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OBJECTIVES: Our aim was to compare retrospectively hepatic venous and delayed phase images for the detection of tumour washout during multiphasic multidetector row CT (MDCT) of the liver in patients with hepatocellular carcinoma (HCC). METHODS: 30 cirrhotic patients underwent multiphasic MDCT in the 90 days before liver transplantation. MDCT was performed before contrast medium administration and during hepatic arterial hepatic venous and delayed phases, images were obtained at 12, 55 and 120 s after trigger threshold. Two radiologists qualitatively evaluated images for lesion attenuation. Tumour washout was evaluated subjectively and objectively. Tumour-to-liver contrast (TLC) was measured for all pathologically proven HCCs. RESULTS: 48 HCCs were detected at MDCT. 46 of the 48 tumours (96%) appeared as either hyper- or isoattenuating during the hepatic arterial phase subjective washout was present in 15 HCCs (33%) during the hepatic venous phase and in 35 (76%) during the delayed phase (p

Urography (IVU) is considered the best first investigation in patients with suspected ureteric colic, but recently ultrasonography (US), combined with a plain film of the abdomen (KUB), has been suggested as an alternative. We have undertaken a prospective study to see if this approach can be used in an Emergency Department by radiologists with different amounts of ultrasound experience. Some 180 patients with suspected ureteric colic presenting to the Emergency Department over an 8-month period were studied. They had a plain abdominal film (KUB) and US examination of the kidneys, ureters and bladder following hydration. Some 120 patients subsequently underwent IVU at a mean interval of 3.5 days after the ultrasound examination. Of these, 15 patients passed a stone before their IVU. Of the remaining 105 patients, 44 had an IVU positive for stone and 61 had a negative IVU. Fifty of the 60 patients who did not have an IVU had clinical follow-up and 31 had ultrasound. Our findings in this prospective study suggest that in the hydrated patient the combination of KUB plus US is a sensitive but not very specific screening test (sensitivity 95%, specificity 67%). Because of the high negative predictive value of KUB plus US (95%), urography is not likely to be helpful when KUB plus US are negative. Urography is indicated only if KUB plus US findings are equivocal or if intervention is necessary. If we had used KUB plus US alone as the first test in our patients, urography would have been unnecessary in approximately 60%. Twenty per cent of our patients passed a stone in the first 48 h.

Background: The identification of reliable markers for diagnosis of breast cancer has been thoroughly addressed by metabolic profiling using nuclear magnetic resonance (NMR) spectroscopy or imaging. Several clear diagnostic indicators have emerged using either in vitro analysis of tissue extracts, ex vivo analysis of biopsies or in vivo direct spectral observations. Most of the breast cancer characteristic metabolites could be assayed by mass spectrometry (MS) to exploit the superior sensitivity of this technique and therefore reduce the traumatic impact of current biopsy procedures. Methods: Following extraction, aqueous metabolite mixtures were obtained that were submitted to liquid-chromatography, electrospray-ionization, mass spectrometry (LC/ESI-MS) analysis to estimate the content of choline (Cho) and its phosphorylated derivatives, phosphocholine (PCho) and glycerophosphocholine (GPCho). The determinations were performed using 10 samples from breast tissue biopsies, surgical specimens and one single sample of a hepatic metastasis. In addition, some measurements were also repeated using high-resolution 1H NMR spectroscopy to complement the mass spectrometry results. Results: The contents of Cho, PCho and GPCho in breast tissue extracts were estimated by LC/ESI-MS based on standard compound calibration curves. Sharply increased ratios of phosphorylated-to-unphosphorylated metabolites, PCho/ Cho and (PCho+GPCho)/Cho, were observed in all tumor samples, although without discrimination between benign and malignant lesions, contrary to samples from healthy individuals and from those with fibrocystic disease. Conclusions: The assessment of breast cancer markers by LC/ESI-MS is feasible and diagnostically valuable. In addition to high sensitivity, the approach also shows a resolution advantage for assaying choline derivatives compared to NMR, and could complement the latter.

This study was performed to assess the role of magnetic resonance cholangiography (MRC) in the clinical decision-making process of referring physicians when managing liver-transplanted patients.Over a 6-month period, 21 liver-transplanted patients with a suspected biliary complication were referred for MRC. Referring physicians were asked to prospectively state, before and after MRC, the leading diagnosis; the level of confidence (on a 0-100% scale); the most appropriate diagnostic/therapeutic plan. Data analysis assessed was the diagnostic yield of MRC; the proportion of change in the leading diagnosis; the therapeutic efficacy (i.e. proportion of change in the initial diagnostic/therapeutic plan); the diagnostic thinking efficacy (i.e., gain in diagnostic confidence). Statistical significance was assessed with the Mann-Whitney U test. MRC accuracy was also calculated.Data analysis showed a diagnostic yield of 85.7%; a proportion of change in leading diagnosis of 19.0%; a therapeutic efficacy of 42.8%; a diagnostic thinking efficacy for concordant and discordant leading diagnoses of 18.8% and 78.7%, respectively (p0.01). MRC accuracy was 92.3%.MRC significantly increased the diagnostic confidence, irrespective of the concordance between pre- and posttest diagnoses. Moreover, MRC determined a change in patient management in a significant proportion of cases, leading to clinical benefits.

To estimate the prevalence of incidental pancreatic cysts (IPCs) in asymptomatic patients addressed to magnetic resonance cholangiopancreatography (MRCP), and to correlate it with clinical and imaging features. Magnetic resonance cholangiopancreatography performed over 26-months on 152 patients with unsuspected/unknown pancreatic disease were reviewed to assess IPCs’ features of presentation. Multivariate analysis was performed to evaluate the correlation of IPCs with clinical information and type of pancreaticobiliary findings at MRCP. Prevalence of IPCs was 44.7%. Cysts sized 3–24 mm (mean, 6.08 mm), and were ≤4 in number in 83.8% of patients. Based on number, dimensions and relation with the main pancreatic duct, IPCs presented with intraductal-papillary-mucinous neoplasm (IPMN)-like or indeterminate patterns in 31.7% and 13.1% of patients, respectively. At follow-up on 24 patients, no evolution was found, except in one patient with proven IPMN showing increase in cysts number and dimensions (evolution rate of 4.1%). Features correlating with IPCs were age ≥60 years old, and history of autoimmune hepatobiliary disease, showing odds ratios of 5.95 (95% CI 2.77–12.79) and 0.13 (95% CI 0.04–0.44), respectively. Incidental pancreatic cysts represent a frequent finding at MRCP, correlating positively with increasing age, and negatively with biliary autoimmune disease. Cysts more frequently present with IPMN-like pattern.

Post-cholecystectomy syndrome (PCS) is defined as a complex of heterogeneous symptoms, consisting of upper abdominal pain and dyspepsia, which recur and/or persist after cholecystectomy. Nevertheless, this term is inaccurate, as it encompasses biliary and non-biliary disorders, possibly unrelated to cholecystectomy. Biliary manifestations of PCS may occur early in the post-operative period, usually because of incomplete surgery (retained calculi in the cystic duct remnant or in the common bile duct) or operative complications, such as bile duct injury and/or bile leakage. A later onset is commonly caused by inflammatory scarring strictures involving the sphincter of Oddi or the common bile duct, recurrent calculi or biliary dyskinesia. The traditional imaging approach for PCS has involved ultrasound and/or CT followed by direct cholangiography, whereas manometry of the sphincter of Oddi and biliary scintigraphy have been reserved for cases of biliary dyskinesia. Because of its capability to provide non-invasive high-quality visualisation of the biliary tract, magnetic resonance cholangiopancreatography (MRCP) has been advocated as a reliable imaging tool for assessing patients with suspected PCS and for guiding management decisions. This paper illustrates the rationale for using MRCP, together with the main MRCP biliary findings and diagnostic pitfalls.

The purposes of our study were to evaluate the surgical outcome of cases of radial scar without atypia diagnosed at imaging-guided percutaneous needle biopsy and to determine whether the mammographic and sonographic features are able to predict which lesions will be upgraded to malignancy at surgical excision.The records of 4,458 consecutive imaging-guided biopsies were retrospectively reviewed. Surgical excision results were available in 62 cases in which radial scar was the highest-risk lesion at stereotactically guided or sonographically guided biopsy. The mammographic and sonographic images and surgical findings were reviewed. The underestimation rate of malignancy of percutaneous biopsy was calculated. Differences in mammographic and sonographic appearances between radial scars with and without associated malignancy were evaluated using the Fisher's exact test.The percutaneous malignancy underestimation rate was 8% (5/62): 9% (4/43) for sonography guided 14-gauge biopsies and 5% (1/19) for stereotactically guided 11-gauge vacuum-assisted biopsies (p = 1.000). Mammographic and sonographic appearances were not significantly different between radial scars with and those without associated malignancy.A percutaneous diagnosis of a radial scar does not exclude associated malignancy at surgical excision. Mammographic and sonographic features of a lesion diagnosed as a radial scar at percutaneous imaging-guided biopsy do not predict which lesions will have associated malignancy at surgery. Therefore, all patients with percutaneous diagnosis of a radial scar should undergo surgical excision regardless of mammographic and sonographic appearances, until further criteria can be determined.

The authors evaluated the diagnostic yield of chest multidetector computed tomography (MDCT) in acute pulmonary embolism (PE) and the proportion of other clinically relevant findings in a large cohort of consecutive inpatients and patients referred from the emergency department (outpatients).A total of 327 radiological reports of chest MDCT scans performed for suspected acute PE in 327 patients (158 men, 169 women; mean age 69 years, standard deviation 17.33 years; 233 inpatients, 94 outpatients) were retrospectively evaluated and classified into four categories: 1, positive for PE; 2, negative for PE but positive for other findings requiring specific and immediate intervention; 3, completely negative or positive for findings with a potential for significant morbidity requiring specific action on follow-up; 4, indeterminate. The distribution of findings by categories among the entire population and inpatients and outpatients separately was calculated (chi-square test, α=0.05).In the entire population, the diagnostic yield (i.e. proportion of cases classified as category 1) was 20.2% (66/327). Proportions of cases classified as categories 2, 3 and 4 were 27.5% (90/327), 44.3% (145/327) and 7.9% (26/327), respectively. No statistically significant difference was found between inpatients and outpatients (p=0.193).In patients with suspected acute PE, chest MDCT provides evidence of conditions requiring immediate and specific intervention (i.e. categories 1 and 2) in nearly 50% of cases, without differences between inpatients and outpatients.

Find full text(opens in a new window)|Order document(opens in a new window)|View at Publisher| Export | Download | Add to List | More... Radiologia Medica Volume 115, Issue 2, March 2010, Pages 205-214 Impact of clinical data on chest radiography sensitivity in detecting pulmonary abnormalities in immunocompromised patients with suspected pneumonia (Article) [Impatto della conoscenza delle informazioni cliniche sulla sensibilità del radiogramma del torace nel riconoscimento di infiltrati polmonari in pazienti immunocompromessi con sospetta polmonite] Cereser, L.a , Zuiani, C.a, Graziani, G.a, Girometti, R.a, Como, G.a, Zaja, F.b, Bazzocchi, M.a a Istituto di Radiologia, Università Degli Studi di Udine, Via Colugna 50, Udine 33100, Italy b Clinica Ematologica, Università Degli Studi di Udine, Piazza Santa Maria della Misericordia, Udine 33100, Italy View references (25) Abstract Purpose: Chest radiography (CXR) of immunocompromised patients has low sensitivity in the early evaluation of pulmonary abnormalities suspected to be infectious. The purpose of the study was to evaluate whether the knowledge of clinical data improves the diagnostic sensitivity of CXR in the particular setting of immunocompromised patients after hematopoietic stem cell transplantation (HSCT). Materials and methods: Sixty-four CXRs of immunocompromised patients with clinically suspected pneumonia were retrospectively and independently evaluated by two radiologists to assess the presence of radiological signs of pneumonia, before (first reading) and after (second reading) the knowledge of clinical data. A chest computed tomography (CT) performed within 3 days was assumed as the standard of reference. For each reading, sensitivity of both radiologists was calculated. Results: Readers showed a sensitivity of 39% and 58.5% for the first reading, and 43.9% and 41.5% for the second reading, respectively. For both readers, these values were not significantly different from those obtained at first reading (McNemar's test, p>0.05). Interobserver agreement at second reading was fair (Cohen test, k=0.33). Conclusions: The sensitivity of CXR is too low to consider it a stand-alone technique for the evaluation of immunocompromised patients after HSCT with suspected pneumonia, even if the radiologist knows detailed clinical data. For these patients, an early chest CT evaluation is therefore recommended.

Objective: To retrospectively compare portal venous phase (PVP) and delayed phase (DP) for the detection of tumor washout at gadobenate dimeglumine-enhanced liver magnetic resonance imaging (MRI) in cirrhotic patients with hypervascular hepatocellular carcinoma (HCC). Methods: Thirty-three patients with 55 HCCs underwent 1.5-T MRI by means of fat-suppressed T1-weighted sequence obtained before and after gadobenate dimeglumine administration, during early and late arterial phases, PVP (70 seconds), and DP (180 seconds). Detection rates of contrast washout of hypervascular HCCs and tumor-to-liver contrast on PVP and DP were measured and compared. Results: Among 54 hypervascular HCCs, washout was present in 24 (44%) of 54 tumors on PVP and in 44 (82%) of 54 on DP (P < 0.001). In 20 (37%) of 54 tumors, washout was deemed present only on DP. Delayed phase images yielded significantly higher mean tumor-to-liver contrast absolute values compared with PVP images (—24.5 [56.1] vs -9.3 [52.6], P = 0.001). Conclusions: Delayed phase is superior to PVP for the washout detection of hypervascular HCC at gadobenate dimeglumine-enhanced MRI of cirrhotic liver.

L’endometriosi e definita come una patologia nella quale ghiandole endometriali e stroma sono presenti al di fuori della cavita e della muscolatura uterine. Non e del tutto chiaro se sia necessaria la contemporanea presenza di tessuto ghiandolare e di stroma ai fini della diagnosi anatomopatologica [1, 2].

The purpose of this study was to evaluate the reliability of volumetric magnetic resonance imaging (MRI) in breast cancer size assessment before, during and after neoadjuvant chemotherapy (NAC). Volumetric MRI measures performed on 15 patients with breast cancer were compared with volumes reckoned upon mean lesional diameters, using the same MRI data. Concordance correlation coefficient (CCC), Bland & Altman plots, RECIST evaluation and Cohen's Kappa were assessed, to evaluate the agreement between the two methods. CCC was computed before (0.9357), during (0.8053) and after (0.7499) NAC, in all examinations pooled together (0.8617), and on final tumor volume as a percentage of baseline volume (0.9224). In 2/15 (13.3%) cases RECIST assessment was different. Cohen's Kappa was 0.787 (CI95% = 0.513–1.062). In summary, volumetric MRI is a reliable tool to assess breast cancer size before, during and after NAC. Further investigations are needed to understand whether improvements in surgical planning are feasible.

PURPOSE To investigate the relevance of increasing b-values in evaluating liver fibrosis through the agreement of two diffusion-weighted (DW) sequences. MATERIALS AND METHODS A total of 29 cirrhotic patients and 29 healthy volunteers were studied on a 1.5T system. Two single-shot spin-echo echo-planar sequences were acquired using sets of increasing b-values: 0, 150, 250, and 400 seconds/mm(2) (first sequence: DW1a) and 0, 150, 250, 400, 600, and 800 seconds/mm(2) (second sequence: DW2a). Apparent diffusion coefficients (ADCs) of the hepatic parenchyma were calculated on ADC maps. Noise-scaled single-point ADCs were calculated for each sequence from b = 400 seconds/mm(2). RESULTS ADCs resulted significantly lower in cirrhotic patients compared to controls using both DW1a (mean 1.14 +/- 0.20 x 10(-3)mm(2)/second vs. 1.54 +/- 0.12 x 10(-3)mm(2)/second; P < 0.0001) and DW2a (mean 0.91 +/- 0.18 x 10(-3)mm(2)/second vs. 1.04 +/- 0.18 x 10(-3)mm(2)/second; P = 0.0089). DW1 and DW2, respectively significantly differed in diagnostic performance at receiver operating characteristic (ROC) curve analysis (P = 0.003), showing AUCs of 0.93 (sensitivity 89.7%, specificity 100%) and 0.73 (sensitivity 62.1%, specificity 79.3%), respectively. Noise-scaled single-point ADCs showed a progressive convergence to similar values in cirrhotic and healthy livers at b = 800 seconds/mm(2) (1.12 +/- 0.27 x 10(-3)mm(2)/second vs. 1.13 +/- 0.17 x 10(-3)mm(2)/second). CONCLUSION A DW sequence is accurate in assessing liver fibrosis using intermediate (400 seconds/mm(2)) rather than high (800 seconds/mm(2)) maximum b-values, but after proper recalculation of ADCs the effects of perfusion rather than diffusion should be considered responsible for the higher accuracy at lower b-values.

The purpose of the study was to evaluate the outcome of initially only magnetic resonance mammography (MRM)-detected breast lesions as a function of radiologic features, history of breast cancer and lesion size. We evaluated core needle biopsy (CNB) (148) and follow-up (25) results of 173 initially only MRM-detected lesions-142 with and 31 without "second-look" correlate, as a function of (1) radiologic features (sonographic correlate, MRI BI-RADS category); (2) history of breast cancer; (3) MRM indication in case of history of breast neoplasm; (4) side and size of synchronous cancer; (5) lesion diameter. (1) Overall malignancy rate was 28.3% (49/173); significantly higher among lesions with a sonographic correlate (46/142), than among those without (3/31) (p=0.014). Frequencies of malignancy for MRI BI-RADS categories 2, 3, 4 and 5, were 0% (0/1), 5.4% (4/73), 26.1% (17/65) and 82.3% (28/34), respectively. (2) Malignancy rate was significantly higher in case of history of breast carcinoma (40/118 versus 9/55; p=0.027); in particular, of 42 MRI BI-RADS category 3 lesions in women with history of breast cancer and of 31 in patients without history, 3 (7%) and 1 (3%) proved to be malignant, respectively (non-significant). (3) Malignancy was more frequent when MRM was performed for pre-operative assessment than for follow-up (30/78 versus 10/40; non-significant). (4) Malignancy rate increased in presence of ipsilateral (19/35 versus 11/43; p=0.018), large (cut-off 6 mm: 30/75 versus 0/3, non-significant; 11 mm: 28/61 versus 2/17, p=0.011; 16 mm: 24/48 versus 6/30, p=0.015; 21 mm: 14/21 versus 16/57, p=0.004) primary tumors. (5) The frequency of malignancy was significantly higher in lesions equal to or larger than 6, 11 and 16 mm, compared with smaller lesions (6 mm: 45/136 versus 4/37, p=0.007; 11 mm: 21/51 versus 28/122, p=0.025; 16 mm: 12/24 versus 37/149, p=0.021). Radiologic features, history of breast cancer and large diameter are associated with high likelihood of malignancy in case of initially only MRM-detected lesions. Nevertheless, biopsy might be spared just for MRI BI-RADS 3 lesions in patients without history of breast carcinoma.

The purpose of this study is to assess the positive predictive value (PPV) for malignancy of core needle biopsy (CNB) demonstrating lobular neoplasia (LN). From 3920 CNBs, 35 (0.89%) LNs (14 atypical lobular hyperplasia - ALH - and 21 lobular carcinoma in situ - LCIS) were identified. Twenty-eight patients underwent surgical excision and seven radiologic follow-up. We describe the imaging findings and excision histology outcomes. We report the PPV for malignancy based on excision histology (n=28) and on excision or follow-up (n=35), and according to the histologic type, biopsy probe and guidance, lesion diameter, and BI-RADS category. PPV for malignancy (based on excision histology) was 46.4% (13/28) and PPV (based on excision or follow-up) was 37.1% (13/35). The overall rate of malignancy for LN was 37.1% (13/35), with a PPV for malignancy of ALH and LCIS of 7.1% (1/14) and 57.1% (12/21), respectively (p=0.003). Estimates of the PPV for malignancy were: stereotactic-guided vacuum-assisted biopsy (22.7%) versus ultrasound-guided automated CNB (61.5%), p=0.053; lesions20mm (31.2%) versus lesions20mm (100%), p=0.043; lesions classified as BI-RADS 3 (16.7%) versus BI-RADS 4 or 5 (41.4%), p=0.377. Underestimation of malignancy was therefore more likely in cases of LCIS, US-guided CNB, and lesions that were large and suspicious on imaging. Nevertheless, the absence of these features does not spare the need for surgical excision in lobular neoplasia diagnosed on CNB.

The clinical use of breast magnetic resonance (MR) imaging is increasing, especially for applications requiring paramagnetic contrast-agent injection. This document presents a synthetic list of acceptable indications with potential advantages for women according to evidence from the literature and the expert opinion of the panel that developed this statement. We generally recommend that breast MR imaging be performed in centres with experience in conventional breast imaging [mammography and ultrasonography (US)] and needle-biopsy procedures (under stereotactic or US guidance) as well as in breast MR imaging and second-look US for findings not revealed by conventional imaging performed before MR imaging. In our opinion, there is no evidence in favour of breast MR imaging as a diagnostic tool to characterise equivocal findings at conventional imaging when needle-biopsy procedures can be performed, nor for the study of asymptomatic, non-high-risk women with negative conventional imaging. After a description of technical and methodological requirements, we define the indications and limitations of breast MR imaging for surveillance of high-risk women, local staging before surgery, evaluation of the effect of neoadjuvant chemotherapy, breast previously treated for carcinoma, carcinoma of unknown primary syndrome, nipple discharge and breast implants.

The purpose of this study is to assess whether magnetic resonance mammography (MRM) can exclude associated malignancy in case of diagnosis of borderline breast lesions (B3) at core needle biopsy (CNB). Retrospective analysis of MRM findings of 79 borderline breast lesions (26 benign papillomas, 29 radial sclerosing lesions, 6 atypical ductal hyperplasias, 18 lobular neoplasias) diagnosed at CNB was performed. Lesions were classified as “non-suspicious” or “suspicious” according to Fischer score. These findings were compared to the results of histological analysis of the excisional specimens. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of MRM in predicting the presence of malignancy were calculated. Out of 24 (30.4%) lesions classified as “suspicious”, 8 (33.3%) proved to be malignant and 16 (66.7%) benign. Among the 55 (69.6%) “non-suspicious” lesions, only 1 (1.8%) was malignant (low-grade ductal carcinoma in situ), while the remaining 54 (98.2%) proved to be benign. MRM sensitivity, specificity, PPV, and NPV were 88.9%, 77.1%, 33.3%, and 98.2%, respectively. When a borderline lesion is diagnosed on CNB, in case of mild or no enhancement at MRM, follow-up rather than excisional biopsy might be prompted.

In recent years some structures or features such as the "inter-renuncular septum", the "echogenic triangle" and the "echogenic line" have been described to support the concept of a kidney resulting from the fusion of two masses or renunculi. To clarify this concept and to understand the meaning of the above echographic features better, the authors have examined prospectively by sonography the kidneys of 50 children, 200 adults with a single collecting system, 25 adults with a duplicated collecting system and 32 cadavers. Furthermore, to help explain the sonographic features, we have examined 32 cadaver kidneys with sonography and 10 cadaver kidneys with magnetic resonance imaging (MRI). The sonographic, MRI and anatomical correlations have shown that the "echogenic triangle" and the "echogenic line" are not renuncular residuals, but simply an extension of the hilar fat visible when the renal sinus is rather deep. The intermediate cortical mass is not a septum dividing the kidney into an upper and lower renunculus, but a column of parenchymal tissue crossing the renal sinus, which, from an anatomical point of view, is an accessory renal lobe. The presence of two renunculi, suggested in a previous study with cortical nephrotomography, has not been confirmed.

Rationale and Objectives We sought to investigate the value of a MRI scoring system including dynamic motility evaluation in the assessment of small bowel Crohn’s disease activity. Materials and Methods From March 2005 to December 2006, 52 patients with suspected Crohn’s disease onset or relapse underwent MRI on a 1.5-T magnet. Bowel distention was achieved orally assuming a mean of 1.6 L of a polyethyleneglycol (PEG) preparation. Per-patient assessment of disease activity was based on a scoring system including evaluation of morphology and motility of the small bowel and perivisceral structures (true-FISP, cine-true-FISP, and HASTE T2W sequences) and dynamic assessment of parietal contrast enhancement (FLASH T1W sequence). Patients were included in three categories, using endoscopic biopsy as the standard reference: no activity/quiescent disease, mild activity, or moderate-to-severe activity. Patients without terminal ileum involvement were excluded from data analysis. Results MRI allowed a detailed and panoramic evaluation of the small bowel in all subjects examined. MRI properly assessed 14 of 16 (87.5%) cases of no activity/quiescent disease, 12 of 14 (85.7%) cases of mild activity, and 15 of 15 (100%) cases of severe activity. Overall, activity score led to a per-patient misdiagnosis of disease activity in a nonsignificant proportion of subjects (4 of 45; 8.8%) (P > .05), determining two false-positive and two false-negative results of mild disease activity. Sensitivity, specificity, PPV, NPV, and overall accuracy in assessing disease activity were 93.1%, 87.5%, 93.1%, 87.5%, and 91.1%, respectively. Conclusion Accurate assessment of Crohn’s disease activity is achieved by using an activity score providing an overall interpretation of MRI findings.

Purpose The purpose of this article is the demonstration of virtual reality (VR) and rapid prototyping (RP) in surgical planning in maxillofacial surgery. The authors emphasize the role of reverse engineering (RE) and RP, suggesting a model of cooperative work, with the interaction of maxillofacial surgeons, radiologists, and engineers. Materials and Methods Data acquisition is performed using computed tomography. The 3D model is the result of RE practices based on image segmentation, and the real model is produced via stereolithography. Virtual simulations are performed on the 3D model obtained from image segmentation. All these stages require the interaction and collaboration of various experts: maxillofacial surgeons, radiologists, and RE and RP experts. Results VR and stereolithography models represent a new technology to help the surgeon who has to work in cooperation with engineers and radiologists to improve the results in surgical planning of maxillofacial distraction. Conclusion When performing the VR simulation, surgeons and engineers operate together in order to optimize the exploitation of the instruments available. Both VR and RP, with different and complementary advantages and limitations, can improve surgical planning activities and this is particularly effective when dealing with complex anatomical structures in maxillofacial surgery.

Background Cross-sectional studies have reported an elevated prevalence of renal cysts in patients with primary aldosteronism. The nature of this association could be related to hypokalemia and/or hypertension and has never been evaluated in prospective studies. Methods A consecutive sample of 54 patients with tumoral or idiopathic primary aldosteronism was followed after adrenalectomy or treatment with aldosterone antagonists. At baseline, renal cysts were evaluated by renal ultrasound and patients with primary aldosteronism were compared with 323 essential hypertension patients with the same severity and duration of disease, and 113 age- and sex-matched normotensive subjects. Results The adjusted prevalence and average number of renal cysts were significantly greater in patients with primary aldosteronism than in patients with essential hypertension and normotensive subjects. Multivariate analysis revealed that age and plasma potassium levels were independently associated with the presence of renal cysts in patients with primary aldosteronism. Treatment of primary aldosteronism decreased blood pressure (BP) and restored normal potassium concentrations. After a median follow-up of 6.2 years, no significant change from baseline of cyst number and cyst total volume was observed in patients with both tumoral and idiopathic aldosteronism and in a subset of 100 patients with essential hypertension. In patients with primary aldosteronism, stepwise logistic analysis showed that the presence of renal cysts was associated with worse BP outcome after treatment. Conclusion Renal cystic disease is highly frequent in patients with primary aldosteronism and either surgical or medical treatment halt its progression, supporting the contention that hypokalemia and its severity are the main contributors to cyst formation in these patients.

Introduction Little is known about the structural abnormalities underlying generalized anxiety disorder (GAD). However, there is evidence of larger volumes of dorsomedial prefrontal cortex (Schienle et al, 2011). Also, increased n-acetyl-aspartate in right dorsolateral prefrontal cortex (DLPFC) (Mathew et al, 2004), and hyperactivation in right middle frontal to negative stimuli have been shown in GAD (Blair et al, 2008). Objectives To investigate variations in cortical thickness (CT) in GAD patients versus healthy controls (HCs). Aims GAD patients and matched HCs underwent a 3T magnetic resonance imaging (MRI) session. Methods Structural MRI was acquired from 24 DSM-IV GAD patients (age=41±13.9) and 23 HCs (age=39±13.4). CT was estimated using Freesurfer5.3 (Fischl and Dale, 2000). Results were manually corrected if necessary. We considered 21 regions of interest (ROIs) per hemisphere (4 cingulate, 6 frontal, 3 parietal, 5 temporal, 1 occipital, entorhinal, insula), for each of which a mean CT value was calculated. A t-test was performed for each region, correcting results for multiple comparisons. Results The groups were statistically homogeneous in terms of age, gender, handedness, and IQ (p>0.05). Though ROI volumes were preserved in GAD (p>0,05; Bonferroni corrected), a significantly reduced CT was found in right caudal middle (t(46)=3.621, p=0.015) and right superior frontal (t(46)=3.215, p=0.049) regions. Conclusions The found decreased CT in GAD patients compared to HCs in superior frontal and caudal middle areas (right side) sustains prior neuroimaging findings showing abnormalities in prefrontal cortex. Reduced right frontal CT may be involved in cognitive dysfunction and symptomatology of the disorder.

The aim of this study was to evaluate the role of ultrasound (US)-guided core biopsy in the diagnosis of ductal carcinoma in situ (DCIS) and to correlate the histological results on percutaneous biopsy and surgical excision.Out of 2,423 consecutive core biopsies performed under US guidance, we evaluated 65 lesions with a histological diagnosis of DCIS. All patients underwent mammography, high-frequency broadband US and percutaneous breast biopsy with a 14-gauge needle and a mean number of five samples (range 4-7 passes). Surgical excision was performed in all cases, and the histological results on the surgical specimen were correlated with those on core biopsy samples. The sonographic features of DCIS lesions were described, comparing pure DCIS (those confirmed by definitive histology) and DCIS with invasive component at surgical excision.Twenty-seven out of 65 DCIS at core biopsy were found to have an invasive or microinvasive component at surgical excision, leading to rate of histological underestimation of core biopsy of 41.5%. The most frequent sonographic appearances were: (a) mass without microcalcifications (47.4% of pure DCIS, 63% of DCIS with invasive component); (b) mass with microcalcifications (23.7% of pure DCIS, 22% of DCIS with invasive component); (c) isolated microcalcifications (10.5% of pure DCIS); (d) ductal abnormalities (18.4% of pure DCIS, 15% of DCIS with invasive component).Due to the high underestimation rate of core biopsy, caution is mandatory in the case of DCIS diagnosis on core biopsy. Although some histological features (such as stromal fibrosis, periductal inflammatory infiltrate, high nuclear grade) can suggest the presence of an invasive component, the sonographic appearance of DCIS cannot be used to predict the cases that are underestimated on US-guided core biopsy. Nevertheless, a sonographically detectable solid component, either inside dilatated ducts or associated with microcalcifications, and a size greater than 20 mm are frequently associated with the presence of an invasive component.

This study was designed to establish whether the measurement of apparent diffusion coefficients (ADCs) is clinically accurate in diagnosing liver fibrosis in a selected series of cirrhotic patients.Twenty-eight cirrhotic patients (mean age 58.1 years) with histologically proven liver fibrosis and 29 healthy controls (mean age 43.8 years) underwent liver diffusion-weighted magnetic resonance (MR) using a 1.5-Tesla (T) magnet equipped with a phased-array coil. Diffusion studies with parallel imaging [generalized autocalibrating partially parallel acquisitions (GRAPPA)] were performed within a single breath-hold using a single-shot spin-echo echo-planar sequence (TE 74 ms) using four b values: b=0, 150, 250 and 400 s/mm(2). A unidirectional diffusion gradient was applied. ADCs were measured on ADC maps.Mean ADC was significantly lower in cirrhotic livers than in controls (1.11+/-0.16 vs. 1.54+/-0.12.10(-3)mm(2)/s) (p0.0001). Receiver operating characteristic (ROC) analysis showed an area under the curve (AUC) of 0.96 [confidence interval (CI) 95%:(0.87; 0.94)], demonstrating higher sensitivity and specificity (92.9% and 100%, respectively) for an ADC cutoff of 1.31.10(-3)mm(2)/s. Positive predictive value (PPV), negative predictive value (NPV) and overall accuracy were 100%, 99.9% and 96.4%, respectively.Diffusion-weighted MRI is an accurate tool in evaluating advanced liver fibrosis if an optimised single-shot spin-echo echo-planar sequence with maximum intermediate b value is used. The ADC threshold for liver fibrosis was 1.31.10(-3)mm(2)/s.

In breast cancer patients with negative sentinel node biopsy (SNB), surveillance of the unremoved nodes is recommended. Clinical examination has poor sensitivity. The aim of this study was to evaluate the role of axillary ultrasound scan (AUS) in the follow-up of these patients. AUS was performed every 12 months in a series of 165 patients with negative SNB. During the follow-up (median 45.6 months), in 154 patients, the AUS was carried out as a routine examination and in three cases (1.9%) it showed suspicious nodes, which underwent core biopsy. No evidence of axillary recurrence was found. Conversely, in 11 patients, AUS was performed to clarify a palpable lymphadenopathy; none of them was suspicious at US. We conclude that routine AUS to follow-up patients who have had a negative SNB is unnecessary. However, AUS may be useful in the presence of palpable nodes, to select those patients who do not require biopsy.

The purpose of this study was to assess the accuracy and clinical usefulness of stereotactic vacuum-assisted biopsy (VAB) for diagnosing suspicious, nonpalpable, only mammographically detectable breast lesions. We retrospectively evaluated the results of percutaneous stereotactic VAB with 11-gauge needles performed over a period of 34 months on 228 nonpalpable suspicious breast lesions detectable on mammography only [Breast Imaging Reporting and Data System (BI-RADS) 3: 25.9%; BI-RADS 4: 67.1%; BI-RADS 5: 7%]. The imaginghistological concordance was ascertained for each lesion. In cases of discordance, repeat biopsy or surgical excision were recommended; in cases of benign lesions, we urged a follow-up of at least 6 months and for borderline and malignant lesions a surgical excision. We also evaluated concordance between VAB results and subsequent examinations (surgical excision or followup). VAB demonstrated 123 (54%) benign lesions (with six cases of imaging–histological discordance), 26 (11.4%) borderline lesions and 79 (34.6%) malignant lesions. We obtained a suitable post-VAB mammographic or histological evaluation for 78 benign lesions, 17 borderline lesions and 76 malignant lesions, with one (1.3%) false negative (FN) case, two (11.8%) underestimations of borderline lesions, 14 (18.4%) underestimations of malignant lesions and no (0%) false positive cases. We did not observe any postbiopsy complications or scars. Percutaneous histological VAB with an 11-gauge needle proved to be, as reported in previous studies, a reliable method for diagnosing nonpalpable, mammographically detectable only breast lesions, with an underestimation rate lower than core biopsy and a FN rate similar to that of surgical biopsy, without any significant complications.

AIM: To demonstrate the use of grid technology to produce a database of mammograms and supporting patient data, specifically using breast density as a biomarker of risk for breast cancer, for epidemiological purposes. METHOD: The cohort comprised 1737 women from the UK and Italy, aged 28e87 years, mean 54.7 years, who underwent mammography after giving consent to the use of their data in the project. Information regarding height, weight, and exposure data (mAs and kV) was recorded. The computer program Generate-SMF was applied to all films in the database to measure breast volume, dense breast volume, and thereby percentage density. Visual readings of density using a six-category classification system were also available for 596 women. RESULTS: The UK and Italian participants were similar in height, but the UK women were significantly heavier with a slightly higher body mass index (BMI), despite being younger. Both absolute and percentage breast density were significantly higher in the Udine cohort. Images from the medio-lateral projection (MLO) give a significantly lower percentage density than cranio-caudal (CC) images (p < 0.0001). Total breast volume is negatively associated with percentage density, as are BMI and age (p

The purpose of this study was to determine whether the double arterial phase with multidetector computed tomography MDCT and high–iodine–concentration contrast material (CM) improves identification of hepatocellular carcinoma (HCC). Fifty patients with 111 HCC foci (61 confirmed histologically, 46 confirmed by percutaneous interventional procedures, four confirmed by CT follow–up of at least 6 months) underwent MDCT with a double arterial phase and a portal venous phase after administration of contrast material with a high iodine concentration (400 mgI/ml, 2 ml/kg, 5 ml/s). Two radiologists independently evaluated the images in three distinct reading sessions (early arterial phase (EAP), late arterial phase (LAP) and double arterial phase) to determine presence, number and degree of suspicion of HCC. The sensitivity and the positive predictive value (PPV) were calculated for every reading session. The following statistical evaluations were used: k statistic and McNemar’s test. Mean sensitivity and PPV in the detection of HCC were, respectively, 83.8% and 93.5% for EAP, 90.5% and 94.8% for LAP, and 94.1% and 95.1% for the double arterial phase. Sensitivity of the double arterial phase was statistically higher when compared with EAP alone but showed no statistically significant difference when compared with LAP. The k values indicated moderate–to–excellent interobserver agreement in all reading sessions. Sensitivity and PPV increase progressively when passing from EAP to LAP to double–arterial–phase images obtained with contrast material with a high iodine concentration. However, the difference in sensitivity between LAP and the double arterial phase was not statistically significant.

To retrospectively correlate high-risk proliferative breast lesions (radial scar, atypical lobular hyperplasia, lobular carcinoma in situ and papillary lesions) diagnosed on core biopsy with the definitive histopathological diagnosis obtained after surgical excision or with the follow-up, in order to assess the role of core biopsy in such lesions. To discuss the management of the patient after a core biopsy diagnosis of high-risk proliferative breast lesion.We evaluated 74 out of 1776 core biopsies consecutively performed on 67 patients. The histopathologic findings were as follows: 11 radial scars (RS), 3 atypical lobular hyperplasias (ALH), 3 lobular carcinomas in situ (LCIS), 57 benign papillary lesions. All patients underwent bilateral mammography, whole-breast ultrasound with a linear-array broadband transducer, and core biopsy with a 14 Gauge needle and a mean number of samples of 5 (range 4-7). Sixty-two of 67 patients, for a total of 69/74 lesions, underwent surgical biopsy despite benign histopathologic findings, mostly because of highly suspicious imaging for malignancy (BIRADS 4-5), whereas 5 patients refused surgery and have been followed up for a least 18 months and are still being followed up (2 with RS, 1 with ADH and 2 with papillary lesions).Among the core biopsied lesions with a diagnosis of RS (n = 11) pathology revealed one ductal carcinoma in situ (DCIS) (this case was characterized by granular microcalcifications on mammography and by a mass with irregular margins on ultrasound). Also in the group of ADH (n = 3) pathology revealed one DCIS (lesion not visible on mammography but depicted as a suspicious mass on US). In the group of LCIS (n = 3) pathologists found an invasive lobular carcinoma (ILC). Among the benign papillary lesions (n = 57) histopathologic analysis of the surgical specimen revealed 7 malignant lesions (4 papillary carcinomas and 3 DCIS), whose mammographic and ultrasound findings were indistinguishable from benign lesions. Altogether there were 10 false negative results (underestimation) out of 74 core biopsies with a diagnosis of high-risk proliferative breast lesions.The high rate of histological underestimation after core biopsy (10/74) (13.5%) demands a very careful management of patents with a core biopsy diagnosis of high-risk proliferative breast lesions, especially in the case of RS, lobular neoplasia and papillary lesions. However, the high imaging suspicion for malignancy prompts surgery. It is possible to assume that, when there is a low imaging suspicion for malignancy, when enough tissue has been sampled for pathology and no atypia is found within the lesions, surgery is not mandatory but a very careful follow-up is recommended. We must underline that there is no agreement regarding the quantity of tissue to sample. Vacuum-assisted biopsy may lead to better results, although there is as yet no proof that it can actually replace surgery in this group of lesions, since it seems only to reduce but not abolish the histological underestimation.

To validate a protocol for creating virtual models to be used in the construction of solid prototypes useful for the planning-simulation of maxillo-facial surgery, in particular for very complex anatomic and pathologic problems. To optimize communications between the radiology, engineering and surgical laboratories.We studied 16 patients with different clinical problems of the maxillo-facial district. Exams were performed with multidetector computed tomography (MDCT) and single slice computed tomography (SDCT) with axial scans and collimation of 0.5-2 mm, and reconstruction interval of 1 mm. Subsequently we performed 2D multiplanar reconstructions and 3D volume-rendering reconstructions. We exported the DICOM images to the engineering laboratory, to recognize and isolate the bony structures by software. With these data the solid prototypes were generated using stereolitography. To date, surgery has been preformed on 12 patients after simulation of the procedure on the stereolithographyc model.The solid prototypes constructed in the difficult cases were sufficiently detailed despite problems related to the artefacts generated by dental fillings an d prostheses. In the remaining cases the MPR/3D images were sufficiently detailed for surgical planning. The surgical results were excellent in all patients who underwent surgery, and the surgeons were satisfied with the improvement in quality and the reduction in time required for the procedure.MDCT enables rapid prototyping using solid replication, which was very helpful in maxillo-facial surgery, despite problems related to artifacts due to dental fillings and prosthesis within the acquisition field; solutions for this problem are work in progress. The protocol used for communication between the different laboratories was valid and reproducible.

Purpose: To evaluate efficacy and diagnostic accuracy of BARCO LCD 5Mpixel displays, compared to BARCO CRT 5Mpixel displays in full-field-digital-mammography (FFDM) interpretation. Material and Methods: FFDM mammograms obtained by 100 patients, were analyzed by three independent radiologists experienced in breast imaging, using two different CRT and LCD displays. All cases were selected by a fourth radiologist in order to cover several possible ages and types of breast. Half of cases were negative and half were positive for malignancy, proven by percutaneous biopsy. Readers were blinded to history of patients, ultrasound examination and biopsy results. To minimize recall bias, an interval of at least 30 days between interpretations of each case on two different monitors was chosen. Each reader evaluated cases classifying them according the ACR BIRADS categories. Moreover, they assigned a rate (0-100) corresponding to the Probability of Malignancy (POM) of each case classified into BIRADS categories 3 to 5. Finally, they assigned a rate (0-100) corresponding to reading confidence. Analysis included ROC curves of POM for each doctor and for pooled data, sensitivity and specificity for the BIRADS≥3 and BIRADS≥4 thresholds for each doctor and for pooled data, and finally main results of “Multireader- Multicase ROC Analysis Of Variance”. For each analysis a comparison was made between the two monitors. Results: No statistical significance was seen between the two displays regarding POM, sensitivity and specificity, nor for single reader either for pooled data. Conclusions: This study provides a reasonable assurance that the examined CRT and LCD display systems are comparable for FFDM interpretation.

The purpose of this study was to evaluate whether lesion size may influence the value of sonographic findings in the differential diagnosis between benign or malignant breast lesions.Sonographic features of 256 histologically confirmed (148 benign, 108 malignant) breast lesions were retrospectively and independently reviewed by three radiologists unaware of mammographic findings and pathology results. Each lesion was assessed for several sonographic features and assigned a level of suspicion. Logistic modelling defined the predictive value of each sonographic feature per se and in relation to lesion size. The k statistic (k) evaluated interobserver agreement in lesion classification. The accuracy of breast sonography in characterising solid lesions was also evaluated.Analysis of the sonographic features predictive of malignant disease, taken as a whole, showed that only irregular margins and marked hypoechogenicity maintain their predictive value independent of lesion size. When lesion size is considered, the other features remain significant only for lesions larger than 7 mm. Interobserver agreement for sonographic suspicion, when calculated not taking into account lesion size, was good or excellent whereas it was reduced for lesions smaller than 7 mm. Accuracy of breast sonography improved when evaluating lesions larger than 7 mm.Lesion size influences the value of sonographic findings in distinguishing benign from malignant lesions. The usually adopted criteria in sonography have a significantly lower accuracy in characterisation of small lesions.

The aim of this study was to evaluate the ability of ultrasound (US) to measure the parietal thickness of varicose veins.In a blind in vitro analysis, 28 great saphenous veins, obtained after stripping surgery from 28 patients with chronic venous insufficiency, were examined with a digital US scanner ATL-HDI5000, linear 5-1 to 2-MHz broadband probe, compound imaging technique and analogic-digital zooming. We obtained one to three progressive measurements for each vein wall (total 67 parietal thicknesses). The samples, fixed in formalin, were sent to the pathology laboratory: sections were obtained at the same level of the sonographic planes, and images were obtained by digital camera mounted on an optical microscope. Measurements obtained at histology were considered as the gold standard. K-statistic was applied to compare sonographic and histologic measurements.Considering only the hypoechoic wall portion, 29/29 (100%) diagnoses of hypotrophy (K=0.91), 19/22 (86%) diagnoses of normotrophy (K=0,47) and 12/16 (75%) diagnoses of hypertrophy (K=0.7) were obtained by sonography.In our preliminary experience, the in vitro study of varicose veins allows precise, at least morphological, detection of hypotrophic walls. If these preliminary data are confirmed in vivo, sonography could be used to discriminate patients eligible for conservative treatment instead of surgery.

The objective of our study was to test dynamic MRI in evaluating mammographically detected suspicious microcalcifications.One hundred twelve patients with mammographically detected microcalcifications with BI-RADS category 5 (n = 78) or 4 (n = 34) lesions were studied at 17 centers a using 3D gradient-echo dynamic coronal technique (or = 3 mm thickness) and 0.1 mmol/kg of gadoteridol. A pathologic sample was obtained in all cases. Agreement between the major diameter measured on mammography, MRI, or both and the major diameter measured at pathologic examination was calculated in 62 cases.Of the 112 lesions, pathologic examination revealed 37 benign lesions, 33 ductal carcinoma in situ (DCIS), and 42 invasive carcinomas. The specificity of MRI for benign lesions was 68%. Considering the subgroups of calcifications alone and calcifications associated with masses, the specificity values became 79% and 33%, respectively. The sensitivity of MRI for DCIS was 79%. Analysis of the two subgroups showed sensitivity values of 68% for calcifications alone and of 1% for calcifications associated with masses. The sensitivity for invasive carcinomas was 93%. Analysis of the two subgroups showed sensitivity values to be 92% for calcifications alone and 94% for calcifications associated with masses. Considering the overall results, the sensitivity of MRI was 87%; specificity, 68%; positive predictive value, 84%; negative predictive value, 71%; and accuracy, 80%. Considering the subgroups of calcifications alone and calcifications associated with masses, the sensitivity values became 80% and 97%; the positive predictive values, 86% and 82%; the negative predictive values, 71% and 75% (95% confidence interval [CI], 0.19-0.99); and the accuracy values, 80% and 82% (95% CI, 0.66-0.92), respectively. An odds ratio (OR) of 13.54 (95% CI, 5.20-35.28) showed a raised risk of malignant breast tumor in subjects with positive MR examination of mammographically detected suspicious clusters of microcalcifications. The statistical analysis on each subgroup showed an OR of 15.07 (95% CI, 4.73-48.08) for calcifications alone and an OR of 14.00 (95% CI, 1.23-158.84) for calcifications associated with masses. Any significant improvement in the predictive ability of dynamic MRI depending on the extent of calcifications on mammography was not proved. Considering the 62 cases of proved malignancy with measured maximal diameter at pathologic examination, both mammography and MR examination seem to overestimate tumor extent.The not-perfect sensitivity of MRI (87%), when applying our interpretation criteria and imaging sequences, is a crucial point that prevents us from clinical use of MRI in the diagnosis of mammographically detected microcalcifications.

Mummies are the most interesting discovery from ancient Egypt, and like the hieroglyphs, they have become a symbol of the civilization of the pharaohs. Interest grows even stronger when science and technology allow us to learn about what the ancient Egyptians carefully embalmed and prepared for the afterlife. For archaeologists and conservators, studying mummies is like traveling through history between the iconography of the outer container of the body to the interior of the body itself. Our research in an Egyptian mummy at the National Museum of Archaeology in Venice includes the analysis of the stucco layer of the wood sarcophagus, the masque and linen bandages, chemistry, and CT scanning. We offer data regarding materials, pigments, and the conservation of the body

The aim of this study was to evaluate the diagnostic accuracy of axillary lymph node sonography, if necessary in combination with US-guided large core biopsy, in the preoperative evaluation of breast cancer patients scheduled for quadrantectomy and sentinel lymph node excision.From July 2001 to December 2002, we evaluated 117 breast cancer patients with ultrasound and, where indicated, FNAB. Breast lesions had diameters between 4 and 26 mm (mean diameter 11 mm). Fifteen (13%) of the 117 patients were excluded from the series as they did not fulfil the criteria for preliminary sonography of the axilla: in 9 patients fewer than 4 nodes were detected and in 6 patients the breast lesions were intraoperatively found to be benign. Eleven patients (10.7 %) with sonographically suspicious axillary nodes were sampled by US-guided core biopsy using a 14 or 16 Gauge Tru-Cut needle.The ultrasound study aims to evaluate the dimensions and morphology of the breast lesion as well as detect and assess at least 4 axillary nodes. These were evaluated for hilar and cortical thickening and ratio between the sinus diameter and the total longitudinal diameter. Lymph nodes with hilar diameters equal to or greater than 50% of the longitudinal diameter were considered normal. Of the 102 patients evaluated, 77 (75.7%) had normal axillary nodes according to the US criteria adopted. Negativity was confirmed by histology in 56 cases (72.7%, true negative); 21 (27.3%, false negative) were found to be positive, in contrast with the sonographic appearance. The false negative cases were due to lymph node micrometastasis which probably did not cause morphologic alterations perceptible at ultrasound. The remaining 25 patients (24.5%) had axillary lymph nodes classified as suspicious. In 13 cases of (52%, true positive) there was agreement with histology, whereas in 12 cases (48%, false positive) the US suspicion was not confirmed at surgery. The most important sonographic alteration was the gradual reduction in hilar echogenicity (seen in 100% metastatic nodes); conversely, hilar denting or irregularities, as well as dimensional criteria, proved to be poorly specific.The sonographic assessment of axillary and internal mammary chain nodes, possibly in addition to core biopsy, improves the preoperative evaluation of breast cancer patients scheduled for conservative surgery of the breast (quadrantectomy) and the axilla (sentinel node biopsy). US findings suspicious for metastatic involvement of axillary lymph nodes should be considered as an exclusion criterion for sentinel node biopsy. A more widespread use of axillary node biopsy and an accurate sonographic evaluation of the excised lymph node increase the specificity of the procedure, allowing a better correlation between sonographic findings and definitive histology.

To evaluate the accuracy of multislice CT angiography, investigating vascular anatomy and anatomical variants of hepatic artery in patients undergoing liver transplantation.The study concerns 20 patients (12 male and 8 female) candidates to liver transplantation were examined using multislice CT with a triphasic protocol following the administration of Iomeron 400 mg/ml at a rate of 5 ml/s using Sure Start technique. The following protocol was applied in all patients: row thickness 3, pitch 5.5, image thickness 3, reconstruction 1. Vascular reconstruction was obtained with 3D Maximum Intensity Projection and Volume Rendering algorithms using the data of the arterial phase. All variants were classified by Michels's classification. All patients were transplanted and the anatomical results of CT have been verified surgically.CT angiography detected 5 anatomical variants of the hepatic artery and one aneurysm of the celiac trunk; the other 14 patients had a normal anatomy. In all patients the results of CT correlates with the surgical ones.Our results suggest that multislice CT angiography is useful for planning surgical transplantation, giving precise information about vascular anatomy and its variants, (those are common). In our opinion this technique can replace conventional angiography.

Our aim was to compare the effectiveness of mammography and MRI in the detection of multifocal, multicentric breast cancer.Ninety patients with planned mastectomies (nine bilateral) underwent mammography and dynamic gadolinium-enhanced MRI. Off-site reviewers aware of the entry criterion (planned mastectomy) evaluated both examinations for the presence of malignant foci, recording the density pattern on mammography. The gold standard was pathologic examination of the whole excised breast (slice thickness, 5 mm).Of 99 breasts, pathologic findings revealed 52 unifocal, 29 multifocal, and 18 multicentric cancers for a total of 188 malignant foci (158 invasive and 30 in situ). Overall sensitivity was 66% (124/188) for mammography and 81% (152/188) for MRI (p0.001); 72% (113/158) and 89% (140/158) for invasive foci (p0.001); and 37% (11/30) and 40% (12/30) for in situ foci (p0.05, not significant), respectively. Mammography and MRI missed 64 and 36 malignant foci, respectively, with median diameters of 8 and 5 mm (p = 0.033) and an invasive-noninvasive ratio of 2.4:1 (45:19) and 1.0:1 (18:18) (p = 0.043), respectively. The overall positive predictive value (PPV) was 76% (124/164) for mammography and 68% (152/222) for MRI (not significant). In breasts with an almost entirely fatty pattern, sensitivity was 75% for mammography and 80% for MRI (not significant), and the PPV was 73% and 65% (not significant), respectively. In breasts with fibroglandular or dense pattern, the sensitivity was 60% and 81% (p0.001), and the PPV was 78% and 71% (not significant), respectively.MRI was more sensitive than mammography for the detection of multiple malignant foci in fibroglandular or dense breasts. Mammography missed larger and more invasive cancer foci than MRI. A relatively low PPV was a problem for both techniques.

To evaluate the relative activity of the sequential administration of doxorubicin and cyclophosphamide (AC) followed by docetaxel alone, as primary systemic therapy in patients with breast cancer, using an in vivo chemosensitivity predictive assay.Patients with stage II-III breast cancer received two cycles of AC (60/600 mg/m2 every 3 weeks) followed by two cycles of docetaxel (100 mg/m2 every 3 weeks). All patients underwent comprehensive breast imaging prior to chemotherapy, after two AC and after docetaxel.Forty-two patients were accrued and evaluated by intention-to-treat analysis. After two cycles of AC, the median tumor shrinkage was 18.3%, whereas treatment with docetaxel provided an additional median tumor shrinkage of 34.2%. Pathological complete remission was observed in 5 patients (11.9%), whereas 26 patients (61.9%) experienced a partial response.The relative contribution of docetaxel to tumor mass reduction seemed to be greater than that of AC. However, the slow rate of tumor shrinkage observed may indicate that the activity of the first 2 cycles of AC is carried over into the part of treatment with docetaxel.

Analysis of tumour samples by a proteomic technology, which combines two-dimensional gel electrophoresis and mass spectrometry analysis, is a promising approach for molecular characterization of cancer. Proteomic analysis of neoplasms is usually performed on surgical material. The possibility to perform proteomic analysis on pre-operative samples might be useful for diagnostic purposes or for determination of tumour sensitivity to therapy. In this study, we report how tissues from core biopsy of breast lesions can be routinely used to obtain accurate protein expression profiles by proteomic analysis. Protein profiles from fibroadenomas were compared to those from ductal infiltrating carcinomas. By using mass spectrometry, identification of proteins overexpressed in carcinomas with respect to fibroadenomas was obtained. Thus, our study provides a methodology to perform proteomic analysis on pre-operative samples of breast lesions.

Objective In this study, we addressed the influence of the observer's background and experience on the accuracy of imaging-based tumor measurements. The consistency of measures with Response Evaluation Criteria in Solid Tumors (RECIST) vs. WHO criteria is also reported. Study design and setting Twenty-five observers (five radiologists, five thoracic surgeons, five radiotherapists, five pulmonologists, and five medical oncologists) were asked to measure three lesions on selected serial chest computed tomographic images from three non–small cell lung cancer patients treated with chemotherapy. The observers were asked to measure the longest diameter (RECIST), along with its perpendicular diameter (WHO criteria). Measurements by radiologists were used as reference values. Results There was no significant difference in the accuracy of measurements among the different groups. The highest intraobserver consistency was achieved by radiologists. Neither familiarity with measuring tumor lesions nor years since the MD degree correlated with measurement accuracy. A comparison of RECIST and WHO criteria showed consistent response ratings (κ = .74, CI 95% = .57–.91). Conclusion Measurements of selected lesions were consistent among specialists, suggesting that assessment of tumor response is reliable even when it is not done by radiologists.

Background: Preoperative staging of pelvic endometriosis helps the gynecologist plan therapy and offers a prognosis to patients. We compared a staging system of pelvic endometriosis based on magnetic resonance imaging (MRI) findings with the American Fertility Society (AFS) laparoscopic classification. Methods: Forty-four consecutive females with clinically suspected endometriosis underwent MRI examination to demonstrate the presence of endometriomas and pelvic implants. Laparoscopy was performed within 2 weeks. An MRI score was developed to classify endometriosis into four classes comparable to those of AFS laparoscopic staging. Concordance between MRI and laparoscopic classification was evaluated with κ statistics. Results: Laparoscopy confirmed 60 of 61 endometriomas detected by MRI. Implants were discovered in 20 of 44 patients with MRI and in 23 of 44 with laparoscopy. MRI detected 50 endometrial implants of 65 detected by laparoscopy (76.9%). With regard to endometriosis staging, we obtained a concordance between MRI and AFS classification in 42 of 44 patients (κ = 0.913). Conclusion: Although MRI has limitations such as suboptimal depiction of small implants and adhesions, this technique is very useful to guide laparoscopy. Moreover, the optimal concordance (95%) between our proposed MRI staging and the AFS laparoscopic classification demonstrated a new advantage of MRI in preoperative staging of endometriosis.

Purpose The aim of this study was to analyze the role of the resistance index (RI), systolic acceleration time (SAT), and spectral waveform's morphologic characteristics in the sonographic evaluation of the hepatic artery for early detection of stenosis or thrombosis after orthotopic liver transplantation. Methods Arterial Doppler sonograms of 174 transplanted livers in 150 patients were analyzed for presence or absence of blood flow, RI, SAT, and peak systolic velocity. A qualitative evaluation of the spectral waveform morphologic characteristics was also made. In patients who had had abnormal findings on sonography, we compared those results with results obtained on multislice helical CT or angiography. Results At least 1 of the Doppler criteria for hepatic artery stenosis or thrombosis was identified in 25 of the transplants. The findings on multislice helical CT, angiography, or both confirmed the diagnosis of stenosis or thrombosis in 20 of the 25 cases: in 9 of 10 cases of absent hepatic arterial blood flow, 5 of 9 with an RI lower than 0.5, 6 of 7 cases with an SAT longer than 0.08 second, 10 of 11 cases of changes to a tardus-parvus–like spectral waveform, and in the 1 case of a peak systolic velocity greater than 2 m/second. Conclusions The most accurate indicator of hepatic arterial stenosis or thrombosis was a change in the spectral waveform to a tardus-parvus pattern, with 91% sensitivity and 99.1% specificity. Among the other parameters, an increase of the SAT value (> 0.08 second), when associated with the morphologic modification of the systolic peak, is a more reliable parameter than the RI for early detection of artery stenosis, especially when the type of anastomosis is unknown. © 2003 Wiley Periodicals, Inc. J Clin Ultrasound 31:339–345, 2003

The aim of this study was to compare real time compound sonography with conventional sonography in the evaluation of rotator cuff tears.A prospective study was performed on 50 supraspinatus tendons in 101 patients treated by surgical acromioplasty. The surgeon described 33 (66%) full-thickness tears and 17 (34%) partial-thickness tears. All tendons were examined by conventional sonography and real time compound sonography on the day before surgery. The techniques were compared by evaluating the images for freedom from artefacts, contrast resolution and overall image definition.Real time compound sonography proved to be superior to conventional sonography as regards freedom from artefacts in 50 cases out of 50 (100%). It was superior to conventional sonography in evaluating the image contrast resolution in 45 cases out of 50 (90%), and superior to conventional sonography in overall image definition in 45 out of 50 cases (90%).Real-time compound sonography reduces the intrinsic artefacts of conventional sonography and allows better overall image definition. In particular, the digital technique allowed us to study the rotator cuff with better contrast resolution and sharper and more detailed images than did conventional sonography.

Background: It is well recognized that distinguishing benign from malignant papillary lesions of the breast may pose challenging diagnostic problems. To prospectively evaluate the potential role of mammography, ultrasound and image-guided core biopsy in the diagnosis of papillary lesions of the breast. Methods: 1,442 women consecutively underwent 14-gauge core biopsy and in 51 cases (3.5%) a diagnosis of papillary lesion was formulated. Both radiologists and pathologists independently expressed their degree of suspicion of malignancy (not suspicious, low, moderate, high) on the basis of radiological and core biopsy findings, respectively. Surgical excision of the lesion was used as gold standard and diagnostic agreement was assessed by the kappa statistic. Results: At surgery, 19 of the 49 (38.7%) resected cases had a diagnosis of malignancy. A poor agreement was found between mammography and core biopsy results in the categorization of suspicion of malignancy (k = 0.03). Similar data were obtained between ultrasound and core biopsy (k = 0.07). A poor agreement was also observed between radiological and surgical results (k < 0.20). In contrast, a good agreement was found between core biopsy and surgical samples (k > 0.70). However, 5 (26%) out of the 19 malignant cases at surgery were judged as benign or probably benign on core biopsy. Depending on how the categories of suspicion on core biopsy were set up, the range of sensitivity was 74–89%, whereas specificity ranged from 91 to 97%. Conclusions: Image-guided large core biopsy allows for a correct diagnosis in the majority of papillary lesions. However, its sensitivity is not good enough for surgical excision to be avoided.