Radiological findings in mammary autologous fat injections: a multi-technique evaluation.

AIM: To describe the radiological appearance of normal and pathological findings resulting from mammary autologous fat injections (lipofilling). MATERIALS AND METHODS: Informed consent and institutional review board approval were obtained. From January 2008 to December 2010, all patients that had undergone breast lipofilling at our institution (Catholic University) were consecutively enrolled. The site and amount of autologous fat injections were known. Mammography, ultrasonography, and magnetic resonance imaging (MRI) were prospectively obtained preoperatively, and 6 and 12 months after the procedure. Normal and pathological findings were described. RESULTS: Twenty-four patients (mean age 50.8 ± 10.5 years; range 26-70 years) were included. Fourteen patients underwent lipofilling after mastectomy, eight after wide local excision, one as a treatment for a congenital asymmetry, and one as a treatment for Poland syndrome. No severe complications were observed after treatment. Normal findings due to lipofilling ("oil cysts") were identified in 23 cases using ultrasound and in 16 using MRI. Liponecrosis, the most frequently observed complication, was detected in four cases using ultrasound and in eight by MRI. In one case mammography showed calcific fat necrosis. Mean amount of fat injected was 114.8 ± 55 ml. The average amount of fat grafted in patients who developed liponecrosis was 158.4 ± 42.7 versus 104.6 ± 52.3 ml (p = 0.0043, t-test). In one case breast cancer recurrence was diagnosed. CONCLUSION: Normal findings due to lipofilling are better identified by ultrasound, and pathological findings are best identified using MRI. Liponecrosis most frequently occurs when large amounts of fat are injected. In the authors' experience lipofilling does not interfere with breast cancer early diagnosis.

Extra-mammary findings in breast MRI.

OBJECTIVES: Incidental extra-mammary findings in breast Magnetic Resonance Imaging (MRI) may be benign in nature, but may also represent a metastasis or another important lesion. We aimed to analyse the prevalence and clinical relevance of these unexpected findings. METHODS: A retrospective review of 1535 breast MRIs was conducted. Only axial sequences were reassessed. Confirmation examinations were obtained in all cases. RESULTS: 285 patients had a confirmed incidental finding, which were located in the liver (51.9%), lung (11.2%), bone (7%), mediastinal lymph nodes (4.2%) or consisted of pleural/pericardial effusion (15.4%). 20.4% of incidental findings were confirmed to be malignant. Positive predictive value for MRI to detect a metastatic lesion was high if located within the bone (89%), lymph nodes (83%) and lung (59%), while it was low if located within the liver (9%) or if it consisted of pleural/pericardial effusion (6%). The axial enhanced sequence showed superior sensitivity to unenhanced images in detecting metastatic lesions, especially if only smaller (≤10 mm.) lesions were considered. CONCLUSIONS: The prevalence of metastatic incidental extra-mammary findings is not negligible. Particular attention should be to incidental findings located within the lung, bone and mediastinal lymph nodes.

Gastric cancer surveillance in a high-risk population in tuscany (Central Italy): preliminary results.

BACKGROUND/AIMS: The surveillance of subjects at high risk for developing gastric cancer (GC) may represent an effective strategy for reducing specific morbidity and mortality. The aim of this study was to identify GC at its initial phase and to identify precancerous lesions in a group of GC high-risk subjects. METHODS: We enrolled first-degree relatives of patients affected by GC who resided in a GC high-risk area (Tuscany, Central Italy). The study's protocol included the collection of several individual measurements, including a blood sample for the determination of specific biomarkers, an upper digestive tract endoscopy with detailed gastric biopsies and Helicobacter pylori (Hp) treatment followed by a specific check. RESULTS: We enrolled 167 subjects who were members of 128 different familial groups with GC history. We identified 1 case of initial-phase GC, 1 gastric dysplasia type II, 32 intestinal metaplasia, 10 gastric atrophy, and 21 atrophic chronic gastritis. 81 subjects were Hp-positive and underwent eradication therapy. CONCLUSION: This study of a GC high-risk Italian population reveals positive results in terms of population compliance, the identification of specific gastric lesions requiring close follow-up and successful therapy for Hp infection. To define future surveillance strategies, a longer follow-up of these patients is necessary.

Is subareolar intraoperative biopsy still necessary to predict nipple involvement?

OBJECTIVE: To predict the occult tumor involvement of nipple-areola complex (NAC) using preoperative MR imaging and to investigate whether the intraoperative histopathological examination of the subareolar tissue is still necessary. PATIENTS AND METHODS: Out of 712 patients submitted to nipple-sparing mastectomy (NSM) between 2014 and 2019, we selected 188 patients who underwent preoperative breast MRI. Breast MRI and intraoperative histopathological examination of the subareolar tissue were performed to predict NAC involvement at permanent pathology. All parameters were correlated with final pathological NAC assessment by univariate and multivariate analysis. RESULTS: Forty-three patients (22.9%) had tumor involvement of the NAC. At univariate analysis, non-mass enhancement type (p = 0.009), multifocality/multicentricity (p = 0.002), median tumor size (p < 0.001), median tumor-NAC distance measured by MRI (p < 0.001), tumor-NAC distance ≤ 10 mm (p < 0.001) and tumor-NAC distance ≤ 20 mm (p < 0.001), and lymphovascular invasion (p = 0.001) were significantly correlated with NAC involvement. At multivariate analysis, only tumor-NAC distance ≤ 10 mm retained statistical significance. The sensitivity and specificity of MRI tumor-NAC distance ≤ 10 mm were 79.1% and 97.2% and those of intraoperative pathologic assessment were 74,4% and 100%, respectively. CONCLUSIONS: Tumor-NAC distance is the only reliable MRI characteristic that can predict NAC involvement in breast cancer patients. Although several cut-offs showed promising performances, intraoperative pathologic assessment is still mandatory.

Diffusion-weighted imaging in breast cancer: relationship between apparent diffusion coefficient and tumour aggressiveness.

AIM: To assess the utility of diffusion-weighted imaging in diagnosing and characterizing breast malignancy. MATERIALS AND METHODS: From April 2006 to April 2009, all consecutive patients with breast cancer undergoing breast magnetic resonance imaging (MRI) and subsequent surgery in our hospital were enrolled in this study. MRI was performed using a 1.5 T MRI unit using a dedicated, bilateral, four-channel breast coil. The MRI protocol included a diffusion sequence acquired using b values of 0 and 1000 s/mm(2). For each malignant lesion the relationships between tumour grade and histology and the relative value of the apparent diffusion coefficient (ADC) were analysed. RESULTS: There were 136 female patients with 162 lesions. Histology revealed 149 invasive carcinomas and 13 ductal carcinomas in situ. There were 34 grade 1, 61 grade 2, and 67 grade 3 lesions. The mean ADC value of all malignant lesions was 1.03×10(-3) mm(2)/s. The mean ADC values for invasive and in situ carcinomas were 1.03×10(-3) mm(2)/s and 1.05×10(-3) mm(2)/s, respectively. The mean ADC values for grade 1, 2, and 3 tumours were 1.25×10(-3) mm(2)/s, 1.02×10(-3) mm(2)/s, and 0.92×10(-3) mm(2)/s, respectively. A statistically significant (p<0.001) inverse correlation was disclosed between the ADC value and the tumour grading. The mean ADC value of the "less aggressive" group of disease (G1 and in situ lesions) was 1.19×10(-3) mm(2)/s, whereas the mean ADC value of the "more aggressive" group (G2-G3 invasive carcinomas) was 0.96×10(-3) mm(2)/s (p<0.001). CONCLUSION: The study confirms the usefulness of diffusion imaging in assessing the aggressiveness of breast tumours. ADC appears to be a promising parameter in the evaluation of the degree of malignancy of breast cancer tissue.

Diffusion-weighted imaging in breast lesion evaluation.

PURPOSE: The purpose of this study was to investigate the ability of diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) in the detection and characterisation of breast lesions. MATERIALS AND METHODS: From September 2005 to September 2007, 86 patients with breast lesions who underwent magnetic resonance imaging (MRI) in our department were included in our study. MRI was performed with a 1.5-T unit using a standard protocol including DWI sequence. For each breast lesion, the ADC value was calculated and compared with that of normal breast tissue and to the definitive pathological diagnosis. Mann-Whitney U and Kruskal-Wallis tests were used for statistical analysis. RESULTS: A total of 126 breast lesions were detected. Pathology results revealed 100 malignant and 26 benign lesions. Mean diameter of lesions was 26.02 mm (range 4-90 mm), including 52 lesions

Association between background parenchymal enhancement and tumor response in patients with breast cancer receiving neoadjuvant chemotherapy.

PURPOSE: To analyze the relationships between background parenchymal enhancement (BPE) of the contralateral healthy breast and tumor response after neoadjuvant chemotherapy (NAC) in women with breast cancer. MATERIALS AND METHODS: A total of 228 women (mean age, 47.6 years±10 [SD]; range: 24-74 years) with invasive breast cancer who underwent NAC were included. All patients underwent breast magnetic resonance imaging (MRI) before and after NAC and 127 patients underwent MRI before, during (after the 4th cycle of NAC) and after NAC. Quantitative semi-automated analysis of BPE of the contralateral healthy breast was performed. Enhancement level on baseline MRI (baseline BPE) and MRI after chemotherapy (final BPE), change in enhancement rate between baseline MRI and final MRI (total BPE change) and between baseline MRI and midline MRI (early BPE change) were recorded. Associations between BPE and tumor response, menopausal status, tumor phenotype, NAC type and tumor stage at diagnosis were searched for. Pathologic complete response (pCR) was defined as the absence of residual invasive cancer cells in the breast and ipsilateral lymph nodes. RESULTS: No differences were found in baseline BPE, final BPE, early and total BPE changes between pCR and non-pCR groups. Early BPE change was higher in non-pCR group in patients with stages 3 and 4 breast cancers (P=0.019) and in human epidermal growth factor receptor 2 (HER2)-negative patients (P=0.020). CONCLUSION: Early reduction of BPE in the contralateral breast during NAC may be an early predictor of loss of tumor response, showing potential as an imaging biomarker of treatment response, especially in women with stages 3 or 4 breast cancers and in HER2 - negative breast cancers.

Usefulness of automated breast volume scanner (ABVS) for monitoring tumor response to neoadjuvant treatment in breast cancer patients: preliminary results.

OBJECTIVE: We investigated the accuracy of Automated Breast Volume Scanner (ABVS) compared to handheld ultrasound (HHUS) for monitoring tumor response to neoadjuvant treatment (NAT) in breast cancer (BC). PATIENTS AND METHODS: All the patients submitted to biopsy in our Institution, from January 2017 to May 2017, proven invasive BC and eligible for NAT, were enrolled in this prospective study. The participants underwent ABVS, HHUS, dynamic contrast-enhanced Magnetic Resonance Imaging (DCE-MRI) and mammography at the beginning of NAT and ABVS, HHUS and DCE-MRI at the halfway point of therapy and before the surgery. DCE-MRI was considered the standard of reference. Two breast radiologists (R1, R2), with fifteen and five years of experience in breast imaging, independently assigned a visibility score (ordinal 5-point scale) to ABVS, HHUS, and DCE-MRI. Diagnostic performance of ABVS and HHUS as measured by sensitivity, specificity, positive and negative predictive values (PPV and NPV) was calculated. Correlations between ABVS and MRI, and between HHUS and MRI were analyzed using Pearson's correlation test. RESULTS: A total of 21 patients were enrolled. 189 examinations were performed. The comparison between ABVS and DCE-MRI was similar for the both readers: ABVS had a sensitivity of 63,16%, specificity of 83,58%, PPV of 76,60%, NPV of 72,73%, accuracy of 74,19% (R1) and a sensitivity of 54.54%, specificity of 85.51%, PPV of 75%, NPV of 70,24%, accuracy of 71.77% (R2). The comparison between HHUS and DCE-MRI showed that HHUS had a sensitivity of 63,16 %, specificity of 83,58%, PPV of 76,60%, NPV of 72,73%, accuracy of 74,19% (R1) and a sensitivity of 36.84%, specificity of 85.07%, PPV of 67.74%, NPV of 61.29%, accuracy of 62.90% (R2). The calculated Pearson's correlation coefficient r values were 7.8 for HHUS vs. DCE-MRI and 28.5 for ABVS vs. DCE-MRI (R1) and 7.8 for HHUS vs. DCE-MRI and 22.4 for ABVS vs. DCE-MRI (R2). Statistical significance of ABVS and HHUS was p < 0.0001 and 0.005 < p < 0.01, respectively (R1, R2). CONCLUSIONS: DCE-MRI is recommended for the tumor response assessment. ABVS, a product of the biotechnology development, providing reproducible images, in addition to DCE-MRI, can be a potentially useful tool for the monitoring of response to NAT.

Background parenchymal enhancement in breast magnetic resonance imaging: A review of current evidences and future trends.

Background parenchymal enhancement (BPE) on breast magnetic resonance imaging (MRI) is a dynamic process, which varies among women and within the same woman over time due to different factors. BPE has profound implications for women with or at risk of breast cancer. Breast radiologist should be aware of factors that could potentially influence BPE and have to be familiar with its typical appearance. Marked BPE could indeed affect the diagnostic accuracy of breast MRI, but this shortcoming can be minimized through evaluation by dedicated radiologists, in order to correctly interpret and properly manage the additional findings. BPE shows promise as an imaging biomarker but many issues need to be addressed before it can be used either to determine screening strategy or the value of risk-reducing interventions. This review analyzes the clinical influence of BPE on breast MRI interpretation, breast cancer staging and surgical outcome and discusses current available evidences about BPE as an imaging biomarker.

Role of DWI assessing nodal involvement and response to neoadjuvant chemotherapy in advanced breast cancer.

OBJECTIVE: To explore the role of diffusion-weighted imaging (DWI) in the staging of axillary lymph nodes and the restaging after neoadjuvant chemotherapy (NAD) in advanced breast cancer. PATIENTS AND METHODS: MRI examinations of forty-two patients diagnosed with advanced breast cancer addressed to NAD and axillary lymph node dissection (ALND) were reviewed. Apparent diffusion coefficients (ADC) of each visible node in DWI in the pathologic axilla (PA) and healthy axilla (HA) were measured at the time of diagnosis (t0) and after chemotherapy (t1); mean values of the ADC were calculated. Patients were classified as responders (R), non-responders (NR), macrometastasis (MA), micrometastasis (Mi). RESULTS: Mean ADC was 0.92 ± 0.07 x 10-3 mm2/sec at t0 and 0.97 ± 0.06 x 10-3 mm2/sec at t1 (p = 0.284) in PA, 0.89 ± 0.06 x 10-3 mm2/sec at t0 and 0.92 ± 0.06 x 10-3 mm2/sec at t1 (p = 0.403) in HA, 0.95 ± 0.111 x 10-3 mm2/sec at t0 and 0.95 ± 0.14 x 10-3 mm2/sec at t1 (p = 0.954) in R group, 0.90 ± 0.09 x 10-3 mm2/sec at t0 and 0.97 ± 0.07 x 10-3 mm2/sec at t1 (p = 0.085) in NR group, 0.86 ± 0.10 x 10-3 mm2/sec at t0 and 0.99 ± 0.09 x 10-3 mm2/sec at t1 (p = 0.055) in MA, and 0.99 ± 0.23 x 10-3 mm2/sec at t0 and 0.95 ± 0.15 x 10-3 mm2/sec at t1 in Mi (p = 0.667). CONCLUSIONS: Mean ADC between PA and HA, R and NR, MA and Mi did not significantly differ at t0 and t1 (p > 0.05). Variation in mean ADC between t0 and t1 was not significant in all groups (p > 0.05), except for a trend toward significance (p = 0.055) in MA. DWI has a potential role in restaging of macrometastatic axillary nodes after NAD.

Unenhanced breast magnetic resonance imaging: detection of breast cancer.

OBJECTIVE: To evaluate the diagnostic performance of unenhanced MRI (UE-MRI) for malignant breast lesions and its reproducibility. PATIENTS AND METHODS: We retrospectively included 118 patients who had breast MRI. DWI and STIR images were read in combination and referred to as UE-MRI; the presence or absence of the malignant lesion was noted by two observers. Their results were compared with those of final histopathology or with a two-year negative follow-up for diagnostic performance assessment; ROC curves were built. Diagnostic performance was stratified according to lesion site and size. Interobserver agreement was evaluated through the Cohen's k statistic. RESULTS: Specificity of STIR and DWI was 99.3% and 95.7% for Reader 1; 99.3% and 96.4% for Reader 2. Sensitivity was 76.5% and 76.5% for Reader 1; 77.5% and 77.6% for Reader 2. The ROC AUC (Reader 1) was 0.869 and 0.844 for STIR and DWI, respectively (p<0.001 both); for Reader 2, values were 0.874 and 0.853 respectively (p<0.001 both). Lesion dimension ≤10 mm was associated with lower AUC values. Lesion site didn't influence the diagnostic performance. Interobserver agreement was very good for STIR and DWI (k=0.887, p <0.001, and k=0.867, p <0.001). DISCUSSION: UE-MRI has a good overall diagnostic performance in the detection of breast cancer and a very good specificity for both STIR and DWI sequences. We observed reduced diagnostic performance for lesions ≤10 mm in size. Lesion's site isn't associated with a significantly decreased diagnostic performance of UE-MRI. There's a good interobserver agreement for both sequences (STIR and DWI). CONCLUSIONS: UE-MRI may be employed in patients with contraindication to gadolinium. It has considerable specificity and positive predictive value and good reproducibility.

Chest and breast MRI: the added value of a fast imaging for a new diagnostic approach in the planning of augmentation surgery in patients with thoracic asymmetries.

OBJECTIVE: In breast augmentation surgery, breast symmetry depends on the breast tissue, implants and chest wall. Any asymmetry of the anterior thoracic wall can influence the breast shape. If breast asymmetry is detected in the preoperative evaluation, a chest wall deformity should be suspected. Until now, very few reports describe the use of MRI to objectively assess breast and chest measurements with the aim of providing customized augmentation. This study describes the use of MRI to evaluate breast and chest wall asymmetry, and considers the feasibility of preoperative measurements which are useful for performing an objective preoperative evaluation. PATIENTS AND METHODS: Between April 2012 and February 2013, 13 patients underwent chest/breast MRI scan. Scans were performed on a 1.5 T scanner using a single T1 FSE non-suppressed axial sequence, without contrast administration. Acquisitions included the breast and chest wall. Specific measurements were obtained to assess the overall shape of the chest wall and breast, as well as any asymmetry. RESULTS: All patients showed some degree of left-right side asymmetry on specific thoracic, breast and implant measurements. MRI provided detailed and objective data. CONCLUSIONS: Preliminary findings revealed the value of breast/chest wall MRI in the planning of augmentation surgery. MRI is a valuable technique in young women because there is no use of ionizing radiation. Scans allow surgeons to determine the best surgical approach and obtain reproducible and better aesthetic results.

Sensitivity of the Western blot detection of prion protein PrPres in natural sheep scrapie.

The sensitivity of Western blot detection of PrPres using two different extraction procedures on brain material of 30 scrapie-affected sheep was compared. Whereas PrPres could be detected in all sheep after extraction with the first method, 30% did not give any signal after extraction with the second method. However, the second method, when positive, permitted the detection of PrPres from smaller amounts of infected brain tissue. When used with the ruminant specific monoclonal antibody p4, the second method gave positive signals corresponding to less than 12.5 microg of scrapie-infected brain, that, up to now, is the highest sensitivity described for PrPres detection from naturally infected ruminant brains. The overall results showed highly variable levels of PrPres between sheep and are presented in relation to breed, survival time and animal genotype data. Further progress can thus be expected for PrPres detection in prion diseases, if more efficient extraction procedures and more sensitive immunological reagents are used. Such technical improvements could contribute to more accurate diagnosis in animals affected naturally.

Longitudinal transgastric echocardiographic views utilizing a single-plane probe: anatomic correlations and clinical applications.

In order to widen the diagnostic capability of single-plane transesophageal echocardiography, which has been so far confined to transverse imaging planes, we obtained four transgastric longitudinal echocardiographic views which have not been previously described. These views can image structures such as superior and inferior vena cava, the right ventricular inflow and outflow tract, the mitral apparatus and the ascending aorta, which are poorly visualized by transesophageal transverse single-plane echocardiography. Among 400 consecutive patients these scans gave relevant additional diagnostic information in 62 cases (15.5%) and provided the correct diagnosis in 37 (9.2%). There were no complications related to the longer gastric manipulation of the probe and the quality of the images was high. We conclude that longitudinal echotomographic scanning of the heart is not exclusively confined to the use of biplane or omniplane probes, but longitudinal views can be consistently obtained with a single-plane instrument.

Atypical Sweet's syndrome in a neutropenic patient with acute myeloid leukemia, secondary to a RAEB-T, simulating thrombophlebitis.

We report a rare case of a patient with acute myeloid leukemia following refractory anemia with excess of blasts transformed (RAEB-T) who presented a clinical picture suggestive of thrombophlebitis. The ultrasonographic procedure and the response to corticosteroid treatment suggest that this condition was compatible with an atypical Sweet's syndrome.

Case report acute respiratory failure after posterior cranial fossa surgery: report of two cases with unusual etiology.

Acute respiratory failure (ARF) occurred in two patients who had normal preoperative findings and intraoperative courses, early after posterior cranial fossa (PCF) surgery. In both instances, the postoperative pulmonary failure appeared to be due to an unknown pulmonary cancer, revealed by autopsy. The diagnosis of an asymptomatic pulmonary malignancy might be considered in the presence of ARF of unclear etiology in patients who undergo PCF surgery for removal of a brain tumor.

Unilateral testicular microlithiasis.

Testicular microlithiasis is a rare pathology which usually affects both testicles (less than 100 cases have been described in the literature), histologically characterized by numerous calcified deposits situated inside the seminiferous tubules, the diameter of which does not usually exceed 2 mm. The pathogenesis of the phenomenon is not completely clear; it has however been noted that there is a higher incidence in patients affected by cryptorchidism, subfertility, Klinefelter's syndrome and in particular those with testicular neoplasms, although the reason for this remains obscure. The case reported seems atypical in that there is no association with the conditions mentioned above and the finding is monolateral, something which is unusual in the literature reviewed.

Vertebral instability in non-neurologic thoracolumbar fractures: the predictive value of methods of measurement.

It is the purpose of this study to evaluate the radiographic results of the conservative treatment of fractures of the thoracolumbar passage in relation to the initial and long-term injury parameters measured by using three different methods: the sagittal index (SI), by Farcy et al., the McRae Index, the Knight et al. Index. The predictive value for each single method was calculated, to determine which of them could be reliable for the purposes of defining primary stability of the injured spine segment. The three methods of measurement were used for initial evaluation and at follow-up (mean 31 months; range 9-45) in 60 non-neurologic thoracolumbar fractures treated conservatively. The fractures were classified based on Magerl et al. Initial instability was evaluated on the basis of the progression of the kyphotic deformity (by at least 5 Cobb degrees as compared to the pre-treatment condition). The Pearson chi 2 test was used for a statistical analysis of the data. There was progression in kyphosis of the fracture in 36 cases (60%). The sagittal index (SI) measured on initial X-rays revealed 27 (76%) potentially stable fractures, while the McRae Index considered 19 to be at risk (55%), the Knight Index, 15 (43%). The higher predictive value (73%) of the sagittal index shows the greater reliability of this method of measurement, as compared to the McRae Index (predictive value = 60%) and the Knight Index (53%) in recognizing the initial phases to be those where the potential instability of the fracture is observed. Even when the SI is applied, the probability of an error in evaluation occurring is 27%. This fact once again stresses the need for more accurate radiological examinations (CT scan, MRI) that clarify the morphological aspects of the lesion injury in an exact manner.

A comparative analysis of the different fixation devices used in pertrochanteric fractures.

The effectiveness of four different fixation devices in the treatment of pertrochanteric fractures of the femur were evaluated in 147 patients. Based on long-term clinical and radiographic evaluation of cases, it is observed that although the screw plates, Ender nails, and gamma nail provide satisfactory results in the treatment of such fractures, each of these with its own indications, the more recent PFN nail, because of its features, seems to adapt best to the needs of the orthopaedist.