Commentary: diffusion-weighted magnetic resonance imaging - a novel way to assess disease activity in Crohn's disease? Authors' reply

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The role of tomosynthesis in breast cancer staging in 75 patients

International audienceObjectives: Compare tomosynthesis to mammography, ultrasound, MRI, and histology for the detection and staging of BI-RADS 4—5 anomalies, as a function of breast composition, lesion location, size, and histology.Patients and methods: Seventy-five patients underwent mammography, tomosynthesis, ultrasound, and MRI. The diagnostic accuracy of the different examinations was compared.Results: The sensitivities for detection were as follows: 92.5% with MRI, 79% for ultrasound, 75% for tomosynthesis, and 59.5% for mammography. Tomosynthesis improves the sensitivity of mammography (P = 0.00013), but not the specificity. The detection of multifocality and multicentricity was improved, but not significantly. Tomosynthesis identified more lesions than mammography in 10% of cases and improved lesion staging irrespective of the density, but was still inferior to MRI. The detection of ductal neoplasia was superior with tomosynthesis than with mammography (P = 0.016), but this was not the case with lobular cancer. The visualization of masses was improved with tomosynthesis (P = 0.00012), but not microcalcifications. Tomosynthesis was capable of differentiating lesions of all sizes, but the smaller lesions were easier to see. Lesion sizes measured with tomosynthesis, excluding the spicules, concurred with histological dimensions. Spicules lead to an overestimation of the size.Conclusion: In our series, tomosynthesis found more lesions than mammography in 10% of patients, resulting in an adaption of the surgical plan

Hepatic haemangioma: Common and uncommon imaging features

AbstractThe haemangioma, the most common non-cystic hepatic lesion, most often discovered by chance, may in certain situations raise diagnostic problems in imaging. In this article, the authors first demonstrate that the radiological appearance of the hepatic haemangioma, in its typical form, is closely related to three known histological sub-types. They then show that certain atypical features should be known in order to establish a diagnosis. They also observe the potential interactions between the haemangioma, an active vascular lesion, and the adjacent hepatic parenchyma. Finally, they discuss the specific paediatric features of hepatic haemangiomas and illustrate the case of a hepatic angiosarcoma

Diffusion-weighted magnetic resonance imaging for detecting and assessing ileal inflammation in Crohn's disease

International audienceBackground Whether diffusion-weighted imaging (DWI)-MRI is of value in detecting and assessing inflammation of ileal Crohn's disease (CD) remains poorly investigated. Aim To compare DWI-MR enterography (MRE) with conventional MRE in estimating inflammation in small bowel CD, to determine an apparent diffusion coefficient (ADC) threshold to differentiate active from non-active lesions and to assess inter-observer agreement. Methods Thirty-one CD patients from the Clermont-Ferrand IBD unit with ileal involvement were consecutively and prospectively included between April and June 2011. All patients underwent DWI-MRI to detect the digestive segment with the most severe lesions, which was then used to calculate the ADC. Qualitative and quantitative results were compared with conventional MRE including MaRIA (Magnetic Resonance Index of Activity) score calculation and independent activity predictors (wall thickening, oedema, ulcers). Each examination was interpreted independently by two radiologists blinded for clinical assessment. Results Seventeen patients (54.8%) had active CD as defined by the MaRIA score 7. DWI hyperintensity was highly correlated with disease activity evaluated using conventional MRE (P=0.001). Qualitative analysis of DW sequences determined sensitivity, specificity, positive predictive value and negative predictive value as 100%, 92.9%, 94.4% and 100% respectively. Quantitative analysis using a cut-off of 1.6x103 mm2/s for ADC yielded sensitivity and specificity values of, respectively, 82.4% and 100%. Inter-observer agreement was high with regard to DWI hyperintensity (=0.69, accuracy rate=85.7%) and ADC (correlation=0.74, P<0.001, and concordance=0.71, P<0.001). Conclusion DWI-MR enterography is a well-tolerated, non-time-consuming and accurate tool for detecting and assessing inflammation in small bowel Crohn's disease

Diffusion-weighted magnetic resonance imaging in ileocolonic Crohn's disease: Validation of quantitative index of activity

International audienceOBJECTIVES : Magnetic resonance imaging (MRI) allows accurate assessment of Crohn's disease (CD), but requires gadolinium injection. Diffusion-weighted (DW)-MRI yields comparable performances in small bowel CD. We compared the accuracy of DW-MR enterocolonography (MREC) and the magnetic resonance index of activity (MaRIA), and performed an external validation of the Clermont score in assessing inflammation in CD. METHODS : This was an observational prospective study of a single-center cohort. A total of 130 CD patients underwent consecutively MREC with gadolinium injection and DWI sequences between July 2011 and December 2012. RESULTS : Of the 848 evaluated segments (small bowel = 352, colon/rectum = 496), 175 (20.6%) were active (small bowel = 111, colon/rectum = 64) defined as MaRIA >= 7. Using a receiver operating characteristic (ROC) curve, we determined an apparent coefficient of diffusion (ADC) threshold of 1.9x10(-3) mm(2)/s that yielded a sensitivity and a specificity in discriminating active from nonactive CD of 96.9% and 98.1%, respectively, for the colon/rectum, and 85.9% and 81.6%, respectively, for the ileum. ADC was better correlated to MaRIA >= 7 than related contrast enhancement obtained with injected sequences (P 0.9, P 0.9, P < 0001). CONCLUSIONS : DW-MREC is a reliable tool to assess inflammation in colonic (ADC) and ileal (Clermont score) CD and its use in daily practice would avoid gadolinium injection