Tl-201 scintigraphy, mammography and ultrasonography in the evaluation of palpable and nonpalpable breast lesions: a correlative study.

PURPOSE: To determine the feasibility of Tl-201 as a tumor localizing agent in palpable and nonpalpable breast lesions, in comparison with mammography and ultrasonography (US), and to evaluate the contribution of these modalities to each other in obviating biopsy. MATERIALS AND METHODS: Seventy-two palpable and nonpalpable breast lesions were prospectively classified as benign, indeterminate, or malignant according to the sonographic and mammographic criteria and were further analyzed with Tl-201 scanning. These classifications were compared with biopsy results. The sensitivity, specificity, accuracy, false positive and false negative rates (FPR, FNR), negative and positive predictive values (npv, ppv) were calculated for each individual modality and combination of modalities to evaluate the contribution of these three techniques to each other. RESULTS: Of 72 lesions 52 were histologically malignant and 20 were benign. Overall, mammography was the most sensitive (92%) and Tl-201 was the most specific (75%) of the three modalities. Mammography + Tl combination was the most specific (90%) and accurate (97%) of dual combinations. In mammographically or sonographically indeterminate cases, Tl-201 was much more specific (75% versus 37% for mammography and US) and more accurate (82% versus 36% for mammography and 54% for US) than the other two modalities, and mammography + Tl combination was significantly superior to other dual combinations (87% specific and 91% accurate). Use of Tl-201 scanning as an adjunct to mammography + US combination increased the specificity, ppv, and accuracy rates overall, particularly in mammographically or sonographically indeterminate cases. CONCLUSIONS: In mammographically and sonographically indeterminate breast lesions thallium scanning may be offered as a third step of investigation to obviate biopsy.

MRI of brucella polyneuritis in a child.

MRI of a rare case of polyneuritis following brucellosis is presented. An 8-year-old boy with a history of brucellosis showed marked enlargement of the origin of the left fifth cranial nerve and contrast enhancement of the fifth cranial nerves and the Gasserian ganglion in Meckel's caves. A well-defined low-signal cystic mass showing peripheral contrast enhancement lay anteromedial to the left seventh and eighth cranial nerves. The seventh and eighth nerves showed marked enhancement. The prechiasmatic portion of the right optic nerve showed fusiform enlargement with marked contrast enhancement of the nerve and right optic tract. MRI immediately after treatment showed no enhancement of the cranial nerves. Enlargement of the origin of the left fifth cranial nerve persisted, but there was no enlargement of the optic nerve. The mass near the left seventh and eighth cranial nerves was still present with no obvious morphological change, but no longer showed peripheral enhancement.