Arzu Ozsoy

Nonpalpable BI-RADS 4 breast lesions: sonographic findings and pathology correlation.

PURPOSE We aimed to evaluate ultrasonography (US) findings for Breast Imaging Reporting and Data System (BI-RADS) category 4 lesions using BI-RADS US lexicon and determine the positive and negative predictive values (PPV and NPV) of US with respect to biopsy results. METHODS Sonograms of 186 BI-RADS 4 nonpalpable breast lesions with a known diagnosis were reviewed retrospectively. The morphologic features of all lesions were described using BI-RADS lexicon and the lesions were subcategorized into 4A, 4B, and 4C on the basis of the physicians level of suspicion. Lesion descriptors and biopsy results were correlated. Pathologic results were compared with US features. PPVs of BI-RADS subcategories 4A, 4B, and 4C were calculated. RESULTS Of 186 lesions, 38.7% were malignant and 61.2% were benign. PPVs according to subcategories 4A, 4B, and 4C were 19.5%, 41.5%, and 74.3%, respectively. Microlobulated, indistinct, and angular margins, posterior acoustic features, and echo pattern were nonspecific signs for nonpalpable BI-RADS 4 lesions. Typical signs of malignancy were irregular shape (PPV, 66%), spiculated margin (PPV, 80%) and nonparallel orientation (PPV, 58.9%). Typical signs of benign lesions were oval shape (NPV, 77.1%), circumscribed margin (NPV, 67.5%), parallel orientation (NPV, 70%), and abrupt interface (NPV, 67.6%). CONCLUSION BI-RADS criteria are not sufficient for discriminating between malignant and benign lesions, and biopsy is required. Subcategories 4A, 4B, and 4C are useful in predicting the likelihood of malignancy. However, objective and clear subclassification rules are needed.

Added value of diffusion-weighted magnetic resonance imaging for the diagnosis of perianal fistula

PURPOSE To evaluate the added value of diffusion-weighted (DWI) magnetic resonance imaging (MRI) by comparison with T2-weighted images alone in the diagnosis of perianal fistula. MATERIAL AND METHODS MRI examinations of 123 patients (97 men, 26 women; mean age, 41.9 years) with suspected perianal fistula were retrospectively evaluated by two radiologists. Fat-suppressed T2-weighted fast spin echo images, DWI (b values, 0 and 1000s/mm2) and fat-suppressed gadolinium chelate-enhanced T1-weighted images were evaluated for each patient by using a four-point scale. Confidence scores and sensitivities were calculated for T2-weighted images alone, the combination of DWI and T2-weighted images and the combination of gadolinium chelate-enhanced T1-weighted images and T2-weighted images. The combination of gadolinium chelate-enhanced and T2-weighted images was used as reference standard. RESULTS Perianal fistulas were present in 92/123 patients (74.8%). An almost perfect interobserver agreement was found for T2-weighted images (kappa=0.868), the combination of gadolinium chelate-enhanced T1-weighted images and T2-weighted images (kappa=0.96) and the combination of DWI and T2-weighted images (kappa=0.90). The confidence scores for the diagnosis of perianal fistula for the combination of gadolinium chelate-enhanced T1-weighted images and T2-weighted images were greater than those of T2-weighted images alone for observer 1 (P<0.001) and observer 2 (P=0.009). The confidence scores of the combination of DWI and T2-weighted images were greater than those of T2-weighted images alone for observer 1 (P<0.001) and observer 2 (P=0.032). Sensitivity and specificity of the combination of DWI and T2-weighted images were greater than those of T2-weighted images alone for both observers. CONCLUSION DWI has a significant added value compared to T2-weighted imaging alone in the diagnosis of perianal fistula.

Diffusion-Weighted Mri of Postmenopausal Women with Vaginal Bleeding and Endometrial Thickening: Differentiation of Benign and Malignant Lesions

Purpose: To investigate the feasibility of diffusion-weighted magnetic resonance imaging (DWI) with apparent diffusion coefficient (ADC) values in differentiating endometrial cancer from benign endometrial lesions in postmenopausal patients with vaginal bleeding and endometrial thickening and to predict the depth of myometrial invasion in endometrial cancer. Materials and Methods: Postmenopausal patients with vaginal bleeding and endometrial thickening were enrolled in this prospective study. T2-weighted, pre- and postcontrast T1-weighted and diffusion-weighted images were obtained. The ADC values of all the patients with endometrial pathologies were recorded. The staging accuracies of DWI and postcontrast T1-weighted images in the assessment of myometrial invasion were evaluated in histopathologically proven endometrial cancer patients. Results: Fifty-two patients (mean age: 57 ± 10, range: 41–79) were enrolled in the study. Thirty-eight of the lesions were benign (27 as hyperplasia and endometritis; 11 as polyps). Fourteen of the 52 endometrial lesions were pathologically proven as cancers and underwent hysterectomy, and all the specimens were reported as endometrioid adenocarcinomas. The mean ADC value (10–3 mm2/second) of cancer (0.88 ± 0.10) was significantly lower than that of benign lesions (1.78 ± 0.27, p = 0,001). There was no significant difference between ADC values of endometrial tissue in patients with FIGO stage 1A (0.87 ± 0.11, n = 9) and FIGO stage 1B (0.91 ± 0.07, n = 5). The staging accuracy was 92.9 per cent (13/14) for DWI and 85.7 per cent (12/14) for postcontrast T1-weighted images. Conclusion: ADC values allow benign endometrial lesions to be differentiated from endometrial cancer in postmenopausal patients but do not correlate with the depth of myometrial invasion and histological tumor grading.

Ultrasound Findings in a Case of Myeloid Sarcoma of the Breast

Myeloid sarcoma is a rare, solid extramedullary tumor originating from immature granulocytic cells or monocytes. Breast involvement without an aleukemic or myeloproliferative disorder is very infrequent. A 21-year-old female patient was admitted with bilateral palpable breast masses for four months. The patient had given birth approximately one year ago. The ultrasonographic examination revealed multiple, oval shaped—some of them with microlubulated margins—hypoechoic, solid masses of which, the largest mass measured 4.5 × 2.5 cm, evaluated as BI-RADS 4. The histopthological examination suggested hematolymphoid neoplasm. In the differential diagnosis of solid breast lesions, myeloid sarcoma should be kept in mind even without hematological findings. Early diagnosis of this tumor is important for the effectiveness of the medical treatment.

Aberrant Internal Carotid Artery in the Temporal Bone: A Case Report

An aberrant internal carotid artery (ICA) in the middle ear is a rare and potentially serious vascular anomaly. Symptoms and signs of aberrant internal carotid artery are often non-specific, therefore radiographic investigation with the combination of CT scan and MRA is required for the diagnosis. It is also essential to inform physicians to avoid disastrous consequences.

Memenin Fronkülosis Olgusu: Ultrasonografi Bulguları

Fronkul, koagulaz pozitif S.aureus tarafindan olusturulan kil koklerinin akut nekrotik bir enfeksiyonudur. Bu olgu sunumunda, meme tutulumu bulunan bir kronik fronkulozis vakasini memenin diger lezyonlarindan ayirt edebilmek icin tipik ultrasonografi bulgulari ile sunuyoruz. Yirmiyedi yasinda, bayan hastaya klinigimizde meme ultrasonografi tetkiki yapildi. Meme ultrasonografi incelemesinde en buyukleri sol memede 24 x 14 mm, sag memede 9 x 6 mm boyutlarinda olmak uzere ciltten cilt altina uzanim gosteren, internal ekolar ve septalar iceren kalin cidarli apse ile uyumlu multiple komplike kistik lezyonlar izlendi. Hastanin oykusunde ITP ve steroid kullanimi mevcuttu. Memedeki lezyondan yapilan biopsi sonucunda akut apse, inflamatuar surec tanisi kondu. Kultur sonucunda metisilin sensitif S.aureus uredi. Birden fazla sayida cilt ciltalti yerlesimli, kalin cidarli, internal ekolar ve septalar iceren apse ile uyumlu heterojen hipoekoik kistik lezyonlar saptadigimizda fronkulozis tanisini dusunmeliyiz.