cases. T1-weighted images revealed lesions of marked hypointensity. Signal intensity on T2-weighted images varied with the presence of necrosis and hemorrhage in relation to size, regardless of the grade of the tumor. Contrast-enhanced images revealed enhancement of the solid components; no enhancement was observed in the necrotic or hemorrhagic parts.High and heterogeneous signal on T2-weighted images of Grade I, II, and III tumors is not specific for the dedifferentiated component, due to hemorrhage and necrosis in large masses. Therefore, high signal intensity on T2-weighted images is not always a reliable way to predict the grade of the tumor. Contrast enhanced T1-weighted images can be valuable to show the solid component in the heterogeneous areas on T2-weighted images, and can be useful in guiding the biopsy.

Effectiveness of morphological descriptors based on normalized maximum intensity-time ratio (nMITR) maps generated using a 3 x 3 pixel moving mask on dynamic contrast-enhanced magnetoresistance (MR) mammograms are studied for assessment of malignancy. After a rough indication of volume of interest on the nMITR maps, lesions are automatically segmented. Two-dimensional (2D) convexity, normalized complexity, extent, and eccentricity as well as three-dimensional (3D) versions of these descriptors and contact surface area ratio are computed. On a data set consisting of dynamic contrast-enhanced MR DCE-MR mammograms from 51 women that contain 26 benign and 32 malignant lesions, 3D convexity, complexity, and extent are found to reflect aggressiveness of malignancy better than 2D descriptors. Contact surface area ratio which is easily adaptable to different imaging resolutions is found to be the most significant and accurate descriptor (75% sensitivity, 88% specificity, 89% positive predictive values, and 74% negative predictive values).

Background Concomitant thyroid nodules are the most common reason for false-positive ultrasonography (US) results in primary hyperparathyroidism. The aims of this prospective clinical study were to evaluate false-positive US results according to the characteristics of concomitant thyroid nodules and to determine which characteristics of thyroid nodules are important. Study design This prospective study included 120 consecutive patients with primary hyperparathyroidism. The patients were divided into 2 groups according to preoperative US results. Group 1 consisted of 32 patients with false-positive US results and group 2 consisted of 88 patients with true-positive US results. Results The risk for false-positive US result was increased 25-fold for patients with parathyroid adenoma weight of more than 500 mg (odds ratio [OR], 25; 95% confidence interval [CI], 8.6–74.5), 75-fold for more than 1 posteriorly located thyroid (OR, 75; 95% CI, 19.3–293.4), 358-fold for the presence of exophytic thyroid nodules (OR, 358; 95% CI, 42.3–3036), and 423-fold for the presence of posteriorly located thyroid nodules (OR, 423; 95% CI, 49–3662). Conclusion Although there was no particular characteristic of concomitant thyroid nodules that contributes to false-positive US results, the posteriorly located thyroid nodules were the strongest correlate for the false-positive US results to other features.

Cellular neural networks (CNNs) are massively parallel cellular structures with learning abilities. They can be used to realize complex image processing applications efficiently and in almost real time. In this preliminary study, we propose a novel, robust, and fully automated system based on CNNs to facilitate lesion localization in contrast-enhanced MR mammography, a difficult task requiring the processing of a large number of images with attention paid to minute details. The data set consists of 1170 slices containing one precontrast and five postcontrast bilateral axial MR mammograms from 39 patients with 37 malignant and 39 benign mass lesions acquired using a 1.5 Tesla MR scanner with the following parameters: 3D FLASH sequence, TR/TE 9.80/4.76 ms, flip angle 250, slice thickness 2.5 mm, and 0.625 x 0.625 mm2 in-plane resolution. Six hundred slices with 21 benign and 25 malignant lesions of this set are used for training the CNNs; the remaining data are used for test purposes. The breast region of interest is first segmented from precontrast images using four 2D CNNs connected in cascade, specially designed to minimize false detections due to muscles, heart, lungs, and thoracic cavity. To identify deceptively enhancing regions, a 3D nMITR map of the segmented breast is computed and converted into binary form. During this process tissues that have low degrees of enhancements are discarded. To boost lesions, this binary image is processed by a 3D CNN with a control template consisting of three layers of 11 x 11 cells and a fuzzy c-partitioning output function. A set of decision rules extracted empirically from the training data set based on volume and 3D eccentricity features is used to make final decisions and localize lesions. The segmentation algorithm performs well with high average precision, high true positive volume fraction, and low false positive volume fraction with an overall performance of 0.93 +/- 0.05, 0.96 +/- 0.04, and 0.03 +/- 0.05, respectively (training: 0.93 +/- 0.04, 0.94 +/- 0.04, and 0.02 +/- 0.03; test: 0.93 +/- 0.05, 0.97 +/- 0.03, and 0.05 +/- 0.06). The lesion detection performance of the system is quite satisfactory; for the training data set the maximum detection sensitivity is 100% with false-positive detections of 0.28/lesion, 0.09/slice, and 0.65/case; for the test data set the maximum detection sensitivity is 97% with false-positive detections of 0.43/lesion, 0.11/slice, and 0.68/case. On the average, for a detection sensitivity of 99%, the overall performance of the system is 0.34/lesion, 0.10/slice, and 0.67/case. The system introduced does not require prior information concerning breast anatomy; it is robust and exceptionally effective for detecting breast lesions. The use of CNNs, fuzzy c-partitioning, volume, and 3D eccentricity criteria reduces false-positive detections due to artifacts caused by highly enhanced blood vessels, nipples, and normal parenchyma and artifacts from vascularized tissues in the chest wall due to oversegmentation. We hope that this system will facilitate breast examinations, improve the localization of lesions, and reduce unnecessary mastectomies, especially due to missed multicentric lesions and that almost real-time processing speeds achievable by direct hardware implementations will open up new clinical applications, such as making feasible quasi-automated MR-guided biopsies and acquisition of additional postcontrast lesion images to improve morphological characterizations.

A fully automated software is introduced to facilitate MR mammography (MRM) examinations and overcome subjectiveness in diagnosis using normalized maximum intensity-time ratio (nMITR) maps. These maps inherently suppress enhancements due to normal parenchyma and blood vessels that surround lesions and have natural tolerance to small field inhomogeneities and motion artifacts. The classifier embedded within the software is trained with normalized complexity and maximum nMITR of 22 lesions and tested with the features of remaining 22 lesions. Achieved diagnostic performances are 92% sensitivity, 90% specificity, 91% accuracy, 92% positive predictive value and 90% negative predictive value. DynaMammoAnalyst shortens evaluation time considerably and reduces inter and intra-observer variability by providing decision support.

Purpose. The key to successful parathyroid surgery is accurate preoperative tumor localization. This study investigates the use of ultrasound (US)-guided parathyroid fine needle aspiration (FNA) as a confirmatory diagnostic method in patients with hyperparathyroidism undergoing minimally invasive parathyroidectomy. Methods. Patients were selected for minimally invasive parathyroidectomy based on the finding of a single parathyroid adenoma identified with US and/or sestamibi scans and confirmation of the suspected parathyroid lesion via FNA and parathyroid hormone (PTH) assay. The value of aspirate obtained from the thyroid gland intraoperatively served as the negative control. Results. A total of 56 tissue FNAs were performed in 27 patients. US detected masses suggestive of parathyroid lesion in all 27 patients, and 31 US-guided FNAs were performed. No complications related to the procedure were noted. Intraoperatively, FNA was performed in the thyroids of 25 patients undergoing minimally invasive parathyroidectomy. Aspirates from lesions subsequently confirmed as having developed from the parathyroid gland had a mean PTH level of 4,677 ± 123 pg/ml (range, 3,600–5,000 pg/ml), which was significantly higher than thyroid aspirates, which yielded a mean PTH level of 48 ± 7 pg/ml (range, 5–57 pg/ml). The sensitivity of US and sestamibi scans in the detection of abnormal parathyroid glands was 88% and 77%, respectively. The sensitivity of US-guided FNA in confirming the parathyroid origin of a lesion was 100%. Conclusion. US-guided FNA for PTH assay can be performed safely for the confirmation of lesions identified with preoperative US for the selection of patients eligible for minimally invasive parathyroidectomy. © 2006 Wiley Periodicals, Inc. J Clin Ultrasound, 2006

The objective of this work was to develop a quantitative method for improving lesion detection in dynamic contrast-enhanced magnetic resonance mammography (DCEMRM). For this purpose, we segmented and analyzed suspicious regions according to their contrast enhancement dynamics, generated a normalized maximum intensity-time ratio (nMITR) projection, and explored it to extract important features, to improve accuracy and reproducibility of detection.A novel automated method is introduced to segment and analyze lesions in three dimensions. It consists of four consecutive stages: volume of interest selection, nMITR projection generation using a voxel sampling method based on a moving 3 x 3 mask, three-dimensional lesion segmentation, and feature extraction. The nMITR projection of the detected lesion is used to extract six features: mean, maximum, standard deviation, kurtosis, skewness, and entropy, and their diagnostic significance is studied in detail. High-resolution MR images of 52 breast masses from 46 women are analyzed using the technique developed.Entropy, standard deviation, and the maximum and mean value features were found to have high significance (P0.001) and diagnostic accuracy (0.86-0.97). The kurtosis and skewness were not significant. Automated analysis of DCEMRM using nMITR was shown to be feasible.The lesion detection method described is efficient and leads to improved, accurate, reproducible diagnoses. It is reliable in terms of observer variability and may allow for a better standardization of clinical evaluations. The findings demonstrate the usefulness of nMITR based features; nMITR-entropy shows the best performance for quantitative diagnosis.

Our objective was to reveal the frequency and MDCT appearances of sternal variations and anomalies in subjects without sternal deformities.One thousand consecutive patients who underwent thoracic MDCT examination were enrolled in the study. All MDCT data, including multiplanar and curved-planar reconstructed images, were evaluated for detection of sternal variations and anomalies. Various kinds of sternal variations and anomalies, such as suprasternal bones and tubercles, manubriosternal and sternoxiphoidal fusions, sternal clefts and foramina, and sternal sclerotic bands were documented.In 1,000 subjects, the frequencies of main sternal variations and anomalies were as follows: suprasternal bone in 4.1%, suprasternal tubercle in 4%, complete manubriosternal fusion in 19.6%, complete sternoxiphoidal fusion in 30.3%, sternal foramen in 4.5%, and sternal sclerotic band in 37.1%. Xiphoidal foramen was seen in 27.4%, and the most common type was single foramen. Xiphoid process mostly ended as a single process (71%). Double-ended xiphoid process was also frequent (27.2%). Pseudocleft and pseudoforamen at the sternoxiphoidal junction were detected in 3.3% and in 3.6% of subjects, respectively.MDCT exhibited various sternal variations and anomalies. Sternal foramen is a frequent minor anomaly and generally associated with sternal sclerotic bands. Early manubriosternal and sternoxiphoidal fusions can be seen in early adulthood without osteodegeneration. Double-ended xiphoid process and single xiphoidal foramen are frequent sternal variations. Awareness of MDCT appearances of sternal variations and anomalies provides a better differential diagnosis with pathologic conditions.

Objective: To measure the distances between the internal mammary arteries (IMAs) and the sternum for determining a route for parasternal transthoracic interventions. Methods: Coronal reconstructed multidetector computed tomography images of 202 patients were evaluated to measure the distances between the IMAs and sternum at 3 levels (manubrium, midsternal corpus, and distal sternal corpus). The arrangements (2 veins-single artery or single vein-single artery) were documented. Results: The most frequently encountered arrangement (42.1%) was a single vein and single artery on both sides. Mean distances on the right and left sides were 10.2 and 10.1 cm at the manubrium, 14.5 and 14.3 cm at the midsternal corpus, and 17.9 and 17.5 cm at distal sternal corpus, respectively. Conclusion: To be aware of the courses of the IMAs at different sternal levels is important during attempts at transthoracic intervention via a parasternal approach.

Summary Arterial manifestations of Behcet's disease consist of aneurysm formation, stenosis and occlusion. Aneurysms in Behcet's disease most commonly involve the pulmonary arteries and have been shown to resolve with medical treatment. However, this regression pattern with medical therapy has not been reported for aortic aneurysms to date. We present a 43-year-old man with bilateral abdominal aortic aneurysms resulting from Behcet's disease resolving with medical therapy.

Diffuse pulmonary lymphangiomatosis is a rare pulmonary disorder affecting the lymphatic channels from the mediastinum to the pleura. The disease usually occurs in children and young adults and frequently ends with death due to progressive course. Imaging findings of the disease are based on lymphatic involvement which appear as mediastinal soft tissue infiltration and thickening of pulmonary peribroncovascular bundles and interlobular septae. In this report, spiral and high-resolution computed tomography, and ultrasonography findings of severe form of this rare disease are presented. Furthermore, some lymphatic disorders, which are called with similar name but different appearances on imaging, are discussed.

To evaluate the diagnostic efficiency of multislice CT colonography in the detection of colorectal tumors by comparing it with conventional colonography in patients with high risk of colorectal cancer.Thirty-seven patients who had undergone conventional colonoscopy because of a suspicion of colorectal cancer were scanned with a four-detector multislice CT scanner with 4 x 1 mm detector collimation, 120 kV, 0.5 sec gantry rotation and 120 mAs scan parameters. Multiplanar reformatted images, virtual colonography and virtual colonoscopy images were compared with conventional colonoscopy. With conventional colonoscopy taken as the reference standard, the results were calculated with 95% confidence interval technique.Seventeen of the 23 polyps detected in conventional colonoscopy were identified correctly with multislice CT. Nine of 11 lesions with a diameter of 10 mm or greater (81%), three of four lesions with a diameter of 6-9 mm (75%), and five of eight lesions with a diameter of 1-5 mm (62%) were correctly identified with multislice CT.Multislice CT colonography is a good alternative to other colorectal screening tests because it has high sensitivity for polyps 10 mm or larger in diameter, is relatively safe and minimally invasive.

Contrast-enhanced 3D MR voiding urethrography (CE 3D MRVU) was performed on 5 healthy volunteers and 18 patients with urethral disease. After intravenous injection of 0.3 ml/kg gadolinium, the images of the three consecutive acquisitions of the 3D MRVU technique were obtained during voiding. The raw data were reconstructed on all patients for visual analysis. The image quality of the volunteers was technically sufficient to demonstrate normal urethral anatomy. Contrast-enhanced 3D MR voiding urethrography of the urethral strictures was compared with conventional retrograde urethrography (n = 10) and urethroscopy (n = 12). The urethral pathologies including strictures and other obstructive causes of impaired urethral flow were correctly identified on CE 3D MRVU.

The purpose of this study was to describe the magnetic resonance imaging (MRI) appearance of hepatic alveolar echinococcosis (HAE) on T(1)-weighted, T(2)-weighted and postgadolinium images. A total of 13 lesions were demonstrated in 13 patients. All patients underwent MR examination at 1 T imager. MR examinations included precontrast T(1)-weighted breathing averaged spin echo (SE), breath-hold spoiled gradient echo, T(2)-weighted TSE sequences with and without fat suppression, and T(1)-weighted breath-hold spoiled gradient echo (SGE) sequence following i.v. after gadolinium administration. All lesions were confirmed with histopathology. HAE hepatic lesions revealed geographic patterns of variable signal intensities on noncontrast T(1)- and T(2)-weighted images. Slightly hyperintense, iso- and hypointense signal on T(1)-weighted images corresponded to calcified regions, which appeared hypo-isointense signal on T(2)-weighted images. Necrotic areas were hypointense signal on T(1)-weighted and hyperintense signal on T(2)-weighted images. On postgadolinium images, lesions did not reveal enhancement. Dilatation of intrahepatic bile ducts distal to HAE abscesses were observed in five patients and portal vein invasion or compression was observed in four patients, lobar atrophy of the liver was coexistent finding in cases with portal vein compression. The MRI appearance of HAE abscesses included large irregularly marginated masses with heterogenous signal on T(1)- and T(2)-weighted images and lack of enhancement with gadolinium.

Behcet’s disease (BD) is a relapsing chronic inflammaX-ray (CXR) showed bilateral hilar opacities. A CT scan of the thorax revealed multiple aneurysms in both tory disorder of unknown aetiology. Although BD has originally been described as a triad of recurrent oral right and left pulmonary arteries, as well as peripheral nodular opacities (Fig. 1). Multiple aneurysms in the aphthous ulceration, genital ulceration and uveitis, it is now recognized as a multisystem disease with vasculitis lobar, lobular and even segmental pulmonary arteries were further documented by a digital subtraction angioas the main pathological finding [1]. Involvement of the lungs is a rare feature of BD graphy. He started to receive 1 mg/kg prednisolone daily and 1 g i.v. pulse cyclophosphamide monthly. A partial [2–6 ]. Pulmonary artery aneurysm (PAA) is the bestdefined type of pulmonary disease in BD with an remission was achieved both clinically and radiologically with the regression of size of the aneurysms in 3 months, important morbidity and mortality [5]. After the widespread use of computed tomographic (CT ) and magnetic but he continued to suffer from haemoptysis intermittently while he was tapering the dosage of prednisolone. resonance imaging (MRI) methods, more BD patients with pulmonary parenchymal changes have been noted. He developed deep vein thrombosis in both his legs following a long journey, and his symptoms improved However, the pulmonary parenchymal involvement in BD still needs to be explored fully [6 ]. with bed rest and an increase in the dosage of prednisolone from 5 to 25 mg daily, which was later tapered Herein, we describe a patient with BD who developed multiple PAA and died of massive haemoptysis, and again to 10 mg. One month before his last admission, the haemoptysis discuss the pathological correlation of his peripheral pulmonary opacities. began to worsen when he experienced another attack of fever, productive cough and right-sided pleuritic chest pain. His symptoms were partially relieved with antiCase report biotics and increased doses of prednisolone (30 mg daily), and he was referred to our clinic. A 26-yr-old male patient was referred to our hospital On examination, the patient appeared chronically ill because of haemoptysis, dyspnoea and cough. The and pale. His blood pressure was 105/65 mmHg and the patient was well until 5 yr earlier, when he began to pulse rate was 100/min. Inspiratory crackles were heard experience recurrent oral and genital aphthous ulceraat both lung bases without a pleural friction rub. Scars tion and erythema nodosum. A skin pathergy test was of genital ulcers in the scrotum were noted. There was found to be positive when he was seen in another pretibial oedema in his left leg with signs of chronic hospital 4 yr later, and colchicine 0.5 mg t.d.s. was venous stasis. The erythrocyte sedimentation rate (ESR) started with the diagnosis of BD [7]. was 113 mm/h, white blood count (WBC) was Two months later, he suffered from bilateral pleuritic 15.05× 109/l, haemoglobin was 9.3 g/dl and haematochest pain with fever, cough and vomiting, and was crit was 29.4%. A CXR and high-resolution CT (HRCT) given antibiotics with a diagnosis of pneumonia. The scan of the thorax did not show any significant changes patient was admitted to the department of chest diseases in the sizes of the PAAs since the last control, but a when he developed haemoptysis 2 weeks later. Chest more marked mural thrombosis and perianeurysmal ground-glass opacities. Nodular or mass-like opacities Submitted 29 December 1998; revised version accepted 25 May 1999. with ill-defined margins and in broad contact with Correspondence to: A. Gul, Zuhuratbaba mah. Turkis cad. No: pleural surface and major fissure were seen in right 14/8, Bakirkoy 34740, Istanbul, Turkey. † Deceased. lower lobe scans (Fig. 2). Parenchymal patchy non