Detection of Breast Cancer in Asymptomatic and Symptomatic Groups Using Computer-Aided Detection with Full-Field Digital Mammography / 한국유방암학회지

PURPOSE: We aimed to determine the sensitivity of computer-aided detection (CAD) applied to digital mammography in asymptomatic and symptomatic breast cancer patients. METHODS: We retrospectively analyzed digital mammography and CAD images from 210 patients diagnosed with breast cancer. The patients were divided into symptomatic and asymptomatic groups. The sensitivity of CAD in both groups was assessed in relation to breast tissue density, histopathological type of breast cancer, and tumor size. RESULTS: The detection rate of the CAD system was 87.8% in the asymptomatic group. The sensitivity in different tissue densities was 100% in fatty breasts (P1), 88.9% with scattered fibroglandular densities (P2), 94.4% in heterogeneously dense breasts (P3), and 66.7% in extremely dense breasts (P4). The detection rate of the CAD system in the symptomatic group was 87.2%, and the sensitivity was 90.5%, 90%, 86.6%, and 75% in P1-P4 breasts, respectively. In the asymptomatic group, the CAD system detected 90.3% of invasive ductal carcinomas, not otherwise specified (IDC-NOS) and 88.9% of ductal carcinomas in situ (DCIS), but did not detect other types of malignancy. In the symptomatic group, the CAD system detected 88.2% of IDC-NOS, 88.9% of DCIS and 75% of other types of malignancy. When analyzed according to tumor size, the sensitivity of CAD in the asymptomatic and symptomatic groups was 82.6% and 83.3% for tumors 2 cm. CONCLUSION: The sensitivity of CAD was low in P4 breasts and high for tumors larger than 2 cm, with no statistically significant differences between the asymptomatic and symptomatic groups for IDC-NOS and DCIS. CAD showed greater sensitivity for other neoplasms in symptomatic patients.

Killian-Jamieson Diverticula Mimicking a Right Thyroid Nodule on Ultrasonography: A Case Report

A Killian-Jamieson diverticulum is a type of pharyngoesophageal diverticuli and can be visualized on thyroid ultrasonography (US). Although most of the lesions are located in the deep layer of the left thyroid lobe, we encountered a case of a right-sided Killian-Jamieson diverticulum in a 64-year-old man that was mistaken for a thyroid nodule on US. We describe the US, computed tomographic, and esophagraphic findings of this case. In addition, we describe the US findings of a left Killian-Jamieson diverticulum in a 55-year-old woman that was seen as a hyperechoic mass in the thyroid on US.. The shape and echogenecity of the diverticulum changed with swallowing as depicted on real-time US and the need for a needle aspiration biopsy was avoided.

Extraskeletal Ewing Sarcoma of Cervical Epidural Region: Cases Report

Extraskeletal Ewing sarcoma is a rare malignant tumor found in children and young adults. It commonly occurs in deep soft tissue of the trunk, especially in the paravertebral region and extremities. We report two cases of extraskeletal Ewing sarcoma occurring as a cervical epidural tumor in elderly patients. The MRI and CT findings showed that paravertebral epidural tumors had invaded the spinal canal through the intervertebral foramen. At T1-weighted MR imaging, the masses were isointense to muscle, and at T2* and T2-weighted images were hyperintense, and heterogeneous contrast enhancement was observed. Extraskeletal Ewing sarcoma, though quite rare, should be borne in mind in the differential diagnosis of paraspinal epidural tumors.

CT Findings of Tracheal Mucormycosis: A Case Report

Pulmonary mucormycosis is a opportunistic mycosis, typically occurring in immunocompromised or diabetic patients. It is characterized as an infection of the pulmonary parenchyma and larger bronchi, and involves extensive vascular thrombosis and tissue necrosis. A variety of CT findings have been reported, but tracheal involvement is extremely rare. We report the case of a patient with tracheal mucormycosis placing particular emphasis on the CT findings.

Acute and Chronic Tears of Anterior Cruciate Ligament: Role of Gadolinium-enhanced MR Imaging

PURPOSE: To evaluate the efficacy of fat-suppressed gadolinium-enhanced MR imaging in differentiating acutefrom chronic ligament tears of anterior cruciate ligament. MATERIALS AND METHODS: MR images of 22 patients witharthroscopically proven complete tear of the anterior cruciate ligament were retrospectively reviewed. Theinterval between injury and MR examination was one day to seven years. When ligament tear was detected on MR imagewithe three months of injury, the case was considered acute;if detected after three months had elapsed, it wasjudged to be chronic. The extent of contrast enhancement was graded as 1, 2 or 3; grade 1, enhancement wasconfined to the expected ligament region; grade 2, enhancement extended to the joint capsule; grade 3, enhancementextended beyond the joint capsule. The grades of contrast enhancement correlated with the acute and chronic stagesof ligament tears. Associated bone bruise and/or adjacent soft tissue edema were also evaluated. RESULT: Among15 patients with acute ligament tear, nine (60%) showed grade 3 enhancement; among seven in whom tearing waschronic, four (57%) showed grade 1 enhancement. Bone bruising was present in 100% of acute tears (15/15) and 29%of chronic tears (2/7). Soft tissue edema was associated in 87% of acute tears (13/15) and 29% of chronic tears(2/7). CONCLUSION: Fat-suppressed gadolinium-enhanced MR imaging could help differentiate acute from chronictears of anterior cruciate ligament, as well as bone bruising and tissue edema.

Carcinoma of Ampulla of Vater: Emphasis on the CT Technique

PURPOSE: To demonstrate a CT technique by which carcinoma of the ampulla of Vater can be more accurately diagnosed, and to describe the radiologic findings this carcinoma. MATERIALS AND METHODS: We retrospectively reviewed CT findings in 26 patients with pathologically proven carcinoma of the ampulla of Vater. One additional cup of diluted oral contrast medium was ingested immediately before the scan. We analysed the difference in detection rate of the mass in the duodenal lumen with and without duodenal luminal opacification of gastrografin.We also evaluated the size and shape of the mass, dilatation of CBD and the pancreatic duct, and lymph node metastasis. In addition, we analyzed multimodality imaging findings ultrasonogram (US) : 13; hypotonic duodenogram (HTDG): 7; ERCP : 17) of carcinoma of the ampulla of Vater. RESULTS: Nodular soft tissue masses protruding into the duodenal lumen were identified in 21 of 26 cases. In 95% of cases (21/22) with favorable opacification and distension of the duodenum, masses were clearly identified on CT imaging. However, in four caseswith poor opacification and distension of the duodenum, masses could not be observed(P=0.000). The mass on CT scanshowed a well-defined margin, round or lobulated contour, and contrast enhancement similar to that of thepancreas. CBD dilatation was identified in 20 cases and pancreatic duct dilatation in 12. On US, protruding massesin the distal CBD were observed in nine of 13 cases(60%) and on HTDG, in six of seven cases(86%). as well-definedfilling defects. Conclusion : Since the accuracy of CT diagnosis of intestinal lesions is directly proportional tothe degree of intestinal distension and opacification with oral contrast, we believe that adequate ct techniquefor distending and opacitying the duodeual lumen are necessary for early diagnosis of carcinoma of the ampulla ofVater.

MR Appearance of Synovial Plica in Patients with Plica Syndrome and Normal Plica

PURPOSE: To compare MRI appearance between plicae syndrome and normal plicae. MATERIALS AND METHODS: MR images of 60 cases of arthroscopically-confirmed plicae syndrome and 18 of arthroscopically-proven normal plicae were retrospectively analyzed. Sagittal T2-weighted MR images in all cases and MPGR(200) in 37 cases of plicae syndrome were obtained. Statistical analysis was performed using the chi-square test. RESULTS: On the basis of operatingresults, we observed 55 medial plicae, eight combined medial and suprapatellar plicae, four suprapatellar plicae,and one lateral plica. T2-weighted sagittal MR scans of the 60 cases demonstrated 37 medial plicae, 8 suprapatellar and one lateral plica. Joint effusion was found in 26 cases of 55 medial plicae. In T2-weighted sagittal MR scans, the identification of medial plicae was superior in the presence of joint effusion than its absence(plicae syndrome, p < 0.001 ; normal plicae group, p < 0.05). Medial plicae were well demonstrated onMPGR(200) axial images; on T2-weighted sagittal MR scans, they could be more frequently identified in the plicae syndrome group than in the normal control group(p < 0.001). Plicae syndrome-associated pathology included degenerative change of the articular cartilage of the medial femoral condyle in eight cases(14.5%), discoidmeniscus in nine(16.4%), lateral meniscus tear in 12(21.8%), medial meniscus tear in 21(38.1%), anterior cruciate ligament tear in three(5.5%), medial collateral ligament tear and osteochondritis dissecans in one case. CONCLUSION: The present study revealed that synovial plicae were well demonstrated in T2-weighted sagittal images, particularly on the presence of joint effusion. Medial plicae could be more frequently identified in the plicae syndrome group than in the normal control group, especially on T2-weighted sagittal MR scans.

MR Findings of Fibrous Dysplasia

PURPOSE: To describe the MR findings of fibrous dysplasia. SUBJECTS AND METHODS: MR images of fibrousdysplasia in 13 pathologically proved cases were retrospectively analyzed regarding the signal intensity, hypointense rind, internal septations, cortical disruption, soft tissue extension, and the pattern of contrast enhancement. RESULTS: All cases showed low signal intensity on T1-weighted images. On T2-weighted images, 8cases(62%) were hyperintense and 5 cases(38%) hypointense. Hypointense rind was seen in 10 cases(77%), internal septations in 3 cases(23%), and cystic change in 2 cases(15%). Soft tissue extension was observed in fourcases(31%) including one case with pathologic fracture. After Gd-DTPA infusion, central contrast enhancement wasnoted in 8 cases(73%) and peripheral rim enhancement in 3 cases(23%). Pathologically, hypointensity on T2-weighted images was due to numerous bony trabeculae. CONCLUSION: Hypointensity on T1W1 and hyperintensity(62%) or hypointensity(38%) on T2W1 as well as contrast enhancement in fibrous dysplasia depend on degree of cellularity, collagen, cystic and hemorrhagic changes, and bony trabeculae.