Fiammetta Venditti

Color-coded automated signal intensity curves for detection and characterization of breast lesions: preliminary evaluation of a new software package for integrated magnetic resonance-based breast imaging.

Objectives:The objective of this study was to evaluate the value of a color-coded automated signal intensity curve software package for contrast-enhanced magnetic resonance mammography (CE-MRM) in patients with suspected breast cancer. Materials and Methods:Thirty-six women with suspected breast cancer based on mammographic and sonographic examinations were preoperatively evaluated on CE-MRM. CE-MRM was performed on a 1.5-T magnet using a 2D Flash dynamic T1-weighted sequence. A dosage of 0.1 mmol/kg of Gd-BOPTA was administered at a flow rate of 2 mL/s followed by 10 mL of saline. Images were analyzed with the new software package and separately with a standard display method. Statistical comparison was performed of the confidence for lesion detection and characterization with the 2 methods and of the diagnostic accuracy for characterization compared with histopathologic findings. Results:At pathology, 54 malignant lesions and 14 benign lesions were evaluated. All 68 (100%) lesions were detected with both methods and good correlation with histopathologic specimens was obtained. Confidence for both detection and characterization was significantly (P ≤ 0.025) better with the color-coded method, although no difference (P > 0.05) between the methods was noted in terms of the sensitivity, specificity, and overall accuracy for lesion characterization. Excellent agreement between the 2 methods was noted for both the determination of lesion size (kappa = 0.77) and determination of SI/T curves (kappa = 0.85). Conclusions:The novel color-coded signal intensity curve software allows lesions to be visualized as false color maps that correspond to conventional signal intensity time curves. Detection and characterization of breast lesions with this method is quick and easily interpretable.

Multidetector-row CT angiography of the infrarenal aortic and lower extremities arterial disease

Since its first clinical implementation in 1991, CT angiography with volumetric scanning has had a substantial impact in the field of non-invasive diagnostic imaging. Helical CT has experienced, over the past decade, a revolution of its technology improving X-ray tubes capabilities, gantry rotation and interpolation algorithm performances, and has challenged digital subtraction angiography (DSA) in the evaluation of many districts of the vascular system [2, 6]. Nevertheless, the greatest advance has been the introduction of multidetector-row computed tomography (MDCT) scanners that have profound implication for clinical CT scanning [1, 3]. Currently capable of acquiring 16 channels of helical data simultaneously, MDCT scanners have substantially improved the quality and ease of performing angiographic studies, leading CT angiography to a robust method of volumetric vascular imaging. Based on the greatest incremental gain in scan speed since the development of helical CT, fundamental advantages of MDCT include substantially shorter acquisition times, but also acquisition of large volumes at high resolution (0.625, 1.25-mm effective thickness), with excellent visualization also of small branches, reducing the amount of iodinated contrast agent and improved threedimensional (3D) rendering with diminished artefacts. As CT angiography has become a mainstream examination in many radiology departments, a discussion of techniques toward optimizing CT angiography performed with MDCT scanners is important. An overview of clinical setting of peripheral arterial disease (PAD) and an elucidation of MDCT principles focused on optimizing peripheral vascular imaging is presented. A discussion of contrast medium administration strategies proceeds, with attention toward injection protocol and bolus timing. An outline of 3D visualization techniques is subsequently presented.

Radial scars of the breast: Contrast-enhanced magnetic resonance mammography appearance

Abstract:  The purpose of this study was to evaluate the appearance of contrast‐enhanced magnetic resonance mammography (CE‐MRM) in patients with suspected radial scar on mammography. Thirty women with radial opacities or black star findings at mammography, preoperatively underwent CE‐MRM. Examinations were performed with a 1.5 T magnet with a bilateral surface coil using a FS T2‐weighted turbo spin echo (TSE) and three‐dimensional (3D) dynamic T1‐weighted fast low‐angle shot (FLASH) sequences. Criteria for lesion evaluation included morphologic patterns and signal intensity curves. Mammography and CE‐MRM findings were compared with pathologic findings. CE‐MRM suggested the presence of radial scar in 18 of 30 cases and the presence of malignancy in 11 of 30 cases; 1 lesion was classified as borderline. At surgery 22 radial scars (including 4 with associated ductal carcinoma in situ) and 8 carcinomas were detected. CE‐MRM provided a specificity of 89%, sensitivity of 83%, and accuracy of 87%. Differently from breast cancer, radial scars are nonenhancing at CE‐MRM. Nevertheless, the possibility of nonenhancing carcinomatous foci existing within radial scars implies that surgical excision should be performed in all cases.