Sonographic Correlation Research Articles

Facial Venous Tumour Thrombus from Submandibular Gland Mucoepidermoid Carcinoma: An Atypical Tumour Spread in Head and Neck Cancer.

Tumour thrombus of the facial vein is an exceedingly rare complication arising from mucoepidermoid carcinoma of the salivary glands. Early detection is pivotal for appropriate management, as delays can lead to metastatic disease, worsening the prognosis. We present a case involving a 76-year-old male with a history of mucoepidermoid carcinoma of the right submandibular gland, previously treated with surgical resection and radiotherapy. The patient, a long-term worker in a rubber factory, presented with a painless, firm swelling in the right cheek, persisting for three months. Contrast-enhanced computed tomography (CECT) showed distended facial vein with enhancing thrombus confirmed by sonographic correlation demonstrating intralesional vascularity. Cannon ball pulmonary nodules were also noted. Radiological findings led to a core biopsy, confirming tumor thrombosis of the facial vein due to mucoepidermoid carcinoma. However, the patient declined a biopsy of the pulmonary nodules, and has been referred to oncology for further management. This case highlights the critical importance of considering venous tumour thrombus in patients with previous salivary gland malignancies presenting with new or persistent facial swellings. It emphasises the role of advanced imaging techniques in the early identification of this rare entity. Additionally, it stresses the need for healthcare providers to engage in thorough discussions with patients about the potential consequences of forgoing recommended treatments, reinforcing the need for vigilance in monitoring such patients. Tumours of head and neck may cause thrombosis of veins by direct invasion resulting in a tumour thrombus, or indirectly by exerting a mass effect and vein compression.These can be distinguished by contrast-enhanced computed tomography (CECT) or magnetic resonance imaging (MRI).Doppler ultrasound may show patchy neovascularisation in a tumour thrombus, which would be absent if thrombosis was caused by compression.

Feasibility and Accuracy of Ultrasound-Guided Core Needle Biopsy for Nipple Lesions: A Pilot Study.

Due to the superficial location, suspicious findings of the nipple-areolar complex (NAC) are not amenable to stereotactic or MRI-guided sampling and have historically necessitated surgical biopsy or skin-punch biopsy. There are limited reports of US-guided core biopsy of the nipple (US-CBN). We report our nearly 3-year pilot experience with US-CBN at an academic breast imaging center. An institutional review board-exempt and HIPAA-compliant retrospective review was performed. We assessed patient demographics, breast imaging characteristics, procedural data, pathology, and outcomes. Nine female patients aged 27 to 64 underwent US-CBN from January 2021 to October 2023. Initial imaging abnormalities included abnormal MRI enhancement, mammographic calcifications, and sonographic masses. After initial or second-look US, all imaging findings had sonographic correlates for biopsy specimens, the majority of which were sonographic masses (8/9). US-CBN was performed by 6 breast radiologists using a variety of devices. All biopsy specimen results were concordant with sonographic abnormalities, although 1 was considered discordant from the initial abnormality seen on MRI. There were no complications, and discomfort during the procedure was well-treated. Two patients (22%, 2/9) were diagnosed with malignancy. This pilot study demonstrated that US-CBN can be performed by a breast radiologist for definitive diagnosis of suspicious nipple abnormalities seen on breast imaging, avoiding surgery, and maintaining nipple integrity. In our population, 22% (2/9) of US-CBNs revealed malignancy.

Architectural distortion on digital breast tomosynthesis mammograms in symptomatic breast clinics: what are the result outcomes?

In April 2020, standard two-dimensional (2D) full-field digital mammograms were replaced with digital breast tomosynthesis (DBT) and synthesised 2D views for symptomatic breast clinics. This study aimed to evaluate the positive predictive value (PPV) for malignancy in DBT-detected Architectural distortion (AD). All mammogram reports with the word "distortion" were assessed between April 2020 and October 2022. There were 458 mammograms with the word "distortion." After excluding mammograms with no distortion (n = 128), post-surgical distortion (n = 173), distortion with mass (n = 33), and unchanged distortion (n = 14), there were 111 patients with pure distortion. Correlation with histopathology was obtained where possible. All patients were followed for a minimum of 2 years. Forty-two out of 111 patients (37.84%) with AD had a normal ultrasound (US) and were discharged. Fifty-five (49.5%) patients had sonographic correlation corresponding to the distortion, leading to US-guided biopsy. Thirteen (23.6%) had tomosynthesis-guided biopsy, and one had a skin biopsy. The PPV for malignancy was 42.34%. Malignancy diagnoses were higher with US-guided biopsies than tomosynthesis-guided biopsies, 78.1% and 30%, respectively. With a total malignancy rate of 42.34%, DBT-detected AD has a high enough PPV for malignancy to justify selective tissue sampling if a sonographic correlate is present or with suspicious mammograms. The chances of malignancy are higher when a sonographic correlate corresponding to AD is present. AD on DBT/synthesized mammograms views in symptomatic breast clinic patients justifies selective sampling.

Yield of MR-directed US for MRI-detected breast findings: how often can we avoid MR biopsy?

PurposeTo evaluate the yield of MR-directed ultrasound for MRI detected breast findings. MethodsThis retrospective study included 857 consecutive patients who had a breast MRI between January 2017–December 2020 and received a BI-RADS 4 assessment. Only exams recommended for MR-directed ultrasound were included in the study, yielding 765 patients. Findings were characterized by presence or absence of a sonographic correlate. Utilizing the electronic medical record, for those with a sonographic correlate, the size, location, and morphology were noted. Imaging guided (Ultrasound and MRI) pathology results as well as excisional pathology results were recorded. A multivariable logistical regression analysis was used to investigate the clinical utility of MR-directed ultrasound. ResultsThere were 1262 MRI-detected BI-RADS category 4 findings in 765 patients. Of the 1262 findings, MR-directed ultrasound was performed on 852 (68 %). Of these, 291/852 (34 %) had an ultrasound correlate, including 143/291 (49 %) benign lesions, 81/291 (28 %) malignant lesions, 16/291 (5 %) with high-risk pathology and 51/291 (18 %) unknown due to lost to follow-up. Of those findings with ultrasound correlates, 173/291 (59 %) represented masses, 69/291 (24 %) were regions of non-mass enhancement, 22/291 (7.6 %) were foci and 27/291 (9.3 %) fell into the category of other which included lymph node, cysts, and scar tissue. Masses were significantly more likely to be identified on MR-directed ultrasound (p < 0.0001) compared to foci. ConclusionThe yield of MR-directed ultrasound is significantly higher for masses, than foci and non-mass enhancement, which should be taken into consideration when recommending an MR-directed ultrasound.

Sonographic Correlations between Intravesical Prostatic Protrusion and Bladder Outlet Obstruction in Patients with Symptomatic Benign Prostatic Hyperplasia in Ibadan, Nigeria

Background: Evaluating bladder outlet obstruction (BOO) in patients with prostatic enlargement may reflect the severity of the disease and aid in predicting the treatment outcome. Objectives: To determine the sonological correlation between intravesical prostatic protrusion and bladder outlet obstruction in patients with symptomatic benign prostatic enlargement. Methods: This prospective study was conducted over one year at the Department of Radiology, University College Hospital, Ibadan. A transabdominal ultrasound scan of the urinary bladder and prostate gland was carried out on patients with prostatic enlargement and BOO. The intravesical prostatic protrusion, pre-and post-void urine volumes, prostate volume and bladder wall thickness were measured. Results: A total of 132 men aged 43 to 90 years (mean age: 63.8±8.64 years) were studied. The median size of the intravesical prostatic protrusion (IPP) was 7.25 mm (IQR: 0.00 mm; 14.9 mm). The mean prostate volume was 63.3ml±36.0ml. Most subjects (55; 41.7%) had a prostate volume above 60ml, and most patients (101, 77.2%) had bladder wall thickness less than 5mm. The mean bladder wall thickness was 4.26mm±1.54mm. There was a statistically significant correlation between IPP and pre-void urine volume and prostate volume (p = 0.002 and &lt;0.001, respectively). Patients over 70 years had increasing IPP and post-void urine, which lacked statistical significance (p = 0.15). Conclusion: The severity of bladder outlet obstruction was reflected in the pre-void urine volume, which correlated with the size of IPP.

Short-term follow-up of contrast-enhanced mammography lesions after negative breast MRI in women with elevated breast cancer risk

PurposeTo determine the outcome of enhancing lesions detected on contrast-enhanced mammography (CEM) that had no correlate on magnetic resonance imaging (MRI) and underwent short-term follow-up CEM. MethodsIn this retrospective single-center study, we identified patients with elevated breast cancer risk who had a CEM between 2014 and 2021 showing indeterminate enhancement on recombined images (BI-RADS 0, 3, 4) that had no correlate on subsequent MRI (performed within one month), and therefore underwent short-term follow-up CEM (performed within eight months). Medical records and imaging studies were reviewed to collect data on patient and lesion characteristics, and outcomes. Cancer incidence with 95% confidence interval (CI) was calculated. ResultsThis study included 71 women (median age 49 years) with 81 enhancing CEM lesions who underwent short-term follow-up CEM (median 6.2 months) after MRI reported no correlate. Of 81 lesions (median size = 0.7 cm), 73 (90%) were non-mass enhancement and 8 (10%) were enhancing masses. No sonographic correlate was identified for 75 lesions that had a same-day targeted ultrasound. Two cancers (2.5%, 95% CI 0.3–8.6) were diagnosed during the short-term follow-up period, one at 6-months (invasive ductal carcinoma) and one at 12-months (ductal carcinoma in situ). The remaining 79 lesions were benign at 6-month follow-up CEM and at one-year mammographic follow-up. ConclusionsFollow-up CEM of MRI-occult lesions is prudent and may be reasonable to perform at one-year given the low incidence of cancer detected at six-months (one of 81) in our small study sample.

Sonographic Correlation of Polycystic Ovaries (PCO) with the Fatty Liver

Objective: To assess the Sonographic Correlation of polycystic ovaries (PCO) for the fatty liver. Method: This is a study carried out at the Dhaka National Medical Institute Hospital, Johnson Road, Dhaka from June 2022 to November 2022 for a period of 6 months. A total number of 60 female patients with an age range of 18 years to 45 years, who had Sonographic features of polycystic ovaries, were included. Postmenopausal women and patients with a history of HbsAg+ were excluded from this study. Proper history was taken from all patients. Then every patient underwent USG of the Radiology &amp; Imaging department of DNMC. Curvilinear probe 3-5 MHz Samsung HS40 machine was utilized patients with polycystic ovaries and NAFLD (Non-Alcoholic Fatty Livers Disease) are remembered for this examination and patients with some other pelvic pathology are avoided in this investigation. Results: During the study, 40% belonged to 27-35years age group and all patients had bilateral PCOS. Plus, 83.33% had fatty liver. 40% had grade-II fatty liver. Followed by 32% had grade-III fatty liver and only 28% had grade-I fatty liver. Among the 18-26 years group grade-I fatty liver was higher, 70% followed by in 27-35 years group grade-II fatty liver was higher, 52.38%, and the 36-45years years group grade-III fatty liver was higher, 42.85%. Prevalence of Hepatomegaly is typically seen higher in the 36-45years age group, 25%. Conclusion: Based on our study we can conclude that there was a significant correlation between fatty liver and PCOS.

Challenges in MRI-Guided Breast Biopsy and Some Suggested Strategies: Case Based Review.

With the increasing use of MRI in clinical practice, the need for MRI-guided intervention is also increasing. Indeterminate lesions identified on MRI without mammographic or sonographic correlates will need to be approached under MRI guidance. MRI-guided biopsy is a skill that can be acquired with proper training and guidance. These procedures have their own set of challenges and issues; some of them are specific to the patient habitus in this region. Adequate knowledge and understanding of the challenges can help the radiologist to be better equipped to face these issues and solve them promptly during the procedure, thus increasing the overall success rate of the procedure. Not much local data from Asian countries is available on this front. This paper aims to share common challenges one may face while performing MRI-guided biopsy and share some tips and tricks to address these problems. Hopefully, this will help the readers achieve a higher success rate for MRI-guided interventions in their clinical practice.

Contrast Enhanced Mammography in Routine Clinical Practice: Frequency and Malignancy Rates of Enhancing Otherwise Occult Findings

BackgroundIn routine clinical practice, contrast-enhanced mammography (CEM) examinations identify enhancing findings seen only on subtraction images that have no low-energy mammographic or sonographic correlate. The purpose of this study is to report the frequency and malignancy rates of enhancing findings seen only on subtraction images in a tertiary care breast imaging practice. Materials and methodsConsecutive review of CEM exams from December 2015 to May 2020. Chi square tests were used to determine associations between cancer diagnosis and clinical characteristics of enhancing findings seen only on subtraction images, P < .05 indicating a statistically significant difference. ResultsFour percent (100/2464) of CEM examinations identified 108 enhancing findings seen only on subtraction images. Twenty of those CEM enhancing findings were directly managed as a multifocal disease. Of those further evaluated with MR, 23% (19/78) with associated MR correlates were treated surgically as presumed multicentric or multifocal disease following multidisciplinary review. The remaining 76% (59/78) of enhancing findings were seen only on subtraction images, these included: 20% (12/59) and downgraded to benign on MR 80% (47/59) with suspicious findings which underwent MR vacuum assisted breast biopsy yielding: 26% (12/47) malignancy, 9% (4/47) high risk, and 66% (31/47) benign diagnoses. ConclusionEnhancing findings seen on subtraction only CEM images are seen in 4% of cases in clinical practice. MR correlation can help characterize CEM findings to: (1) avoid unnecessary biopsy for benign findings, and (2) guide tissue sampling or empiric surgical planning for suspicious findings.

Outcomes of Canceled Tomosynthesis-Guided Biopsy of Architectural Distortion Due to Nonvisualization.

Architectural distortion without a sonographic correlate is an indication for digital breast tomosynthesis-guided vacuum-assisted biopsy (DBT-VAB). However, when the finding is not visualized on the day of biopsy, the procedure is canceled. This study reports the outcomes of canceled DBT-VAB of architectural distortion due to nonvisualization. In this IRB-approved retrospective study, chart review was performed to identify DBT-VABs of architectural distortion at our institution between June 1, 2017, and November 1, 2020, that were canceled because of nonvisualization at the time of biopsy. Cases without follow-up imaging were excluded. Statistical analysis, including the frequency of cases yielding malignancy by the end of the study period, was performed. In total, 7.2% (39/544) of architectural distortions recommended for biopsy during the study period were canceled because of nonvisualization, 30 of which had follow-up imaging and were included in the study. Mean patient age was 56 years (standard deviation [SD], 9.6 years) and mean follow-up time was 26.7 months (SD, 11.2 months; range, 8.4-50.9 months). During the follow-up period, 16.7% (5/30) underwent repeat biopsy attempt, with one malignant result (1/30, 3.3%; SD, 18%; 95% confidence interval: 0.6%-16.7%). In total, 86.7% (26/30) of cases were declared benign during the follow-up period and 10% (3/30) remained stable with a BI-RADS 3 assessment category. During available follow-up, there was a low likelihood that distortions not visualized at the time of DBT-VAB represented malignancy (3.3%, 1/30). While this low malignancy rate is reassuring, imaging follow-up is warranted.

Sonographic correlation of portal vein diameter with gender in population of Lahore.

Objective: To determine the reference values of normal portal vein diameter in correlation to gender in population of Lahore. Study Design: Cross Sectional study. Setting: Ultrasound Lab University of Lahore and Gondal Complex Lahore. Period: 5th October 2020 to 13th April 2021. Material &amp; Methods: Sample size of my study were 164 males and 143 females. Simple random sampling was conducted. Healthy Individual with normal body mass index, both (male and female) individuals in fasting state and age between (20-25) years. Individual with history of portal hypertension, Fatty liver, Hepatomegaly and any other hepatic disorder. Xario XG. Convex 3.5 MHz-7.5MHz. Results: The mean diameter of portal vein for male was calculated as 10.51 + 1.468 mm (ranging from 13mm to 15mm), and for females was 10.085 ±1.336 mm (ranging from 7 to 14mm). Independent t-test was applied to examine the difference of mean Portal vein in males and females. We found a statistical significant difference in two means of portal vein diameter as the p-value = 0.008 is less than α =0.05. Conclusion: In this study, portal vein diameter in adult men and women were found within the normal range among age limit 20-25years.But the diameter of portal vein showed direct relation with weight and Body Mass Index among females but in males none of the body factors had any impact on the diameter of portal vein.

Sonographic Correlation of Caudate Lobe and Liver Size Among Hepatitis C Virus Patients

Hepatitis C virus (HCV) is a leading cause of liver disease in the world. Ultrasound is considered to be the first choice to diagnose hepatomegaly and caudate lobe enlargement in HCV patients by measuring the liver and Caudate lobe size Objective: To assess the sonographic correlation of caudate lobe size with liver size among hepatitis C virus patients Methods: The cross-sectional analytical study was conducted in the Department of Radiology at Sabiry Surgical Hospital, Faisalabad, Pakistan. A total of 68 patients (33 males and 35 females) with the HCV from March 2021 to November 2021 were included in this study. The craniocaudal length of the liver and vertical diameter of the caudate lobe was measured and compared in a ratio by using ultrasonography. Results: In total patients, the minimum age was 22 years and the maximum age was 70 years with an average age of 41.76 (SD=12.46) years. The mean liver size was 171.34 (SD=12.96) mm and the mean caudate lobe size was 61.06 mm (SD=12.96). The percentage between the normal and enlarged caudate lobe was 10.3% and 89.7% respectively. In total there were 60 patients with the present while 8 with absent hepatomegaly and 7 with normal and 61 with enlarged caudate lobe size the p-value is 0.021 which was significant because it was &lt;0.05 Conclusions: The caudate lobe size measurement by ultrasonography is a strong reliable parameter for early assessment and early possible treatment of the HCV in patients.

Efficacy of MRI-Directed Breast Ultrasound and Lesion Characteristics Affecting Visualization on Breast Ultrasound

ObjectiveTo assess the efficacy of magnetic resonance imaging (MRI)-directed ultrasound (US) in further characterizing lesions detected on MRI and to evaluate the correlation between lesion characteristics and their visibility on US. MethodsA retrospective review was performed of the records of patients with breast abnormalities detected on MRI between May 2018 and December 2020. All patients who were given a Breast Imaging-Reported and Data System Assessment Category 4 or 5 on breast MRI and sent to breast US for assessment of the MRI abnormality were included. Patients lost to follow-up or those who did not get their subsequent ultrasound at our institution were excluded. The following factors were recorded for all lesions described on the MRI reports: breast density, degree of background parenchymal enhancement, type of MRI finding (mass, areas of non-mass enhancement [NME], enhancing focus), largest dimension, T2 signal intensity, kinetics, shape, margins, enhancement pattern, and presence of ipsilateral breast malignancy. For the subset of the lesions that were identified on MRI-directed US, we recorded the following sonographic features: largest dimension, shape, and margin. The chi-square or Fisher exact tests of association were used to compare categorical characteristics. ResultsTwo hundred and thirty-three MRI-detected breast lesions were included in the study, which consisted of 171 masses, 7 enhancing foci, and 55 NME lesions. Of all lesions, 52% (89/171) of masses, 29% (16/55) of areas of NME, and 29% (2/7) of foci were seen on US. Moreover, 43 per 63 (68%) of malignant, 18 per 47 (38%) of high-risk and 46 per 123 (37%) of benign lesions were seen on MRI-directed US. Of the invasive malignant lesions, 77% (36/47) had a sonographic correlate. For masses, the average size on MRI was 1.1 cm, and MRI size had a statistically significant association with US visibility (P value 0.01). Similarly, spiculated margins on MRI for masses had a significant association with US visibility (P value 0.0006). Linear, segmental, and regional distributions of areas of NME were associated with decreased likelihood of sonographic visibility (P = 0.049). ConclusionMRI-directed US is a useful tool in the management of MRI-detected breast lesions. Our study indicates that masses, particularly those with spiculated margins on MRI, should be sent to US for further assessment. Additionally, masses are more likely to be seen under US as their size increases. MRI-directed US is less likely to visualize areas of NME and enhancing foci, which may be managed with MRI follow-up or MRI-guided biopsy depending on their level of suspicion.

Sonographic Correlation of Liver Dimensions with Anthropometric Variables in Apparently Healthy Pediatrics in Kano Metropolis, Nigeria

Accurate measurement of liver size allows for the diagnosis of various liver pathologies. Establishing normal liver size and how it is influenced by anthropometric variables is critical in diagnosis and determining the treatment method for the underlying liver pathology. This study was aimed at establishing the relationship between liver dimensions and anthropometric variables. The study was a cross-sectional study conducted in some selected hospitals in Kano Metropolis, Nigeria. Four hundred and twenty-six apparently normal pediatric subjects were studied within the age range of 0 – &lt;18years. The liver was examined with the patient in supine position, both the cranio-caudal and antero-posterior liver dimension were obtained through the mid clavicular line in longitudinal and transvers planes respectively. Both descriptive inferential statistics were employed for the data analysis. Statistical Package for Social Sciences (SPSS) was used and p&gt;0.05 was set as significance level. There was a statistical significant strong positive correlation between cranio-caudal dimension and age, height, weight, BMI and BSA in &lt;1 month &gt;12month age group (r=0.74, p=0.000; r=0.86, p=0.000; r=0.64, p=0.000; r=0.74, 0.p=000 and r=0.53, p=0.000 respectively for males and r=0.60, p=0.000; r=0.61, p=0.000; r=0.59; p=0.000; r=0.81, p=0.000 and r=0.66, p=0.001 respectively for females). Also, in the same age group both male and female subjects show significant strong positive correlation between anterior-posterior dimension and BMI &amp; BSA: (r=0.67, p=0.000, r=0.67, p=0.000 respectively for males and r=0.69, p=0.000, r=0.77, p=0.000 respectively for females). This study reported that anthropometric variable such as age, height, BMI and BSA is positively correlated with both cranio-caudal and antero-posterior liver dimension.&#x0D; Keywords: Ultrasound, Liver, Cranio-Caudal, Antero-Posterior, Dimension

Sonographic Correlation of Placental thickness with Estimated fetal Weight at term among the Pregnants in Lahore

Introduction: Placenta develops in the uterus and provides oxygen and nutrients to the baby. It begins to form in the 2nd month of pregnancy and is usually matured in the 4th month. It can be seen through ultrasonography by 9th or 10th week. The normal functioning of the placenta is determined by measuring placental thickness through ultrasonography which increases with the gestational age and is considered normal when it does not exceed 4 cm at any time during pregnancy. The objective of this study is to find Sonographic Correlation of Placental thickness with fetal weight at term among the pregnant in Lahore. Material and Method: A total of 213 cases were included in this cross-sectional analytical study. All subjects were scanned at term and gestational age, estimated fetal weight and placental thickness were measured. Pearson’s correlation was used to evaluate the correlation of placental thickness and estimated fetal weight. Results:Placental thickness and Estimated Fetal weight showed progressive increase in the value from 36 weeks to 40 weeks in this study. The mean placental thickness ranged from30.15±5.12 mm at 36th week to 37.49±2.31 mm at 40th week. The mean estimated fetal weight ranged from 2885.00±194.18 grams at 36th week to 3919.85±352.88 grams at 40th week. A significantly moderate correlation has been found between estimated fetal weight and placental thickness measured after 36 weeks of pregnancy. Conclusion:It is concluded that placental thickness is directly related to estimated fetal weight after 36 weeks of pregnancy. Therefore, it is helpful to assess placental thickness for the proper evaluation of fetal growth and well-being.

Imaging and pathologic features of non-calcified ductal carcinoma in situ: can sonography predict upgrade?

The purpose of this study was to evaluate the imaging and pathologic features and upgrade rate of non-calcified ductal carcinoma in situ (NCDCIS). The study tested the hypothesis that lesions with sonographic findings have higher upgrade rate compared to lesions seen on mammography or MRI only. This retrospective study included patients with ductal carcinoma in situ (DCIS) diagnosed by image-guided core breast biopsy from December 2009 to April 2018. Patients with microcalcifications on mammography or concurrent ipsilateral cancer on core biopsy were excluded. An upgrade was defined as surgical pathology showing microinvasive or invasive cancer. A total of 71 lesions constituted the study cohort. 62% of cases (44/71) had a mammographic finding, and 38% (27/71) of mammographically occult lesions had findings on either ultrasound, MRI, or both. Of the 67 cases that underwent sonography, a mass was noted in 56/67 (83.6%) cases and no sonographic correlate was identified in 11/67 (16.4%) cases. 21% (15/71) of lesions were upgraded on final surgical pathology. The upgrade rate of patients with sonographic correlate was 27% (15/56) vs with mammographic findings only was 0% (0/11). DCIS should be considered in the differential diagnosis of architectural distortion, asymmetries, focal asymmetries, and masses, even in the absence of microcalcifications. NCDCIS diagnosed by ultrasound may be an independent risk factor for upgrade. Radiologists must be aware of imaging features of DCIS and consider increased upgrade rate when NCDCIS is diagnosed by ultrasound.

Developing Asymmetries without Sonographic Correlate at Digital Breast Tomosynthesis.

Background Digital breast tomosynthesis (DBT) has improved the accuracy of mammography, including resolving many breast asymmetries as overlapping breast tissue. The pathologic outcomes of persistent developing asymmetries visualized at DBT are not well established. Purpose To characterize the outcomes and the predictors of malignancy for developing asymmetries visualized at DBT without a sonographic correlate. Materials and Methods This retrospective study included all tomosynthesis-guided biopsies of developing asymmetries performed at a single institution from May 2017 through January 2020. A reader study including three breast imaging radiologists determined interrater agreement and inclusion into the study. Electronic medical records were used to extract patient characteristics, imaging characteristics, and pathologic diagnoses. The Wilcoxon rank sum test, Fisher exact test, and χ2 test were used to analyze correlations of patient and imaging characteristics with likelihood of malignancy. Results The reader study included 95 DBT examinations with moderate interrater reliability (Fleiss κ = 0.45). There was majority reader agreement in 85 of the 95 DBT examinations (89%) of 83 women (median age, 56 years; interquartile range, 47-69 years), and this finalized the study data set. At pathologic examination, most asymmetries (68 of 85, 80%) were benign, with common diagnoses being fibrocystic change (n = 20), stromal fibrosis (n = 10), and fat necrosis (n = 10). The overall malignancy rate was 20% (17 of 85 asymmetries; 95% CI: 12, 29); 15 of the 17 malignancies (88%) were invasive cancers. Malignancies were more common in women with a personal history of breast cancer (35% vs 10%, P = .02). Conclusion In 85 developing asymmetries visualized at digital breast tomosynthesis without a sonographic correlate, there was a 20% (95% CI: 12, 29) malignancy rate, which was higher than the rates of malignancy for a developing asymmetry detected at digital mammography. © RSNA, 2021 See also the editorial by Skaane in this issue.

12-year review of MRI-detected breast cancers. How often was a diagnosis of malignancy established using targeted ultrasound and standard 14-gauge core biopsy?

This retrospective study aimed to determine the percentage of MRI-detected breast cancers diagnosed using targeted ultrasound and standard 14-gauge (14g) biopsy in the setting of an Australian breast MRI service. This is of clinical relevance because malignancies not identifiable on mammography or by ultrasound may then require more invasive, technically demanding and costly MRI-guided interventional procedures, usually by large-core vacuum-assisted biopsy (VAB) or hook-wire localisation with open surgical biopsy. On review of the 12-year period 2006-2018, we identified 67 new breast cancer events in 64 women where the diagnosis was made on the basis of the MRI scan findings either alone (n = 60) or in combination with a concurrent mammogram (n = 7), with no recorded clinical abnormality. The percentage in which malignancy was confirmed on histopathology using targeted ultrasound in combination with 14g biopsy was determined versus other biopsy methods, for both invasive cancer and insitu disease. Ultrasound-guided 14g biopsy was successful in establishing the presence of malignancy in 42/46 (91%) of events with a final diagnosis of invasive cancer, with 2 more proven by MRI-guided interventional procedures (1 VAB and 1 hook-wire) and 1 by open surgical biopsy. In the final case, a 5 mm focus on MRI with no sonographic correlate at the initial presentation was only identified and biopsied by ultrasound at 12-month follow-up. For events with a final diagnosis of DCIS/pLCIS (pleomorphic LCIS, n = 2), US-guided 14g biopsy was successful in 10/21 (48%), while 4/7 events with corresponding mammographic microcalcifications were proven by x-ray stereotactic interventions. A further 5 events had MRI-guided interventions (3 VAB and 2 hook-wires) and 1 an open surgical biopsy to confirm malignancy. In the final case (a woman with a 30 × 20 mm focal area of non-mass enhancement with corresponding microcalcifications consistent with DCIS), a pathologic diagnosis was not made until the patient presented 5 years later with invasive disease. There were also 3 instances of upgrades to invasion on final surgical pathology, one from pLCIS to microinvasion and 2 others from DCIS to IDC. Among the DCIS/pLCIS events, semi-random 14g core biopsy (sampling at the expected location of the MRI abnormality without a specific sonographic correlate) proved to be successful in 3 women. Ultrasound-guided 14g core biopsy established a malignant diagnosis in 91% of invasive cancers and in 48% of DCIS/pLCIS cases. This relatively non-invasive, technically easy to perform and low-cost biopsy procedure can be used immediately when targeted ultrasound shows a correlate for a suspicious MRI scan finding. Careful imaging-pathologic correlation is required after 14g biopsy, and a discordant result will usually prompt recourse to an MRI-guided VAB or hook-wire localisation.

Recalibrating the decision for MRI-directed breast ultrasound in patients with newly diagnosed breast cancer, factors predicting sonographic success

ObjectiveEvaluate utilization of MRI-directed breast ultrasound (US) in patients with newly diagnosed breast cancer and refine practices to increase success of sonographic lesion detection. MethodsThis retrospective single-institution review was restricted to women with breast cancer who underwent MRI from November 2006 to January 2017. Enhancing breast lesions, separate from the index tumor, recommended for MRI-directed US were assessed to see which were detected and which characteristics predicted success in detection. Univariate mixed-effects logistic modeling predicted likelihood of finding breast lesions with US, with odds ratios reported. All tests were two-sided with p < 0.05 considered significant. ResultsA total of 275 patients underwent MRI-directed US for 361 breast lesions, of which 187 (51.8%) were found on US. Of those detected, 171 (91.4%) were masses and 16 (8.6%) were nonmass enhancement (NME), with masses 14 times more likely to be seen (p < 0.001). Size alone was not a significant predictor but achieved significance when associated with lesion type (mass size, p < 0.001). Masses with irregular shapes or margins and invasive carcinomas were more frequently detected. Patient age, internal enhancement pattern, and distribution of NME were not significant predictors in sonographic detection. A presumed sonographic correlate for NME was found for 16 (16.2%) of 99 attempted lesions. ConclusionAs MRI access expands, utilization of MRI-directed US should be scrutinized to avoid downstream practice inefficiencies. Sonographic detection rates for NME remain low for women undergoing MRI for disease extent, with NME often better suited for MRI-guided biopsy.

Sonographic Correlation of Fetal Foot Length as a Reliable Parameter for Estimation of Gestational Age in 2ND and 3RD Trimester

Objective : To sonographic correlation fetal foot length as a reliable parameter for estimation of gestational age in 2 nd and 3 rd trimester. Study Design : An analytical cross-sectional prospective study was performed. Settings : The study was performed in Meer Children and family clinic, Tajpora Lahore. Period: An analytical cross-sectional study was conducted from 15 October, 2021 to 15 January, 2021. Material &amp; Methods : The present study is conducted in the in the Meer Children and Family Clinic Tajpura Lahore .In pregnant women attending the OPD during 2 nd and 3 rd trimester for routine checkups. The present study done in 60 normal pregnant women who were sure about their last menstrual period, have regular menstrual cycle, not experienced any vaginal bleeding. Ultrasonographic fetal foot length measurements was done without previous knowledge of gestational age and then the gestational age confirmed by biparietal diameter, abdominal circumference and head circumference . Results : The present study is conducted in 63 pragnent women between 15 to 35 weeks of gestational age attending the OPD for 2 nd and 3 rd trimester routine checkups the in the Meer Children and Family Clinic Tajpura Lahore . Sonographically we calculated foot length from 15 to 35 weeks of gestation. In our study to Early age at which fetal foot length could be seen and measured sonographically was found to be 15 weeks of gestation age. In 27 weeks of gestational age and mean foot length 83.67 with std. deviation 5.718 and std. Error Mean -720 and the mean value of foot length by gestational age is 93.33 with std. deviation and std. error mean 338.740 and 42.677 respectivly. Along with foot length bipraietal diameter(BPD),Abdominal circumference(AC),head circumference(HC) also measured for comparison. Conclusion : In the normal growing fetus the fetal foot length increases with increasing gestational age. Fetal foot length is a good parameter for gestational age especially in cases of femur achondroplasia, dolichocephaly or brachycephaly and in cases who are not sure about their L.M.P. Fetal foot length is used as an investigational implement to measured of gestational age in the late second and third trimesters of pregnancy. Fetal foot length was especially useful when other parameters did not correctly estimate gestational age, e.g., in cases of short-limb dwarfism hydrocephalus or anencephaly. Keywords: Gestational age, Fetal foot length, Ultrasonographically age estimation DOI: 10.7176/JHMN/93-04 Publication date: September 30 th 2021