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Background: Prediction of histological tumor size by post-neoadjuvant therapy (NAT) ultrasound and magnetic resonance imaging (MRI) was evaluated in different breast cancer subtypes., Methods: Imaging was performed after 12-week NAT in patients enrolled into three neoadjuvant WSG ADAPT subtrials. Imaging performance was analyzed for prediction of residual tumor measuring ≤10 mm and summarized using positive (PPV) and negative (NPV) predictive values., Results: A total of 248 and 588 patients had MRI and ultrasound, respectively. Tumor size was over- or underestimated by < 10 mm in 4.4% and 21.8% of patients by MRI and in 10.2% and 15.8% by ultrasound. Overall, NPV (proportion of correctly predicted tumor size ≤10 mm) of MRI and ultrasound was 0.92 and 0.83; PPV (correctly predicted tumor size > 10 mm) was 0.52 and 0.61. MRI demonstrated a higher NPV and lower PPV than ultrasound in hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-positive and in HR-/HER2+ tumors. Both methods had a comparable NPV and PPV in HR-/HER2- tumors., Conclusions: In HR+/HER2+ and HR-/HER2+ breast cancer, MRI is less likely than ultrasound to underestimate while ultrasound is associated with a lower risk to overestimate tumor size. These findings may help to select the most optimal imaging approach for planning surgery after NAT., Trial Registration: Clinicaltrials.gov , NCT01815242 (registered on March 21, 2013), NCT01817452 (registered on March 25, 2013), and NCT01779206 (registered on January 30, 2013).

Objectives: To evaluate whether multiparametric breast-MRI, obtained before the initiation of neoadjuvant systemic therapy (NST) for operable breast cancer, predicts which cancer will achieve a pathological complete response (pCR) after the completion of NST., Methods: This was an IRB-approved retrospective study on 31 consecutive patients (median age, 56 years) with operable invasive breast cancer (median size: 22 mm; triple-negative: 11/31 [35%], HER2-positive: 7/31 [23%], triple-positive: 13/31 [42%]) who underwent multiparametric DCE-MRI before the initiation of NST. The MRI protocol consisted of high-resolution dynamic contrast-enhanced MRI (DCE-MRI), T2-TSE, and DWI (b-values 0, 100, 800 s/mm 2 ). The results of surgical pathology after the completion of NST served as a standard of reference. Patient characteristics (age and menopausal status), pathological tumor characteristics (type, stage, nuclear grade, ER/PR and HER2 receptor status, and Ki-67 staining), and MRI characteristics (size, morphology, T2 signal intensity, enhancement kinetics, and ADC values) before NST were evaluated and compared between patients achieving pCR vs. non-pCR., Results: Among 31 patients, 17 achieved pCR (55%) and 14 non-pCR (45%). No correlation was observed between patient- or tumor pathology-derived characteristics and pCR vs. non-pCR. Among MRI-derived tumor characteristics, tumor growth orientation parallel to Cooper's ligaments (p = 0.002) and wash-out rates (p = 0.019) correlated with pCR. Pre-NST ADC values were lower in patients achieving pCR (P = 0.086)., Conclusions: A tumor growth pattern parallel with Cooper's ligaments and a fast wash-out rate on pre-treatment multiparametric MRI are predictive of pCR and more closely associated with pCR than ADC values., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Purpose To compare the diagnostic performance of radiomic analysis (RA) and a convolutional neural network (CNN) to radiologists for classification of contrast agent-enhancing lesions as benign or malignant at multiparametric breast MRI. Materials and Methods Between August 2011 and August 2015, 447 patients with 1294 enhancing lesions (787 malignant, 507 benign; median size, 15 mm ± 20) were evaluated. Lesions were manually segmented by one breast radiologist. RA was performed by using L1 regularization and principal component analysis. CNN used a deep residual neural network with 34 layers. All algorithms were also retrained on half the number of lesions (n = 647). Machine interpretations were compared with prospective interpretations by three breast radiologists. Standard of reference was histologic analysis or follow-up. Areas under the receiver operating curve (AUCs) were used to compare diagnostic performance. Results CNN trained on the full cohort was superior to training on the half-size cohort (AUC, 0.88 vs 0.83, respectively; P = .01), but there was no difference for RA and L1 regularization (AUC, 0.81 vs 0.80, respectively; P = .76) or RA and principal component analysis (AUC, 0.78 vs 0.78, respectively; P = .93). By using the full cohort, CNN performance (AUC, 0.88; 95% confidence interval: 0.86, 0.89) was better than RA and L1 regularization (AUC, 0.81; 95% confidence interval: 0.79, 0.83; P < .001) and RA and principal component analysis (AUC, 0.78; 95% confidence interval: 0.76, 0.80; P < .001). However, CNN was inferior to breast radiologist interpretation (AUC, 0.98; 95% confidence interval: 0.96, 0.99; P < .001). Conclusion A convolutional neural network was superior to radiomic analysis for classification of enhancing lesions as benign or malignant at multiparametric breast MRI. Both approaches were inferior to radiologists' performance; however, more training data will further improve performance of convolutional neural network, but not that of radiomics algorithms. © RSNA, 2018 Online supplemental material is available for this article.

Morphological imaging of cartilage at high resolution allows the differentiation of chondral and osteochondral lesions. Nowadays, magnetic resonance imaging is the principal diagnostic tool in the assessment of cartilage structure and composition. Conventional radiography, computed tomography, ultrasound or optical coherence tomography are adjunct diagnostic modalities in the assessment of cartilage pathologies. The present article discusses the up-to-date diagnostic practice of cartilage imaging in terms of its scientific basis and current clinical status, requirements, techniques and image interpretation. Innovations in the field such as functional MRI are discussed as well due to their mid- to long-term clinical perspective.

Purpose To (a) compare the diagnostic accuracy of breast magnetic resonance (MR) imaging with that of conventional imaging (digital mammography and breast ultrasonography) in the identification of ductal carcinoma in situ (DCIS) components of biopsy-proven invasive breast cancer before surgery and (b) investigate the surgical outcome (positive margin rates and mastectomy rates) of women with breast cancer who underwent preoperative MR imaging combined with MR-guided needle biopsy and/or MR-guided lesion localization or bracketing where appropriate. Materials and Methods The authors performed a prospective two-center study of 593 consecutive patients with biopsy-proven invasive breast cancer who underwent breast MR imaging in addition to conventional imaging. MR-guided vacuum biopsy and MR-guided lesion bracketing were performed for DCIS components visible at MR imaging alone. The accuracy of breast MR imaging was compared with that of conventional imaging, and surgical outcomes (positive margin and mastectomy rates) were investigated. Results Surgical-pathologic assessment demonstrated DCIS components in 139 of the 593 women (23.4%). The sensitivity of MR imaging for the diagnosis of DCIS components pre-operatively (84.9%; 118 of 139) was significantly higher than that of conventional imaging (36.7%; 51 of 139) (P < .0001); more than half of DCIS components (51.1%; 71 of 139) were detected only with MR imaging. The sensitivity advantage of MR imaging over conventional imaging increased with increasing relative size of DCIS components, as follows: The sensitivity of MR imaging versus conventional imaging for small, marginal DCIS components was 56.8% (21 of 37) versus 29.7% (11 of 37); the sensitivity for extensive DCIS components was 91.7% (55 of 60) versus 41.7% (25 of 60); the sensitivity for large, predominant DCIS components was 100.0% (42 of 42) versus 35.7% (15 of 42). Moreover, the sensitivity advantage of MR imaging over conventional imaging increased with increasing nuclear grade of DCIS components, as follows: The sensitivity of MR imaging versus conventional imaging for low-grade DCIS components was 74.0% (20 of 27) versus 40.7% (11 of 27); the sensitivity for intermediate-grade DCIS components was 84.1% (53 of 63) versus 34.9% (22 of 63); the sensitivity for high-grade DCIS components was 91.8% (45 of 49) versus 36.7% (18 of 49) (P < .05-.001 for all). Positive margin rates were low overall (3.7% [95% Clopper Pearson confidence interval [CI]: 2.3%, 5.6%]) and did not differ significantly between the 139 women with DCIS components (5.0% [95% CI: 2.0%, 10.1%]) compared with the 454 women without such components (3.3% [95% CI: 1.9%, 5.4%]). The same was true for mastectomy rates (10.8% [95% CI: 6.2%, 17.2%] vs 8.1% [95% CI: 5.8%, 11.1%]). Conclusion Breast MR imaging improves depiction of DCIS components of invasive breast cancers before surgery and is associated with positive margin and mastectomy rates that are low irrespective of the presence or absence of DCIS components. © RSNA, 2017.

Purpose To investigate the utility and accuracy of breast magnetic resonance (MR) imaging as a supplemental screening tool in women at average risk for breast cancer and to investigate the types of cancer detected with MR imaging screening. Materials and Methods This prospective observational study was conducted at two academic breast centers in women aged 40-70 years without breast cancer-associated risk factors (lifetime risk <15%). Between January 2005 and December 2013, women with at least minimal residual breast tissue (American College of Radiology categories A-D) and normal conventional imaging findings (screening mammography with or without screening ultrasonography [US]) were invited to undergo supplemental MR imaging screening. Outcome measures were supplemental cancer detection rates, interval cancer rates, and biologic profiles of MR imaging-detected additional cancers, as well as specificity and positive predictive value (PPV) of MR imaging screening. Tissue diagnoses or 2 years of follow-up were used to establish the reference standard. Results A total of 2120 women were recruited and underwent 3861 screening MR imaging studies, covering an observation period of 7007 women-years. Breast MR imaging depicted 60 additional breast cancers (ductal carcinoma in situ, n = 20; invasive carcinoma, n = 40) for an overall supplemental cancer detection rate of 15.5 per 1000 cases (95% confidence interval [CI]: 11.9, 20.0). Forty-eight additional cancers were detected with MR imaging at initial screening (supplemental cancer detection rate, 22.6 per 1000 cases). During the 1741 subsequent screening rounds, 12 of 13 incident cancers were found with MR imaging alone (supplemental cancer detection rate, 6.9 per 1000 cases). One cancer was diagnosed with all three methods (mammography, US, and MR imaging), and none were diagnosed with mammography only or US only. Cancers diagnosed with MR imaging were small (median, 8 mm), node negative in 93.4% of cases, and dedifferentiated (high-grade cancer) in 41.7% of cases at prevalence screening and 46.0% of cases at incidence screening. No interval cancers were observed. MR imaging screening offered high specificity (97.1%; 95% CI: 96.5, 97.6) and high PPV (35.7%; 95% CI: 28.9, 43.1). Conclusion In women at average risk for breast cancer, MR imaging screening improves early diagnosis of prognostically relevant breast cancer. © RSNA, 2017 Online supplemental material is available for this article.

Background: A correctly chosen radiographic technique, good image quality and correct image interpretation are the basis of all surgical planning. It is only when the cause and extent of the hip pathology are evaluated carefully based on radiologic imaging that the long-term surgical success of hip and pelvis osteotomy is possible., Target: This article gives an overview over performance, quality criteria and interpretation of the most important radiographic images of the hip., Results: The anterior-posterior pelvic view is the most important radiograph for planning an osteotomy of the hip. Besides the evaluation of the underlying cause, the caput-collum-diaphyseal angle (CCD) can be calculated from the pelvic view. For the evaluation of the real femoral antetorsion angle (AT-angle) a Rippstein II projection needs to be performed. Lequesne's false-profile view is important to assess the ventral part of the joint, especially to measure the anterior coverage of the femoral head. In neonates and children, the pelvic hip view is important to assess hip dysplasia. The relevant characteristic lines and angles that should evaluated in the pelvic hip view are the Hilgenreiner line, of the Perkin line, the acetabular angle (AC-angle) and Reimers migration index. Computed tomography allows 3D surgical planning and is the most accurate technique for measuring the AT-angle., Conclusion: Magnet resonance imaging is of help for the evaluation of hip pathologies such as labrum and cartilage injuries. MRI for this purpose should always be performed as an MR-arthrography.

Purpose: To prospectively investigate the influence of taxane-containing neoadjuvant chemotherapy (T-NACT) versus non-taxane-containing NACT (NT-NACT) on the contrast material enhancement of breast cancers, benign enhancing lesions (BELs), and background parenchymal enhancement (BPE) at dynamic contrast-enhanced magnetic resonance (MR) imaging., Materials and Methods: This institutional review board-approved study was performed in 62 patients with invasive breast cancer who underwent multiagent NACT with (n = 49) or without (n = 13) taxanes between 2008 and 2011. Written informed consent was obtained. Patients underwent dynamic contrast-enhanced MR imaging according to a standardized protocol before and 2 weeks after completing NACT. The percentage reduction of enhancement of breast cancers, BELs, and BPEs was calculated for patients undergoing NT-NACT versus those undergoing T-NACT. Final surgical pathologic results served as standard of reference. Changes in mean enhancement of breast cancers, BELs, and BPEs between the regimens were compared by using the Student t test for unpaired samples; for intraindividual comparison, the Student t test for paired samples was used., Results: Similar rates of complete pathologic response were observed after T-NACT and NT-NACT (28 [57.2%] of 49 vs eight [61.5%] of 13). T-NACT was associated with an almost complete suppression of enhancement in not only breast cancers but also BELs and BPE in the same patients, with an average reduction of enhancement of -89.9% ± 9.3, -90.2% ± 11.8, and -91.2% ± 7.5, respectively. After T-NACT, cancers with partial (n = 21) or complete (n = 28) pathologic response exhibited a similar reduction of enhancement (-81.8% ± 17.5 vs -93.9% ± 2.3; P = .22). The reduction of enhancement of cancers after NT-NACT was significantly less pronounced than that after T-NACT (-41.1% ± 22.8 vs 88.1% ± 13.9; P < .0001), and effects on enhancement of BELs and BPE were significantly less pronounced compared with effects on enhancement of cancers in the same women (P < .0001). MR imaging led to an overestimation of response (yielded false-negative results for residual disease) in 66.7% (14 of 21) of patients after T-NACT, versus in 20% (one of five) of patients after NT-NACT., Conclusion: The reduction of enhancement observed in breast cancers after T-NACT is, in part, unrelated to their oncologic response. MR imaging-detectable effects of taxanes represent a combination of specific antimitotic and nonspecific antiangiogenic effects. This impacts the accuracy with which dynamic contrast-enhanced MR imaging helps predict complete pathologic response to T-NACT. (©) RSNA, 2015 Online supplemental material is available for this article.

Purpose: To investigate the utility of magnetic resonance (MR) imaging according to different types of Breast Imaging Reporting and Data System (BI-RADS) category 4 findings from screening mammography and/or screening ultrasonography (US)., Materials and Methods: This institutional review board-approved prospective study included 340 patients in whom 353 lesions were detected at screening mammography or US and were rated BI-RADS category 4 after appropriate conventional work-up. Written informed consent was obtained from all patients. Women underwent standard dynamic contrast material-enhanced MR imaging for further assessment. Women with negative or benign MR findings who did not proceed to biopsy underwent intensified follow-up for at least 18 months. Pure clustered microcalcifications were followed up for at least 24 months., Results: Of the 353 study findings, 66 (18.7%) were finally shown to be true-positive (23 cases of ductal carcinoma in situ [DCIS], 43 invasive cancers) and 287 (81.3%) were false-positive. Assessment of MR imaging findings led to a correct diagnosis of no breast cancer in 264 of the 287 false-positive findings (92%) and helped confirm the presence of breast cancer in 63 of 66 malignancies. The false-negative rate for pure clustered microcalcifications was 12% (three of 25 cases) because of three nonenhancing low-grade DCIS cases; in turn, MR imaging depicted additional invasive cancers in three women with false-positive findings from mammography and US. For mammographic findings other than pure clustered microcalcifications, MR imaging increased the positive predictive value (PPV) from 17.5% (21 of 120 cases; 95% confidence interval [CI]: 10.7%, 24.3%) to 78% (21 of 27 cases; 95% CI: 62.1%, 93.5%), with a false-negative rate of 0%. For all US findings, MR imaging increased the PPV from 12.9% (20 of 155 cases; 95% CI: 7.6%, 18.2%) to 69% (20 of 29 cases; 95% CI: 52.2%, 85.8%), again with a false-negative rate of 0%. MR imaging resulted in false-positive findings that led to MR imaging-guided biopsy in five of the 340 patients (1.5%)., Conclusion: MR imaging is useful for the noninvasive work-up of lesions classified as BI-RADS category 4 at mammography or US and can help avoid 92% of unnecessary biopsies. The false-negative rate was 0% for all US findings and for all mammographic findings except pure clustered microcalcifications. Additional invasive cancers were identified in three women with false-positive findings from mammography and US., (© RSNA, 2014.)

Purpose: We investigated whether an abbreviated protocol (AP), consisting of only one pre- and one postcontrast acquisition and their derived images (first postcontrast subtracted [FAST] and maximum-intensity projection [MIP] images), was suitable for breast magnetic resonance imaging (MRI) screening., Methods: We conducted a prospective observational reader study in 443 women at mildly to moderately increased risk who underwent 606 screening MRIs. Eligible women had normal or benign digital mammograms and, for those with heterogeneously dense or extremely dense breasts (n = 427), normal or benign ultrasounds. Expert radiologists reviewed the MIP image first to search for significant enhancement and then reviewed the complete AP (consisting of MIP and FAST images and optionally their nonsubtracted source images) to characterize enhancement and establish a diagnosis. Only thereafter was the regular full diagnostic protocol (FDP) analyzed., Results: MRI acquisition time for FDP was 17 minutes, versus 3 minutes for the AP. Average time to read the single MIP and complete AP was 2.8 and 28 seconds, respectively. Eleven breast cancers (four ductal carcinomas in situ and seven invasive cancers; all T1N0 intermediate or high grade) were diagnosed, for an additional cancer yield of 18.2 per 1,000. MIP readings were positive in 10 (90.9%) of 11 cancers and allowed establishment of the absence of breast cancer, with a negative predictive value (NPV) of 99.8% (418 of 419). Interpretation of the complete AP, as with the FDP, allowed diagnosis of all cancers (11 [100%] of 11). Specificity and positive predictive value (PPV) of AP versus FDP were equivalent (94.3% v 93.9% and 24.4% v 23.4%, respectively)., Conclusion: An MRI acquisition time of 3 minutes and an expert radiologist MIP image reading time of 3 seconds are sufficient to establish the absence of breast cancer, with an NPV of 99.8%. With a reading time < 30 seconds for the complete AP, diagnostic accuracy was equivalent to that of the FDP and resulted in an additional cancer yield of 18.2 per 1,000., (© 2014 by American Society of Clinical Oncology.)

Purpose: To investigate whether mammographic breast densities and the respective degree of MRI background enhancement would correlate. Mammographic breast density is coded to communicate how likely a cancer is obscured by parenchyma. Similarly, background enhancement in breast MRI could obscure enhancing cancer tissue., Materials and Methods: A total of 468 women underwent standard full-field digital mammography and dynamic contrast-enhanced breast MRI in our institution. Mammographic breast density was scored according to the American College of Radiology-classification; background enhancement in MRI was scored on a 4-point scale from absent to severe. Breast "density classes" were retrospectively compared by analyzing the differences between scores for mammography and MRI. Statistical correlation was calculated using the Spearman coefficient., Results: Scores matched in 19% of women (90/468) but differed in 81% (378/468). A deviation by 1 point was observed in 33% (157/468), by 2 points in 38% (179/468), by 3 in 9% (42/468). Scores for background enhancement were lower than mammographic scores in 371/468 (79.3%), equivalent in 90/468 (19.2%), and higher in 7/468 (1.5%)., Conclusion: Mammographic breast density does not correlate with the degree of background enhancement in MRI. In the majority of women, scores for background enhancement in MRI will be lower than the respective mammographic density scores., (© 2014 Wiley Periodicals, Inc.)

Purpose: To prospectively investigate the effects of two antihormonal medications, tamoxifen and aromatase inhibitor (AI), on the degree of background enhancement in breast magnetic resonance (MR) imaging., Materials and Methods: This institutional review board-approved study was performed in 40 postmenopausal women (mean age, 63 years; range, 49-78 years) with unilateral breast cancer between January 2005 and December 2010. Informed consent was obtained from all participants. All patients underwent breast MR imaging before starting any medication, under tamoxifen, and after switching to an AI. Qualitative and quantitative degrees of benign parenchymal enhancement were investigated before treatment, under tamoxifen, and under AI. Data were analyzed by using the Wilcoxon singed-rank test and Student t test for matched pairs., Results: Before treatment, the distribution of background enhancement MR-American College of Radiology (ACR) categories 1, 2, 3, and 4 was 20%, 35%, 33%, and 13%, respectively. With tamoxifen, background enhancement was suppressed, with a distribution of 80%, 15%, 5%, and 0% for MR-ACR categories 1, 2, 3, and 4, respectively. With AI, background enhancement recovered in part, with a distribution of 25%, 53%, 23%, and 0% for categories 1, 2, 3, and 4, respectively. In all 40 women, background enhancement rates were highest before treatment (mean, 51.3% ± 33.3 [standard deviation]). By using tamoxifen, background enhancement rates were significantly reduced (mean, 8.4% ± 9.2), and rose again after the switch to an AI (mean, 22.9% ± 19.1 [P < .001]). Prevalence of benign enhancing foci was 65% (26 of 40) at baseline, 12.5% (five of 40) with tamoxifen, and 40% (16 of 40) with AI., Conclusion: The effects of tamoxifen and AI on benign parenchymal enhancement differ. Whereas tamoxifen leads to a virtually complete suppression of enhancement, the effects of AI are less pronounced. Accordingly, whereas enhancement is unusual and deserves a more careful work-up in a patient in whom tamoxifen is used, this is not necessarily true for women in whom AIs are used. Online supplemental material is available for this article., (RSNA, 2013)

The incidence of renal cell carcinoma (RCC) after kidney transplantation is 15-fold increased. Acquired cystic kidney disease (ACKD) is one of the known risk factors. We performed a small pilot study to assess the role of non-enhanced magnetic resonance imaging (MRI) as a tool for intensified screening in renal transplant recipients with ACKD. Renal ultrasound was used to assess the native kidneys of 215 renal transplant recipients. Thirty patients with 54 kidneys, fulfilling the criteria of ACKD, underwent non-enhanced MRI at 1.5T using T2- and T1-weighed as well as diffusion-weighted sequences with a high spatial resolution. Among the 54 kidneys assessed by both methods, three RCCs were identified (6%). Of those, one RCC was detected by both imaging methods (33%), while two RCCs were diagnosed by MRI alone (67%). MRI identified an additional four proteinaceous or hemorrhagic cysts that did not fulfill the criteria for RCC but were classified as suspicious. All of these lesions were stable in size and appearance in follow-up studies. In conclusion, non-enhanced MRI was more sensitive than ultrasound in identifying RCCs and lesions suspicious for RCC and thus appears to be a useful secondary screening tool in patients with ACKD after renal transplantation., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: Polymer-based textile meshes for abdominal hernia treatment are invisible by conventional imaging methods, including magnetic resonance imaging (MRI). Integration of iron particles in the mesh base material allows MRI visualization of meshes. Positive-contrast susceptibility imaging (PCSI) was implemented to separate susceptibility-induced voids from proton-deficient voids. The purpose of this study was to compare PCSI with conventional gradient echo and turbo spin echo (TSE) sequences for the in vivo assessment of superparamagnetic iron oxide particle-loaded surgical meshes in an animal model., Methods and Materials: Iron-loaded polymer meshes were implanted into the abdominal wall of 10 rabbits. At days 1, 30, and 90 after surgery, conventional gradient echo, TSE, and PCSI were performed at 1.5 T in the sagittal and axial planes. Images were scored by 2 radiologists with respect to mesh visibility, delineation of the surrounding tissue, differentiation from other structures, and overall diagnostic use, on a 4-point scale ranging from 1 (insufficient) to 4 (excellent). The results were compared using Wilcoxon signed-rank tests. The mesh shape, possible deformation or fracture, and possible mesh migration were evaluated on the different pulse sequences and compared with the results at surgery and autopsy., Results: The iron-loaded meshes appeared as hypointense signal voids on gradient echo sequences, as a hyperintense line on PCSI, and as a very thin dark line on TSE images. In all animals, a precise depiction of the mesh location and its spatial configuration and integrity was possible by MRI and confirmed by surgical and autopsy results. In all 4 categories and at all 3 time points of imaging, image quality scores were significantly higher for gradient echo imaging (range, 3.60-3.80) compared with PCSI (range, 3.12-3.42) and TSE (range, 1.64-1.89). At day 90, the image quality ratings of gradient echo and PCSI were comparable. In 2 cases, the complete delineation of mesh borders was impossible because of signal voids of adjacent anatomical structures, whereas PCSI helped achieve this differentiation., Conclusion: In this rabbit model of iron-loaded implanted abdominal meshes, standard gradient echo imaging was best suitable to assess implant location, integrity, and configuration. In 2 of 10 animals, PCSI helped achieve a complete delineation of mesh borders.

Purpose: Accelerated partial breast irradiation (APBI) after breast-conserving therapy is currently under investigation in prospective randomized studies. Multifocality and multicentricity are exclusion criteria for APBI. Preoperative breast magnetic resonance imaging (MRI) can detect ipsilateral and contralateral invasive tumor foci or ductal carcinoma in situ in addition to conventional diagnostic methods (clinical examination, mammography, and ultrasonography). The objective of this retrospective study was to evaluate the impact of preoperative MRI on patient selection for APBI., Methods and Materials: From 2002 to 2007, a total of 579 consecutive, nonselected patients with newly diagnosed early-stage breast cancer received preoperative breast MRI in addition to conventional imaging studies at the Bonn University Breast Cancer Center. In retrospect, 113 patients would have met the criteria for APBI using conventional imaging workup (clinical tumor size ≤3 cm; negative axillary lymph node status; unifocal disease; no evidence of distant metastases; no invasive lobular carcinoma, ductal and lobular carcinoma in situ, or Paget's disease). We analyzed the amount of additional ipsilateral and contralateral tumor foci detected by MRI., Results: MRI detected additional tumor foci in 8.8% of patients eligible for APBI (11 tumor foci in 10 of 113 patients), either ipsilateral (n = 7, 6.2%) or contralateral (n = 4, 3.5%). In 1 patient, MRI helped detect additional tumor focus both ipsilaterally and contralaterally., Conclusions: Preoperative breast MRI is able to identify additional tumor foci in a clinically relevant number of cases in this highly selected group of patients with low-risk disease and may be useful in selecting patients for APBI., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Purpose: Evaluation of the impact of preoperative magnetic resonance imaging (MRI) of the breast on the clinical management of patients with operable breast cancer (BC)., Methods: Retrospective analysis of 160 patients with operable breast cancer (stages Tis through T4), treated from 2002 through 2004. All patients underwent a full mammographic assessment, high frequency breast ultrasound, and breast MRI. The impact of preoperative MRI was evaluated for each patient with regard to changes in the therapeutic procedure. Patient and tumor characteristics were analyzed to identify possible patient subgroups that predominantly would benefit from preoperative MRI., Results: Preoperative MRI affected the clinical management in 44 of 160 patients (27.5%). In 30 cases (18.75%) additional in situ or invasive cancers or a more widespread tumor extent were diagnosed correctly which went undetected by clinical palpation, mammography, and breast ultrasound. In 14 cases (8.75%) additional surgical procedures were performed based on suspicious MRI findings that turned out to be benign in final pathology. Age, menopausal status, breast density, tumor characteristics (type, tumor size, grading), ER-, PR- and HER2-receptor features did not significantly differ between patients in which breast MRI affected the clinical management and patients that experienced no additional information from MRI., Conclusions: Preoperative breast MRI changes surgical management of patients with operable breast cancer. MRI detects additional invasive carcinoma and proves to be a powerful supplement to the conventional work-up in the clinical management of breast cancer. This advantage is independent from patients- and tumor-specific characteristics.

Purpose: To prospectively investigate the imaging (mammographic, ultrasonographic [US], magnetic resonance [MR] imaging) features of invasive and intraductal breast cancers in women at familial risk., Materials and Methods: Ethics committee approval and informed consent were obtained. Breast cancers were identified in women at moderately increased risk, in women at high familial risk, and in documented BRCA1 and BRCA2 mutation carriers. All cancers were investigated with mammography, US, and bilateral dynamic breast MR imaging. Imaging findings of breast cancer in women in the different risk categories were prospectively collected and compared. With the two-sample Wilcoxon signed rank test, imaging features of cancers were compared., Results: Seventy-six breast cancers were identified in 68 women (mean age, 41.3 years). Mammographic breast density had no influence on detectability of cancers. Imaging phenotypes differed among risk categories: 15 (23%) of 64 invasive cancers appeared as fibroadenoma-like masses without calcifications but without fibroadenoma-like internal enhancement or enhancement kinetics at breast MR imaging. Of those, 12 (80%) occurred in women at high risk and documented BRCA1 mutation carriers. A posterior (immediately prepectoral) location was observed in 67% (32 of 48) of all breast cancers in women at high risk and mutation carriers (P < .009). None of the remaining BRCA1-associated invasive cancers exhibited calcifications; intraductal cancers were not observed. In 28 cancers in BRCA2 carriers or women at moderately increased risk, imaging features seemed equivalent to those reported for sporadic cancers; cases of ductal carcinoma in situ were observed, and there was no preference for a posterior location in the breast. At MR imaging, a high percentage (20% [13 of 64]) of invasive cancers appeared as non-masslike enhancement; benign kinetic features were observed in 33% (25 of 76)., Conclusion: Imaging phenotypes of cancers differ among risk categories. If MR imaging is used for screening, high sensitivity rates are achievable only if morphologic and kinetic features are assessed and if non-masslike enhancement is considered. Lesion location is important in regard to malignancy., Supplemental Material: http://radiology.rsnajnls.org/cgi/content/full/246/1/58/DC1., (RSNA, 2008)

Background: Diagnosing breast cancer in its intraductal stage might be helpful to prevent the development of invasive cancer. Our aim was to investigate the sensitivity with which ductal carcinoma in situ (DCIS) is diagnosed by mammography and by breast MRI., Methods: During a 5-year period, 7319 women who were referred to an academic national breast centre received MRI in addition to mammography for diagnostic assessment and screening. Mammograms and breast MRI studies were assessed independently by different radiologists. We investigated the sensitivity of each method of detection and compared the biological profiles of mammography-diagnosed DCIS versus DCIS detected by MRI alone. We also compared the risk profiles of women with mammography-detected DCIS with those of MRI-detected DCIS., Findings: 193 women received a final surgical pathology diagnosis of pure DCIS. Of those, 167 had undergone both imaging tests preoperatively. 93 (56%) of these cases were diagnosed by mammography and 153 (92%) by MRI (p<0.0001). Of the 89 high-grade DCIS, 43 (48%) were missed by mammography, but diagnosed by MRI alone; all 43 cases missed by mammography were detected by MRI. By contrast, MRI detected 87 (98%) of these lesions; the two cases missed by MRI were detected by mammography. Age, menopausal status, personal or family history of breast cancer or of benign breast disease, and breast density of women with MRI-only diagnosed DCIS did not differ significantly from those of women with mammography-diagnosed DCIS., Interpretation: MRI could help improve the ability to diagnose DCIS, especially DCIS with high nuclear grade.

Purpose: To compare the effectiveness of mammography, breast ultrasound, and magnetic resonance imaging (MRI) for surveillance of women at increased familial risk for breast cancer (lifetime risk of 20% or more)., Patients and Methods: We conducted a surveillance cohort study of 529 asymptomatic women who, based on their family history and/or mutational analysis, were suspected or proven to carry a breast cancer susceptibility gene (BRCA). A total of 1,542 annual surveillance rounds were completed with a mean follow-up of 5.3 years. Diagnostic accuracies of the three imaging modalities used alone or in different combinations were compared., Results: Forty-three breast cancers were identified in the total cohort (34 invasive, nine ductal carcinoma-in-situ). Overall sensitivity of diagnostic imaging was 93% (40 of 43 breast cancers); overall node-positive rate was 16%, and one interval cancer occurred (one of 43 cancers, or 2%). In the analysis by modality, sensitivity was low for mammography (33%) and ultrasound (40%) or the combination of both (49%). MRI offered a significantly higher sensitivity (91%). The sensitivity of mammography in the higher risk groups was 25%, compared with 100% for MRI. Specificity of MRI (97.2%) was equivalent to that of mammography (96.8%)., Conclusion: Mammography alone, and also mammography combined with breast ultrasound, seems insufficient for early diagnosis of breast cancer in women who are at increased familial risk with or without documented BRCA mutation. If MRI is used for surveillance, diagnosis of intraductal and invasive familial or hereditary cancer is achieved with a significantly higher sensitivity and at a more favorable stage.

Purpose: To investigate the respective diagnostic accuracies of the different breast imaging modalities, i. e., mammography (Mx), high-frequency breast ultrasound (US), and dynamic contrast-enhanced breast (MRI) regarding the early diagnosis of familial (hereditary) breast cancer., Materials and Methods: A prospective, non-randomized controlled clinical multi-center trial is performed at 4 academic tertiary care centers in Germany (Ulm, Munchen/Grosshadern, Munster and Bonn) for a total period of 4 years, sponsored by the German Cancer Aid. The protocol consists of semiannual clinical visits and breast ultrasound, and annual bilateral two-view Mx, US and MRI. Imaging studies were first analyzed independently, then Mx was read in conjunction with US, followed by Mx combined with MRI, and finally, all three imaging modalities were read in synopsis. We present the concept and first results of this trial., Results: So far, 748 screening rounds are available for analysis in 613 women. A total of 12 breast cancers have been identified, with 11/12 cases in the pTis or pT1/N0 stage. The mean size of detected invasive cancers was 7 mm. A total of 19 benign lesions were biopsied due to false-positive imaging diagnoses. The breast cancer detection rates were: Mx: 5/12 (42 %), US 3/12 (25 %), MRI 10/12 (83 %), and the positive predictive values: Mx 5/17 (29 %), US 3/15 (30 %), and MRI 10/23 (43 %)., Conclusion: The preliminary data suggest that early diagnosis of familial breast cancer is feasible by intensified surveillance, in particular with the addition of MRI.

Parturition-induced rupture of pubic symphysis is an uncommon but severe complication of delivery. Characteristic symptoms are an immediate onset of suprapubic and/or sacroiliac pain within the first 24 hours postpartum, often accompanied by an audible crack. Diagnosis can be confirmed by imaging including X-ray, Magnet Resonance Imaging (MRI), and ultrasound. However, there is no consensus on the optimal therapy. Conservative treatment is predominantly used. It has been reported that, in cases of extreme symphyseal rupture with pelvic instability or persisting pain after conservative therapy, operative treatment achieves a successful outcome. In this report, we present a case of a twenty-year-old primigravida who developed suprapubic pain after a nonoperative vaginal birth with shoulder dystocia. A rupture of pubic symphysis with a gap of 60 mm was confirmed by means of X-ray and MRI. Simultaneously, other pelvic joint injuries could be excluded. Operative treatment by an open reduction and internal plate fixation yielded excellent results. [ABSTRACT FROM AUTHOR]