Solving the preoperative breast MRI conundrum: design and protocol of the MIPA study.

Despite its high diagnostic performance, the use of breast MRI in the preoperative setting is controversial. It has the potential for personalized surgical management in breast cancer patients, but two of three randomized controlled trials did not show results in favor of its introduction for assessing the disease extent before surgery. Meta-analyses showed a higher mastectomy rate in women undergoing preoperative MRI compared to those who do not. Nevertheless, preoperative breast MRI is increasingly used and a survey from the American Society of Breast Surgeons showed that 41% of respondents ask for it in daily practice. In this context, a large-scale observational multicenter international prospective analysis (MIPA study) was proposed under the guidance of the European Network for the Assessment of Imaging in Medicine (EuroAIM). The aims were (1) to prospectively and systematically collect data on consecutive women with a newly diagnosed breast cancer, not candidates for neoadjuvant therapy, who are offered or not offered breast MRI before surgery according to local practice; (2) to compare these two groups in terms of surgical and clinical endpoints, adjusting for covariates. The underlying hypotheses are that MRI does not cause additional mastectomies compared to conventional imaging, while reducing the reoperation rate in all or in subgroups of patients. Ninety-six centers applied to a web-based call; 36 were initially selected based on volume and quality standards; 27 were active for enrollment. On November 2018, the target of 7000 enrolled patients was reached. The MIPA study is presently at the analytic phase. Key Points • Breast MRI has a high diagnostic performance but its utility in the preoperative setting is controversial. • A large-scale observational multicenter prospective study was launched to compare women receiving with those not receiving preoperative MRI. • Twenty-seven centers enrolled more than 7000 patients. The study is presently at the analytic phase.

Whole-Body MRI Screening in Asymptomatic Subjects; Preliminary Experience and Long-Term Follow-Up Findings.

BACKGROUND: The aim of this study is to describe the technique and to evaluate the results of whole-body magnetic resonance imaging in an asymptomatic population. MATERIAL/METHODS: Between March 2009 and December 2011, 118 consecutive subjects undergoing thorough medical check-up were prospectively included in the study. MRI was performed with a 205-cm moving table, parallel imaging and automatic image composing software. RESULTS: In 83 subjects (70%), 103 benign lesions were detected. Two malignant (adrenal and renal carcinoma) lesions and one precancerous (pancreatic mucinous carcinoma) lesion were detected. The most common lesions were renal cysts, liver hemangiomas, liver cysts, thyroid nodules, and uterine leiomyomas. CONCLUSIONS: WB-MRI is able to cover area from head to toes in one diagnostic work-up, and besides the anatomic regions evaluated by conventional radiological modalities, i.e. brain parenchyma, bones and extremities, can be evaluated in one examination.

Ultrasound-Guided Fine Needle Aspiration (USFNA) of Thyroid Nodules; Does Aspiration Site Matter?

BACKGROUND: The goal of ultrasound guided fine-needle aspiration (USFNA) is to obtain most cellular specimen that represents the nodule. However, there is substantial variability in specimen cellularity depending on the obtaining techniques. While performing USFNA, it is not clear whether the needle tip should be placed at hypovascular or hypervascular site of the nodule to obtain more cells for cytological analysis. OBJECTIVES: The aim of the study was to assess whether USFNA of the hypovascular or hypervascular site of a thyroid nodule would reveal more cells for cytological analysis. PATIENTS AND METHODS: Twenty-three consecutive patients with solid thyroid nodules larger than 2 cm were aspirated under color Doppler sonography guidance. First pass was from the hypovascular site and the second pass from the hypervascular site. The aspirates were scored from 1-3 by cytologist according to number of cell groups. RESULTS: When only hypervascular site was used, adequate sampling was limited to 65% of the cases. When both sites were evaluated together, overall adequate sampling was 91%. Adding a sample from the hypervascular site to hypovascular aspirate increased the adequate sampling by 8%. The highest pathological score was achieved when both hypo- and hypervascular site aspirates were evaluated together. CONCLUSIONS: The aspirates from the hypovascular and hypervascular sites of solid nodules are complementary and should be performed consecutively.

Magnetic resonance imaging evaluation of fetal maxillary sinuses.

BACKGROUND AND OBJECTIVE: The growth of maxillary sinus is closely connected to the development of facial structures. However, its definition and reference standards on fetal magnetic resonance imaging (MRI) have not been analyzed so far. In this study, the objectives were to define and evaluate the fetal maxillary sinus (fMS) formation with MRI. METHODS: We reviewed T2-weighted coronal MRI images of 75 fetuses. The MRI features, time of appearance, and boundaries of fMS were defined. Craniocaudal and transverse diameters of both maxillary sinuses and bone biparietal diameters were measured and statistically evaluated. RESULTS: In 150 fMS site analysis, 91 fMSs were identified. The fMSs were visualized as a hyperintense structures on T2-weighted image above the tooth bud. It first appeared at the 22nd gestational week, and in 4% (3/75) of fetuses, there was unilateral development. Mean craniocaudal length was 2.84 mm (1.1-4.8 mm), and mean transverse diameter was 2.67 mm (1.5-4.2 mm). CONCLUSIONS: Magnetic resonance imaging features of fMS that should be sought for the assessment of craniofacial anatomy are identified in this study. Fetal maxillary sinuses can be observed as hyperintense structures on T2-weighted MRI images starting from 22 weeks of gestation. The growth of fMS follows a predictable course throughout gestation; however, the dimensions are larger than the previously reported ex vivo series.

Is there a role for BLADE acquisition in T2-weighted breast MRI?

BACKGROUND: standard T2-weighted (T2W) magnetic resonance imaging (MRI) is a necessary component of routine breast MRI. However, breast MRI suffers from minor subject movements, which degrade the image quality. BLADE acquisition MRI is a promising motion degradation method currently used in brain imaging. PURPOSE: to compare T2W BLADE acquisition breast MR images with routine T2W images in the evaluation of motion artifacts and overall image quality. MATERIAL AND METHODS: MRI was performed with a 1.5 T system on 25 volunteers and 25 consecutive patients with identical imaging parameters for both MRI sequences (TR 5240 ms, TE 112-108 ms, acquisition 1, spatial resolution 0.9×0.9× 4 mm). Motion and flow artifacts and pectoral muscle and lesion contour delineations were assessed. Signal to noise ratios (SNRs) of images and contrast to noise ratios (CNRs) of the incidental lesions were calculated. The results were evaluated with the Wilcoxon signed-ranks test. RESULTS: of the 50 patients, 44 were included in the analysis (mean age 42.1 years). Motion artifacts were prominent in 48% cases on routine T2W and in only 2% of BLADE cases. The SNR values of BLADE images were significantly higher than routine T2W (P<0.05). Pectoral muscle contours were better assessed on BLADE in all cases. Sequence performances were similar in flow artifacts, CNR values, and contour delineation of incidental lesions. The readers chose BLADE sequence MRI in 25 cases and found the overall performance of sequences equal in 19 cases. None of the readers preferred routine T2W to BLADE. CONCLUSION: the performance of BLADE is superior to routine T2W images in eliminating motion artifacts, provides better SNRs, shows detailed pectoral muscle contours, and may be the sequence of choice.

Rapidly involuting congenital hemangioma: a case of complete prenatal involution.

We report a case of rapidly involuting congenital hemangioma of the flank, which was diagnosed in the 2(nd) trimester of gestation and showed complete involution before term. In our case sonography revealed a highly vascular soft tissue mass with smooth contours, which was isointense with the placenta on T2-weighted MR images. The fetus was born with scar tissue at the site of the lesion. To our knowledge this is the 1(st) reported case of rapidly involuting congenital hemangioma showing complete involution before term.