Preoperative breast MRI and mortality in older women with breast cancer.

PURPOSE: The survival benefit from detecting additional breast cancers by preoperative magnetic resonance imaging (MRI) continues to be controversial. METHODS: We followed a cohort of 4454 women diagnosed with non-metastatic breast cancer (stage I-III) from 2/2005-6/2010 in five registries of the breast cancer surveillance consortium (BCSC). BCSC clinical and registry data were linked to Medicare claims and enrollment data. We estimated the cumulative probability of breast cancer-specific and all-cause mortality. We tested the association of preoperative MRI with all-cause mortality using a Cox proportional hazards model. RESULTS: 917 (20.6%) women underwent preoperative MRI. No significant difference in the cumulative probability of breast cancer-specific mortality was found. We observed no significant difference in the hazard of all-cause mortality during the follow-up period after adjusting for sociodemographic and clinical factors among women with MRI (HR 0.90; 95% CI 0.72-1.12) compared to those without MRI. CONCLUSION: Our findings of no breast cancer-specific or all-cause mortality benefit supplement prior results that indicate a lack of improvement in surgical outcomes associated with use of preoperative MRI. In combination with other reports, the results of this analysis highlight the importance of exploring the benefit of preoperative MRI in patient-reported outcomes such as women's decision quality and confidence levels with decisions involving treatment choices.

Improved diagnostic accuracy of breast MRI through combined apparent diffusion coefficients and dynamic contrast-enhanced kinetics.

This study investigated the relationship between apparent diffusion coefficient (ADC) measures and dynamic contrast-enhanced magnetic resonance imaging (MRI) kinetics in breast lesions and evaluated the relative diagnostic value of each quantitative parameter. Seventy-seven women with 100 breast lesions (27 malignant and 73 benign) underwent both dynamic contrast-enhanced MRI and diffusion weighted MRI. Dynamic contrast-enhanced MRI kinetic parameters included peak initial enhancement, predominant delayed kinetic curve type (persistent, plateau, or washout), and worst delayed kinetic curve type (washout > plateau > persistent). Associations between ADC and dynamic contrast-enhanced MRI kinetic parameters and predictions of malignancy were evaluated. Results showed that ADC was significantly associated with predominant curve type (ADC was higher for lesions exhibiting predominantly persistent enhancement compared with those exhibiting predominantly washout or plateau, P = 0.006), but was not significantly associated with peak initial enhancement or worst curve type (P > 0.05). Univariate analysis showed significant differences between benign and malignant lesions in both ADC (P < 0.001) and worst curve (P = 0.003). In multivariate analysis, worst curve type and ADC were significant independent predictors of benign versus malignant outcome and in combination produced the highest area under the receiver operating characteristic curve (0.85 and 0.78 with 5-fold cross validation).

Compensation examination of the cervical and lumbar spines: critical disagreement in radiographic interpretation.

Radiographic interpretation is often the major factor in the decision to award compensation for job-related complaints, especially in the Veterans Administration system. Three board-certified radiologists reviewed 200 consecutive lumbar and cervical spine examinations and assigned each case to one of three categories: normal, normal for age (not compensable), or degenerative disease (compensable). A critical disagreement, in which at least one radiologist considered the examination compensable and another not compensable, occurred in interpretation of 31% of the cervical and 46% of the lumbar spine examinations. Although the overall detection of radiographic findings was similar among all three radiologists, diagnostic interpretation of the findings varied greatly. Although most radiologists and orthopedists agree that the use of plain radiography of the spine as a deciding factor in awarding compensation is unjustified and inappropriate, until the regulations are changed there is a pressing need for strict, objective, radiographic criteria for determining "normal aging" of the cervical and lumbar spines so that interpreatations can be more uniform.

Bacteriologic flora on diagnostic ultrasonic transducers.

In a study to determine the presence of bacteria on ultrasonic transducers, the authors found micro-organisms in 82% of cultures. The results show that 70% isopropyl alcohol is not a consistently effective germicide for the sterilization of transducers. The presence of bacteria, however, appears to be of little clinical consequence.

The central uterine cavity echo: a useful anatomic sign in the ultrasonographic evaluation of the female pelvis.

The frequency with which the central uterine cavity was seen during gray-scale ultrasonography was evaluated both retrospectively (100 patients) and prospectively (20 patients). In the retrospective study, the echo was seen in 90% of patients; in the prospective study it was demonstrated 100% of the time. Of 30 patients with intrauterine pregnancies between three and twelve weeks fetal age, the echo was not seen on any scan. The demonstration of this echo can be diagnostically useful in excluding an intrauterine pregnancy or identifying the uterus when confusing pelvic pathology is present.

Ultrasonographic demonstration of a simple ureterocele and dilated ureter in an adult.

A 54 year old man was found to have a simple ureterocele with a dilated ureter. Ultrasonography demonstrated the ureterocele as an echo-free structure at the base of the bladder without involvement of the bladder wall. The course of the dilated ureter and its entrance into the bladder were clearly defined.

Computed tomography of subcapsular splenic hematoma. Clinical and experimental studies.

Computed tomography (CT) was performed in 3 patients and 2 dogs with subcapsular hematoma of the spleen. When fresh blood is in the subcapsular space, the hematoma may have the same attentuation value as the adjacent spleen, making it difficult to identify unless contrast material is injected. As the hematoma ages, the attenuation value decreases. CT appears to be a simple and accurate method of diagnosing a subcapsular splenic hematoma.