Value of Shear Wave Elastography for the Differentiation of Benign and Malignant Microcalcifications of the Breast.

OBJECTIVE. The objective of our study was to evaluate whether shear wave elastography (SWE) can differentiate benign from malignant microcalcifications of the breast when detected on ultrasound (US). SUBJECTS AND METHODS. Between February 9, and June 23, 2016, 74 patients with mammographically detected suspicious microcalcifications underwent breast US. When microcalcifications were identified on US, stiffness was assessed using SWE. Biopsy was subsequently performed under US guidance using a 10-gauge vacuum-assisted needle. Qualitative and quantitative elastography results were compared between benign and malignant calcifications as well as between pure ductal carcinoma in situ and lesions with invasive components using the Mann-Whitney U test. ROC curves were created to assess the performance of SWE in detecting malignancy and invasive components. RESULTS. Twenty-nine groups of microcalcifications in 29 patients were identified on US. At pathology, 16 groups were benign and 13 were malignant. Stiffness of malignant calcifications was significantly higher than that of the benign ones (p = 0.0004). The AUC, sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of SWE for the diagnosis of malignancy were 0.89, 69%, 100%, 80%, 100%, and 86%, respectively, and for detection of an invasive component were 0.93, 75%, 100%, 75%, 100%, and 85%. CONCLUSION. SWE has the potential to differentiate benign from malignant micro-calcifications of the breast when detected on US with high specificity.

Magnetic resonance imaging of acute appendicitis in pregnancy: a 5-year multiinstitutional study.

OBJECTIVE: The purpose of this study was to determine the diagnostic performance of magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis during pregnancy in a multiinstitutional study. STUDY DESIGN: In this multicenter retrospective study, the cases of pregnant women who underwent MRI evaluation of abdominal or pelvic pain and who had clinical suspicion of acute appendicitis between June 1, 2009, and July 31, 2014, were reviewed. All MRI examinations with positive findings for acute appendicitis were confirmed with surgical pathologic information. Sensitivity, specificity, negative predictive values, and positive predictive values were calculated. Receiver operating characteristic curves were generated, and area under the curve analysis was performed for each participating institution. RESULTS: Of the cases that were evaluated, 9.3% (66/709) had MRI findings of acute appendicitis. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive values were 96.8%, 99.2%, 99.0%, 92.4%, and 99.7%, respectively. There was no statistically significant difference between centers that were included in the study (pair-wise probability values ranged from 0.12-0.99). CONCLUSION: MRI is useful and reproducible in the diagnosis of suspected acute appendicitis during pregnancy.

Breast reconstruction: review of surgical methods and spectrum of imaging findings.

Breast reconstruction after mastectomy is often requested by women with breast cancer who are ineligible for breast-conserving therapy and women with a high genetic risk for breast cancer. Current breast reconstruction techniques are diverse and may involve the use of an autologous tissue flap, a prosthetic implant, or both. Regardless of the technique used, cancer may recur in the reconstructed breast; in addition, in breasts reconstructed with autologous tissue flaps, benign complications such as fat necrosis may occur. To detect breast cancer recurrences at a smaller size than can be appreciated clinically and as early as possible without evidence of metastasis, radiologists must be familiar with the range of normal and abnormal imaging appearances of reconstructed breasts, including features of benign complications as well as those of malignant change. Images representing this spectrum of findings were selected from the clinical records of 119 women who underwent breast magnetic resonance (MR) imaging at the authors' institution between January 2009 and March 2011, after mastectomy and breast reconstruction. In 32 of 37 women with abnormal findings on MR images, only benign changes were found at further diagnostic workup; in the other five, recurrent breast cancer was found at biopsy. Four of the five had been treated initially for invasive carcinoma, and one, for multifocal ductal carcinoma; three of the five were carriers of a BRCA gene mutation. On the basis of these results, the authors suggest that systematic follow-up examinations with breast MR imaging may benefit women with a reconstructed breast and a high risk for breast cancer recurrence.

Comparison between constrained and non-constrained Cobb techniques for the assessment of thoracic kyphosis and lumbar lordosis.

Sagittal curvatures of the spine can be assessed using the constrained or non-constrained Cobb techniques. However, there is no study that specifically compares these two techniques. The objective of this study is to assess the reproducibility and clinical relevance of the non-constrained Cobb technique (non-constrained limit vertebrae) compared to the constrained Cobb technique (constrained limit vertebrae). Standing sagittal radiographs of the spine of ten adolescents with idiopathic scoliosis, ten adolescents with spondylolisthesis and ten normal adolescents were selected. Thoracic kyphosis (TK) and lumbar lordosis (LL) were measured twice by three observers using both constrained and non-constrained Cobb techniques. Pearson's correlation coefficients, as well as intra- and inter-observer intra-class correlation coefficients (ICC) were calculated. Inter-observer ICCs were similar for TK and LL with both techniques, ranging from 0.84 to 0.89. Intra-observer ICCs for both techniques were between 0.74 and 0.92 for TK, while they were between 0.87 and 0.97 for LL. The two techniques were highly correlated for the measurement of the TK (r = 0.96) and LL (r = 0.94). Computer-assisted assessment of the sagittal profile using the non-constrained Cobb technique provides excellent reproducibility. As opposed to the constrained Cobb technique, the non-constrained Cobb technique takes into account the variability in the level of transition between the TK and LL. However, adequate use of this technique requires accurate identification of the limit vertebrae in the thoracolumbar spine. Consequently, a computer-assisted technique is recommended when using the non-constrained Cobb technique.

Computerized assessment of sagittal curvatures of the spine: comparison between Cobb and tangent circles techniques.

OBJECTIVE: The tangent circles technique has been proposed as an alternative to the Cobb angle technique to assess sagittal curves of the spine. However, it has never been compared directly to the Cobb technique. This study compares the reproducibility and clinical relevance of the maximum Cobb angle and tangent circles techniques. METHOD: Standing sagittal radiographs of the spine of 10 adolescents with idiopathic scoliosis, 10 adolescents with spondylolisthesis, and 10 healthy adolescents were used. Thoracic kyphosis (TK) and lumbar lordosis (LL) were measured by 3 observers using the maximum Cobb angle and the tangent circles techniques. Intra- and interobserver intraclass correlation coefficients (ICCs) were calculated. RESULT: Intra- and interobserver ICCs for TK were 0.88 and 0.85, respectively, for the maximum Cobb angle technique, and 0.94 and 0.83, respectively, for the tangent circles technique. Intra- and interobserver ICCs for LL were 0.97 and 0.77, respectively, for the maximum Cobb angle technique, and 0.88 and 0.94, respectively, for the tangent circles technique. The 2 techniques were highly correlated for the measurement of the TK (r=0.93) and LL (r=0.88). CONCLUSION: Both techniques provide excellent intra- and interobserver reproducibility. Tangent circles technique may be a good alternative to the Cobb angle technique because it allows the evaluation of the global geometry of sagittal spinal curves, especially when there is limited visibility of bony structures on radiographs.