Mariko Goto

Diagnosis of breast tumors by contrast‐enhanced MR imaging: Comparison between the diagnostic performance of dynamic enhancement patterns and morphologic features

To compare the diagnostic performance of breast lesions by the enhancement patterns and morphologic criteria on magnetic resonance imaging (MRI).

Microperfusion-induced elevation of ADC is suppressed after contrast in breast carcinoma

To investigate the effect of gadolinium (Gd)‐DTPA on the apparent diffusion coefficient (ADC) of breast carcinoma and to analyze the relationship between pre/postcontrast ADC and the degree of contrast enhancement.

MR Imaging of Ventral Thalamic Nuclei

BACKGROUND AND PURPOSE: The Vim and VPL are important target regions of the thalamus for DBS. Our aim was to clarify the anatomic locations of the ventral thalamic nuclei, including the Vim and VPL, on MR imaging. MATERIALS AND METHODS: Ten healthy adult volunteers underwent MR imaging by using a 1.5T whole-body scanner. The subjects included 5 men and 5 women, ranging in age from 23 to 38 years, with a mean age of 28 years. The subjects were imaged with STIR sequences (TR/TE/TI = 3200 ms/15 ms/120 ms) and DTI with a single-shot echo-planar imaging technique (TR/TE = 6000 ms/88 ms, b-value = 2000 s/mm2). Tractography of the CTC and spinothalamic pathway was used to identify the thalamic nuclei. Tractography of the PT was used as a reference, and the results were superimposed on the STIR image, FA map, and color-coded vector map. RESULTS: The Vim, VPL, and PT were all in close contact at the level through the ventral thalamus. The Vim was bounded laterally by the PT and medially by the IML. The VPL was bounded anteriorly by the Vim, laterally by the internal capsule, and medially by the IML. The posterior boundary of the VPL was defined by a band of low FA that divided the VPL from the pulvinar. CONCLUSIONS: The ventral thalamic nuclei can be identified on MR imaging by using reference structures such as the PT and the IML.

The role of breast MR imaging in pre-operative determination of invasive disease for ductal carcinoma in situ diagnosed by needle biopsy

ObjectivesTo evaluate whether magnetic resonance (MR) imaging features can predict the presence of occult invasion in cases of biopsy-proven pure ductal carcinoma in situ (DCIS).MethodsWe retrospectively reviewed 92 biopsy-proven pure DCIS in 92 women who underwent MR imaging. The following MR imaging findings were compared between confirmed DCIS and invasive breast cancer (IBC): lesion size, type, morphological and kinetic assessments by ACR BI-RADS MRI, and findings of fat-suppressed T2-weighted (FS-T2W) imaging.ResultsSixty-eight of 92 (74%) were non-mass-like enhancements (NMLE) and 24 were mass lesions on MR imaging. Twenty-one of 68 (31%) NMLE and 13 of 24 (54%) mass lesions were confirmed as IBC. In NMLE lesions, large lesions (P = 0.007) and higher signal intensities (SI) on FS-T2W images (P = 0.032) were significantly associated with IBC. Lesion size remained a significant independent predictor of invasion in multivariate analysis (P = 0.032), and combined with FS-T2W SIs showed slightly higher observer performances (area under the curve, AUC, 0.71) than lesion size alone (AUC 0.68). There were no useful findings that enabled the differentiation of mass-type lesions.ConclusionsBreast MR imaging is potentially useful to predict the presence of occult invasion in biopsy-proven DCIS with NMLE.Key PointsMR mammography permits more precise lesion assessment including ductal carcinoma in situA correct diagnosis of occult invasion before treatment is important for cliniciansThis study showed the potential of MR mammography to diagnose occult invasionTreatment and/or aggressive biopsy can be given with greater confidenceMR mammography can lead to more appropriate management of patients

CT-based evaluation of axillary sentinel lymph node status in breast cancer: value of added contrast-enhanced study

Purpose: To evaluate the diagnostic reliability of CT-based sentinel lymph node (SLN) size criteria for selecting the candidates for direct axillary dissection without SLN biopsy and to determine the value of added contrast-enhanced study. Material and Methods: Breast cancer patients (n=107) underwent triple phasic (1-min, 3-min, 8-min) contrast-enhanced 5 mm-computed tomography (CT) of the breasts and axillae. In the CT image, the most inferior lymph node in the axilla was designated the SLN. Axillary status was judged based on SLN size criteria. CT density, enhancement rate, and peak enhancement time of each SLN were correlated with histopathological results. Results: SLN size criteria demonstrated a sensitivity of 76% and a positive predictive value of 95% in predicting SLN metastasis. The density values at each scanning time-point were significantly different for metastatic and non-metastatic SLN. However, their enhancement rates differed significantly only at 1 min. Their peak enhancement occurred primarily at 1 min. The use of contrast-enhancement criteria improved the predictive sensitivity, but failed to decrease the false-positive rate of the SLN size criteria. Conclusion: The enhancement rate at 1 min proved to be the most useful parameter in contrast-enhanced CT studies; however, it failed in improving the accuracy of the SLN size criteria.

Equivalent cross-relaxation rate imaging of breast cancer.

To determine whether equivalent cross‐relaxation rate (ECR) imaging is a feasible method for demonstrating breast cancer.

Assessment of the solid-state gamma camera to depict axillary sentinel lymph nodes in breast cancer patients

PurposeThe solid-state gamma camera is now commercially available offering the advantages of a compact and portable system, currently used mainly in the cardiac region. We evaluate the ability of the solid-state gamma camera to depict axillary sentinel lymph nodes (SLNs) in breast cancer patients.Materials and MethodsPreoperative SLN lymphoscintigraphy (LSG) was performed in 19 patients with breast cancer using the solid-state gamma camera. Immediately thereafter, we performed a second LSG using a single detector Anger-type gamma camera, and compared the findings from the two cameras.ResultsConcordant results were obtained in 12 (63%) patients with both cameras. In 4 (21%) patients, axillary SLNs were correctly identified only with the solid-state gamma camera. In these patients, the distance between the SLN and the radiopharmaceutical injection site was closer than that of patients who had concordant results (p = 0.001).ConclusionWe can depict correctly axillary SLNs with the solid-state gamma camera in comparison with the Anger-type gamma camera. This technique would be useful for assessing SLNs in breast cancer patients.

Myoid hamartoma of the breast that proved difficult to diagnose: a case report

Myoid hamartomas of the breast are extremely rare breast lesions, with a poorly understood pathogenesis. We describe the case of a 38-year-old premenopausal woman who presenting with a mass in the left breast. Mammography revealed an oval mass that was partly indistinct, and ultrasonography showed a hypoechoic mass with a slightly irregular margin. Bilateral breast dynamic magnetic resonance imaging was performed for a more detailed evaluation. The images showed rapid initial enhancement and a microlobulated margin. Because the suspicion of malignancy was strong at that time, core needle biopsy was performed. Histologically, the tumor was identified as fibroadenoma. A case of myoid hamartoma of the breast that proved difficult to diagnose is reported, and discussed with reference to the literature.

A case of testicular seminoma in persistent Mullerian duct syndrome with transverse testicular ectopia

We present a rare case of testicular seminoma in persistent Mullerian duct syndrome (PMDS) with transverse testicular ectopia (TTE). A 42-year-old man noticed scrotal swelling a few weeks earlier and underwent magnetic resonance imaging (MRI) on suspicion of testicular tumor. MRI revealed a normal left testis on the left side of the left scrotum and a heterogeneous mass on the right side within the left scrotum. No right testis was found in the right scrotum. A blind-ending tubular structure with thickened wall showed a three-layer appearance on T2-weighted imaging and extended from the prostate through the left inguinal canal to the left scrotum. Findings during surgery suggested right testicular tumor associated with right TTE. The histopathological and immunohistochemical diagnoses of the testicular tumor and blind-ending tubular structure were seminoma and persistent Mullerian duct, respectively. Testicular tumor in PMDS with TTE is rare but may possess a characteristic appearance on imaging. Proper knowledge of these diseases will allow correct preoperative diagnosis.

MR Imaging of Tubular Adenoma of Breast Associated with Lactating Change

A 24-year-old lactating woman presented with an enlarged mass in her left breast. On physical examination, a 4.4-cm mobile lump was palpable in the internal inferior area of her left breast. Mammography showed dense breast tissue and a focal mass, and ultrasonography showed a circumscribed heterogeneous hyperechoic solid mass. Fat-suppressed T2-weighted MR image showed a circumscribed heterogeneous hyperintense mass with several spotty strongly hyperintensity areas (Fig. 1a). On contrast-enhanced T1-weighted MR image with fat suppression, the mass showed heterogeneous gradual enhancement (Fig. 1b). A histologic section revealed that the mass was well-circumscribed with heterogeneous internal structures composed of microscopically numerous tightly packed acinar units, scant stroma, and secretory change including cytoplasmic vacuoles and lumeral eosinophilic secretion (Fig. 1c). The mixture of genuine adenoma and lactating change were shown in the tumor and the final pathologic diagnosis was tubular adenoma of the breast associated with lactating change. Tubular adenomas are rare benign tumors of the breast often found in young women. They has been identified in postpartum biopsies that first presented during pregnancy, because the tumors are markedly enlarged, reflecting internal lactating physiologic changes that may represent the same lesion in lactating adenoma. The most important differential diagnosis of an enlarging mass in the breast during pregnancy or lactation is breast cancer. Diagnosis of breast cancer is difficult in this patient group, as pregnant and lactating women have extremely dense breast at mammography. Ultrasonography is the preferred initial study for evaluating a palpable mass in this group of patients. However, tissue sampling is usually warranted to avoid delay in diagnosis of breast cancer. There are few reports of the usefulness of contrastenhanced MR imaging for lactating mass. In our case, the findings of MR mammography seemed to represent histologic features of the lactating change of tubular adenoma. The internal heterogeneous hyperintense on T2-weighted image and heterogeneous internal enhancement on T1-weighted image reflects histologically scattered secretory change in the tubular adenoma, and several spotty strongly hyperintensity areas in the mass are considered to reflect trapped secretion products. Contrast-enhanced MR mammography has had limited use in lactating woman; however, if clinical course, ultrasound, and mammography cannot rule out breast cancer, MR mammography may contribute to distinguishing between benign and malignant breast masses in lactating woman.