Comparison of the Diagnostic Performance of Response Evaluation Criteria in Solid Tumor 1.0 with Response Evaluation Criteria in Solid Tumor 1.1 on MRI in Advanced Breast Cancer Response Evaluation to Neoadjuvant Chemotherapy

OBJECTIVE: To compare the diagnostic performance in evaluating the response of neoadjuvant chemotherapy (NAC), between the response evaluation criteria in solid tumor (RECIST) 1.0 and RECIST 1.1, on magnetic resonance imaging (MRI) for advance breast cancer patients. MATERIALS AND METHODS: Breast cancer patients, who underwent NAC between 2005 and 2010, were included. Both prechemotherapy and post-chemotherapy MRIs were performed within 1-4 weeks before and after NAC. Only the patients with subsequent surgery were included. The response to NAC was assessed by using RECIST 1.0 and RECIST 1.1. Patients with a complete or partial response on MRI were considered as responders, and those with stable or progressive disease were considered as non-responders. Tumor necrosis > 50% on pathology was defined as responders and necrosis < 50% was defined as non-responders. The diagnostic accuracy of both RECIST 1.0 and RECIST 1.1 was analyzed and compared by receiver operating characteristic curve analysis. RESULTS: Seventy-nine females (mean age 51.0 +/- 9.3 years) were included. Pathology showed 45 responders and 34 non-responders. There were 49 responders and 30 non-responders on RECIST 1.0, and in 55 patients, RECIST 1.0 results agreed with pathologic results (69.6%). RECIST 1.1 showed 52 responders and 27 non-responders. In 60 patients, RECIST 1.1 results were in accordance with pathology results (75.9%). The area under the ROC curve was 0.809 for RECIST 1.0 and 0.853 for RECIST 1.1. CONCLUSION: RECIST 1.1 showed better diagnostic performance than RECIST 1.0, although there was no statistically significant difference between the two.

Factors Influencing the Finding of Strain Ultrasound Elastography in Benign Subcutaneous Tumors

PURPOSE: The purpose of this study is to investigate factors influencing strain sonoelastography findings in evaluation of subcutaneous tumors. MATERIALS AND METHODS: Retrospective analysis of sonoelastography findings performed by two radiologists in 38 consecutive patients with 38 pathologically confirmed benign subcutaneous tumors was performed. Elastographic finding of the lesions was graded from 1 (softer) to 3 (harder) according to stiffness. Analysis of correlations between elastographic findings and height, width and depth of the lesion, and the distance from bone was performed using the Kruskal-Wallis test. RESULTS: By reviewer 1, 11 lesions were grade 1 on sonoelastography, eight were grade 2, and 19 were grade 3, respectively. By reviewer 2, 11 lesions were grade 1 on sonoelastography, nine were grade 2, and 18 were grade 3, respectively. The distance from bone differed significantly among the three grades groups for both reviewers; grade 1, 2, and 3, 0.78 +/- 0.75 cm, 1.56 +/- 0.68 cm, and 1.77 +/- 0.63 cm, for reviewer 1 (P = .006) and 0.86 +/- 0.79 cm, 1.55 +/- 0.72 cm, and 1.74 +/- 0.65 cm for reviewer 2 (P = .016). No significant difference in height, width, and depth of the lesion was observed among the three groups. CONCLUSION: Distance from bone showed a significant association with strain sonoelastographic findings of benign subcutaneous tumors.

Sonographic Findings of Morel-Lavallee Lesions

PURPOSE: We reviewed the sonographic features of Morel-Lavallee lesions by correlating the US image findings with a lesion's age. MATERIALS AND METHODS: We obtained the sonography reports of 20 Morel-Lavallee lesions of the hip and extremities from 18 patients with a history of trauma. The US images were reviewed to characterize the echogenicity, shape, homogeneity, margins, location and size of the lesions. The results were correlated with the age of the lesions and the clinical histories. RESULTS: All the Morel-Lavallee lesions were hypoechoic or anechoic fluid collections located between the subcutaneous fat and the underlying fascia. Regarding the shape of the fluid collections, the lobular shaped lesions were all less than 21 days for the lesion's age, and the flat fluid collections were all greater than 1 month of age. Regarding the homogeneity, the heterogeneous fluid collections were all less than 25 days of age, and the homogeneous fluid collections were all greater than 1 month of age. CONCLUSION: A Morel-Lavallee lesion is seen as a posttraumatic fluid collection in the potential space between the subcutaneous fat and the underlying fascia on an ultrasound examination. Acute Morel-Lavallee lesions tended to be heterogeneous and lobular, and they became more homogeneous and flat in shape as the lesions evolved. Awareness of these imaging findings will help us to properly diagnose Morel-Lavallee lesions.

Contrast-Enhanced Magnetic Resonance Angiography for Evaluation of the Steno-occlusive Disease of the Supraaortic Arteries: Comparison with Computed Tomography Angiography and Digital Subtraction Angiography

PURPOSE: To intra-individually compare diagnostic accuracy of high-resolution contrast-enhanced magnetic resonance angiography (CE-MRA) with computed tomography angiography (CTA) and digital subtraction angiography (DSA) for the assessment of supraaortic steno-occlusive disease. MATERIALS AND METHODS: Twenty-eight patients (20 men, 8 women, 53-79 years of age) underwent supraaortic CE-MRA, CTA and DSA. CE-MRA was performed on two 1.5T MR scanners (voxel dimension: 0.66x0.66x1.1 or 1.2 mm3), and CTA on 64-slice CT scanners (voxel dimension: 0.42x0.42x0.63 mm3). All the three examinations were completed within 40 days (median 19 days; range 1-40 days). Retrospective evaluation and measurement of diameter of 6 extracranial and 9 intracranial arterial segments was done by 2 experienced radiologists. RESULTS: A total of 420 arterial segments were examined by CE-MRA, CTA and DSA. On DSA, 34 stenoocclusive lesions were noted at extracranial (n=19) and intracranial (n=15) vessels. For extracranial stenosis greater than 70%, sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) were 94.7%, 98.7%, 90.0% and 99.3% on CE-MRA, and 94.7%, 99.3%, 94.7% and 99.3% on CTA. For intracranial stenosis greater than 50%, sensitivity, specificity, PPV and NPV were 93.3%, 98.3%, 77.8%and 99.6% on CE-MRA, and 86.7%, 97.9%, 72.2% and 99.1% on CTA, with DSA as the standard of reference. CONCLUSION: Supraaortic CE-MRA is as reliable as CTA in depicting the arterial stenosis, and is effective in screening of significant stenosis of both extracranial and intracranial arterial stenosis.

The Role of Preoperative Magnetic Resonance Imaging for Detecting the Extent of Disease and Predicting the Prognosis of Ductal Carcinoma In Situ / 한국유방암학회지

PURPOSE: Magnetic Resonance Imaging (MRI) is widely used for the preoperative staging of breast cancer. In this study, we investigated a role of preoperative breast MRI for detecting the extent of disease and predicting the prognosis of ductal carcinoma in situ (DCIS). METHODS: From January 2002 to April 2008, preoperative MRI was performed for evaluating the extent of disease in 26 patients with DCIS. The MRI findings, the modified Van Nuys scores and the clinicopathological results were reviewed. The accuracy of breast MRI was analyzed with respect to the detection of tumor multiplicity and disease extending into the nipple, and this was compared with that of mammography. RESULTS: For detecting multiple lesions, the sensitivity and specificity of breast MRI were 25.0% and 86.4%, respectively, and the results of mammography were 0.0% and 86.4%, respectively. The accuracy of breast MRI was 76.9% and that of mammography was 73.1%. For detecting tumor extension into the nipple, the sensitivity and specificity of breast MRI was 100.0% and 80.0%, respectively, and that for mammography was 0.0% and 92.0%. respectively. The accuracy of MRI was 80.8% and that for mammography was 88.5%. The MRI final assessment was not associated with the modified Van Nuys score (p=0.474). CONCLUSION: For detecting the disease extent of DCIS, preoperative breast MRI is not superior to mammography due to the low specificity and accuracy of MRI. MRI did not show a definite ability to predict the prognosis of DCIS in this study.