Positron emission mammography-guided breast biopsy.

UNLABELLED: Positron emission mammography (PEM) is a technique to obtain planar images of the breast for detection of potentially cancerous, radiotracer-avid tumors. To increase the diagnostic accuracy of this method, use of minimally invasive methods (e.g., core biopsy) may be desirable for obtaining tissue samples from lesions detected with PEM. The purpose of this study was to test the capabilities of a novel method for performing PEM-guided stereotactic breast biopsies. METHODS: The PEM system consisted of 2 square (10 x 10 cm) arrays of discrete scintillator crystals. The detectors were mounted on a stereotactic biopsy table. The stereotactic technique used 2 PEM images acquired at +/-15 degrees and a new trigonometric algorithm. The accuracy and precision of the guidance method was tested by placement of small point sources of (18)F at known locations within the field of view of the imager. The calculated positions of the sources were compared with the known locations. In addition, simulated stereotactic biopsies of a breast phantom consisting of a 10-mm-diameter gelatin sphere containing a concentration of (18)F-FDG consistent with that reported for breast cancer were performed. The simulated lesion was embedded in a 4-cm-thick slab of gelatin containing a commonly reported concentration of FDG, simulating a compressed breast (target-to-background ratio, approximately 8.5:1). An anthropomorphic torso phantom was used to simulate tracer uptake in the organs of a patient 1 h after a 370-MBq injection of FDG. Five trials of the biopsy procedure were performed to assess repeatability. Finally, a method for verifying needle positioning was tested. RESULTS: The positions of the point sources were successfully calculated to within 0.6 mm of their true positions with a mean error of +/-0.4 mm. The biopsy procedures, including the method for verification of needle position, were successful in all 5 trials in acquiring samples from the simulated lesions. CONCLUSION: The success of this new technique shows its potential for guiding the biopsy of breast lesions optimally detected with PEM.

Effect of postmenopausal hormonal replacement therapy on mammographic density and parenchymal pattern.

PURPOSE: To measure changes and predictors of change in mammograms obtained in postmenopausal women undergoing continuous combined hormonal replacement therapy (HRT). MATERIALS AND METHODS: Mammograms of 41 postmenopausal women obtained before and 1 year after the initiation of HRT were evaluated blindly according to the quantitative density percentage method and the Wolfe classification system. RESULTS: Mammographic densities increased compared with baseline values in 73% of subjects (mean increase, 6.7%; 95% confidence interval, 2.5%, 11.0%; P = .003). A shift in Wolfe classification from lower to greater parenchymal density was noted in 24% of subjects (P = .016). Multivariate analysis results indicated that the lower the tissue density percentage before treatment, the greater the increase in density percentage after treatment. CONCLUSION: An increase in mammographic density was demonstrated in most subjects undergoing continuous combined HRT and was most pronounced in subjects with a lower baseline density percentage.

Congenital syphilis in Nebraska: a case report.

In the United States, the incidence of acquired syphilis has increased thirty four percent in the last decade with young, black, urban dwelling, drug dependent females representing the highest risk group. Concomitantly, congenital syphilis has increased causing spontaneous abortions, stillbirths, and neonatal morbidity and longterm neurologic sequela. Because physicians are no longer familiar with the disease, it is estimated that only twenty-five percent of neonatal syphilis is diagnosed during the first year of life. This report describes the first reported case of congenital syphilis in Nebraska. Our patient demonstrates the typical clinical findings of lethargy, extremity swelling and the pseudoparalysis of Parot, while laboratory evaluation showed anemia, abnormal hepatic enzymes, hypoproteinemia, and confirmatory positive neonatal VDRL and FTA-ABS. The plain film radiographic survey illustrated the characteristic findings of periostitis, metaphyseal banding and cortical erosion. By relying upon the relatively inexpensive and easy to obtain radiographic long bone survey a prompt diagnosis can be made and immediate treatment instituted while awaiting confirmatory serology. We must reacquaint ourselves with the increasing incidence of acquired and congenital syphilis. This will enable us to make a timely and cost-effective diagnosis of cogenital syphilis and prevent its devastating complications.

The reproducibility of measuring the anorectal angle in defecography.

Dynamic proctography is a radiographic procedure that has become widely used in the evaluation of pelvic floor function. The anorectal angle (ARA) is one parameter which is usually quantified during this examination. To determine the accuracy with which this measurement can be made, three physicians independently measured the resting and squeezing ARAs of 22 women. The coefficient of variation and the kappa statistic were used to describe the degree of agreement among the three examiners. These analyses revealed poor agreement among examiners for all 22 patients taken as individuals, (kappa less than or equal to 0.40; mean coefficient of variation at rest = 18 percent; mean coefficient during squeezing = 21 percent). These results suggest that measurements of ARAs will vary among examiners for any particular patient, even though individual examiners may demonstrate consistency in recording ARA data. There is wide interobserver variation in the measurement of the ARA from lateral radiographs, making quantification an exercise of only limited clinical value.

Iopamidol as a gastrointestinal contrast agent. Lack of peritoneal reactivity.

The ideal contrast agent in patients suspected of having gastrointestinal perforation is an iso-osmolar, or nearly iso-osmolar substance, that causes no peritoneal reaction. Iopamidol is a nonionic water-soluble contrast medium that may be considered in such situations. Intraperitoneal injections of ionic and nonionic contrast agents were compared in rats to study potentially harmful peritoneal inflammation. Only intraperitoneal barium injection produced any significant tissue reaction, such as adhesions and ascites. There was no difference between iopamidol and the other water-soluble contrast agents. Iopamidol may satisfy the need for nonreactive and nearly iso-osmolar contrast agents for evaluating patients with possible bowel perforation. However, the high cost of this agent may make its clinical application impractical.

A calcified vascular mediastinal mass.

We report the incidental finding of a late post-traumatic pseudoaneurysm of the thoracic aorta in a patient being treated for subarachnoid hemorrhage from a motorcycle accident. The diagnosis of calcified vascular mediastinal masses may be suspected from routine chest roentgenograms and confirmed by aortography. Computed tomography and magnetic resonance imaging are helpful when the diagnosis remains obscure. The recognition of chronic pseudoaneurysms is clinically important.

Osteosarcoma: role of CT in limb-sparing treatment.

The computed tomographic (CT) examinations of 17 patients undergoing evaluation for limb-sparing treatment of osteosarcoma were evaluated. In all cases information from CT directly affected the operative approach. The CT findings that helped in planning the operative approach included determination of intramedullary extent and evidence of "skip" metastases, direct extension into an adjacent joint, and neurovascular compromise. Performing CT of the affected bone at 1-cm intervals from the joint above through the joint below and including the contralateral side in the field of view allow precise localization of findings that can direct the operative approach. Close and contiguous scanning intervals allow identification of small intramedullary "skip" metastases that affect the resection margins.

Sternocostoclavicular hyperostosis: a review and report of 11 cases.

Sternocostoclavicular hyperostosis is a benign ossifying diathesis of unknown etiology characterized by hyperostosis and soft-tissue ossification between the clavicles, anterior portion of the upper ribs, and manubrium, with variable hyperostosis or ankylosis in the spine and sacroiliac joints. Our cumulative experience with 11 cases is reported, with emphasis on radiographic features of the condition. Scintigraphic results in five patients and computed tomographic findings in one patient are presented. A review of the literature and our own material indicates that sternocostoclavicular hyperostosis may be more common than has been previously recognized.

Computed tomography in diagnosis and management of multiple myeloma and its variants.

The use of computed tomography (CT) was evaluated in 25 patients with multiple myeloma, six with extramedullary plasmacytoma, and two with undiagnosed lesions. We found that CT was useful for (1) patients with multiple myeloma who had bone pain but normal roentgenograms, (2) patients with an M-protein, bone marrow plasmacytosis, and back pain from osteoporosis and compression fractures but an inconclusive diagnosis of multiple myeloma, (3) the determination of extent of tumor, and (4) guidance in needle biopsy.

Multiple myeloma: evaluation by CT.

Although patients who have multiple myeloma usually have straightforward clinical symptoms and corroborative radiographs, in some instances, these patients will present atypically, with symptoms suggesting active disease but radiographs that are normal or nonspecific. We reviewed the records of 32 patients who had documented multiple myeloma and had undergone CT examinations, assessing the value of those examinations. Although CT is not indicated in all patients who have multiple myeloma, it is especially useful in patients who have bone pain and normal or nonspecific radiographs. CT provided confirmatory information in all cases in which lesions were seen on radiographs. CT also frequently demonstrated a greater extent of disease than could be appreciated on the radiographs.

Ultrasound transmission computed tomography of the breast.

A preliminary clinical study of ultrasound transmission computed tomography of the breast (UTCTB) was undertaken to evaluate its capacity in the detection of breast abnormalities and to establish criteria for distinguishing benign from malignant lesions. Only patients with palpable and/or mammographically evident lesions were selected for study; complete analysis was accomplished in 78 cases. Visual and computer interpretations of reconstructed UTCTB scans were based on changes in speed of sound wave transmission and attenuation between the suspicious area and the surrounding tissue. In the computer-aided classification, discriminant functions were derived to predict the presence or absence of carcinoma. Visual analysis was subject to a low sensitivity. The presence of high speed transmission within a lesion usually indicated malignancy, although the converse was not true. Computer-aided preliminary screening of UTCTB scans by a trained technician may have the potential of contributing to interpretation accuracy; however, this finding must be highly qualified, given the methodologic constraints of the study.