Exploring the latest advances in 18F-FDG PET/CT and cardiac magnetic resonance for imaging for cardiac sarcoidosis diagnosis.

Sarcoidosis is a systemic inflammatory disease that affects multiple organs. Various clinical signs are associated with cardiac sarcoidosis (CS), and the diagnosis process is complicated because any organ could be involved. Despite the critical clinical importance of early and precise diagnosis of CS, there is currently no gold-standard method for CS evaluation. The non-invasive imaging modalities of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and cardiac magnetic resonance (CMR) imaging have demonstrated the potential for identifying various histological characteristics of CS. Recently, the development of hybrid FDG-PET/CMR scanners has enabled the simultaneous acquisition of these attributes. Compared to just one imaging modality, these scanners detect CS and stratify risk more accurately and with higher sensitivity. Analyzing the potential role of concurrent FDG-PET/CMR in enhancing the diagnosis of CS, the present review concentrates on the advantages of this technique in light of recent technological developments.

Our experience using synthesized mammography vs full field digital mammography in population-based screening.

Background: Synthesized Mammogram (SM) from Digital Breast Tomosynthesis (DBT) images is introduced to replace the routine Full Field Digital Mammography (FFDM) to reduce radiation dose. Purpose: to compare the conspicuity of cancer related findings between SM and FFDM and combination of these methods with DBT. Methods: The study was conducted in a tertiary breast imaging center, where 200 women referred for screening were enrolled in the study sequentially. Patients underwent FFDM and DBT simultaneously and a two-year follow-up was done. Data was evaluated for Breast Imaging Reporting and Data System (BI-RADS) score, breast density, mass lesions, calcification, and focal asymmetry by two expert breast radiologists. Comparison between different methods was made by Cohen Kappa test. Results: 22 patients with likely malignant findings went under biopsy. Taking histopathologic findings and two-year follow up as reference, the overall sensitivity and specificity for FFDM+DBT (86.1 and 88.9 respectively) and SM+DBT (86.1 and 88.2) didn't show a meaningful difference. Comparing SM and FFDM, calcification in 20 subjects were overlooked on SM, but later detected when combined with DBT. Considering breast composition and BI-RADS categorization, an excellent agreement existed between the readers. Conclusion: Screening with SM+DBT shows comparable results with FFDM+DBT considering BI-RADS categorization of the patients. Although SM showed slightly inferior sensitivity compared to FFDM, after combining DBT with SM no malignant appearing calcification or mass lesion was missed.

Fetal brain imaging: A comparison between fetal ultrasonography and intra uterine magnetic resonance imaging (a systematic review and meta-analysis).

OBJECTIVE: The aim of this study was to compare ultrasound (US) and intra uterine MRI (IUMRI) of the brain in the diagnosis of fetal brain abnormalities. METHODS: The present systematic review is done based on guidelines for preferred reporting items for systematic reviews and meta-analysis. All major articles comparing fetal US with IUMRI in fetuses with suspected brain abnormalities were qualified. Articles published before 2010 were excluded from the study. An I2  > 20% was considered as a sign of significant change. The statistical analysis was done using STATA -15 and Meta-Disk 1.4 applications. RESULTS: Five articles were considered for meta-analysis. The sensitivity of US and IUMRI in diagnosing fetal abnormalities were 86% and 95%, respectively. The corresponding rates for specificity were 77% and 80%. IUMRI and US were concordant in 72.5% (95% CI: 68%-77%) of diagnoses. However, IUMRI added information in 21.7% of cases, while US added value was only 1.48. CONCLUSION: Our results approved the good diagnostic performance of both US and IUMRI in confirming fetal brain normal development and emphasized that US is an appropriate screening technique in pregnancy. In cases of detected abnormalities in US, IUMRI is suggested as it was the most accurate imaging method and added information about the diagnosis in 22.2% of cases.

Comparison of Qualitative (Time Intensity Curve Analysis), Semi-Quantitative, and Quantitative Multi-Phase 3T DCEMRI Parameters as Predictors of Malignancy in Adnexal.

Objective: The present study aimed to compare the qualitative (time intensity curve analysis), the semi-quantitative and the quantitative multiphase 3T dynamic contrast-enhanced (DCE) MRI parameters as predictors of malignancy in adnexal masses. Materials and Methods: In this prospective study, women with an adnexal mass who were scheduled for surgical resection or were followed for more than one year period to confirm the benignity of their lesions, underwent multiphase 3T DCE-MRI. The qualitative (time intensity curve), semi-quantitative (SImax, SIrel, WIR) and quantitative (Ktrans, Kep, Vb) analyses were performed on DCE-MRI sequences and their predictive values were compared. Results: A total of 17 benign and 14 malignant lesions were included. According to the qualitative analysis, none of the lesions with Type I time intensity curves (TIC) were malignant and none of the masses with Type III TICs were benign. The accuracy of the quantitative parameters in detection of malignancy was found to be higher than that of semi-quantitative variables, particularly when calculated for a small ROI within the high signal area of the mass (sROI) rather than the largest ROI including the whole mass (lROI), and when inter-MRI variations were omitted using ratios. The Kep(tumor)/Kep(myometrium) ratio measured from sROI was the best parameter for differentiating a malignant lesion with a sensitivity of 100% and a specificity of 92.3%. Conclusion: We concluded that a Type I TIC confirms a benign lesion, and a type III TIC confirms the malignancy and further evaluation is not recommended for these lesions. So complementary quantitative analysis is only recommended for adnexal masses with type II TICs.

Correlation Between Mammographic Breast Density, Breast Tissue Type in Ultrasonography, Fibroglandular Tissue, and Background Parenchymal Enhancement in Magnetic Resonance Imaging.

OBJECTIVE: Breast cancer is the most common malignancy in the female population, and imaging studies play a critical role for its early detection. Mammographic breast density (MBD) is one of the markers used to predict the risk stratification of breast cancer in patients. We aimed to assess the correlations among MBD, ultrasound breast composition (USBC), fibroglandular tissue (FGT), and the amount of background parenchymal enhancement (BPE) in magnetic resonance imaging, after considering the subjects' menopausal status. METHODS: In this retrospective cross-sectional study, the medical records' archives in a tertiary referral hospital were reviewed. Data including age, menopausal status, their mammograms, and ultrasound assessments were extracted from their records. All of their imaging studies were reviewed, and MBD, USBC, FGT, and BPE were determined, recorded, and entered into SPSS software for analysis. RESULTS: A total of 121 women (mean age = 42.7 ± 11.0 years) were included, of which 35 out of 115 (30.4%) had reached menopause. Using the Jonckheere-Terpstra test for evaluating the trends among above mentioned 4 radiologic characteristics in the total sample population, a significant positive relation was found between each of these paired variables: (1) USBC-MBD (P = .006), (2) FGT-MBD (P = .001), (3) USBC-BPE (P = .046), (4) USBC-FGT (P = .036), and (5) BPE-FGT (P < .001). These trends were not found to be significant among premenopausal subjects. CONCLUSIONS: Considering the trends between different measures of breast density in the 3 radiologic modalities, these factors can be used interchangeably in certain settings.