Volumetric breast ultrasound as a screening modality in mammographically dense breasts.

This investigation is part of an ongoing large scale study using volumetric breast ultrasound (VBUS) as a screening modality in mammographically dense breasts, offering a substantial benefit to MR imaging of the breast in terms of cost and efficiency. The addition of VBUS to mammography in women with greater than 50% breast density resulted in the detection of 12.3 per 1,000 breast cancers, compared to 4.6 per 1,000 by mammography alone with an overall attributable risk of breast cancer of 19.92 (95% confidence level, 16.75-23.61) in our screened population. These preliminary results may justify the cost benefit of implementing the judicious use of VBUS as an alternative to MR imaging of the breast in conjunction with mammography in the dense breast screening population.

Imaging features of breast malignancy: breast ultrasound and MR imaging correlation.

Recent advances in breast imaging, including volumetric breast ultrasound and breast magnetic resonance (MR) imaging, now provide multiplanar capability for detailed morphologic assessment of breast malignancies. This article describes the imaging findings of common breast cancers, utilizing volumetric breast ultrasound with MR imaging correlation. Knowledge of the characteristic appearances of breast malignancy can facilitate the diagnosis and management of breast masses, particularly when obscured by excessive breast density on mammography examinations.

Improved breast cancer detection in asymptomatic women using 3D-automated breast ultrasound in mammographically dense breasts.

Automated breast ultrasound (ABUS)was performed in 3418 asymptomatic women with mammographically dense breasts. The addition of ABUS to mammography in women with greater than 50% breast density resulted in the detection of 12.3 per 1,000 breast cancers, compared to 4.6 per 1,000 by mammography alone. The mean tumor size was 14.3 mm and overall attributable risk of breast cancer was 19.92 (95% confidence level, 16.75 - 23.61) in our screened population. These preliminary results may justify the cost-benefit of implementing the judicious us of ABUS in conjunction with mammography in the dense breast screening population.

Kinematic cervical spine magnetic resonance imaging in low-impact trauma assessment.

Kinematic magnetic resonance imaging can be implemented as a noninvasive adjunct examination for injuries in the cervical spine in the clinical assessment of ligamentous, disk, and soft-tissue injuries, as a basis for determining medical vs. surgical management, and in establishing the degree of functional clinical impairment. This article discusses the clinical indications and application of kinematic cervical spine magnetic resonance imaging method in the diagnosis and management of cervical spine injuries. The spectrum and grading classification of cervical spine injuries using kinematic magnetic resonance imaging is also discussed.

CT features of descending necrotizing mediastinitis--a pictorial essay.

Descending necrotizing mediastinitis (DNM) is a relatively rare condition caused by downward spread of neck infections into the mediastinum. This infection previously had a much worse prognosis. In recent years, prompt computer topography (CT) diagnosis has been recommended. CT scan provides the earliest means of detecting DNM for optimal management and early surgical intervention. This paper provides an illustrated summary of our extensive clinical experience with DNM, involving 36 documented cases with CT over a 5-year period.

Chronic appendicitis "syndrome" manifested by an appendicolith and thickened appendix presenting as chronic right lower abdominal pain in adults.

In this short report, we describe a small series of adult patients with chronic appendicitis presenting with chronic right lower quadrant abdominal pain. The clinical presentation was unusual and atypical for classic appendicitis because of the absence of fever, peritoneal tenderness on focused graded compression of the abdomen, and leukocytosis. Computed tomography (CT) findings included the presence of an appendicolith and appendiceal thickening, without mesenteric infiltration, abscess, or collection. In this series, the appendicolith appeared to represent a marker rather than an actual cause of appendicitis. Focused CT scans with additional lung and bone windows proved optimal in detecting appendicoliths, which were not visible on the scout localizer scans, despite windowing modifications. Our findings suggest that chronic appendicitis may be a phenomenon unique to adults and should be included in the differential diagnosis of chronic right lower quadrant pain in patients seen in the emergency room setting. Surgery is curative in such patients, although expectant management is an alternative when tolerated by the patient.

CT method for visualization of the appendix using a fixed oral dosage of diatrizoate--clinical experience in 525 cases.

PURPOSE: The purpose of this study is to determine if focused CT examinations of the pelvis, utilizing fixed oral dosage of diatrizoate contrast media, improve overall reader confidence in visualization of the appendix. MATERIALS AND METHODS: Five hundred and twenty-five patients referred for, rule out appendicitis, evaluations underwent focused CT examinations of the pelvis following fixed oral dosage of diatrizoate contrast media. A five-point scale was used to assess the effect of contrast enhancement of the distal small bowel, cecum, and appendix on overall reader confidence, and subsequent visualization of the appendix. RESULTS: Bowel preparation was ideal in 504 of 525 (96%) patients. Enhanced supine CT images following oral administration of fixed dosage of diatrizoate had consistently good scores for reader confidence for bowel opacification (4.8+/-0.1, P<0.005) and visualization of the appendix (3.7+/-0.1, P<0.005), at 50 min following oral contrast administration. This method improved visualization of the normal appendix in 446 of 504 (88%) patients, with a specificity of 99%. In a patients meeting CT criteria for appendicitis, 21 of 21 (100%) patients were proven at surgery. CONCLUSION: The use of fixed oral dosage of diatrizoate contrast media resulted in good overall reader confidence to visualize the appendix and peri-appendiceal area, in addition to high specificity and rapid transit time.

Rapid CT scan visualization of the appendix and early acute non-perforated appendicitis using an improved oral contrast method.

The purpose of this study was to optimize detection of the normal appendix in the clinical exclusion of acute nonperforated appendicitis using an improved and rapid method of bowel opacification in conjunction with the CT examination. A prospective evaluation of 100 consecutive patients, ranging from 13 to 50 years in age, was performed over a 4-month period using water-soluble oral contrast medium consisting of a fixed dose of diatrizoate salts administered as a prepared beverage in the emergency ward 50 min prior to performing a CT scan to evaluate clinical signs and symptoms of early acute appendicitis. The appendix was visualized in 84% (84 of 100) of patients, with a mean transit time of 50 min. The appendix filled with oral contrast medium in 89% (75 of 84) patients, and this sign was reliable in excluding appendicitis. In no instance did a contrast-filled appendix prove to represent appendicitis. The earliest signs of appendicitis were seen in 8% (8 of 100) patients. CT scan findings included absence of a contrast- or air-containing appendix with appendiceal thickening and infiltration of the periappendiceal mesenteric fat. CT scan utilizing a fixed dosage of orally administered water-soluble contrast containing diatrizoate salts, with a mean transit time of 50 min, provides a rapid and efficient means of visualizing the appendix in the clinical exclusion of appendicitis in the emergency setting.

Soft tissue injury protocol (STIP) using motion MRI for cervical spine trauma assessment.

The purpose of this study was to establish a noninvasive scoring method, using motion MRI, to determine the degree of clinical impairment in traumatized cervical spines. This method is called the soft tissue injury protocol (STIP) scoring method. The cervical spines of 100 adult accident victims were evaluated prospectively using motion MRI at 12 weeks following hyperflexion/hyperextension injury from rear, low-impact motor vehicle collisions. Subjects were scored for degree of functional impairment based on an eight-point scale derived from the following clinical criteria: hypolordosis, motion restriction, disk herniation, and spinal stenosis. Five classes of impairment, ranging from normal to severe impairment, were identified as a basis for therapeutic management. Using the STIP scoring method, 94% of patients (94 of 100) were determined to have nonsurgical injuries. Class 1 and 2 injuries indicated mild impairment and were found in 68% of patients, who were considered to have reached maximum medical improvement at 12 weeks after injury. A Class 3 injury indicated moderate impairment and was found 26% of patients, who required an additional 12 weeks of rehabilitative and medical treatment to achieve maximum medical improvement. Class 4 and 5 injuries indicated severe impairment; these were identified in 6% of patients and required surgical intervention. Five of the six patients requiring surgery (83%) achieved maximum medical improvement at 36 weeks after injury. The STIP scoring method is a practical, noninvasive method of determining the degree of clinical impairment, as a basis for distinguishing injury requiring medical treatment from injury requiring surgical treatment, in cases of subacute cervical spine trauma.

The use of flexion and extension MR in the evaluation of cervical spine trauma: initial experience in 100 trauma patients compared with 100 normal subjects.

The purpose of this study was to determine the value of flexion and extension MR in traumatized cervical spines following rear low-impact acceleration-deceleration injury. The cervical spines of 100 consecutive uninjured normal asymptomatic adults and 100 adult accident victims following rear low-impact motor vehicle accidents were evaluated using rapid T2-weighted MRI. Subjects were matched for age but not gender. The age range was 18 to 53 years, with a mean of 35 years. Injured subjects were evaluated during the subacute period, at 12 to 14 weeks after injury, following clinically resolved muscle spasm. Imaging findings were compared between normal and injured subjects. The normal subjects showed a stepwise segmental motion pattern that started at C1-C2 and transmitted to the lower cervical segments. Loss of normal cervical lordosis (hypolordosis) was observed in 4% (4 of 100) patients. Normal range of motion (rounded to the nearest 5 masculine ) was quantified as 50 masculine flexion (range, 45-65 masculine; standard deviation, 6.5 masculine ) and 60 masculine extension (range, 50-70 masculine; standard deviation, 6.5 masculine ). Asymptomatic disk herniations were observed in 2% (2 of 100) patients. In the subacute post-traumatic subjects, there was a loss of the normal segmental motion pattern, with hypolordosis in 98% (98 of 100) patients. Range of motion (rounded to the nearest 5 masculine ) was restricted, quantified as 25 masculine flexion (range, 5-40 masculine; standard deviation, 15 masculine ) and 35 masculine extension (range, 20-50 masculine; standard deviation, 10 masculine ). Disk herniations were observed in 28% (28 of 100) patients. Biomechanical changes in the herniated disk were noted, with mildly increased spinal stenosis following flexion. The authors conclude that flexion and extension MR can be a valuable adjunct examination in the evaluation of patients in the clinical setting of subacute cervical spine trauma.