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Objectives To report mastectomy and reoperation rates in women who had breast MRI for screening (S-MRI subgroup) or diagnostic (D-MRI subgroup) purposes, using multivariable analysis for investigating the role of MRI referral/nonreferral and other covariates in driving surgical outcomes. Methods The MIPA observational study enrolled women aged 18–80 years with newly diagnosed breast cancer destined to have surgery as the primary treatment, in 27 centres worldwide. Mastectomy and reoperation rates were compared using non-parametric tests and multivariable analysis. Results A total of 5828 patients entered analysis, 2763 (47.4%) did not undergo MRI (noMRI subgroup) and 3065 underwent MRI (52.6%); of the latter, 2441/3065 (79.7%) underwent MRI with preoperative intent (P-MRI subgroup), 510/3065 (16.6%) D-MRI, and 114/3065 S-MRI (3.7%). The reoperation rate was 10.5% for S-MRI, 8.2% for D-MRI, and 8.5% for P-MRI, while it was 11.7% for noMRI (p ≤ 0.023 for comparisons with D-MRI and P-MRI). The overall mastectomy rate (first-line mastectomy plus conversions from conserving surgery to mastectomy) was 39.5% for S-MRI, 36.2% for P-MRI, 24.1% for D-MRI, and 18.0% for noMRI. At multivariable analysis, using noMRI as reference, the odds ratios for overall mastectomy were 2.4 (p p = 0.957) for D-MRI, and 1.9 (p Conclusions Patients from the D-MRI subgroup had the lowest overall mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). This analysis offers an insight into how the initial indication for MRI affects the subsequent surgical treatment of breast cancer. Key Points • Of 3065 breast MRI examinations, 79.7% were performed with preoperative intent (P-MRI), 16.6% were diagnostic (D-MRI), and 3.7% were screening (S-MRI) examinations. • The D-MRI subgroup had the lowest mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). • The S-MRI subgroup had the highest mastectomy rate (39.5%) which aligns with higher-than-average risk in this subgroup, with a reoperation rate (10.5%) not significantly different to that of all other subgroups.

Objectives Preoperative breast magnetic resonance imaging (MRI) can inform surgical planning but might cause overtreatment by increasing the mastectomy rate. The Multicenter International Prospective Analysis (MIPA) study investigated this controversial issue. Methods This observational study enrolled women aged 18–80 years with biopsy-proven breast cancer, who underwent MRI in addition to conventional imaging (mammography and/or breast ultrasonography) or conventional imaging alone before surgery as routine practice at 27 centers. Exclusion criteria included planned neoadjuvant therapy, pregnancy, personal history of any cancer, and distant metastases. Results Of 5896 analyzed patients, 2763 (46.9%) had conventional imaging only (noMRI group), and 3133 (53.1%) underwent MRI that was performed for diagnosis, screening, or unknown purposes in 692/3133 women (22.1%), with preoperative intent in 2441/3133 women (77.9%, MRI group). Patients in the MRI group were younger, had denser breasts, more cancers ≥ 20 mm, and a higher rate of invasive lobular histology than patients who underwent conventional imaging alone (p p p p Conclusions Clinicians requested breast MRI for women with a higher a priori probability of receiving mastectomy. MRI was associated with 11.3% more mastectomies, and with 3.2% fewer reoperations in the breast conservation subgroup. Key Points • In 19% of patients of the MIPA study, breast MRI was performed for screening or diagnostic purposes. • The current patient selection to preoperative breast MRI implies an 11% increase in mastectomies, counterbalanced by a 3% reduction of the reoperation rate. • Data from the MIPA study can support discussion in tumor boards when preoperative MRI is under consideration and should be shared with patients to achieve informed decision-making.

Contains fulltext : 225795.pdf (Publisher’s version ) (Closed access) Despite its high diagnostic performance, the use of breast MRI in the preoperative setting is controversial. It has the potential for personalized surgical management in breast cancer patients, but two of three randomized controlled trials did not show results in favor of its introduction for assessing the disease extent before surgery. Meta-analyses showed a higher mastectomy rate in women undergoing preoperative MRI compared to those who do not. Nevertheless, preoperative breast MRI is increasingly used and a survey from the American Society of Breast Surgeons showed that 41% of respondents ask for it in daily practice. In this context, a large-scale observational multicenter international prospective analysis (MIPA study) was proposed under the guidance of the European Network for the Assessment of Imaging in Medicine (EuroAIM). The aims were (1) to prospectively and systematically collect data on consecutive women with a newly diagnosed breast cancer, not candidates for neoadjuvant therapy, who are offered or not offered breast MRI before surgery according to local practice; (2) to compare these two groups in terms of surgical and clinical endpoints, adjusting for covariates. The underlying hypotheses are that MRI does not cause additional mastectomies compared to conventional imaging, while reducing the reoperation rate in all or in subgroups of patients. Ninety-six centers applied to a web-based call; 36 were initially selected based on volume and quality standards; 27 were active for enrollment. On November 2018, the target of 7000 enrolled patients was reached. The MIPA study is presently at the analytic phase. Key Points • Breast MRI has a high diagnostic performance but its utility in the preoperative setting is controversial. • A large-scale observational multicenter prospective study was launched to compare women receiving with those not receiving preoperative MRI. • Twenty-seven centers enrolled more than 7000 patients. The study is presently at the analytic phase.

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.

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.

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.

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.

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.

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.

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.

Extramedullary myeloma refers to the infiltration of neoplastic monoclonal plasma cells in either organs or soft tissues. The disease is clinically and radiologically underestimated compared with the autopsy findings and is usually associated with a more aggressive clinical course and poorer outcome. A minority of patients with extramedullary myeloma show hepatic involvement, usually in the form of diffuse parenchymal infiltration. When focal infiltration is present, variable imaging findings have been described both on CT scan and MRI. We report the case of a 63-year-old male with hepatitis B virus-related liver disease and biopsy-proven multiple myeloma involving the liver, manifesting as hypervascular focal liver lesions on MRI. A brief review of the literature is also proposed.

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.

The lack of quantitative objective measures of psychiatric diseases such as anxiety and depression is one reason that the causative factors of psychiatric diseases remain obscure. The fact that human behavior is complex and cannot be easily tested in laboratories or reproduced in animal models further complicates our understanding of psychiatric diseases. During the past 3 decades, several magnetic resonance (MR)-based tools such as MR morphometry, diffusion-tensor imaging, functional MR imaging, and MR spectroscopy have yielded findings that provide tangible evidence of the neurobiologic manifestations of psychiatric diseases. In this article, we summarize major MR findings of schizophrenia, bipolar disorder, anxiety disorders, and attention deficit-hyperactivity disorder as examples to illustrate the promise that MR techniques hold for not only revealing the neurobiological underpinnings of psychiatric disorders but also enhancing our understanding of healthy human behavior. However, many radiologists remain skeptical about the diagnostic value of MR in psychiatric disease. Many inconsistent, noncomparable reports in the literature contribute to this skepticism. The aims of this article are to (a) illustrate the most reported MR findings of major psychiatric disorders such as schizophrenia, mood disorders, anxiety disorders, and attention deficit-hyperactivity disorder; (b) inform radiologists of the potential roles of MR imaging in psychiatric imaging research; and (c) discuss several confounding factors in the design and interpretation of MR imaging findings in psychiatry.

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).

Elevated urinary albumin excretion has been reported in primary aldosteronism and might partially reflect reversible abnormalities initiated by glomerular hyperfiltration.The aim of the study was to examine the outcome of renal function and intrarenal Doppler velocimetric indices in primary aldosteronism.We conducted a prospective study of patients with primary aldosteronism who were reevaluated 1 yr after either adrenalectomy or treatment with spironolactone.The study was conducted at a university referral center.Fifty-four patients with tumoral or idiopathic aldosteronism were followed after either surgical (n = 24) or medical (n = 30) treatment. Patients with primary aldosteronism were compared with 100 patients with primary hypertension and comparable severity and duration of disease.Changes in renal function and intrarenal echo-Doppler indices were measured.Patients with primary aldosteronism had greater creatinine clearance and urinary albumin excretion than patients with primary hypertension. Patients with primary aldosteronism and creatinine clearance above the median (105 ml/min per 1.73 m(2)) had significantly lower resistance and pulsatility index than patients with creatinine clearance below the median, independent of disease subtype. After 1 yr, creatinine clearance and albuminuria declined, and resistance and pulsatility index increased to the same extent in patients with primary aldosteronism treated with either adrenalectomy or spironolactone. Changes in glomerular filtration and albuminuria were inversely related with baseline values of the resistance index. In primary hypertension, echo-Doppler velocimetric indices did not change during follow-up.In primary aldosteronism, sonographic evidence of decreased intrarenal vascular resistance is associated with glomerular hyperfiltration. Both adrenalectomy and spironolactone revert the intrarenal hemodynamic pattern and decrease urinary protein losses.

The authors sought to evaluate the sensitivity of chest ultrasound (US) versus chest radiography in detecting lung consolidation and pleural effusion in children with a clinical suspicion of pneumonia.Thirty-two chest radiographs and 32 chest US examinations were performed in 28 consecutive patients (aged 4 months to 17 years) with a clinical suspicion of pneumonia. Chest US examinations were carried out with a convex-array broadband probe (2-5 MHz) and a high-frequency linear-array broadband probe (5-12 MHz). The results obtained were compared with those of chest radiography.Chest radiography identified subpleural consolidation in 22 patients, perihilar consolidation in 7, and pleural effusion in eight. In the same 22 patients, chest US showed 22 cases of subpleural consolidation but no cases of perihilar consolidation; pleural effusion was detected in 15 patients.Chest US is capable of identifying subpleural consolidation with the same sensitivity as chest radiography and is highly accurate in demonstrating pleural effusion. For this reason, chest US may be a valuable aid and possible alternative to standard chest radiography in the evaluation and follow-up of children with suspected pneumonia.

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.

Background Sentinel node biopsy (SNB) is a time-consuming procedure that can be avoided in presence of axillary metastases. The aim of this study was to assess the accuracy of ultrasound scan (US) in the prediction of axillary nodes status in patients scheduled for SNB. Methods Axillary US was performed and when feasible, a core biopsy of suspicious nodes was taken. The nodal status as assessed by US and/or core biopsy was compared with final histology. Results Of the 132 patients enrolled, 31 (23.5%) had suspicious axillary nodes according to US; 19 (61.3%) were true positive, whereas 12 cases (38.7%) were not. In 14 of 31 suspicious cases an US-guided core-biopsy was taken, which in 11 of 14 cases (78.5%) confirmed the neoplastic involvement. Overall, core biopsy of the nodes correctly predicted the final histology in 13 of 14 cases (92.8%). Conclusions The US of axillary nodes, possibly associated with core biopsy, improved the preoperative evaluation of breast cancer patients scheduled for SNB.

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.

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.

Our purpose was to define the diagnostic accuracy of helical computed tomography (CT) in the identification, characterisation and evaluation of extension of gastrointestinal stromal tumours (GIST) through correlation with some pathological findings. Between August 2000 and September 2004, we conducted a retrospective study of the abdominal CT of 15 patients with histological diagnosis of GIST – that is, the immunopositivity for c–kit (CD117) – on a surgical specimen of the primary disease. We used a helical CT single–slice (Toshiba, Asteion; rotation time 0.75 s) in ten cases and helical CT multislice (Toshiba, Aquilion; 4 slices/rotation; rotation time 0.5 s) in five cases. In all cases, we used an organ–iodate nonionic contrast agent intravenously at a concentration of 350~400 mgI/ml. All cases studied the entire abdomen. Site, morphology and tumour size (smaller than 5 cm, 5–10 cm and larger than 10 cm) were considered parameters for tumour identification. Size, partial or total extraluminal tumour growth, homogeneous or inhomogeneous lesion enhancement and the eventual presence of calcifications were assumed to be criteria for characterisation of a GIST. Hepatic, peritoneal and/or lymph node metastases were considered parameters of intermediate or high malignancy. We correlated the results with some pathological features derived from the analysis of surgical tissue: site, morphology and tumour size, tissue components and risk of malignancy of GIST (on the basis of the 2002 Fletcher classification). We demonstrated one substantial concordance between radiological and pathological valuation of site, morphology, tumour size and absence of intralesional calcifications of GIST. Nine of ten GIST smaller than 5 cm, the two 5–10 cm and the three larger than 10 cm presented extraluminal growth. Enhancement was inhomogeneous in five of ten lesions smaller than 5 cm and in all cases larger than 5 cm. At pathological analysis, in all cases of inhomogeneous enhancement, solid, hemorrhagic, necrotic and cystic areas were found. Of seven tumours of intermediate malignancy, six were smaller than 5 cm and only one larger than 10 cm; the two 5–10 cm were of high malignancy and all tumours superior of 10 cm were at intermediate or high malignancy. Of the two cases with metastases, one was of intermediate and one of high malignancy. In the other cases of intermediate or high malignancy, metastases were absent. The immunopositivity for c–kit is requisite for definitive diagnosis of GIST, but imaging, and particularly helical CT, has a primary role. In this study, CT is was reliable for tumour identification. All tumours larger than 5 cm presented extraluminal growth, inhomogeneous enhancement, absence of calcifications and lymph node metastases. Furthermore, the tumour larger than 5 cm showed extraluminal growth and inhomogeneous enhancement. Tumour size established with CT was not sufficient to determine the degree of malignancy. Metastases at the time of diagnosis were indicative of intermediate or high malignancy, but the absence of metastases did not allow classification of GIST in the group of low and very low risk of malignancy.

Evaluation of breast lesions using core needle biopsies (CNB) under stereotactic or ultrasound or MR guidance is a well-established practice [1–3]. This diagnostic approach is able to provide excellent results and to guide the management of the majority of patients with breast lesions [1–3]. However, CNB diagnosis of a group of non-malignant lesions, called “B3” or “high-risk” lesions, poses several dilemmas in terms of subsequent patient management. The diagnosis of B3 lesions accounts for as many as 9% of all imaging-guided CNB [3–6]. These lesions include lobular neoplasia (LN)(lobular carcinoma in situ, atypical lobular hyperplasia), atypical ductal hyperplasia (ADH), papilloma, radial scar, fibroepithelial lesions, mucocele-like lesions and columnar cells lesions. CNB diagnosis of these lesions is considered unreliable because it can result in underestimation of the histopathologic finding at surgical excision. The reported risk of associated malignancy at surgical excision varies widely (0–35%), and is higher for LN and ADH, compared to other B3 lesions [4–8]. Because of this variability, there is no consensus as to how to treat patients who receive CNB diagnosis of B3 lesions: imaging follow-up or surgical excision [9,10]. These management differences might translate into thousands of patients undergoing unnecessary surgical procedures or an equal number of patients with delays in diagnosis of malignancy, depending on the recommendations. Several papers have investigated the role of conventional imaging in the management of B3 lesions, but published data are contradictory and non-conclusive [11–15]. In addition, most of these studies are small, single-institution, retrospective and have inherent built-in selection bias.

To evaluate second-look digital breast tomosynthesis (SL-DBT) for additional findings (AFs) at preoperative MRI compared with second-look ultrasound (SL-US). We included 135 patients with breast cancer who underwent digital mammography (DM), DBT, US, and MRI at two centres. MR images were retrospectively evaluated to find AFs, described as focus, mass, or non-mass; ≤10 mm or >10 mm in size; BI-RADS 3, 4, or 5. DM and DBT exams were reviewed looking for MRI AFs; data on SL-US were collected. Reference standard was histopathology or ≥12-month negative follow-up. Fisher exact test and McNemar test were used. Eighty-four AFs were detected in 53/135 patients (39 %, 95 %CI 31–48 %). A correlate was found for 44/84 (52 %, 95 %CI 41–63 %) at SL-US, for 20/84 (24 %, 95 %CI 11–28 %) at SL-DM, for 42/84 (50 %, 95 %CI 39–61 %) at SL-DBT, for 63/84 (75 %, 95 %CI 64–84 %) at SL-DBT, and/or SL-US, the last rate being higher than for SL-US only, overall (p 10 mm, BI-RADS 4 or 5, or malignant lesions (p

Purpose. To quantify the impact of diagnostic confidence on radiological diagnosis with a fuzzy logic-based method.Materials and Methods. Twenty-two oncologic patients with 20 cysts and 30 metastases ≤1 cm in size found at 64-row computed tomography were included. Two readers (R1/R2) expressed diagnoses as a subjective level of confidenceP(d)in malignancy within the interval [0,1] rather than on a “crisp” basis (malignant/benign); confidence in benignancy was1-p(d). When cross-tabulating data according to the standard of reference,2×2table cells resulted from the aggregation betweenp(d)/1-p(d)and final diagnosis. We then assessed (i) readers diagnostic performance on a fuzzy and crisp basis; (ii) the “divergence”δ(F,C)(%) as a measure of how confidence impacted on crisp diagnosis.Results. Diagnoses expressed with lower confidence increased fuzzy false positives compared to crisp ones (from 0 to 0.2 for R1; from 1 to 2.4 for R2). Crisp/fuzzy accuracy was 94.0%/93.6% (R1) and 94.0/91.6% (R2).δ(F,C)(%) was larger in the case of the less experienced reader (R2) (up to +7.95% for specificity). According to simulations,δ(F,C)(%) was negative/positive depending on the level of confidence in incorrect diagnoses.Conclusion.Fuzzy evaluation shows a measurable effect of uncertainty on radiological diagnoses.

Despite advances in patient and graft management, biliary complications (BC) still represent a challenge both in the early and delayed period after orthotopic liver transplantation (OLT). Because of unspecific clinical presentation, imaging is often mandatory in order to diagnose BC. Among imaging modalities, magnetic resonance cholangiography (MRC) has gained widespread acceptance as a tool to represent the reconstructed biliary tree noninvasively, using both the conventional technique (based on heavily T2-weighted sequences) and contrast-enhanced MRC (based on the acquisition of T1-weighted sequences after the administration of hepatobiliary contrast agents). On this basis, MRC is generally indicated to: (1) avoid unnecessary procedures of direct cholangiography in patients with a negative examination and/or identify alternative complications; and (2) provide a road map for interventional procedures or surgery. As illustrated in the review, MRC is accurate in the diagnosis of different types of biliary complications, including anastomotic strictures, non-anastomotic strictures, leakage and stones.

Orthotopic liver transplantation (OLT) represents a major treatment for end-stage chronic liver disease, as well as selected cases of hepatocellular carcinoma and acute liver failure. The ever-increasing development of imaging modalities significantly contributed, over the last decades, to the management of recipients both in the pre-operative and post-operative period, thus impacting on graft and patients survival. When properly used, imaging modalities such as ultrasound, multidetector computed tomography, magnetic resonance imaging (MRI) and procedures of direct cholangiography are capable to provide rapid and reliable recognition and treatment of vascular and biliary complications occurring after OLT. Less defined is the role for imaging in assessing primary graft dysfunction (including rejection) or chronic allograft disease after OLT, e.g., hepatitis C virus (HCV) recurrence. This paper: (1) describes specific characteristic of the above imaging modalities and the rationale for their use in clinical practice; (2) illustrates main imaging findings related to post-OLT complications in adult patients; and (3) reviews future perspectives emerging in the surveillance of recipients with HCV recurrence, with special emphasis on MRI.

Multiple prognostic indicators, namely histological grade and immunostaining for estrogen (ER) and progesterone receptors (PgR), MIB1, bcl-2, and p53, were retrospectively determined on preoperative core biopsies from 75 patients with pT1 breast carcinoma. The association of the preoperatively evaluated factors with those on the corresponding resected tumors (i.e. nodal status, histological grade, presence or absence of vascular invasion and necrosis) was assessed. In univariate analysis, histological grade on resected tumors was significantly associated with histological grade on core biopsy, p53 expression, MIB1 immunostaining. An inverse association was found between postoperative histologic grade and ER, PgR, and bcl-2. Necrosis was significantly associated with grade, p53, MIB1, and inversely with ER, PgR, and bcl-2. Nodal involvement and vascular invasion were significantly associated with MIB1. In multivariate analysis, histological grade and ER were the only independent core biopsy variables associated with postoperative histological grade and necrosis, respectively. This study showed that image-guided core biopsy is a suitable method that can be used to reveal some characteristics of the tumor biology in a preoperative stage.

The purpose of this study is to evaluate the role of MRI for characterization of high-risk breast lesions diagnosed at imaging-guided needle biopsy.In this retrospective analysis of 220 patients, 227 high-risk lesions (94 papillomas, 64 radial sclerosing lesions, 46 lobular neoplasias, and 23 atypical ductal hyperplasias) found at 11-gauge vacuum-assisted or 14-gauge needle biopsy were studied with dynamic MRI (time resolution, 84 or 88 seconds; gadopentetate dimeglumine or gadobenate dimeglumine, 0.1 mmol/kg). When lesions showed contrast enhancement on subtracted images, they were considered suspicious for malignancy. The reference standard was histopathologic examination after surgical excision in 190 of 227 (84%) lesions and negative follow-up (≥ 24 months) in 37 of 227 (16%) lesions. Predictive values and likelihood ratios were calculated.Of 227 lesions, 155 (68%) were contrast enhancing and 72 (32%) were not. Of 155 contrast-enhancing lesions, 28 (18%) were upgraded to malignancy after surgical excision (nine papillomas, one radial sclerosing lesion, 11 lobular neoplasias, and seven atypical ductal hyperplasias); there were 11 invasive carcinomas and 17 ductal carcinomas in situ, four of the latter being G3. Of 72 non-contrast-enhancing lesions, two (3%) were upgraded to malignancy after surgical excision (one radial sclerosing lesion and one lobular neoplasia), both of which were G1 ductal carcinoma in situ. Cancer probability was significantly higher for contrast-enhancing (18%) than for non-contrast-enhancing (3%) lesions (p = 0.001) and for nonmasslike (43%) than for masslike (14%) lesions (p = 0.005). The positive predictive value was 18% (28/155; 95% CI, 13-24%), the negative predictive value was 97% (70/72; 95% CI, 94-99%), the positive likelihood ratio was 1.448 (95% CI, 1.172-1.788), and the negative likelihood ratio was 0.188 (95% CI, 0.152-0.232).The absence of enhancement at dynamic MRI allowed reliable exclusion of invasive cancers among high-risk lesions diagnosed at needle biopsy.

Background The hypothalamus is a brain structure involved in the neuroendocrine aspect of stress and anxiety. Evidence suggests that generalized anxiety disorder (GAD) and panic disorder (PD) might be accompanied by dysfunction of the hypothalamus-pituitary-adrenal axis (HPA), but so far structural alterations were not studied. We investigated hypothalamic volumes in patients with either GAD or PD and in healthy controls. Methods Twelve GAD patients, 11 PD patients and 21 healthy controls underwent a 1.5T MRI scan. Hypothalamus volumes were manually traced by a rater blind to subjects' identity. General linear model for repeated measures (GLM-RM) was used to compare groups on hypothalamic volumes, controlling for total intracranial volume, age and sex. Results The hypothalamus volume was significantly reduced ( p =0.04) in GAD patients, with significant reductions in both the left ( p =0.02) and right side ( p =0.04). Patients with PD did not differ significantly ( p =0.73). Anxiety scores were inversely correlated with hypothalamic volumes. Limitations The small sample size could reduce the generalizability of the results while the lack of stress hormone measurements renders functional assessment of the hypothalamus-pituitary-adrenal axis not feasible. Conclusions The present study showed decreased hypothalamic volumes in GAD patients but not in those with PD. Future longitudinal studies should combine volumetric data with measurements of stress hormones to better elucidate the role of the HPA axis in GAD.

To investigate the negative predictive value (NPV) for malignancy of 3.0 Tesla (T) MRI in patients with "gray zone" PSA level and prior negative biopsies.We enrolled 26 patients with PSA level between 2.5 and 10 ng/mL and no cancer at previous biopsies. Examinations were performed on a 3.0T system using T2-weighted imaging, diffusion-weighted imaging, spectroscopy, and postcontrast dynamic study. A regional scheme was used to record MRI findings and to perform subsequent transrectal-ultrasonography-guided biopsy. Based on the matching between imaging and biopsy findings we estimated MRI predictive values, sensitivity, specificity and accuracy on a per-patient and per-region basis.On a per patient basis, MRI had five true-positive (5/26; 19.2%), eight true-negative (8/26; 30.8%) and no false-negative cases, corresponding to a NPV and sensitivity of 100% each. Thirteen patients were assessed as false-positive cases (13/26; 50.0%) (specificity of 38.1%). Five of them (5/26; 19.2%) showed high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical small-acinar proliferation (ASAP) at biopsy. T2-weighted imaging alone showed per-region NPV (96.8%).Because of the high NPV, MRI had the potential to avoid unnecessary biopsy in approximately one-third of "gray-zone" patients with a negative examination. Additionally, MRI was useful to address to biopsy more than one-third of patients with cancer or high-risk lesions as HGPIN and ASAP.

The authors report their experience on the use of a biopsy gun for histological sampling in the field of breast lesions. The use of cytological sampling by (FNAB) fine needle aspiration biopsy has been preferred so far, because it has been thoutht to be simpler, less risky and reliable. Nevertheless, the cytological sampling shows a number of drawbacks such as the need for passes to get sufficient cellular material, frequent problems in diagnosing benign lesions and the decisive influence of the operator's skill. By using a biopsy gun for histological sampling these disadvantages are eliminated. In this case, in fact, the validity of the sample is not influenced by the operator's skill; fewer passes are necessary and their validity does not depend on the nature of the lesion. The personal series of cases involves 91 patients subjected to histological sampling for suspected lesions. Two different kinds of needles were used with one an 18 G diameter and a 23-mm extension of the sytlet, as well as a sampling window 17 mm; the other with the same diameter and extension of the stylet, as as a sampling window 8 mm. The first needle was used in all 91 patients, and the second only in 30. The results were not influenced by the employ of the different kinds of needles. A total of 268 samples were made and 110 lesions were discovered, 79 of which were malignant and 31 benign (fibroadenoma, fibrocystic change and epitheliosis). Three carcinomas were not found (3 false-negative) and one specimen was inadequate. The values of sensibility, specificity and diagnostic accuracy of the method were, respectively, 96.2%, 100% and 97.2%, with 3.8% false-negative due to three cases where the lesion was not centred for guidance mistake.

The authors compared the accuracy of diffusion-weighted imaging (DWI) visual analysis (VA) vs. apparent diffusion coefficient quantification (ADC-Q) in assessing malignancy of solid focal liver lesions (FLLs).Using a 1.5-T system, two radiologists retrospectively assessed as benign or malignant 50 solid FLLs: (a) by VA of signal intensity on DWI images at b=800 s/mm(2) and ADC map; (b) by quantifying lesion ADC. Reference standard included histology or follow-up confirmation of diagnosis by a consensus panel. Receiver operating characteristic (ROC) curve analysis was performed.because of 20 false-negative hepatocellular carcinomas, VA showed lower accuracy than ADC-Q (52.0% VS. 68.0%). however, stratified accuracy for metastases was higher with VA (75.0 VS. 66%). ADC and signal features of malignant and benign FLLs were found to largely overlap.VA performed worse than ADC-Q for hepatocellular carcinoma and better for metastases. Overall, the accuracy of both methods was limited because of the overlap in visual appearance and ADC values between solid benign and malignant FLLs.

This text discusses several aspects of doctor-patient communication in radiology, including the origins, advantages, and ethical and legal aspects. Over the last 10 years, radiologists have assumed increasing responsibilities towards patients and society. Patients, who are becoming better informed and more aware about medical issues, have a right to be given a timely diagnosis and want to receive as much information as possible from the radiologist. This has implications for several levels of everyday radiological practice, including the organisation of work, legal and ethical aspects and radiologist training. Better interaction with the patient helps to build a closer, more trusting, relationship with the result that the radiologist will be more motivated in his or her work. Until now, radiologists were not adequately trained to communicate the diagnosis directly and verbally to patients, especially when the diagnosis was unfavourable. It is important to emphasise the need for more specific and practical training in this respect, which is indispensable for future developments of the discipline.

Rationale and Objectives Water molecule motion has been shown to be isotropic in healthy liver as assessed by diffusion-weighted imaging (DWI). The purpose of this study was to investigate whether this assumption is still valid in the cirrhotic liver. Materials and Methods Twelve cirrhotic patients and 12 controls underwent DWI on a 3.0T-system. We used an echo-planar sequence independently applying unidirectional motion-probing gradients along read-(x), phase-(y), and slice-(z) directions, respectively. Liver apparent diffusion coefficient (ADC) and perfusion fraction ( f ) were calculated along each gradient direction, based on two b-values sets (0–400 and 0–800 seconds/mm 2 ). Measurement was repeated at two different axial slices of the liver. Results No significant difference among x, y, and z- ADC (and f ) of the liver was found within controls and cirrhotic patients ( P > .01), regardless of the set of b-values or the slice of measurement. ADC was lower in cirrhotic patients than in controls (difference of 0.24–0.39 × 10 −3 mm 2 /seconds at b = 800 seconds/mm 2 ; P = .000–.0139). Perfusion fraction f was lower in cirrhotics than in controls, irrespective of the b-values set or the slice of measurement (difference of 0.05–0.15; P Conclusion The liver shows isotropic water diffusion in cirrhotics, despite fibrotic distortion leading to decreased ADC as compared to controls. Our results emphasize that the correlation between parenchymal changes in liver fibrosis and the ADC estimate remains an elusive goal based on the state-of-the-art DWI technique.

Comparing the sensitivity of Contrast-Enhanced Magnetic Resonance Imaging (CEMRI), mammography and ultrasonography in patients with nipple discharge (ND).We retrospectively evaluated 38 women with ND who underwent mammography, ultrasound and 1.5 T CEMRI between March 2007 and July 2009. Imaging findings, pathological diagnosis and follow-up data (mean follow-up: 20 months) were compared. Sensitivity and specificity values were reckoned. Statistical differences in sensitivity were assessed.5/38 malignancies (13.2%; 3 invasive, 2 intraductal; 4 ipsilateral, 1 contralateral to ND), and 14/38 High-Risk Lesion (HRL--36.8%; 11 intraductal papillomas, 1 papilloma with LCIS, 1 sclerosing papilloma and 1 atypical intraductal hyperplasia, all ipsilateral) were found. CEMRI identified 5/5 cancers and 13/14 HRL (Overall Sensitivity-OSS = 94.7%; Overall Specificity-OSP = 78.9%). 3/5 cancers (1 invasive, 1 in-situ; 1 invasive contralateral) and 2/14 HRL were detected by CEMRI only. Mammography found 2/5 cancer and 3/14 HRL (OSS = 26.3%; OSP = 94.7%). Ultrasound identified 1/5 cancer and 11/14 HRL (OSS = 63.2%; OSP = 84.2). 1/14 HRL was detected by ultrasound only. Compared with mammography and ultrasound, CEMRI showed statistically significantly higher OSS values (p0.0001, p = 0.042 respectively).In women with ND, CEMRI should be recommended when conventional imaging is negative. Unexplained ND could be considered an indication for CEMRI.

To compare malignancy underestimation rates in the case of percutaneous diagnosis of borderline breast lesions(B3) at 14-g core-needle-biopsy (CNB) and at 11-g vacuum-assisted-biopsy (VAB).The histological results of 4764 image-guided breast biopsies were retrospectively reviewed. 300 B3, 151 benign papillomas, 88 radial sclerosing lesions, 46 lobular neoplasia, 15 atypical ductal hyperplasia diagnosed at ultrasound-guided 14-g CNB (76%) or stereotactically-guided 11-g VAB (24%) were identified. On average, 5 cores were obtained with CNB and 12 with VAB. Biopsy variables were reviewed and correlated with surgical excision or follow-up (24 months). Lesion- and device-specific underestimation rates of malignancy were calculated.Surgical excision was performed on 237 lesions: 178 were benign, 21 atypical, 38 cancers. The remaining 63 lesions were unchanged at follow-up. Overall malignancy underestimation rate was 12.7% at 14-g CNB and 12.5% at 11-g VAB. Based on excision histology or follow-up, lesion-specific underestimation rates were: benign papillomas: 14-g CNB 11%, 11-g VAB 0%; RSL: 14-g CNB 6%, 11-g VAB 4%; LN: 14-g CNB 40%, 11-g VAB 23%; ADH: 14-g CNB 33%; 11-g VAB 22%.In the case of percutaneous diagnosis of B3 lesions, underestimation of malignancy occurs regardless of the biopsy method.