Evaluating the influence of marine protected areas on surf zone fish.

Marine protected areas (MPAs) globally serve conservation and fisheries management goals, generating positive effects in some marine ecosystems. Surf zones and sandy beaches, critical ecotones bridging land and sea, play a pivotal role in the life cycles of numerous fish species and serve as prime areas for subsistence and recreational fishing. Despite their significance, these areas remain understudied when evaluating the effects of MPAs. We compared surf zone fish assemblages inside and outside MPAs across 3 bioregions in California (USA). Using seines and baited remote underwater videos (BRUVs), we found differences in surf zone fish inside and outside MPAs in one region. Inside south region MPAs, we observed higher abundance (Tukey's honest significant difference [HSD] = 0.83, p = 0.0001) and richness (HSD = 0.22, p = 0.0001) in BRUVs and greater biomass (HSD = 0.32, p = 0.0002) in seine surveys compared with reference sites. Selected live-bearing, fished taxa were positively affected by MPAs. Elasmobranchs displayed greater abundance in BRUV surveys and higher biomass in seine surveys inside south region MPAs (HSD = 0.35, p = 0.0003 and HSD = 0.23, p = 0.008, respectively). Although we observed no overall MPA signal for Embiotocidae, abundances of juvenile and large adult barred surfperch (Amphistichus argenteus), the most abundant fished species, were higher inside MPAs (K-S test D = 0.19, p < 0.0001). Influence of habitat characteristics on MPA performance indicated surf zone width was positively associated with fish abundance and biomass but negatively associated with richness. The south region had the largest positive effect size on all MPA performance metrics. Our findings underscored the variability in species richness and composition across regions and survey methods that significantly affected differences observed inside and outside MPAs. A comprehensive assessment of MPA performance should consider specific taxa, their distribution, and the effects of habitat factors and geography.

Evaluación de la influencia de las áreas marinas protegidas sobre los peces de la zona de rompientes Resumen Las áreas marinas protegidas (AMP) cumplen los objetivos de conservación y manejo de pesquerías a nivel mundial, lo que genera efectos positivos en algunos ecosistemas marinos. Las zonas de rompientes y las playas arenosas, ecotonos importantes que conectan la tierra con el mar, tienen un papel esencial en el ciclo de vida de varios peces y fungen como áreas óptimas para la pesca recreativa y de sustento. A pesar de su importancia, estas áreas están poco estudiadas con respecto a la evaluación del efecto de las AMP. Comparamos la composición de peces del área de rompientes dentro y fuera de las AMP de tres bioregiones de California, EUA. Usamos chinchorros y videos submarinos con carnada (BRUVs) y descubrimos diferencias en los peces de la zona de rompientes dentro y fuera de las AMP en una región. Dentro de las AMP de la región sur observamos una mayor abundancia (diferencia significativa honesta de Tukey [DSH]  =  0.83, p = 0.0001) y riqueza (DSH  =  0.22, p = 0.0001) en los BRUV y una mayor biomasa (DSH  =  0.32, p = 0.0002) en los censos con chinchorro en comparación con los sitios de referencia. Los taxones seleccionados de peces de sustento fueron afectados de manera positiva por las AMP. Los elasmobranquios mostraron una mayor abundancia en los BRUV y una mayor biomasa en los censos con chinchorro dentro de las AMP de la región sur (DSH  =  0.35, p = 0.0003 y DSH  =  0.23, p = 0.008, respectivamente). Aunque no observamos una señal generalizada de las AMP para la familia Embiotocidae, la abundancia de Amphistichus argenteus juveniles y adultos, la especie pescada más abundante, fue mayor dentro de las AMP (prueba K­S D  =  0.19, p < 0.0001). La influencia de las características del hábitat sobre el desempeño de las AMP indicó que el ancho de la zona de rompientes está asociado de forma positiva con la abundancia y biomasa de los peces, pero de forma negativa con la riqueza. La región sur tuvo el mayor tamaño de efecto positivo sobre todas las medidas de desempeño de las AMP. Nuestros hallazgos destacan la variabilidad en la riqueza y composición de especies en todas las regiones y los censos que afectan significativamente las diferencias observadas dentro y fuera de las AMP. Una evaluación completa del desempeño de las AMP debe considerar taxones específicos, su distribución y el efecto de los factores de hábitat y la geografía.

Monkeypox virus isolation from longitudinal samples from four patients to infer risk of onwards transmission: an interim analysis.

Monkeypox virus (mpxv) is a DNA virus in the Orthopoxvirus genus which causes Mpox (previously monkeypox). Symptoms include fever, lymphadenopathy and vesicular lesions. There is limited evidence for the duration of mpxv infectivity. This study used cell culture as a proxy for infectivity. Clinical samples from four patients with Mpox were inoculated into African green monkey kidney (Vero E6) cells and monitored for cytopathic effects (CPE). From one patient, infectious mpxv was recovered 25 days after illness onset. Infectious virus was not isolated from samples with an Orthopoxvirus polymerase chain reaction (PCR) Ct value over 31.0, nor from urine.

Direct-fed microbial supplementation and health and performance of pre- and postpartum dairy cattle: a field trial.

A double-blind field trial was conducted on a commercial dairy to study the effects of feeding a direct-fed microbial (DFM) product consisting of 2 strains of Enterococcus faecium plus Saccharomyces cerevisiae yeast on prepartum and postpartum performance of Holstein cows. Treatments consisted of the normal pre- and post-fresh TMR supplemented with the DFM (2 g/cow per d) or a placebo. Treatments started approximately 10 d prepartum and continued until about 23 d in milk (DIM). A total of 366 Holstein cows were enrolled in 1 of 2 placebo groups or 2 DFM-supplemented groups. Groups were enrolled consecutively, starting with the placebo treatment. Sample size was limited to 4 groups because the cooperating dairy prematurely terminated the study due to increased health problems in one of the groups. Blood samples were taken during the prefresh period between 2 and 10 d prior to calving and at weekly intervals from 3 to 23 DIM. Blood concentrations of nonesterified fatty acids before calving and beta-hydroxy-butyrate after calving were not affected by treatment. Supplementation with the DFM product increased milk fat percentage for the first lactation cows and increased milk protein percentage for the second and greater lactation cows during the first 85 DIM. Second-lactation cows fed the DFM product received fewer antibiotic treatments before 85 DIM than cows receiving the placebo. This validated the dairy producer's concern that cows consuming one of the diets (revealed to be the placebo diet after the study was completed) were experiencing more health problems. Most measures of milk yield were numerically increased by supplementation with the DFM product. However, differences in milk yield were not significant. Key covariates for main study outcomes included milk yield in the previous (first) lactation, body condition score prior to calving, days spent in the maternity pen, and stocking density of the pre-fresh pen.

Monitoring nonlactating cow intramammary infection dynamics using DHI somatic cell count data.

Although the nonlactating period presents a risk for intramammary infection, efficient systems to monitor infection status of recently calved cows have not been developed, and benchmarks for interpretation have not been established. Individual cow somatic cell count (SCC) data for the current and previous six monthly Dairy Herd Improvement milk tests and the last SCC of the previous lactation and first SCC of the current lactation were summarized for all milking cows in a selection of Wisconsin dairy herds. Prevalence of infection, herd new infection rate, fresh cow contribution to herd new infection rate, dry cow new infection rate, heifer new infection rate, and dry cow cure rate were estimated using a threshold of 200,000/ml. In 145 herds, mean (range) heifer new infection rate was 21.3% (0 to 58%). The cut-point for the 10th percentile of herds was 8%. Mean (range) dry cow new infection rate in cows that were uninfected at the last test before dry off was 22.4% (0 to 71%), and the cut-point for the 10th percentile of herds was 9%. Although nonlactating cow and heifer new infection rates increased with weighted 6-mo mean herd SCC, the between-herd variation was large, suggesting that on-farm factors are important in determining the rates of infection. In a subset of 51 Wisconsin dairy herds, significant monthly variation in weighted SCC, prevalence, herd new infection rate, and fresh cow contribution to herd new infection rate were detected. Elevations in SCC and prevalence of infection during the summer (July through September) were associated with significant increases in fresh cow and herd new infection rates.

Absent peritoneal fluid on screening trauma ultrasonography in children: a prospective comparison with computed tomography.

BACKGROUND: Although the accuracy of focused abdominal sonography for trauma (FAST) in adults has been demonstrated, results of this technique in children have been conflicting with few comparisons against computed tomography (CT), the imaging gold standard. METHODS: A total of 160 hemodynamically stable pediatric trauma victims referred for abdominal CT initially underwent rapid screening sonography looking for free fluid. Both studies were interpreted in blinded fashion. RESULTS: Forty-four of the 160 patients had an intraabdominal injury on CT, 24 (55%) of which had normal screening sonography. Fifteen of the 44 (34%) had no free fluid on either modality. Accuracy of sonography compared with CT was 76% with a negative predictive value 81%. CONCLUSIONS: Sonography for free fluid alone is not reliable to exclude blunt intraabdominal injury in hemodynamically stable children given the considerable percentage of injured patients without free fluid. J Pediatr Surg 36:565-569.

Risk factors for severe pulmonary and disseminated coccidioidomycosis: Kern County, California, 1995-1996.

Surveillance for coccidioidomycosis (CM) and a case-control study for risk factors among adults were conducted in Kern County, California. From January 1995 through December 1996, 905 cases of CM were identified, for an annual incidence of 86 cases per 100,000 population. A total of 380 adults were enrolled in the case-control study: 77 had severe pulmonary disease, 33 had disseminated disease, and 270 control patients had mild disease. Independent risk factors for severe pulmonary disease included diabetes, recent history of cigarette smoking, income of < $15,000 per year, and older age. Oral antifungal therapy before hospitalization was associated with a reduced risk of CM pneumonia. Risk factors for disseminated disease were black race, income of < $15,000 per year, and pregnancy. Early treatment of CM with oral antifungal agents may prevent severe pulmonary disease in groups considered to be at high risk, such as elderly individuals, persons with diabetes, and smokers. Persons at risk for severe CM may benefit from vaccination once an effective CM vaccine is available.

Minimizing radiation dose for pediatric body applications of single-detector helical CT: strategies at a large Children's Hospital.

Adjustments of the standard helical CT protocols for adults can result in reduced radiation dose when imaging children. It is the radiologist's responsibility to critically evaluate the CT techniques used at their institution. Adjustments to CT protocols should be made to choose the appropriate mA and pitch when imaging children.

Incidence of Latent Infection of Immature Peach Fruit by Monilinia fructicola and Relationship to Brown Rot in Georgia.

Peach fruit are most susceptible to infection by Monilinia fructicola during the preharvest ripening stage. Although various sources of inoculum for preharvest infection have been characterized, the role of latent infection of immature fruit in the carryover of M. fructicola from the spring (blossom blight phase) to the preharvest period (fruit rot phase) is unknown for the southeastern United States. From 1997 to 1999, immature peach fruit were collected at 14-day intervals from orchards in middle and northern Georgia. Fruit were surface disinfested and treated with paraquat (1997) or frozen overnight (1998 and 1999) to induce tissue senescence and activate latent infections. Across sites and years, the incidence of latent infection remained low until the final sampling date 7 to 12 days before harvest. The incidence of latent infection on the final sampling date ranged from 0 to 22.0% and correlated significantly with both the incidence of blossom blight earlier in the season (r = 0.9077, P = 0.0332) and the incidence of fruit rot at harvest (r = 0.9966, P = 0.0034). There also was a significant association between the incidence of latent infection at the onset of pit hardening (between 7 and 10 weeks before harvest) and subsequent fruit rot incidence (r = 0.9763, P = 0.0237). Weather variables (cumulative rainfall or rainfall frequency) alone did not correlate with fruit rot incidence (P > 0.05), whereas combined latent infection-rainfall variables did. The results suggest that latent infections can serve as a source of inoculum for subsequent fruit rot in peach orchards in Georgia. Despite its significant association with fruit rot incidence, the potential for using latent infection incidence as a biological indicator of disease risk at harvest may be limited; the assessment of latent infection during the fruit ripening stage (similar to the timing of the final sampling date in this study) would not provide sufficient lead time for preharvest disease management decisions, whereas an earlier assessment (e.g., at the onset of pit hardening) would require large sample sizes due to the low incidence of latent infection present during that period.

Splenic injury diagnosed with CT: US follow-up and healing rate in children and adolescents.

PURPOSE: To determine if pediatric splenic injury healing observed during ultrasonography (US) is related to the computed tomographic (CT) grade of injury severity, to review any delayed complications, and to formulate a grade-specific timetable for follow-up imaging. MATERIALS AND METHODS: Sixty-eight children and adolescents with CT-documented blunt splenic injury underwent US at approximate 6-week intervals to document injury healing (normal parenchyma or linear echogenic "scar"). Medical records of those not followed up to complete healing were reviewed. RESULTS: Forty-eight patients were followed up to complete injury healing: 14 of injury grade 1 (mean, 7 weeks; range, 4-12 weeks), 24 of injury grade 2 (mean, 9.5 weeks; range, 6-17 weeks), and 10 of injury grade 3 (mean, 16 weeks; range, 6-29 weeks). The difference in mean time to healing among all grades was significant (P < .02). Only two cysts were found; one decreased in size over time. No complications occurred in the 68 study patients. CONCLUSION: The time course to US-documented healing of blunt pediatric splenic injury is related to injury severity. This information can be used to tailor follow-up imaging and provide cost savings.

Evaluation of the population dynamics of the forage legume (Lotus corniculatus), using matrix population models.

The population dynamics of perennial crop plants are influenced by numerous factors, including management practices. Conditions in the field vary from year to year, and matrix population models are useful for evaluating population behaviour in relation to environmental variability. In Missouri, the stand persistence of birdsfoot trefoil (Lotus corniculatus), a perennial legume, is often limited by disease and poor seed production. A stage-based, matrix population model was developed to evaluate the population dynamics of birdsfoot trefoil in relation to clipping treatment. The plant growth stages represented in the model were seeds, seedlings, mature vegetative and reproductive plants. Two phases of population growth were evaluated in clipped and unclipped stands. Establishment-phase populations were characterized by relatively high mortality and low reproduction. Elasticity analysis indicated that growth of these populations was most sensitive to the survival of vegetative plants. Mature vegetative plants and seeds comprised the majority of surviving individuals in clipped and unclipped populations, respectively; however, establishment-phase populations under both management treatments tended toward extinction. Populations in the post-establishment phase of growth were characterized by relatively low mortality and high reproduction. Population growth in this phase of growth was most sensitive to seed production, and most individuals in these populations were at the seed stage.

Tarsal coalition: a blinded comparison of MRI and CT.

OBJECTIVE: To determine how well MRI can detect tarsal coalition compared with CT, the current imaging standard. MATERIALS AND METHODS: Coronal and axial CT and MRI were performed within 3 weeks of each other on 40 feet in 20 consecutive patients referred with symptoms of possible tarsal coalition. Scans were read independently in blinded fashion by different imagers. Coalitions were either complete (osseous) or incomplete (non-osseous). Results were compared with available surgical data and clinical follow-up. RESULTS: Both modalities prospectively identified 15 coalitions (9 patients) and each missed 1 calcaneonavicular coalition. Twenty-three of the remaining 24 feet were negative for coalition on both CT and MRI. An atypical incomplete talocalcaneal coalition seen on CT was not identified prospectively on MRI. CONCLUSION: MRI is very good for detecting tarsal coalition and has a high rate of agreement with CT, the imaging "gold standard." When clinical suspicion for coalition is high, CT remains a more cost-effective diagnostic modality. If other causes for ankle pain are also entertained, MRI can be performed and provide nearly equivalent diagnostic accuracy for detecting tarsal coalition.

Fat necrosis after trauma: a benign cause of palpable lumps in children.

OBJECTIVE: Our objective is to describe the clinical entity and MR imaging appearance of fat necrosis after trauma, a benign cause of palpable soft-tissue lesions in children. A related objective is to establish MR imaging criteria that can be used reliably to differentiate this entity from other more serious causes of soft-tissue masses. CONCLUSION: Fat necrosis after trauma is a common cause of palpable lumps in children and has a benign course on long-term follow-up. When characteristic MR imaging findings are seen, conservative therapy is appropriate.

Acidic glycosaminoglycans and laminin-1 in renal corpuscles of mutant blebs (my) and control mice.

Deposition of glycosaminoglycans and laminin-1 in the renal corpuscles of the kidneys of mylencephalic blebs, 'blebs', (my) and normal C57BL/ 6J mice was compared in embryonic, neonatal (newborn to approximately two days old) and adult animals. Utilization of Alcian Blue 8GX staining, at a pH of 2.5, revealed an increase in acidic glycosaminoglycans in the parietal layer of Bowman's capsule and in general, an increase in the mesangial matrix of the glomerulus of my mutant adults. An increase in glycosaminoglycans was also noted in the developing kidney in certain my embryos in tissues associated with the glomeruli, but no significant differences were observed between the kidneys of neonatal my and control mice. The laminin-1 procedure revealed more deposition of laminin in the basement membrane of the parietal layer of Bowman's capsule in the neonatal and adult mutant my mice. Altered deposition of basement membrane and extracellular matrix components may reflect changes in the pattern of development and in the functioning of the kidney. Morphological changes in the human kidney are associated with alteration of function; a similar association may be occurring in the mice homozygous for the my gene.

Splenic emergencies.

Of medical and surgical emergencies in the pediatric abdomen, those involving the spleen are relatively less common than other abdominal organs, though equally important to recognize. A more sophisticated clinical understanding of the important role of the spleen in immunocompetence has developed in parallel with advancements in imaging. A healthy respect for the preservation of splenic tissue has emerged, altering traditional surgical management of splenic emergencies. Non-invasive imaging has come to play a vital role in depicting acute abnormalities and in determining the need for conservative, interventional, or surgical management.

An overview of plague in the United States and a report of investigations of two human cases in Kern county, California, 1995.

Plague was confirmed in the United States from nine western states during 1995. Evidence of Yersinia pestis infection was identified in 28 species of wild or domestic mammals. Thirteen of the plague positive species were wild rodents; 15 were predators/carnivores. Yersinia pestis was isolated from eight species of fleas. Seven confirmed cases of human plague were reported in 1995 (New Mexico 3; California 2; Arizona and Oregon 1 each). Five of the seven cases were bubonic; one was septicemic and one a fatal pneumonic case. Months of onset ranged from March through August. In California, during 1995, plague was recorded from 15 of the 58 counties. Over 1,500 animals were tested, of which 208 were plague positive. These included 144 rodents and 64 predators/carnivores. Two confirmed human cases (one bubonic and one fatal pneumonic) occurred, both in Kern County. Case No. 1 was reported from the town of Tehachapi. The patient, a 23 year-old male resident, died following a diagnosis of plague pneumonia. The patient's source of plague infection could not be determined precisely. Field investigations revealed an extensive plague epizootic surrounding Tehachapi, an area of approximately 500-600 square miles (800-970 square kilometers). Case No. 2 was a 57 year-old female diagnosed with bubonic plague; she was placed on an antibiotic regimen and subsequently recovered. The patient lives approximately 20 miles (32 km) north of Tehachapi. Field investigations revealed evidence of a plague epizootic in the vicinity of the victim's residence and adjacent areas. Overall results of the joint field investigations throughout the entire Kern county area revealed a high rate of plague positive animals. Of the numerous samples submitted, 48 non-human samples were plague positive.

Asymptomatic, palpable, anterior chest wall lesions in children: is cross-sectional imaging necessary?

PURPOSE: To review results from cross-sectional imaging studies performed to evaluate asymptomatic anterior chest wall lesions in children. MATERIALS AND METHODS: All magnetic resonance (MR) images or computed tomographic (CT) scans of the chest obtained from 1989 to 1996 for evaluation of asymptomatic, palpable, focal, anterior chest wall lesions in otherwise healthy children were reviewed. Fifty-one children were considered for the study. Findings from 27 examinations in 27 children (13 underwent MR imaging, and 14 underwent CT) were included in the study. All children had normal radiographs of the region. Twenty-four patients did not meet the inclusion criteria and were excluded. RESULTS: The cause of the lesion palpated at physical examination was identified in 26 of 27 patients: prominent anterior convex ribs in 10 patients; "tilted" sternum in six; prominent asymmetric costal cartilage in four; bifid rib in one; and well-defined, small (< 1-cm) subcutaneous nodule adjacent to costal cartilage in five. One examination demonstrated no abnormality. Of the 27 patients, none required treatment. CONCLUSION: All palpable, asymptomatic, anterior chest wall lesions were benign and usually related to normal variations in the bone or cartilage of the chest wall. The low yield of cross-sectional imaging performed for evaluation of these asymptomatic "bumps" should be considered when decisions are made with regard to imaging.

Normal changes in the MR appearance of the spleen during early childhood.

OBJECTIVE: During the first year of life, the spleen undergoes histologic changes as the lymphoproliferative system matures. The purposes of this study were to describe the normal MR appearance of the spleen during infancy and early childhood and to correlate imaging findings with age-related histologic changes. MATERIALS AND METHODS: The spleen was evaluated on 28 abdominal MR studies obtained during the first 23 months of life. Splenic signal intensity was compared to that of the liver. Selected autopsy specimens were compared with the imaging results. RESULTS: The T2-weighted signal intensity of the spleen gradually increased from isointense to hypointense relative to the liver during the first week of life to moderately hyperintense to the liver by 8 months of age. T1-weighted splenic signal intensity gradually decreased. These findings corresponded to histological increases in white-pulp-red-pulp ratios. CONCLUSION: Before the lymphoid system completely matures, the T2-weighted signal intensity of the normal neonatal spleen appears decreased compared with the moderately hyperintense splenic signal seen in older children and adults. This finding should not be mistaken for disease.

Perflubron as a gastrointestinal MR imaging contrast agent in the pediatric population.

OBJECTIVE: To evaluate the safety and efficacy of orally administered perflubron for bowel recognition on MR imaging in a pediatric population. MATERIALS AND METHODS: A multicenter trial evaluated 39 pediatric subjects before and after ingestion of perflubron with T1-, proton-density, and T2-weighted sequences through the abdomen and/or pelvis. Post-contrast images were compared with pre-contrast images. Safety was evaluated through assessment of adverse events, clinical laboratory parameters, and vital signs. RESULTS: With regard to efficacy analysis, improvement in the percent of bowel darkened was observed for 85 % of the subjects on T1-weighted images and for 95 % of the subjects on proton-density and T2-weighted images. For images of the abdominal region, the percent of bowel darkened was improved for 90-92 % of the subjects across pulse sequences. Improvement rates for the images of the pelvic region ranged from 71 % to 100 %. For at least 75 % of the subjects, proton-density and T2-weighted images of the body and tail of the pancreas, left lobe of the liver, mesenteric fat, and pathological tissue were improved relative to predosing images. Twenty-three percent of the subjects experienced some adverse effects, most of which were minor and related to the digestive system. Clinical laboratory and vital sign evaluations revealed no trends associated with the administration of perflubron. CONCLUSION: Perflubron is a relatively safe and effective gastrointestinal MR contrast agent in the pediatric population.

MR imaging of soft-tissue masses: diagnostic efficacy and value of distinguishing between benign and malignant lesions.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of MR imaging in predicting the pathologic diagnosis of soft-tissue masses, both neoplastic and nonneoplastic, and in distinguishing benign from malignant lesions. MATERIALS AND METHODS: The imaging features of 225 soft-tissue tumors (179 benign, 46 malignant) in 222 patients were analyzed. Univariate analysis of multiple individual imaging features was done, along with stepwise logistic regression analysis of combinations of imaging features, to determine how useful these are for predicting malignancy or benignity. A subjective (group consensus) analysis of each case was done prospectively, and each tumor was placed into one of three diagnostic categories: (1) benign, diagnostic of a specific entity; (2) nonspecific, most likely benign; or (3) nonspecific, most likely malignant. Results were compared with the final diagnosis established by pathologic examination (n = 184) or imaging/clinical data (n = 41). RESULTS: By quantitative analysis, no single imaging feature or combination of features could reliably be used to distinguish benign from malignant lesions. For the subjective analysis, a correct and specific benign diagnosis could be made on the basis of MR imaging findings in 100 (44%) of the 225 tumors. For the entire cohort, the sensitivity was 78%, the specificity was 89%, the positive predictive value was 65%, and the negative predictive value was 94% for a malignant diagnosis. When the diagnostic benign tumors were excluded, the specificity and negative predictive value decreased to 76% and 86%, respectively, whereas the sensitivity and positive predictive value remained the same. CONCLUSION: Many benign soft-tissue masses can be correctly and confidently diagnosed with MR imaging. The prevalence of benign lesions among soft-tissue masses accounts for the relatively high specificity and negative predictive value that can be achieved with MR imaging for tissue characterization. However, the accuracy of MR imaging declines when these characteristic benign tumors are excluded from analysis. A significant percentage of malignant lesions may appear deceptively "benign" with the currently used criteria. For lesions whose imaging appearance is nonspecific, MR imaging is not reliable for distinguishing benign from malignant tumors, and these lesions warrant biopsy in most cases.