Complex US adnexal masses during pregnancy: Is pelvic MR imaging accurate for characterization?

OBJECTIVE: To retrospectively evaluate the accuracy of pelvic magnetic resonance (MR) imaging for the characterization of complex sonographic adnexal masses discovered in women during pregnancy. STUDY DESIGN: The study population comprised 31 pregnant women (median age: 32 years (range: 19-42); mean gestation age of 16 weeks) referred to our institution for MR imaging for characterization of an adnexal mass discovered incidentally during routine ultrasound (US) for other indications. The population comprised of 31 women, with 36 adnexal lesions (mean size: 103mm [range: 20-290]), of which 27 were benign and 9 were malignant masses. Prospective US and MR reports were reviewed to determine the presence of a benign or malignant lesion. Two radiologists (R1 and R2) blinded to the final outcome, retrospectively evaluated the MR images using the criteria based on the ADNEXMR-SCORE and classified the lesion as benign or malignant. The reference standard was surgical pathology or at least a 1-year imaging follow-up. RESULTS: Prospective US and MR imaging correctly identified the diagnosis in 27/36 (75%) (95% confidence interval (CI): 58.9%-86.2%) and in 32/36 (88.9%) (95% CI: 74.6%-95.6%) of lesions, respectively. MR imaging with ADNEXMR-SCORE allowed a correct diagnosis in 32/36 (88.9%) (95% CI: 74.6%-95.6%) of lesions for R1 and in 30/36 (83.3%) (95% CI: 68.1%-92.1%) of lesions for R2. The sensitivities and specificities of MR imaging using the MR ADNEXMR-SCORE were 100% (95% CI: 70.1%-1000%) for both readers and 85.1% (95% CI: 67.5%-94%) and 77.7% (95% CI: 59.2%-89.4%) for R1 and R2, respectively. No malignancy was classified as benign using MR criteria. The reproducibility between the two readers was almost perfect, with a kappa of 0.914. CONCLUSION: MR imaging is highly accurate for the characterization of complex adnexal masses incidentally discovered during pregnancy. CLINICAL RELEVANCE: MR imaging can accurately characterize adnexal masses in pregnancy and could be useful in opting for expectant management until delivery.

Breast Biopsies Under Magnetic Resonance Imaging Guidance: Challenges of an Essential but Imperfect Technique.

Magnetic resonance imaging (MRI)-guided breast biopsy is an essential tool of a breast imager; yet, a decade after its introduction, this technique remains challenging and imperfect. This article presents the technique of MRI-guided biopsy, with an emphasis on challenges particular to the technique: technical considerations related to adequate lesion sampling and difficulties in confirming radiologic-pathologic correlation for enhancing lesions. Through clinical vignettes, challenges unique to MRI-guided biopsy are discussed and practical tips are offered. Prebiopsy planning including second-look targeted studies, patient preparation, and equipment is covered. Challenging situations pertaining to breast size, lesion location, or type of enhancement are illustrated, as well as the topic of performing multiple MRI-guided breast biopsies in a single session and biopsies of women with implants. Postbiopsy management is discussed. Success of MRI-guided biopsies requires careful prebiopsy planning, as well as appropriate choice of biopsy device, optimized for the specifics of breast shape and lesion size and location. Special features of biopsy systems (smaller apertures and blunt tips) facilitate the sampling of lesions in challenging locations. Vanishing lesions should undergo short-term follow-up, because malignancy cannot be excluded, as should lesions diagnosed as benign after pathologic analysis when the result is felt to be concordant with imaging features. To this end, radiologic-pathologic correlation is essential. Underestimation rates after MRI-guided breast biopsy are superior to those for vacuum-assisted stereotactic biopsy and ultrasound-guided biopsy. Close follow-up and rebiopsy should be considered when there is imaging-discordant histology. For benign and concordant histology, a first follow-up can be offered at 6 months.

Postoperative imaging after lung transplantation.

Lung transplantation (LT) is an established procedure for chronic end-stage lung diseases. Complications are frequent and diverse and are the consequence of the complex surgical technique, the severity of the initial pathology, and the deep state of posttransplantation immunosuppression. Complications following LT include primary graft dysfunction, rejection (hyperacute, acute, and chronic), infections, posttransplantation lymphoproliferative disease, pleural and airway complications, native lung complications, and recurrence of primary disease. An understanding of these complications, their temporal evolution, and the role of radiology and other diagnostic methods in their diagnosis and management will help reduce the morbidity and mortality associated with LT.