The value of DCE- MRI of the breast as a diagnostic tool in assessing amorphous calcifications in screening mammography

PurposeTo evaluate the diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging in differentiating benign and malignant amorphous calcifications.MethodsThis study included 193 female patients with 197 suspicious amorphous calcifications detected on screening mammography. The patients’ demographics, clinical follow-up, imaging, and pathology outcomes were reviewed, and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of DCE-MRI were calculated.ResultsOf 197 lesions (193 patients) included in the study, 50 (25.4%) were histologically proved to be malignant. DCE-MRI based on breast imaging report and diagnosis system (BI-RADS) had a sensitivity of 94.4%, specificity of 85.7%, PPV of 69.1%, and NPV of 97.7% for the detection of malignant amorphous calcifications. Notably, diagnosis solely based on the presence or absence of DCE-MRI enhancement showed the same sensitivity but significantly decreased specificity (44.8%, p < 0.001) and PPV (44.8%, p < 0.001). In patients with a minimal or mild degree of background parenchymal enhancement (BPE), the sensitivity, specificity, PPV, and NPV increased to 100%, 90.6%, 78.6%, and 100%, respectively. However, in patients with a moderate degree of BPE, MRI resulted in three false negatives of ductal carcinoma in situ (DCIS). Overall, the addition of DCE-MRI detected all invasive lesions and could decrease unnecessary biopsy by 65.5%.ConclusionDCE-MRI based on BI-RADS has the potential to improve the diagnosis of suspicious amorphous calcifications and avoid unnecessary biopsy, especially for those with low-degree BPE

Evaluation of the role of dynamic contrast-enhanced MR imaging for patients with BI-RADS 3-4 microcalcifications.

The purpose of study was to prospectively evaluate the diagnostic performance of dynamic contrast-enhanced MR imaging in the differentiation of malignant lesions from benign ones in patients with BI-RADS 3-4 microcalcifications detected by mammography.93 women with 100 microcalcifications had undergone breast MRI from June 2010 to July 2013. Subsequently, 91 received open biopsy and 2 received stereotactic vacuum-assisted biopsy. All results were compared with histological findings. The PPV, NPV and area under curve (AUC) of the mammography and breast MRI were calculated.There were 31 (31.0%) BI-RADS 3 microcalcifications and 69 (69.0%) BI-RADS 4. The PPV and NPV of mammography is 65.2% (45/69) and 90.3% (28/31). The PPV and NPV of breast MRI was 90.2% (46/51) and 95.9% (47/49). Among 31 BI-RADS 3 microcalcifications, the PPV and NPV of breast MRI was 100% (3/3) and 100% (28/28). Among 69 BI-RADS 4 microcalcifications, the PPV and NPV of breast MRI was 89.6% (43/48) and 90.5% (19/21). The AUC of mammography and breast MRI assessment were 0.738 (95% CI, 0.639-0.837) and 0.931 (95% CI, 0.874-0.988) (p<0.05).Dynamic contrast-enhanced MR imaging of breast is able to be applied to predict the risk of malignance before follow-up for BI-RADS 3 microcalcifications and biopsy for BI-RADS 4 microcalcifications

The Drug H+ Antiporter FgQdr2 Is Essential for Multiple Drug Resistance, Ion Homeostasis, and Pathogenicity in Fusarium graminearum

Increased emergence of drug resistance and DON pollution pose a severe problem in Fusarium head blight (FHB) control. While the H+ antiporter (DHA) family plays crucial roles in drug resistance, the characterization of DHA transporters has not been systematically studied in pathogenetic fungi. In this study, a systematic gene deletion analysis of all putative DHA transporter genes was carried out in Fusarium graminearum, and one DHA1 transporter FgQdr2 was found to be involved in multiple drug resistance, ion homeostasis, and virulence. Further exploration showed that FgQdr2 is mainly localized in the cell membrane; its expression under normal growth conditions is comparatively low, but sufficient for the regulation of drug efflux. Additionally, investigation of its physiological substrates demonstrated that FgQdr2 is essential for the transport of K+, Na+, Cu2+, and the regulation of the membrane proton gradient. For its roles in the FHB disease cycle, FgQdr2 is associated with fungal infection via regulating the biosynthesis of virulence factor deoxynivalenol (DON), the scavenging of the phytoalexin, as well as both asexual and sexual reproduction in F. graminearum. Overall, the results of this study reveal the crucial roles of FgQdr2 in multiple drug resistance, ion homeostasis, and pathogenicity, which advance the understanding of the DHA transporters in pathogenetic fungi

44-year-old woman with invasive ductal carcinoma in the upper inner quadrant of the right breast.

<p>(a–b) Right craniocaudal view mammogram of punctate microcalcifications with clustered distribution (yellow ring) classified as BI-RADS category 3; (c–d) Axial maximum intensity projection (MIP) of mass-like enhancement in the upper inner quadrant of right breast with plateau form of dynamic curve.</p

Study flowchart.

<p>BI-RADS:Breast Imaging Reporting and Data System, DCE MRI:Dynamic Contrast-Enhanced MRI.</p

Receiver operating characteristic (ROC) curves of mammography and breast MRI.

<p>Receiver operating characteristic (ROC) curves of mammography and breast MRI.</p

Distribution of histological findings in 100 lesions.

<p>IDC invasive ductal carcinoma, MAC mucinous adenocarcinoma, DCIS ductal carcinoma in situ, ADH atypical ductal hyperplasia. Dash(-) indicates none.</p

Comparison of BI-RADS category assessment of mammography and HR-DCE MRI.

<p>Numbers in parentheses are percentages of all lesions with that feature classified in the specified final assessment category. Dash(-) indicates none.</p