Can tamoxifen cause a significant mammographic density change in breast parenchyma?

To evaluate tamoxifen-induced glandular tissue density changes in women who are on an adjuvant tamoxifen therapy. We examined serial mammograms of 27 women (average age 67) who had surgery for unilateral breast carcinoma and were on tamoxifen for 5 years. Mammograms obtained at the beginning of treatment, within 2 or 3 years, at the end of 5 years and 1 year after cessation of tamoxifen treatment, were evaluated by two radiologists experienced in reading mammograms. Four 1-cm-diameter circular areas of the glandular tissue and retroglandular fat were sampled by a densitometer and a relative glandular density (glandular tissue/fat density) was used for comparison between serial mammograms. Most cases (79%) did not show tamoxifen-induced change in glandular density. Three patients (13%) showed an early and two (8%) a delayed mild reduction in glandular density as compared to baseline mammograms. No patient was found to have increased glandular density following the cessation of tamoxifen therapy (in subjective evaluation). Densitometer readings showed a mild reduction in glandular densities in 16 cases (60%) during treatment and a minimal increase in 13 cases (48%) following cessation of treatment. There was a slight decrease in breast density during treatment [relative density of 0.012+/-0.006 (standard error) per interval, P value:.06] and the difference between years 5 and 6 was nearly zero [relative density of 0.00042+/-0.01 (standard error), P value:.97]. Long-term use of tamoxifen may cause a mild reduction in breast glandular density, although this, in part, may be attributed to the age-related mammographic density change. Following cessation of tamoxifen, no significant increase in glandular density was observed. Therefore, any increase in mammographic density during or after tamoxifen treatment should be viewed with suspicion and further evaluated.

Subdural empyema secondary to odontogenic masticator space abscess: detection by indium-111-labeled white cell scan.

Subdural empyema (SDE) is an extremely rare but serious complication of dental infection. A case is presented in which dental infection was complicated by a masticator space abscess and eventually led to a SDE. This report illustrates a rare sequence of events leading to SDE and its serendipitous detection by indium-111-labeled leucocyte scan.

Mesenchymal hamartoma of the liver.

We present a multiseptated mesenchymal hamartoma of the liver in a 10-year-old male patient, a rare benign tumor of childhood. The characteristic ultrasound and CT appearances of this unusual tumor are reviewed. A single septal calcification associated with this tumor was demonstrated, an association which has not previously been reported. The differential diagnosis for cystic liver lesions is discussed in detail.

Functioning liver metastases on an I-131 whole-body scan: a case of malignant struma ovarii.

A 46-year-old women was examined for severe constipation. Pelvic examination revealed a large pelvic mass extending to the level of the umbilicus. Computed tomography showed a large multicystic, septated mass in the pelvis and a small amount of fluid in the cul de sac. In addition, multiple ill-defined, mixed-attenuation hepatic lesions were identified. A malignant ovarian neoplasm with liver metastases was considered, so the pelvic mass was resected. Interestingly, histopathologic analysis revealed malignant struma ovarii of the follicular type. Biopsy of the liver lesions confirmed metastatic disease with similar histopathologic findings. All thyroid laboratory values were in the normal range. The patient then had a total thyroidectomy to optimize thyroid ablation therapy with I-131. This revealed a small follicular adenoma but no evidence of cancer. An I-131 whole-body scan was performed and showed uptake in multiple functioning liver metastases.

Renal branch artery occlusion in a 13-year-old hypertensive girl: initial treatment and treatment of recurrent stenosis by balloon angioplasty.

A 13-year-old girl who recently developed hypertension was diagnosed to have an occluded right renal branch artery and was treated successfully with percutaneous transluminal angioplasty (PTA). To our knowledge, PTA has not been reported as a treatment for totally occluded renal branch arteries, and there is no data available regarding the success rate and possible complications.

Cervicofacial venous malformations. MRI features and interventional strategies.

SUMMARY: We retrospectively evaluated 53 consecutive patients with cervicofacial venous malformation who had sclerotherapy. This review included a demographic analysis, MRI reexamination and tabulation of interventional therapeutic strategies. All patients whose MRI studies were included in this review demonstrated characteristic findings: space occupying lesion with hyperintense T2 signal abnormality, patchy contrast enhancement, and no flow signal on the gradient echo images.We concluded that a complete MRI work-up of these patients requires post-contrast scanning and gradient-echo imaging in addition to the standard T1 and T2 weighted spin echo imaging. The majority of patients had sporadic (non-familial) venous anomalies. Sinus pericranii (SP) was identified in six patients (11%) and blue rubber bleb nevus syndrome (BRBNS) was found in two patients (4%). MRI findings of sinus pericranii are discussed in detail. Although sodium tetradecyl and/or absolute ethanol are the most commonly used sclerosants, a wide variety of therapeutic strategies (depending on the nature of the abnormality) are also needed for these patients.

Disseminated lymphangiomatosis presenting with massive chylothorax.

BACKGROUND: Lymphangiomatosis is a disease characterized by involvement of various body constituents and can involve the skeletal system, connective tissues, and visceral organs. MATERIALS AND METHODS: We present a case of a 9-year-old girl where this entity presented with extensive right-sided chylothorax. Conventional imaging, including skeletal scintigraphy and contrast enhanced CT of the chest and abdomen, may have underestimated the extent of the disease, as seen on follow-up T2-weighted MR images of the chest and abdomen in our case. RESULTS: MRI easily demonstrated additional bone lesions as well as multiple small splenic lesions, which were difficult to appreciate on prior CT examinations. CONCLUSION: We suggest that MRI may be helpful to assess the extent of this disease more accurately.

Malignant pleural mesothelioma in a 13-year-old girl.

Pleural mesothelioma is an uncommon tumor in all age groups, but is especially rare in childhood. We describe the clinical and radiological features of malignant pleural mesothelioma in a 13-year-old girl. The chest radiograph showed nearly complete opacification and loss of volume in the left hemithorax. Computed tomography demonstrated a large pleural effusion centrally surrounded by a thick enhancing rind of soft tissue. The radiological features of childhood pleural mesothelioma in our case were similar to those described in adults with this disease.

Sonographic appearance of the Angelchik prosthesis.

The Angelchik prosthesis is a silicone-filled, doughnut-shaped device used for the surgical treatment of gastroesophageal reflux. This device appears on sonograms as a C-shaped, hypoechoic structure with nonspecific Doppler waveforms. Because the Angelchik prosthesis is rarely used anymore, recently trained sonographers and radiologists may misinterpret this sonolucent appearance as an unusual vascular lesion. We report a case of an Angelchik prosthesis that was incidentally noted at the gastroesophageal junction on a routine abdominal sonographic examination.

Gradient-echo perfusion imaging of musculoskeletal abnormalities with contrast-enhanced two-dimensional fat-saturation FLASH.

The objective of this study was to evaluate the utility of MR perfusion imaging of various musculoskeletal lesions with a contrast-enhanced two-dimensional fat saturation fast low angle shot (FLASH) sequence and to assess the potential of this technique for distinguishing malignant from benign conditions. Thirty-six musculoskeletal lesions were studied at 1.5 T. The signal intensity of the lesions, adjacent artery, muscle, bone marrow, and fat were plotted against time. The time to peak enhancement, time to maximum signal intensity, percent enhancement, rate of peak enhancement, and rate of enhancement parameters were calculated. Because of a significant overlap between malignant and benign conditions, accuracy rates were lower than reported previously. The best parameter based on these values was the rate of peak enhancement (sensitivity, 84.6%; specificity, 65.2-66.6%; positive predictive value, 57.8-68.7%). Fat saturation gradient-echo MR perfusion imaging allows for a rapid assessment of the vascularity of musculoskeletal pathology; however, a significant overlap persists between malignant neoplasms and several benign conditions.

Mesenteric circulation: three-dimensional MR angiography with a gadolinium-enhanced multiecho gradient-echo technique.

To evaluate the mesenteric circulation with magnetic resonance (MR) angiography, the authors examined 16 individuals (12 patients, four volunteers) with a gadolinium-enhanced, breath-hold, fat-saturated, multiecho, three-dimensional, gradient-echo sequence. Twenty examinations were performed. Grades of 3 or 4 (on a five-point scale [4 = best seen, 0 = not seen]) were applicable to 17 (85%) of 20 MR angiograms obtained in superior mesenteric artery trunks, 15 (75%) in celiac arteries, five (25%) in inferior mesenteric arteries; 15 (75%) of first-order branching, 12 (60%) of second-order branching, and 10 (50%) of third-order branching; 17 (85%) in superior mesenteric veins; and 17 (85%) in portal veins. MR angiography with this technique depicted the mesenteric arterial and venous circulation and the portal vein with excellent resolution in a short time.

Contrast-enhanced MR angiography of the mesenteric circulation: a pictorial essay.

Outstanding results have been achieved with magnetic resonance (MR) angiography, which has become competitive with conventional angiography as a vascular imaging technique. With the advances in gradient technology and the capability of imaging vessels in a single breath hold, one can track an intravenous bolus of paramagnetic contrast agent and evaluate the entire mesenteric circulation. Use of a breath-hold technique obviates the problem of motion artifact. Use of targeted maximum-intensity projection images from the three-dimensional (3D) volume data allows evaluation of the vascular anatomy at different phases (arterial and venous) of contrast enhancement. MR angiography performed with a contrast-enhanced breath-hold fat-suppressed 3D technique allows visualization of the superior mesenteric vessels, celiac artery, and portal vein in healthy subjects. Pathologic conditions of the mesenteric vessels that can be identified with this technique include stenosis or occlusion of the superior mesenteric artery, celiac artery aneurysm, thrombosis of the superior mesenteric vein, portal hypertension with varices, and vascular invasion by pancreatic carcinoma.

MR cholangiopancreatography (MRCP).

Magnetic resonance cholangiopancreatography (MRCP) is an evolving new technique for noninvasive imaging of diseases of the biliary tree and pancreatic duct. The advantage of this method is that one can obtain maximum intensity projection (MIP) images of the pancreatico-biliary system similar to those obtained with endoscopic retrograde cholangiopancreatography (ERCP) without the need of administration of intravenous or oral contrast. Heavily T2-weighted sequences are used that render the bile and the intraductal pancreatic fluid bright against a dark background.