Correlation between MRI results and intraoperative findings in patients with silicone breast implants.

BACKGROUND: Silicone gel breast implants may silently rupture without detection. This has been the main reason for magnetic resonance imaging (MRI) of the augmented or reconstructed breast. The aim of the present study was to investigate the accuracy of MRI for implant rupture. METHODS: Fifty consecutive patients with 85 silicone gel implants were included in the study. The mean age of the patients was 51 (range 21-72) years, with a mean duration of implantation of 3.8 (range 1-28) years. All patients underwent clinical examination and breast MRI. Intraoperative implant rupture was diagnosed by the operating surgeon. RESULTS: Nineteen of the 50 patients suffered from clinical symptoms. An implant rupture was diagnosed by MRI in 22 of 85 implants (26%). In seven of 17 removed implants (41%), the intraoperative diagnosis corresponded with the positive MRI result. However, only 57% of these patients were symptomatic. Ultrasound imaging of the harvested implants showed signs of interrupted inner layers of the implant despite integrity of the outer shell. By microsurgical separation of the different layers of the implant shell, we were able to reproduce this phenomenon and to produce signs of implant rupture on MRI. CONCLUSION: Our results show that rupture of only the inner layers of the implant shell with integrity of the outer shell leads to a misdiagnosis on MRI. Correlation with clinical symptoms and the specific wishes of the patient should guide the indication for implant removal.

Benign breast lesions: minimally invasive vacuum-assisted biopsy with 11-gauge needles patient acceptance and effect on follow-up imaging findings.

PURPOSE: To evaluate patient acceptance of stereotactic or ultrasonographically (US) guided directional vacuum-assisted 11-gauge needle biopsy of breast lesions and short- and long-term changes at mammography and US resulting from the procedure. MATERIALS AND METHODS: For 91 benign lesions that had been sampled at either stereotactic or US-guided directional vacuum-assisted breast biopsy performed with 11-gauge needles, clinical, mammographic, and US changes were evaluated 1 week after biopsy; 6-month follow-up findings were available for 74 lesions. The subjective outcome of the procedure and patient satisfaction were assessed on the basis of a patient-completed questionnaire that incorporated a multistage scoring system. Statistical analysis of scores for condition for both biopsy methods was performed with the chi2 test. RESULTS: Adverse events occurred during the procedure in four patients. Clinically visible hematomas were observed at 1-week follow-up in 79% of patients. Densities were observed on mammograms in 46% of patients 1 week after biopsy; hematomas with a maximum diameter of 2 cm were seen on sonograms in 74%. Six months after biopsy, mammography revealed discrete architectural changes in one case. No abnormalities were found at 6-month follow-up US. Fifteen patients had various complaints during the procedure; six reported feeling constrained during the first few days after biopsy, and one patient was not satisfied with the cosmetic result. No patient reported a retrospective preference for surgical biopsy instead of directional vacuum-assisted biopsy. Analysis of scores for the stereotactic and US-guided methods revealed a significant difference (P <.001) in favor of the stereotactic method for condition during biopsy, while scores for condition in the first days after biopsy were more equally distributed between the two methods (P =.386). CONCLUSION: Directional vacuum-assisted 11-gauge needle biopsy of the breast is well accepted by patients and rarely produces changes that may alter the mammographic or sonographic appearance of the breast at 6-month follow-up.

Value of ultrasound and magnetic resonance imaging in the preoperative evaluation of suspected ovarian masses.

BACKGROUND: The stage of ovarian carcinoma at diagnosis directly affects prognosis. Thus, thorough pretreatment evaluation is basic to the successful management of suspected ovarian masses. Among currently available imaging techniques in characterization of suspected ovarian neoplasms, sonography (US) is indisputedly the primary imaging approach. When US is inconclusive, magnetic resonance imaging (MRI) is generally prefered to computed tomography (CT). MATERIALS AND METHODS: 93 patients, who on the basis of clinical findings were suspected to have ovarian cancer and who were scheduled for subsequent surgical staging underwent preoperative transvaginal and abdominal ultrasound as well as magnetic resonance imaging in a prospective comparative study. US and MR images were evaluated for their information on the characterization and staging of the ovarian masses. RESULTS: MRI correctly characterized malignant and benign tumors in 89% of cases versus 85% by ultrasound. The site of the primary tumor was correctly diagnosed in 94% of cases by MRI vs. 90% by ultrasound. For US, the positive predictive value was 85%, the negative predictive value 73% vs. 92% and 89% for MRI. In differentiation of nonadvanced disease from advanced malignancy, US showed a false-positive rate of 0.416 and false-negative rate of 0.258 vs. 0.125 and 0.032 respectively, for MRI. CONCLUSION: MRI was superior in diagnosis of malignant ovarian masses though US, too, performed well at lesion detection and characterization. With regard to tumor staging MRI is emerging as a problem-solving modality and may allow more appropriate clinical decisions to be made in selected patients with complex adnexal disease.

Real-time spatial compound imaging in breast ultrasound.

To determine the role of real-time spatial compound imaging in breast ultrasound (US), 38 patients with a total of 50 benign changes (fibroadenomas, cysts, lactiferous duct dilatation) underwent both conventional B-mode US and real-time spatial compound imaging under standardized examination settings. Subsequently, images were reviewed independently by three readers experienced in breast US and evaluated according to a multistage scoring system with regard to the presence of artefacts, delineation of boundaries and depiction of internal structures. With significant reader concordance, real-time spatial compound imaging was found to produce speckle reduction with improvement of tissue differentiation, increased conspicuity of low-contrast lesions, enhanced delineation of capsular margins and ducts, and improved depiction of internal architecture of solid lesions, as well as clearer visualization of cystic contents due to clutter reduction. Preservation of central acoustic enhancement and lateral edge shadowing in cysts and fibroadenomas, however, was recorded better in conventional imaging.

Guidelines and algorithms: strategies for standardization of referral criteria in diagnostic radiology.

Guidelines can be regarded as special forms of algorithms and have been shown to be useful tools for supporting medical decision making. With the Council Directive 97/43/Euratom recommendations concerning referral criteria for medical exposure have to be implemented into national law of all EU member states. The time- and cost-consuming efforts of developing, implementing, and updating such guidelines are balanced by the acceptance in clinical practice and eventual better health outcomes. Clearly defined objectives with special attention drawn on national and regional differences among potential users, support from organisations with expertise in evidence-based medicine, separated development of the evidence component and the recommendations component, and large-scale strategies for distribution and implementation are necessary. Editors as well as users of guidelines for referral criteria have to be aware which expectations can be met and which cannot be fulfilled with this instrument; thus, dealing with guidelines requires a new form of "diagnostic reasoning" based on medical ethics.