Contrast-enhanced breast MRI for cancer detection using a commercially available system--a perspective.

The diagnosis and treatment of breast cancer are dependent upon early detection of the disease by physical examination and mammography. Although mammography is a relatively good and cost-effective method of early breast cancer detection, there are some inherent weaknesses associated with this imaging modality that limit its sensitivity and specificity. Contrast-enhanced MRI of the breasts provides the additional capability to answer questions raised or unanswered with conventional imaging methods. This paper reviews contrast-enhanced breast MRI interpretation guidelines and patient preselection criteria for diagnostic problem cases. Technical aspects using a commercially available three-dimensional (3D) spoiled gradient-echo technique are discussed.

Ultrasound guidance for selected dilatation and evacuation procedures.

Intraoperative ultrasound was used as an adjunct in difficult dilatation and evacuation (D&E) procedures for first-trimester abortions. This technique was useful in eight technically difficult D&Es in the presence of acute retroflexion, acute anteflexion, cervical stenosis and lower uterine segment fibroids.

Prediction of fetal lung maturity: inaccuracy of study using conventional ultrasound instruments.

The ability of three ultrasound (US) parameters--echogenicity, texture, and through transmission--to predict fetal lung maturity was tested in 59 patients using currently available clinical US equipment. The chi square test was used to determine whether there was an association between any single parameter and a "mature" lecithin/sphingomyelin (LS) ratio or specific phosphatidycholine (SPC). Multiple linear regression analysis was used to assess the combined ability of these three parameters and gestational age to predict LS ratio and SPC. There was no correlation between fetal lung maturity, as determined by mature LS and SPC indices, and the US parameters tested using unmodified clinical equipment.

A new barium paste for computed tomography of the esophagus.

A new 3% barium paste for use in CT of the esophagus was evaluated for its ability to coat the esophageal lumen in 31 patients. The esophagus was divided into proximal, mid, and distal segments to analyze the effectiveness of lumenal opacification. The average percent opacification of these segments was 74.5, 87.7, and 60.8%, respectively, for all patients. These results indicate that this product visibly coats the esophageal lumen in the majority of patients. We found that it is easy to use, is well tolerated, and did not produce scanning artifacts. We conclude that this new oral contrast agent could be used routinely in CT of the esophagus or in selected cases to clarify problem areas.

The accuracy of double-contrast arthrographic evaluation of the anterior cruciate ligament. A retrospective review of one hundred and sixty-three knees with surgical confirmation.

In a retrospective review of 163 knees, the double-contrast arthrogram proved to be an accurate method of evaluating the anterior cruciate ligament. The status of the ligament was examined arthrographically with two stress lateral projections: a horizontal cross-table radiograph and a fluoroscopic spot radiograph. The condition of the ligament was interpreted as being normal, lax but intact, torn with intact synovial tissue, or torn or absent. The status of the ligament was subsequently determined at either arthrotomy or arthroscopy by inspection, palpation, and judgment of the degree of tension under stress. The arthrographic diagnosis was found to be 91.4 per cent accurate within the individual subclassifications and 95 per cent accurate in confirming the ligament to be either intact or abnormal. Injury to the anterior cruciate ligament frequently occurs in association with meniscal tears. In our series, 138 of the 163 knees had either a meniscal or a cruciate lesion, or both. Of these, forty-one (30 per cent) had a meniscal lesion, thirty-four (25 per cent) had a cruciate lesion, and sixty-three (45 per cent) had both. We have found the double-contrast arthrogram to be an accurate method of determining the condition of both the anterior cruciate ligament and the menisci in a single outpatient examination.

Lucent articular lesion in the lateral femoral condyle: source of patellar femoral pain in the athletic adolescent.

A lucent femoral lesion was identified on the articular surface of the lateral femoral condyle in four young athletic males. The lesion occurred on the anterior aspect of the lateral femoral condyle just distal to the epiphyseal plate corresponding to the level of the patella. These patients had patellar femoral pain and symptoms consistent with "chondromalacia patellae" or one of the patellar pain syndromes. This femoral lesion has clinical and radiographic manifestations and probably a traumatic etiology similar to osteochondritis dissecans. Radiographically, the femoral lesion is not demonstrated on the routine anteroposterior, tunnel, or skyline views, and it is easily overlooked on the lateral view. The lesion can be identified radiographically on a Merchant view or on fluoroscopic spot films, and it is "hot" on a radionuclide bone scan. Once identified, arthrography and arthrotomography are useful to determine the integrity of the overlying articular cartilage.

Atypical pulmonary malaria.

Three atypical cases of pulmonary malaria are presented and discussed. Radiologically, they were manifested by very subtle thickening of interlobular septae or by more overt interstitial edema and pleural effusion. They were all relatively mild and cleared completely on antimalarial drugs. This is in contrast to most reported cases which were severe and fatal. This resultant widening of the clinical and radiologic spectrum of pulmonary malaria leads to the conclusion that such a complication is likely more common than previously recognized. The radiologist can suggest the correct diagnosis by being aware of its many manifestations and by having a high index of suspicion.