Detection of breast cancer by soft-copy reading of digital mammograms: comparison between a routine image-processing parameter and high-contrast parameters.

BACKGROUND: Recent studies have reported the clinical usefulness of the soft-copy reading of mammograms. However, image-processing parameters for soft-copy reading of digital mammograms have not been established. PURPOSE: To compare observer performance in detecting breast cancer by soft-copy reading of digital mammograms using a routine image-processing parameter versus each of several high-contrast parameters. MATERIAL AND METHODS: The mammograms of 154 breasts, including 48 abnormal breasts with breast cancer and 106 normal breasts, were examined. Cancers were classified into 34 mass-dominant cancers, 11 microcalcification-dominant cancers, two cancers showing only architectural distortion, and one cancer without abnormal findings. All mammograms were performed using a computed radiography (CR) system. Each image was processed using GA (1.2), which was the contrast parameter recommended by the manufacturer for hard-copy film, GA (1.4), GA (1.6), and GA (1.8). These images were displayed on 5-megapixel (M) liquid-crystal display monitors. Five experienced radiologists classified them into BI-RADS category 1-2 or 3-5, and were also asked to rate the images on a scale of 0 to 100 for the likelihood of the presence of masses and microcalcifications in each breast. RESULTS: In mass-dominant cancers of dense breast tissue, the mean sensitivities of GA (1.2), GA (1.4), GA (1.6), and GA (1.8) were 32.7, 38.2, 36.4, and 40.0, and the A(Z) values were 0.67, 0.73, 0.71, and 0.73, respectively; in microcalcification-dominant cancers, the mean sensitivities were 80.0, 74.5, 80.0, and 78.2, respectively; however, there were no significant differences among them. CONCLUSION: High-contrast parameters tended to show relatively high sensitivity and A(Z) values in the detection of masses in dense breast tissue, but relatively low sensitivity for microcalcifications.

Meteorological effects on severe hemoptysis: A hospital-based observational study.

BACKGROUND: Although some meteorological factor are likely to contribute to the onset of hemoptysis, few studies have investigated this issue, with none conducted in the Asia-Pacific region. Therefore, the present study aimed to evaluate the associations of meteorological factors with the occurrence of hemoptysis. Differences in the frequency of hemoptysis among several calendar variables were also assessed. METHODS: A total of 47 hemoptysis patients aged ≥ 20 years undergoing bronchial artery embolization in Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers from January 2012 to December 2017 were included in the study. All hemoptysis events were assembled in a single time series, and the proportion of hemoptysis days was 2.1%. The associations of meteorological variables with hemoptysis days were estimated as odds ratios with 95% confidence intervals by using multivariable-adjusted logistic regression models. The frequency of hemoptysis days was compared among several calendar variables using a chi-square test. RESULTS: Mean relative humidity was negatively associated with hemoptysis (P for trend = 0.02). The inverse association remained significant when only the hemoptysis events with no infectious lung diseases were used (P for trend=0.02). No significant difference was observed in the occurrence of hemoptysis among seasons, months, or other calendar variables (all P ≥ 0.21). CONCLUSIONS: Lower relative humidity was a significant risk factor for the development of hemoptysis. Clinicians should be aware of the potential for increases in hemoptysis events on days with low ambient humidity.

Parotid gland tumors: can addition of diffusion-weighted MR imaging to dynamic contrast-enhanced MR imaging improve diagnostic accuracy in characterization?

PURPOSE: To determine the value of adding diffusion-weighted (DW) magnetic resonance (MR) imaging to dynamic contrast material-enhanced MR imaging when distinguishing between benign and malignant parotid tumors. MATERIALS AND METHODS: This retrospective study was approved by the institutional review board, and the informed consent requirement was waived. The authors analyzed MR images of 50 lesions (36 benign, 14 malignant) in 47 patients. DW MR imaging and dynamic contrast-enhanced MR imaging were performed in all patients. Time-intensity curve (TIC) patterns were categorized as follows: type A, time to peak was more than 120 seconds; type B, time to peak was 120 seconds or less with high washout ratio (> or = 30%); type C, time to peak was 120 seconds or less with low washout ratio (< 30%); and type D, flat. The apparent diffusion coefficient (ADC) values were measured on DW MR images. Sensitivity, specificity, accuracy, and positive and negative predictive values were calculated for type A, B, and D tumors regarded as benign and for type C tumors regarded as malignant. On the basis of DW MR imaging results, ADC threshold values between pleomorphic adenomas and carcinomas and between Warthin tumors and carcinomas were selected. Diagnostic accuracy was compared before and after modification diagnosis referring to the ADC value obtained with the McNemar test. P < .05 was considered to indicate a significant difference. RESULTS: ADC threshold values were 1.4 x 10(-3) mm(2)/sec between pleomorphic adenomas and carcinomas and 1.0 x 10(-3) mm(2)/sec between Warthin tumors and carcinomas. Accuracy (82% vs 94%) and positive predictive value (67% vs 92%) significantly improved with the addition of ADC values in the evaluation of patients with type B or C tumors. CONCLUSION: A persistent or flat TIC pattern on dynamic contrast-enhanced MR images indicates benign disease, but there is added value from including the ADC value in the evaluation of tumors that show a plateau or washout TIC pattern.

Optimal gradation processing parameter for soft-copy reading of digital mammogram: comparison between the parameter recommended for hard-copy and other parameters.

PURPOSE: To investigate optimal gradation processing parameter for soft-copy reading comparing the parameter recommended for hard-copy with other parameters. MATERIALS AND METHODS: Digital mammograms using a Computed Radiography system were evaluated. The gradation processing parameter recommended by the manufacturer was GA (1.2). We prepared seven parameters that changed the degree of contrast: GA (0.6, 0.8, 1.0, 1.2, 1.4, 1.6, and 1.8). Images of an anthropomorphic breast phantom were displayed on a 5-megapixel liquid crystal display monitor using each parameter. Three readers independently assessed each image, and scored for the following items: intramammary contrast, extramammary contrast, sharpness, and graininess. Total score was calculated in each parameter. We also displayed normal mammograms of nine cases: three with a scattered fibroglandular density, three with a heterogeneously dense breast, and three with an extremely dense breast. These were displayed using GA (1.2) or using parameters with a higher total score than GA (1.2) in the phantom test. Three readers assessed each mammogram as in the phantom test. RESULTS: In phantom test, GA (1.4), GA (1.6), and GA (1.8) obtained higher scores than GA (1.2). In normal cases tested using these parameters, GA (1.4) obtained the highest score. This was significantly higher than that of GA (1.2) (P=0.004). The score obtained for GA (1.4) was the highest in cases with extremely dense and heterogeneously dense breast tissue, though there was no statistically significant difference. CONCLUSION: Soft-copy image quality was improved by gradient processing using higher contrast parameter than that routinely used in hard-copy, especially in dense breast cases.

Computed tomographic and magnetic resonance features of inflammatory myofibroblastic tumor of the lung in children.

We report two cases of inflammatory myofibroblastic tumor (IMT) of the lung in a 4-year-old boy and a 7-year-old girl. We performed dynamic contrastenhancement computed tomography in both of our cases and dynamic contrast enhancement magnetic resonance imaging (MRI) in one case. These dynamic studies showed a demarcated mass with delayed enhancement in both cases. A T1-weighted MR image shows a mass with homogeneous low signal intensity, and a T2- weighted image shows a mass with slightly high signal intensity. A post-contrast-enhanced T1-weighted image demonstrates homogeneous enhancement. We speculate that the delayed enhancement could be attributed to the abundant fibrous tissue, which was the main structural material of the tumor. This same finding has been described in previous reports of IMT in other organs.

Apparent diffusion coefficients of breast tumors: clinical application.

PURPOSE: To evaluate the usefulness of apparent diffusion coefficient (ADC) for the differential diagnosis of breast tumors and to determine the relation between ADC and tumor cellularity. MATERIALS AND METHODS: One hundred and thirty-six female patients (age range, 17-83 years; average age, 51.7 years) with 140 histologically proven breast tumors underwent diffusion-weighted magnetic resonance (MR) imaging (DWI) using the spin-echo echo-planar technique, and the ADCs of the tumors were calculated using 3 different b values, 0, 500, and 1000 s/mm(2). The diagnoses consisted of fibroadenoma (FA, n=16), invasive ductal carcinoma, not otherwise specified (IDC, n=117), medullary carcinoma (ME, n=3) and mucinous carcinoma (MU, n=4). Tumor cellularity was calculated from surgical specimens. The ADCs of breast tumors and cellularity were compared between different histological types by analysis of variance and Scheffe's post hoc test. The correlation between tumor cellularity and ADC was analyzed by Pearson correlation test. RESULTS: Significant differences were observed in ADCs between FA and all types of cancers (P<0.05) and between MU and other types of cancers (P<0.01) and in cellularity between FA and cancers except MU (P<0.01) and between MU and other types of cancers (P<0.01). There was an inverse correlation between ADC and tumor cellularity (P<0.01, r(2)=0.451). CONCLUSIONS: The ADC may potentially help in differentiating benign and malignant breast tumors. Tumor ADC correlates inversely with tumor cellularity.

Circumscribed mass lesions on mammography: dynamic contrast-enhanced MR imaging to differentiate malignancy and benignancy.

PURPOSE: We evaluated the magnetic resonance (MR) features of breast lesions showing circumscribed mass on mammography to understand the characteristics that differentiate malignancy and benignancy. MATERIALS AND METHODS: Our institutional review board approved the study, and informed consent was waived. Using logistic regression analysis, we examined morphologic and kinetic MR imaging data of 90 breast lesions (43 malignant, 47 benign) that showed circumscribed mass on mammography. RESULTS: Features identified as having high odds for malignancy included: rim enhancement (odds ratio, 70.894; 95% confidence interval (CI), 7.525-667.938); heterogeneous enhancement (odds ratio, 10.839; 95% CI, 1.032-113.856); and washout dynamic pattern (odds ratio, 46.262; 95% CI, 3.716-575.901). Combinations of washout dynamic pattern and either rim or heterogeneous enhancement reflected excessively high prediction probability for malignancy (>0.95), whereas combinations lacking washout dynamic pattern and with either homogeneous enhancement or dark internal septation revealed excessively low prediction probability for malignancy (<0.05). CONCLUSION: Breast cancers with circumscribed mass on mammography could be differentiated from benign masses using internal enhancement and the kinetic pattern of contrast-enhanced breast MR imaging.

Pulmonary lesions associated with visceral larva migrans due to Ascaris suum or Toxocara canis: imaging of six cases.

OBJECTIVE: The objective of our study was to evaluate chest radiographic and CT findings of patients with pulmonary lesions associated with visceral larva migrans due to Ascaris suum or Toxocara canis. CT investigation was focused on the location, size, contour, and internal features of the lesions; migration of lesions; mediastinal lymphadenopathy; and pleural effusion. CONCLUSION: Pulmonary visceral larva migrans appears on CT as multifocal subpleural nodules with halo or ground-glass opacities and ill-defined margins.

MR imaging features of pure mucinous carcinoma of the breast.

OBJECTIVE: To characterize MR imaging features of pure mucinous carcinoma of the breast. MATERIALS AND METHODS: MR images obtained from 16 women (age range, 29-81; mean age, 57 years) with pure mucinous carcinoma of the breast determined at surgery were reviewed. The MR findings used were shape, margin, internal mass enhancement, kinetic curve pattern on dynamic study, signal intensity on short time inversion recovery (STIR) T2-weighted images, and non-mass-like enhancement around the main tumor. Non-mass-like enhancement was compared with the presence of extensive intraductal component (EIC) on histopathological findings. RESULTS: Eleven tumors (69%) had lobular contour, and nine tumors (56%) had smooth margin. Eight tumors (50%) showed rim enhancement and six tumors (38%) showed heterogeneous enhancement. Fourteen tumors (88%) showed a persistent enhancing pattern on kinetic curve. Fifteen tumors exhibited homogenous strongly high signal intensity on STIR T2-weighted images. In six cases with EIC, five cases had non-mass-like enhancement around the main mass. CONCLUSIONS: MR findings such as lobular shape, rim or heterogeneous enhancement, persistent pattern on kinetic curve, and homogeneous strongly high signal intensity on STIR T2-weighted images may be useful in diagnosing pure mucinous carcinoma. Moreover, linear-ductal enhancement around main mass may indicate presence of EIC.

A case of pulmonary synovial sarcoma diagnosed with detection of chimera gene: imaging findings.

Pulmonary synovial sarcoma is a rare disease, and reports detailing clinicians' radiological findings are few. We report a case of a primary pulmonary synovial sarcoma in a 68-year-old woman. Chest CT revealed a well-defined and homogeneous oval mass measuring 3x2.5 cm in the left lower lobe in contact with the visceral pleura. No pleural effusion was evident. No calcification or fat component was detected. The tumor showed homogeneous hypointensity on both T1- and T2-weighted MR imaging. In this case, a lung metastasis could be excluded with fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET), and the final diagnosis was histopathologically confirmed by the chimeric gene detection.

Multifocal nodular lymphoid hyperplasia of the lung.

Nodular lymphoid hyperplasia (NLH) is one of the pulmonary lymphoproliferative disorders, and was initially described as pseudolymphoma. However, reports focusing on CT findings of NLH of the lung have been rare. We report a case of a pulmonary NLH in a 49-year-old woman who showed multiple pulmonary nodules on HRCT and was misdiagnosed preoperatively with adenocarcinoma on the basis of transthoracic cytology. A final diagnosis of NLH was made on postoperative histologic examination.

Gorham's disease of the chest wall: CT and MR characteristics.

We report a case of Gorham's disease of the chest wall in a 29-year-old man. A chest radiograph showed osteolysis of the left first, second, and third ribs. CT and MR images revealed a soft tissue mass around the affected ribs. The mass presented as having heterogeneous high signal intensity on T2-weighted MR images, and it showed minimal enhancement on contrast-enhanced MR images. A histologic specimen obtained by incisional biopsy from the left third rib revealed proliferation of lymphangiomatous tissue in the bone marrow. A diagnosis of Gorham's disease was made based on these clinical, radiologic, and histologic findings.

Adult rhabdomyosarcoma in the nasal and paranasal sinuses showing complete local response to a combination of chemotherapy and radiotherapy using 3D-CRT and IMRT.

We report on a 69-year-old woman with rhabdomyosarcoma arising from the nasal and paranasal sinuses. She was referred to our hospital with a reduced ability to smell and impaired bilateral vision, narrowing of the visual field, and left facial pain. Computed tomography (CT) revealed a large tumor in the nasal and left paranasal sinuses invading the left orbital cavity and anterior skull base, and lymph node swellings in the submental and left accessory nerve areas. A biopsy specimen from the nasal tumor was diagnosed histologically as a rhabdomyosarcoma, alveolar type. Because the intracranial direct invasion and distant metastases to the thoracic spine were suspected by pretreatment examination, our case was determined to be inoperable by a head and neck surgeon. Radiotherapy with a total dose of 60 Gy was carried out to control the primary disease. The three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) techniques were used in order to reduce the doses to risk organs. Combined with radiotherapy, chemotherapy was also performed for the treatment of lymph-node metastases and distant diseases. After the treatment was completed, the primary tumor and lymph-node metastases disappeared completely; there was no sign of re-growth during the follow-up period. Chemoradiotherapy may be an effective treatment also for inoperable adult rhabdomyosarcoma in the head and neck region. Furthermore, the 3D-CRT and IMRT techniques are both useful methods of radiotherapy for this disease.

Reversible Ceftriaxone-Induced Pseudolithiasis in an Adult Patient with Maintenance Hemodialysis.

Ceftriaxone (CTRX) is a third-generation cephalosporin widely used for the treatment of bacterial infections in patients with renal disease because of its excretion by both renal and hepatic mechanisms. Biliary pseudolithiasis is a known CTRX-associated complication; however, there have been no studies of this adverse event in adult patients receiving maintenance hemodialysis. Here we report the case of a 79-year-old Japanese woman with end-stage renal disease (ESRD) receiving maintenance hemodialysis who developed CTRX-induced pseudolithiasis. The patient received CTRX for bronchial pneumonia. Fifteen days following CTRX initiation, the patient presented with stomachache. Because of the presence of one gallstone and increased gallbladder wall thickness on computed tomography scans, not detected at the onset of pneumonia, the patient was diagnosed with CTRX-induced gallbladder pseudolithiasis. CTRX was discontinued immediately. At 48 days following CTRX withdrawal, the gallstone and thickening of the gallbladder wall had completely resolved. ESRD may be a risk factor for CTRX-induced pseudolithiasis as hepatic excretion of CTRX is the predominant clearance mechanism in patients with ESRD. More attention should be paid to CTRX-induced pseudolithiasis following the use of CTRX in ESRD patients.

Pulmonary cryptococcosis in immunocompetent patients: HRCT characteristics.

We analyzed the high-resolution CT (HRCT) findings of cryptococcosis in immunocompetent patients. The predominant manifestations were multiple nodules (n=6) and a single nodule (n=7). Regarding the pattern of multiple nodules, two cases of cavities or necrosis, four cases of surrounding centrilobular micronodules and five cases of "acinar" nodules were seen. No "tree-in-bud" appearance was detected. Five of seven cases of a single nodule were classified as polygonal, and two of them were round. Two cases accompanied micronodules and one case cavitation. Although no "tree-in-bud" appearance was observed, pulmonary cryptococcosis mimics tuberculosis.

Transcatheter arterial embolization for chest wall metastasis of hepatocellular carcinoma.

Hemothorax due to rupture of metastatic hepatocellular carcinoma (HCC) is a very rare complication with high mortality because of uncontrollable hemorrhage. A 71-year-old man treated by transcatheter arterial embolization for HCC with massive bleeding from chest wall metastasis is reported. Enhanced computed tomography and selective intercostal angiogram showed a hypervascular mass in the right chest wall and extravasation of contrast agent. After successful transcatheter arterial embolization with gelatin sponge particles and metallic coils, the patient recovered from shock without major complication. To our knowledge, a successfully treated case of hemothorax due to rupture of metastatic HCC has not previously been described.

Non-mass-like enhancement on contrast-enhanced breast MR imaging: lesion characterization using combination of dynamic contrast-enhanced and diffusion-weighted MR images.

PURPOSE: To evaluate the diagnostic accuracy of a combination of dynamic contrast-enhanced MR imaging (DCE-MRI) and diffusion-weighted MR imaging (DWI) in characterization of lesions showing non-mass-like enhancement on breast MR imaging and to find the strongest discriminators between carcinoma and benignancy. MATERIALS AND METHODS: We analyzed consecutive MR images in 45 lesions showing non-mass like enhancement in 41 patients. We analyzed lesion size, distribution, internal enhancement, kinetic curve pattern, and apparent diffusion coefficient (ADC) values. We applied univariate and multivariate analyses to find the strongest indicators for malignancy. In a validation study, 22 non-mass-like enhancement lesions in 21 patients were examined. We calculated diagnostic accuracy when we presume category 4b, 4c, and 5 lesions as malignant or high to moderate suspicion for malignancy, and category 4a and 3 as low suspicion for malignancy or benign. RESULTS: Segmental distribution (P=0.018), clumped internal enhancement (P=0.005), and ADC less than 1.3 x 10(-3) mm(2)/s (P=0.047) were the strongest MR indicators of malignancy. In a validation study, sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 87% (13/15), 86% (6/7), 93% (13/14), 75% (6/8) and 86% (19/22), respectively. CONCLUSION: The combination of DCE-MRI and DWI showed high diagnostic accuracy in characterization of non-mass-like enhancement lesions on breast MR images.

Enhanced mass on contrast-enhanced breast MR imaging: Lesion characterization using combination of dynamic contrast-enhanced and diffusion-weighted MR images.

PURPOSE: To evaluate the diagnostic accuracy of a combination of dynamic contrast-enhanced MR imaging (DCE-MRI) and diffusion-weighted MR imaging (DWI) in characterization of enhanced mass on breast MR imaging and to find the strongest discriminators between carcinoma and benignancy. MATERIALS AND METHODS: We analyzed consecutive breast MR images in 270 patients; however, 13 lesions in 93 patients were excluded based on our criteria. We analyzed tumor size, shape, margin, internal mass enhancement, kinetic curve pattern, and apparent diffusion coefficient (ADC) values. We applied univariate and multivariate analyses to find the strongest indicators of malignancy and calculate a predictive probability for malignancy. We added the corresponding categories to these prediction probabilities for malignancy and calculated diagnostic accuracy when we consider category 4b, 4c, and 5 lesions as malignant and category 4a, 3, and 2 lesions as benign. In a validation study, 75 enhancing lesions in 71 patients were examined consecutively. RESULTS: Irregular margin, heterogeneous internal enhancement, rim enhancement, plateau time-intensity curve (TIC) pattern, and washout TIC pattern were the strongest indicators of malignancy as well as past studies, and ADC values less than 1.1x10(-3) mm2/s were also the strongest indicators of malignancy. In a validation study, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 92% (56/61), 86% (12/14), 97% (56/58), 71% (12/17), and 91% (68/75), respectively. CONCLUSION: The combination of DWI and DCE-MRI could produce high diagnostic accuracy in the characterization of enhanced mass on breast MR imaging.