W. P. Evans

Silicone-suppressed 3D MRI of the breast using rotating delivery of off- resonance excitation

Objective A new silicone-suppressed MR technique was developed, and its efficacy in identifying free silicone and differentiating it from other breast tissues was investigated. Materials and Methods Silicone-suppressed MRI was performed using the RODEO (rotating delivery of excitation off-resonance) pulse sequence, which selectively eliminated signal from the narrow range of (CH3)4Si resonance. Ninety breasts in 61 patients were evaluated with both a fat-suppressed 3D MR sequence and a silicone-suppressed 3D MR sequence. Results Extracapsular free silicone and silicone injections demonstrated a unique appearance compared with normal breast tissue in all cases. Magnetic resonance identified free silicone in 26 breasts, 10 of which were confirmed pathologically or from a history of previous silicone injections. No free silicone was present on MR in 64 breasts; 8 of these were confirmed by biopsy or mastectomy as showing no evidence of free silicone. This technique was useful in evaluation of prosthesis integrity, free silicone, focal palpable or mammo-graphic lesions, and the breast with silicone injections. Conclusion Silicone-suppressed RODEO MRI of the breast can accurately identify free and intracapsular silicone and can distinguish silicone from other tissues. This provides unique information about the breast in a number of specific applications.

U.S. Preventive Services Task Force

Editor We read with dismay the May 2010 Radiology editorial by Drs Berlin and Hall regarding the reactions of the medical community to the recommendations of the U.S. Preventive Services Task Force (USPSTF) ( 1 , 2 ). The authors’ conclusion that the medical community supports the recommendations of the task force is overly simplifi ed. Organizations such as the American College of Obstetricians and Gynecologists and the American Society of Breast Surgeons support the existing guidelines. The authors say that one-third of breast cancers currently detected by mammography are “overdiagnosed.” Breast imagers believe that this is not a detection or diagnosis problem but, rather, that it is an overtreatment problem. However, until prognostic indicators can accurately predict which cancers will progress, surgeons and medical oncologists recommend treatment. The authors propose public discussion of the costs and benefi ts of screening mammography. However, where was such dialogue when the task force was convened? Why weren’t experts in the breast imaging community included on the task force? The authors suggest that only those who have agreed with the USPSTF have balance. While we welcome an informed discussion, we also believe that women must be given correct information if they are to choose wisely. We believe that the estimates of benefi t used by the task force were too low and that the harms were overemphasized. This is truly unbalanced. It has been known for 30 years that screening mammography saves lives, and this was acknowledged by the USPSTF. The disagreement pertains not to the known fact that mammography saves lives, but to whether the trade-offs between costs and benefi ts are worth the effort for women of different age groups. We value such a discussion, but better estimates of the magnitude of the mortality benefi t must be considered, and years of life saved must be included in the analysis.