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Background:Persistent enlargement of major salivary glands (SGs) is one of the main risk factors for B-cell lymphoma in primary Sjögren’s syndrome (pSS). The Ultrasound-guided Core Needle Biopsy (US-guided CNB) could be a novel technique for the management of SGs enlargement in pSS (1).Objectives:To evaluate the procedure safety and the patient tolerance of US-guided CNB in pSS patients with major SGs enlargement.Methods:Consecutive patients, with either definite or clinically suspected pSS, and with clinical indication for SGs biopsy due to persistent glandular enlargement were screened for US-guided CNB from September 2019 to December 2020. All patients were evaluated clinically between 1 and 2 weeks and 12 weeks following US-guided CNB. All patients were asked to complete a questionnaire to report post-procedural complications (Figure 1, English version) and intra- and post-procedural pain Visual Analogue Scale (VAS). The complications were classified as transient (Results:US-guided CNB was performed in 21 glands (12 parotid and 9 submandibular glands) in 20 pSS patients. 16/20 (80%) patients fulfilled the ACR-EULAR classification criteria for pSS (2). The mean age at the time of biopsy was 62.1 (±11.7) years. US-guided CNB was well tolerated, no long-term complications were reported in the follow-up period (mean 9.5 ±5.7 months). Only transient complications were noticed in 11 patients (55%). In particular, two cases of local swelling at the biopsy site lasting no more than 6 days, one case of local bleeding and subsequently hematoma of the submandibular area, one case of transient facial paresis (lasting less than one hour), seven cases of post-procedural mild local pain, that resolved within 10 days without the need of analgesics (Table 1). The procedure was well tolerated, with a very low reported intra-operative pain (mean VAS 1.74 ±2.49) and a mean post-operative pain VAS of 1.39 (±2.33). The biopsy sampling was diagnostic in 19/20 patients (95%).Conclusion:US-guided CNB represents a novel approach for the management of pSS patients with SGs enlargement. This procedure shows a remarkable patient safety and tolerance, allowing an adequate glandular sampling and definite diagnosis in almost all the studied patients.References:[1]Zabotti A, Zandonella Callegher S, Lorenzon M, Pegolo E, Scott CA, Tel A, et al. Ultrasound-guided core needle biopsy compared with open biopsy: a new diagnostic approach to salivary gland enlargement in Sjögren’s syndrome? Rheumatology (Oxford) 2020.[2]Shiboski CH, Shiboski SC, Seror R, Criswell LA, Labetoulle M, Lietman TM, Rasmussen A, Scofield H, Vitali C, Bowman SJ, Mariette X; International Sjögren’s Syndrome Criteria Working Group. 2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjögren’s Syndrome: A Consensus and Data-Driven Methodology Involving Three International Patient Cohorts. Arthritis Rheumatol. 2017 Jan;69(1):35-45. doi: 10.1002/art.39859. Epub 2016 Oct 26. PMID: 27785888; PMCID: PMC5650478.Table 1.Description of complicationsComplications of US-guided CNBPatients presenting complications, n/N (%)11/20 (55%)Description of transient complicationsSwelling at biopsy site, n2Bleeding, n1Hematoma, n1Local Pain, n7Local infection, n0Sialocele or fistula, n0Anaesthesia/paraesthesia, n0Transient facial palsy (< 1 hour), n1No persistent complications reportedAll the above specified complications were transient (< 12 weeks). No persistent complications were reported in the follow up.Figure 1.Post-biopsy complication QuestionnaireDisclosure of Interests:Alen Zabotti Speakers bureau: UCB, Novartis, Janssen, Paid instructor for: Amgen, Consultant of: Janssen, Ivan Giovannini: None declared, Sara Zandonella Callegher: None declared, Valeria Manfrè: None declared, Michele Lorenzon Consultant of: not relevant for this study, Enrico Pegolo: None declared, Cathryn Ann Scott: None declared, Alessandro Tel: None declared, Massimo Robiony Consultant of: not relevant for this study, Grant/research support from: not relevant for this study, Chiara Zuiani Consultant of: not relevant for this study, Grant/research support from: not relevant for this study, Salvatore De Vita Consultant of: GSK, Roche, Grant/research support from: not relevant for this study

Preoperative breast volume estimation is very important for the success of the breast surgery. In this study four different breast volume determination methods were compared. The end-point of this prospective study was to evaluate the concordance between different modalities of breast volume assessment (MRI, BREAST-V, mastectomy specimen weight, conversion from weight to volume of mastectomy specimen) and the breast prosthetic volume implanted. The study enrolled 64 patients between 2017 and 2019, who had all been treated by the same surgeons for monolateral nipple–areola complex-sparing mastectomy and implant breast reconstruction. Only patients who had a breast reconstruction classified as “excellent” from an objective (BCCT.core software) and subjective (questionnaire) point of view at the 6-month interval after the operation were included in the study. Data analysis highlighted a strong correlation between the volumes of the chosen prostheses and the weights of mastectomy converted into volume, especially for patients with grades B and C parenchymal density. The values of the agreement between the volumes of the chosen prostheses and the assessments from MRI and BREAST -V proved to be lower than expected from the literature. None of the four studied methods presented any strong correlation with the initial breast width. Our results suggest that conversion from weight to volume of mastectomy specimen should be used to assist in determining the volume of the breast implant to be implanted. This method would help the reconstructive surgeon guide the choice of the most appropriate implant preoperatively.

Automated breast ultrasound (ABUS) is a recently introduced ultrasonography technique, developed with the purpose to standardize breast ultrasonography and overcome some limitations of handheld ultrasound (HHUS), such as operator dependence and the considerable amount of medical time necessary to perform and interpret HHUS. This new ultrasonography technique separates the moment of image acquisition (that may be performed also by a technician) from that of its interpretation, increasing reproducibility, reducing operator-dependence and physician time. Moreover, multiplanar reconstructions, especially the coronal view, introduce new diagnostic information. ABUS, with those advantages, has the potential to be used as an adjunctive tool to screening mammography, especially in the dense breast, where mammography has a relatively low sensitivity. Women's awareness of risks related to breast density is a hot topic, especially in the USA where legislative breast density notification laws increase the demand for supplemental ultrasound screening. Therefore, ABUS might have the potential to respond to this need. The purpose of this article is to present a summary of current state-of-the-art of ABUS technology and applications, with an emphasis on breast cancer screening. This article discusses also how to overcome some ABUS limitations, in order to be familiar with the new technique.

Liver transplantation (LT) is the treatment of choice for end-stage chronic liver disease, fulminant liver failure and early stage hepatocellular carcinoma. As discussed in this review, state-of-the-art imaging modalities including ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) play a pivotal role in the selection of patients and donors, as well as in early detection of those complications at risk of impairing graft function and/or survival. We also illustrate main imaging findings related to the wide spectrum of clinical problems raised by LT.

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a recently introduced technique aimed to perform two-stage hepatectomy in patients with a variety of primary or secondary neoplastic lesions. ALPSS is based on a preliminary liver resection associated with ligation of the portal branch directed to the diseased hemiliver (DH), followed by hepatectomy after an interval of time in which the future liver remnant (FLR) hypertrophied adequately (partly because of preserved arterialization of the DH). Multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) play a pivotal role in patients' selection and FLR assessment before and after the procedure, as well as in monitoring early and late complications, as we aim to review in this paper. Moreover, we illustrate main abdominal MDCT and MRI findings related to ALPPS.

Objective: To evaluate the usefulness of short-term (6 months) follow-up in patients with Breast Imaging Report and Data System (BI-RADS) 3 and 4a lesions, after a diagnosis of fibroadenoma at an image-guided biopsy. Patients and Methods: The data of 318 women with 349 biopsy-proven fibroadenomas, a 6-month follow-up, and a follow-up of ≥ 24 months were retrospectively reviewed. Information on clinical history, lesion characteristics on ultrasound (US), mammography, and magnetic resonance imaging (MRI), BI-RADS classification, and follow-up was collected. The false-negative (FN) rate and the negative predictive value (NPV) for the biopsy were calculated. Results: 43 patients (13.5%) presented with a palpable nodule; 18 (5.7%) had a history of breast cancer. There were 334 lesions visible on US (95.7%), 57 on US and mammography (16.3%), and 15 on mammography only (4.3%); 37 lesions were first detected on MRI. All lesions were stable at 6 months. After an at least 1-year follow-up, 4 lesions changed their features and were excised. Histology showed 1 invasive lobular cancer, 1 ductal carcinoma in situ, 1 phyllodes tumor, and 1 papilloma. The FN rate of the needle biopsy was 1.1% and the NPV was 98.9%. Conclusion: For lesions initially described as BI-RADS 3 and 4a with a histological diagnosis of fibroadenoma after biopsy, short-term follow-up can be avoided.

Multiparametric magnetic resonance imaging (mpMRI) has become the standard of care to achieve accurate and reproducible diagnosis of prostate cancer. However, mpMRI is quite demanding in terms of technical rigour, patient’s tolerability and safety, expertise in interpretation, and costs. This paper reviews the main technical strategies proposed as less-is-better solutions for clinical practice (non-contrast biparametric MRI, reduction of acquisition time, abbreviated protocols, computer-aided diagnosis systems), discussing them in the light of the available evidence and of the concurrent evolution of Prostate Imaging Reporting and Data System (PI-RADS). We also summarised research results on those advanced techniques representing an alternative different-is-better line of the still ongoing evolution of prostate MRI (quantitative diffusion-weighted imaging, quantitative dynamic contrast enhancement, intravoxel incoherent motion, diffusion tensor imaging, diffusional kurtosis imaging, restriction spectrum imaging, radiomics analysis, hybrid positron emission tomography/MRI).

BACKGROUND It is unclear whether clinical models including the Partin tables (PT), the Memorial Sloan Kettering Cancer Center nomogram (MSKCCn), and the cancer of the prostate risk assessment (CAPRA) can benefit from incorporating multiparametric magnetic resonance imaging (mpMRI) when staging prostate cancer (PCa). PURPOSE To compare the accuracy of clinical models, mpMRI, and mpMRI plus clinical models in predicting stage ≥pT3 of PCa. STUDY TYPE Prospective monocentric cohort study. POPULATION Seventy-three patients who underwent radical prostatectomy between 2016-2018. FIELD STRENGTH/SEQUENCE 3.0T using turbo spin echo (TSE) imaging, single-shot echoplanar diffusion-weighted imaging, and T1 -weighted high-resolution-isotropic-volume-examination (THRIVE) contrast-enhanced imaging. ASSESSMENT We calculated the probability of extraprostatic extension (EPE) using the PT and MSKCC, as well as the CAPRA score. Three readers with 2-8 years of experience in mpMRI independently staged PCa on imaging. STATISTICAL TESTS Receiver operating characteristics analysis and logistic regression analysis to investigate the per-patient accuracy of mpMRI vs. clinical models vs. mpMRI plus clinical models in predicting stage ≥pT3. The alpha level was 0.05. RESULTS Median probability for EPE and MSKCCn was 27.3% and 47.0%, respectively. Median CAPRA score was 3. Stage ≥pT3 occurred in 32.9% of patients. Areas under the curve (AUCs) were 0.62 for PT, 0.62 for MSKCCn, 0.64 for CAPRA, and 0.73-0.75 for mpMRI (readers 1-3) (P > 0.05 for all comparisons). Compared with mpMRI, the combination of mpMRI with PT or MSKCCn provided lower AUCs (P > 0.05 for all the readers), while the combination with CAPRA provided significantly higher (P < 0.05) AUCs in the case of readers 1 and 3. On multivariable analysis, mpMRI by reader 1 was the only independent predictor of stage ≥pT3 (odds ratio 7.40). DATA CONCLUSION: mpMRI was more accurate than clinical models and mpMRI plus clinical models in predicting stage ≥pT3, except for the combination of mpMRI and CAPRA in two out of three readers. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:1604-1613.

IntroductionLung function abnormalities are common in sickle cell anaemia (SCA) but data from sub-Saharan Africa are limited. We hypothesised that children with SCA from West Africa had worse lung function than their counterparts from Europe.MethodsThis prospective cross-sectional study evaluated spirometry and anthropometry in black African individuals with SCA (haemoglobin phenotype SS) aged 6–18 years from Nigeria and the UK, when clinically stable. Age-matched controls were also included in Nigeria to validate the Global Lung Initiative spirometry reference values.ResultsNigerian SCA patients (n=154) had significant reductions in both FEV1 and FVC of ~1 z-score compared with local controls (n=364) and ~0.5 z-scores compared with the UK patients (n=101). Wasting (body mass index z-score1/FVC≥−1.64).ConclusionsThis study showed that chronic respiratory impairment is more severe in children with SCA from West Africa than Europe. Our findings suggest the utility of implementing respiratory assessment in African children with SCA to early identify those with chronic lung injury, eligible for closer follow-up and more aggressive therapies.

Objective To assess the accuracy of Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) in detecting clinically significant prostate cancer (csPCa) on multiparametric magnetic resonance imaging (mpMRI) using whole-mount sections after radical prostatectomy (RP) as reference standard. Methods Forty-eight patients undergoing mpMRI before RP were prospectively enrolled. Two experienced radiologists independently scored and mapped imaging findings according to PI-RADS v2. One experienced uropathologist mapped cancers detected on whole-mount sections using the PI-RADS v2 sector scheme. Per-lesion and per-patient analyses were run. Primary outcomes were sensitivity and false discovery rate (FDR) in detecting csPCa using PI-RADS v2 score ≥3 and ≥4 as thresholds. Secondary outcome was inter-reader agreement. Results On the per-lesion analysis, sensitivity and FDR at the PI-RADS v2 threshold score ≥3 were 0.75 and 0.17 for Reader 1, and 0.67 and 0.13 for Reader 2, respectively. At the PI-RADS v2 threshold score ≥4, sensitivity was slightly lower, and FDR nearly halved for both readers. On the per-patient analysis, sensitivity for csPCa at the PI-RADS v2 threshold score ≥3 was 0.85 for Reader 1, and 0.78 for Reader 2. At the PI-RADS v2 threshold score ≥4, sensitivity was slightly lower for both readers. Inter-reader agreement was substantial (k 0.72 and 0.65 for PI-RADS v2 threshold score ≥3 and ≥4, respectively). Conclusion In our prospective study with pathology after RP as standard of reference, PI-RADS v2 showed good sensitivity in detecting csPCa on mpMRI with substantial agreement between 2 experienced readers. Threshold score ≥4 had lower FDR.

Women who were previously treated for breast cancer (BC) are an important particular subgroup of women at intermediate BC risk. Their breast follow-up should be planned taking in consideration a 1.0-1.5 % annual rate of loco-regional recurrences and new ipsilateral or contralateral BCs during 15-20 years, and be based on a regional/district invitation system. This activity should be carried out by a Department of Radiology integrating screening and diagnostics in the context of a Breast Unit. We recommend the adoption of protocols dedicated to women previously treated for BC, with a clear definition of responsibilities, methods for invitation, site(s) of visits, methods for clinical and radiological evaluation, follow-up duration, role and function of family doctors and specialists. These women will be invited to get a mammogram in dedicated sessions starting from the year after the end of treatment. The planned follow-up duration will be at least 10 years and will be defined on the basis of patient's age and preferences, taking into consideration organizational matters. Special agreements can be defined in the case of women who have their follow-up planned at other qualified centers. Dedicated screening sessions should include: evaluation of familial/personal history (if previously not done) for identifying high-risk conditions which could indicate a different screening strategy; immediate evaluation of mammograms by one or, when possible, two breast radiologists with possible addition of supplemental mammographic views, digital breast tomosynthesis, clinical breast examination, breast ultrasound; and prompt planning of possible further workup. Results of these screening sessions should be set apart from those of general female population screening and presented in dedicated reports. The following research issues are suggested: further risk stratification and effectiveness of follow-up protocols differentiated also for BC pathologic subtype and molecular classification, and evaluation of different models of survivorship care, also in terms of cost-effectiveness.

Purpose To investigate the impact of multiparametric magnetic resonance imaging (mpMRI) on risk group assessment of patients with prostate cancer (PCa) initially addressed to external beam radiation therapy (EBRT). Materials and methods We prospectively performed mpMRI (3.0Tsystem) in 44 patients addressed to EBRT, using a multiparametric protocol (high-resolution multiplanar T2-weighted, diffusion-weighted and dynamic contrast-enhanced imaging). Risk group was assessed in accordance with the National comprehensive cancer network (NCCN) categories, by combining prostate-specific-antigen level, Gleason score and the T-stage as established by digital rectal examination (clinical risk assessment; c-RA) versus mpMRI (mpMRI-risk assessment; mpMRI-RA). The agreement between c-RA and mpMRI-RA was investigated using Cohen's kappa. Results Patients were included in very low/low risk, intermediate risk, high risk, very high risk and metastatic NCCN categories in 10 (22.7%), 18 (40.9%), 15 (34.1%), 1 (2.3%) and 0 cases using c-RA vs. 8 (18.2%), 14 (31.8%), 14 (31.8%), 4 (9.1%) and 4 (9.1%) cases using mpMRI-RA, respectively, with only moderate agreement ( k = 0.43). mpMRI-RA determined risk downgrading in 2/44 patients (4.5%), and risk upgrading in 16/44 patients (36.3%). After mpMRI, EBRT remained indicated in all patients. Conclusion mpMRI changed clinical risk stratification in about 41% of patients with PCa, with potential impact on EBRT planning.

Purpose To reduce the fraction number in Partial Breast Irradiation (PBI) with initial prescription of 40 Gy in 10 fractions using radiobiological models with specific focus on risk of moderate/severe radiation-induced fibrosis (RIF) and report clinical results. Methods and materials 68 patients (patient group A) were treated with 40 Gy in 10 fractions delivered by field-in-field, forward-planned IMRT. Isotoxic regimens with decreasing number of fractions were calculated using Biological Effective Dose (BED) to the breast. Risk for RIF in hypofractionated treatment was predicted by calculating NTCP from DVHs of group A rescaled to fractions and dose of novel regimens. Moderate/severe RIF was prospectively scored during follow-up. Various NTCP models, with and without incomplete repair correction, were assessed from difference to observed incidence of RIF. In order to verify the value for α/β of 3 Gy assumed for breast, we fitted α/β to observed incidences of moderate/severe RIF. Results Treatments with 35 Gy/7f and 28 Gy/4f were selected for the fraction reduction protocol. 75 patients (group B) were treated in 35 Gy/7f. Incidence of moderate/severe RIF was 5.9% in group A, 5.3% in group B. The NTCP model with correction for incomplete repair had lowest difference from observed RIF. The α/β obtained from fitting was 2.8 (95%CIs 1.1–10.7) Gy. Conclusions The hypofractionated regimen was well tolerated. The model for NTCP corrected for incomplete repair was the most accurate and an assumed α/β value of 3 Gy is consistent with our patient data. The hypofractionation protocol is continuing with patients treated with 28 Gy/4f.

RATIONALE AND OBJECTIVES To evaluate the impact on perceived report quality of referring rheumatologists for a chest high-resolution computed tomography (HRCT) structured report (SR) template for patients with connective tissue disease (CTD), compared to the traditional narrative report (NR). MATERIALS AND METHODS We retrospectively considered 123 HRCTs in patients with CTD. Three radiologists, blinded to the original NRs they wrote during clinical routine, re-reported each HRCT using an SR dedicated template. We then divided all NR-SR couples into three groups (41 HRCT each). Each group was evaluated by one of three rheumatologists (R1, R2, R3), who expressed their perceived report quality for the respective pools of NRs and SRs in terms of completeness, clarity (both on a 10-points scale), and clinical relevance (on a 5-points scale). The Wilcoxon test and the McNemar test were used for statistical analysis. RESULTS For each rheumatologist, SR received higher ratings compared to NR for completeness (median ratings: R1, 10 vs. 7; R2, 10 vs. 8; R3, 10 vs. 6, all p

To evaluate excision histology outcome of B3a lesions diagnosed at imaging-guided core biopsy and assess whether clinical and radiologic features may predict upgrade to malignancy. A total of 153 B3a lesions (74 papillomas, 51 radial scars and 28 fibro-epithelial lesions) that underwent surgical excision were assessed. PPV for malignancy in all B3a lesions and specific for each sub-category was evaluated. Multivariate analysis was conducted to identify association between clinical (age, family or personal history of breast cancer, symptoms), diagnostic findings (imaging modality, lesion size, final BI-RADS category) and final excision outcome. Eleven (7%) of 153 B3a lesions were upgraded to malignancy. All carcinomas diagnosed on excision were non-high grade DCIS. Following features were significantly associated with malignancy: lesions identified only on mammography (3/21; 14%), both mammography and ultrasound (7/44; 16%), lesion size > 10 mm (10/74; 13.5%) and BI-RADS category 4-5 (8/29; 27.6%). The absence of residual microcalcification after biopsy was associated with decreased risk for malignancy (15/16[93.7%]; p = 0.0297). Lesion size > 10 mm (OR = 9.3832; 95%; p = 0.0398) and BI-RADS category 4–5 (OR = 12.6004; 95%; p = 0.0006) were found to be independent predictors of upgrade to malignancy. B3a lesions are associated with low risk of malignancy at excision. Lesion size > 10 mm and BI-RADS 4–5 category may represent useful predictors of upgrade to malignancy.

BACKGROUND Previous studies have shown that abbreviated magnetic resonance imaging (aMRI) compares well to full-protocol MRI (fpMRI) in breast cancer (BC) screening, with the potential advantage of a less costly and complex examination. To our knowledge, the role for aMRI in staging BC has been poorly investigated, especially in assessing additional disease (ie, additional lesions compared to the index one prompting the examination). PURPOSE To compare aMRI and fpMRI in detecting additional disease in BC staging. STUDY TYPE Retrospective monocentric cohort study. POPULATION In all, 87 patients with 89 biopsy-proven index lesions referred to staging fpMRI between January-June 2016. FIELD STRENGTH/SEQUENCE A 1.5T magnet using short tau inversion recovery (STIR) T2 -weighted imaging, echoplanar diffusion-weighted imaging, and 3D fast long angle shot (FLASH) T1 -weighted imaging. ASSESSMENT During independent sessions, four readers with 1.5-20 years of experience in breast imaging, blinded to the pathological examination and previous imaging, assessed multifocal, multicentric, and contralateral additional lesions on fpMRI and aMRI (including precontrast T1 -weighted 3D FLASH sequence, first postcontrast subtracted T1 -weighted 3D FLASH sequence, and a transverse maximum intensity projection reconstruction). STATISTICAL TESTS We calculated the per-lesion cancer detection rate (CDR), positive predictive value (PPV), and false discovery rate (FDR) for additional disease, assessing the significance of intrareader differences in CDR with the McNemar test. RESULTS Pathological analysis found 36 additional lesions (multifocal, multicentric, and contralateral in 20, 15, and 1 cases, respectively). Readers' CDR was comparably high using aMRI (range 88.9-94.4%) or fpMRI (range 91.7-94.4%) (P > 0.05). PPV and FDR of aMRI (ranges 76.2-84.6% and 15.4-23.8%, respectively), and fpMRI (ranges 76.7-82.9% and 17.2-23.3%, respectively) were comparable on an intrareader basis. Using aMRI, two out of four readers induced two false-negative cases (one case each) with presumably limited impact on surgical planning (multifocal cancers

To evaluate the agreement between automated breast volume scanner (ABVS) and conventional ultrasound (US) as a second-look (SL) tool for assessing additional findings found on MRI.Over a 7-month period, we prospectively assigned to SL-US and SL-ABVS all patients undergoing 1.5 T breast MRI in whom additional findings were found. Five experienced breast radiologists independently interpreted SL-US and SL-ABVS in blinded sessions to evaluate the detection rate of MRI findings and assign them to BI-RADS categories. We calculated the agreement between the two methods in assessing MRI findings as significant (BI-RADS 3-5) versus not significant (BI-RADS 1-2), as well as their cancer detection rate.In a population of 131 patients, SL-ABVS and SL-US showed a comparable detection rate of MRI findings (69.3 vs. 71.5%) (p 0.05; McNemar test), with an almost perfect agreement in assessing them as significant or not (k = 0.94). This translated into a comparably high cancer detection rate (83.8% for SL-ABVS vs. 87.0% for SL-US). Only 1/31 cancers was missed by SL-ABVS.SL-ABVS and SL-US are nearly equivalent in assessing the significance of MRI findings, leading to a comparable cancer detection rate. SL-ABVS has the potential to replace SL-US in the SL scenario.• SL-ABVS shows almost perfect agreement with SL-US in assessing MRI findings. • SL-ABVS shows a comparably high cancer detection rate with respect to SL-US. • SL-ABVS has the potential to replace SL-US in evaluating additional MRI findings.

Prostate cancer (PCa) is one of the few neoplasms that are not well served by 18F-Fluorodeoxyglucose (FDG) positron emission tomography (PET). As a result, a number of PET tracers have been developed to target particular biological features of PCa. Such agents can be used for diagnosis, staging, identification of biochemical recurrence (BCR) and evaluation of metastatic disease. Here, we focus on primary disease and local staging. To date, magnetic resonance imaging (MRI) has proven superior to PET in the imaging of primary PCa. However, some PET agents have shown remarkable promise in staging high-risk PCa (defined as any combination of a clinical T3, a PSA score >20 ng/mL, or a Gleason score of 8-10), as well as biochemical relapse after definitive therapy and metastatic PCa. PET agents can be divided into those that interrogate tumor metabolism (18F-FDG, 11C-Choline, 18F-Choline, 11C-Acetate, 18F-FACBC), hormone receptors (18F-FDHT), and other targets such as prostate specific membrane antigen (PSMA) (68Ga-PSMA, 18F-DCFBC, 18F-DCFPyl) or gastric releasing peptide (18F-GRP or 18F-Bombesin). In this review, we compare the available PCa targeted PET tracers utilized in staging of high risk tumors.

Humoral primary immunodeficiency diseases (hPIDs) are a heterogeneous group of hereditary disorders resulting in abnormal susceptibility to infections of the sinopulmonary tract. Some of these conditions (e.g., common variable immunodeficiency disorders [CVID]) imply a number of non-infectious thoracic complications such as non-infectious airway disorders, diffuse lung parenchymal diseases, and neoplasms. Chest high-resolution computed tomography (HRCT) is a key imaging tool to characterise and quantify the extent of underlying thoracic involvement, as well as to direct and monitor treatment. The aims of this review are to provide a brief clinical overview of hPIDs and describe the related chest HRCT imaging features in the adult population, with a special focus on CVID and its complications.

X-ray mammography remains the most effective technique for routine breast cancer screening and plays a key role in imaging the breast in symptomatic patients aged from 40 years. The quality of mammography images has improved significantly during the last decade with the introduction of full-field digital mammography. However, although it is the most acceptable and effective technique used for population-based screening with reported breast cancer mortality reductions of up to 20%, the sensitivity and specificity of mammography are limited particularly in younger women and in those with dense glandular breasts.

This position paper, issued by ICBR/SIRM and GISMa, summarizes the evidence on DBT and provides recommendations for its use. In the screening setting, DBT in adjunct to digital mammography (DM) increased detection rate by 0.5-2.7‰ and decreased false positives by 0.8-3.6% compared to DM alone in observational and double-testing experimental studies. The reduction in recall rate could be less prominent in those screening programs which already have low recall rates with DM. The increase in radiation exposure associated with DM/DBT protocols has been solved by the introduction of synthetic mammograms (sDM) reconstructed from DBT datasets. Thus, whenever possible, sDM/DBT should be preferred to DM/DBT. However, before introducing DBT as a routine screening tool for average-risk women, we should wait for the results of randomized controlled trials and for a statistically significant and clinically relevant reduction in the interval cancer rate, hopefully associated with a reduction in the advanced cancer rate. Otherwise, a potential for overdiagnosis and overtreatment cannot be excluded. Studies exploring this issue are ongoing. Screening of women at intermediate risk should follow the same recommendations, with particular protocols for women with previous BC history. In high-risk women, if mammography is performed as an adjunct to MRI or in the case of MRI contraindications, sDM/DBT protocols are suggested. Evidence exists in favor of DBT usage in women with clinical symptoms/signs and asymptomatic women with screen-detected findings recalled for work-up. The possibility to perform needle biopsy or localization under DBT guidance should be offered when DBT-only findings need characterization or surgery.

We investigated whether diffusion-weighted Imaging (DWI) adds diagnostic confidence in assessing focal liver lesions (FLLs). By reviewing FLLs without and with DWI at 1.5 T, two radiologists scored the confidence in diagnosing benignancy/malignancy (confidence score), and DWI usefulness (usefulness score). We showed that adding DWI significantly decreased the confidence score of the most experienced radiologist and increased his confidence in false-negative diagnoses showing atypical features on conventional magnetic resonance imaging.

We retrospectively compared the accuracy of two computer-aided detection (CAD) systems for the detection of malignant breast lesions on full-field digital mammograms. Mammograms of 326 patients were analyzed (117 patients with breast cancer, 209 negative cases), and each set of cases was read by two CAD systems (Second Look versus AccuDetect Galileo). True-positive fractions per image and case for soft densities, microcalcifications, and total cancers were assessed. Study results showed better overall performance of AccuDetect Galileo (when compared to Second Look) in detecting masses, microcalcifications, and all cancer types, especially in extremely dense breast parenchyma.

A technique is presented for computing a normalised image in which each pixel directly describes the radiodensity of the underlying anatomy. Precisely, each pixel quantifies the equivalent thickness of reference material per unit traversal distance required to match the radiodensity of the breast tissues present within the traversal between the focal spot and the image receptor pixel. Measurements are computed using a model of image formation, which includes consideration of both the attenuation and scattering phenomena that occur. In view of the complexity of the underlying model, substantial computational optimisation has been made to yield clinically realistic execution times. Validation experiments are described using a purpose designed and manufactured tissue equivalent test object which allows both the assessment of the performance of the image normalisation, and a comparison with "ground truth". © 2008 Springer-Verlag Berlin Heidelberg.

AIM To investigate the type and timing of evolution of incidentally found branch-duct intraductal papillary mucinous neoplasms (bd-IPMN) of the pancreas addressed to magnetic resonance imaging cholangiopancreatography (MRCP) follow-up. METHODS We retrospectively evaluated 72 patients who underwent, over the period 2006-2016, a total of 318 MRCPs (mean 4.4) to follow-up incidental, presumed bd-IPMN without signs of malignancy, found or confirmed at a baseline MRCP examination. Median follow-up time was 48.5 mo (range 13-95 mo). MRCPs were acquired on 1.5T and/or 3.0T systems using 2D and/or 3D technique. Image analysis assessed the rates of occurrence over the follow-up of the following outcomes: (1) imaging evolution, defined as any change in cysts number and/or size and/or appearance; and (2) alert findings, defined as worrisome features and/or high risk stigmata (e.g., thick septa, parietal thickening, mural nodules and involvement of the main pancreatic duct). Time to outcomes was described with the Kaplan-Meir approach. Cox regression model was used to investigate clinical or initial MRCP findings predicting cysts changes. RESULTS We found a total of 343 cysts (per-patient mean 5.1) with average size of 8.5 mm (range 5-25 mm). Imaging evolution was observed in 32/72 patients (44.4%; 95%CI: 32-9-56.6), involving 47/343 cysts (13.7%). There was a main trend towards small (< 10 mm) increase and/or decrease of cysts size at a median time of 22.5 mo. Alert findings developed in 6/72 patients (8.3%; 95%CI: 3.4-17.9) over a wide interval of time (13-63 mo). No malignancy was found on endoscopic ultrasound with fine-needle aspiration (5/6 cases) or surgery (1/6 cases). No clinical or initial MRCP features were significantly associated with changes in bd-IPMN appearance (P > 0.01). CONCLUSION Changes in MRCP appearance of incidental bd-IPNM were frequent over the follow-up (44.4%), with relatively rare (8.3%) occurrence of non-malignant alert findings that prompted further diagnostic steps. Changes occurred at a wide interval of time and were unpredictable, suggesting that imaging follow-up should be not discontinued, though MRCPs might be considerably delayed without a significant risk of missing malignancy.

To evaluate the influence of post-processing systems, intra- and inter-reader agreement on the variability of apparent diffusion coefficient (ADC) measurements in breast lesions. Forty-one patients with 41 biopsy-proven breast lesions gave their informed consent and were included in this prospective IRB-approved study. Magnetic resonance imaging (MRI) examinations were performed at 1.5 T using an EPI-DWI sequence, with b-values of 0 and 1000 s/mm2. Two radiologists (R1, R2) reviewed the images in separate sessions and measured the ADC for lesion, using MRI-workstation (S-WS), PACS-workstation (P-WS) and a commercial DICOM viewer (O-SW). Agreement was evaluated using the intraclass correlation coefficient (ICC), Bland–Altman plots and coefficient of variation (CV). Thirty-one malignant, two high-risk and eight benign mass-like lesions were analysed. Intra-reader agreement was almost perfect (ICC-R1 = 0.974; ICC-R2 = 0.990) while inter-reader agreement was substantial (ICC from 0.615 to 0.682). Bland–Altman plots revealed a significant bias in ADC values measured between O-SW and S-WS (P = 0.025), no further systematic differences were identified. CV varied from 6.8 % to 7.9 %. Post-processing systems may have a significant, although minor, impact on ADC measurements in breast lesions. While intra-reader agreement is high, the main source of ADC variability seems to be caused by inter-reader variation. • ADC provides quantitative information on breast lesions independent from the system used. • ADC measurement using different workstations and software systems is generally reliable. • Systematic, but minor, differences may occur between different post-processing systems. • Inter-reader agreement of ADC measurements exceeded intra-reader agreement.

Atypical hyperplasia and lobular carcinoma in situ are rare proliferative breast lesions, growing inside ducts and terminal ducto-lobular units. They represent a marker of increased risk for breast cancer and a non-obligate precursor of malignancy. Evidence available on diagnosis and management is scarce. They are frequently found incidentally associated with other lesions, but can be visible through mammography, ultrasound or magnetic resonance. Due to the risk of underestimation, surgical excision is often performed. The analysis of imaging and histopathological characteristics could help identifying low-risk cases, for which surgery is not necessary. Chemopreventive agents can be used for risk reduction. Careful imaging follow up is mandatory; the role of breast MRI as screening modality is under discussion.

Purpose To investigate the agreement between Roach equations (RE) and multiparametric magnetic resonance imaging (mpMRI) in assessing the T-stage of prostate cancer (PCa). Materials and methods Seventy-three patients with biopsy-proven PCa and previous RE assessment prospectively underwent mpMRI on a 3.0T magnet before external beam radiation therapy (EBRT). Using Cohen’s kappa statistic, we assessed the agreement between RE and mpMRI in defining the T-stage (≥T3 vs.T ≤ 2) and risk category according to the National comprehensive cancer network criteria (≤intermediate vs. ≥high). We also calculated sensitivity and specificity for ≥T3 stage in an additional group of thirty-seven patients with post-prostatectomy histological examination (mpMRI validation group). Results The agreement between RE and mpMRI in assessing the T stage and risk category was moderate (k = 0.53 and 0.56, respectively). mpMRI changed the T stage and risk category in 21.9% (95%C.I. 13.4–33-4) and 20.5% (95%C.I. 12.3–31.9), respectively, prevalently downstaging PCa compared to RE. Sensitivity and specificity for ≥T3 stage in the mpMRI validation group were 81.8% (95%C.I. 65.1–91.9) and 88.5% (72.8–96.1). Conclusion RE and mpMRI show moderate agreement only in assessing the T-stage of PCa, translating into an mpMRI-induced change in risk assessment in about one fifth of patients. As supported by high sensitivity/specificity for ≥T3 stage in the validation group, the discrepancy we found is in favour of mpMRI as a tool to stage PCa before ERBT.

Women who underwent chest radiation therapy (CRT) during pediatric/young-adult age (typically, lymphoma survivors) have an increased breast cancer risk, in particular for high doses. The cumulative incidence from 40 to 45 years of age is 13–20 %, similar to that of BRCA mutation carriers for whom contrast-enhanced magnetic resonance imaging (MRI) is recommended. However, in women who underwent CRT, MRI sensitivity is lower (63–80 %) and that of mammography higher (67–70 %) than those observed in women with hereditary predisposition, due to a higher incidence of ductal carcinoma in situ with microcalcifications and low neoangiogenesis. A sensitivity close to 95 % can be obtained only using mammography as an adjunct to MRI. Considering the available evidence, women who underwent CRT before 30 receiving a cumulative dose ≥10 Gy should be invited after 25 (or, at least, 8 years after CRT) to attend the following program: 1. interview about individual risk profile and potential of breast imaging; 2. annual MRI using the same protocol recommended for women with hereditary predisposition; 3. annual bilateral two-view full-field digital mammography or digital breast tomosynthesis (DBT) with synthetic 2D reconstructions. Mammography and MRI can be performed at once or alternately every 6 months. In the case of MRI or contrast material contraindications, ultrasound will be performed instead of MRI. Reporting using BI-RADS is recommended. At the age for entering population screening, the individual risk profile will be discussed with the woman about opting for only mammography/DBT screening or for continuing the intensive protocol.

To examine the interpretive performance of digital breast tomosynthesis (DBT) as an adjunct to digital mammography (DM) compared to DM alone in a series of invasive lobular carcinomas (ILCs) and to assess whether DBT can be used to characterise ILC.A retrospective, multi-reader study was conducted of 83 mammographic examinations of women with 107 newly diagnosed ILCs ascertained at histology. Consenting women underwent both DM and DBT acquisitions. Twelve radiologists, with varying mammography experience, interpreted DM images alone, reporting lesion location, mammographic features, and malignancy probability using the Breast Imaging-Reporting and Data System (BI-RADS) categories 1-5; they then reviewed DBT images in addition to DM, and reported the same parameters. Statistical analyses compared sensitivity, false-positive rates (FPR), and interpretive performance using the receiver operating characteristics (ROC) curve and the area under the curve (AUC), for reading with DM versus DM plus DBT.Multi-reader pooled ROC analysis for DM plus DBT yielded AUC=0.89 (95% confidence interval [CI]: 0.88-0.91), which was significantly higher (p0.0001) than DM alone with AUC=0.84 (95% CI: 0.82-0.86). DBT plus DM significantly increased pooled sensitivity (85%) compared to DM alone (70%; p0.0001). FPR did not vary significantly with the addition of DBT to DM. Interpreting with DBT (compared to DM alone) increased the correct identification of ILCs depicted as architectural distortions (84% versus 65%, respectively) or as masses (89% versus 70%), increasing interpretive performance for both experienced and less-experienced readers; larger gains in AUC were shown for less-experienced radiologists. Multifocal and/or multicentric and bilateral disease was more frequently identified on DM with DBT.Adding DBT to DM significantly improved the accuracy of mammographic interpretation for ILCs and contributed to characterising disease extent.

The purpose of this study was to investigate whether breast MRI can be used to rule out malignancy in patients with high-risk lesions diagnosed at imaging-guided core needle biopsy.The subjects were women consecutively registered between October 2004 and April 2010 who had high-risk lesions diagnosed at mammographically or sonographically guided core needle biopsy and subsequently underwent MRI and surgical excision. MR images were reviewed by two experienced breast radiologists. Lesions assessed as BI-RADS category 1-3 were considered negative for malignancy, and BI-RADS 4 and 5 lesions were considered malignant. Histologic findings at surgical excision were the reference standard. The sensitivity, specificity, and positive and negative predictive values of MRI in the detection of associated malignancy were calculated for the entire set of lesions and for each histologic subtype.The final sample consisted of 169 high-risk lesions in 166 patients. At MRI analysis, 116 (68.6%) lesions were considered negative for malignancy, and the other 53 (31.4%) malignant. At surgical excision, 22 malignant lesions were found. The overall sensitivity, specificity, and positive and negative predictive values of MRI were 72.7% (16/22), 74.8% (110/147), 30.2% (16/53), and 94.8% (110/116). The negative predictive values for papilloma, radial scar, lobular neoplasia, and atypical ductal hyperplasia were 97.4% (38/39), 97.6% (41/42), 88.0% (22/25), and 90.0% (9/10).Patients with high-risk lesions associated with the lowest likelihood of malignancy (papilloma and radial scar) and without suspicious MRI findings can safely undergo follow-up instead of surgery. Because of the low negative predictive value, however, MRI is not helpful in cases of lobular neoplasia and atypical ductal hyperplasia, and all these lesions should be excised.

The purposes of our study were, first, to evaluate the frequency, clinical presentation, and associated imaging findings of malignant breast lesions presenting as hyperechoic nodules in a large series of consecutive sonographically guided core needle biopsies (CNBs) and, second, to investigate sonographic features that are able to predict malignancy in hyperechoic breast lesions.The radiologic and pathologic records for 4511 consecutive sonographically guided CNBs were retrospectively reviewed. Hyperechoic lesions were identified, and clinical notes and related mammography or MRI reports were reviewed. The sonographic images were evaluated according to the BI-RADS lexicon by two experienced breast radiologists. Surgical pathology results and follow-up served as the reference standard for lesions diagnosed as malignant or high-risk and benign at CNB, respectively. The frequency of hyperechoic carcinomas among all carcinomas was calculated. Differences in sonographic appearance between hyperechoic benign and malignant lesions were evaluated using the chi-square test or the Fisher exact test.Of all biopsied lesions, 25 (0.6%) were hyperechoic. Among the 1849 malignant lesions, nine (0.4%) were hyperechoic. The remaining 16 were benign. None of the hyperechoic malignancies was a "purely" sonographic lesion, because all were palpable, mammographically visible, or detectable on breast MRI. Malignant lesions were more likely than benign lesions to have noncircumscribed margins (9/9 vs 7/16; p = 0.008) and nonparallel orientation (6/9 vs 1/16; p = 0.003).When encountering a hyperechoic nodule, malignant nature cannot be excluded. Suspicious sonographic signs and correlation with other imaging techniques may help avoid misdiagnosis.

Aims and background The purpose of the study was to identify clinical, mammographic or sonographic abnormalities of the male breast that require histological characterization. Methods and study design Clinical and imaging features of 31 male patients with breast lesions were retrospectively evaluated and correlated with core needle biopsy results. Results Seven of 31 (22.6%) lesions proved to be malignant and 24 of 31 (77.4%) benign, with a benign/malignant ratio of 4.4:1. In the case of a suspicious clinical presentation (firm mass, nipple retraction) and/or the presence of risk factors for breast cancer (BRCA2 mutation, previous breast cancer), core needle biopsy always demonstrated malignancy. All malignant lesions identified on mammography (4 of 7) appeared as a mass. Benign lesions detected on mammography (21 of 24) presented as an area of increased density (20 of 21) more frequently than a mass (1 of 21). Conclusions Sonographic features of cancers were not different from those of benign lesions. Clinical and mammographic findings, along with patient history, can be useful in the identification of male breast lesions that require core needle biopsy.

We report the case of a 42-year-old woman being treated for an ovarian cancer who was diagnosed at the age of 40. A CT–positron emission tomography (PET) scan performed as follow-up documented abnormal uptake in the right breast. Mammograms were negative for malignancy, while a focal hyperechoic lesion was observed on ultrasonography in the same breast. Thus, she was referred to our institution for breast MRI, which showed a focal area of enhancement with atypical features. Percutaneous biopsy was performed, and a mammary hibernoma was diagnosed. Radiological and pathological correlation was provided. To our knowledge, this is the only report that describes the features of this rare tumour on four different imaging modalities (mammography, ultrasonography, MRI and CT–PET).

Orthotopic liver transplantation is a widely accepted treatment for end-stage liver disease and selected cases of hepatocellular carcinoma. Despite surgical progresses, biliary complications after transplantation remain a serious cause of morbidity, mortality, and graft dysfunction or failure in recipients. Early complications occur within a few weeks after transplantation and are mainly represented by bile leakage. Late complications, which become evident from 3 months to years, include strictures, stones, intraductal debris or sludge formation, kinking and ampullary dysfunction. Donor-to-recipient common bile duct disproportion has been reported as a borderline condition. Diagnosis is challenging because of the low specificity of clinical and biologic findings. Sonography does not provide projectional images of the biliary tract or direct evaluation of the anastomoses. Moreover, direct cholangiographic procedures have an unacceptable rate of complications to be used in patients with low clinical suspicion. Magnetic resonance cholangiography is a safe and accurate tool, playing an increasing role in the diagnosis and management of biliary complications. Heavily T2-weighted images provide panoramic, detailed evaluation of the biliary tract, showing biliary complications as a variable combination of bile duct dilatation, strictures, filling defects, fluid collections and peculiar morphologic changes, as described in this paper.

The purpose of this study is to describe the semiological features of rare breast neoplasms at magnetic resonance mammography (MRM).Out of 468 MRMs of patients with a histological diagnosis of breast malignancy, 27 (5.7%) cases of rare breast neoplasms, confirmed by definitive histological analysis on surgical specimens, were selected: four (0.9%) intracystic papillary neoplasms, four (0.9%) intraductal papillary neoplasms, five (1.0%) invasive papillary neoplasms, two (0.4%) medullary carcinomas, seven (1.5%) mucinous carcinomas, three (0.6%) tubular carcinomas, one (0.2%) tubulo-lobular carcinoma and one (0.2%) desmoid tumour. Two radiologists evaluated the MRM images according to Fischer criteria and indicated a level of diagnostic suspicion. In particular, MRM lesion morphology and enhancement characteristics were analysed.No semiologic features of malignancy or peculiar appearances indicating rare breast neoplasm were identified. On the contrary, MRM appearance was nonspecific and often suggestive of probably benign (Breast Imaging Reporting and Data System-BI-RADS 3) (40%) or benign lesions (BI-RADS 2) (7.5%), or lesions were undetectable at MRM (BI-RADS 1) (7.5%).Frequently, rare breast neoplasms show low suspicious morphologic and kinetic patterns at MRM, and they are often classified as indeterminate lesions. This is probably due to their high grade of differentiation and their histological features.

The introduction of systems for automated reading in mammography has been proposed to improve the sensitivity [computer-aided detection (CADe) systems] and, more recently, the specificity [computer-aided diagnosis (CADi) systems] of the test. Only CADe systems have been approved by the U.S. Food and Drug Administration (FDA) and are used in current practice. These systems are still under discussion. Several studies have demonstrated that they are beneficial to inexperienced readers and that, through comparison with the computer, radiologists are led to improve their performance. However, there is still considerable variation among different studies in the level of benefit deriving from CAD. Therefore the role of these systems in clinical practice is still debated, and their real contribution to the overall management of the diagnostic process is not yet clear.

Congenital hyperinsulinism (CHI) due to diffuse involvement of the pancreas is a challenging and severe illness in children. Its treatment is based on chronic therapy with diazoxide and/or octreotide, followed by partial pancreatectomy, which is often not resolutive. Sirolimus, a mammalian target of rapamycin inhibitor, was reported to be effective in treating CHI in infants. We report here the case of an 8-year-old boy affected by a severe form of CHI due to a biallelic heterozygous ABCC8 mutation who responded to sirolimus with a dramatic improvement in his glucose blood level regulation and quality of life, with no serious adverse events after 6 months of follow-up. To the best of our knowledge, this is the first report of a successful intervention in an older child. It provides a promising basis for further studies comparing sirolimus with other treatments, particularly in older children.

To evaluate whether the variation of the apparent diffusion coefficient (ADC) values obtained with DWI can predict elevated levels of Ki67 proliferation index and aggressive subtypes in patients with breast cancer.Breast MRI studies of 115 patients (mean age 57.3 years, range 36-81 years) with a biopsy-proven breast cancers were evaluated in this retrospective IRB-approved study. Examinations were performed on a 1.5 T magnet and included a Single-Shot Echoplanar DWI sequence with b values of 0 and 1000 s/mm(2). For each target lesion, ADC was measured. ADC values were compared considering Ki67 status (≥20 % or20 %), histology, grade (G1, G2 or G3) and clinical-pathological classification (Luminal A, Luminal B HER2-positive, Luminal B HER-2 negative, HER-2 enriched and Triple Negative). Mann-Whitney U test and Kruskal-Wallis test were used for comparisons and receiver operating characteristic (ROC) curves were obtained. Inter- and intra-reader variability was evaluated in a subset of 40 patients, using interclass correlation coefficient (ICC) and Bland-Altman plots.Of 115 lesions, 53 (46.1 %) were assessed as Ki67 positive and 62 (53.9 %) as Ki67 negative. ADC values were significantly (p 0.0001) lower in Ki67-positive patients (median 0.86 × 10(-3) mm(2)/s; interquartile range 0.75-0.92) compared to Ki67-negative (median 1.03 × 10(-3) mm(2)/s; interquartile range 0.92-1.13). Median ADC was also lower in G2 and G3 cancer and in the Luminal B Her2-negative subtype (p = 0.0015). No differences were found when evaluating histology. ROC curve showed a sensitivity and specificity of 83.0 and 66.1 %, respectively, when using a cutoff of 0.95 s/mm(2) to differentiate Ki67-positive from Ki67-negative cancers. Inter- and intra-reader variability was moderate (ICC = 0.623; ICC = 0.548, respectively). No systematic differences were identified with Bland-Altman plots.Lower ADC values are associated with elevated Ki67 proliferation index and more aggressive pathologic features. Moderate agreement in ADC measurement could be a limitation.

This study was done to evaluate test–retest reliability of liver diffusion tensor imaging (LDTI). Ten healthy volunteers (median age 23 years) underwent two LDTI scans on a 3.0 T magnet during two imaging sessions separated by 2 weeks (session-1/-2, respectively). Fifteen gradient directions and b values of 0–1,000 s/mm2 were used. Two radiologists in consensus assessed liver apparent diffusion coefficient (ADC) and fraction of anisotropy (FA) values on ADC and FA maps at four reference levels, namely: right upper level (RUL), right lower level (RLL), left upper level (LUL) and left lower level (LLL). We then assessed (a) whether ADC and FA values overlapped when measured on different levels within the same imaging session or between different imaging sessions; (b) the degree of variability on an intra-session and inter-session basis, respectively, using the coefficient of variation (CV). In sessions 1 and 2, the ADC/FA values were significantly larger in the left liver lobe (LUL/LLL) compared to right liver lobe (RUL/RLL) (p

Deep pelvic endometriosis is defined as subperitoneal infiltration of endometrial implants in the uterosacral ligaments, rectum, rectovaginal septum, vagina, or bladder. It is responsible for severe pelvic pain. Accurate preoperative assessment of disease extension is required for planning complete surgical excision, but such assessment is difficult with physical examination. Various sonographic approaches (transvaginal, transrectal, endoscopic transrectal) have been used for this purpose but do not allow panoramic evaluation. Furthermore, exploratory laparoscopy has limitations in demonstrating deep endometriotic lesions hidden by adhesions or located in the subperitoneal space. Despite some limitations, magnetic resonance (MR) imaging is able to directly demonstrate deep pelvic endometriosis. The MR imaging features depend on the type of lesions: infiltrating small implants, solid deep lesions mainly located in the posterior cul-de-sac and involving the uterosacral ligaments and torus uterinus, or visceral endometriosis involving the bladder and rectal wall. Solid deep lesions have low to intermediate signal intensity with punctate regions of high signal intensity on T1-weighted images, show uniform low signal intensity on T2-weighted images, and can demonstrate enhancement on contrast-enhanced images. MR imaging is a useful adjunct to physical examination and transvaginal or transrectal sonography in evaluation of patients with deep infiltrating endometriosis.