Solid Breast Lesions: Evaluation with Power versus Conventional Color Doppler Sonography

PURPOSE: To compare power and conventional color Doppler sonography for depiction of the vasculature of solidbreast lesions, and to evaluate the usefulness of power Doppler sonography for differential diagnosis of malignantbreast lesions. MATERIALS AND METHODS: In order to detect vascularity, 82 cases of solid breast lesions wereevaluated by power and color Doppler sonography. Fifty-eight pathologically proven cases (37 benign and 21malignant lesions) were analyzed for the amount and patterns of Doppler signals, morphology of vessels, and thediagnostic accuracy. RESULTS: In 45 of 82 cases, power Doppler sonography depicted flow better than did colorDoppler sonography, while in 37 cases, depiction was equal. On power Doppler sonography, the incidence of markedblood flow in malignant lesions was three times higher than in benign lesions. The pattern of vasculature was morepredominantly central (85.5 %) and penetrating (61.9 %) in malignant lesions than in benign lesions. Branching(57.1 %) and disordered vessels (33.3 %) were more frequent in malignant lesions than in benign. For the diagnosisof malignancy, sensitivity for power Doppler sonography was 65 %, specificity was 79 % and diagnostic accuracy was74.1 % ; for color Doppler sonography, the corresponding figures were 76.9 %, 75.6 % and 75.9 %. CONCLUSION: Power Doppler sonography was more sensitive than color Doppler sonography for the detection of flow in solidbreast lesions. For the differentiation of benign from malignant lesions, however, there was no difference indiagnostic accuracy between the two modalities. findings of central and penetrating distribution patterns ofDoppler signals, and branching and disordered shapes of vessels, along with other sonographic criteria, arehelpful for predicting malignancy.

CT Findings of Diffuse Pleural Diseases: Differentiation of Malignant Diseases from Tuberculosis

PURPOSE: To evaluate whether or not previously known CT criteria for differentiating malignant and benign pleural diseases are useful in the differentiation of diffuse malignant pleural diseases and tuberculosis. MATERIALS AND METHODS: We retrospectively analyzed CT scans of 42 patients comprising 20 cases of malignant pleural diseases and 22 cases of tuberculous pleural diseases, according to previously known CT criteria for differentiating malignant and benign pleural diseases. RESULTS: The most common shape of pleural effusion was crescentic in malignant pleural diseases and loculated in tuberculosis. The aggressive nature of pleural effusion, pleural rind, and pleura thickenign was 1.5 times more frequently observed in malignant pleural diseases than in tuberculosis. Smooth thickening or smooth nodular pleural thickening and extrapleural deposition of fat were 1.5 times more frequently found in tuberculous than in malignant pleural diseases. Interruption of pleural thickening was found twice as frequently in malignant pleural diseases as in tuberculosis. Decreased lung volume was found twice as frequently in tuberculous as in malignant pleural diseases. Anatomical mediastinal pleural involvement was three times, and irregular nodular pleural thickening nine times more frequent in malignant pleural diseases than in tuberculosis. The sensitivity and specificity of CT findings above 70%, and thus suggesting malignant pleural diseases, were as follows: 1) aggressive nature of pleural fluid collection extending to the azygoesophageal recess or tongue of the lung (51.5%, 75%); 2) involvement of anatomical mediastinal pleura (69.2%,73.7%); 3) irregular nodular pleural thickening (87.5%, 69%). CONCLUSION: Although there in overlap between previously known CT criteria for the differentiation of benign and malignant pleural diseases, the aggressive nature of pleural fluid collection extending to the azygoesophageal recess or tongue of the lung, the involvement of anatomical mediastinal pleura and irregular nodular pleural thickening may suggest malignant pleural diseases.