Diagnostic Value of Contrast-Enhanced Digital Mammography versus Contrast-Enhanced Magnetic Resonance Imaging for the Preoperative Evaluation of Breast Cancer / 한국유방암학회지

PURPOSE: This study aimed to compare the diagnostic performance of contrast-enhanced digital mammography (CEDM) and contrast-enhanced magnetic resonance imaging (CEMRI) in preoperative evaluations, and to evaluate the effect of each modality on the surgical management of women with breast cancer. METHODS: This single-center, prospective study was approved by the Institutional Review Board, and informed consent was obtained from all patients. From November 2016 to October 2017, 84 patients who were diagnosed with invasive carcinoma (69/84) and ductal carcinoma in situ (15/84), and underwent both CEDM and CEMRI, were enrolled. Imaging findings and surgical management were correlated with pathological results and compared. The diagnostic performance of both modalities in the detection of index and secondary cancers (multifocality and multicentricity), and occult cancer in the contralateral breast, was compared. The authors also evaluated whether CEDM or CEMRI resulted in changes in the surgical management of the affected breast due to imaging-detected findings. RESULTS: Eighty-four women were included in the analysis. Compared with CEMRI, CEDM demonstrated a similar sensitivity (92.9% [78/84] vs. 95.2% [80/84]) in detecting index cancer (p=0.563). For the detection of secondary cancers in the ipsilateral breast and occult cancer in the contralateral breast, no significant differences were found between CEDM and CEMRI (p=0.999 and p=0.999, respectively). Regarding changes in surgical management, CEDM resulted in similar changes compared with CEMRI (30.9% [26/84] vs. 29.7% [25/84], p=0.610). Regarding changes in surgical management due to false-positive findings, no significant differences were found between CEDM and CEMRI (34.6% [9/26] vs. 44.0% [11/25], p=0.782). CONCLUSION: CEDM demonstrated a diagnostic performance comparable with CEMRI in depicting index cancers, secondary cancers, and occult cancer in the contralateral breast. CEDM demonstrated similar changes in surgical management compared with CEMRI.

Impact of high-grade obstruction on outcomes in patients with appendiceal inflammatory masses managed by nonoperative treatment

PURPOSE: To retrospectively assess the impact of high-grade obstructions identified on initial CT on outcomes of patients with appendiceal inflammatory masses managed by nonoperative treatment. METHODS: Institutional Review Boards approved this retrospective study and informed consent was waived. Included were 52 consecutive patients diagnosed with appendiceal inflammatory masses by CT scan and managed by nonoperative treatment. The main outcome measure was treatment failure and secondary outcomes were complications and initial and total hospital stay. Patient demographics, inflammatory markers, and CT findings for presence of an appendiceal inflammatory mass and high-grade obstruction were assessed. Patients with and without high-grade obstruction were compared for patient characteristics and outcomes using Fisher exact test and Student t-test. RESULTS: Among 52 patients, 14 (27%) had high-grade obstruction on CT examination at presentation. No significant differences were observed in patient characteristics (P > 0.05), treatment failure (P = 0.33), complications (P = 0.29), or initial (P = 0.73) or total (P = 0.72) hospitalization between patients with and without high-grade obstruction. CONCLUSION: For patients who were managed by nonoperative treatment for appendiceal inflammatory masses, the presence of high-grade obstruction identified on initial CT scan did not significantly affect outcomes of treatment failure, complications, and initial and total hospitalization.

Mammographic Breast Density Evaluation in Korean Women Using Fully Automated Volumetric Assessment

The purpose was to present mean breast density of Korean women according to age using fully automated volumetric assessment. This study included 5,967 screening normal or benign mammograms (mean age, 46.2 +/- 9.7; range, 30-89 years), from cancer-screening program. We evaluated mean fibroglandular tissue volume, breast tissue volume, volumetric breast density (VBD), and the results were 53.7 +/- 30.8 cm3, 383.8 +/- 205.2 cm3, and 15.8% +/- 7.3%. The frequency of dense breasts and mean VBD by age group were 94.3% and 19.1% +/- 6.7% for the 30s (n = 1,484), 91.4% and 17.2% +/- 6.8% for the 40s (n = 2,706), 72.2% and 12.4% +/- 6.2% for the 50s (n = 1,138), 44.0% and 8.6% +/- 4.3% for the 60s (n = 89), 39.1% and 8.0% +/- 3.8% for the 70s (n = 138), and 39.1% and 8.0% +/- 3.5% for the 80s (n = 12). The frequency of dense breasts was higher in younger women (n = 4,313, 92.3%) than older women (n = 1,654, 59.8%). Mean VBD decreased with aging or menopause, and was about 16% for 46-year-old-Korean women, much higher than in other countries. The proportion of dense breasts sharply decreases in Korean women between 40 and 69 years of age.

Evaluation of cervical lymph node metastasis in thyroid cancer patients using real-time CT-navigated ultrasonography: preliminary study

PURPOSE: To evaluate the diagnostic accuracy of real-time neck computed tomography (CT)-guided ultrasonography (US) in detecting cervical neck lymph node metastasis (LNM) in patients with papillary thyroid cancer (PTC). METHODS: We retrospectively reviewed data from 176 patients (mean age, 43 years; range, 23 to 74 years) with surgically confirmed PTC who underwent preoperative US, neck CT, and neck CT-guided US. We then compared the sensitivities and diagnostic accuracies of each of the three above modalities in detecting cervical LNM. RESULTS: Preoperative US showed 17.3% sensitivity and 58.5% diagnostic accuracy in detecting central LNM compared with 64.3% sensitivity and 89.2% diagnostic accuracy in detecting lateral neck LNM. Neck CT showed 23.5% sensitivity and 55.7% diagnostic accuracy in detecting central LNM and 71.4% sensitivity with 90.9% diagnostic accuracy in detecting lateral neck LNM. CT-guided US exhibited 37.0% sensitivity and 63.1% diagnostic accuracy in detecting central LNM compared with 92.9% sensitivity and 96.0% diagnostic accuracy in detecting lateral LNM. CT-guided US showed higher diagnostic accuracy with superior sensitivity in detecting central and lateral LNM than did US (P<0.001, P=0.011) and CT (P=0.026, P=0.063). CONCLUSION: Neck CT-guided US is a more accurate technique with higher sensitivity for detecting cervical LNM than either US or CT alone. Therefore, our data indicate that neck CT-guided US is an especially useful technique in preoperative examinations.

Ultrasonography-Guided Surgical Clip Placement for Tumor Localization in Patients Undergoing Neoadjuvant Chemotherapy for Breast Cancer / 한국유방암학회지

PURPOSE: We investigated the feasibility of using surgical clips as markers for tumor localization and their effect on the imaging evaluation of treatment responses after neoadjuvant chemotherapy (NAC). METHODS: A total of 16 breast cancers confirmed by needle biopsy in 15 patients were included in this study from October 2012 to June 2014. Under ultrasonography (US)-guidance, the surgical clips were placed prior to NAC. Additional mammography, breast US, and breast magnetic resonance examinations were performed within 10 days before surgery. The time period from marker insertion to operation date was documented. Images acquired via the three modalities were evalu-ated for the following parameters: location of clip, clip migration (>1 cm), the presence of complications from clip placement, and the effect of clips on the assessment of treatment. RESULTS: The mean time period was 128.6+/-34.4 days (median, 132.0 days) from the date of clip insertion to the date of surgery. The mean number of inserted clips was 2.3+/-0.7 (median, 2.0). Clip migration was not visualized by imaging in any patient, and there were no complications reported. Surgical clips did not negatively affect the assessment of treatment responses to NAC. CONCLUSION: Surgical clips may replace commercial tissue markers for tumor localization in breast cancer patients undergoing NAC without migration. Surgical clips are well tolerated and safe for the patient, easily visualized on imaging, do not interfere with treatment response, and are cost-effective.

Practice guideline for the performance of breast ultrasound elastography

Ultrasound (US) elastography is a valuable imaging technique for tissue characterization. Two main types of elastography, strain and shear-wave, are commonly used to image breast tissue. The use of elastography is expected to increase, particularly with the increased use of US for breast screening. Recently, the US elastographic features of breast masses have been incorporated into the 2nd edition of the Breast Imaging Reporting and Data System (BI-RADS) US lexicon as associated findings. This review suggests practical guidelines for breast US elastography in consensus with the Korean Breast Elastography Study Group, which was formed in August 2013 to perform a multicenter prospective study on the use of elastography for US breast screening. This article is focused on the role of elastography in combination with B-mode US for the evaluation of breast masses. Practical tips for adequate data acquisition and the interpretation of elastography results are also presented.

Ultrasound and Clinicopathological Characteristics of Triple Receptor-Negative Breast Cancers / 한국유방암학회지

PURPOSE: Triple receptor-negative (TRN) breast cancer is associated with high risk of recurrence and poor prognosis. The present study assessed the clinicopathologic characteristics and ultrasound (US) features of TRN breast cancers. METHODS: Pathological and biological data were reviewed for 558 breast cancer patients treated at Kangbuk Samsung Hospital, between January 2003 and December 2009. The patients were separated into TRN breast cancer and non-TRN breast cancer groups, based on the results of immunohistochemical prognostic panels. Clinical and pathologic features were compared for the two groups. US features, including shape, orientation, margins, boundaries, echo patterns, posterior acoustic features, surrounding tissues, and microcalcifications, were determined for 41 TRN patients and 189 non-TRN controls (ER+/PR+/HER2-). RESULTS: Of 558 cases, 58 (10.4%) had the TRN phenotype. Four hundred and thirty-four cases (77.8%) were invasive ductal carcinomas. TRN cancer was significantly associated with specific characteristics of tumor size, nuclear grade, histologic grade, venous invasion, and lymphatic invasion. With respect to US features, TRN cancers were more likely to have an oval shape, a circumscribed margin, and marked hypoechogenicity. CONCLUSION: Tumor characteristics were different between TRN and non-TRN breast cancers, although US cannot differentiate the subtype of breast cancers TRN cancer tend to show somewhat different US morphology.

Preoperative Diagnosis of Extraglandular Invasion of Thyroid Papillary Carcinoma: High Resolution Sonography versus Multidetector Computed Tomography

PURPOSE: To compare the diagnostic efficacy of high-resolution sonography (HRS) and multidetector computed tomography (MDCT) in determining the presence of extraglandular invasion of thyroid papillary cancer and to define ultrasound (US) features of perithyroidal invasion that correlate with histopathological findings. MATERIALS AND METHODS: We prospectively evaluated extracapsular invasion in 177 thyroid cancer patients using both HRS and MDCT. Receiver operating characteristics (ROC) were assessed with a four-point confidence scale (0 = no extracapsular invasion; 1 = possible invasion; 2 = probable invasion; 3 = definite invasion) by two reviewers for each imaging modality. Sensitivity, specificity, and accuracy were analyzed for each modality, along with interobserver variability. RESULTS: MDCT had a mean area under the ROC curve larger than that of HRS (HRS = 0.733, MDCT = 0.807, p < 0.05). HRS and MDCT were significantly different with regard to diagnostic sensitivity, specificity, and accuracy for extrathyroidal extension (p < 0.05; HRS = 75.7%, 66.1%, and 69.8%, respectively; MDCT = 86.7%, 69.7%, and 76%, respectively). Interobserver reliability was greater for MDCT than for HRS (kappa value, 0.861 versus 0.429). The cutoff value used in HRS for estimating the status of perithyroidal invasion was 2. CONCLUSION: HRS may be useful for preoperative investigation of thyroid papillary carcinoma extension, but it was inferior to MDCT because of lower diagnostic accuracy and lower interobserver reliability.

Imaging and Clinicopathologic Characteristics of Breast Cancers in Younger Group Compared to in Old Group / 한국유방암학회지

PURPOSE: We wanted to evaluate the difference of the images and the clinicopathological characteristics of young-age female breast cancer patients as compared to older Korean women with breast cancer. METHODS: A total of 351 breast cancers cases during the previous 3 years were evaluated. A cut-off level of 40 years was used to divide the patients into the young (40 years, 265 cases, 75.5%). We reviewed the BI-RADS results, the sensitivity of mammography (MMG) and sonography (US), the presenting symptoms, the histopathological type, the post-operative stage and the receptor status. These factors were compared between the young age group and the older age group. Chi-squared tests were used for statistical analysis. RESULTS: BI-RADS category 1 disease on the MMG (12.8% vs 6.4%, respectively) and BI-RADS category 3 disease on the US (3.5% vs 1.1%) were more common for the younger group as compared to the older group. The sensitivity of MMG and US was lower for the younger group than for the older group (69.2% and 82.3% vs 84.5% and 93.3%, respectively). Clinical symptom, histopathology, final stage, and the size of tumor or receptor status did not show statistical significant differences. CONCLUSION: Imaging young women breast cancers were less sensitive, more frequently assessed as normal on MMG and as more probably benign on US, and no clinicopathological differences were shown.

The Role of the Use of US-guided Vacuum-Assisted Breast Biopsy for the Total Removal of Sonographic Evidence in Low- and High-Risk Benign and Malignant Breast Lesions

PURPOSE: To determine the role of the use of a US-guided vacuum-assisted biopsy for the removal of sonographic evidence (excisional mammotome) for low- and high-risk benign and malignant breast lesions. MATERIALS AND METHODS: We retrospectively reviewed the pathological results of 678 excisional mammotomes (611 low- and 46 high-risk benign and 21 malignant lesions). We compared the pathological results of the excisional mammotomes and the corresponding subsequent surgery of 27 high-risk benign (7/46 cases) and malignant (20/21 cases) lesions. We also reviewed the follow-up US findings of low- (306/611 cases) and high-risk benign lesions (33/39 cases). RESULTS: Fifteen of 27 (55.6%) surgical cases revealed a residual lesion on the excisional mammotome. There was no case of upgrade pathology seen for a surgical specimen. Follow-up sonography of 306 low-risk benign lesions showed a negative finding for 231 (75.2%) cases, post-biopsy changes in 56 (17.8%) cases, and residual lesions in 19 (5.7%) cases. None of the lesion was palpable. Follow-up sonography of 33 high-risk benign lesions revealed a negative finding in 28 (85%) cases, a post-biopsy scar in 4 (12%) cases, and a local recurrence in 1 (3%) case; none of the cases showed a residual lesion. CONCLUSION: We suggest that an excisional mammotome can replace surgical excision for low-risk cases and may avoid the immediate surgery for high-risk benign lesions; however, surgery is crucial for a malignancy.

US-guided Vacuum-assisted Breast Biopsy with Air Localization for Patients with Microcalcifications

PURPOSE: Stereotactic vacuum-assisted breast biopsy (SV AB) has recently been introduced as an alternative to the traditional surgical excisional biopsy with needle localization (NLBB). Although SVAB has excellent sensitivity and specificity with very low false negative results, patients might complain about the uncomfortable table and the painful breast compression that is done during SVAB. Furthermore, the cost of SVAB is too expensive to be widely adopted in Korea. So we developed a new technique of vacuum-assisted breast biopsy with air localization (VAB-AL) for the patients suffering with microcalcifications. METHODS: From April 2005 to Oct 2005, 10 microcalcification patients, whose lesions were difficult to be seen on breast ultrasonography, underwent vacuum-assisted breast biopsies with air localization (VAB-AL). First, classical NL was done to localize the mammographic abnormalities. Instead of insertion of the wire, 1 cc amounts of air were injected through a needle. The injected air could be easily visualized as a hyperechogenic density on breast sonography. Vacuum-assisted breast biopsy for the air-induced hyperechogenic densities was then done under sonographic guidance. The specimen radiography was performed to confirm that the lesion was removed. RESULTS: The mean age of the patients was 46 (range: 37~55). The upper-outer quadrant of the breast was the most common site of the lesions (6/10, 60%); the upper-inner quadrant (2/10, 20%), and then the lower-inner quadrant (1/10, 10%) followed. The specimen radiology for all 10 patients showed that the mammographic abnormalities were successfully removed. The most common pathologic type was fibrocystic disease (6/10, 70%); intraductal carcinoma (3/10, 30%), and then atypical ductal hyperplasia (1/10, 10%) followed. There were no major complications. CONCLUSION: Vacuum-assisted breast biopsy with air localization is a new technique that can minimize the complaints of patients with microcalcifications about the uncomfortable table, the painful breast compression and the economic burden of SVAB. This new procedure was successfully performed in our 10 patients, and we believe this procedure shows a lot of promise as one of alternatives to classical NLBB and SVAB.

The Usefulness of US-guided Vacuum-Assisted Breast Biopsy for Probably Benign Lesions

PURPOSE: We wished to determine the usefulness of ultrasound-guided vacuum-assisted biopsy (mammotome) for the removal of the breast lesions that had displayed benign evidence on sonography. METHODS: During an 11 month period, vacuum-assisted breast biopsy was performed for 186 probably benign lesions on sonography using 11-gauge (127 cases) and 8-gauge (59 cases) devices. The age of the patients ranged from 19 to 65 years, and the size of the lesions ranged from 0.4 to 3 cm. We retrospectively analyzed the clinical findings and medical history of the patients who underwent vacuum- assisted breast biopsy, and we then evaluated the complications, the histopathologic results, and the follow-up US findings. RESULTS: Of the 186 cases, the lesions were palpated in 95 cases (51%), and lesions were detected in women during a screening examination in 40 cases (36%), and lesions were detected in women having a history of benign breast biopsy or having a cancer operation in the remaining 18 cases (10%). Severe bleeding during or after the procedures was noted in 4 cases (2.2%). The lesions were pathologically proved as benign in 185 cases and malignant in 1 case. With vacuum-assisted breast biopsy, high-risk benign disease was found in 7 cases, but none of the lesions was pathologically upgraded on the subsequent open surgical biopsy. On the 3-month follow-up US, variable sized hematomas were observed in 6 of 24 cases (25%). We performed incidental treatment on four of the vacuum- assisted breast biopsy patients for nipple discharge that was caused by intraductal papilloma. CONCLUSION: US-guided vacuum-assisted breast biopsy is a minimally invasive, fast and convenient biopsy technique. In addition, it is safe and accurate to use for the histological diagnosis because it would remove all the sonographically demonstrated evidence of a probable benign lesion. This technique can potentially be a useful alternative to some forms of surgical biopsy for the properly selected patients.

The Results and Usefulness of Marker Clip Placement after Ultrasound-guided Mammotome Excision of Breast Lesion

PURPOSE: We wanted to know the results and the usefulness of placing a marker clip (a surgical titanium clip) after ultrasound (US)-guided excisional mammotome biopsy for breast lesion. MATERIALS AND METHODS: We have placed marker clips at the biopsy sites after performing US-guided excisional mammotome biopsies in 24 cases (mean age; 46 years, mean size of the 12.6 mm, pathologic results; benign in 19 cases, malignant in 5 cases) from Nov. 2003 to Jun. 2004. We designed the needle that we used. Twenty-five cases of follow-up sonography (at 1-month follow-up; 13 cases, at 6-months follow-up; 12 cases) were performed for 18 cases of clip placement. We retrospectively reviewed the success rate and the complications for 24 cases of clip placement, and we analyzed the visibility, conspicuity and location of the clips on 25 cases of follow-up sonography for 18 cases of clip placement. RESULTS: The marker clip is successfully placed in all 24 cases (100%). None of the patients complained of pain or infection, except for 1 case of a large hematoma (3.5 cm). On the follow-up sonography, the titanium clip was well visualized as a short echogenic line on the interval follow-up (for the 1-month follow-up; 85%, for the 6 month follow-up; 84%) and parenchymal composition of the breast was well observed at the location of the clip (intraparenchymal; 80%, parenchyma-fat interface; 90%). The clips were easily found when there was hematoma (85%) or scar (89%). Marker clips were found within the hematoma, scar or the distorted region of tissue in all cases (100%), and there was no evidence of migration on the post-biopsy findings. CONCLUSION: Marker clip placement after US-guided excisional mammotome biopsy is a simple, inexpensive and successful (100%) procedure without any significant complications. Because the maker clips were easily found and well visualized within the biopsy site on follow-up sonography, clip placement was useful as a post-biopsy marker.

SENSE (Sensitivity Encoding) for Diffusion Tensor Imaging of the Brain

PURPOSE: The sensitivity encoding (SENSE) technique is increasingly being used with clinical MRI scanners. The object of this study is to compare the normative human data and image quality of the diffusion tensor imaging (DTI) with sensitivity encoding (SENSE) and standard single-shot EPI techniques. MATERIALS AND METHODS: 16 normal volunteers underwent single-shot echo-planar DTI with both standard and SENSE sequences using a 1.5 T Philips Intera MR scanner (TR/TE=6755/74 or 5871/66 ms, echo train length 127 or 67, NEX=3, matrix=128x128, FOV=220x220 mm, slice thickness=4 mm, b value=600 s/mm2, six orthogonal diffusion gradients). The diffusion tensor-encoded MR images were transferred to a PC workstation and analyzed using in-house software. The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) maps were calculated. The presence of artifacts (ghost susceptibility, eddy current) was graded with a two- or three-point scale. The ADC and FA values were measured in the major white matter tract and gray matter nuclei. The signal-to-noise ratio was also measured. Fisher's exact test and the Mann-Whitney test were used for the statistical analysis. RESULTS: With SENSE, the acquisition time was reduced from 2 min 57 sec to 1 min 22 sec for DTI. Susceptibility artifacts (around the brain stem and temporal base) and eddy current artifacts were significantly reduced on the SENSE DTI as compared with those on the standard DTI (p<0.05). No ghost artifacts were observed on the SENSE DTI, whereas such artifacts were observed in 14 cases (87.5%) on the standard DTI. The ADC value was not significantly different between the SENSE DTI and the standard DTI, whereas the FA values in the cerebral cortex and white matter were significantly higher on the SENSE DTI than on the standard DTI (p<0.05). The signal-to-noise ratio was 8.44 on the standard DTI and 11.40 on the standard DTI. CONCLUSION: The use of SENSE DTI significantly reduces the geometric distortion caused by artifacts, shortens the acquisition time, and allows a relatively high SNR to be maintained, but tends to erroneously increase the FA value of the tissue. Therefore, DTI with SENSE may provide better white matter fiber tracking and diffusivity indices when the imaging parameters for SENSE are optimized.

Correlation of Contrast-Enhanced MR Findings and Tumor Microvessel Density of Breast Masses

PURPOSE: To compare the contrast-enhanced dynamic MR findings of solid breast masses with their histopathologic tumor angiogenesis. MATERIALS AND METHODS: Thirty-two cases of pathologically proved breast lesions (8 benign and 24 malignant lesions) examined with contrast-enhanced MRI were retrospectively reviewed, focusing on the tumor size, the maximum amount of contrast enhancement (% Signal Intensity Change, SIC), the time to peak (early or late peak) and the type of time-signal intensity curve (TSC). We compared the characteristic MR findings of breast cancer with the microscopic maximum microvessel density (MVD). RESULTS: Among the total of 11 small lesions ( or = 20). On the other hand, among the 21 large lesions (> 2 cm, 15 malignant and 6 benign), only two cases of malignant and five cases of benign lesions showed high MVD. More than 100% SIC was observed in a total of 11 malignant and two benign lesions, but 8 of these 11 malignant lesions showed low MVD (< 20), whereas the two benign lesions showed high MVD. Early time to peak (< or = 3 min) was observed in 18 (17 malignant and 1 benign) lesions, and 11 of these 17 malignant lesions showed low MVD. An early high peak and early or slow wash-out pattern, which is typical of the malignant type, was seen in 18 (17 malignant and 1 benign) lesions, but 12 of these 17 malignant lesions showed low MVD. There is no statistically significant correlation between the characteristic MR findings of breast cancer and the MVD. CONCLUSION: Although high MVD indicated malignancy in the case of the small lesions, the histopathologic MVD was not significantly correlated with either the increased amount of enhancement, early time-to peak or the malignant pattern of the TSC.

The Usefulness of STIR Image in Breast MRI

PURPOSE: To assess the usefulness of STIR (short tau inversion recovery) imaging in breast MRI (magnetic resonance imaging). MATERIALS AND METHODS: We retrospectively reviewed T1- and T2-weighted (T1WI, T2WI), STIR, and dynamically enhanced images of 44 pathologically confirmed breast lesions (benign, 13; malignant, 31) in 36 patients. We selected the dynamically image which best depicted a particular lesion, and then made hard copy of the corresponding T1WI, T2WI, and STIR images. Using the dynamically enhanced image as a standard, we analysed these in terms of parenchymal pattern, lesion detectability, differentiation between benign and malignant lesions, extent, multifocality, and the ductal system. The results were statistically analyzed. RESULTS: In 33 of 44 cases (75%), detectability was greater at STIR imaging than at T1- and T2WI, especially in fibrofatty or fatty breast (14/14 cases, p<0.05). STIR images did not always differentiate between benign and malignant lesions, and extent (50%) and multifocality (46%) were commonly exaggerated compared with T1- and T2WI. In 18 of 44 cases (41%), STIR images suggested the presence of ductal structures. CONCLUSION: For the detection of lesions, STIR imaging was more useful than T1- and T2WI, though STIR did not differentiate between benign and malignant lesions. The extent and multifocality of a lesion were exaggerated on STIR images, compared with T1- and T2WI.

Three Dimensional Digital Rotational Imaging in the Evaluation of the Fractures

PURPOSE: To evaluate the usefulness and the application of three dimensional digital rotational imaging (3D DRI) by the evaluation of fractures. MATERIALS AND METHODS: Sixteen patients with clinically diagnosed or suspicious fracture were involved in this study. The lesion or suspicious sites of all 16 cases were spines (n=7), pelvis (n=3) and so on (n=6; knee, elbow, ankle, wrist and foot). In all cases, conventional radiography, multiplanar 2D (slice thickness/pitch=3 or 5 mm/1:1)and volume rendering 3D reconstructed single detector helical CT (HiSpeed Advantage, GE Medical Systems, Milwaukee, WIS) scans and 3D DRI (Integris V-5000,Philips Medical Systems, The Netherlands) with multiplanar intersection and gray scaling as postprocessing technique were performed. 3D DRI was evaluated and compared with conventional radiography, multiplanar 2D CT and volume rendering 3D CT. RESULTS: 3D DRI provided more detail and additional information in 14 cases (88%), comparing with 2D and 3D CT scans. Two fractures were revealed only on 3D DRI other than conventional radiography and CT scans and one case was revealed on 2D CT and 3D DRI. In all cases, we could acquired more detail and additional information from 3D DRI than from 3D CT in the acquisition of 3D imaging. 3D DRI didn't change the classification of fracture in 12 of 13 cases (92%),which revealed the fracture on the conventional radiography or CT. CONCLUSION: 3D DRI can diagnose and evaluate the fracture rapidly and easily with anatomical and spatial resolution by acquisition of 3D imaging with postprocessing using DRI.

Acute Appendicitis: Sensitivity, Specificity and Diagnostic Accuracy of Thin-Section Contrast-Enhanced CT Findings

PURPOSE: To assess the sensitivity, specificity, and diagnostic accuracy of individual contrast-enhanced helical CT findings of acute appendicitis. MATERIALS AND METHODS: We retrospectively reviewed the appendiceal helical CT scans, obtained after intravenous contrast administration (abdomen; 7-mm collimation, abdominopelvic junction; 5-mm collimation), of 50 patients with surgically proven acute appendicitis and 112 with alternative diagnoses. The following parameters were analysed by three radiologists: enlarged appendix (> 6 mm in diameter), appendiceal wall thickening, appendiceal wall enhancement, no identification of the appendix, appendicolith(s), (appendiceal) intraluminal air, (appendiceal) intraluminal air extraluminal air, periappendiceal fat stranding, extraluminal fluid, phlegmon, abscess, lymphadenopathy, terminal ileal wall thickening, focal cecal apical thickening, focal colonic wall thickening, and segmental colonic wall thickening. RESULTS: The CT findings of acute appendicitis that statistically distinguished it from alternative diagnoses were an enlarged appendix (sensitivity; 92%, specificity; 93%, diagnostic accuracy; 93%), appendiceal wall thickening (for these three parameters: 68%, 96% and 88%, respectively), periappendiceal fat stranding (90%, 79%, 82%), appendiceal wall enhancement (72%, 86%, 82%), appendicolith (16%, 100%, 74%), and focal cecal apical thickening (14%, 100%, 74%) (for each, p < 0.05). CONCLUSION: On thin-section contrast-enhanced helical CT, an enlarged appendix and periappendiceal fat stranding were found in 90% or more patients with acute appendicitis. Appendiceal wall thickening and enhancement were clearly demonstrated and significant findings for diagnosis. Less common but specific findings include appendicolith, focal cecal apical thickening and intramural air, can also help us establish a diagnosis of acute appendicitis.

The Diagnostic Value of Contrast Enhanced Power Doppler US on Small Breast Lesions

PURPOSE: To evaluate the usefulness of contrast-enhanced power Doppler ultrasonography (PDUS) in differentiating small benign from small malignant breast lesions. MATERIALS AND METHODS: Thirty-one solid breast lesions (<2 cm in size; 17 benign and 14 malignant) prospectively underwent US and PDUS before and after the injection of contrast agent (SH U 508A). Morphologic analysis involved independent assessment of the findings of US and the patterns of Doppler signals before and after contrast enhancement at PDUS, and sensitivity and specificity were thus evaluated. The diagnostic accuracy of US accompanied by PDUS was also determined before and after contrast enhancement. Hemodynamic analysis involved measurement of the time lapse between contrast injection at PDUS and observed change in Doppler signals. For this, a sonic VIOR computer-assisted program was used and the results were correlated with the pathologic findings. RESULTS: The sensitivities of US before and after contrast enhanced PDUS were 100%, 35.7%, and 57%, with specificities of 47%, 88.2% and 76%, respectively. The diagnostic accuracy of US was 35% with noncontrast PDUS, and 77% before and after contrast enhanced PDUS. The recorded time lapse between contrast injection at PDUS and observed change in Doppler signals did not correlate closely with the pathologic findings. CONCLUSION: In that it improved visualization of the morphology of vascular Doppler signals, microbubble contrast-enhanced PDUS complemented US and PDUS in differentiating between small benign and small malignant breast lesions.

Correlation of Power Doppler Ultrasonographic Findings and Histopathologic Maximum Microvessel Density of Solid Breast Masses

PURPOSE: To compare the power Doppler ultrasonographic (PDUS) findings of angiogenesis occurring in solid breast with the histopathologic findings. MATERIALS AND METHODS: Thirty-one cases of pathologically proven solid breast lesions (eight benign, 23 malignant) were retrospectively reviewed, focusing on tumor size (= 3 cm), the amount (none, mild, marked), morphology (none/linear, branching, disordered) and pattern (none/peripheral, central, penetrating), as demonstrated by power Doppler ultrasonography. We compared the PDUS findings with microscopic micro- vessel density (Max-MVD, the number of micro-vessels revealed at pathologic examination after factor-VIII staining). Statistical significance was determined using the x2-test. RESULTS: Max-MVD tended to increase according to fumor size, but the relationship was not statistically significant. In solid breast lesions there was close correlation between the observed increase in the intensity of Doppler signals and increased Max-MVD (p < 0.05). Morphologically, branching and disordered vessels were more often seen in malignant lesions, though the relationship between this finding and increased Max-MVD was not statistically significant. Penetrating and central Doppler signals were more frequent in malignant lesions and showed close correlation with increased Max-MVD (p < 0.05). CONCLUSION: The increased intensity of Doppler signals and the central and penetrating pattern of solid breast lesions seen at power Doppler sonography were closely related with increases in Max-MVD.