DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY

PURPOSE We aimed to retrospectively compare three-dimensional vascular maps of both breast obtained by dynamic magnetic resonance imaging (MRI) and determine the association of one-sided vascular prominence with ipsilateral breast cancer. MATERIALS AND METHODS MRI was performed using gadolinium in 194 cases. Two readers scored vascular density using maximum intensity projections (MIPs). Dynamic fat-saturated T1-weighted gradient-echo MIPs were acquired. Two readers evaluated the MIPs, and vessels greater than 2 mm in diameter and longer than 3 cm were counted. The difference in vessel numbers detected in the two breasts determined the score. RESULTS A total of 54 patients had malignant lesions (prevalence, 28%), including invasive ductal carcinoma (n=40), invasive mixed ductal-lobular carcinoma (n=5), invasive lobular carcinoma (n=3), ductal carcinoma in situ (n=3), mucinous carcinoma (n=1), medullary carcinoma (n=1), and leukemic metastasis (n=1). In 62 patients, there were benign lesions (fibroadenomas, fibrocysts), and four patient had inflammation (granulomatous mastitis in two patients, breast tuberculosis in two patients). There were 78 normal cases. When a difference of at least two vessels was scored as vascular asymmetry, the sensitivity, specificity, positive likelihood ratio (+LR), and negative (-LR) of unilaterally increased vascularity associated with ipsilateral malignancy were 69%, 92%, 8.72, and 0.34, respectively. When four infection and three post-operative cases with vascular asymmetry were excluded; prevalence, specificity, and +LR increased to 29%, 97%, and 22.8, respectively, with the same sensitivity and -LR. Differences in mean vascularity scores were evaluated with regard to tumor size. T1 and T2 tumors were not significantly different from each other. The mean score of T3 tumors differed significantly from T1 and T2 tumors. CONCLUSION MRI vascular mapping is an effective method for determining breast tissue vascularization. Ipsilateral increased vascularity was commonly associated with malignant breast lesions

SEMINARS IN MUSCULOSKELETAL RADIOLOGY

Spinal tumors consist of a large spectrum of various histologic entities. Multiple spinal lesions frequently represent known metastatic disease or lymphoproliferative disease. In solitary lesions primary neoplasms of the spine should be considered. Primary spinal tumors may arise from the spinal cord, the surrounding leptomeninges, or the extradural soft tissues and bony structures. A wide variety of benign neoplasms can involve the spine including enostosis, osteoid osteoma, osteoblastoma, aneurysmal bone cyst, giant cell tumor, and osteochondroma. Common malignant primary neoplasms are chordoma, chondrosarcoma, Ewing sarcoma or primitive neuroectodermal tumor, and osteosarcoma. Although plain radiographs may be useful to characterize some spinal lesions, magnetic resonance imaging is indispensable to determine the extension and the relationship with the spinal canal and nerve roots, and thus determine the plan of management. In this article we review the characteristic imaging features of extradural spinal lesions

SINGAPORE MEDICAL JOURNAL

INTRODUCTION The specificity of conventional magnetic resonance (MR) imaging is lower than its high sensitivity. Diffusion-weighted imaging (DWI), based on alterations in the microscopic motion of water molecules, promises improved specificity for breast MR imaging. In this study, we aimed to determine the diagnostic potential of DWI to differentiate between benign and malignant breast lesions and normal breast tissue. METHODS Dynamic contrast-enhanced breast MR imaging and DWI were applied to 108 women. Apparent diffusion coefficient (ADC) values were obtained for normal breast tissue (n = 183), benign lesions (n = 66) and malignant lesions (n = 58). The results were compared with the patients' final diagnoses. RESULTS Mean ADC values for benign and malignant breast lesions were 1.04 x 10(-3) +/- 0.29 x 10(-3) mm(2)/s and 2.00 x 10(-3) +/- 0.55 x 10(-3) mm(2)/s, respectively (p = 0.001, Student's t-test), while that for normal breast tissue was 1.78 x 10(-3) +/- 0.33 x 10(-3) mm(2)/s. With a cut-off value of 1.46 x 10(-3) mm(2)/s for ADC in receiver operating characteristic analysis, 95% sensitivity and 85% specificity were achieved for differentiating between benign and malignant lesions. CONCLUSION DWI of the breast can help differentiate benign and malignant breast lesions from normal breast tissue. DWI, which can be easily introduced into standard breast MR imaging protocols without increasing imaging times, promises to increase the accuracy of breast MR imaging without contrast media. However, its clinical value will depend on the standardisation of b-values and other technical parameters in larger future study series

INDIAN JOURNAL OF MEDICAL RESEARCH

Background & objectives: Marnmographic screening is an effective tool for the early detection of breast cancer. Hormone replacement therapy (HRT) has been shown to increase mammographic density and thus may hinder early detection of small tumours. We undertook this study to determine and compare the frequency and degree of change in mammographic density in postmenopausal women in HRT using two different methods: the classical Wolfe classification and a new semiquantitative method, which we named as the comparison wheel. Methods: This study included 285 women, 206 under hormone treatment, and 79 control subjects. All women underwent baseline mammographic study before the beginning of treatment. Mean interval of the follow up mammograms was 16 months. The methods were compared in evaluating the effects of three types of hormone therapies on marnmographic density. Results: The frequency of change was only significant in the combined hormone replacement group when Wolfe classification was used. However, the frequency of increase in density (estrogen group 21 %, combined therapy group 42%, tibolone group 28%) was markedly higher when the comparison wheel was used. The inter-rater Kappa value was calculated as 0.977 for the first and 0.957 for the second readings of the two radiologists for the comparison wheel, and 0.973 and 0.968 for the Wolfe classification. The intra-rater Kappa values were determined as 0.972 and 0.957 for the first and and 0.963 and 0.926 for the second radiologist for comparison wheel and Wolfe classification respectively. Interpretation & conclusion: Our findings indicate that the estimated increase of mammographic density depends on the selected hormone regimen, as well as the method of evaluation. The comparison wheel is a serniquantitative method of evaluating changes of mammographic density and is sensitive and reproducible with high inter- and intra- rater Kappa values. This method can be used as an alternative for comparison of digital mammographic applications in the future

BALKAN MEDICAL JOURNAL

Objective: To assess the contribution of kinetic characteristics in the discrimination of malignant-benign axillary lymph nodes. Material and Methods: One hundred fifty-five female patients were included in the study. Following magnetic resonance imaging (MRI) examinations post-processing applications were applied, dynamic curves were obtained from subtracted images. Types of dynamic curves were correlated with histopathological results in malignant cases or final clinical results in patients with no evidence of malignancy. Sensitivity, specificity, positive likehood ratio (+LHR), negative (-LHR) of dynamic curves characterizing the axillary lymph nodes were calculated. Results: A total of 178 lymph nodes greater than 8 mm were evaluated in 113 patients. Forty-six lymph nodes in 24 cases had malignant axillary involvement. 132 lymph nodes in 89 patients with benign diagnosis were included in the study. The sensitivity of type 3 curve as an indicator of malignancy was calculated as 89%. However the specificity, +LHR, -LHR were calculated as 14%, 1.04, 0.76 respectively. Conclusion: Since kinetic analysis of both benign and malignant axillary lymph nodes, rapid enhancement and washout (type 3) they cannot be used as a discriminator, unlike breast lesions. MRI, depending on the kinetic features of the axillary lymph nodes, is not high enough to be used in the clinical management of breast cancer patients

TURKIYE KLINIKLERI TIP BILIMLERI DERGISI

Schwannomas are essentially benign tumors originating from schwann cells of peripheral, cranial or sympathetic nerves. They are not aggressive, encapsulated and grow slowly. Malignant transformation can rarely be seen. Even though they can be localized in any where in the body, cutaneous nerves of the head-neck region and flexor parts of the extremities are most commonly involved. Schwannomas are usually solitary, however multiple schwannomas can rarely be seen in the peripheral nervous system including cranial nerves, spinal nerve roots, brachial-lumbosacral plexus and peripheral nerves. In these two cases, we aimed to report ultrasonography (US), magnetic resonance imaging (MRI) and pathology findings of different axillary schwannomas mimicking lymphadenopathy, and discuss the differential diagnosisin the light of the literature. In these patients, the lesions were noted to be in direct continuity with a cord-like structure resembling a nerve. US and MRI findings were compatible with the literature. Radiologic findings were confirmed by pathologic examination. As seen in our cases, a detailed differential diagnosis should be considered in every axillary lesion including frequently seen axillary lymphadenopathies

DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY

The metastasis of extramammary malignancies into the breast is very unusual. Lymphoma, malignant melanoma, and rhabdomyosarcoma are the most common tumors that metastasize into breast tissue. The histological spectrum of breast masses in children and adolescents is different from that of adults. Imaging findings are useful for performing a diagnosis, but in a patient with a known malignancy, any enlarging breast mass, even one with a benign radiological appearance, should be investigated with a biopsy. In this article, we present the imaging findings of a 12-year-old female patient with breast metastasis of Ewing's sarcoma

JOURNAL OF CLINICAL NEUROSCIENCE

We report a case of rhinocerebral mucormycosis associated with an abscess in the lateral aspect of the pons associated with perineural spread of disease via the trigeminal nerve. Contrast enhanced MRI was useful in depicting the extent of the disease and suggesting perineural spread. A pathological diagnosis of mucormycosis was established by means of rhino-orbital punch biopsy. (c) 2005 Elsevier Ltd. All rights reserved

RHEUMATOLOGY INTERNATIONAL

The purpose of this study was to compare the value of conventional magnetic resonance imaging (MRI) finding of rheumatoid arthritis (RA) and computer-aided dynamic MRI measurements in predicting the activity of disease. The activity of the disease in 40 RA patients was evaluated by the disease activity score in 28 joints (DAS28). The conventional MRI of the wrists of all patients were scored for bone edema, synovitis and erosions, according to the criteria of RA-MRI scoring system (RAMRIS) developed by Outcome measures in rheumatology clinical trials (OMERACT) MR Imaging Group. Synovitis was also quantified by dynamic postcontrast MRI imaging using color coded maximum slope of increase maps and measurements of early enhancement rate (EER) and relative enhancement (RE). Twenty-two (55 %) patients with a score higher than 5.1 constituted the high disease activity group, 18 (45 %) patients with a score of 5.1 or less constituted moderate disease activity group. The dynamic MRI-EER score was the most significant parameter to differentiate between the groups (p = 0.001). Among OMERACT scores, only bone edema [p = 0.020 for wrist and p = 0.037 for metacarpophalangeal joints (MCP)] had a significant difference between the two groups. Dynamic MRI RE score and OMERACT scores for erosions and synovitis for both the wrist and MCP joints did not differ significantly between the two groups. Computer-aided dynamic MRI is a reliable, noninvasive method of evaluating the RA patients, which correlates with the DAS28 scores, at a higher significance than the OMERACT-RAMRIS scores