Contrast-enhanced Mammography Artifacts and Pitfalls: Tips and Tricks to Avoid Misinterpretation.

Contrast-enhanced mammography (CEM) involves addition of intravenous iodinated contrast material at digital mammography, thus increasing the ability to detect breast cancer owing to tumor contrast enhancement. After image acquisition, interpretation includes careful assessment of the technique, artifacts, and pitfalls and reporting with a standard lexicon category and appropriate follow-up recommendations. Artifacts and pitfalls that may cause image misinterpretation should be detected and distinguished from pathologic conditions. Different artifacts apparent on CEM images are usually caused during image acquisition and include CEM-specific and contrast agent-related artifacts, apart from the typical digital mammography artifacts. The pitfalls are related to technical and diagnostic difficulties. One disadvantage of CEM that MRI does not have is a technical factor related to a mammography technique that consists of blind spots that may not be included in the imaging field of mammography views, including the axilla, medial region of the breast, or areas close to the breast wall. Normal breast tissue enhancement called background parenchymal enhancement is also present at CEM and may affect interpretation performance. Diagnostic pitfalls are caused by minimally enhancing lesions, such as invasive lobular carcinomas and mucinous carcinomas, which are difficult to detect with CEM, resulting in false-negative findings. Benign lesions can show enhancement at CEM and represent false-positive lesions that should also be recognized. The authors discuss image interpretation of CEM studies and focus on the artifacts and pitfalls that may be encountered. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.

Systemic thrombosis in a large cohort of COVID-19 patients despite thromboprophylaxis: A retrospective study.

BACKGROUND: Incidence of thrombotic events associated to Coronavirus disease-2019 (COVID-19) is difficult to assess and reported rates differ significantly. Optimal thromboprophylaxis is unclear. OBJECTIVES: We aimed to analyze the characteristics of patients with a confirmed thrombotic complication including inflammatory and hemostatic parameters, compare patients affected by arterial vs venous events and examine differences between survivors and non-survivors. We reviewed compliance with thromboprophylaxis and explored how the implementation of a severity-adjusted protocol could have influenced outcome. METHODS: Single-cohort retrospective study of COVID-19 patients admitted, from March 3 to May 3 2020, to the Infanta Leonor University Hospital in Madrid, epicenter of the Spanish outbreak. RESULTS: Among 1127 patients, 80 thrombotic events were diagnosed in 69 patients (6.1% of the entire cohort). Forty-three patients (62%) suffered venous thromboembolism, 18 (26%) arterial episodes and 6 (9%) concurrent venous and arterial thrombosis. Most patients (90%) with a confirmed thrombotic complication where under low-molecular-weight heparin treatment. Overt disseminated intravascular coagulation (DIC) was rare. Initial ISTH DIC score and pre-event CRP were significantly higher among non-survivors. In multivariate analysis, arterial localization was an independent predictor of mortality (OR = 18, 95% CI: 2.4-142, p < .05). CONCLUSIONS: Despite quasi-universal thromboprophylaxis, COVID-19 lead to a myriad of arterial and venous thrombotic events. Considering the subgroup of patients with thrombotic episodes, arterial events appeared earlier in the course of disease and conferred very poor prognosis, and an ISTH DIC score ≥ 3 at presentation was identified as a potential predictor of mortality. Severity-adjusted thromboprophylaxis seemed to decrease the number of events and could have influenced mortality. Randomized controlled trials are eagerly awaited.

Papillary endothelial hyperplasia (Masson's tumor) developed in the capsule of the implant in a breast cancer patient treated with mastectomy and radiation therapy.

Papillary endothelial hyperplasia (PEH) is an uncommon benign vascular proliferation appearing in soft tissues in different body areas including the breast, which may be related to radiation therapy. A 48-year-old woman previously treated for breast cancer with mastectomy followed by radiation therapy and reconstruction with an implant presented with a newly developing mass in the implant capsule. Pathological diagnosis was PEH. Imaging features of this rare entity are described, and lesions included in differential diagnosis are discussed.

US of the eye made easy: a comprehensive how-to review with ophthalmoscopic correlation.

When performed by a trained examiner, ultrasonography (US) of the eye is a useful tool in diagnosing conditions of the ocular globe, especially when combined with ophthalmoscopy. Pathologic conditions of the ocular globe include several usual and unusual entities, most of which may be properly identified at US. For instance, the ocular globe may have an abnormal size or unusual morphologic characteristics. Lesions of the anterior chamber (eg, hyphema), lens (eg, cataract, luxation), and iris or ciliary bodies (eg, cysts) are usually seen at ophthalmoscopy but may also be depicted at US. Vitreous pathologic conditions may demonstrate echoes caused by various entities such as degeneration, asteroid hyalosis, hemorrhage, and infection, and lines are indicative of different types of detachment, including retinal, choroidal, and hyaloid detachment and retinoschisis. Posterior wall masses are usually tumors (eg, melanoma, metastasis, nevus, hemangioma) but may also result from subretinal hemorrhage or granulomas (from tuberculosis or histoplasmosis). Calcifications may be caused by drusen or be nonspecific. Foreign bodies may also be seen. Knowledge of ocular US techniques and protocols and familiarity with normal and pathologic imaging findings are critical in making a correct diagnosis.

Dual-energy x-ray absorptiometry in the diagnosis of osteoporosis: a practical guide.

OBJECTIVE: The purpose of this essay is a quick and comprehensive review of dual-energy x-ray absorptiometry in the diagnosis of osteoporosis that shows how to achieve the best performance in three steps. CONCLUSION: The three-step procedure for dual-energy x-ray absorptiometry includes image acquisition emphasizing proper patient positioning and regions of interest; analysis, including areas to scan and detection of artifacts that should be excluded from the analysis and noted in the report because they can necessitate additional imaging; and interpretation of results.

Sonographic and computed tomographic demonstration of hydatid cysts communicating with the biliary tree.

Hepatic hydatid disease is usually silent and discovered incidentally. Rupture of a hydatid cyst into the biliary tree is a serious complication and produces a clinical picture of biliary obstruction. We present the cases of 2 patients who had only nonspecific symptoms and laboratory test results indicative of biliary tract obstruction. The results of sonographic examinations of both patients strongly suggested the presence of hepatic hydatid cysts communicating with the biliary tree. CT examination provided additional information in 1 patient but only confirmed the sonographic findings in the other. Both cases were surgically confirmed. Demonstration of the cyst and intrabiliary hydatid contents should form the basis for the diagnosis of a hydatid cyst's rupture into the biliary tree; detecting the point of communication further supports the diagnosis. An accurate preoperative diagnosis of this disease is essential for its prompt surgical management.