Atlas of breast magnetic resonance imaging.

Magnetic resonance imaging (MRI) of the breast has become important not only for assessing the extent of breast cancer for breast-conserving surgery but also for the evaluation and diagnosis of other benign and malignant pathologies. We radiologists therefore need to know the appropriate indications for performing breast MRI and understand the MRI features of breast disease. We herein review and discuss the application of current pulse sequences and the imaging strategies for MRI of breast pathologies. We will illustrate the MRI features of various breast pathologies including malignant tumors such as invasive and noninvasive ductal carcinoma, special types of invasive carcinoma (mucinous, apocrine, lobular carcinoma, spindle cell carcinoma, and so on), inflammatory carcinoma, semimalignant tumor (phyllodes tumor), benign tumors (fibroadenoma, intraductal and intracystic papilloma), inflammatory conditions, and postsurgical changes. We will also demonstrate three-dimensional fusion images of MR ductography and breast MRI of patients with nipple discharge.

The combination of cisplatin and vinorelbine with concurrent thoracic radiation therapy for locally advanced stage IIIA or IIIB non-small-cell lung cancer.

AIMS: The aims of this study were to assess the efficacy and toxicity of concurrent chemoradiotherapy with divided schedule of cisplatin and vinorelbine in patients with locally advanced non-small-cell lung cancer (NSCLC). METHODS: Patients with previously untreated, unresectable, and stage IIIA or IIIB NSCLC were eligible if they had a performance status of 0 or 1, were 75 years or younger, and had adequate organ function. Twenty-six patients (24 men and 2 women; median age, 66 years; age range, 42-75 years) were enrolled. Both cisplatin (40 mg/m(2)) and vinorelbine (20 mg/m(2)) were given on days 1 and 8 every 3 weeks. Beginning on day 2 of chemotherapy, thoracic radiotherapy was given for approximately 6 weeks (2 Gy per fraction; total dose, 60 Gy). RESULTS: Five of the 26 patients achieved a complete response, and 16 achieved a partial response for an overall response rate of 80.8% (95% confidence interval, 60.6-93.4%). The median survival time was 23 months (range, 4-43 months). Overall survival rates at 1 and 2 years were 80 and 56%, respectively. Hematologic toxicities included grade 3-4 neutropenia in 84.6% of patients, grade 3-4 thrombocytopenia in 3.8%, and grade 3-4 anemia in 61.5%. Two patients (7.7%) had grade 3 radiation esophagitis that resolved completely without dilation. Grade 3-4 radiation pneumonitis occurred in two patients (7.7%) and was treated with corticosteroids. Both patients had a good partial resolution of symptoms and radiographic abnormalities. There were no treatment-related deaths. The actual delivered dose intensities for both cisplatin and vinorelbine were 79.5%. Radiotherapy was completed in 96% of patients. CONCLUSION: Concurrent chemoradiotherapy with cisplatin and vinorelbine administered on a divided schedule is effective and well tolerated in patients with locally advanced NSCLC.

[Clinical phase trial of concurrent chemoradiotherapy combined TS-1 and nedaplatin].

We have treated head and neck carcinoma by concurrent chemoradiotherapy combined with 5-fluorouracil (5-FU) and cisplatin (CDDP). However,this chemoradiotherapy could not show an enormous effect in the advanced carcinoma of Stage III and IV. Therefore,we changed the contents of the chemotherapy, i.e., we replaced 5-FU, one of the agents with time dependency, to continuous administration of TS-1 for 2 weeks,also replacing CDDP, one of the agents with dose dependency, to nedaplatin (CDGP) in order to reduce kidney dysfunction. In this concurrent chemoradiotherapy, oral TS-1 was continued for 2 weeks and CDGP was administered on the 4 th day from the start of TS-1. In addition, radiotherapy was performed concurrently. In this way,we performed a phase I clinical trial of concurrent chemoradiotherapy combining TS-1 and nedaplatin (CDGP). As for the incidence of adverse events,grade 3 mucositis due to radiation was observed in two patients. As a result of the phase I clinical trial,we decided the maximum-tolerated dose (MTD) of TS-1 to be 80 mg/m2 (maximum 120 mg/body) and 100 mg/m2 for CDGP, and then determined the recommended dose(RD) of TS-1 as 80 mg/m2 (maximum 120 mg/ body) TS-1 and of CDGP as 9 0 mg/m2 CDGP.

Moderately T2-weighted images obtained with the single-shot fast spin-echo technique: differentiating between malignant and benign urinary obstructions.

The purpose of this study was to determine whether a distinction could be made between benign and malignant urinary obstructions in moderately T(2)-weighted images obtained with the single-shot fast spin-echo technique. Forty-four lesions in 39 patients with urinary obstruction were evaluated with the single-shot fast spin-echo (SSFSE) technique with an effective TE of 90-100 ms and without fat saturation. Benign and malignant lesions were compared for the presence of ureteral wall thickening and a signal intensity relative to the proximal ureteral wall. Statistically significant differences were found between benign and malignant lesions in both morphologic change (P<0.0001) and signal intensity of the lesions at the obstruction position (P<0.0001). The combination of wall thickening and increased signal intensity as a predictor of malignant disease yielded a sensitivity of 88% and a specificity of 100%. Neither increased signal intensity nor wall thickening as a predictor of benign disease yielded a sensitivity of 89% and a specificity of 88%. The moderately T(2)-weighted SSFSE technique without fat saturation can accurately distinguish between benign and malignant urinary obstructions.

MR arthrography of shoulders after suture-anchor Bankart repair.

PURPOSE: To determine the ability of magnetic resonance (MR) arthrography to depict the anatomic reestablishment of the capsulolabral complex after suture-anchor Bankart repair. MATERIALS AND METHODS: Thirty patients (25 men, five women; mean age, 28 years) who had undergone suture-anchor Bankart repair of one shoulder underwent MR arthrography before second-look arthroscopy. Ninety-eight anchors were used for the sutures. MR arthrographic diagnosis of anatomic reestablishment of the capsulolabral complex was correlated with arthroscopic findings. Contingency table analysis was performed to determine the relationship between MR arthrographic findings and arthroscopic findings. RESULTS: MR findings of reattachment of the capsulolabral complex were in agreement with arthroscopic findings in 93 anchor points (accuracy, 93 of 98 anchor points; 95%). In 28 shoulders, oblique transverse images obtained with the shoulder in the abduction and external rotation position showed that the anterior band of the inferior glenohumeral ligament (AIGHL) abutted the humeral head and that reattachment of the AIGHL to the glenoid rim was seamless. Arthroscopy revealed satisfactory reestablishment of the capsulolabral complex in these shoulders. In the remaining two shoulders, a pool of contrast material was seen between the AIGHL and humeral head and a "divot" was detected at the point of reattachment of the AIGHL to the glenoid rim. Arthroscopy revealed unsatisfactory reestablishment of the capsulolabral complex. MR arthrographic findings of reattachment of the AIGHL were significantly associated with arthroscopic findings of reestablishment of the capsulolabral complex (P <.01). CONCLUSION: MR arthrography can be reliably used for the postoperative assessment of suture-anchor Bankart repair.

[Evaluation of ultra-low-dose thoracic multi-detector-row CT using different reconstruction kernels and new reconstruction algorithms].

CT has great advantages in detecting early-stage small lung cancer and is becoming common in lung cancer screening. Multi-detector-row CT (MDCT) can provide thin-slice images with low radiation exposure. In this study, ultra-low-dose (5 mAs: 10 mAs, 0.5 sec/rot) thoracic MDCT images were evaluated. We describe the differences in image quality and quantity between the different reconstruction kernels. We also propose a new reconstruction algorithm (ultra-low-dose reconstruction algorithm: ULR) for ultra-low-dose thoracic CT, to reduce noise and streak artifacts. We are convinced of the usefulness and possibility of ultra-low-dose thoracic MDCT with ULR algorithms for lung cancer screening.