Diane M. Renz

Magnetic resonance imaging of inflammatory breast carcinoma and acute mastitis. A comparative study

The aim of this study was to evaluate the potential of magnetic resonance mammography (MRM) to distinguish inflammatory breast carcinomas (IBC) from acute mastitis (AM). This study compared MRM examinations of two selected groups of patients: 48 subjects with IBC and 42 patients with AM. No statistical differences were revealed between the two groups for morphology of masses and of non-mass-like enhancement, breast enlargement, diffuse skin thickening, abnormal nipple configuration, prominent vessels, and also for cutaneous/subcutaneous, perimamillar and diffuse oedema. However, initial and postinitial dynamic characteristics significantly differed between the two groups (p < 0.001). In IBC, more masses with a greater average size were detected (p < 0.05). The following morphological criteria were also observed more often in IBC (p < 0.05): T2-hypointensity of masses (77.5%/18.2%), blooming sign (62.5%/31.8%), infiltration of pectoralis major muscle (interruption of fat plane: 54.2%/16.7%; pathological enhancement: 33.3%/7.1%), perifocal (66.7%/33.3%), prepectoral (72.9%/31.0%) and intramuscular pectoral oedema (41.7%/7.1%). The main localisation of AM was subareolar, of IBC central or dorsal (p < 0.001). The discrimination between AM and IBC remains a diagnostic challenge because of overlapping imaging features. However, the combination of multiple dynamic and morphological MRM criteria seems to have the potential for a differential diagnosis.

Inflammatory Breast Carcinoma in Magnetic Resonance Imaging: A Comparison with Locally Advanced Breast Cancer

RATIONALE AND OBJECTIVES Although inflammatory breast carcinoma (IBC) accounts for 1%-4% of all breast cancer cases, the appearance of this highly malignant tumor in magnetic resonance imaging (MRI) is still not well characterized. The aim of this study was to identify typical imaging features of IBC in comparison with noninflammatory locally advanced breast carcinoma (LABC). MATERIALS AND METHODS MRIs of 48 patients with IBC were compared with an equivalent cohort of 52 subjects with LABC. Age and histopathologic subtype were equivalent between the two groups. To delineate characteristic features, a multitude of dynamic and morphologic parameters were evaluated using T1- and T2-weighted sequences. RESULTS No significant differences of prevalences could be found for the following criteria: dynamic tumor signal characteristics, prominent vessels, perifocal edema, axillary lymph node involvement, morphology of focal masses, and morphologic pattern of non-mass like enhancement. Otherwise, the quantity of focal masses and the spatial distribution of the tumoral infiltration significantly differed between the two cancer groups. The following parameters occurred more frequently in the IBC cases: edema (cutaneous/subcutaneous 81.3%, perimamillar 70.8%, diffuse 89.6%, prepectoral 72.9%, intramuscular pectoral 41.7%), thickening (75.0%) and pathologic enhancement (60.4%) of Coopers ligaments, skin thickening (83.3%), punched-out sign (initially strong, focal increase of some dermal or subcutaneous parts followed by slow-continuous enhancement of the surrounding skin; 56.3%). CONCLUSIONS Inflammatory breast carcinoma seems to represent a specific biological entity resulting in typical MRI characteristics. Some of the parameters are supposed to visualize the characteristic extensive lymphovascular infiltration and therefore may improve the diagnosis of IBC.

Detection and classification of different liver lesions: comparison of Gd-EOB-DTPA-enhanced MRI versus multiphasic spiral CT in a clinical single centre investigation.

OBJECTIVE To compare the diagnostic efficacy of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) vs. multidetector computed tomography (MDCT) for the detection and classification of focal liver lesions, differentiated also for lesion entity and size; a separate analysis of pre- and postcontrast images as well as T2-weighted MRI sequences of focal and exclusively solid lesions was integrated. METHODS Twenty-nine patients with 130 focal liver lesions underwent MDCT (64-detector-row; contrast medium iopromide; native, arterial, portalvenous, venous phase) and MRI (1.5-T; dynamic and tissue-specific phase 20 min after application of Gd-EOB-DTPA). Hepatic lesions were verified against a standard of reference (SOR). CT and MR images were independently analysed by four blinded radiologists on an ordinal 6-point-scale, determining lesion classification and diagnostic confidence. RESULTS Among 130 lesions, 68 were classified as malignant and 62 as benign by SOR. The detection of malignant and benign lesions differed significantly between combined and postcontrast MRI vs. MDCT; overall detection rate was 91.5% for combined MRI and 80.4% for combined MDCT (p<0.05). Considering all four readers together, combined MDCT achieved sensitivity of 66.2%, specificity of 79.0%, and diagnostic accuracy of 72.3%; combined MRI reached superior diagnostic efficacy: sensitivity 86.8%, specificity 94.4%, accuracy 90.4% (p<0.05). Differentiated for lesion size, in particular lesions <20mm revealed diagnostic benefit by MRI. Postcontrast MRI also achieved higher overall sensitivity, specificity, and accuracy compared to postcontrast MDCT for focal and exclusively solid liver lesions (p<0.05). CONCLUSION Combined and postcontrast Gd-EOB-DTPA-enhanced MRI provided significantly higher overall detection rate and diagnostic accuracy, including low inter-observer variability, compared to MDCT in a single centre study.

Detection and classification of contrast-enhancing masses by a fully automatic computer-assisted diagnosis system for breast MRI

To evaluate a fully automatic computer‐assisted diagnosis (CAD) method for breast magnetic resonance imaging (MRI), which considered dynamic as well as morphologic parameters and linked those to descriptions laid down in the Breast Imaging Reporting and Data System (BI‐RADS) MRI atlas.

Value of digital X-ray radiogrammetry in the assessment of inflammatory bone loss in rheumatoid arthritis

Introduction Rheumatoid arthritis (RA) is a systemic inflammatory disease characterized by progressive joint destruction based on the synovitis of large and small joints (1,2). The small joints of the hands and feet are particularly affected in the majority of RA patients, leading to destruction of articular tissue, including cartilage and bone (2). Osteoporosis, a typical phenomenon of RA, occurs in two forms: periarticular osteoporosis, adjacent to the inflamed joints, and generalized osteoporosis, resulting in an increased risk of fractures. Periarticular osteoporosis is a specific feature of bone involvement in RA (3,4) and is one of the bone involvement criteria in addition to erosions in the American College of Rheumatology criteria for RA (5). The onset of periarticular bone loss in the hands and feet is an early sign of RA (6) and may precede erosions (7). Periarticular bone loss is mainly caused by the local release of inflammatory agents and is a direct consequence of the inflammatory process (8), whereas generalized bone loss is additionally influenced by immobility and treatment effects (e.g., glucocorticoids) (9–11). In the hand, inflammatory bone loss includes not only the direct periarticular region of the joints, but also the cortical bone of the metacarpal diaphysis, indicating that inflammation-induced bone loss is present independent of direct synovial contact (12–14). Immunologic aspects of periarticular bone loss in RA

Original investigationInflammatory Breast Carcinoma in Magnetic Resonance Imaging: A Comparison with Locally Advanced Breast Cancer

RATIONALE AND OBJECTIVES Although inflammatory breast carcinoma (IBC) accounts for 1%-4% of all breast cancer cases, the appearance of this highly malignant tumor in magnetic resonance imaging (MRI) is still not well characterized. The aim of this study was to identify typical imaging features of IBC in comparison with noninflammatory locally advanced breast carcinoma (LABC). MATERIALS AND METHODS MRIs of 48 patients with IBC were compared with an equivalent cohort of 52 subjects with LABC. Age and histopathologic subtype were equivalent between the two groups. To delineate characteristic features, a multitude of dynamic and morphologic parameters were evaluated using T1- and T2-weighted sequences. RESULTS No significant differences of prevalences could be found for the following criteria: dynamic tumor signal characteristics, prominent vessels, perifocal edema, axillary lymph node involvement, morphology of focal masses, and morphologic pattern of non-mass like enhancement. Otherwise, the quantity of focal masses and the spatial distribution of the tumoral infiltration significantly differed between the two cancer groups. The following parameters occurred more frequently in the IBC cases: edema (cutaneous/subcutaneous 81.3%, perimamillar 70.8%, diffuse 89.6%, prepectoral 72.9%, intramuscular pectoral 41.7%), thickening (75.0%) and pathologic enhancement (60.4%) of Coopers ligaments, skin thickening (83.3%), punched-out sign (initially strong, focal increase of some dermal or subcutaneous parts followed by slow-continuous enhancement of the surrounding skin; 56.3%). CONCLUSIONS Inflammatory breast carcinoma seems to represent a specific biological entity resulting in typical MRI characteristics. Some of the parameters are supposed to visualize the characteristic extensive lymphovascular infiltration and therefore may improve the diagnosis of IBC.

Application of computer-aided diagnosis (CAD) in MR-mammography (MRM): do we really need whole lesion time curve distribution analysis?

RATIONALE AND OBJECTIVES The identification of the most suspect enhancing part of a lesion is regarded as a major diagnostic criterion in dynamic magnetic resonance mammography. Computer-aided diagnosis (CAD) software allows the semi-automatic analysis of the kinetic characteristics of complete enhancing lesions, providing additional information about lesion vasculature. The diagnostic value of this information has not yet been quantified. MATERIALS AND METHODS Consecutive patients from routine diagnostic studies (1.5 T, 0.1 mmol gadopentetate dimeglumine, dynamic gradient-echo sequences at 1-minute intervals) were analyzed prospectively using CAD. Dynamic sequences were processed and reduced to a parametric map. Curve types were classified by initial signal increase (not significant, intermediate, and strong) and the delayed time course of signal intensity (continuous, plateau, and washout). Lesion enhancement was measured using CAD. The most suspect curve, the curve-type distribution percentage, and combined dynamic data were compared. Statistical analysis included logistic regression analysis and receiver-operating characteristic analysis. RESULTS Fifty-one patients with 46 malignant and 44 benign lesions were enrolled. On receiver-operating characteristic analysis, the most suspect curve showed diagnostic accuracy of 76.7 +/- 5%. In comparison, the curve-type distribution percentage demonstrated accuracy of 80.2 +/- 4.9%. Combined dynamic data had the highest diagnostic accuracy (84.3 +/- 4.2%). These differences did not achieve statistical significance. With appropriate cutoff values, sensitivity and specificity, respectively, were found to be 80.4% and 72.7% for the most suspect curve, 76.1% and 83.6% for the curve-type distribution percentage, and 78.3% and 84.5% for both parameters. CONCLUSIONS The integration of whole-lesion dynamic data tends to improve specificity. However, no statistical significance backs up this finding.

Volumetric breast composition analysis: reproducibility of breast percent density and fibroglandular tissue volume measurements in serial mammograms.

Background Volumetric breast composition analysis represents a useful tool for assessing changes in breast composition over time. However, no data exist on the reproducibility of this method in serial mammograms. Purpose To assess the reproducibility of two volumetric breast composition parameters, breast percent density (PD) and fibroglandular tissue volume (FTV), in consecutive mammograms. Material and Methods Volumetric breast composition analysis to determine PD and FTV was performed in two consecutive unilateral mammograms of 211 patients. All mammograms were obtained on the same digital mammography unit within a maximum interval of 24 months. Volumetric data for analysis for both examinations were available for 174 patients. Thirty-two patients had successful volumetric analysis of additional consecutive examinations on a second digital mammography unit. Inter-examination correlation of measurements and absolute differences were analyzed. Bland-Altman analysis was performed to compare readings from different mammography units. Results Mean FTV remained constant over the study period. A reduction in PD of 0.5% and a mean increase in breast volume (BV) of 3% were observed. FTV measurements obtained on the same mammography unit were significantly more reproducible than PD measurements (Pearson correlation coefficients of 0.947 and 0.920, respectively; P < 0.05). A 15% difference between mean absolute volume measurements (FTV and BV) obtained on different mammography units was observed (P ≤ 0.001), while mean PD was close to the expected value. Conclusion Volumetric breast composition analysis is highly reproducible in serial mammograms in normal women. FTV is a more reproducible parameter than PD, indicating that absolute quantification of breast parenchyma may be preferable to the measurement of relative parameters such as PD. However, a disadvantage of using FTV is that it is susceptible to systematic differences when measurements are obtained on different imaging platforms.

Volumetric breast density assessment: reproducibility in serial examinations and comparison with visual assessment.

BACKGROUND AND PURPOSE Mammographic breast density is the strongest known marker of breast cancer risk. Visual breast density assessment is subject to significant intra- and inter-rater variability. The aim of the present study was to test the reproducibility of automatic breast density assessment and to compare the results to the visual assessment. PATIENTS AND METHODS Serial mammograms of 141 patients were retrospectively reviewed. Breast density was assessed both visually using a BI-RADS four-category breast density scale and with a software tool for volumetric breast density measurement. RESULTS The intra- and inter-rater reproducibility as well as inter-examination reproducibility were assessed for both techniques by calculating the intraclass correlation coefficient (ICC). The inter-examination reproducibility of the volumetric measurement of breast percent density was 0.91 (ICC; 95 % CI 0.87 - 0.93). There was no difference in the strength of the correlation between patients with a large vs. small difference in compression force. The intra- and inter-rater reproducibility ranged from 0.81 - 0.84 and 0.71 - 0.77, respectively. The inter-examination reproducibility of visual assessment was 0.75 - 0.81. The agreement of visual assessment with volumetric measurement was similar to the agreement among readers. CONCLUSION Our results indicate that volumetric breast density measurement provides higher reproducibility in serial examinations than visual assessment and may thus be preferable in the longitudinal assessment of breast density and in the measurement of breast density for risk stratification.

Comparison between magnetic resonance imaging and computed tomography of the lung in patients with cystic fibrosis with regard to clinical, laboratory, and pulmonary functional parameters.

ObjectiveTo evaluate whether magnetic resonance imaging (MRI) is effective as computed tomography (CT) in determining morphologic and functional pulmonary changes in patients with cystic fibrosis (CF) in association with multiple clinical parameters. Materials and MethodsInstitutional review board approval and patient written informed consent were obtained. In this prospective study, 30 patients with CF (17 men and 13 women; mean (SD) age, 30.2 (9.2) years; range, 19–52 years) were included. Chest CT was acquired by unenhanced low-dose technique for clinical purposes. Lung MRI (1.5 T) comprised T2- and T1-weighted sequences before and after the application of 0.1-mmol·kg−1 gadobutrol, also considering lung perfusion imaging. All CT and MR images were visually evaluated by using 2 different scoring systems: the modified Helbich and the Eichinger scores. Signal intensity of the peribronchial walls and detected mucus on T2-weighted images as well as signal enhancement of the peribronchial walls on contrast-enhanced T1-weighted sequences were additionally assessed on MRI. For the clinical evaluation, the pulmonary exacerbation rate, laboratory, and pulmonary functional parameters were determined. ResultsThe overall modified Helbich CT score had a mean (SD) of 15.3 (4.8) (range, 3–21) and median of 16.0 (interquartile range [IQR], 6.3). The overall modified Helbich MR score showed slightly, not significantly, lower values (Wilcoxon rank sum test and Student t test; P > 0.05): mean (SD) of 14.3 (4.7) (range, 3–20) and median of 15.0 (IQR, 7.3). Without assessment of perfusion, the overall Eichinger score resulted in the following values for CT vs MR examinations: mean (SD), 20.3 (7.2) (range, 4–31); and median, 21.0 (IQR, 9.5) vs mean (SD), 19.5 (7.1) (range, 4–33); and median, 20.0 (IQR, 9.0). All differences between CT and MR examinations were not significant (Wilcoxon rank sum tests and Student t tests; P > 0.05). In general, the correlations of the CT scores (overall and different imaging parameters) to the clinical parameters were slightly higher compared to the MRI scores. However, if all additional MRI parameters were integrated into the scoring systems, the correlations reached the values of the CT scores. The overall image quality was significantly higher for the CT examinations compared to the MRI sequences. ConclusionsOne major diagnostic benefit of lung MRI in CF is the possible acquisition of several different morphologic and functional imaging features without the use of any radiation exposure. Lung MRI shows reliable associations with CT and clinical parameters, which suggests its implementation in CF for routine diagnosis, which would be particularly important in follow-up imaging over the long term.