Impact of Preoperative MRI in Invasive Ductal Carcinoma With Lobular Features on Core Biopsy.

BACKGROUND: Invasive breast cancer is comprised of a wide spectrum of histological types with different clinical presentations, imaging characteristics, and behaviors. Almost 10% of breast cancers with predominantly invasive ductal features have lobular components on core biopsy at primary diagnosis. Although the role of magnetic resonance imaging (MRI) in patients with purely lobular cancers is well-established, it is not clear if preoperative MRI is indicated in ductal cancer with lobular features. The aim of this study was to assess the role of preoperative MRI in patients with invasive ductal cancers with lobular features on core biopsy. MATERIALS AND METHODS: Data regarding patients with lobular features on core biopsy who underwent a preoperative MRI from January 2015 to December 2017 were retrospectively identified and analyzed. Imaging findings, additional investigations, and changes in treatment plans following the MRI scan were reviewed. RESULTS: The study included 120 patients, of whom 42 (35%) patients required a second-look ultrasound. Following a repeat ultrasound scan, 25 breasts and 4 axillae were biopsied. Thirty-eight percent of the breast biopsies and 50% of the axillary biopsies were malignant. Based on MRI findings, treatment plans changed in 22.5% of patients. MRI size was concordant with the histological size in 58.3% of cases, and MRI was accurate in 90% of patients in detecting multifocal disease requiring mastectomy. The majority of patients with changes in the management plans had mixed ductal and lobular cancer on final histology. CONCLUSION: This study has demonstrated that MRI picks up additional malignancies and changes management plans in patients with lobular features on core biopsy and should be considered in the preoperative workup.

Optimization of bio-cement production from cement kiln dust using microalgae.

The main aim of this study was to maximize bio-cement (CaCO3) production through a waste feedstock of cement kiln dust (CKD) as a source of calcium by deployment of microalgae sp. Chlorella kessleri. The effect of process parameters such as temperature, pH and time-intervals of microalgae cultivation, were set as criteria that ultimately subscribe to a process of optimization. In this regard, a single factor experiments integrated with response surface methodology (RSM) via central composite design (CCD) was considered. A quadratic model was developed to predict the maximum CaCO3 yield. A ceiling of 25.18 g CaCO3 yield was obtained at an optimal set of 23 °C, pH of 10.63 and day-9 of microalgae culture. Under these optimized conditions, maximum 96% calcium was extracted from CKD. FTIR, XRD and EDS analyses were conducted to characterize the CaCO3 precipitates. Compressive modes of mechanical testing seemed to hold conventional cement complimented by CaCO3 co-presence markedly superior to mere cement performance as far as compressive strength is concerned. The latter criterion exhibited further increase in correspondence with rise in cement to bio-cement ratio. This investigative endeavour at hand offers a simple pivotal platform on the basis of which a scale-up of microalgae-infested bio-cement production might be facilitated in conjunction with the added benefit of alleviation in environmental pollution through cement waste utilization.

Comprehensive Imaging Review of Abnormalities of the Placenta.

The placenta has a fundamental role in fetal health and functions as an important bridge to normal fetal development throughout pregnancy. A complete fetal ultrasound (US) survey should include full assessment of the placenta for any possible abnormalities. Placental diseases range from abnormal morphology, size, location, extent, and degree of placentation, to abruption and the presence of rare placental neoplasms of benign or malignant nature. Some of these conditions are associated with other diseases including aneuploidies, and their discovery should alert the radiologist to perform a very thorough fetal US examination. At times, a fetal karyotype may be needed to provide additional information. Timely detection of placental abnormalities can alert the clinician regarding the need to make important management decisions to reduce fetal and maternal morbidity and mortality. Familiarity with the normal and abnormal imaging appearance of the placenta is therefore necessary for the radiologist. Ultrasound with Doppler is the initial imaging modality of choice for placental assessment. Magnetic resonance imaging serves as a problem-solving examination in instances where the US findings are equivocal or where additional information is needed. Computed tomography has a limited role in the evaluation of placental disease because of its relatively limited tissue characterization and in particular because of the resultant direct radiation exposure of the fetus. However, in specific instances, particularly after trauma, computed tomography can provide invaluable information for patient management.

A stuck haemodialysis central venous catheter: not quite open and shut!

Removal of tunnelled central venous catheters can become complex if left in situ for a prolonged period. We report a challenging case of a stuck tunnelled haemodialysis catheter, which required sternotomy with cardio-pulmonary bypass for retrieval. A 47-year-old female had failed attempts to remove the venous limb of a Tessio line on the ward. A cut down on the internal jugular vein and division of the fibrin sheath failed to release it. Synchronous traction was applied via a snare inserted through a femoral approach. On table trans-oesophageal echocardiogram showed the tip of the catheter traversing the tricuspid valve. At sternotomy with cardio-pulmonary bypass, the tip of the catheter was found attached to the septal leaflet of the tricuspid valve requiring release and repair. The management of stuck line has potential serious complications. Prophylactic catheter exchange should be considered to avoid complications.

Evaluation of image registration in subtracted 3D dynamic contrast-enhanced MRI of treated hepatocellular carcinoma.

OBJECTIVE. The objective of our study was to quantify hepatic displacement between breath-holds in multiphasic contrast-enhanced MRI and assess the value of a 3D registration algorithm for displacement correction on subtracted images. MATERIALS AND METHODS. For this retrospective analysis, we evaluated MR images of 25 cirrhotic patients with treated hepatocellular carcinoma (HCC) and at least one coexisting small hepatic cyst that was hypointense on T1-weighted imaging. With the use of an automated 3D deformable registration algorithm, registered base and subtraction images were created using portal venous phase images as the baseline images. The relative displacement of the cysts over the dynamic phases was used to estimate hepatic displacement before and after registration. The width of the subtraction band artifact, HCC lesion conspicuity, and overall subtraction artifact level (i.e., image quality of the entire volume) of the subtraction images were evaluated before and after registration on a 5-point scale (1 = nondiagnostic, 5 = excellent image quality) by two blinded radiologists. Hepatic displacement and subtraction band artifact results were analyzed using the paired Student t test, and the results for HCC lesion conspicuity and image quality of the volume results were analyzed using the Wilcoxon signed rank test. Interobserver agreement was assessed using kappa statistics. RESULTS. The average total cyst displacement on unenhanced, arterial, and delayed phase images was significantly reduced by registration from 4.0, 3.2, and 4.6 mm, respectively, on pre-registered images to 2.4, 1.6, and 1.3 mm on postregistered images (p < 0.01). The mean HCC lesion conspicuity grade improved from 3.4 before registration to 4.4 after registration (p < 0.01), and the mean grade for image quality of the volume improved from 3.3 before registration to 4.6 after registration (p < 0.01). The average width of the subtraction band artifact decreased from 5.3 mm before registration to 2.4 mm after registration, from 6.1 mm before registration to 2.6 mm after registration, and from 5.2 mm before registration to 2.8 mm after registration for the arterial, portal venous, and delayed phase subtractions, respectively (p < 0.01). CONCLUSION. Automated registration of the liver in multiphasic MRI examinations reduced interphasic hepatic displacement, improved the conspicuity of the treated HCC lesion, and improved the overall subtraction image quality.

ASER Core Curriculum Illustration Project: coronal femoral condyle (Hoffa) fracture.

This is the 13th installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for study online at http://www.aseronline.org/curriculum/toc.htm.

Core curriculum illustration: testicular torsion.

This is the 7th installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for Study online at http://www.aseronline.org/curriculum/toc.htm .

Comprehensive imaging review of abnormalities of the umbilical cord.

A complete fetal ultrasonographic (US) study includes assessment of the umbilical cord for possible abnormalities. Knowledge of the normal appearance of the umbilical cord is necessary for the radiologist to correctly diagnose pathologic conditions. Umbilical cord abnormalities can be related to cord coiling, length, and thickness; the placental insertion site; in utero distortion; vascular abnormalities; and primary tumors or masses. These conditions may be associated with other fetal anomalies and aneuploidies, and their discovery should prompt a thorough fetal US examination. Further workup and planning for a safe fetal delivery may include fetal echocardiography and karyotype analysis. Doppler US is a critical tool for assessment and diagnosis of vascular cord abnormalities. US also can be used for follow-up serial imaging evaluation of conditions that could result in fetal demise. Recent studies suggest that three- or four-dimensional Doppler US of the fetal umbilical cord and abdominal vasculature allows more accurate diagnosis of vascular abnormalities. Doppler US also is invaluable in assessment of fetal growth restriction since hemodynamic changes in the placenta or fetus would appear as a spectral pattern of increased resistance to forward flow in the fetal umbilical artery. Early detection of umbilical cord abnormalities and close follow-up can reduce the risk of morbidity and mortality and assist in decision making.

Abdominal compartment syndrome--a fatal complication from a rectus sheath haematoma.

Rectus sheath haematoma is increasingly being seen in patients with anticoagulation therapy. Abdominal compartment syndrome is a rare complication of rectus sheath haematoma with only two cases reported in literature. The authors report a case of a young male who developed abdominal compartment syndrome from a rectus sheath haematoma secondary to anticoagulation therapy. The case highlights the need for a surgical intervention in such exceptional cases.

Endoscopic management of migrated biliary stent causing sigmoid perforation.

Endoscopically deployed biliary stents are a well established method for dealing with biliary diseases. Perforation of the gut secondary to migrated biliary stent is reported in less than 1% cases. The authors present the first case of a colonic perforation from migrated biliary stent which was managed endoscopically. An 82-year-old female had a biliary stent for a postcholecystectomy bile leak and presented 6 months later with left iliac fossa pain. Barium enema showed a stent perforating the sigmoid colon. In view of the patient's frailty and absence of peritonitis, an endoscopic retrieval of stent was attempted. Flexible sigmoidoscopy showed a stent partially embedded within the sigmoid diverticulum which was successfully removed and the defect was closed endoscopically using three titanium clips. She had an uncomplicated recovery following the procedure and was discharged home on the second day following the procedure.