Expert recommendations about the use of gadoxetic acid in patients with liver metastases in Spain.

BACKGROUND AND AIMS: Magnetic resonance imaging (MRI) with gadoxetic acid is widely used in clinical practice in Spain for the diagnosis, treatment, and follow-up of patients with liver metastases, although its use varies. This paper aims to provide recommendations for the use of MRI with gadoxetic acid in the detection and diagnosis of liver metastases in clinical practice in Spain. MATERIAL AND METHODS: This project was undertaken by a group of nine experts who analyzed a series of recommendations about the use of gadoxetic acid extracted from international consensus documents. From this analysis, the experts decided to reject, adopt, contextualize, or adapt each of the recommendations. Once established, the final recommendations were voted on by the same group of experts. RESULTS: The experts reached a consensus about five recommendations related to the use of this imaging technique in the management of liver metastases in three clinical situations: (i) in the detection, (ii) in the diagnosis and preoperative characterization, and (iii) in the detection after a chemotherapy treatment. CONCLUSION: The results support a clinical benefit for MRI with gadoxetic acid in the detection of liver metastases, favoring preoperative planning, especially in metastases measuring less than 1 cm, thus facilitating early diagnosis of metastatic spread.

Hepatic Flow Redistribution is Feasible in Patients with Hepatic Malignancies Undergoing Same-Day Work-Up Angiography and Yttrium-90 Microsphere Radioembolization.

PURPOSE: To assess the feasibility of performing same-day vascular flow redistribution and Yttrium-90 radioembolization (90Y-RE) for hepatic malignancies. MATERIALS AND METHODS: From November 2015 to February 2019, patients undergoing same-day hepatic flow redistribution during work-up angiography, 99mTechnetium-labeled macroaggregated albumin (99mTc-MAA) SPECT/CT and 90Y microsphere-RE, were recruited. Within 18 h following the delivery of 90Y resin microspheres, an 90Y-PET/CT study was performed. According to patients' vascular anatomy, flow redistribution was performed by microcoil embolization of extrahepatic branches (group A), intrahepatic non-tumoral vessels (group B) and intrahepatic tumoral arteries (group C). The accumulation of 99mTc-MAA particles and microspheres in the redistributed areas was qualitatively evaluated using a 5-point visual scale (grade 1 = < 25% accumulation; grade 5 = 100% accumulation). Differences in the distribution of microspheres among groups were assessed with Mann-Whitney U test. RESULTS: Twenty-two patients were treated for primary (n = 17) and secondary (n = 5) hepatic malignancies. The MAA-SPECT/CT showed uptake in all the redistributed areas. Regarding the accumulation of microspheres within the redistributed segments in all the groups, perfusion patterns were classified as 2 in 1 case, 4 in 6 cases and 5 in 15 cases. No statistically significant differences were observed between groups A and B-C (U value = 34, p = 0.32) and between groups B and C (U value = 26, p = 0.7). Mean predicted absorbed doses by the tumoral and normal hepatic tissues were 163.5 ± 131.2 Gy and 60.4 ± 69.3 Gy, respectively. Mean total procedure time (from work-up angiography to 90Y delivery) was 401 ± 0.055 min. CONCLUSION: Performing same-day redistribution of the arterial hepatic flow to the target and 90Y-microsphere delivery is feasible in the treatment of liver tumors. Clinical Trials Registry NCT03380130.

Errores comunes en la interpretación oncológica / Common errors in image interpretation in oncology

Los errores en la interpretación radiológica son inevitables y generalmente multifactoriales. Pueden deberse a fallos de interpretación del radiólogo (incluyendo causas cognitivas, errores de percepción o ambigüedad en el informe) o a fallos relacionados con el sistema (problemas técnicos al adquirir la imagen, información clínica incorrecta, excesiva carga de trabajo o condiciones laborales inadecuadas). Es responsabilidad del radiólogo conocer por qué se producen los errores y cómo detectarlos para evitar su repetición. En este artículo nos vamos a centrar en el problema del error diagnóstico en el paciente oncológico, tanto en el momento del diagnóstico como en el seguimiento y en el estudio de la respuesta al tratamiento con las nuevas terapias moleculares. Una lectura sistemática y una valoración evolutiva de la respuesta oncológica en el contexto clínico del paciente son factores importantes que reducen los posibles errores cometidos por el radiólogo, así como el conocimiento y el manejo de los nuevos criterios específicos de respuesta de cada tipo tumoral

Errors in image interpretation are inevitable and generally multifactorial. They can be due to the radiologist's failure to interpret the findings correctly (including cognitive causes, perceptual errors, or ambiguity in reporting) or to problems related with the system (technical problems in image acquisition, incorrect clinical information, excessive workload, or inadequate working conditions). It is the radiologist's responsibility to know why errors occur and how to detect them to prevent them from occurring again. This article focuses on the problem of errors in diagnosing oncologic patients, both at the time of diagnosis and during follow-up as well as in the study of the response to treatment with new molecular therapies. To reduce possible errors, radiologists should ensure a systematic reading and an assessment of the oncologic response over time in the clinical context of the patient; they also need to have and apply knowledge of the new specific criteria for the response of each tumor type in the management of the patient

Tratamiento de fugas biliares mediante colocación transparietohepática de endoprótesis metálicas recubiertas / Treatment of benign biliary leaks with transhepatic placement of coated self-expanding metallic stents

Objetivo. Analizar la seguridad y eficacia en el uso percutáneo de endoprótesis metálicas autoexpandibles recubiertas (EMAR) en pacientes con fuga biliar. Material y métodos. Este estudio ha sido aprobado por el Comité de Ética de nuestro centro. Se realizó una revisión retrospectiva de las EMAR colocadas entre octubre de 2008 y septiembre de 2015. Se analizaron la enfermedad primaria subyacente, los procedimientos hepáticos previos y el éxito clínico. Se evaluó la localización, el número, el tipo de fuga y las características del procedimiento intervencionista (número de prótesis empleadas, localización, éxito técnico y funcionalidad primaria). Se recogieron las complicaciones registradas. Resultados. Se estudiaron 14 pacientes. El seguimiento medio fue de 375,5 días (rango de 15-1920 días). En 12 pacientes las fugas biliares fueron posquirúrgicas. Un paciente presentó una fístula arteriobilioportal. En otro paciente, la fuga biliar fue post-CPRE. Se colocaron un total de 23 EMAR: 21 prótesis tipo Fluency® (Bard, Tempe, Arizona, EE.UU.) y dos prótesis tipo Wallflex® (Boston Scientific, Galway, Irlanda). Se consiguió éxito técnico total en el 78,6% (n=11), parcial en el 14,3% (n=2) y no se obtuvo éxito en el 7,2% (n=1). Se consiguió éxito clínico en 13 de 14 pacientes. La media de funcionalidad primaria de las EMAR fue de 331 días (rango de 15-1920 días). Once pacientes no presentaron ninguna complicación mayor. Conclusiones. La colocación percutánea de EMAR es un método seguro y eficaz en el tratamiento de fugas biliares benignas, con una alta tasa de éxito técnico y clínico y un nivel moderado de complicaciones (AU)

Objectives. To analyze the safety and efficacy of percutaneous placement of coated self-expanding metallic stents (SEMS) in patients with biliary leaks. Material and methods. This ethics committee at our center approved this study. We retrospectively reviewed all coated SEMS placed between October 2008 and September 2015. We analyzed patient-related factors such as the primary underlying disease, prior hepatic procedures, and clinical outcome. We evaluated the location, the number and type of leak (anastomotic or non-anastomotic), and the characteristics of the interventional procedure (number of stents deployed, location of the stents, technical success, and primary functionality). We recorded the complications registered. Results. We studied 14 patients (11 men and 3 women). The mean follow-up period was 375.5 days (range 15-1920 days). Leaks were postsurgical in 12 patients. One patient developed an arteriobilioportal fistula. In another, the biliary leak occurred secondary to the rupture of the common bile duct after ERCP. A total of 23 coated SEMS were placed, including 21 Fluency® stents (Bard, Tempe, AZ, USA) and 2 Wallflex® stents (Boston Scientific, Galway, Republic of Ireland). The technical success of the procedure was considered total in 11 (78.6%) patients, partial in 2 (14.3%) patients, and null in 1 (7.2%) patient. The clinical outcome was good in 13 of the 14 patients. The mean period of primary functionality of the coated SEMS was 331 days (range 15-1920 days). No major complications were observed in 11 (78.6%) patients. Conclusions. Percutaneous placement of coated SEMS for the treatment of benign biliary leaks is safe and efficacious, with a high rate of technical and clinical success and a moderate rate of complications (AU)

Treatment of benign biliary leaks with transhepatic placement of coated self-expanding metallic stents. / Tratamiento de fugas biliares mediante colocación transparietohepática de endoprótesis metálicas recubiertas.

OBJECTIVES: To analyze the safety and efficacy of percutaneous placement of coated self-expanding metallic stents (SEMS) in patients with biliary leaks. MATERIAL AND METHODS: This ethics committee at our center approved this study. We retrospectively reviewed all coated SEMS placed between October 2008 and September 2015. We analyzed patient-related factors such as the primary underlying disease, prior hepatic procedures, and clinical outcome. We evaluated the location, the number and type of leak (anastomotic or non-anastomotic), and the characteristics of the interventional procedure (number of stents deployed, location of the stents, technical success, and primary functionality). We recorded the complications registered. RESULTS: We studied 14 patients (11 men and 3 women). The mean follow-up period was 375.5 days (range 15-1920 days). Leaks were postsurgical in 12 patients. One patient developed an arteriobilioportal fistula. In another, the biliary leak occurred secondary to the rupture of the common bile duct after ERCP. A total of 23 coated SEMS were placed, including 21 Fluency® stents (Bard, Tempe, AZ, USA) and 2 Wallflex® stents (Boston Scientific, Galway, Republic of Ireland). The technical success of the procedure was considered total in 11 (78.6%) patients, partial in 2 (14.3%) patients, and null in 1 (7.2%) patient. The clinical outcome was good in 13 of the 14 patients. The mean period of primary functionality of the coated SEMS was 331 days (range 15-1920 days). No major complications were observed in 11 (78.6%) patients. CONCLUSIONS: Percutaneous placement of coated SEMS for the treatment of benign biliary leaks is safe and efficacious, with a high rate of technical and clinical success and a moderate rate of complications.

Hallazgos de angiografía por tomografía computarizada de la mediólisis arterial segmentaria / Segmental arterial mediolysis: findings at computed tomography angiography

Objetivo. Repasar los principales hallazgos de angiografía por tomografía computarizada de la mediólisis arterial segmentaria y enfatizar aquellos puntos que ayuden a diferenciarla de otras vasculopatías, como las vasculitis. Asimismo, se repasarán los protocolos de seguimiento y las diversas opciones terapéuticas. Conclusión. La mediólisis arterial segmentaria es una enfermedad rara que se define como una vasculopatía no ateroesclerótica, no hereditaria y no inflamatoria, caracterizada por la lisis de la capa media de la pared arterial. Debe sospecharse en pacientes de edad media con aneurismas, disecciones o roturas espontáneas de arterias viscerales de etiología desconocida, que no cumplen los criterios clínicos y analíticos de vasculitis. Las arterias viscerales abdominales son las más frecuentemente afectadas, entre ellas el tronco celíaco y las arterias mesentéricas superior e inferior. Sus formas de presentación radiológica incluyen la dilatación arterial, los aneurismas (saculares o fusiformes) únicos o múltiples, las estenosis y las disecciones (AU)

Objective. To review the principal findings on computed tomography angiography for segmental arterial mediolysis, and to emphasize the points that help to differentiate it from other vasculopathies such as vasculitis. We also review the protocols for follow-up and the various treatment options. Conclusion. Segmental arterial mediolysis is a rare disease that is defined as a non-atherosclerotic, non-hereditary, and non-inflammatory vasculopathy characterized by lysis of the medial layer of the arterial wall. It should be suspected in middle-aged patients with aneurysms, dissections, or spontaneous ruptures of visceral arteries of unknown etiology who do not fulfill the clinical and laboratory criteria for vasculitis. The arteries of the abdominal organs are the most commonly affected, including the arteries of the celiac trunk and the superior and inferior mesenteric arteries. Radiologically, segmental arterial mediolysis can present as arterial dilation; single or multiple, saccular or fusiform aneurysms; stenoses; or dissections (AU)

Segmental arterial mediolysis: findings at computed tomography angiography. / Hallazgos de angiografía por tomografía computarizada de la mediólisis arterial segmentaria.

OBJECTIVE: To review the principal findings on computed tomography angiography for segmental arterial mediolysis, and to emphasize the points that help to differentiate it from other vasculopathies such as vasculitis. We also review the protocols for follow-up and the various treatment options. CONCLUSION: Segmental arterial mediolysis is a rare disease that is defined as a non-atherosclerotic, non-hereditary, and non-inflammatory vasculopathy characterized by lysis of the medial layer of the arterial wall. It should be suspected in middle-aged patients with aneurysms, dissections, or spontaneous ruptures of visceral arteries of unknown etiology who do not fulfill the clinical and laboratory criteria for vasculitis. The arteries of the abdominal organs are the most commonly affected, including the arteries of the celiac trunk and the superior and inferior mesenteric arteries. Radiologically, segmental arterial mediolysis can present as arterial dilation; single or multiple, saccular or fusiform aneurysms; stenoses; or dissections.

Nuevos horizontes en el desarrollo de medios de contraste en Radiología / New horizons in the development of contrast media in Radiology

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The celiac axis compression syndrome (CACS): critical review in the laparoscopic era.

The celiac axis compression syndrome (CACS) due to median arcuate ligament (MAL) was first described by Harjola in 1963; originating postpandrial abdominal pain, weight loss, epigastric bruit and celiac axis stenosis > 75% in angiographic studies. This clinical condition has been the origin of controversies about its pathogenesis, diagnosis and its long term clinical results. Advances in diagnostic imaging as 64 multidetector-row CT (MDCT), 3-D reconstruction, magnetic resonance (MR) and color duplex ultrasonography, provide better understanding of the syndrome and allow to identify the best candidates for surgical division of MAL fibers. Since the introduction of laparoscopic approach, and also endovascular procedures, in 2000, a new perspective has established in this challenging syndrome. With the occasion of our own experience, a critical review of the syndrome is presented.

Síndrome de compresión del tronco celiaco. Revisión crítica en la era de la cirugía laparoscópica / The celiac axis compression syndrome (CACS): critical review in the laparoscopic era

El síndrome de compresión del tronco celiaco fue descrito porHarjola en 1963 como la compresión extrínseca del tronco celiacopor las fibras tendinosas del ligamento arcuato; causando uncuadro de dolor intenso post-pandrial en epigastrio, pérdida depeso, soplo epigástrico y estenosis mayor del 75% en la angiografíaselectiva. Desde entonces, dicho síndrome ha sido motivo demúltiples controversias relacionadas con su patogenia y la variabilidadde los resultados obtenidos con la cirugía.Debido a la proliferación y accesibilidad de técnicas de imagenmás precisas y menos invasivas (angio-TAC multicorte, angio-RMN, eco-doppler), el diagnóstico de dicho síndrome puede realizarsecon mayor precisión y sentar las bases de la indicación quirúrgicacon mayor seguridad y eficacia.La introducción, en el año 2000, de técnicas laparoscópicasen la liberación del tronco celiaco, junto con procedimientos endovascularescomplementarios, ha representado un notable avanceen el tratamiento del síndrome.Basados en nuestra experiencia personal, presentamos una revisióncrítica y propuesta terapéutica del síndrome(AU)

The celiac axis compression syndrome (CACS) due to medianarcuate ligament (MAL) was first described by Harjola in 1963;originating postpandrial abdominal pain, weight loss, epigastricbruit and celiac axis stenosis > 75% in angiographic studies. Thisclinical condition has been the origin of controversies about itspathogenesis, diagnosis and its long term clinical results.Advances in diagnostic imaging as 64 multidetector–row CT(MDCT), 3-D reconstruction, magnetic resonance (MR) and colorduplex ultrasonography, provide better understanding of the syndromeand allow to identify the best candidates for surgical divisionof MAL fibers.Since the introduction of laparoscopic approach, and also endovascularprocedures, in 2000, a new perspective has establishedin this challenging syndrome. With the occasion of our ownexperience, a critical review of the syndrome is presented(AU)

Oxaliplatin plus gemcitabine as a salvage schedule for hormone-refractory prostate adenocarcinoma.

We report a case of hormone-refractory prostate cancer (HRPC) treated with oxaliplatin plus gemcitabine in a third-line schedule after liver progression, with an excellent clinical, biochemical and radiological response and with an acceptable tolerance. Prior chemotherapy regimens included docetaxel plus estramustine and oral etoposide. To our knowledge, this is the first report that shows this approach in an HRPC patient.

Oxaliplatin plus gemcitabine as a salvage schedule for hormone-refractory prostate adenocarcinoma

We report a case of hormone-refractory prostate cancer (HRPC) treated with oxaliplatin plus gemcitabine in a third-line schedule after liver progression, with an excellent clinical, biochemical and radiological response and with an acceptable tolerance. Prior chemotherapy regimens included docetaxel plus estramustine and oral etoposide. To our knowledge, this is the first report that shows this approach in an HRPC patient (AU)

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Detección y caracterización del nódulo pulmonar por tomografía computarizada / Detection and characterization of pulmonary nodules using multislice computed tomography

El nódulo pulmonar es un hallazgo frecuente en los estudios torácicos realizados durante la práctica clínica diaria. Aunque no existen datos clínicos o radiológicos patognomónicos que indiquen su naturaleza exacta, el contexto clínico y la caracterización adecuada del nódulo pulmonar permiten realizar el diagnóstico correcto en la mayoría de los casos. En este artículo se exponen los aspectos más relevantes de lautilidad de la tomografía computarizada multicorte (TCMC) para detectar y caracterizar los nódulos pulmonares de forma no invasiva

Pulmonary nodules are a common finding in routine chest studies. Although there are no pathognomic clinical or radiological signs that enable the exact nature of a pulmonary nodule to be determined, the clinical context and the appropriate characterization of the pulmonarynodule make it possible to reach the correct diagnosis in most cases. This article discusses the most important aspects involved in the use of multislice computed tomography in the noninvasive detection and characterization of pulmonary nodules (AU)

[Detection and characterization of pulmonary nodules using multislice computed tomography]. / Detección y caracterización del nódulo pulmonar por tomografía computarizada multicorte.

Pulmonary nodules are a common finding in routine chest studies. Although there are no pathognomic clinical or radiological signs that enable the exact nature of a pulmonary nodule to be determined, the clinical context and the appropriate characterization of the pulmonary nodule make it possible to reach the correct diagnosis in most cases. This article discusses the most important aspects involved in the use of multislice computed tomography in the noninvasive detection and characterization of pulmonary nodules.

Doppler ultrasound for TIPS: does it work?

The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of complications of portal hypertension such as variceal hemorrhage and ascites is well established. However, TIPS has a limited patency due to dysfunction consisting in occlusion or stenosis of the intrahepatic tract or stenosis of the outflow hepatic vein. Timing of dysfunction cannot be predicted, so routine surveillance and percutaneous intervention are continuously required to maintain TIPS patency. Trans-shunt venography is the gold standard technique in TIPS evaluation, but it is expensive and invasive. Doppler ultrasound (DU) has been the most commonly used noninvasive tool in TIPS patency. Despite many reported series, its role remains controversial. After more than 10 years of experience with TIPS, we followed our patients with DU and trans-shunt venography to establish Doppler criteria of dysfunction and its accuracy in assessing shunt dysfunction.

Lesiones mamarias no palpables: experiencia inicial con la biopsia estereotáxica automatizada / Non-palpable breast lesions: initial experience with the automated stereotaxic biopsy

Analizamos retrospectivamente en nuestra experiencia la eficacia de los sistemas MIBB (minimally invased breast biopsy) y ABBI (advanced breast biopsy instrumentation) en el diagnóstico de las lesiones mamograficas sospechosas no palpables. Se realizaron 70 biopsias: 36 con el MIBB y 34 con el ABBI. Mediante el MIBB se obtuvieron varios cilindros por un único punto de punción, con la biopsia ABBI se obtuvo un único cilindro de 1-2 cm de diámetro. La biopsia se indicó por microcalcificaciones (n = 40) y nódulos (n = 30). Analizamos las complicaciones técnicas, postbiopsia y los resultados histológicos. La lesión sospechosa fue correctamente localizada y biopsiada en el 98,5 per cent (36 de 36 MIBB y 33 de 34 ABBI) comprobada por la radiografía de la pieza, las imágenes estereotáxicas y el análisis histológico. En 4 casos (5,7 per cent) se observaron complicaciones técnicas que no impidieron completar la biopsia. En 3 casos (4,3 per cent) se presentaron complicaciones postbiopsia: 2 hematomas post ABBI y un sincope vagal post MIBB. 27 lesiones fueron malignas (38,5 per cent); 10 biopsiadas por MIBB y 13 por ABBI. No se observó tumor residual en la tumorectomía posterior en 5 de los 10 ABBI malignos reintervenidos. Tres pacientes con carcinomas de mama con márgenes de resección negativos se extirparon con la cánula ABBI sin practicar una intervención posterior. Los sistemas MIBB y ABBI fueron métodos de biopsia mamaria seguros y precisos y evitaron la cirugía posterior en el 71,2 per cent de casos. La localización, tamaño y grado de sospecha de la lesión son muy importantes para decidir el tipo de biopsia. Las lesiones sospechosas de más de 1 cm o las multifocales deben biopsiarse con el sistema MIBB. Las lesiones únicas de menos de 1cm deben biopsiarse con el sistema ABBI. Tumores de mama de pequeño tamaño en casos seleccionados podrían extirparse por completo con el ABBI sin necesitar una posterior tumorectomía (AU)

An experience with the Advanced Breast Biopsy Instrumentation (ABBI) system in the management of non-palpable breast lesions.

Our objective was to evaluate our experience with the Advanced Breast Biopsy Instrumentation system (ABBI) in non-palpable breast lesions in a prospective study from July 1998 to November 2000. The ABBI system was included in a protocol for BIRADS 4 non-palpable, small (<15 mm) breast lesions. Digital radiographs of both specimen and biopsy cavity were obtained to validate the procedure. A total of 255 ABBI biopsies were performed in 254 patients. In 251 cases the lesions were successfully removed (98.4%). Mammographic lesions consisted of 176 cases of microcalcifications (69%), 51 cases of architectural distortions (20%) and 28 cases of nodules (11%). Seventy-two carcinomas were diagnosed (28.2%). Affected margins were found in 41 cases (56.9%). Residual tumour was seen in 31 patients (43%). Seventeen borderline results and 33 benign architectural distortions obviated further procedures. The complication rate in 10 cases was as follows: 3 wound infections; 4 haematomas; and 3 vasovagal reactions. The main utility of the ABBI system is to allow a reliable diagnosis in complex lesions, such as small clusters of microcalcifications and especially architectural distortions. Surgery can be avoided for borderline cases if the lesion is completely removed and free margins are obtained in the pathology study. Therapeutic use is controversial and can be applied only in selected cases.

T-helper cell response to woodchuck hepatitis virus antigens after therapeutic vaccination of chronically-infected animals treated with lamivudine.

BACKGROUND/AIMS: Immunotherapy of patients chronically-infected with hepatitis B virus (HBV) may have the risk of fulminant hepatitis. This risk might be diminished if immunotherapy was carried out under conditions of low viremia. METHODS: Five woodchucks chronically-infected with woodchuck hepatitis virus (WHV), a virus closely related to HBV, were treated with lamivudine for 23 weeks. At week 10, when viremia had decreased by 3-5 logs, three woodchucks were vaccinated with woodchuck hepatitis virus surface antigen (WHsAg) plus the T-helper determinant FISEAIIHVLHSR. RESULTS: It was found that the administration of lamivudine only, had no effect on the T-helper response against WHV antigens. By contrast, vaccination induced T-helper responses against WHV antigens, shifting the cytokine profile from Th2 to Th0/Th1, but was without effect on viremia, WHsAg levels, or anti-WHs antibodies. Analysis of liver biopsies showed that lamivudine administration may have reduced hepatic inflammation. By contrast, vaccination clearly enhanced hepatic inflammation. After lamivudine withdrawal, viremia returned to high levels. CONCLUSIONS: These results suggest that therapeutic vaccination of chronically-infected woodchucks under conditions of low viremia shifts the cytokine profile against viral antigens towards Th0/Th1. This shift may prevent the efficient induction of anti-WHs antibodies.

Calcified filariasis of the breast: report of four cases.

Circumscribed to endemic areas throughout tropical countries, filariasis is a rare and unknown disease in Europe. We report four cases of calcified filariasis involving the breast, supporting the diagnosis on the typical mammographic appearance of the calcified worms and the past history of filarial infection. Few reports have been published in the radiology literature about this infrequent manifestation of the parasitation. The purpose of this article is to show the mammographic characteristics of this disease that soon will be seen frequently in developed countries due to the increasing population from the endemic areas.