Lobular Breast Cancer Conspicuity on Digital Breast Tomosynthesis Compared to Synthesized 2D Mammography: A Multireader Study.

OBJECTIVES: To compare the conspicuity of lobular breast cancers at digital breast tomosynthesis (DBT) versus synthesized 2D mammography (synt2D). MATERIALS AND METHODS: Seventy-six women (mean age 61.2 years, range 50-74 years) submitted to biopsy in our institution, from 2019 to 2021, with proven invasive lobular breast cancer (ILC) were enrolled in this retrospective study. The participants underwent DBT and synt2D. Five breast radiologists, with different years of experience in breast imaging, independently assigned a conspicuity score (ordinal 6-point scale) to DBT and synt2D. Lesion conspicuity was compared, for each reader, between the synt2D overall conspicuity interpretation and DBT overall conspicuity interpretation using a Wilcoxon matched pairs test. RESULTS: A total of 50/78 (64%) cancers were detected on both synt2D and DBT by all the readers, while 28/78 (26%) cancers where not recognized by at least one reader on synt2D. For each reader, in comparison with synt2D, DBT increased significantly the conspicuity of ILC (p < 0.0001). The raw proportion of high versus low conspicuity by modality confirmed that cancers were more likely to have high conspicuity at DBT than synt2D. CONCLUSIONS: ILCs were more likely to have high conspicuity at DBT than at synt2D, increasing the chances of the detection of ILC breast cancer.

Distribution of Solid Solitary Pulmonary Nodules within the Lungs on Computed Tomography: A Review of 208 Consecutive Lesions of Biopsy-Proven Nature.

BACKGROUND: The solitary pulmonary nodule (SPN) is a common radiologic abnormality on chest x-rays or computed tomography (CT) scans of the lungs. The differential diagnosis of SPNs is particularly wide as it includes a multitude of benign as well as malignant entities. Nodule location within the lungs has been proposed as a predictive feature in the literature. This study aims at illustrating the distribution within the lungs of a large current series of consecutive SPNs according to their histological subtype, which was definitely proved at core biopsy. MATERIAL/METHODS: Two hundred-eight SPNs referred to our center for characterization were reviewed in this single-centre retrospective study. Histological subtypes were defined following the IASLC/ATS/ERS and WHO (2004) histological classification. RESULTS: This study provides evidence with respect to the prevalence of adenocarcinomas and other non-neuroendocrine primary lung cancer types in the right upper lobe. It also provides new evidence with respect to the prevalence of carcinoid tumors in the middle and right lower lobe, with a tendency to occur in the central lung parenchyma. CONCLUSIONS: This work updates existing knowledge of solid SPNs location within the lungs by providing a current picture of SPN distribution according to their nature.

CT Imaging Features in the Characterization of Non-Growing Solid Pulmonary Nodules in Non-Smokers.

BACKGROUND: A disappearing or persistent solid pulmonary nodule is a neglected clinical entity that still poses serious interpretative issues to date. Traditional knowledge deriving from previous reports suggests particular features, such as smooth edges or regular shape, to be significantly associated with benignity. A large number of benign nodules are reported among smokers in lung cancer screening programmes. The aim of this single-center retrospective study was to correlate specific imaging features to verify if traditional knowledge as well as more recent acquisitions regarding benign SPNs can be considered reliable in a current case series of nodules collected in a non-smoker cohort of patients. MATERIAL/METHODS: Fifty-three solid SPNs proven as non-growing during follow-up imaging were analyzed with regard to their imaging features at thin-section CT, their predicted malignancy risk according to three major risk assessment models, minimum density analysis and contrast enhanced-CT in the relative subgroups of nodules which underwent such tests. RESULTS: Eleven nodules disappeared during follow-up, 29 showed volume loss and 16 had a VDT of 1121 days or higher. There were 48 nodules located peripherally (85.71%). Evaluation of the enhancement after contrast media (n=29) showed mean enhancement ±SD of 25.72±35.03 HU, median of 18 HU, ranging from 0 to 190 HU. Minimum density assessment (n=30) showed mean minimum HU ±SD of -28.27±47.86 HU, median of -25 HU, ranging from -144 to 68 HU. Mean malignancy risk ±SD was 15.05±26.69% for the BIMC model, 17.22±19.00% for the Mayo Clinic model and 19.07±33.16% for the Gurney's model. CONCLUSIONS: Our analysis suggests caution in using traditional knowledge when dealing with current small solid peripheral indeterminate SPNs and highlights how quantitative growth at follow-up should be the cornerstone of characterization.

Multifocal branch-duct intraductal papillary mucinous neoplasms (IPMNs) of the pancreas: magnetic resonance (MR) imaging pattern and evolution over time.

PURPOSE: The aim of our study was to follow the evolution over time of multifocal intraductal papillary mucinous neoplasms (IPMN) of the pancreatic duct side branches by means of magnetic resonance imaging (MRI). MATERIALS AND METHODS: A total of 155 patients with multifocal IPMN of the side branches were examined with MRI and MR cholangiopancreatography (MRI/MRCP). Inclusion criteria were patients with ≥2 dilated side branches involving any site of the parenchyma; presence of communication with the main pancreatic duct and previous investigations by MRI/MRCP within at least six months. Median follow-up was 25.8 months (range, 12-217). Patients with a follow-up period shorter than 12 months (n=33) and those with a diagnosis of multifocal IPMN of the side branches without any follow-up (n=14) were excluded from the study. The final study population thus comprised 108 patients. A double, quantitative and qualitative, analysis was carried out. The quantitative image analysis included: number of dilated side branches in the head-uncinate process and body-tail; maximum diameter of lesions in the head-uncinate process; maximum diameter in the body-tail; maximum diameter of the main pancreatic duct in the head and body-tail. The qualitative image analysis included: presence of malformations or anatomical variants of the pancreatic ductal system; site of the lesions (head-uncinate process, body-tail, ubiquitous, bridge morphology); presence of gravity-dependent intraluminal filling defects; presence of enhancing mural nodules. RESULTS: At diagnosis, the mean number of cystic lesions of the side branches was 7.09. The mean diameter of the cystic lesions was 13.7 mm. The mean diameter of the main pancreatic duct was 3.6 mm. At follow-up, the mean number of cystic lesions was 7.76. The mean diameter of the cystic lesions was 13.9 mm. The mean diameter of the main pancreatic duct was 3.7 mm. Intraluminal filling defects in the side branches were seen in 18/108 patients (16.6%); enhancing mural nodules were seen in 3/108 patients (2.7%). CONCLUSIONS: Multifocal IPMN of the branch ducts shows a very slow growth and evolution over time. In our study, only 3/108 patients showed mural nodules which, however, did not require any surgical procedure, indicating that careful nonoperative management may be safe and effective in asymptomatic patients.

Evolution of ventriculomegaly: comparison between foetal MR imaging and postnatal diagnostic imaging.

PURPOSE: We evaluated the evolution of ventriculomegaly (VM) by comparing foetal magnetic resonance imaging (MRI) with postnatal transcranial ultrasonography (US) and/or encephalic MRI. MATERIALS AND METHODS: Between January 2006 and April 2011, 70 foetuses with a mean gestational age of 28 weeks and 4 days (range, 18-36) weeks with VM on foetal MRI were assessed in this prospective study. Half-Fourier rapid acquisition with relaxation enhancement (RARE) T2-weighted, T1-weighted and diffusion-weighted (DWI) images along the three orthogonal planes according to the longitudinal axis of the mother, and subsequently of the foetal brain, were acquired. Quantitative image analysis included the transverse diameter of lateral ventricles in axial and coronal planes. Qualitative image analysis included searching for associated structural anomalies. RESULTS: Thirty-four of 70 patients with a diagnosis of VM on foetal MRI underwent postnatal imaging. Twenty-five of those 34 (73%) had mild, four (12%) had moderate and five (15%) had severe VM on MRI. Normalisation of the diameter of lateral ventricles was observed in 16 of the 34 (47%) newborns. Among these 16, 13 (81%) had mild and three (19%) had moderate VM (two isolated and one associated VM). VM stabilisation was observed in 16 of the 34 (47%) babies. Among them, 11 (69%) had mild (eight isolated and three associated), one (6%) had moderate associated and four (25%) had severe associated VM. Progression from mild to severe (associated) VM was observed in two of the 34 (6%) babies. CONCLUSIONS: The absence of associated anomalies and a mild VM are favourable prognostic factors in the evolution of VM.