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  • Radiology in Public Focus

    December 01, 2012

    Press releases were sent to the medical news media for the following articles appearing in recent issues of Radiology.

    Nonmalignant Breast Lesions: ADCs of Benign and High-Risk Subtypes Assessed as False-Positive at Dynamic Enhanced MR Imaging

    Assessing apparent diffusion coefficients (ADCs) along with dynamic contrast-enhanced MR imaging features may decrease the number of avoidable false-positive findings at breast MR imaging and reduce the number of preventable biopsies, new research shows.

    In the study, Sana Parsian, M.D., of the University of Washington School of Medicine, Seattle, and colleagues retrospectively reviewed lesions assessed as Breast Imaging Reporting and Data System (BI-RADS) category 4 or 5 at clinical dynamic contrast material–enhanced MR imaging that subsequently proved nonmalignant at biopsy. Researchers evaluated 175 nonmalignant breast lesions in 165 women. ADCs from diffusion-weighted (DW) imaging were calculated for each lesion and compared between subtypes and with an ADC threshold determined in a prior study to achieve 100 percent sensitivity.

    Results showed that 46 percent of nonmalignant breast lesions assessed as false-positive findings at dynamic contrast-enhanced MR imaging had ADCs higher than the previously determined diagnostic threshold.

    “Our findings show promise for using diffusion-weighted imaging to reduce the number of avoidable false-positive findings at breast dynamic contrast-enhanced MR imaging; improving the specificity of breast MR imaging would reduce the number of avoidable biopsies and associ-ated morbidity for the patient,” the researchers write.

    Comparison of Digital Screening Mammography and Screen-Film Mammography in the Early Detection of Clinically Relevant Cancers: A Multicenter Study

    In a large, population-based breast cancer screening program, digital mammography performed substantially better than screen-film mammography (SFM) in detecting ductal carcinoma in situ (DCIS) and invasive carcinoma, new research shows.

    In the study, Adriana M.J. Bluekens, M.D., of the National Expert and Training Centre for Breast Cancer Screening in Nijmegen and St. Elisabeth Hospital in Tilburg, both in the Netherlands, and colleagues compared digital mammography to SFM in 1,198,493 screening mammograms performed between 2003 and 2007. Of those, 83.3 percent were SFM examinations and 12.7 percent were digital mammography examinations. Recall was indicated in 18,896 cases.

    For initial screening examinations, the detection rate per 1,000 women was 5.6 with SFM and 6.8 with digital mammography. The difference in detection for subsequent screening examinations was also in favor of digital mammography, with respective rates of 5.2 and 6.1 per 1,000 women. Detection of high-grade DCIS with digital mammography was 58.5 percent, compared with 50.5 percent for SFM.

    “Digital screening mammography demonstrates advantages in the early detection of breast cancer by increasing the detection of clinically relevant cancers while keeping potential overdiagnosis low,” the authors write. “This gain is largely due to enhanced depiction of microcalcifications, resulting in improved detection of both DCIS and invasive carcinoma.”

    Coronary Vessel Wall 3-T MR Imaging with Time-resolved Acquisition of Phase-Sensitive Dual Inversion-Recovery (TRAPD) Technique: Initial Results in Patients with Risk Factors for Coronary Artery Disease

    TIME-RESOLVED acquisition of phase-sensitive dual-inversion recovery (TRAPD) imaging of coronary arteries improves arterial wall visualization and quantitative assessment by increasing the success rate of obtaining good- to excellent-quality images and sections orthogonal to the longitudinal axis of the vessel. The technique also resulted in vessel wall thickness measurements that show a more distinct difference between healthy subjects and those with CAD risk factors, new research shows.

    In the study of 12 healthy subjects and 26 with at least one CAD risk factor, Khaled Z. Abd-Elmoniem, Ph.D., of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, and colleagues developed the TRAPD coronary vessel wall imaging sequence and validated it with a flow phantom. Researchers obtained time-resolved coronary artery wall images at three to five cine cases in all subjects and made qualitative and quantitative comparisons between TRAPD and conventional single-image wall measurements.

    Use of three to five frames increased the success rate of acquiring at least one image of good to excellent quality from 76 percent in single-image acquisitions to 95 percent with the TRAPD sequence, results showed. The difference in vessel wall thickness between healthy subjects and CAD risk factor subjects was significant with the TRAPD sequence, according to the authors.

    “Preliminary experience with the TRAPD sequence in healthy subjects and subjects with risk factors for coronary artery disease suggests improved ability to distinguish coronary wall thickness between the two groups compared with that with single-frame dual inversion-recovery imaging,” the authors write.

    Images in 61-year-old woman with a personal history of right-breast ductal carcinoma in situ
    Images in 61-year-old woman with a personal history of right-breast ductal carcinoma in situ. The patient underwent breast MR imaging for high-risk screening. (a) Axial dynamic contrast-enhanced initial postcontrast subtraction MR image shows 13-mm lobular heterogeneously enhancing mass (arrow) in the subareolar region of the left breast, 16 mm from the nipple. The lesion has a smooth margin and is at an anterior depth. This lesion was classified as BI-RADS category 4. On (b) an axial dynamic contrast-enhanced MR image, the lesion shows mixed kinetics overall: 28 percent delayed persistent enhancement (blue), 34 percent delayed plateau (green) and 38 percent delayed washout (red). The lesion is hypointense on (c) an axial T2-weighted MR image. The lesion is hyperintense on (d) axial DW image and has a low ADC (mean, 1.06 × 10−3 mm2/sec) on (e) an ADC map. Insets in d and e = ROIs. The lesion was classified as ADH on the basis of (f) US-guided core biopsy results, which showed intraductal papilloma and ductal hyperplasia with focal atypia with no evidence of invasive carcinoma. (Hematoxylin- eosin stain; original magnification, ×200.) No evidence of carcinoma was detected at excisional biopsy. (Radiology 2012;265;3:699-706) ©RSNA, 2012. All rights reserved. Printed with permission.
    TRAPD signed-magnitude images of four different subjects show subject variability encountered in the study
    TRAPD signed-magnitude images of four different subjects show subject variability encountered in the study. White circles = images with good- or excellentquality scores, filled circles = images with thinnest vessel walls. Cases 1 and 2 are healthy subjects in which all images had adequate (good or excellent) scores for quantitative analysis. Cases 3 and 4 subjects with CAD risk factors and short cardiac cycles in whom it was impossible to acquire the fifth frames. Case 3 also shows a situation in which only the first two frames had acceptable quality. The label beside each case shows average, minimum and maximum heart rate (HR) in beats per minute during the examination, age in years, Framingham risk factor (RF) and body mass index (BMI). (Radiology 2012;265;715–723) ©RSNA, 2012. All rights reserved. Printed with permission.
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