Comparison Of Imaging Findings Research Articles

Comparative Study of Positron Emission Tomography/Computed Tomography and Computed Tomography in the Evaluation of Post-treatment Carcinoma Cervix Patients.

Purpose of Study:To evaluate and compare imaging findings using computed tomography (CT) alone and positron emission tomography/CT (PET/CT) fusion imaging in posttreatment carcinoma cervix patients for recurrence.Subjects and Methods:From June 2014 to May 2016, 50 posttreatment carcinoma cervix patients were referred to our institution for PET/CT imaging. In all 50 of these patients referred for evaluation, a reliable reference standard was available. The reference standard was established by histopathological examination of accessible locoregional and nodal/distant metastatic involvement or follow-up of patients. CT and PET/CT were performed and analyzed for locoregional, pelvic nodal, and distant metastasis involvement in posttreatment carcinoma cervix cases.Results:In the evaluation of locoregional involvement, CT alone was found to have a sensitivity of 75% and specificity of 90% while PET/CT was found to have a sensitivity of 95% and specificity of 100%. Furthermore, in evaluation of pelvic nodal involvement, CT alone was found to have a sensitivity of 72% and specificity of 92.6% while PET/CT was found to have a sensitivity of 95.5% and specificity of 92.9%. In context to distant metastasis involvement (including para-aortic nodes), CT alone was found to have a sensitivity of 91.7% and specificity of 96.2% while PET/CT was found to have a sensitivity of 95.8% and specificity of 100%. PET/CT fusion in comparison to CT alone is better in sensitivity and specificity in the detection of locoregional involvement, pelvic node invasion, and distant metastasis in posttreatment carcinoma cervix cases.

Subtalar instability: imaging features of subtalar ligaments on 3D isotropic ankle MRI

BackgroundMRI analysis of subtalar ligaments in the tarsal sinus has not been well performed. We retrospectively investigated the appearance of subtalar ligaments using 3D isotropic MRI and compared imaging findings of subtalar ligaments between patients with subtalar instability (STI) and controls.MethodsPreoperative MRIs of 23 STI patients treated with arthroscopic subtalar reconstruction were compared to MRIs of 23 age- and sex-matched control subjects without STI. Thickness and width of anterior capsular ligament (ACL) and interosseous talocalcaneal ligament (ITCL) as well as thickness of calcaneofibular ligament (CFL) and anterior talofibular ligament (ATFL) were measured. Abnormalities in ACL, ITCL, CFL, ATFL, cervical ligament, and inferior extensor retinaculum were analyzed.ResultsSTI patients had significantly smaller ACL thickness and ACL width than controls (ACL thickness: 1.73 mm vs. 2.22 mm, p = 0.007; ACL width: 7.21 mm vs. 8.80 mm, p = 0.004). ACL thickness of ≤2.1 mm had a sensitivity of 66.7% and a specificity of 66.7% for diagnosis of STI. ACL width of ≤7.9 mm had a sensitivity of 80.0% and a specificity of 76.2% for the diagnosis of STI. However, thickness and width of ITCL, thickness of CFL, or thickness of ATFL was not significantly different between the two groups. Absence or complete tear of ACL was significantly more frequent in STI patients than that in controls (34.8% vs. 8.7%, p = 0.035). Complete tear of CFL and ATFL was more common in STI patients than that in controls, although the difference between the two groups was not statistically significant. Abnormalities of ITCL, cervical ligament, or inferior extensor retinaculum were not significantly different between the two groups.ConclusionsMRI features of thin or narrow ACLs may suggest STI. Absence or complete tear of ACL was significantly more common in STI patients than that in controls.

MRI assessment of the postprandial gastrointestinal motility and peptide response in healthy humans

Feeding triggers inter-related gastrointestinal (GI) motor, peptide and appetite responses. These are rarely studied together due to methodological limitations. Recent MRI advances allow pan-intestinal, non-invasive assessment of motility in the undisturbed gut. This study aimed to develop a methodology to assess pan-intestinal motility and transit in a single session using MRI and compare imaging findings to GI peptide responses to a test meal and symptoms in a healthy volunteer cohort. Fifteen healthy volunteers (29.3±2.7years and BMI 20.1±1.2kgm-2 ) underwent baseline and postprandial MRI scans, symptom questionnaires, and blood sampling (for subsequent GI peptide analysis, Glucagon-like peptide-1 [GLP-1], Polypeptide YY [PYY], Cholecystokinin [CCK]) at intervals for 270minutes following a 400g soup meal (204kcal, Heinz, UK). Gastric volume, gall bladder volume, small bowel water content, small bowel motility, and whole gut transit were measured from the MRI scans. (mean±SEM) Small bowel motility index increased from fasting 39±3 arbitrary units (a.u.) to a maximum of 87±7a.u. immediately after feeding. PYY increased from fasting 98±10pgmL-1 to 149±14pgmL-1 at 30minutes and GLP-1 from fasting 15±3μgmL-1 to 22±4μgmL-1 . CCK increased from fasting 0.40±0.06pmolmL-1 to 0.94±0.1pmolmL-1 . Gastric volumes declined with a T1/2 of 46±5minute and the gallbladder contracted from a fasting volume of 19±2mL-1 to 12±2mL-1 . Small bowel water content increased from 39±2mL-1 to 51±2mL-1 postprandial. Fullness VAS score increased from 9±5mm to 41±6mm at 30minutes postprandial. The test meal challenge was effective in inducing a change in MRI motility end-points which will improve understanding of the pathophysiological postprandial GI response.

Early Postoperative Imaging of the Labyrinth by Cone Beam CT After Stapes Surgery for Otosclerosis With Correlation to Audiovestibular Outcome.

Sensorineural complications of stapes surgery are rare but potentially serious. Imaging is usually performed to identify an underlying cause, such as excessive intravestibular penetration of the prosthesis or pneumolabyrinth suggesting perilymphatic fistula. Unfortunately, there is very little data in an unselected series of uneventful patients.The aim of this study was to analyze the depth of prosthesis penetration within the vestibule and the rate of pneumolabyrinth the day or the day after the procedure by performing a cone beam computed tomography of the temporal bone in a cohort of unselected patients, and to correlate imaging findings to clinical outcome. A prospective monocentric study was conducted in a tertiary referral medical center. A cone beam computed tomography was performed in 80 consecutive patients having undergone stapes surgery for otosclerosis, the day or the day after the procedure. Penetration length and location of the prosthesis within the vestibule, as well as presence or absence of a pneumolabyrinth, were recorded, and compared with clinical data (vertigo, nystagmus, hearing measurement). Pneumolabyrinth was found in 15% of the patients. The mean penetration length of the prosthesis within the vestibule was 1 mm (0-1.9 mm). No serious complication occurred during the study period. No correlations were found when comparing imaging findings to clinical outcome. Our results do not support empirically insights into detrimental effects of postoperative pneumolabyrinth or too long prosthesis after stapes surgery. Further studies are needed to better understand the causes of postoperative complications of stapes surgery.

Sinonasal imaging findings in granulomatosis with polyangiitis (Wegener granulomatosis): A systematic review.

Granulomatosis with polyangiitis (GPA) (Wegener granulomatosis) frequently presents in the head and neck, and the sinonasal cavity is among the most common areas affected. Although the clinical findings, histologic appearance, and laboratory workup have been described, characteristic findings and the distribution of disease on sinonasal imaging are not well established. The appropriate imaging modality to evaluate for sinonasal involvement is also unclear. To describe the imaging characteristics, distribution, and location of sinonasal pathology in patients with GPA as noted on computed tomography and magnetic resonance imaging modalities. A systematic review was conducted of English language articles, by using appropriate search terms, which reported the computed tomography and magnetic resonance imaging findings specific to sinonasal disease in adult subjects with GPA. Studies were included only when they focused primarily on specific imaging results in patients with GPA. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. A total of 50 articles were identified on an initial search of medical literature data bases. There were seven articles that comprised 224 patients who met inclusion criteria. All the articles were retrospective case series and descriptive in nature. A high incidence of patients with GPA who were imaged showed evidence of pathologic findings. The prevalence of key radiographic findings in patients with GPA were the following: mucosal thickening (87.7% of patients), bony destruction (59.9%), and septal erosion (59.4%). There were no randomized or prospective studies that compared imaging findings between patients with GPA and the controls, and no studies that correlated imaging findings with prognosis. Sinus imaging in GPA revealed a spectrum of nonspecific findings. The constellation of septal erosion, mucosal thickening, and bony changes should raise suspicion for GPA. The current literature was insufficient to make any comments on the time course of sinonasal disease and imaging manifestations. Further comparative studies are needed to determine a role for sinonasal imaging in the diagnosis and prognosis of GPA.

Abstract P1-01-09: Ductal carcinoma in situ: A comparative study between histopathological characteristics and imaging findings

Abstract Background: The treatment policy for ductal cancer in situ (DCIS) of the breast greatly depends on the spreading diagnosis. However, a problem is that we cannot compare imaging findings with the histopathology of DCIS. The purpose of this study was to investigate the histopathological characteristics of DCIS and the association with imaging findings. Methods: Subjects were 128 patients from Tokai University Hospital, diagnosed with DCIS. A positive finding on ultrasonography (USG) was defined as Breast Imaging Reporting and Data System (BI-RADS) of US category 3 or above, in mammography (MMG) it was Japan Breast Cancer Society category 2 or above, and in MRI it was BI-RADS-MRI category 3 or above. Histopathologically, we re-classified DCIS into 3 subtypes. Table. Histopathological classification of the 3 DCIS subtypesSubtypesArchitectures of DCISType 1Flat and/or micropapillaryType 2Cribriform and/or papillaryType 3Solid and/or comedo, solid or comedo with any other architecture patterns, e.g. solid and cribriform or papillary, etc. The microscopic examination items included the nuclear grade, necrosis and calcification, stromal reactions surrounding DCIS, distribution of DCIS, and with or without adenosis or other benign changes in the background breast. The automated image analysis using figures captured from virtual system are planned to evaluate concentration of DCIS distribution. Results: 1) The clinical characteristics and association between imaging findings and histopathological classification of the 3 subtypes of DCIS are summarized as: a) Histopathologically, in type 3, there was a higher frequency of necrosis and calcification in the ducts of DCIS (χ2, p<0.001), the number of dilated peri-ductal capillaries was greater than in type 1 (p=0.023), and the distribution of DCIS was concentrated in type 3 (p=0.020); b) In imaging findings, type 3 was easier to detect than type 1 on USG (p=0.008), but there were no significant differences in MMG and MRI. 2) The 14 DCIS cases that could not be detected by USG, showed slight edematous or myxoid change in the stroma histopathologically (p<0.001), and were less likely to be detected by MRI (p=0.004). 3) The 6 MRI un-detected cases were less likely to be detected by USG (p=0.004), and the occurrence of adenosis or other benign changes in the background breast interfered with MRI (p=0.010). Peri-ductal capillaries seemed to be an important factor for MRI detection (p=0.007). 4) The results of automated image analysis will be presented. Conclusion: USG imaging reflected the histopathological subtypes of DCIS, myxoid changes of the stroma, and the concentration of DCIS ducts. MRI was correlated with the peri-ductal capillaries of DCIS and the changes in the background breast, while MMG can make up for the shortcomings of USG and MRI. It is important for us to keep the histopathological type in mind and interpret the imaging findings comprehensively, when we do a spreading diagnosis of DCIS. Citation Format: Tang X, Yamashita T, Kumaki N, Tokuda Y, Masuda S. Ductal carcinoma in situ: A comparative study between histopathological characteristics and imaging findings. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-01-09.

Comparison of CT and contrast-enhanced ultrasound findings in hepatic angiomyolipoma with pathological correlations

To compare imaging findings of CT and contrast-enhanced US (CEUS) in hepatic angiomyolipoma (HAML) and investigate their pathological correlations. Imaging findings and preoperative diagnosis of CT and CEUS were retrospectively compared head to head in 46 patients with 54 histologically proven HAMLs. Correlations between imaging features and preoperative diagnosis with pathological types of HAMLs were analyzed. Fat was detected in 100% of lipomatous type, 84.6% of mixed type, and 7.1% of myomatous type (p = 0.000) of HAML at unenhanced CT. Well-defined hyper-echogenicity was displayed in 100% of lipomatous type, 88.5% of mixed type, 50% of myomatous type, and 66.7% of angiomatous type of HAMLs at unenhanced US. More arterial hyper-enhancement was noted on CEUS (100%) than on CT (73.1%) in mixed type (p = 0.015) and in lipomatous type (90.9% vs. 9.1%, p = 0.000) of HAMLs. Washout was present in more HAMLs on CT than on CEUS (42.6% vs. 18.5%, p = 0.007). Correct preoperative diagnosis was suggested in more HAMLs of myomatous type on CEUS than on CT (42.9% vs. 0%, p = 0.016) but showed no difference in other types of HAMLs. There are considerable discrepancies between CT and CEUS findings of HAMLs, and the imaging appearance and preoperative diagnosis of HAMLs on CT and CEUS are significantly affected by pathological types of HAMLs.

(18)F-DOPA PET/CT in the diagnosis and localization of persistent medullary thyroid carcinoma.

To evaluate the performance of (18)F-L-dihydroxyphenylalanine ((18)F-DOPA) PET/CT in the detection of locoregional and distant medullary thyroid carcinoma (MTC) metastases and to compare imaging findings with histological data. We retrospectively evaluated 86 MTC patients with persistently high serum calcitonin levels after initial surgery who had undergone (18)F-DOPA PET/CT between January 2007 and December 2014 in two referral centres. They were followed up for at least 6months after the PET/CT assessment. The results were compared with histological data or with the findings obtained during follow-up using a complementary imaging modality. (18)F-DOPA PET/CT was positive in 65 of the 86 patients, corresponding to a patient-based sensitivity of 75.6 %. Distant metastatic disease (M1) was seen in 29 patients including 11 with previously unknown metastases revealed only by PET/CT. Among the 36 patients without distant metastatic spread, 25 had nodal involvement limited to the neck, and 10 of these 25 patients underwent reoperation. The lymph node compartment-based sensitivity of (18)F-DOPA PET/CT was 100 % in the two institutions but lesion-based sensitivity was only 24 %. Preoperative and postoperative median calcitonin levels were 405 pg/mL (range 128-1,960 pg/mL) and 259 pg/mL (range 33-1,516 pg/mL), respectively. None of the patients achieved normalization of serum calcitonin after reoperation. (18)F-DOPA PET/CT enables early diagnosis of a significant number of patients with distant metastasis. It has a limited sensitivity in the detection of residual disease but provides high performance for regional analysis. A surgical compartment-oriented approach could be the approach of choice whatever the number of nodes revealed by (18)F-DOPA PET/CT.

Vascular uterine abnormalities: Comparison of imaging findings and clinical outcomes

ObjectiveTo retrospectively compare the imaging findings and the outcomes for patients with vascular uterine abnormalities (VUA) and to identify prognostic factors. Material and methodsBetween 2007 and 2012, 38 patients with vaginal bleeding and abnormal ultrasonographic (US) findings consistent with acquired VUA were consecutively included (mean age 31.6 years, range 19–62). Follow-up was 32 months in mean (1–78 months). Seventeen women (44.7%) started bleeding immediately after curettage, spontaneous miscarriage, trophoblastic disease, or section scars, with the remainder starting bleeding after 8 days to 2 years. All US, CT (n=2), MR (n=5) and angiographic (n=26) images were reviewed and compared to medical reports in order to identify severe VUA requiring treatment, and predictive factors. ResultsNo information about severity was provided by US, MRI or CT. Twelve patients were successfully managed conservatively. Angiography identified 6 non-severe VUA, corresponding to an isolated uterine hyperemia, and 20 severe VUA, corresponding to an association of a nidus and early venous drainage. Recurrences were more often observed for severe VUA (p=0.001). The hemoglobin level was significantly lower (below 11g/L) in these cases (p=0.004). Recurrences were significantly more frequently observed for patients with history of dilatation and curettage (p=0.02). Hysterectomy was performed for three patients only (8%). Among the women who wished to have children, 14 (77.8%) were pregnant after 9 months in mean (range 2–23). ConclusionsRecurrence happens more frequently after curettage and in case of anemia or severe VUA findings on angiography, justifying adequate embolization for these patients.

Angiomyolipoma (AML) without visible fat: Ultrasound, CT and MR imaging features with pathological correlation.

To compare imaging findings with histopathology in AML without visible fat (AMLwvf). With IRB approval, we identified 18 AMLwvf that underwent CT between 2002-2014. A radiologist measured NECT-attenuation, corticomedullary (CM) and nephrographic (NG) enhancement, echogenicity relative to renal cortex (RC) (N = 5), T2W (T2AML/T2RC) signal-intensity (SI), and chemical-shift SI ([SIIN-PHASE - SIOPPOSED-PHASE]/SIIN-PHASE) indices (N = 6). A pathologist re-evaluated 15/18 AMLwvf for 1) < or > 25% adipocytes/high-power-field (HPF), 2) "many or few" blood vessels. Comparisons were performed using chi-square and independent t-tests. 73.3%(11/15) of AMLwvf had <25% adipocytes/HPF and 86.7%(13/15) had "many" blood vessels. NECT-attenuation was 41.8(±6.9) HU. 61.1 %(11/18) of AMLwvf were hyper-attenuating and 38.9%(7/18) iso-attenuating; attenuation was associated with %-adipocytes/HPF, (p = 0.01). CM/NG enhancement were 63.3(±20.8)/51.7(±15.5) HU. 72.2%(13/18) of AMLwvf had wash-out enhancement, with no association with amount of blood vessels at pathology, (p = 0.68). No difference in echogenicity was noted by histology (p > 0.05). All AMLwvf were T2-hypointense (SI ratio = 0.61 [±0.1]). 2/6 AMLwvf showed SI drop on chemical-shift MRI; both were iso-attenuating and were associated with >25% adipocytes/HPF (p = 0.04). AMLwvf are typically T2-hypointense and hyper-attenuating with wash-out enhancement due to abundant smooth muscle and vessels respectively. Iso-attenuating AMLwvf with microscopic fat on MRI contain more adipocytes/HPF. • Five percent of AML do not demonstrate detectable fat on imaging • These AML are hyperattenuating and T2-hypointense due to abundant smooth muscle • These AML show washout enhancement without association to vessel count at histopathology • Iso-attenuating AML with microscopic fat on MRI show >25% adipocytes/HPF • The term "AML without visible fat" is proposed to reduce ambiguity.

A systematic review and meta-analysis of 18F-labeled amyloid imaging in Alzheimer's disease

BackgroundAmyloid imaging using fluorine 18–labeled tracers florbetapir, florbetaben, and flutemetamol has recently been reported in Alzheimer's disease (AD). MethodsWe systematically searched MEDLINE and EMBASE for relevant studies published from January 1980 to March 2014. Studies comparing imaging findings in AD and normal controls (NCs) were pooled in a meta-analysis, calculating pooled weighted sensitivity, specificity, and diagnostic odds ratio (OR) using the DerSimonian-Laird random-effects model. ResultsNineteen studies, investigating 682 patients with AD, met inclusion criteria. Meta-analysis demonstrated a sensitivity of 89.6%, a specificity of 87.2%, and an OR of 91.7 for florbetapir in differentiating AD patients from NCs, and a sensitivity of 89.3%, a specificity of 87.6%, and a diagnostic OR of 69.9 for florbetaben. There were insufficient data to complete analyses for flutemetamol. ConclusionsResults suggest favorable sensitivity and specificity of amyloid imaging with fluorine 18–labeled tracers in AD. Prospective studies are required to determine optimal imaging analysis methods and resolve outstanding clinical uncertainties.

Histopathological characteristics of breast ductal carcinoma in situ and association with imaging findings.

The treatment policy for ductal cancer in situ (DCIS) of the breast greatly depends on the spreading diagnosis. However, a problem is that we cannot compare imaging findings with the histopathology of DCIS. The purpose of this study was to investigate the histopathological characteristics of DCIS and the association with imaging findings. Subjects were 185 patients from Tokai University Hospital, diagnosed with DCIS from April 2005 to December 2010. A positive finding on ultrasonography was defined as Breast Imaging Reporting and Data System (BI-RADS) of US category 3 or above, in mammography it was Japan Breast Cancer Society category 2 or above, and in MRI it was BI-RADS-MRI category 3 or above. Histopathologically, we re-classified flat and/or low papillary DCIS into type 1; papillary and/or cribriform DCIS into type 2; and comedo and/or solid DCIS into type 3. The clinical characteristics and association between imaging findings and histopathological classification of the 3 subtypes of DCIS are summarized as follows: (1) histopathologically, in type 3, there was a higher frequency of necrosis and calcification in the ducts of DCIS (χ²), p < 0.001), the number of dilated periductal capillaries was greater than in type 1 (p = 0.023), and the distribution of DCIS was concentrated in type 3 (p = 0.020); (2) on ultrasonography, type 3 was easier to detect than type 1 (p = 0.008); (3) on mammography and MRI, there were no significant differences between type 1 and type 3. The histopathological characteristics of small (< 10 mm) DCIS and DCIS that cannot be detected by ultrasonography or MRI were also discussed. When carrying out spreading diagnosis of DCIS, we need to keep the histopathological type in mind and interpret the imaging findings comprehensively.

Detection of Subclinical Atherosclerosis in Peripheral Arterial Beds With B-Mode Ultrasound: A Proposal for Guiding the Decision for Medical Intervention and an Artifact-Corrected Volumetric Scoring Index

ObjectivesTo assess subclinical atherosclerotic cardiovascular disease (ASCVD) using B-mode ultrasound, with special emphasis on the incremental value of performing imaging in multiple peripheral arteries, and to compare imaging findings with traditional risk factors for medical intervention eligibility. MethodsData from 2 asymptomatic cohorts from India with unknown ASCVD risk factors were compared to 2 cohorts from North America with known ASCVD risk factors. Carotid and iliofemoral arteries of the Indian cohorts were examined with automated ultrasound in a high-pace environment by non-experts. A simplified metric of atherosclerotic disease burden (FUster-Narula or FUN Score) was developed from 3D imaging data by summing intima-media volume (IMV) over 5-cm arterial segments. Effectiveness of ASCVD prevention guidelines to direct therapy was compared to results from direct imaging. ResultsOf the 941 (mean age 44.27 ± 13.76 years, 34% female) enrollees from India, 224 (24%) demonstrated plaques in at least 1 of the 4 arterial sites examined; 107 (11%) had plaques in only the carotids, 70 (7%) in both the carotids and iliofemoral arteries, and 47 (5%) had plaques in only the iliofemoral arteries. Older age and male sex were associated with the presence of plaque, but association with systolic blood pressure was not observed.Data from 2 North American clinics (n = 481, mean age 59.68 ± 11.95 years, 39% female) showed that 203 subjects (42%) had carotid plaque; 82% of whom would not have qualified for lipid-lowering therapy under the Adult Treatment Panel (ATP) III Guidelines. Using the recently published ATP IV Guidelines, 33% of the individuals with carotid plaque would also have failed to qualify for treatment. ConclusionsB-mode ultrasound examination of bilateral iliofemoral arteries provided an incremental yield in identifying subclinical atherosclerotic disease compared to carotid evaluation alone. Ultrasound examination allowed improved identification of individuals who could be targeted for prophylactic medical intervention compared to ATP III and ATP IV Guidelines.

Reproducibility of short axis slice locations in longitudinal cardiovascular magnetic resonance (CMR) studies

Background Longitudinal dynamic changes of myocardial ischemic injury determine left ventricular (LV) remodelling. Using conventional clinical cardiovascular magnetic resonance (CMR) imaging, the registration of short axis (SA) images for comparison of imaging findings at different time points is aided by the application of the same protocol to consistently identify the atrio-ventricular (AV) groove and SA planes. We hypothesise that, discrepancies in the selection of short and long axis planes lead to significant differences in location and angle between SA slices manually identified as corresponding in two studies of the same patient. Methods

FRI0508 Correlation of power doppler ultrasonographic findings with site-matched histopathology of the synovial tissue

BackgroundUltrasonography (US) has been recently established as an imaging modality to evaluate inflamed joints of patients with rheumatoid arthritis (RA). It is reported that power doppler ultrasonography (PDUS) is capable...

Abstract P4-01-12: Compliance with Recommended Follow-Up after MRI-guided Core Needle Biopsy of Suspicious Breast Lesions: A Retrospective Study

Abstract Purpose: The purpose of this study was to assess patient compliance with recommended follow-up after MRI-guided core needle biopsy and investigate the reasons why patients did not comply with their recommended MRI imaging follow-up. Materials and Methods: A HIPAA compliant retrospective review was performed of 576 MRI-guided core needle biopsies between 2007–2010 with IRB approval and waiver of informed consent. Of 576 biopsies, 73.3% (422/576) were compliant and 26.7% (154/576) were noncompliant with follow-up recommendations and composed this study. Imaging and surgical planning was determined by comparing imaging findings, clinical findings, and biopsy histology. Results: Out of 135 lesions in patients noncompliant with follow-up imaging, 50.4% (68/135) were referred for biopsy by non-affiliated physicians, 41.5% (56/135) received a screening MRI, and 40.3% (56/135) were a focus or foci. Referring physicians provided information regarding the follow-up status of 88/154 (57%) lesions in noncompliant patients, of which 44/88 (50%) were followed by mammogram instead of MRI. Among compliant patients, 7/178 (3.9%) lesions seen on follow-up MRI were found to be high risk or malignant. Conclusion: Compliance with follow-up MRI recommendation after core needle biopsy is low. Three characteristics were found to be associated with noncompliance with follow-up imaging: referral from non-affiliated physician, screening MRI, and a focus lesion. Moreover, patients who do not comply with recommended MRI follow-up are more likely to have follow-up mammography. Follow-up imaging among compliant patients found high-risk lesions and malignancy. Facilities performing MRI-guided core biopsies should therefore be aware of a high risk of noncompliance with follow-up. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-01-12.

Silicosis in sandblasters of shipyard versus silicosis in stone carvers in Brazil: A comparison of imaging findings, lung function variables and cardiopulmonary exercise testing parameters

ObjectivesTo compare imaging findings, lung function variables and cardiopulmonary exercise testing (CPET) results between Brazilian sandblasters of shipyard and stone carvers with silicosis. MethodsOf the 41 patients, 25 subjects were sandblasters and 16 were stone carvers, with median ages of 52 and 46.4 years, respectively. All of the patients underwent pulmonary function tests (PFTs) and CPET. Chest radiographs were classified according to the International Labour Organization recommendations. The following parameters were examined through the use of high-resolution computerized tomography (HRCT): nodules, progressive massive fibrosis (PMF), emphysema, and intrathoracic lymph node enlargement. ResultsLarge opacities on chest radiography were observed in 76% of sandblasters and only 18.7% of stone carvers. Using HRCT, PMF was identified in 92% of sandblasters and only 43.7% of stone carvers. Although carbon monoxide diffusing capacity results were significantly different between the sandblasters and stone carvers, these differences were more pronounced in the CPET results. While 92% of sandblasters failed to reach at least 80% of their predicted peak oxygen uptake (VO2), this was observed for only 43.7% of stone carvers. A breathing reserve of less than 25% was observed in 40.5% of sandblasters but not in any of the stone carvers. ConclusionIn silicosis, imaging findings, lung function and CPET results are strongly influenced by the type of exposure to silica dust. Additionally, CPET abnormalities are more pronounced compared to measurements taken at rest.

Diffusion‐weighted magnetic resonance imaging in follow‐up of superficial urinary bladder carcinoma after transurethral resection: initial experience

What's known on the subject? and What does the study add? Diffusion-weighted (DW) MRI is a non-invasive technique measuring the microscopic mobility of water molecules in the tissues without contrast administration. It provides information on perfusion and diffusion simultaneously in any organ, so it can be used to differentiate normal and abnormal tissue structure, and it might help in the characterization of various abnormalities. In recent years, DW-MRI has been applied in the evaluation of urinary tract lesions, such as malignant renal, prostatic and bladder tumours; however, it has not previously been tested on its ability to distinguish residual cancer from fibrotic and inflammatory changes secondary to transurethral resection (TUR) and intravesical chemotherapy, both of which manifest as bladder-wall thickening on T2-weighted MRI. This is the first study to show the feasibility of DW-MRI in follow-up of patients with superficial bladder tumours after TUR. DW-MRI was highly reliable in differentiating post-TUR inflammatory changes from bladder tumours, with results similar to those of conventional cystoscopy. This non-invasive method could be used efficiently in future for follow-up of this patient group and may obviate the need for routine cystoscopy. • To study the feasibility of using diffusion-weighted (DW) magnetic resonance imaging (MRI) in bladder cancer follow-up after transurethral resection (TUR). • Included in the study were 47 patients with a history of TUR of superficial bladder carcinoma, who were admitted to our centre between January and December 2011 for follow-up cystoscopy. • Before cystoscopy, DW-MRI was performed and the apparent diffusion coefficient (ADC) value was measured in a circular region of interest within the carcinoma and normal bladder wall. • Two radiologists, blinded to the results of cystoscopy, independently interpreted the DW images. • A comparison of imaging findings with those of cystoscopy was performed using the McNemar test. • In our 47 patients, cystoscopy identified 34 bladder lesions in 24 patients and in the remaining 23 the bladder looked normal. • In the 24 patients with malignant bladders, DW-MRI detected 32/34 tumours with two false-negative findings of lesions in two patients. • In 23 patients with non-malignant bladders, the DW-MRI data were accurate for 21 patients, as two patients were misdiagnosed as malignant. • The sensitivity, specificity, accuracy, positive and negative predictive values of DW-MRI for identifying bladder tumours were 91.6% (22/24), 91.3% (21/23), 91.5% (43/47), 91.6 (22/24) and 91.3 (21/23), respectively. • Using the McNemar test there was no significant difference between DW-MRI and cystoscopy. • DW-MRI has a high reliability in differentiating post-TUR inflammatory changes from bladder tumours, which is similar to that of cystoscopy. • DW-MRI could be a first-line diagnostic test in follow-up of patients after TUR.

Silicose em jateadores de areia de estaleiro versus silicose em escultores de pedra no Brasil: uma comparação dos achados de imagem, função pulmonar e teste de exercício cardiopulmonar

ObjectivesTo compare imaging findings, lung function variables and cardiopulmonary exercise testing (CPET) results between Brazilian sandblasters of shipyard and stone carvers with silicosis. MethodsOf the 41 patients, 25 subjects were sandblasters and 16 were stone carvers, with median ages of 52 and 46.4 years, respectively. All of the patients underwent pulmonary function tests and CPET. Chest radiographs were classified according to the International Labour Organization recommendations. The following parameters were examined through the use of high-resolution computerized tomography (HRCT): nodules, progressive massive fibrosis (PMF), emphysema, and intrathoracic lymph node enlargement. ResultsLarge opacities on chest radiography were observed in 76% of sandblasters and only 18.7% of stone carvers. Using HRCT, PMF was identified in 92% of sandblasters and only 43.7% of stone carvers. Although carbon monoxide diffusing capacity results were significantly different between the sandblasters and stone carvers, these differences were more pronounced in the CPET results. While 92% of sandblasters failed to reach at least 80% of their predicted peak oxygen uptake (VO2), this was observed for only 43.7% of stone carvers. A breathing reserve of less than 25% was observed in 40.5% of sandblasters but not in any of the stone carvers. ConclusionIn silicosis, imaging findings, lung function and CPET results are strongly influenced by the type of exposure to silica dust. Additionally, CPET abnormalities are more pronounced compared to measurements taken at rest.

Contralateral Enhancing Lesions on Magnetic Resonance Imaging in Patients With Breast Cancer

The purposes of this study were to assess the clinical utility of sonography for evaluation of contralateral suspicious lesions detected on magnetic resonance imaging (MRI) in patients with breast cancer and to compare imaging findings of the index and synchronous contralateral cancers. We performed breast MRI on 853 consecutive patients with histologically confirmed breast cancer between January 2006 and December 2009. All patients underwent mammography and whole-breast sonography before MRI. We included 126 contralateral enhancing lesions in 98 patients who underwent second-look sonography. Lesions with sonographic correlation were biopsied using sonographic guidance, and lesions without sonographic correlation were biopsied using computed tomographic guidance or followed with imaging modalities. Of 126 suspicious lesions, 81 (64%) were correlated on sonography, and 45 (36%) were not. Of 81 correlated lesions, 16 (20%) were malignant, and 65 (80%) were benign. Of 45 lesions that were not correlated on sonography, only 1 (2%) was malignant. Of 17 contralateral cancers, 11 were detected on initial sonography and 5 on second-look sonography. The index and contralateral cancers showed statistically significant differences in the sonographic boundary (P = .003) and posterior echogenicity (P = .013). The contralateral cancers detected on initial or second-look sonography showed significant differences in the echo pattern (P = .001). Magnetic resonance imaging is a reliable tool for detection of occult contralateral breast cancer. With second-look sonography, we can find additional contralateral cancer. When enhancing lesions on MRI are not correlated on sonography, MRI- or computed tomography-guided biopsy or short-term imaging follow-up should be done.