Pearls and Pitfalls of Interpretation of Automated Breast US.

Dense breast tissue is an independent risk factor for breast cancer and reduces the sensitivity of mammography. Patients with dense breast tissue are more likely to present with interval cancers and higher-stage disease. Successful breast cancer screening outcomes rely on detection of early-stage breast cancers; therefore, several supplemental screening modalities have been developed to improve cancer detection in dense breast tissue. US is the most widely used supplemental screening modality worldwide and has been proven to demonstrate additional mammographically occult cancers that are predominantly invasive and node negative. According to the American College of Radiology, intermediate-risk women with dense breast tissue may benefit from adjunctive screening US due to the limitations of mammography. Several studies have demonstrated handheld US (HHUS) and automated breast US (AUS) to be comparable in the screening setting. The advantages of AUS over HHUS include lack of operator dependence and a formal training requirement, image reproducibility, and ability for temporal comparison. However, AUS exhibits unique features that can result in high false-positive rates and long interpretation times for new users. Familiarity with the common appearance of benign mammographic findings and artifacts, technical challenges, and unique AUS features is essential for fast, efficient, and accurate interpretation. The goals of this article are to (a) examine the role of AUS as a supplemental screening modality and (b) review the pearls and pitfalls of AUS interpretation. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.

Pseudolesions Impersonating Osseous Tumor Involvement on Both Contrast Enhanced CT and FDG PET/CT.

A 27-year-old man with stage IV-B Hodgkin's lymphoma status post autologous peripheral stem cell transplant in 2015 with complete response, presented in 2017 with increasing back pain. Restaging contrast enhanced CT demonstrated left brachiocephalic vein occlusion with peripheral nodular high density areas within C7-T2 vertebral bodies with corresponding radiotracer uptake on same day PET/CT. No matching lesion was seen on noncontrast CT. Findings were consistent with pooling of contrast and radiotracer within vertebral venous plexus collaterals at the cervicothoracic junction secondary to brachiocephalic vein occlusion. Repeat PET/CT with contralateral injection of radiotracer and MRI confirmed absence of osseous lymphomatous involvement.