Imaging of the Reconstructed Breast.

The incidence of breast cancer and, therefore, the need for breast reconstruction are expected to increase. The many reconstructive options available and the changing aspects of the field make this a complex area of plastic surgery, requiring knowledge and expertise. Two major types of breast reconstruction can be distinguished: breast implants and autologous flaps. Both present advantages and disadvantages. Autologous fat grafting is also commonly used. MRI is the modality of choice for evaluating breast reconstruction. Knowledge of the type of reconstruction is preferable to provide the maximum amount of pertinent information and avoid false positives. Early complications include seroma, hematoma, and infection. Late complications depend on the type of reconstruction. Implant rupture and implant capsular contracture are frequently encountered. Depending on the implant type, specific MRI signs can be depicted. In the case of myocutaneous flap, fat necrosis, fibrosis, and vascular compromise represent the most common complications. Late cancer recurrence is much less common. Rarely reported late complications include breast-implant-associated large cell anaplastic lymphoma (BIA-ALCL) and, recently described and even rarer, breast-implant-associated squamous cell carcinoma (BIA-SCC). In this review article, the various types of breast reconstruction will be presented, with emphasis on pertinent imaging findings and complications.

A novel experimental animal model of arterial stenosis based on endovascular radiofrequency energy application.

PURPOSE: To develop a new rabbit model of arterial stenosis using endovascular radiofrequency (RF) energy. MATERIALS AND METHODS: Ten rabbits were used for multiple endovascular RF applications to the aorta and left common carotid artery through the Habib™ VesCoag™ catheter. Angiography and color Doppler ultrasound were used to assess vessel patency immediately following the procedure and six weeks later. One rabbit was sacrificed following the procedure for histopathologic analysis of the vessel wall. Two rabbits died of aortic and carotid rupture, respectively, immediately after the procedure. The remaining seven rabbits were sacrificed after six-week follow-up for histopathological analysis. RESULTS: Optimal RF generator settings to induce significant arterial stenosis (>50%) without complications were standardized at 24-26 watts (W) for 1.5 min for the aorta and 6 W for 1 min for the common carotid artery. The six-week follow-up showed permanent results in all surviving rabbits. Histopathology revealed intima and medial smooth muscle layer necrosis. CONCLUSION: We have developed a novel rabbit model of arterial stenosis using endovascular RF energy. Our model is fast, safe, inexpensive, and reproducible. It would be useful for experimental investigations and new therapeutic devices.

Incidental non-cardiac findings of a coronary angiography with a 128-slice multi-detector CT scanner: should we only concentrate on the heart?

OBJECTIVE: To evaluate the spectrum, prevalence, and significance of incidental non-cardiac findings (INCF) in patients referred for a non-invasive coronary angiography using a 128-slice multi-detector CT (MDCT). MATERIALS AND METHODS: The study subjects included 1,044 patients; 774 males (mean age, 59.9 years) and 270 females (mean age, 63 years), referred for a coronary CT angiography on a 128-slice MDCT scanner. The scans were acquired from the level of the carina to just below the diaphragm. To evaluate INCFs, images were reconstructed with a large field of view (> 300 mm) covering the entire thorax. Images were reviewed in the axial, coronal, and sagittal planes, using the mediastinal, lung, and bone windows. The INCFs were classified as severe, indeterminate, and mild, based on their clinical importance, and as thoracic or abdominal based on their locations. RESULTS: Incidental non-cardiac findings were detected in 56% of patients (588 of 1,044), including 435 males (mean age, 65.6 years) and 153 females (mean age, 67.9 years). A total of 729 INCFs were observed: 459 (63%) mild (58% thoracic, 43% abdominal), 96 (13%) indeterminate (95% thoracic, 5% abdominal), and 174 (24%) severe (87% thoracic, 13% abdominal). The prevalence of severe INCFs was 15%. Two severe INCFs were histologically verified as lung cancers. CONCLUSION: The 128-slice MDCT coronary angiography, in addition to cardiac imaging, can provide important information on the pathology of the chest and upper abdomen. The presence of severe INCFs is not rare, especially in the thorax. Therefore, all organs in the scan should be thoroughly evaluated in daily clinical practice.

Myocardial bridging evaluated with 128-multi detector computed tomography coronary angiography.

PURPOSE: The aim of the study was to evaluate the prevalence, length, depth, and location of myocardial bridging of the coronary arteries using 128-multi detector computed tomography coronary angiography. METHODS: The study cohort consisted of 875 patients who underwent coronary computed tomography angiography (CTA) for various indications. We evaluated the presence, length, and location of complete and incomplete bridging. In cases of complete bridging the thickness of the overlying muscle was also measured. RESULTS: From a total of 875 subjects, 184 subjects (21%) were found to a single myocardial bridge. Complete bridging was detected in 161 patients (18.4%) and incomplete bridging in 23 patients (2.6%). The coronary arteries involved were the mid portion of the left anterior descending artery (LAD) (67.9%), the distal portion of the LAD (28.8%), and the proximal portion of the LAD (3.2%). No myocardial bridging was detected in other arteries in our study. The mean length and maximum myocardial thickness overlying the complete bridging were 20.9 mm (range 8-32 mm) and 2.6 mm (range 1.2-5.3 mm), respectively. The mean length of the incomplete bridging was 17 mm (range 9-2.3 mm). CONCLUSIONS: Multi detector computed tomography is a reliable non-invasive modality for diagnosing myocardial bridging. The prevalence of myocardial bridging in this patient group was 21%. Our results are in agreement with those reported in pathologic studies, the gold standard for detecting this anomaly.