CT Patterns of Interstitial Lung Disease in Patients with Plaque Psoriasis: A Retrospective Case Series Study.

Background and Objectives: Recently published articles reported an association between psoriasis and interstitial lung diseases (ILDs). The aim of this study is to evaluate the differences in ILD computed tomography (CT) patterns between smoker and never smoker plaque psoriasis (PP) patients under topical treatment without psoriatic arthritis (PA), inflammatory bowel disease (IBD) or connective tissue diseases (CTDs). Matherials and Methods: Two radiologists evaluated chest CT examinations of 65 patients (33 smokers, 32 never smokers) with PP. Results: Usual interstitial pneumonia (UIP) pattern was diagnosed in 36 patients, nonspecific interstitial pneumonia pattern in 19, hypersensitivity pneumonitis in 7 and pleuropulmonary fibroelastosis (PPFE) in 3 patients. UIP pattern showed a statistically significant higher frequency in smoker patients (p = 0.0351). Respiratory symptoms were reported in 80% of patients. Conclusions: ILDs seems to represent a new comorbidity associated with psoriasis. Moreover, a statistically significant association between smokers and UIP pattern in PP patients is found. Respiratory symptoms should be evaluated in PP patients, in collaboration with a radiologist and a pneumologist. However, further studies are required to better understand the epidemiology of ILDs in PP patients.

Cardiac Masses and Pseudomasses: An Overview about Diagnostic Imaging and Clinical Background.

A cardiac lesion detected at ultrasonography might turn out to be a normal structure, a benign tumor or rarely a malignancy, and lesion characterization is very important to appropriately manage the lesion itself. The exact relationship of the mass with coronary arteries and the knowledge of possible concomitant coronary artery disease are necessary preoperative information. Moreover, the increasingly performed coronary CT angiography to evaluate non-invasively coronary artery disease leads to a rising number of incidental findings. Therefore, CT and MRI are frequently performed imaging modalities when echocardiography is deemed insufficient to evaluate a lesion. A brief comprehensive overview about diagnostic radiological imaging and the clinical background of cardiac masses and pseudomasses is reported.

Cut-off point of CT-assessed epicardial adipose tissue volume for predicting worse clinical burden of SARS-CoV-2 pneumonia.

OBJECTIVE: To identify a cut-off value of epicardial adipose tissue (EAT) volume quantified by CT associated with a worse clinical outcome in patients with SARS-CoV-2 pneumonia. MATERIALS AND METHODS: In this retrospective study, sixty patients with a diagnosis of laboratory-confirmed COVID-19 pneumonia and a chest CT exam on admission were enrolled. Based on a total severity score (range 0-20), patients were divided into two groups: ordinary group (total severity score < 7) and severe/critical group (total severity score > 7). Clinical results and EAT volume were compared between the two groups. RESULTS: The severe/critical patients, compared to the ordinary ones, were older (66.83 ± 11.72 vs 58.57 ± 16.86 years; p = 0.031), had higher body mass index (27.77 ± 2.11 vs 25.07 ± 2.80 kg/m2; p < 0.001) and higher prevalence of comorbidities. EAT volume was higher in severe/critical group, compared with the ordinary group (151.40 ± 66.22 cm3 vs 92.35 ± 44.46 cm3, p < 0.001). In severe/critical group, 19 (73%) patients were admitted in intensive care unit (ICU), compared with 6 (20%) patients in the ordinary group (p < 0.001). The area under the ROC curve (AUC) is equal to 0.781 (p < 0.001) (95% CI: 0.662-0.900). The cut-off found, in correspondence with the highest value of the Youden Index, is 97 cm3: the sensitivity is equal to 83.3%, while the specificity is equal to 70% for predicting a worse outcome. The risk (odds ratio) of belonging to the severe/critical group in this population due to EAT ≥ 97 cm3 is 11.667 (95% CI: 3.384-40.220; p < 0.001). CONCLUSION: An EAT volume of 97 cm3 has good sensitivity and specificity to predict a greater extent of pulmonary involvement and therefore a worse clinical outcome in patients with SARS-CoV-2 pneumonia.

Comparison of point shear wave elastography and transient elastography in the evaluation of patients with NAFLD.

PURPOSE: To compare point shear wave elastography (pSWE, ElastPQ®) and transient elastography (TE) with Liver Biopsy in order to evaluate fibrosis stage in non-alcoholic fatty liver disease (NAFLD). METHODS: Our prospective study from September 2017 to October 2020 included 50 consecutively enrolled patients with NAFLD (52.2 ± 13.0 years, 32 male). All patients underwent clinical evaluation, B-mode ultrasound, pSWE, TE and liver biopsy in a single evaluation. The clinical, laboratory and liver biopsy data were compared with liver stiffness (LS) measurement obtained with pSWE and TE. TE and pSWE diagnostic accuracy for the diagnosis of the different fibrosis stages were evaluated using the area under receiver operating characteristic curve (AUROC). RESULTS: Only fibrosis stage was independently associated with TE and pSWE. The median liver stiffness measurement for fibrosis stages F0, F1, F2, F3, and F4 using TE was 4.8 (4.7-6.1) kPa, 5.5 (4.4-7.3) kPa, 7.7 (6.1-9.1) kPa, 9.9 (8.8-13.8) kPa, and 20.2 kPa, respectively. The corresponding median liver stiffness measurement using pSWE was 4.2 (4.0-4.8) kPa, 4.7 (4.2-5.8) kPa, 5.1 (4.1-6.9) kPa, 8.5 (5.2-13.3), and 15.1 kPa, respectively. The AUROC of TE for diagnosis of fibrosis stage F1, ≥ F2, ≥ F3, and F4 were 0.795, 0.867, 0.927, and 0.990, respectively. The corresponding AUROC of pSWE was 0.717, 0.733, 0.908, and 1.000, respectively. No association was observed with other histological parameters. CONCLUSION: TE was significantly better than pSWE for the diagnosis of fibrosis stage ≥ F2. No statistically significant differences were found between TE and pSWE AUROC of fibrosis stage ≥ F1, ≥ F3, and F4.

Ultra-low-dose chest CT in adult patients with cystic fibrosis using a third-generation dual-source CT scanner.

INTRODUCTION: Chest computed tomography (CT) examinations are performed routinely in some cystic fibrosis (CF) centers in order to evaluate lung disease progression in CF patients. Continuous CT technological advancement in theory could allows a lower radiation exposure of CF patients during chest CT examinations without an image quality reduction, and this could become increasingly important over time in order to reduce the cumulative radiation dose effects given the continuous increase of CF patients predicted median survival. OBJECTIVE: The aim of this study was to compare objective and subjective image quality and radiation dose between low-dose chest CT examinations performed in adult CF patients using a third-generation DSCT scanner and a 64-slices single-source CT (SSCT) scanner. MATERIALS AND METHODS: Between January 2016 and August 2019, 81 CF patients underwent low-dose chest CT examinations using both a 64-slices SSCT scanner (2016-2017) and a third-generation DSCT scanner (2018-2019). Objective image noise standard deviation (INSD), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), overall subjective image quality (OSIQ), subjective image noise (SIN), subjective evaluation of streaking artifacts (SA), movement artifacts (MA) and edge resolution (ER), dose-length product (DLP), volume computed tomography dose index (CTDIvol) and effective radiation dose (ERD) were compared between DSCT and SSCT examinations. DSCT examinations consisted in spiral inspiratory end expiratory acquisitions. SSCT examinations consisted in spiral inspiratory acquisitions and five axial expiratory ones. RESULTS: DSCT protocol showed statistically significant lower spiral inspiratory phase mean DLP, CTDIvol and ERD than SSCT protocol, with a 25% DLP, CTDIvol and ERD reduction. DSCT protocol showed statistically significant higher overall (inspiratory and expiratory phases) mean DLP, CTDIvol and ERD than SSCT protocol, with a 40% DLP, CTDIvol and ERD increase. Objective image quality (INSD, SNR and CNR) and SIN differences were not statistically significant, but subjective evaluation of DSCT images showed statistically significant better OSIQ and ER, as well as statistically significant lower SA and MA with respect to SSCT images. CONCLUSIONS: To our knowledge, this is the first study evaluating chest CT image quality and radiation dose in adult CF patients using a third-generation DSCT scanner, and it showed that technological advancements could be used in order to reduce radiation exposure of volumetric examinations. The spiral inspiratory dose reduction can be obtained with concomitant improvements in subjective image quality with comparable objective quality. This will probably allow a wider use of this imaging modality in order to assess bronchiectasis and will probably foster spiral expiratory acquisition for small airways disease evaluation.

Shear wave elastography and transient elastography in HCV patients after direct-acting antivirals.

PURPOSE: To compare the ultrasound (US) and pulse shear wave elastography (pSWE, Elast PQ®) methods with transient elastography (TE), clinical scores and laboratory tests, during the follow-up of HCV patients receiving direct-acting antiviral drugs (DAA). METHODS: Our prospective study from June 2016 to December 2017 included 22 consecutively enrolled HCV-positive patients (59.7 ± 12.3 years, 11 male) which were subjected to antiviral therapy. All patients underwent B-mode ultrasound, color-Doppler, pSWE and TE five times: before therapy (T0), at the end of therapy (post-Tx), and at 12, 24, 48 weeks post-therapy. The liver stiffness (LS) values obtained with pSWE and TE and the data coming from US assessment and clinical evaluation were compared. RESULTS: We obtained a statistically significant reduction of LS values (kPa) measured by pSWE, between T0 (14.3 ± 9.3), post-Tx (11.8 ± 10.5), 12 weeks (7.5 ± 3.3), 24 weeks (8 ± 3.8) and 48 weeks (8.5 ± 4.6) (p = 0.02). The reduction of kPa measured by TE was not significant between T0 (14.7 ± 9.3), post-Tx (12 ± 9.5), 12 weeks (11.6 ± 7.7), 24 weeks (10.3 ± 6) and 48 weeks (10.8 ± 7.5) (p > 0.05). Multivariate baseline analysis showed significant independent association among measurement of TE stiffness with cirrhosis, type of vein hepatic flow and showed significant independent association between delta-pSWE measurement (difference between stiffness measurements at the baseline and 12 months after treatment) with staging of fibrosis (p = 0.006) and sustained virologic response after 12 weeks of treatment (SVR12, p = 0.017). CONCLUSION: The pSWE method has shown better ability than TE to identify a reduction in LS. Therefore, pSWE allow to evaluate stiffness reduction in HCV patient during DAA treatment follow-up, which is related to SVR12.

Apparent diffusion coefficient values in borderline breast lesions upgraded and not upgraded at definitive histopathological examination after surgical excision.

PURPOSE: The study aims were to evaluate if the apparent diffusion coefficient (ADC) value could distinguish between breast lesions classified as B3 at core needle biopsy (CNB) that show or do not show atypia or malignancy at definitive histopathological examination (DHE) after surgical excision. MATERIAL AND METHODS: From January 2013 to December 2017, 141 patients with a B3 breast lesion underwent magnetic resonance imaging and were included in the study. The ADC value was assessed drawing a ROI outlining the entire lesion, evaluating the mean (ADCmean) and minimum ADC values (ADCmin). RESULTS: Both ADCmean and ADCmin values showed a statistically significant difference between B3 lesions without and with malignancy or, for B3a lesions, atypia at DHE. They both showed a statistically significant difference also between B3a lesions without or with atypia or malignancy at DHE, but only ADCmin (not ADCmean) showed statistically significant difference between B3b lesions without or with malignancy at DHE. CONCLUSIONS: The ADC value could help distinguish between B3a lesions without or with atypia/malignancy at DHE after surgical excision and between B3b lesions without or with malignancy at DHE. Therefore, it could be used to help guide the diagnostic-therapeutic pathway of these lesions, particularly of B3a lesions.

Invasive lobular carcinoma mammographic findings: correlation with age, breast composition, and tumour size.

PURPOSE: The aim of this study was to evaluate mammographic findings associated with invasive lobular carcinoma in different age groups, taking into account breast composition and tumour size. MATERIAL AND METHODS: A total of 1023 invasive lobular carcinoma preoperative mammograms were evaluated. According to the American College of Radiology Breast Imaging Reporting and Data System, cancer mammographic findings were classified as mass, calcifications, architectural distortion, and asymmetry, and breasts were assessed as dense (C or D breast composition) or non-dense (A or B). The patient cohort was subdivided into 3 age groups (< 50, 50-69, ≥ 70 years of age). In order to make the size and age groups dichotomous variables and to perform multiple regression analysis, a cut-off of 10 mm was chosen for tumour size, and < 50-years-old and 50-69-years-old age groups were grouped together (< 70-years-old age group). RESULTS: Significant results of multivariate analysis were the association between mass finding and non-dense breasts and size ≥ 10 mm (p < 0.0001), between calcifications, and dense breasts, size < 10 mm and < 70-years-old age group (p < 0.0001), between distortion and < 70-years-old age group (p = 0.0366), and between asymmetry and ≥ 70-years-old age group (p = 0.0090). CONCLUSIONS: Various mammographic findings are differently associated with age group, breast composition, and tumour size.

Contrast-enhanced ultrasound in delayed splenic vascular injury and active extravasation diagnosis.

INTRODUCTION: We describe the use of contrast-enhanced ultrasound (CEUS) in the diagnosis of delayed splenic vascular injury (DSVI) and active extravasation (DAE) during spleen injury follow-up. CEUS might be used instead of contrast-enhanced computed tomography (CECT) during spleen injury follow-up in order to reduce radiation exposure. OBJECTIVE: Assess diagnostic comparability between CEUS and CECT in the evaluation of DSVI and DAE during spleen injury follow-up. SUBJECTS AND METHODS: A total of 139 trauma patients (101 males, 38 females; mean age 48.6 years) with CECT diagnosed spleen injury were prospectively evaluated. They performed CEUS and CECT follow-up. All CEUS studies were performed using the same ultrasound scan, convex probe, mechanical index and ultrasound contrast agent dose. Twelve patients performed digital subtraction angiography (DSA) during follow-up, and the diagnostic performance comparability between CEUS and DSA was evaluated. RESULTS: CEUS showed 17 delayed spleen injury complications, and in 122 patients no complication was suspected. CECT diagnosed 16 delayed spleen injury complications in these 17 patients and showed a small DSVI in another patient. A total of 122 follow-up CT scans were negative. CEUS and CECT diagnostic comparability was 98.6%. Compared to DSA, CEUS showed a sensitivity of 100% and a positive predictive value of 91.7%. CONCLUSIONS: CEUS can be used during spleen injury follow-up instead of CECT. Positive CEUS examinations could perform CECT and, when necessary, DSA in order to confirm and treat spleen injury complications.

Contrast-enhanced ultrasound in the evaluation of splenic injury healing time and grade.

AIMS: To assess mean healing time of blunt spleen injuries managed nonoperatively using CEUS (contrast-enhanced ultrasound); to analyze whether spleen injury grade, subcapsular hematoma (SCH) presence, SCH grade and spleen infarct after spleen artery angioembolization could be related to healing time; and to evaluate CEUS sensitivity in diagnosing spleen injury and to assess CEUS performance in classifying spleen injury grade compared to CT. MATERIALS AND METHODS: After CT evaluation in the Emergency Department, 101 hemodynamic stable blunt spleen trauma patients (73 males; 28 females; mean age 46.4 years, range 18-92) underwent serial CEUS follow-up examinations at pre-established intervals (1, 3, 8, 15, 30, 60, 90 and 180 days after trauma), until spleen injury became no more identifiable. RESULTS: Mean CEUS examinations performed before spleen injury healing were 4.5; mean spleen injury healing time was 22.6 days. Spleen injury healing time was significantly related to spleen injury grade, subcapsular hematoma (SCH) presence, SCH grade and spleen infarct. CEUS spleen injury diagnostic sensitivity was 96.9% and, according to the American Association for the Surgery of Trauma (AAST)-spleen injury scale (SIS), CEUS-CT concordance was 95.8%. CONCLUSIONS: Spleen injury healing time in blunt abdominal trauma nonoperatively managed is significantly related to AAST-SIS grade, SCH presence and grade, and spleen infarct development, and CEUS can be used in order to evaluate spleen injury grade.

Correlation between apparent diffusion coefficient of magnetic resonance imaging and tumor-infiltrating lymphocytes in breast cancer.

PURPOSE: To evaluate a possible correlation between apparent diffusion coefficient (ADC) value and tumor-infiltrating lymphocytes (TILs) level in breast cancer (BC). A second objective was to assess whether there were other histopathologic features that could affect mean ADC value. METHODS: In this 4-year retrospective study were included 125 patients who underwent radical or modified mastectomy for monofocal BC. All subjects had performed preoperative MRI with the same 1.5-T machine and protocol, which consisted of STIR, DWI and DCE sequences. Based on TIL score, BCs were stratified into two groups: absent-low TIL (≤ 10%) and medium-high TIL (> 10%). The t test was used to correlate mean ADC value with TIL groups. Receiver operating characteristic curve and Youden index were used in order to identify ADC value threshold to distinguish the two TIL groups. RESULTS: BC patients with absent-low TIL level and medium-high TIL one were, respectively, 66 (52.8%) and 59 (47.2%). Mean ADC value was 1.05 ± 0.19 * 10-3 mm2 s-1. Absent-low TIL group showed a lower mean ADC value than medium-high TIL one (0.96 ± 0.18 * 10-3 mm2 s-1 vs 1.14 ± 0.16 * 10-3 mm2 s-1; p < 0.0001). ADC value threshold in order to distinguish the two TIL groups with maximum sensitivity (67.8%) and specificity (80.3%) was 1.03 * 10-3 mm2 s-1. ADC value was shown to be significantly related to TILs level (p < 0.0001) and cancer histotype (p = 0.0006), with a lower mean ADC value correlated to absent-low TIL level and ductal histotype. CONCLUSION: BCs with absent-low TIL showed a statistically significant lower mean ADC value than those with medium-high TIL. ADC value threshold in order to distinguish these two groups was 1.03 * 10-3 mm2 s-1.

MRI evaluation of peripheral vascular anomalies using time-resolved imaging of contrast kinetics (TRICKS) sequence.

INTRODUCTION: We describe the use of time-resolved imaging of contrast kinetics (TRICKS) sequence in the diagnosis of Peripheral Vascular Anomalies. In case of suspected vascular malformations time-resolved MR angiography might add important information for therapeutic decisions and follow-up. OBJECTIVE: The objective of our study was to assess the usefulness and diagnostic performance of time-resolved imaging of contrast kinetics sequence in the evaluation of peripheral vascular anomalies. SUBJECTS AND METHODS: Sixty-six patients (23 pediatric, 43 adult; mean age 26) affected by upper or lower limb vascular anomalies and studied using time-resolved imaging of contrast kinetics sequence were prospectively evaluated. All studies were performed on a 1.5-T whole-body MR system. Two independent readers tried to categorized the suspected vascular anomalies in pre-contrast and post-contrast MR sequences and assessed the overall TRICKS image quality. In 11 patients, the diagnostic performance comparability between TRICKS sequence and digital subtraction angiography was evaluated. RESULTS: On the basis of time-resolved imaging of contrast kinetics, 31 of the vascular anomalies were classified as high-flow vascular malformations, 29 as low-flow vascular lesions and 6 as hemangiomas. There was no significant difference in image quality evaluation and vascular anomaly classification between the two observers. The vascular anomalies characteristics provided by moderate, good or excellent quality TRICKS images were confirmed by digital subtraction angiography. CONCLUSION: Time-resolved imaging of contrast kinetics sequence let the radiologist to acquire useful temporal information to correctly evaluate vascular anomalies components, adding more data to those provided by conventional MR sequences, especially in case of arteriovenous malformation. Therefore, both in pediatric and adult population, TRICKS could be used as an additional initial diagnostic tool to rightly classify these lesions and evaluate if a treatment is needed and which.

Diffusion-weighted imaging in the early diagnosis of intraventricular rupture of a brain abscess.

Brain abscess is a potentially fatal injury that must be treated promptly to avoid complications that require neurosurgery such as intraventricular rupture. Patients with brain abscess may exhibit a multiple variety of nonspecific symptoms, simulating the presence of neurological diseases such as ischemic stroke or intracranial tumor masses. Early radiological diagnosis with adequate subsequent treatment improves the patient's chances of recovery. We report the case of a 48-year-old male patient with brain abscess complicated by an initial rupture into the ventricle. Magnetic resonance imaging with diffusion-weighted images, and apparent diffusion coefficient maps made it possible to diagnose an intraventricular rupture of the abscess with consequent appropriate neurosurgical treatment.

Sinus Disease Grading on Computed Tomography Before and After Modulating Therapy in Adult Patients with Cystic Fibrosis.

Objectives: Cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy effects on respiratory function, pulmonary exacerbations and quality of life have been well documented. However, CFTR modulator therapy effects on sinus disease have not been so well reported. A previous study reported that ivacaftor improves appearance of sinus disease on Computed Tomography (CT) in cystic fibrosis (CF) patients with G551D mutation. The aim of this study was to evaluate the effect of CFTR modulator therapy in sinus disease using CT scores in a wider CF patient population. Materials and Methods: Forty-eight adult patients with CF underwent at least one CT sinus examination before CFTR modulator therapy (ivacaftor, lumacaftor, ivacaftor/lumacaftor or elexcaftor/tezacaftor/ivacaftor) and one CT sinus examination one year after CFTR modulator therapy initiation. Two radiologists assessed the images in consensus. The Lund-Mackay score (LM score) and the Sheikh-Lind CT sinus disease severity scoring system (SL score) were used. The 22-item SinoNasal Outcome Test (SNOT-22) questionnaire was evaluated before CFTR modulator therapy and one year after CFTR modulator therapy initiation. Results: CT sinus examination after CFTR modulator therapy showed statistically significant lower mean LM, SL and SNOT-22 scores than CT sinus examination before CFTR modulator therapy (p < 0.001). Conclusion: Evolution of imaging findings on CT during follow-up closely correlate with improved SNOT-22 score one year after CFTR modulator therapy initiation, indicating that CT may be a useful adjunct during follow-up of CF patients under this treatment as an objective measure of sinonasal disease improvement.

Thoracoabdominal computed tomography neoplasia detection in patients with paraneoplastic pemphigus: the importance of collaboration between specialists.

INTRODUCTION: Paraneoplastic pemphigus (PNP) is an autoimmune disorder that is almost always linked to an underlying neoplasia. General radiologists are usually not aware of what kind of neoplasia can be associated with PNP. Therefore, this study evaluates the effect of a dermatology lecture on radiologists' neoplasia diagnosis performance. METHODS: Two radiologists evaluated thoracoabdominal computed tomography (CT) examination images of 43 patients with PNP in separate reading sessions blinded to each other's assessments. Six months after the first CT image evaluation session, the two radiologists attended a lecture by two dermatologists about PNP, and 6 months later the two radiologists assessed the same CT examinations again. RESULTS: Statistical analysis showed statistically significant differences in CT sensitivity between the first and the second round of image evaluation for both radiologists (reader 1: p = 0.0313; reader 2: p = 0.0156). CONCLUSIONS: This is the first study to evaluate the effectiveness of a dermatology lecture on diagnostic performance. It is very important for radiologists to be familiar with the particular neoplasms that can be associated with PNP because this can have a direct clinical impact on diagnostic performance.

Invasive ductal carcinoma mammographic findings: Correlation with age, breast composition and tumor size.

BACKGROUND/OBJECTIVE: The aim of this study was to identify the mammographic findings associated with malignancy in different age groups, taking into account breast composition (BC) and lesion size. METHODS: Preoperative mammograms of 1023 invasive ductal carcinomas were retrospectively evaluated. According to the American College of Radiology Breast Imaging Reporting and Data System, cancer mammographic findings were classified as mass, calcifications, architectural distortion and asymmetry, and breasts were assessed as non-dense (A or B BC) and dense (C or D BC). Patient cohort was subdivided into three age groups (group 1: <50 years of age; group 2: between 50 and 69; group 3: ≥70 years of age). RESULTS: Significant results of multinomial logistic regression were the association between mass and non-dense breast (p < 0.0001) and the association between mass and tumor size larger than 15 mm (p = 0.0049). CONCLUSIONS: Mass finding of invasive ductal breast carcinoma is associated with breast composition and tumor size.

Low diffusion level within a fibroadenoma as the sole sign of ductal carcinoma in situ: A case report.

We present a case of ductal carcinoma in situ within a fibroadenoma. Breast cancer arising within fibroadenoma incidence ranges from 0.125% to 0.02%, and ductal carcinoma in situ is not the most frequent malignancy that can be found within a fibroadenoma. Dynamic contrast-enhanced magnetic resonance imaging showed an oval mass with circumscribed margins and dark internal septations, suspicious for fibroadenoma. According to European Society of Breast Radiology diffusion-weighted imaging consensus, mean apparent diffusion coefficient value obtained by drawing a small region of interest on the lesion apparent diffusion coefficient map showed a low diffusion level. Therefore, ductal carcinoma in situ within a fibroadenoma was diagnosed at final pathology after surgical excision.