Evaluation of solid breast lesions with power Doppler: value of penetrating vessels as a predictor of malignancy

<p><b>INTRODUCTION</b>This study aimed to evaluate the vascular pattern of solid breast lesions using power Doppler ultrasonography (PDUS) and assess whether the presence of intratumoural penetrating vessels can predict breast cancer malignancy.</p><p><b>METHODS</b>Greyscale ultrasonography (US) and PDUS were prospectively performed on 91 women in Malaysia with histopathologically proven breast lesions. The diagnostic accuracy of greyscale US, PDUS, and both greyscale US and PDUS was calculated and compared.</p><p><b>RESULTS</b>The 91 women had 102 breast lesions (55 benign, 47 malignant). Of the 47 malignant lesions, 36 demonstrated intratumoural penetrating vessels. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of greyscale US findings in diagnosing malignancy were 100.0%, 71.4%, 74.1% and 100.0%, respectively. The presence of calcification in the breast lesion and the margin, shape and posterior acoustic features of the lesion were significant parameters in predicting malignancy (p < 0.01). The sensitivity, specificity, PPV and NPV of the presence of intratumoural penetrating vessels in predicting malignancy were 76.5%, 80.0%, 76.5% and 80.0%, respectively. When both greyscale US and PDUS were used, there was a significant correlation in predicting malignancy (p < 0.05). The specificity and PPV values of the combined greyscale US and PDUS method (89.0% and 85.7%, respectively) were higher than those of greyscale US or PDUS alone.</p><p><b>CONCLUSION</b>Flow patterns revealed by PDUS can be useful for differentiating benign and malignant breast lesions. The visualisation of penetrating vessels in solid breast lesions can be used to complement greyscale US findings in predicting malignancy.</p>

Multiloculated hydrocephalus in an adult: Role of MRI FIESTA sequence in diagnosis and management

This is a case of an adult patient with hypertensive intraventricular haemorrhages complicated by hydrocephalus that failed to respond to endoscopic third ventriculostomy (ETV). High-resolution 3D Fast Imaging Employing Steady State Acquisition (FIESTA) magnetic resonance imaging (MRI) revealed underlying multiloculated hydrocephalus. This case report highlights the appropriate sequence and its attributes that offer adequate preoperative information detailing the ventricular system.

Cerebral venous sinus thrombosis: Comparison of multidetector computed tomography venogram (MDCTV) and magnetic resonance venography (MRV) of various fi eld strengths

Objectives: To investigate the accuracy of multidetector computed tomography venography (MDCTV) and magnetic resonance venography (MRV) of differing fi eld strength in diagnosing cerebral venous sinus thrombosis (CVST). To assess the visualization rate of the cerebral veins and dural sinuses between these imaging modalities. Methods: A retrospective review of 27 patients with clinical suspicion of CVST who underwent both MDCTV and corresponding MRI/MRV brain scans at 0.35T, 1.5T or 3.0T fi eld-strength were performed. Results were compared with the defi nitive fi nal diagnosis. In the nonthrombotic group of patients, a descriptive study of the anatomical visualization of cerebral veins and dural sinuses was also undertaken. Results: Ten of the 27 patients had a fi nal diagnosis of CVST. The Neuroradiologists’ consensus reading identifi ed these 10 cases of CVST in both the MDCTV and MRV scans with a sensitivity rate of 100%. There was one false positive in MDCTV and three false-positives in the MRV group (1.5T) with positive predictive values of 90.9% and 76.9%, respectively. MDCTV and MRV demonstrated a specifi city of 94.1% and 82.4%, respectively in diagnosing CVST. No false negative images were seen demonstrating a negative predictive value of 100% in both modalities. There was no statistical difference in the anatomical visualization rate of the cerebral veins or the dural sinuses among the various strengths of MRI. However, statistically signifi cant (p<0.05) fewer visualised vessels in MRV compared to MDCTV, for the SSS, ISS, straight sinus, ICV and VOG. Conclusion: MDCTV is equal to MRV of various strength in its sensitivity for CVST diagnosis. MDCTV also provides better anatomical visualization of the dural sinuses and cerebral veins.