Helical versus conventional CT in detecting meniscal lesions

Purpose. We compared volumetric helical and conventional CT in the study of meniscal injuries. Material and methods. Thirty-three patients with suspected meniscal tear underwent helical and conventional CT. Common parameters were 512 7 512 matrix, 14-15 cm FOV, 120 kV and 175 mA; helical CT was performed with 2 mm beam thickness, 1.5 mm/s table feed, 1 mm reconstruction index and conventional CT with 2 s scan time, 1 mm slice thickness and 1 mm table feed. All scans were photographed with a Laser printer using the same window (180/100). All patients also underwent sagittal and coronal T2 * GE MRI at .5-T; slice thickness was 5 mm and interslice gap 1 mm. Nonparametric scales were used to study the menisci, as follows: for CT we had A = no visible injury; B = diffuse hypodensity (degenerative condition); C = questionable meniscal tear ; D = unquestionable meniscal tear. For MRI, we had A = no visible injury; B = grade 1 or 2 injury; C = grade 3 injury; D = grade 4 injury. We used the 1-4 MR grading by Lotysch et al. and by Crues et al. MRI was used as the gold standard. The agreement between helical CT, conventional CT and MRI was calculated with kappa statistics. Results. Helical and conventional CT found 23 and 15 patterns A, 6 and 10 B, 3 and 1 C and 1 and 7 D, respectively. MRI found 15 A, 8 B, 3 C and 7 D. There was no agreement between helical CT and MRI and between helical CT and conventional CT because of the meniscal tears underestimated by the former. Agreement was very high between conventional CT and MRI (p < .001). Discussion and conclusions. The main result of our experience is that helical CT appears less sensitive than conventional CT in detecting meniscal tears. The helical CT section profile (more roundish than that of conventional CT) and the lower radiation dose used by helical CT (with increased quantum noise) may have played a key role in its underestimation of meniscal tears

Dynamic breast magnetic Resonance imaging : effect of changing the region of interest on early enhancement using 2D and 3D techniques

Objective: To assess the effect of changing the region of interest (ROI) on early enhancement (EE) in dynamic breast magnetic resonance (MR) imaging. Methods: We evaluated retrospectively 102 breast lesions: 54 lesions (33 malignancies and 21 benignancies) studied with 2D and 48 lesions (30 and 18, respectively) with 3D gradient-echo dynamic technique (contrast dose 0.1 mmol/kg). Each lesion was postprocessed using 3 different regions of interest (ROIs): small circular ROI on maximal enhancement (SCR); large circular ROI within the lesion (LCR); and irregular ROI by manual contouring (IRR). EE was classified as benign ( 6450%), uncertain (51-89%), or malignant ( 6590%). Results: With 2D, the uncertain EEs were 17% for both SCR and LCR, 33% for IRR (P = 0.008); with 3D, the uncertain EEs were 4%, 15%, and 13%, respectively (SCR versus LCR, P = 0.063). More uncertain EEs were obtained with 2D (17-33%) than with 3D (4-15%), significantly for SCR (P = 0.043) and IRR (P = 0.013). Considering uncertain EEs as positive, sensitivity was 100% for SCR, 91% for LCR, and 82% for IRR (SCR versus IRR, P = 0.031) with 2D, 100%, 97%, and 87%, respectively, with 3D technique, without significant differences; specificity ranged from 71% to 90% with 2D and 61% to 83% with 3D, without significant differences. Conclusion: The type of ROI influences the EE in dynamic breast MR. Using 3D technique with small ROI located on the area of maximal enhancement gives the best results in terms of certainty of the level of EE together with top levels of sensitivity

Helical versus conventional CT in detecting meniscal injuries

We compared volumetric helical and conventional CT in the study of meniscal injuries

MR dynamic enhancement of breast lesions: high temporal resolution during the first-minute versus eight-minute study

To investigate the value of the early phase of MR enhancement of breast lesions

Mammographic density estimation: one-to-one comparison of digital mammography and digital breast tomosynthesis using fully automated software.

To compare breast density on digital mammography and digital breast tomosynthesis using fully automated software.Following institutional approval and written informed consent from all participating women, both digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) were obtained. Breast percentage density was calculated with software on DBT and FFDM.Fifty consecutive patients (mean age, 51 years; range, 35-83 years) underwent both FFDM and DBT. Using a method based on the integral curve, breast density showed higher results on FFDM (68.1 \ub1 12.1 for FFDM and 51.9 \ub1 6.5 for DBT). FFDM overestimated breast density in 16.2\% (P < 0.0001). Using a method based on maximum entropy thresholding, breast density showed higher results on FFDM (68.1 \ub1 12.1 for FFDM and 51.9 \ub1 6.5 for DBT). FFDM overestimated breast density in 11.4\% (P < 0.0001). There was a good correlation among BI-RADS categories on a four-grade scale and the density evaluated with DBT and FFDM (r = 0.54, P < 0.01 and r = 0.44, P < 0.01).Breast density appeared to be significantly underestimated on digital breast tomosynthesis.Breast density is considered to be an independent risk factor for cancer Density can be assessed on full-field digital mammography and digital breast tomosynthesis Objective automated estimation of breast density eliminates subjectivity Automated estimation is more accurate than BI-RADS quantitative evaluation Breast density may be significantly underestimated on digital breast tomosynthesis

Vacuum assisted breast biopsy (VAB) excision of subcentimeter microcalcifications as an alternative to open biopsy for atypical ductal hyperplasia

Objective: Atypical ductal hyperplasia (ADH) is a proliferative lesion associated with a variable increased risk of breast malignancy, but the management of the patients is still not completely defined, with mandatory surgical excision in most cases. To report the results of the conservative management with mammographic checks of patients with ADH diagnosed by vacuum assisted breast biopsy (VAB), without residual calcifications. Methods: The authors accessed the institutional database of radiological, surgical and pathological anatomy. Inclusion criteria were: ADH diagnosed by VAB on a single group of microcalcifications, without residual post-procedure; follow-up at least of 12 months. Exclusion criteria were the presence of personal history of breast cancer or other high-risk lesions; association with other synchronous lesions, both more and less advanced proliferative lesions. Results: The 65 included patients were all females, with age range of 40-79 years (mean 54 years). The maximum diameter range of the groups of microcalcifications was 4-11 mm (mean 6.2 mm), all classified as BI-RADS 4b (Breast Imaging Reporting and Data System 4b) and defined as fine pleomorphic in 29 cases (45%) or amorphous in 36 cases (55%). The range of follow-up length was 12-156 months (mean 67 months). Only one patients developed new microcalcifications, in the same breast, 48 months after and 15 mm from the first VAB, interpreted as low-grade ductal carcinoma in situ (DCIS) at surgical excision. Conclusion: These results could justify the conservative management, in a selected group of patients, being the malignancy rate lower than 2%, considered in the literature as the "probably benign" definition. Advances in knowledge: Increasing the length of follow-up of selected patients conservatively managed can improve the management of ADH cases

[The role of T2*-weighted gradient-echo magnetic resonance sequences in the study of suspected dorsal-lumbosacral vertebral metastases]

Magnetic resonance (MR) imaging showed high reliability in detecting spine metastases with spin-echo (SE) sequences, T1-weighted sequences being generally more sensitive than T/-weighted ones. We investigated the value of T2*-weighted gradient-echo (GE) sequences in studying spine metastases