Morphologic Classification of Ductal Breast Tumors on Ultrasound: Differential Diagnosis of Benign and Malignant Tumors

PURPOSE: To evaluate the morphologic differential diagnosis of benign and malignant ductal breast tumors, as seen on US. MATERIALS AND METHODS: US findings in 29 pathologically proven cases of ductal breast tumor were retrospectively reviewed. All patients were female and their mean age was 42 years. Nineteen tumors were benign and ten were malignant, and all ductal or cystic lesions showed solid masses. According to the location of the mural nodule, we classified the sonographic appearance of these tumors into three types : intraductal, intracystic and amorphic. The intraductal type was divided into three subtypes: incompletely obstructive, completely obstructive and multiple mural nodules. For the intracystic type, too, three subtypes were designated : the intracystic mural nodule (mural cyst), intracystic mural nodule with the duct (mural cyst+duct) and intracystic multiple mural nodules. The amorphic type is defined as an atypical ductal tumor with the mural nodule extending into adjacent parenchyma. RESULTS: The margin of the duct or cyst was smooth in 68.4% of benign, and irregular in 90% of malignant ductal tumors. Internal echogeneity of the duct or cyst usually showed homogeneity in both benign and malignant tumors. 73.7% of tumors connecting the duct were benign and 50% were malignant. In benign tumors, 52.6% of mural nodule had an irregular margin, while in malignant tumors, the corresponding proportion was 100% ; both types usually showed heterogeneous hypoechogeneity. Among benign tumors, the most common morphologic type was the intraductal incompletely obstructive subtype (36.8%) ; among those that were malignant, the amorphic type was most common, accounting for 40% of tumors. No amorphic type was benign and no incompletely obstructive subtype was malignant. CONCLUSION: When ductal breast tumors are morphologically classified on the basis of sonographic findings, the intraductal incompletely obstructive subtype suggests benignancy, and the amorphic type, malignancy. The morphologic classification of ductal breast tumors based on sonography is therefore useful for the differential diagnosis of benignancy and malignancy.

Radiologic Findings of Sacroiliitis: Emphasis on MR Findings

PURPOSE: To compare the characteristic MR findings of infectious sacroiliitis (IS) and ankylosing spondylitis(AS). MATERIALS AND METHODS: We retrospectively reviewed MR findings in eight patients with IS (pyogenic in six, tuberculosis in two) confirmed by culture and clinical follow-up, and in six with AS by HLA-B27 typing. A control group of 13 asymptomatic volunteers was formed, and they underwent MRI. Findings were analysed for morphology, degree of bone erosion, and adjacent soft tissue change. CT findings of AS in four patients and IS in four were also compared to MR findings. RESULTS: MR characteristics of IS included unilaterality (100 %), abnormal cartilage signal intensity (100 %), bone marrow change (100 %), contrast enhancement (100 %), erosion (63 %), and soft tissue change (63 %). MR findings of AS showed bilaterality (67 %), abnormal cartilage signal intensity (80%), bone marrow change (80 %), erosion (80 %), contrast enhancement (44 %) and soft tissue change (10 %). CT scan showed bony sclerosis and erosion (86 %), and abnormal joint space (71 %). CONCLUSION: MR findings of sacroiliitis were loss of thin zone of a cartilage and erosions on T1-weighted image, and increased signal intensity on T2-weighted image. MRI is regarded as a useful diagnostic method where conventional diagnosis is difficult, and is able to image cartilage abnormalities directly and noninvasively. Significant differences in MR findings between IS and AS were not noted, however.

MR Imaging of Multiple Fibroadenoma in Breast: Comparison with Color Doppler Images and Histologic Findings

PURPOSE: To understand the different signal intensities seen on contrast enhanced magnetic resonance imaging (MRI) in multiple fibroadenoma of the breast, and to compare these with color Doppler ultrasonographic (CDUS) and histologic findings. MATERIALS AND METHODS: MRI (1.0 Tesla, T1WI, T2WI, 3D-gradient echo dynamic contrast enhancement study) findings of 24 histologically proven cases of fibroadenoma in five patients were evaluated and compared with the histologic components (myxoid, adenomatous, fibrous). In addition, vascular flow, as seen on CDUS and histologic section, was compared. RESULTS: The observed degree of signal intensity was classified into three groups, as follows: negative, 8.3%, mild to moderate, 54.2%; marked, 37.5%. On histologic section, the greater the fibrotic component, the higher the intensity of MRI enhancement, the greater the glandular component, and the intensity. CDUS showed vascular flow in only one tumor larger than 3cm in diameter. Vascular patterns of tumors on CDUS were dots in mass and detouring pattern, but in this case and in strongly enhanced cases, tumor vascularity-as seen on histologic section-showed no significant increase. CONCLUSION: Different signal intensities seen on contrast enhanced MRI in multiple fibroadenoma of the breast may be related more to the amount of glandular and fibrotic component than to increased tumor vascularity.

Diagnostic Value of 3D-Gradient Echo Dynamic Contrast Enhanced MRI in Breast Cancer

PURPOSE: To assess the usefulness of 3D-gradient echo dynamic contrast enhanced MRI (3D-DMRI) in the diagnosis of breast cancer and to determine the most useful parameter for this diagnosis. MATERIALS AND METHODS: Using a 1.0T MR unit, (Magnetom, Siemens, Erlaugen, Germany), 3D-DMRI (TR/TE=30/12) with Gd-DTPA was performed in 38 cases of breast cancer, 22 of fibroadenoma, and in three normal volunteers. We retrospectively evaluated the findings according to the speed on dynamic study and maximal amount of contrast enhancement during the delayed phase; we calculated the contrast index and morphology of the cancers and compared diagnostic accuracy among these three diagnostic parameters. RESULTS: On conventional spin-echo T1- and T2-weighted images, there was no significant difference of signal intensity between benign fibroadenoma and breast carcinoma. Rapid contrast enhancement (within one minute) was noted in 35 breast cancer lesions (92.1%), but relatively low and slow contrast enhancement (after five minutes) was noted in three such lesions (7.9%). Gradual contrast enhancement was noted in 21 lesions of fibroadenoma (95.5%), but a moderate degree of rapid contrast enhancement (from three to five minutes) was noted in the other case (7.9%). of On the delayed enhanced phase of 3D-DMRI, the maximal amountof contrast enhancement showed no significant difference between fibroadenoma and cancer. On 3D-DMRI, an irregular, spiculated border, with high contrast enhancement was noted in all cases of breast cancer, in particular, irregular thick peripheral contrast enhancement with central necrosis was noted 11 cases (28.9%). CONCLUSION: For the diagnosis of breast cancer, 3D-DMRI is a useful technique. Among the diagnostic criteria of speed, maximal amount of contrast enhancement and morphology, morphologic change after contrast enhancement study was the most useful diagnostic parameter.

MR Image Findings of Giant Cell Tumor of the Tendon Sheath Involving the Foot: A Case Report

Giant cell tumor of the tendon sheath(GCTTS) is a benign condition which involves the synovium of the tendonsheaths, and usually occurs around the small joints, e. g. the ankle, knee, and wrist. Histologically, GCTTS is similar to pigmented villonodular synovitis(PVNS). The authors report MRI findings of a GCTTS. This showed lower signal-intensity lesions than adjacent muscles on T1-weighted, proton density weighted, and T2-weighted images.

Efficacy of Enteroclysis through Miller-Abbott Tube for Decompression in Patients with Postoperative Intestinal Obstruction

PURPOSE: The purpose of this study is to assess the efficacy of enteroclysis through the previously inserted Miller-Abbott (M-A) tube for decompression in the postoperative intestinal obstruction. MATERIALS & METHODS: This study includes twenty patients who had intestinal obstruction symptoms after operation for benign(12) ormalignant(8) abdominal lesions. Small amount of barium was introduced to M-A tube for enteroclysis. We evaluated the presence, level, degree, and causes of obstruction on enteroclysis, compared with surgical(11) and clinical(9)findings. RESULTS: Obstruction was seen in 18 cases including the two cases in which the level of obstruction wasnot clear. There was no obstruction in two cases. Obstruction on enteroclysis was demonstrated in all 11 operated cases(100% accuracy, 11/11). The level of obstruction on enteroclysis were jejunum in three cases, ileum in seven,and colon in one case. The levels of obstruction on enteroclysis were matched with those in operation field in 10 cases. There were two cases of nonobstruction, nine cases of low-grade partial obstruction, and nine cases of high-grade partial obstruction. We analyzed the findings on enteroclysis regarding causes of obstruction in 16 patients with the findings of adhesive bands of extrinsic cause(9), cancer recurrence of intrinsic cause(6), and bezoar of intraluminal cause(1). Misinterpreted cases were two cases(87.7% accuracy, 14/16). The cause, for nonvisualization of obstruction site on enteroclysis in four patients included technical failure such asin adequate location of tube(1) and bowel overlapping(1), minimal obstruction(1), and nonexistent obstruction(1), in spite of diffuse edematous mucosa. CONCLUSION: Enteroclysis through the M-A tube for decompression in patients with postoperative intestinal obstruction is an useful method for evaluation of intestinal obstruction.