Indications for breast magnetic resonance imaging. Consensus document "Attualità in senologia", Florence 2007.

The clinical use of breast magnetic resonance (MR) imaging is increasing, especially for applications requiring paramagnetic contrast-agent injection. This document presents a synthetic list of acceptable indications with potential advantages for women according to evidence from the literature and the expert opinion of the panel that developed this statement. We generally recommend that breast MR imaging be performed in centres with experience in conventional breast imaging [mammography and ultrasonography (US)] and needle-biopsy procedures (under stereotactic or US guidance) as well as in breast MR imaging and second-look US for findings not revealed by conventional imaging performed before MR imaging. In our opinion, there is no evidence in favour of breast MR imaging as a diagnostic tool to characterise equivocal findings at conventional imaging when needle-biopsy procedures can be performed, nor for the study of asymptomatic, non-high-risk women with negative conventional imaging. After a description of technical and methodological requirements, we define the indications and limitations of breast MR imaging for surveillance of high-risk women, local staging before surgery, evaluation of the effect of neoadjuvant chemotherapy, breast previously treated for carcinoma, carcinoma of unknown primary syndrome, nipple discharge and breast implants.

[The magnetic resonance imaging of abdominal aortic aneurysms]. / L'imaging con Risonanza Magnetica degli aneurismi dell'aorta addominale.

The diagnostic role of Magnetic Resonance Imaging (MRI) was investigated in the study of abdominal aortic aneurysms and compared with that of Computed Tomography (CT) and digital subtraction angiography (DSA). Magnetic Resonance angiography (MRA) was performed on 21 patients with radiologically proved abdominal aortic aneurysms, using a superconductive 1.5 T magnet (GE, Signa Advantage); the 2D TOF technique with gradient-echo sequences was used (SPGR: FA 45-60 degrees, TR/TE 33/7, ST 2 mm, 1 nex, 256 x 128 matrix, inferior presaturation and flow compensation). The images acquired on the axial plane were reconstructed according to MIP and rotated on the z-axis from +90 degrees to -90 degrees. In all cases SE 2D T1- and T2-weighted sequences were acquired on the axial plane. Twelve patients were examined with MRI, CT and DSA; 3 with MRI and CT; 2 with MRI and DSA and finally 4 with MRI only. The radiologic studies were then reviewed blind and the results of the different methods compared. In all cases MRI yielded similar information to CT and DSA as to aneurysm extent and size, vessel involvement, status of visceral, iliac and common femoral arteries and finally the conditions of perianeurysmatic tissues. The authors conclude that MRI is a useful and accurate technique for the preoperative examination of abdominal aortic aneurysm patients.

[Breast lymphoma]. / Il linfoma mammario.

Primary malignant lymphomas of the breast are uncommon findings, representing 0.12% to 0.53% of all breast cancers. Secondary lymphomas are also uncommon, but they make the most frequent metastatic breast cancers. From January 1989 through December 1992, at the Department of Radiology of the University of Perugia, the authors observed 6 cases of breast lymphoma--1 primary and 5 secondary lesions--in women 52 to 67 years old (average 60 years). The only primary lymphoma was unilateral, multiple and localized on the right side; the secondary ones were diffuse and bilateral in 4 cases and unilateral and nodular in 1 case. The clinical findings were always suggestive of a malignant lesion and so were the mammographic and US findings in 4 diffuse lesions--3 bilateral and 1 unilateral cancers; in both the primary lymphoma and the secondary nodular lymphoma mammography showed benign patterns. Diagnosis was made in all cases following biopsy or resection of the breast mass; all the lymphomas were of the non-Hodgkin's type. The authors report on the major clinical, mammographic and US features of this unusual disease and include a short review of the relative literature.

[Mammography and echography in male breast pathology]. / La mammografia e l'ecografia nella patologia mammaria maschile.

From January 1988 through December 1991, 81 men were examined for breast enlargement or mass in our Institute, by means of clinical examination, mammography, and US. The patients' age ranged 15-71 years (mean: 52 years). Of 81 studied patients, 71 had gynecomastia, 8 had adipomastia, 1 had an infiltrating ductal carcinoma, 1 an angiofibrolipoma and 1 a simple cyst. Both the carcinoma and the cyst were associated with gynecomastia. Three mammographic patterns of gynecomastia were observed: a glandular pattern in 42 cases (32 bilateral and 10 monolateral), a dendritic pattern in 12 (8 bilateral and 4 monolateral), and a nodular pattern in 15 (9 bilateral and 6 monolateral). On US, gynecomastia appeared diffuse in 54 patients and focal in 15. The infiltrating ductal carcinoma was clinically evident; no asymptomatic cancers were detected. Surgical biopsy was performed in 40 cases. A good correlation was observed between mammographic and US signs. The combined use of the two modalities can improve diagnostic accuracy. Biopsy must be performed in all questionable cases.

[Mammography and echography in the study of breast prosthesis]. / La mammografia e l'ecografia nello studio delle protesi mammarie.

Between October 1990 and December 1991, the authors studied 58 women with breast implants (46 monolateral and 12 bilateral prostheses) by means of clinical examination, mammography, and US. The patients' age ranged 31-56 years (mean: 32). Thirty women had undergone subpectoral implantation, 22 subcutaneous and 18 retroglandular. In the group of subpectoral prostheses, 4 women had periprosthetic fibrosis and 3 presented benign calcifications; in 1 case both fibrosis and calcifications were observed. In the depiction of retroglandular implants, US appeared to be very useful: indeed, it detected 3 fibroadenomas and 5 cysts that had been missed at mammography. The only 2 breast carcinoma recurrences (1 non-palpable lesion, confirmed at surgery) were observed in patients with retrocutaneous prostheses. Both mammography and US currently play a major role in the follow-up of women with breast implants. Benign complications and breast cancers can be promptly detected even in patients with no palpable findings.

[Aneurysm of the superior mesenteric vein]. / Anévrysme de la veine mésentérique supérieure.

Aneurysms originating in the superior mesenteric vein are extremely rare: 4 cases have been reported in the international literature. The authors describe a case of a female patient admitted to hospital for vague abdominal pain. The CT findings revealed a cyst-like neoformation. By means of angiography it was then identified as a dilatation of the superior mesenteric vein. The causes of such dilatations are not altogether clear. Current interpretations refer to possible congenital and acquired factors, as well as trauma. The accompanying symptoms are abdominal pain, icterus, gastrointestinal haemorrhage or portal hypertension, but occasionally patients may present no symptoms whatsoever.

[Role of mammography in women under 35 years of age]. / Ruolo della mammografia nelle femmine al di sotto di 35 anni.

The detection of breast cancer in women under 35 is quite an uncommon event, accounting only for 3.2-3.4% of all breast cancers. To determine the indications for mammography in women under 35, the authors correlated clinical, mammographic, and US findings with fine-needle aspiration/surgical biopsy and follow-up results in 1040 symptomatic women examined at the Center of Senology of the Institute of Radiology-University of Perugia, Italy, from 1984 to June 1990. Of 1040 women, 482 (41.6%) had normal findings; benign disease was diagnosed in 558 (53.7%) cases, and malignant disease in 49 (4.7%). Mammography was very useful to diagnose malignancy in palpable breast lesions, as well as to suggest the need for biopsy, to detect metachronous cancers and to define lesion sizes. In inflammatory process--e.g., mastitis and abscesses--both mammography and US were capable of evaluating the real extent of the process, as well as its remission after therapy. Galactography had a specific role in the evaluation of the mammary duct and demonstrated intraductal pathologic conditions. In the authors' experience, mammography never showed occult breast cancers in women with no palpable breast lesions or hematic nipple discharge.

[Preoperative localization using a bidimensional mammographic technique of non-palpable lesions of the breast]. / Localizzazione preoperatoria con tecnica mammografica bidimensionale di lesioni mammarie non palpabili.

It is widely known how the early diagnosis and treatment of breast cancer may lead to better prognosis. When a non-palpable breast lesion detected with mammography is correctly localized with fine-needle biopsy under X-ray guidance, the surgeon can easily remove the lesion while preserving normal breast tissue. In such cases, histology is also possible. The authors describe an easy bidimensional technique for the preoperative localization of occult nonpalpable breast lesions with a fine-needle. The procedure is feasible also with out-of-date equipment and does not cause any discomfort to the patients. It should be performed on all women with mammographic suspicion of non-palpable breast lesion. From January through December 1989 the authors performed 64 preoperative fine-needle biopsies of clinically-occult breast lesions. The presence of a lesion associated with microcalcifications was found to be indicative of malignancy more often than in the case of microcalcifications or lesions alone. Of 64 cases, histology demonstrated malignancy in 31 patients.