The objective of this article is to summarize the physical principles, technology features, and first clinical applications of optical imaging techniques to the breast.
Light-breast tissue ...interaction is expressed as absorption and scattering coefficients, allowing image reconstruction based on endogenous or exogenous contrast. Diffuse optical spectroscopy and imaging, fluorescence molecular tomography, photoacoustic imaging, and multiparametric infrared imaging show potential for clinical application, especially for lesion characterization, estimation of cancer probability, and monitoring the effect of neoadjuvant therapy.
OBJECTIVESThe purpose of this study was to assess the incremental value of preoperative breast MRI over mammography and US in depicting the accurate extent of disease in invasive duct carcinoma (IDC) ...compared to invasive lobular carcinoma (ILC). PATIENTS AND METHODSRetrospective analysis of pre-operative mammography, US and MRI was performed in 239 patients with either IDC (n = 193) or ILC (n = 46). Images were evaluated for solitary, multifocal or multi centric disease and compared for concordance with postsurgical pathology. Discordance was documented as either overestimation or underestimation. Two tailed paired T and Fischer's exact tests were used for analysis. RESULTSMultifocality was present on pathology in 35% and 61% of patients with IDC and ILC (P < .05) and multicentricity in 23% and 41% respectively (P = .84). In ILC, MRI demonstrated better concordance with pathology compared to mammography and US (89%, 44%, 49% for multifocality P < .05 and 80.5%, 63%, 71% for multicentricity P = .3). For IDC, concordance with pathology for all modalities was similar (65%-76%). Among discordant cases, underestimation was significantly more common for mammography and US, while MRI more frequently overestimated disease extent. MRI very rarely overestimated multifocal disease in ILC (2%). CONCLUSIONMRI demonstrates an 80% to 90% concordance rate with pathology for ILC, superior to mammography and US. The addition of MRI in IDC patients may decrease underestimation of disease extent and potentially contribute to a reduction in post-operative residual disease.
The authors of this Views and Reviews outline in detail the indispensable role of imaging tools—ultrasound, computed tomography, and magnetic resonance imaging—in the diagnosis and treatment of ...female and male factor infertility. Equipment producing diagnostic images, coupled with ever-increasing computing power, will pave the way for novel functional dynamic studies that will expand the understanding of reproductive processes and their management.
Percutaneous image-guided splenic procedures are seldom performed due to fear of complications, mainly hemorrhage. Percutaneous splenic invasive procedures are, however, safe, and in most cases, the ...complication rates are similar to those of other abdominal organs. In most patients, biopsy of a focal splenic lesion establishes the diagnosis. Aspiration and drainage of splenic collections are performed obviating the need for splenectomy. In this review we describe the indications, technique, complications, and outcomes of percutaneous splenic biopsy, aspiration, and drainage.
American College of Radiology and Society of Breast Imaging guidelines call for routine breast MRI screening only for women with the highest risk profiles for development of breast cancer, suggesting ...that screening of women at lower risk might result in an increased frequency of false-positive biopsy results. The purpose of this study was to test this assumption by comparing MRI-guided biopsy outcomes of lesions detected at MRI screening of women with a personal history of breast cancer with outcomes among women with genetic or familial high risk.
Outcomes of 130 MRI-guided biopsies were analyzed. One group consisted of women with hereditary (genetic or familial) risk, and the other group consisted of women with a personal history of breast cancer. Biopsies were performed with a 9-gauge vacuum-assisted device or surgically after MRI localization.
Of 130 MRI-guided biopsies, 20 (15%) yielded malignant histologic findings, 14 (11%) yielded high-risk lesions, and 96 (74%) had benign findings. There was a slightly higher malignancy rate for the personal-risk group (19%) compared with the hereditary-risk group (13.5%). There also was a slightly higher combined rate of malignancy and high-risk lesions (34% vs 22%) with no statistically significant difference (p < 0.25, p < 0.12). Patients in the hereditary-risk group were younger (44 ± 1.2 vs 54 ± 1.7 years; p < 0.001) than those in the personal-risk group.
Our preliminary data show no difference between the two risk groups with respect to probability of an MRI-guided biopsy result of malignancy, calling into question the proposed assumption. Further prospective studies of the role of MRI screening combined with MRI-guided biopsy when required for patients with previously treated localized breast cancer may be indicated.
PURPOSE OF REVIEWThe aim of this article is to review novel MRI and nuclear medicine methods for detecting and planning salvage treatment for prostate cancer local recurrence after radical ...prostatectomy or radiation therapy.
RECENT FINDINGSTraditional methods for detecting local recurrence (i.e., digital rectal exam or transrectal ultrasound and digital rectal exam or transrectal ultrasound-guided biopsy) have limited accuracy in determining the presence and extent of local recurrence and therefore have limited ability to guide salvage therapy. Recent studies indicate that conventional T1 and T2-weighted prostate MRI could improve the detection of recurrent prostate cancer after radical prostatectomy or radiation therapy and salvage treatment planning. Promising new sequences could further increase the accuracy of MRI. In addition, the use of technically improved PET/computed tomography scanners with new tracers like C and F choline and acetate might offer better assessment of recurrent prostate cancer than F-2-fluoro-D-deoxyglucose-PET and monoclonal antibody imaging with the prostate specific membrane antigen antibody In-capromab pendetide (ProstaScint).
SUMMARYWith systemic therapies for recurrent prostate cancer after radical prostatectomy or radiation therapy being noncurative, the application of MRI and nuclear medicine modalities can help to identify patients who have isolated local recurrence amenable to salvage treatment.
Complex fibroadenomas are a fibroadenoma subtype harboring one or more complex features. We sought to evaluate the incidence of complex fibroadenoma on biopsy and to propose decision criteria for ...managing patients with these breast lesions.
Complex fibroadenomas were diagnosed in 63 of 401 fibroadenomas (15.7%) found at consecutive percutaneous needle or excisional surgical biopsy. We evaluated the clinical and imaging presentations of complex fibroadenomas; compared pathology at core and excisional biopsy; and contrasted age, pathology, and size of complex and simple fibroadenomas using the Student's t test.
Patients with complex lesions were 18.5 years older (median age, 47 years; range, 21-69 years) than patients with noncomplex fibroadenomas (median age, 28.5 years; range, 12-86 years) (p < 0.001). Complex fibroadenomas were half the size (average, 1.3 cm; range, 0.5-2.6 cm) of noncomplex fibroadenomas (average, 2.5 cm; range, 0.5-7.5 cm) (p < 0.001). Only one malignancy, an invasive lobular carcinoma, was found in 63 complex fibroadenomas (1.6%). This patient had atypical lobular hyperplasia at core needle biopsy.
Approximately 16% of fibroadenomas are complex. Complex fibroadenomas are smaller and appear at an older age. At a mean follow-up of 2 years, we found a low incidence of malignancy in complex fibroadenomas. Women with complex fibroadenomas may therefore be managed with a conservative approach, similar to the approach now recommended for women with simple fibroadenomas.
CT Features of Adnexal Torsion Hiller, Nurith; Appelbaum, Liat; Simanovsky, Natalia ...
American journal of roentgenology (1976),
07/2007, Letnik:
189, Številka:
1
Journal Article
Recenzirano
Adnexal torsion is most commonly a clinical diagnosis, often aided by sonographic findings. At times, the clinical presentation can mimic nongynecologic causes of acute lower abdominal pain. In these ...cases, CT may be the initial imaging study. The purpose of this study was to define the CT features associated with adnexal torsion.
On CT, a well-defined adnexal mass abnormally located in the pelvis with ipsilateral deviation of the uterus in a woman or girl with lower abdominal pain should raise the suspicion of adnexal torsion. Inflammatory signs on CT suggest the presence of necrosis.
To evaluate endorectal coil magnetic resonance (MR) imaging in the depiction of local recurrence after radical prostatectomy.
Endorectal MR images were reviewed retrospectively in 82 patients who ...underwent prostatectomy. The interval between prostatectomy and MR imaging ranged between 0.5 and 13.0 years (mean, 3.25 years). Local recurrence was considered present if there was no evidence of distant metastases and there was a positive biopsy result, subsequent reduction in prostate-specific antigen (PSA) level after radiation therapy of the pelvis, or serial MR imaging findings of increased tumor size. Local recurrence on MR images was assessed for location, size, signal intensity, and invasion of adjacent structures. All images were reviewed independently by two readers who were blinded to clinical information.
Thirty-four of 82 patients did not meet inclusion criteria. Forty-one of 48 remaining patients had clinically documented local recurrence, which MR imaging depicted in 39 of 41 (95%) patients. Seven of 48 patients had no evidence of local or distant metastases, and none had positive MR imaging findings. Sensitivity of MR imaging was 95%, and specificity was 100%. Local recurrences were perianastomotic in 12 (29%) patients and retrovesical in 17 (40%), within retained seminal vesicles in nine (22%), and at anterior or lateral surgical margins in four (9%). All local recurrences were hyperintense to adjacent pelvic muscles on T2-weighted MR images. The mean diameter of tumors was 1.4 cm (range, 0.8-4.5 cm). PSA levels at MR imaging in patients with clinically proved recurrences ranged from undetectable to 10 ng/mL (mean, 2.18 ng/mL).
MR imaging depicts a high proportion of local recurrence after prostatectomy. The authors propose incorporation of endorectal coil MR imaging in the diagnostic paradigm of patients who have undergone prostatectomy and are suspected of having local recurrence.
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