Giuseppe Rescinito

MR dynamic enhancement of breast lesions: high temporal resolution during the first-minute versus eight-minute study.

PURPOSE To investigate the value of the early phase of MR enhancement of breast lesions. METHOD To study 63 breast lesions (size 5-45 mm in diameter) in 56 patients, whole-breast and lesion-targeted precontrast T1 -weighted gradient-echo 2D sequences were acquired. After intravenous injection of Gd-DTPA (0.1 mmol/Kg), four targeted scans, each every 15 seconds during the first minute (1-m), and seven whole-breast scans, each every minute up to 8 minutes (8-m), were performed. The subtraction technique was used, and percent enhancement curves were obtained. The final diagnosis was obtained by histology for 36 lesions, including 28 malignancies, and by fine-needle aspiration cytology and at least 1-year negative follow-up for the remaining 27 benign lesions. RESULTS Significant differences in enhancement between malignant and benign lesions were found using both techniques (p<0.0001). However the ratio between the median enhancement of malignant lesions and that of benign lesions was 6.7 (15 s), 4.8 (30 s), 4.6 (45 s), and 3.8 (60 s), descending from 4.3 to 2.5 from the second to the eighth minute. The overlap between the malignant and benign curves was 9% of the malignant range with the 1-m technique, and 50% with the 8-m technique. Three blinded observers obtained a 100% sensitivity with both techniques and a specificity of 94-97% with the 1-m technique and 83-89% with the 8-m technique. CONCLUSION The first minute of Gd-enhancement allows a more prominent differentiation between malignant and benign breast lesions than the following times.

Dynamic breast magnetic resonance imaging: Effect of changing the region of interest on early enhancement using 2D and 3D techniques

Objective To assess the effect of changing the region of interest (ROI) on early enhancement (EE) in dynamic breast magnetic resonance (MR) imaging. Methods We evaluated retrospectively 102 breast lesions: 54 lesions (33 malignancies and 21 benignancies) studied with 2D and 48 lesions (30 and 18, respectively) with 3D gradient-echo dynamic technique (contrast dose 0.1 mmol/kg). Each lesion was postprocessed using 3 different regions of interest (ROIs): small circular ROI on maximal enhancement (SCR); large circular ROI within the lesion (LCR); and irregular ROI by manual contouring (IRR). EE was classified as benign (≤50%), uncertain (51–89%), or malignant (≥90%). Results With 2D, the uncertain EEs were 17% for both SCR and LCR, 33% for IRR (P = 0.008); with 3D, the uncertain EEs were 4%, 15%, and 13%, respectively (SCR versus LCR, P = 0.063). More uncertain EEs were obtained with 2D (17–33%) than with 3D (4–15%), significantly for SCR (P = 0.043) and IRR (P = 0.013). Considering uncertain EEs as positive, sensitivity was 100% for SCR, 91% for LCR, and 82% for IRR (SCR versus IRR, P = 0.031) with 2D, 100%, 97%, and 87%, respectively, with 3D technique, without significant differences; specificity ranged from 71% to 90% with 2D and 61% to 83% with 3D, without significant differences. Conclusion The type of ROI influences the EE in dynamic breast MR. Using 3D technique with small ROI located on the area of maximal enhancement gives the best results in terms of certainty of the level of EE together with top levels of sensitivity.

Diffusion tensor magnetic resonance imaging of the normal breast: reproducibility of DTI-derived fractional anisotropy and apparent diffusion coefficient at 3.0 T

PurposeDiffusion-weighted imaging (DWI) may improve the diagnostic performance of conventional breast magnetic resonance imaging (MRI). Diffusion tensor imaging (DTI) is an extension of DWI. If DTI-derived measurements are to be clinically useful, particularly for predicting and/or monitoring therapeutic effects, they must be robust and reliable. The purpose of this study was to assess intra- and interobserver reproducibility of DTIderived fractional anisotropy (FA) and apparent diffusion coefficient (ADC) at 3.0 T.Materials and methodsThis prospective study was approved by the Institutional Review Board, and participants provided written informed consent. Sixty normal contralateral breasts of 60 patients (28–85 years, median 57) were analysed with a DWI sequence following a standard MRI protocol. Four authors performed all postprocessing and analyses independently and in different sessions. The same authors, blinded to the initial results, repeated the image postprocessing and analysis 4 weeks after the initial session.ResultsMean ADC and FA for DTI sequences were, respectively, 1.92±0.30 and 0.32±0.09. Intra- and seinterobserver agreement of the four radiologists for ADC and FA were good (acceptable). Kappa values for ADC were intra-R1=0.82; intra-R2=0.84; intra-R3=0.89; intra-R4=0.88; inter-R1-R2=0.73; inter-R1-R3=0.74; inter-R1-R4=0.81; inter-R2-R3=0.76; inter-R2-R4=0.77; inter-R3-R4=0.83. Kappa values for FA were intra-R1=0.60; intra-R2=0.72; intra-R3=0.84; intra-R4 = 0.66; inter-R1-R2=0.64; inter-R1-R3=0.69; inter-R1-R4=0.72; inter-R2-R3=0.80; inter-R2-R4=0.71; inter-R3-R4=0.73. Within-subject coefficient of variation was 15% for ADC and 30% for FA. Repeatability with α=0.05 was 0.37×10−3 mm2/s for ADC and 0.112 for FA.ConclusionsADC and FA measurements obtained with DTI are reproducible and may be valid, reliable and sensitive to change. ADC values obtained with DTI are more reproducible than FA.RiassuntoObiettivoL’imaging di diffusione (DWI) può migliorare la performance diagnostica della convenzionale risonanza magnetica (RM) della mammella. L’imaging con tensore di diffusione (DTI) è un recente sviluppo della DWI. Affinché i valori derivanti dallo studio con DTI siano clinicamente utili, in particolare per la prognosi o il monitoraggio degli effetti della terapia, devono essere affidabili e attendibili. Lo scopo di questo studio è quello di valutare la riproducibilità intra- e inter-osservartore dell’anisotropia frazionaria derivante dalla DTI e il coefficiente di diffusione apparente (ADC) utilizzando un apparecchio di risonanza magnetica da 3,0 T.Materiali e metodiQuesto studio prospettico è stato approvato dal Comitato Etico del nostro istituto e le pazienti coinvolte hanno firmato il consenso informato. Sessanta mammelle normali controlaterali, rispetto a quelle malate, di 60 pazienti (28–85 anni di età, mediana di 67 anni) sono state analizzate con una sequenza DTI seguendo il protocollo standard per RM della mammella. Quattro radiologi hanno eseguito il post-processing e l’analisi delle immagini indipendentemente l’uno dall’altro e in sedute diverse. Gli stessi autori, senza conoscere i dati derivati dalla loro prima osservazione, hanno poi ripetuto il post-processing e l’analisi delle immagini 4 settimane dopo la prima sessione.RisultatiI principali valori di ADC e dell’anisotropia frazionaria (FA) per le sequenze DTI sono stati rispettivamente 1,92±0,30 e 0,32±0,09. L’accordo per i risultati intraed inter-osservatori dei quattro radiologi sia per ADC che per FA è stato buono. Il coefficiente di variazione per lo stesso osservatore è stato del 15% per il valore ADC e del 30% per il valore FA. I valori di k per l’ADC erano: intra-R1=0,82; intra-R2=0,84; intra-R3=0,89; intra-R4=0,88; inter-R1-R2=0,73; inter-R1-R3=0,74; inter-R1-R4=0,81; inter-R2-R3=0,76; inter-R2-R4=0,77; inter-R3-R4=0,83. I valori di per l’FA erano: intra-R1=0,60; intra-R2=0,72; intra-R3=0,84; intra-R4=0,66; inter-R1-R2=0,64; inter-R1-R3=0,69; inter-R1-R4=0,72; inter-R2-R3=0,80; inter-R2-R4=0,71; inter-R3-R4=0,73. La ripetibilità con α=0,05 era 0,37×10−3mm2/s per ADC e 0,112 per l’FA.ConclusioniI valori di ADC e FA ottenuti con la tecnica DTI sono riproducibili, e possono essere considerati validi e attendibili.

Characterization of adrenal adenomas and metastases: correlation between unenhanced computed tomography and chemical shift magnetic resonance imaging.

Purpose: To evaluate the correlation of absolute attenuation values of unenhanced computed tomography (CT) with signal intensity (SI) quantitative analysis on chemical shift (CS) magnetic resonance (MR) imaging in differentiating adrenal adenomas from metastases. Material and Methods: Forty-one adrenal masses (27 adenomas, 14 metastases) were studied with CS MR imaging and unenhanced CT. MR included T1-weighted breathhold gradient-echo in-phase (IP) and opposed-phase (OP) sequences. The SI index (SI-i) [(SIIP−SIOP/SIIP)]×100% and chemical-shift ratio (CS-r) relative to the spleen [(SIlesion/SIspleen)OP/(SIlesion/SIspleen)IP] were calculated for each lesion. CT absolute attenuation values were also determined. Results: The mean attenuation value of metastases was significantly greater than that of adenomas (<0.0001). On MR, the mean SI-i of adenomas was significantly greater than that of metastases (P<0.0001) and no overlaps were evident. The CS-r of malignant and benign lesions overlapped considerably, and five adenomas (all with indeterminate Hounsfield Unit values at CT) were misclassified as potentially malignant. CT attenuation values were significantly correlated with both MR quantitative analyses. Conclusion: Since CS MR imaging and CT both depict the presence of lipids within adrenal lesions, absolute attenuation values are highly correlated with MR quantitative analysis. SI-i is the most reliable tool for differentiating adrenal adenomas from metastases, showing better accuracy than lesion-to-spleen CS-r, in particular for adenomas with indeterminate absolute attenuation values.

Body MRI artefacts: from image degradation to diagnostic utility

Magnetic resonance (MR) imaging, as with any other imaging modality, has its share of artefacts, and MR studies of the abdomen and pelvis are particularly affected. These artefacts cause image degradation, can have an adverse effect on imaging quality and are usually considered detrimental. It is thus important to recognise common abdominopelvic MR imaging artefacts and know how to choose protocols and modify scan parameters to eliminate or at least minimise them. Many MR artefacts, on the other hand, provide diagnostically useful information about the underlying tissue, and many powerful MR sequences, such as in-phase or out-of-phase gradient-recalled-echo (GRE) sequences, may be thought of as imaging artefacts applied creatively. To distinguish friend from foe MR artefacts or to convert foes into friends, MR radiologists must recognise and understand the physical basis of such artefacts to take advantage of them for diagnostic purposes.RiassuntoGli artefatti rappresentano un problema comune a tutte le metodiche di imaging. Sono significativamente presenti negli studi di risonanza magnetica (RM) e in particolare nelle indagini RM di addome e pelvi. Questi artefatti possono causare degradazione delle immagini, con potenziale effetto negativo sulla qualità diagnostica, e sono in genere considerati in maniera negativa. È quindi importante sapere riconoscere i comuni artefatti in RM e saper scegliere protocolli e parametri per eliminarli o ridurli al minimo. Molti artefatti, d’altra parte, consentono di ottenere informazioni diagnostiche aggiuntive e alcune sequenze, come ad esempio le gradient-echo (GRE) in fase e in opposizione di fase, possono essere pensate come artefatti applicati creativamente all’imaging clinico. Per poterli definire amici o nemici, o poterli convertire da svantaggiosi a utili, bisogna conoscerne le basi fisiche in modo da trarre dagli artefatti il potenziale vantaggio diagnostico aggiuntivo.

Freehand 3T MR-guided vacuum-assisted breast biopsy (VAB): a five-year experience

Background Magnetic resonance (MR) permits the detection of some malignant lesions that cannot be identified with mammography or ultrasonography. The characterization of these MR-only detectable lesions often requires a biopsy. Purpose To evaluate the technique, the feasibility and the accuracy of freehand 3T MR-guided VAB for the characterization of suspicious, MR-only detectable lesions and to compare VAB results with surgical pathology and follow-up imaging results. Material and Methods During 2010–2015, 118 women who were referred for MR-guided VAB were retrospectively reviewed. All BI-RADS MR 4 and 5 lesions and some BI-RADS MR 3 lesions (according to clinical context and patient anxiety) were scheduled to undergo biopsy. Results A total of 123 suspicious lesions were retrospectively selected. Technical failures occurred in only two cases (1.6%) due to the location of the lesions. Histopathological results revealed 59 benign lesions (48%), 27 high-risk lesions (22%), and 35 malignant lesions (28.4%). Surgical pathology results led to the reclassification of eight B3 lesions: one proved to be a ductal carcinoma in situ, while seven presented with invasive features. B3 underestimation also occurred in 29% of the cases. MR follow-up was achieved for all the benign lesions and no false-negative cases were observed. No complications, 3T-related artefacts, or difficulties were observed. Conclusion Freehand 3T MR-guided VAB was found to be a valid, safe, fast, and inexpensive alternative to surgical histology.

L'imaging con tensore di diffusione nello studio della mammella normale: Riproducibilità dell'anisotropia frazionaria derivante dalla DTI e dal coefficiente apparente di diffusione con una risonanza magnetica da 3.0 T

PurposeDiffusion-weighted imaging (DWI) may improve the diagnostic performance of conventional breast magnetic resonance imaging (MRI). Diffusion tensor imaging (DTI) is an extension of DWI. If DTI-derived measurements are to be clinically useful, particularly for predicting and/or monitoring therapeutic effects, they must be robust and reliable. The purpose of this study was to assess intra- and interobserver reproducibility of DTIderived fractional anisotropy (FA) and apparent diffusion coefficient (ADC) at 3.0 T.Materials and methodsThis prospective study was approved by the Institutional Review Board, and participants provided written informed consent. Sixty normal contralateral breasts of 60 patients (28–85 years, median 57) were analysed with a DWI sequence following a standard MRI protocol. Four authors performed all postprocessing and analyses independently and in different sessions. The same authors, blinded to the initial results, repeated the image postprocessing and analysis 4 weeks after the initial session.ResultsMean ADC and FA for DTI sequences were, respectively, 1.92±0.30 and 0.32±0.09. Intra- and seinterobserver agreement of the four radiologists for ADC and FA were good (acceptable). Kappa values for ADC were intra-R1=0.82; intra-R2=0.84; intra-R3=0.89; intra-R4=0.88; inter-R1-R2=0.73; inter-R1-R3=0.74; inter-R1-R4=0.81; inter-R2-R3=0.76; inter-R2-R4=0.77; inter-R3-R4=0.83. Kappa values for FA were intra-R1=0.60; intra-R2=0.72; intra-R3=0.84; intra-R4 = 0.66; inter-R1-R2=0.64; inter-R1-R3=0.69; inter-R1-R4=0.72; inter-R2-R3=0.80; inter-R2-R4=0.71; inter-R3-R4=0.73. Within-subject coefficient of variation was 15% for ADC and 30% for FA. Repeatability with α=0.05 was 0.37×10−3 mm2/s for ADC and 0.112 for FA.ConclusionsADC and FA measurements obtained with DTI are reproducible and may be valid, reliable and sensitive to change. ADC values obtained with DTI are more reproducible than FA.RiassuntoObiettivoL’imaging di diffusione (DWI) può migliorare la performance diagnostica della convenzionale risonanza magnetica (RM) della mammella. L’imaging con tensore di diffusione (DTI) è un recente sviluppo della DWI. Affinché i valori derivanti dallo studio con DTI siano clinicamente utili, in particolare per la prognosi o il monitoraggio degli effetti della terapia, devono essere affidabili e attendibili. Lo scopo di questo studio è quello di valutare la riproducibilità intra- e inter-osservartore dell’anisotropia frazionaria derivante dalla DTI e il coefficiente di diffusione apparente (ADC) utilizzando un apparecchio di risonanza magnetica da 3,0 T.Materiali e metodiQuesto studio prospettico è stato approvato dal Comitato Etico del nostro istituto e le pazienti coinvolte hanno firmato il consenso informato. Sessanta mammelle normali controlaterali, rispetto a quelle malate, di 60 pazienti (28–85 anni di età, mediana di 67 anni) sono state analizzate con una sequenza DTI seguendo il protocollo standard per RM della mammella. Quattro radiologi hanno eseguito il post-processing e l’analisi delle immagini indipendentemente l’uno dall’altro e in sedute diverse. Gli stessi autori, senza conoscere i dati derivati dalla loro prima osservazione, hanno poi ripetuto il post-processing e l’analisi delle immagini 4 settimane dopo la prima sessione.RisultatiI principali valori di ADC e dell’anisotropia frazionaria (FA) per le sequenze DTI sono stati rispettivamente 1,92±0,30 e 0,32±0,09. L’accordo per i risultati intraed inter-osservatori dei quattro radiologi sia per ADC che per FA è stato buono. Il coefficiente di variazione per lo stesso osservatore è stato del 15% per il valore ADC e del 30% per il valore FA. I valori di k per l’ADC erano: intra-R1=0,82; intra-R2=0,84; intra-R3=0,89; intra-R4=0,88; inter-R1-R2=0,73; inter-R1-R3=0,74; inter-R1-R4=0,81; inter-R2-R3=0,76; inter-R2-R4=0,77; inter-R3-R4=0,83. I valori di per l’FA erano: intra-R1=0,60; intra-R2=0,72; intra-R3=0,84; intra-R4=0,66; inter-R1-R2=0,64; inter-R1-R3=0,69; inter-R1-R4=0,72; inter-R2-R3=0,80; inter-R2-R4=0,71; inter-R3-R4=0,73. La ripetibilità con α=0,05 era 0,37×10−3mm2/s per ADC e 0,112 per l’FA.ConclusioniI valori di ADC e FA ottenuti con la tecnica DTI sono riproducibili, e possono essere considerati validi e attendibili.

Diffusion tensor magnetic resonance imaging of the normal breast: reproducibility of DTI-derived fractional anisotropy and apparent diffusion coefficient at 3.0 T L'imaging con tensore di diffusione nello studio della mammella normale: riproducibilità dell'anisotropia frazionaria derivante dalla DTI e dal coefficiente apparente di diffusione con una risonanza magnetica da 3.0 T

PurposeDiffusion-weighted imaging (DWI) may improve the diagnostic performance of conventional breast magnetic resonance imaging (MRI). Diffusion tensor imaging (DTI) is an extension of DWI. If DTI-derived measurements are to be clinically useful, particularly for predicting and/or monitoring therapeutic effects, they must be robust and reliable. The purpose of this study was to assess intra- and interobserver reproducibility of DTIderived fractional anisotropy (FA) and apparent diffusion coefficient (ADC) at 3.0 T.Materials and methodsThis prospective study was approved by the Institutional Review Board, and participants provided written informed consent. Sixty normal contralateral breasts of 60 patients (28–85 years, median 57) were analysed with a DWI sequence following a standard MRI protocol. Four authors performed all postprocessing and analyses independently and in different sessions. The same authors, blinded to the initial results, repeated the image postprocessing and analysis 4 weeks after the initial session.ResultsMean ADC and FA for DTI sequences were, respectively, 1.92±0.30 and 0.32±0.09. Intra- and seinterobserver agreement of the four radiologists for ADC and FA were good (acceptable). Kappa values for ADC were intra-R1=0.82; intra-R2=0.84; intra-R3=0.89; intra-R4=0.88; inter-R1-R2=0.73; inter-R1-R3=0.74; inter-R1-R4=0.81; inter-R2-R3=0.76; inter-R2-R4=0.77; inter-R3-R4=0.83. Kappa values for FA were intra-R1=0.60; intra-R2=0.72; intra-R3=0.84; intra-R4 = 0.66; inter-R1-R2=0.64; inter-R1-R3=0.69; inter-R1-R4=0.72; inter-R2-R3=0.80; inter-R2-R4=0.71; inter-R3-R4=0.73. Within-subject coefficient of variation was 15% for ADC and 30% for FA. Repeatability with α=0.05 was 0.37×10−3 mm2/s for ADC and 0.112 for FA.ConclusionsADC and FA measurements obtained with DTI are reproducible and may be valid, reliable and sensitive to change. ADC values obtained with DTI are more reproducible than FA.RiassuntoObiettivoL’imaging di diffusione (DWI) può migliorare la performance diagnostica della convenzionale risonanza magnetica (RM) della mammella. L’imaging con tensore di diffusione (DTI) è un recente sviluppo della DWI. Affinché i valori derivanti dallo studio con DTI siano clinicamente utili, in particolare per la prognosi o il monitoraggio degli effetti della terapia, devono essere affidabili e attendibili. Lo scopo di questo studio è quello di valutare la riproducibilità intra- e inter-osservartore dell’anisotropia frazionaria derivante dalla DTI e il coefficiente di diffusione apparente (ADC) utilizzando un apparecchio di risonanza magnetica da 3,0 T.Materiali e metodiQuesto studio prospettico è stato approvato dal Comitato Etico del nostro istituto e le pazienti coinvolte hanno firmato il consenso informato. Sessanta mammelle normali controlaterali, rispetto a quelle malate, di 60 pazienti (28–85 anni di età, mediana di 67 anni) sono state analizzate con una sequenza DTI seguendo il protocollo standard per RM della mammella. Quattro radiologi hanno eseguito il post-processing e l’analisi delle immagini indipendentemente l’uno dall’altro e in sedute diverse. Gli stessi autori, senza conoscere i dati derivati dalla loro prima osservazione, hanno poi ripetuto il post-processing e l’analisi delle immagini 4 settimane dopo la prima sessione.RisultatiI principali valori di ADC e dell’anisotropia frazionaria (FA) per le sequenze DTI sono stati rispettivamente 1,92±0,30 e 0,32±0,09. L’accordo per i risultati intraed inter-osservatori dei quattro radiologi sia per ADC che per FA è stato buono. Il coefficiente di variazione per lo stesso osservatore è stato del 15% per il valore ADC e del 30% per il valore FA. I valori di k per l’ADC erano: intra-R1=0,82; intra-R2=0,84; intra-R3=0,89; intra-R4=0,88; inter-R1-R2=0,73; inter-R1-R3=0,74; inter-R1-R4=0,81; inter-R2-R3=0,76; inter-R2-R4=0,77; inter-R3-R4=0,83. I valori di per l’FA erano: intra-R1=0,60; intra-R2=0,72; intra-R3=0,84; intra-R4=0,66; inter-R1-R2=0,64; inter-R1-R3=0,69; inter-R1-R4=0,72; inter-R2-R3=0,80; inter-R2-R4=0,71; inter-R3-R4=0,73. La ripetibilità con α=0,05 era 0,37×10−3mm2/s per ADC e 0,112 per l’FA.ConclusioniI valori di ADC e FA ottenuti con la tecnica DTI sono riproducibili, e possono essere considerati validi e attendibili.