Reassessing specimen number and diagnostic yield of ultrasound guided breast core biopsy.

To reassess the minimum number of specimens required for an accurate diagnosis compared to the standard acquisition of five specimens. A total of 190 consecutive breast mass biopsies were performed using a 14-gauge core biopsy needle under ultrasound guidance. Two to six specimens were obtained from each mass and placed in sequential containers. Each specimen was evaluated by a pathologist in the order it was obtained and was labeled as "diagnostic' or 'non-diagnostic'. During the biopsy procedure, the radiologist indicated after which number biopsy he was confident that an adequate diagnostic specimen had been obtained. This was based upon real-time visualization of the needle passing through the lesion and whether the specimen sank or floated in formalin. These observations were compared with the pathologic diagnostic yield according to specimen number. Fifty-eight lesions (30.5%) were malignant, four (2.1%) were atypical, and 128 (67.4%) were benign. Histologic diagnosis was obtained after the first specimen in 157 (82.6%) lesions, the second specimen in 172 (90.5%) lesions, the third specimen in 186 (97.9%) lesions, the fourth specimen in 188 (98.9%) lesions, and the fifth specimen in 190 (100%) lesions. A histologic diagnosis was made in 90% of the malignant lesions after the first biopsy pass, 95% after the second pass, 98% after the third pass, and 100% after the fourth and fifth passes. Nine (4.7%) lesions showed discrepancy between the radiologist's confidence of diagnosis and pathologic diagnostic yield. Of these lesions, seven were benign and two were malignant. A diagnostic yield of 95% was obtained based on operator estimate of the minimum number of required core biopsies. A high diagnostic yield of 98% was achieved after three biopsy passes and 100% after five passes.

Imaging of hepatocellular carcinoma after treatment with yttrium-90 microspheres.

OBJECTIVE: Yttrium-90 radioembolization is an emerging therapy for unresectable hepatocellular carcinoma (HCC). Although therapeutic response based on size has been evaluated in numerous studies, necrosis has been used as a criterion of response in only a few studies. The purpose of our study was to describe the imaging features of HCC after 90Y treatment and to compare size criteria (World Health Organization [WHO] and Response Evaluation Criteria in Solid Tumors [RECIST]) with necrosis criteria and combined criteria (RECIST and necrosis) for assessment of response. MATERIALS AND METHODS: CT images of 42 patients with 76 90Y-treated HCC lesions were analyzed. We used four response criteria: WHO size, RECIST size, necrosis, and combined criteria (RECIST and necrosis). Imaging features of treated lesions included both nodular and peripheral rim enhancement. Survival was assessed with the Kaplan-Meier method. RESULTS: The response rate was 23% according to RECIST criteria, 26% according to WHO criteria, 57% according to necrosis criteria, and 59% according to combined criteria. Response according to necrosis and combined criteria was detected earlier than response according to size criteria alone. Ten responding lesions initially increased in size. After therapy, enhancing peripheral nodules increased in size in 10 lesions, decreased in size in two lesions, and disappeared in two lesions. Twenty-one of 25 lesions with thin rim enhancement after 90Y administration responded to treatment. The median survival times were 660 and 236 days for Okuda stage I and Okuda stage II disease, respectively. CONCLUSION: Use of combined size and necrosis criteria may lead to more accurate assessment of response to 90Y therapy than use of size criteria alone. Imaging features after 90Y treatment, including size, necrosis, peripheral enhancing nodules, and thin rim enhancement, are described.

Response of liver metastases after treatment with yttrium-90 microspheres: role of size, necrosis, and PET.

OBJECTIVE: Yttrium-90 radioembolization is an emerging treatment for liver malignancies. The purpose of this study was to evaluate the imaging response of liver metastases to 90Y microspheres based on size and necrosis criteria using CT and comparing the results to PET and to describe imaging features related to 90Y therapy. MATERIALS AND METHODS: We reviewed the imaging studies of 42 patients with unresectable liver metastases treated with lobar radioembolization with 90Y. CT response was determined using traditional size criteria (World Health Organization [WHO] and Response Evaluation Criteria in Solid Tumors [RECIST]), necrosis criteria, and combined criteria (RECIST and necrosis). We compared the response on CT with the response on PET. Complications of treatment were assessed. RESULTS: The response rate was 19% (8/42) by WHO criteria, 24% (10/42) by RECIST, 45% (19/42) by necrosis criteria, and 50% (21/42) by combined criteria. Stabilization of lesion size occurred in 50% of patients. Necrosis and combined criteria identified responders earlier than RECIST and WHO criteria. Seven responders by combined criteria had an increase in lesion size on initial follow-up and would have been considered nonresponders. PET scans were obtained in 23 patients (33 treated lobes). PET detected significantly more responses to treatment (21/33, 63%) than CT using RECIST (2/33, 6%) or combined criteria (8/33, 24%) (p < 0.05, McNemar test). Complications of treatment included radiation cholecystitis (10 patients, 23%) and liver edema (18 patients, 42%). CONCLUSION: The use of necrosis and size criteria on CT and correlation with PET may improve the accuracy of assessment of response to 90Y treatment in patients with liver metastases and detect response earlier than standard size criteria.

CT diagnosis of chyluria after partial nephrectomy.

OBJECTIVE: The purpose of this study was to describe the CT diagnosis of chyluria after partial nephrectomy. CONCLUSION: Fat in the bladder can be identified on CT after partial nephrectomy. This finding is caused by chyluria secondary to lymphatic injury and should not be mistaken for other abnormalities. Our study population did not need treatment of chyluria.

MRI of islet cell tumors of the pancreas.

OBJECTIVE: CT is the most widely used imaging technique for the diagnosis of islet cell tumors, but MRI may be better for detecting small lesions and metastases because of its optimal contrast resolution and ability to easily perform dynamic imaging. The purpose of this pictorial essay is to highlight the MRI features of these tumors and underscore potential pitfalls. CONCLUSION: Although classically considered well-defined, arterially enhancing lesions that are bright on T2-weighted sequences, pancreatic islet cell tumors have quite a broad spectrum of appearances. MRI is well suited for detecting and characterizing pancreatic islet cell tumors as well as their local effects and metastases.

MRI of adenocarcinoma of the pancreas.

OBJECTIVE: CT is the established imaging technique for evaluation of pancreatic adenocarcinoma. MRI, however, can play a major role in this disease. The objective of this study is to illustrate the strengths of MRI for evaluating pancreatic adenocarcinoma. CONCLUSION: The superior soft-tissue contrast of MRI compared with CT is useful in the detection and characterization of non-contour-deforming pancreatic masses. MRI compared with CT may be more sensitive in the detection of distant disease, better for defining appropriate surgical candidates, and better for characterizing small liver metastases and peritoneal and omental metastases.

Unexplained renal colic: what is the utility of IV contrast?

PURPOSE: The aim of this study was to evaluate the benefit of intravenous (IV) contrast in patients with suspected renal colic and unremarkable unenhanced MDCT. MATERIALS AND METHODS: One thousand two hundred and four patients with suspected ureterolithiasis were evaluated with unenhanced MDCT. Seven hundred and eight patients that had additional imaging following IV contrast were our study group. RESULTS: Of the patients, 9.4% (67/708) had abnormalities seen only on contrast-enhanced exams. In 53.1% (376/708) of the patients, no additional finding was identified after IV contrast. CONCLUSION: IV contrast in patients with renal colic is rarely helpful.

Magnetic resonance imaging of the pancreas: the future is now.

MR imaging has made significant advances in recent years, with an increasingly important role in the detection, characterization, and staging of pancreatic diseases. MRI is appealing as a noninvasive imaging modality as it can evaluate the pancreas, the vasculature, and the pancreaticobiliary ducts in a single examination. Advantages of MRI include its excellent soft tissue contrast resolution and anatomic detail and absence of ionizing radiation. This article reviews the utility of MRI and its use not only as a problem-solving tool but its potential use as a primary examination (similar to CT) in a wide variety of pancreatic diseases.

Timoma invasivo: vias locais de disseminaçäo: avaliaçäo por tomografia computadorizada / Invasive thymoma: local pathways of dissemination: computed tomography assessment

Três pacientes com diagnóstico comprovado de timoma invasivo foram estudados por tomografia computadorizada, para determinar as diferentes vias de disseminaçäo local, de acordo com a sua história natural. O envolvimento pleural mediastinal, o envolvimento das estruturas cardiovasculares mediastinais e os implantes pleurais extramediastinais foram os achados mais freqüentes, seguidos pelos implantes pleurais, no ângulo cardiofrênico, nos ângulos costofrênicos, no hiato aórtico e envolvimento retroperitoneal, näo se observando, neste estudo, o envolvimento pulmonar e os implantes pericárdicos e diafragmáticos. Concluímos que a tomografia computadorizada é excelente método de imagem para predizer o caráter invasivo dos timomas, permitindo observar com detalhe as interfaces entre as diferentes estruturas e uma visibilizaçäo clara das superfícies dos grandes vasos do mediastino, das pleuras e da junçäo toracoabdominal

Atelectasia redonda-aspectos tomográficos / Rounded atelectasis - computed tomograpy features

A atelectasia redonda é uma forma de colapso pulmonar associado com espessamento pleural, que pode simular neoplasia à telerradiografia de tórax. A anormalidade foi diagnosticada radiologicamente em três pacientes. Em dois deles a lesäo foi observada no lobo inferior esquerdo, e no outro, no lobo inferior direito. O aspecto era de massa arrendondada ou oval, adjacente à superfície pleural, que se encontrava espessada.Vasos e brônquios encurvados, penetrando na massa, foram vistos na face anterior das três lesöes, configurando o sinal da "cauda do cometa". O aspecto tomográfico típico permite o diagnóstico desta condiçäo benigna, evitando, assim, exames diagnósticos invasivos e procedimentos terapêuticos desnecessários.

Nefroma cístico multilocular benignoÄrelato de um caso / Benign multilocular cystic nephroma: a case report

Nefroma cístico multilocular benigno é uma neoplasia renal incomum, consistindo de múltiplos cistos näoÄcomunicantes.Neste trabalho érelatado um caso cujos achados à ultraÄsonografia e tomografia computadorizada foram característicos desta lesäo.O diagnóstico específico de nefroma cístico multilocular benigno permite limitar o procedimento cirúrgico, evitandonefrectomia desnecessária.

Displasia cemento-óssea florida: relato de dois casos e revisäo bibliográfica / Florid cemento-osseous dysplasia: report of two cases and review of the literature

Neste trabalho säo descritos dois casos de displasia cemento-óssea florida, em pacientes negras do sexo feminino. O exame radiológico evidenciou lesöes escleróticas bilaterais, entremeadas por áreas líticas. Os autores demonstram as características observadas nas radiografias e, em um dos casos, na tomografia computadorizada, e revisam a literatura sobre o assunto