Gozde Arslan

Diffusion Weighted MR Imaging of Breast and Correlation of Prognostic Factors in Breast Cancer

BACKGROUND Through Diffusion Weighted Imaging (DWI), information related to early molecular changes, changes in the permeability of cell membranes, and early morphologic and physiologic changes such as cell swelling can be obtained. AIMS We investigated the correlation between the prognostic factors of breast cancer and apparent diffusion coefficient (ADC) in DWI sequences of malignant lesions. STUDY DESIGN Retrospective cross-sectional study. METHODS Patients who were referred to our clinic between September 2012 and September 2013, who underwent dynamic breast MRI before or after biopsy and whose biopsy results were determined as malignant, were included in our study. Before the dynamic analysis, DWI sequences were taken. ADC relationship with all prognostic factors was investigated. Pearson correlation test was used to compare the numerical data, while Spearman correlation and Fisher exact tests were used to compare the categorical data. The advanced relationships were evaluated with linear regression analysis and univariate analysis. The efficiency of the parameters was evaluated using ROC analysis. The significance level (P) was accepted as 0.05. RESULTS In total, 41 female patients with an average age of 49.4 years (age interval 21-77) and 44 lesions were included into the study. In the Pearson correlation test, no statistically significant difference was determined between ADC and the patients age and tumor size. In the Spearman correlation test, a statistically significant difference was determined between nuclear grade (NG) and ADC (r=-0.424, p=0.04); no statistically significant correlation was observed between the other prognostic factors with each other and ADC values. In the linear regression analysis, the relationship of NG with ADC was found to be more significant alone than when comparing all parameters (corrected r2=0.196, p=0.005). Further evaluations between the NG and ADC correlation were carried out with ROC analysis. A statistically significant difference was determined when NG 1 separately was compared with NG 2 and 3 (p=0.03). A statistically significant difference was also determined (p=0.05) in the comparison of NG 1 with only NG 3. No statistically significant difference was determined when NG 2 separately was compared with NG 1 and NG 3 and when NG 3 separately was compared with NG 1 and 2 (p=0.431, p=0.097). CONCLUSION We found that ADC values obtained by breast DWI showed a higher correlation with the NG of breast cancer, which is an important factor in the patients treatment. Predictions can be made about NG by analyzing the ADC values. Additional studies are needed, however, and the ADC value of the lesion can be used as a prognostic factor proving the aggressiveness.

Complication of non-US guided procedure of aquafilling breast gel

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Computed tomography imaging findings of craniofacial fibrous dysplasia.

Introduction The purpose of this study was to retrospectively describe demographic characteristics and computed tomography (CT) imaging findings of craniofacial fibrous dysplasia (FD). Patients and Methods Between February 2010 and February 2013, we retrospectively studied 64 patients described as FD at CT imaging. Site of involvement and CT imaging findings of craniofacial FD were recorded for each patient. Results Our patients are described as FD at CT imaging with the following findings: expansion, ground glass density, expansion and sclerosis, expansion with sclerosis and lytic appearance, expansion and lytic appearance, and only sclerosis. Expansion was the main feature which was seen with other findings (85%). The most common finding was ground glass density and the least appearance was expansion with lytic areas and only sclerosis. Discussion Our study has shown that it is very effective to know about CT findings and localizations of craniofacial FD to reduce unnecessary biopsy rates and increase the true diagnosis.

Liver trauma grading and biochemistry tests

Among solid organ blunt traumas, the liver and spleen are mostly subject to injury. In addition, the liver is also commonly injured in penetrating traumas because of its size, location, and the ease of injury to the “Glisson Capsule”. Several enzymes are known to be elevated following trauma. In our study, we evaluated the correlation between the levels of serum aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and gamma-glutamyl transpeptidase in 57 patients with blunt trauma to the liver and compared these values to the American Association for the Surgery of Trauma trauma grading system. Additionally, we compared the enzyme level elevations in these patients to the enzyme levels of 29 healthy subjects. As expected, we found significant elevations in enzyme levels of trauma patients compared to the control group. The calculated point estimates were not significantly different between grades 1 and 2 trauma. However, grade 3 trauma group showed a significant increase in enzyme levels.

Background parenchymal enhancement: is it just an innocent effect of estrogen on the breast?

PURPOSE We aimed to retrospectively analyze whether background parenchymal enhancement (BPE) on breast magnetic resonance imaging (MRI) correlates with menarche, menopause, reproductive period, menstrual cycle, gravidity-parity, family history of breast cancer, and the Breast Imaging-Reporting and Data System (BI-RADS) category of the patient. METHODS The study included 126 pre- and 78 postmenopausal women who underwent breast MRI in our institute between 2011 and 2016. Patients had filled a questionnaire form before the MRI. Two radiologists blinded to patient history graded the BPEs and the results were compared and analyzed. RESULTS The BPE was correlated with patient age and the day of menstrual cycle (P < 0.01 for both). No correlation was found with menarche age, menopause age, total number of reproductive years, and family history of breast cancer. In the moderate BPE group, only 1 out of 35 patients and in the marked BPE group only 1 out of 13 patients were postmenopausal and had BI-RADS scores of 4 and 5, respectively. CONCLUSION Increased symmetrical BPE is mainly due to current hormonal status in the premenopausal women. High-grade BPE, whether symmetrical or not, is rarely seen in postmenopausal women; hence, these patients should be further investigated or closely followed up.

MRI of Residual Red Bone Marrow in the Distal Femur of Healthy Subjects

Summary Backround The purpose of our study is to examine the correlation of the residual red bone marrow areas of distal femoral metaphysis with the age, gender, weight and hemoglobin (hgb) values; evaluate the results, and comprehend the importance of these residual areas in the light of the results. Material/Methods 140 nonsmoking patients between the ages of 26 and 72 (92 women, 48 men) who had knee MR examinations were included in the study. The residual red bone marrow areas in the distal femoral metaphysis in MR images were examined by a radiologist. The areas were separated into grades according to their sizes. The hemoglobin values of the cases were measured. The size of the residual red bone marrow area and the age, gender, weight and hemoglobin values of the cases were compared by using the Tukey and Chi-Square Tests. Results Although no significant differences were observed between the mean ages, weights and hemoglobin values of the grades, a significant difference was detected between the gender distribution The male group had less residual red bone marrow in the distal femoral metaphysis than the female group (p=0.003). Conclusions We observed that the hypointensities due to residual red bone marrow observed in the T1WS of the distal femoral metaphysis are not related with the age, weight and hemoglobin values. No grade 2 and grade 3 patient was detected in male group. We observed that these hypointense areas showed difference according to the gender variable; however, were not affected by the hemoglobin values over certain levels.

Internal mammary artery anastomoses in patients without breast lesions (BIRADS 1) and in patients with malignant breast lesions (BIRADS 6) on magnetic resonance imaging (MRI)

Summary Background We aimed to compare the frequency of IMA (internal mammarian artery) anastomoses in right and left breasts in patients without breast lesions and in patients with malignant breast lesions. Material/Methods A total of 100 patients with no breast lesions and a total of 100 patients with malignant breast lesions were included in the study. The anastomoses of IMA of right and left breasts were evaluated on MIP and post-contrast T1-weighted magnetic resonance imaging (MRI) sequences. Breast MRI scans were read by a radiologist. Results In patients with no breast lesions, IMA anastomoses were found in 45% of cases, and in patients with malignant breast lesions, IMA anastomoses were found in 58% cases. In four patients with malignant lesions, ipsilateral IMA was rudimentary, and the lesion was feeding from the contralateral IMA. Conclusions No statistically significant difference was found between patients without any breast lesions and patients with malignant breast lesions with respect to the frequency of IMA anastomoses in right and left breasts. The frequencies were higher than expected in both groups.

Evaluation of Hepatocellular Carcinomas and Liver Metastases- How Far can we Go with Diffusion Weighted Imaging?

Objective: We aimed to determine the usefulness of the apparent diffusion coefficient (ADC) values for the differential diagnosis of hepatocellular carcinomas and most common metastatic liver tumors and we aimed to compare the characteristic properties. We also aimed to detect novel lesions on ADC maps before the lesion is clinically and radiologically detected by conventional methods. Materials and Methods: We evaluated characteristic properties, contrast enhancement patterns of liver metastasis of malignancies like adenocancer, renal cell carcinoma (RCC), gastrointestinal stromal tumor (GIST) and hepatocellular carcinoma (HCC) on magnetic resonance imaging (MRI) and diffusion weighted (DW) imaging. ADCs were measured both from the cystic and solid parts of the tumoral lesions. Solid and cystic parts were grouped seperately and compared individually. Results: 48 cases, (60% male and 40% female) with ages ranging between 48 and 81 were involved. 28 of them had liver metastasis and 20 of them had HCC. MRIs between the years 2009 and 2012 were analyzed. Among mean ADC values measured from solid contrast-enhancing parts, values of the HCC group were significantly higher than the metastasis group (p=0.004). Also, in metastasis group consisting of many distinct primaries, there were differences in ADC values. A retrospective analysis for follow-up cases showed that the ADC values of the parencyhma where a lesion will appear on later follow-up images were lower than the adjacent parenchyma. Conclusion: We believe that this method may be useful to detect early metastasis. Studies with larger patient groups could give more significant results which would enable diffusion imaging method to be used in this area.

Accidental injection of autologous fat into the breast implant: a case report highlighting radiological findings

Autologous fat grafting is a popular technique for breast augmentation and improving breast contour depressions. It is a technique that involves using the patient’s own adipose tissue to be applied on a subcutaneous area to increase total fat volume. Intraimplant fat is an unexpected finding after autologous fat grafting. A 51-year-old asymptomatic female who underwent breast augmentation with silicone implants and secondary breast augmentation with autologous fat grafting presented with unidentified cluster of radiolucencies superimposed to left implant on screening mammogram. Corresponding MRI revealed intraimplant fat intensities. This case represents a previously unreported intraimplant injection of fat with resultant intracapsular rupture and highlights the radiological findings of intracapsular implant rupture.Level of Evidence: Level V, diagnostic study.

Sonographically Unusual Breast Carcinomas, 2 Case Reports

Summary Background For infiltrative breast lesions; sonography might not always be as helpful as mammography and MRI (magnetic resonance imaging). For higher sensitivity and specificity, these 3 imaging methods should be carried out together. Radiologists should be aware of the patient’s history and complaints. Patients who have a specific history like a long-term drug treatment or a palpable tumour should be approached differently. Case Report We would like to present 2 cases with atypical sonographic findings. The first case is an infiltrative breast cancer with occult sonography findings in a patient with a history of a long-term immunosuppressive drug treatment due to kidney transplantation and the second case is a malignant breast tumour which is hyperechogenic on sonography. Conclusions Overall breast sonography should always be correlated with mammography in patients over 40 years old and the images should be interpreted along with the patient’s history and clinical status.