Hereditary Hemorrhagic Telangiectasia Presenting with Asymptomatic Liver Lesions and a History of Early-onset Myocardial Infarction and Multiple Intracranial Aneurysms.

Hereditary hemorrhagic telangiectasia (HHT) is a genetic disorder of the vasculature, characterized by epistaxis, telangiectasia and arteriovenous malformations in multiple organs. We herein report a 49-year-old woman with a history of early-onset myocardial infarction and intracranial aneurysms, in whom we incidentally detected multiple hepatic vascular abnormalities. We subsequently diagnosed her with HHT after discovering gastrointestinal telangiectases and a pulmonary arteriovenous fistula along with a history of recurrent epistaxis. Whole-exome sequencing revealed a novel pathogenic variant in SMAD4, a relatively rare causative gene for HHT. This case highlights the fact that HHT patients may present with asymptomatic liver lesions.

The usefulness of vertebral needle targeting simulation training system using ray-summation imaging: experimental study.

PURPOSE: Using the multi-detector computed tomography and related three-dimensional imaging technology, we developed a vertebral needle targeting simulation training system named spinal needling intervention practice using ray-summation imaging (SNIPURS). Herein, we assessed the utility of SNIPURS by evaluating changes in the learning curves of SNIPURS trainees. METHODS: Twenty-one examinees were enrolled: seven experienced operators (expert group), seven trainees with coaching (coaching group), and seven trainees without coaching (non-coaching group). They performed six tests of vertebral needle targeting simulation on the workstation-generated spinal ray-summation images of six patients with vertebral fractures. In each test, they determined the bilateral trans-pedicular puncture points and angles on two thoracic and two lumbar vertebrae on ray-summation imaging (i.e., 8 simulations per test). The coaching group received coaching by a trainer after Tests 1 and 4, while the others did not. Scores were given based on the trans-pedicular pathway (1 point) or not (0 point). Eight virtual needles were evaluated in each of Tests 1-6. RESULTS: Among the three groups, the expert group had the highest average scores on Tests 1-4 (expert: 3.86, 6.57, 7.43, and 7.57; coaching: 1.86, 6.14, 6, and 6.29; and non-coaching: 1.14, 4.14, 4.71, and 4.86). The coaching group's scores caught up with the expert groups' average scores on Tests 5 and 6, whereas those of the non-coaching group did not (expert and coaching: 7.86 and 8.00, non-coaching: 5.86 and 7.14). All examinees in the expert and coaching groups achieved a perfect score on the final Test 6, whereas three of the seven non-coaching trainees did not. CONCLUSION: SNIPURS might be suitable for vertebral needle targeting training. The coaching provided during SNIPURS training helped the trainees to acquire the spinal puncture techniques in PVP.

Change in cancer diagnosis during the COVID-19 pandemic: Trends estimated from FDG-PET/CT.

The aim of this study is to clarify changes in the circumstances of cancer diagnoses during the COVID-19 pandemic in Tokyo, Japan, estimated from [18F]-2-fluoro-2-deoxy-D-glucose (FDG) -positron emission tomography/ computed tomography (PET/CT) for cancer patients. Cancer diagnosis in pandemic status (PANS) was evaluated by retrospective review of the findings of FDG-PET/CT examinations performed between 11 March 2020 and 28 December 2021 for initial staging and restaging for malignancy. Evaluation of cancer diagnosis in pre-pandemic status (pPANS) was conducted similarly in FDG-PET/CT examinations performed between 4 January 2018 and 10 March 2020. Of these, patients with malignant lymphoma (ML), lung cancer, esophageal cancer, and colorectal cancer who had a pathologically proven diagnosis or clinical diagnosis following therapy of the disease were selected for analysis. Initial cancer staging was determined by the diagnostic report of FDG-PET/CT. Change in cancer stage and in the number of FDG-PET/CT examinations performed was evaluated between pPANS and PANS, and according to term of the pandemic and vaccination status. The COVID-19 epidemic influenced the number of cancer patients who underwent FDG-PET/CT. There was a marked decrease in the number of cancer patients receiving FDG-PET/CT in Terms 1-3 (March 2020 to February 2021), but it recovered in Terms 4-6 (March 2021 to December 2021). There was no significant difference between PANS and pPANS in terms of the initial stage of cancer, but Stage IV ML and Stage II esophageal cancer were more frequent in PANS. Initial staging of ML, lung cancer, and esophageal cancer revealed more advanced cancer stages in Terms 4-6 compared with Terms 1-3. The number of patients receiving FDG-PET/CT in Tokyo was influenced by the COVID-19 epidemic. Staging based on FDG-PET/CT shifted to more advanced cancer stage during the pandemic compared with pre-pandemic.

Accuracy of vertebral puncture in percutaneous vertebroplasty.

PURPOSE: To clarify the accuracy of vertebral puncture of the vertebral tertile area needling (VETERAN) method puncturing the pedicle superimposed on one-third of the width between the lateral vertebral line to the contralateral medial lamina line compared with Cathelin-needle-assisted puncture (CAP) method puncturing using the Cathelin needle as a guide in percutaneous vertebroplasty. MATERIALS AND METHODS: 449 punctures by CAP method and 125 punctures by VETERAN method were enrolled. We compared the puncture accuracy of both methods. We estimated a vertebral estimated tilting ratio (VET-ratio) defined as ratio of the distance between the lateral vertebral line and the contralateral medial laminal line to the distance between the vertebral lateral line and the puncture point measured by computed tomography. We also estimated the procedural items and clinical outcomes. RESULTS: VETERAN method with 100% of punctures within safe zone (cortical breaches within 2 mm) had significantly higher accuracy than CAP method with 97.8% (p < 0.01) for the 2 mm incremental evaluation. No cases with a VET-ratio of 36% or less had cortical breaches. VETERAN method had shorter operative time per puncture (p < 0.01) and exposure time per puncture (p < 0.05). CONCLUSION: VETERAN method reduced the occurrence of the inaccurate puncture, operative times, and exposure times. A VET-ratio with 36% or less is associated with a safe puncture using VETERAN method.

A case of diffuse pulmonary lymphangiomatosis with a venous anomaly presenting with acute respiratory failure and hemoptysis.

Diffuse pulmonary lymphangiomatosis (DPL) is a rare lymphatic disease that can cause diverse respiratory symptoms. A 22-year-old man, whose chest CT had shown an abnormality for years, presented with acute respiratory failure due to the abrupt onset of hemoptysis. The diagnosis of DPL was confirmed by surgical lung biopsy and lymphangiography. Histopathological investigation showed dilated vascular and lymphatic vessels. DPL can cause acute and life-threatening symptoms during its chronic clinical course. A coexisting anomaly in the venous system may be present in DPL patients with hemoptysis.

A Fundamental Study Assessing the Diagnostic Performance of Deep Learning for a Brain Metastasis Detection Task.

PURPOSE: Increased use of deep convolutional neural networks (DCNNs) in medical imaging diagnosis requires determinate evaluation of diagnostic performance. We performed the fundamental investigation of diagnostic performance of DCNNs using the detection task of brain metastasis. METHODS: We retrospectively investigated AlexNet and GoogLeNet using 3117 positive and 37961 negative MRI images with and without metastasis regarding (1) diagnostic biases, (2) the optimal K number of K-fold cross validations (K-CVs), (3) the optimal positive versus negative image ratio, (4) the accuracy improvement curves, (5) the accuracy range prediction by the bootstrap method, and (6) metastatic lesion detection by regions with CNNs (R-CNNs). RESULTS: Respectively, AlexNet and GoogLeNet had (1) 50 ± 4.6% and 50 ± 4.9% of the maximal mean ± 95% confidence intervals (95% CIs) measured with equal-sized negative versus negative image datasets and positive versus positive image datasets, (2) no less than 10 and 4 of K number in K-CVs fell within the respective maximum biases of 4.6% or 4.9%, (3) 74% of the highest accuracy with equal positive versus negative image ratio dataset and 91% of that with four times of negative-to-positive image ratio dataset, (4) the accuracy improvement curves increasing from 69% to 74% and 73% to 88% as positive versus negative pairs of the training images increased from 500 to 2495, (5) at least nine and six out of 10-CV result sets essential to predict the accuracy ranges by the bootstrap method, and (6) 50% and 45% of metastatic lesion detection accuracies by R-CNNs. CONCLUSIONS: Our research presented methodological fundamentals to evaluate diagnostic features in the visual recognition of DCNNs. Our series will help to conduct the accuracy investigation of computer diagnosis in medical imaging.

The safety and efficacy of percutaneous vertebroplasty for patients over 90 years old.

OBJECTIVE: To retrospectively analyze the safety and efficacy of percutaneous vertebroplasty (PVP) for patients aged 90 or over. MATERIALS AND METHODS: We analyzed 130 consecutive patients with osteoporotic vertebral fractures who underwent a first-time PVP between May 2015 and September 2017 at our institution. We divided them into the elder patient group aged 90 years or over (n = 21) and the younger patient group under 90 years (n = 109). We compared the two groups' background, treatments, and outcomes using univariate analyzes and the log rank test. RESULTS: A significant difference was observed in dementia (19% in the younger group vs. 48% in the elder group, p < 0.01). No significant difference was revealed in the procedure time or the rate of complications. The post-PVP mobility function and the pain level were significantly improved compared to before PVP in both groups (p < 0.01 each). No significant differences were observed between the two groups in the recurrence of vertebral fracture after treatment (17% vs. 14%) or the 1-year survival rate (79% vs. 86%), respectively. CONCLUSION: The results of our analyzes suggested that a PVP can safely and effectively contribute to pain relief as well as the restoration of ambulation for patients aged 90 or over.

Artificial intelligence using neural network architecture for radiology (AINNAR): classification of MR imaging sequences.

PURPOSE: The confusion of MRI sequence names could be solved if MR images were automatically identified after image data acquisition. We revealed the ability of deep learning to classify head MRI sequences. MATERIALS AND METHODS: Seventy-eight patients with mild cognitive impairment (MCI) having apparently normal head MR images and 78 intracranial hemorrhage (ICH) patients with morphologically deformed head MR images were enrolled. Six imaging protocols were selected to be performed: T2-weighted imaging, fluid attenuated inversion recovery imaging, T2-star-weighted imaging, diffusion-weighted imaging, apparent diffusion coefficient mapping, and source images of time-of-flight magnetic resonance angiography. The proximal first image slices and middle image slices having ambiguous and distinctive contrast patterns, respectively, were classified by two deep learning imaging classifiers, AlexNet and GoogLeNet. RESULTS: AlexNet had accuracies of 73.3%, 73.6%, 73.1%, and 60.7% in the middle slices of MCI group, middle slices of ICH group, first slices of MCI group, and first slices of ICH group, while GoogLeNet had accuracies of 100%, 98.1%, 93.1%, and 94.8%, respectively. AlexNet significantly had lower classification ability than GoogLeNet for all datasets. CONCLUSIONS: GoogLeNet could judge the types of head MRI sequences with a small amount of training data, irrespective of morphological or contrast conditions.

Diagnostic performance in differentiation of breast lesion on digital mammograms: comparison among hard-copy film, 3-megapixel LCD monitor, and 5-megapixel LCD monitor.

We compared observer performance of digital mammography among hard-copy readings and soft-copy readings using 3-megapixel (3M) and 5-megapixel (5M) liquid crystal display (LCD) monitors. Five experienced radiologists assessed 80 mammograms of 40 cancers and 40 benign lesions. There were no significant differences among the average A(z) of three modalities and among the κ values for intra- and interobserver agreement. The soft-copy reading using the 3M LCD monitor took a slightly longer time, although there were no significant differences.

Non-mass-like enhancement on contrast-enhanced breast MR imaging: lesion characterization using combination of dynamic contrast-enhanced and diffusion-weighted MR images.

PURPOSE: To evaluate the diagnostic accuracy of a combination of dynamic contrast-enhanced MR imaging (DCE-MRI) and diffusion-weighted MR imaging (DWI) in characterization of lesions showing non-mass-like enhancement on breast MR imaging and to find the strongest discriminators between carcinoma and benignancy. MATERIALS AND METHODS: We analyzed consecutive MR images in 45 lesions showing non-mass like enhancement in 41 patients. We analyzed lesion size, distribution, internal enhancement, kinetic curve pattern, and apparent diffusion coefficient (ADC) values. We applied univariate and multivariate analyses to find the strongest indicators for malignancy. In a validation study, 22 non-mass-like enhancement lesions in 21 patients were examined. We calculated diagnostic accuracy when we presume category 4b, 4c, and 5 lesions as malignant or high to moderate suspicion for malignancy, and category 4a and 3 as low suspicion for malignancy or benign. RESULTS: Segmental distribution (P=0.018), clumped internal enhancement (P=0.005), and ADC less than 1.3 x 10(-3) mm(2)/s (P=0.047) were the strongest MR indicators of malignancy. In a validation study, sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 87% (13/15), 86% (6/7), 93% (13/14), 75% (6/8) and 86% (19/22), respectively. CONCLUSION: The combination of DCE-MRI and DWI showed high diagnostic accuracy in characterization of non-mass-like enhancement lesions on breast MR images.

Effect of cardiac function on aortic peak time and peak enhancement during coronary CT angiography.

PURPOSE: To examine the manner in which cardiac function affects the magnitude and timing of aortic contrast enhancement during coronary CT angiography (CTA). MATERIALS AND METHODS: Twenty-nine patients (21 men, 8 women; mean age, 64.4+/-13.4 years; mean weight, 59.4+/-10.3 kg) underwent measurement of cardiac output within 2 weeks of coronary CTA. The cardiac output of each patient was measured by the thermodilution technique and the cardiac index was calculated from the body surface area. During coronary CTA, attenuation of the descending aorta was measured at the workstation every 3s. The aortic peak time (APT) and aortic peak enhancement (APE) of each patient were calculated. Pearson's correlation coefficient analysis was used to investigate the relationships between the cardiac output or cardiac index and APT or APE. Furthermore, the relationship between patient factors or parameters on test bolus injection and APT or APE was also evaluated. RESULTS: The range of cardiac output, cardiac index, APT, and APE was 1.55-10.46 L/min (mean: 4.77+/-2.13), 1.11-5.30 L/(min-m(2)) (mean: 3.28+/-1.08), 25-51 s (mean: 38.3+/-7.5), and 273.1-598.1 HU (mean: 390.4+/-72.1), respectively. With an increase in the cardiac index, both APT (r=-0.698, p<0.0001) and APE (r=-0.573, p=0.0009) decreased. There were significant correlations between the patient body weight and APT and APE with the test bolus injection, and with APT and APE during coronary CTA. CONCLUSION: The APT and APE during coronary CTA are closely related to cardiac function.

Detection of breast cancer by soft-copy reading of digital mammograms: comparison between a routine image-processing parameter and high-contrast parameters.

BACKGROUND: Recent studies have reported the clinical usefulness of the soft-copy reading of mammograms. However, image-processing parameters for soft-copy reading of digital mammograms have not been established. PURPOSE: To compare observer performance in detecting breast cancer by soft-copy reading of digital mammograms using a routine image-processing parameter versus each of several high-contrast parameters. MATERIAL AND METHODS: The mammograms of 154 breasts, including 48 abnormal breasts with breast cancer and 106 normal breasts, were examined. Cancers were classified into 34 mass-dominant cancers, 11 microcalcification-dominant cancers, two cancers showing only architectural distortion, and one cancer without abnormal findings. All mammograms were performed using a computed radiography (CR) system. Each image was processed using GA (1.2), which was the contrast parameter recommended by the manufacturer for hard-copy film, GA (1.4), GA (1.6), and GA (1.8). These images were displayed on 5-megapixel (M) liquid-crystal display monitors. Five experienced radiologists classified them into BI-RADS category 1-2 or 3-5, and were also asked to rate the images on a scale of 0 to 100 for the likelihood of the presence of masses and microcalcifications in each breast. RESULTS: In mass-dominant cancers of dense breast tissue, the mean sensitivities of GA (1.2), GA (1.4), GA (1.6), and GA (1.8) were 32.7, 38.2, 36.4, and 40.0, and the A(Z) values were 0.67, 0.73, 0.71, and 0.73, respectively; in microcalcification-dominant cancers, the mean sensitivities were 80.0, 74.5, 80.0, and 78.2, respectively; however, there were no significant differences among them. CONCLUSION: High-contrast parameters tended to show relatively high sensitivity and A(Z) values in the detection of masses in dense breast tissue, but relatively low sensitivity for microcalcifications.

Circumscribed mass lesions on mammography: dynamic contrast-enhanced MR imaging to differentiate malignancy and benignancy.

PURPOSE: We evaluated the magnetic resonance (MR) features of breast lesions showing circumscribed mass on mammography to understand the characteristics that differentiate malignancy and benignancy. MATERIALS AND METHODS: Our institutional review board approved the study, and informed consent was waived. Using logistic regression analysis, we examined morphologic and kinetic MR imaging data of 90 breast lesions (43 malignant, 47 benign) that showed circumscribed mass on mammography. RESULTS: Features identified as having high odds for malignancy included: rim enhancement (odds ratio, 70.894; 95% confidence interval (CI), 7.525-667.938); heterogeneous enhancement (odds ratio, 10.839; 95% CI, 1.032-113.856); and washout dynamic pattern (odds ratio, 46.262; 95% CI, 3.716-575.901). Combinations of washout dynamic pattern and either rim or heterogeneous enhancement reflected excessively high prediction probability for malignancy (>0.95), whereas combinations lacking washout dynamic pattern and with either homogeneous enhancement or dark internal septation revealed excessively low prediction probability for malignancy (<0.05). CONCLUSION: Breast cancers with circumscribed mass on mammography could be differentiated from benign masses using internal enhancement and the kinetic pattern of contrast-enhanced breast MR imaging.

Enhanced mass on contrast-enhanced breast MR imaging: Lesion characterization using combination of dynamic contrast-enhanced and diffusion-weighted MR images.

PURPOSE: To evaluate the diagnostic accuracy of a combination of dynamic contrast-enhanced MR imaging (DCE-MRI) and diffusion-weighted MR imaging (DWI) in characterization of enhanced mass on breast MR imaging and to find the strongest discriminators between carcinoma and benignancy. MATERIALS AND METHODS: We analyzed consecutive breast MR images in 270 patients; however, 13 lesions in 93 patients were excluded based on our criteria. We analyzed tumor size, shape, margin, internal mass enhancement, kinetic curve pattern, and apparent diffusion coefficient (ADC) values. We applied univariate and multivariate analyses to find the strongest indicators of malignancy and calculate a predictive probability for malignancy. We added the corresponding categories to these prediction probabilities for malignancy and calculated diagnostic accuracy when we consider category 4b, 4c, and 5 lesions as malignant and category 4a, 3, and 2 lesions as benign. In a validation study, 75 enhancing lesions in 71 patients were examined consecutively. RESULTS: Irregular margin, heterogeneous internal enhancement, rim enhancement, plateau time-intensity curve (TIC) pattern, and washout TIC pattern were the strongest indicators of malignancy as well as past studies, and ADC values less than 1.1x10(-3) mm2/s were also the strongest indicators of malignancy. In a validation study, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 92% (56/61), 86% (12/14), 97% (56/58), 71% (12/17), and 91% (68/75), respectively. CONCLUSION: The combination of DWI and DCE-MRI could produce high diagnostic accuracy in the characterization of enhanced mass on breast MR imaging.

Parotid gland tumors: can addition of diffusion-weighted MR imaging to dynamic contrast-enhanced MR imaging improve diagnostic accuracy in characterization?

PURPOSE: To determine the value of adding diffusion-weighted (DW) magnetic resonance (MR) imaging to dynamic contrast material-enhanced MR imaging when distinguishing between benign and malignant parotid tumors. MATERIALS AND METHODS: This retrospective study was approved by the institutional review board, and the informed consent requirement was waived. The authors analyzed MR images of 50 lesions (36 benign, 14 malignant) in 47 patients. DW MR imaging and dynamic contrast-enhanced MR imaging were performed in all patients. Time-intensity curve (TIC) patterns were categorized as follows: type A, time to peak was more than 120 seconds; type B, time to peak was 120 seconds or less with high washout ratio (> or = 30%); type C, time to peak was 120 seconds or less with low washout ratio (< 30%); and type D, flat. The apparent diffusion coefficient (ADC) values were measured on DW MR images. Sensitivity, specificity, accuracy, and positive and negative predictive values were calculated for type A, B, and D tumors regarded as benign and for type C tumors regarded as malignant. On the basis of DW MR imaging results, ADC threshold values between pleomorphic adenomas and carcinomas and between Warthin tumors and carcinomas were selected. Diagnostic accuracy was compared before and after modification diagnosis referring to the ADC value obtained with the McNemar test. P < .05 was considered to indicate a significant difference. RESULTS: ADC threshold values were 1.4 x 10(-3) mm(2)/sec between pleomorphic adenomas and carcinomas and 1.0 x 10(-3) mm(2)/sec between Warthin tumors and carcinomas. Accuracy (82% vs 94%) and positive predictive value (67% vs 92%) significantly improved with the addition of ADC values in the evaluation of patients with type B or C tumors. CONCLUSION: A persistent or flat TIC pattern on dynamic contrast-enhanced MR images indicates benign disease, but there is added value from including the ADC value in the evaluation of tumors that show a plateau or washout TIC pattern.

Effect of passive muscle length change on apparent diffusion coefficient: detection with clinical MR imaging.

PURPOSE: We investigated whether change in muscle microstructure associated with passive extension and contraction affects proton diffusivity. MATERIAL AND METHODS: In 6 male subjects, we compared apparent diffusion coefficients (ADC) along the posterior-to-anterior (ADC-PA), right-to-left (ADC-RL) and superior-to-inferior (ADC-SI) directions of the right tibialis anterior muscle with the ankle joint in passive plantar flexion and passive dorsiflexion. RESULTS: Compared to the respective ADCs at plantar flexion, the ADC-PA (P=0.002) and ADC-RL (P=0.008) were significantly greater, but ADC-SI (P=0.008) significantly lower at dorsiflexion. CONCLUSION: Our results indicate that change in muscle microstructure associated with passive extension and contraction would affect proton diffusivity, and this alteration of proton diffusivity could be detected by measuring ADC with a clinical magnetic resonance scanner.

Alteration of proton diffusivity associated with passive muscle extension and contraction.

PURPOSE: To determine whether passive muscle extension and contraction affect the proton diffusivity of the muscle. MATERIALS AND METHODS: Five male subjects were examined. The fractional anisotropy (FA), and primary (lambda(1)), secondary (lambda(2)), and tertiary eigenvalues (lambda(3)) of the right tibialis anterior and medial gastrocnemius muscles were compared between conditions of passive plantar flexion and passive dorsiflexion of the ankle joint. RESULTS: In the tibialis anterior, FA, and lambda(1) at dorsiflexion decreased significantly (P < 0.01 and P < 0.01, respectively) compared to those at plantar flexion, but lambda(3) at dorsiflexion increased significantly (P = 0.02). In the gastrocnemius, FA and lambda(1) at dorsiflexion increased significantly (P < 0.01 and P < 0.01, respectively) compared to those at plantar flexion, but lambda(3) at dorsiflexion decreased significantly (P < 0.01). The lambda(2) value showed no significant change in either the tibialis anterior or medial gastrocnemius. CONCLUSION: The results indicate that passive muscle extension and contraction associated with passive joint movement would affect the proton diffusivity of the muscle. This alteration of proton diffusivity is probably associated with microscopic structural changes of the muscle.

Computed tomographic and magnetic resonance features of inflammatory myofibroblastic tumor of the lung in children.

We report two cases of inflammatory myofibroblastic tumor (IMT) of the lung in a 4-year-old boy and a 7-year-old girl. We performed dynamic contrastenhancement computed tomography in both of our cases and dynamic contrast enhancement magnetic resonance imaging (MRI) in one case. These dynamic studies showed a demarcated mass with delayed enhancement in both cases. A T1-weighted MR image shows a mass with homogeneous low signal intensity, and a T2- weighted image shows a mass with slightly high signal intensity. A post-contrast-enhanced T1-weighted image demonstrates homogeneous enhancement. We speculate that the delayed enhancement could be attributed to the abundant fibrous tissue, which was the main structural material of the tumor. This same finding has been described in previous reports of IMT in other organs.

Optimal gradation processing parameter for soft-copy reading of digital mammogram: comparison between the parameter recommended for hard-copy and other parameters.

PURPOSE: To investigate optimal gradation processing parameter for soft-copy reading comparing the parameter recommended for hard-copy with other parameters. MATERIALS AND METHODS: Digital mammograms using a Computed Radiography system were evaluated. The gradation processing parameter recommended by the manufacturer was GA (1.2). We prepared seven parameters that changed the degree of contrast: GA (0.6, 0.8, 1.0, 1.2, 1.4, 1.6, and 1.8). Images of an anthropomorphic breast phantom were displayed on a 5-megapixel liquid crystal display monitor using each parameter. Three readers independently assessed each image, and scored for the following items: intramammary contrast, extramammary contrast, sharpness, and graininess. Total score was calculated in each parameter. We also displayed normal mammograms of nine cases: three with a scattered fibroglandular density, three with a heterogeneously dense breast, and three with an extremely dense breast. These were displayed using GA (1.2) or using parameters with a higher total score than GA (1.2) in the phantom test. Three readers assessed each mammogram as in the phantom test. RESULTS: In phantom test, GA (1.4), GA (1.6), and GA (1.8) obtained higher scores than GA (1.2). In normal cases tested using these parameters, GA (1.4) obtained the highest score. This was significantly higher than that of GA (1.2) (P=0.004). The score obtained for GA (1.4) was the highest in cases with extremely dense and heterogeneously dense breast tissue, though there was no statistically significant difference. CONCLUSION: Soft-copy image quality was improved by gradient processing using higher contrast parameter than that routinely used in hard-copy, especially in dense breast cases.