The validity and clinical utility of axillary ultrasonography-guided fine needle aspiration biopsy in detection of nodal metastasis in early-stage breast cancer patients: a retrospective single-center experience.

BACKGROUND: Assessing the validity and clinical utility of axillary ultrasonography (AUS)-guided fine needle aspiration biopsy (FNAB) in detection of nodal metastasis during preoperative axillary investigation in comparison to the histopathologic diagnosis in early-stage breast cancer. METHODS: A total of 279 operated primary breast cancer patients (age: 55.3 ± 12.8, ranged 17-90 years) were included. Data on AUS findings at the time of initial diagnosis (first look AUS), second-look AUS findings performed by the breast radiologist during breast biopsy procedure and the AUS-guided FNAB findings were evaluated with respect to the final histopathology report obtained through axillary surgery via sentinel lymph node biopsy (SLNB) and/or axillary lymph node dissection (ALND). The diagnostic performance of each method in detecting metastatic ALNs were compared in terms of sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). RESULTS: The sensitivity, specificity, and accuracy of the first look AUS in detecting nodal metastasis were 64.56%, 86.78%, and 74.19% while the PPV and NPV were 86.44% and 65.22%, respectively. The sensitivity, specificity, and accuracy of the second-look AUS were 70.25%, 87.60%, and 77.78%, while PPV and NPV were 88.10% and 69.28%, respectively. The sensitivity, specificity, and accuracy of the second-look AUS guided FNAB were 89.19%, 73.33%, and 87.30%, while the PPV and NPV were 96.12% and 47.83%, respectively. The consideration of second-look AUS and finding of nodal metastasis in FNAB was associated with significantly higher likelihood of ALND (55.4% vs. 44.6%, p < 0.001) and lower likelihood of SLNB (34.7% vs. 65.3%, p < 0.001) compared to consideration of nonmetastatic ALN status. In 23 (22.3%) patients with positive findings on AUS-guided FNAB, SLNB was applied; 21 had positive results after surgical dissection, indicating that nearly 20% of patients had unnecessary SLNB. DISCUSSION: US-guided FNAB of suspicious ALNs is a simple, minimally invasive, and highly effective method for preoperative axillary staging in patients with invasive breast cancer avoiding the more invasive method SLNB and it enables the surgeon to proceed directly to ALND in positive cases.

Diagnostic value of 3D power Doppler ultrasound in the characterization of thyroid nodules

Background/aim: This study aimed to evaluate the diagnostic value of vascular indices obtained using 3D power Doppler ultrasound (3D PDUS) in differentiation of benign and malignant thyroid nodules. Materials and methods: Sixty-seven patients (56 female, 11 male, mean age 44.6) with 81 thyroid nodules exhibiting mixed (peripheral and central) vascularization patterns, with the largest diameter between 10 and 30 mm, were prospectively evaluated using 3D PDUS. Nodule volume, vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were calculated using the Virtual Organ Computer-aided Analysis (VOCAL) software, and these indices were then compared with regard to the cytohistopathology-based diagnosis. The optimum cutoff values for the differentiation of benign and malignant nodules were identified, and diagnostic efficacy was calculated using receiver operating characteristic (ROC) analysis. Results: Fifty-six of the 81 nodules included in this study were diagnosed as benign and 25 as malignant. Vascular indices in malignant nodules were significantly higher than those in benign nodules (P < 0.05). In benign nodules, the mean VI was 11.61 ± 6.88, mean FI was 39.75 ± 3.93, and mean VFI was 4.82 ± 2.94, compared to 18.64 ± 12.81, 41.82 ± 4.43, and 8.17 ± 6.37, respectively, in malignant nodules. The area under the curves (AUCs) was calculated as 0.68, 0.61, and 0.67 for VI, FI, and VFI, respectively. At optimal cutoff values of 10.2 for VI, 40.8 for FI, and 5.5 for VFI, the sensitivity and specificity were 72%/55.4%, 68%/57.1%, and 68%/67.9%, respectively. Conclusion: 3D PDUS can be useful in the characterization of thyroid nodules.

Assessment of breast mass morphology with diffusion-weighted MRI: Beyond apparent diffusion coefficient.

BACKGROUND: Diffusion-weighted imaging (DWI) is a noncontrast-enhanced MRI technique. There are new promising studies on the use of DWI as a part of the enhanced or unenhanced abbreviated breast MRI protocols. PURPOSE: To evaluate the ability of breast DWI in the assessment of mass morphology and determine the contribution of this morphologic evaluation in their characterization. STUDY TYPE: Retrospective. POPULATION: In all, 213 consecutive women were breast MR imaged and had a later confirmed diagnosis. FIELD STRENGTH/SEQUENCE: Breast dynamic contrast-enhanced-MRI (DCE-MRI) and DWI at 1.5T. ASSESSMENT: After Institutional Review Board approval, two radiologists first independently, and later in consensus, evaluated the visibility and morphology of the 143 malignant, 70 benign masses on DWI and DCE-MRI in separate sessions, blindly. Shape, margin, and internal pattern of the masses were evaluated according to BI-RADS lexicon. Apparent diffusion coefficient (ADC) and tumor size were measured by one radiologist. STATISTICAL TESTS: Consistency between imaging methods and readers was evaluated with Cohen's kappa statistics. Multivariate analysis was applied to find the best predictors of malignancy. RESULTS: Tumor visibility on DWI was high to moderate in at least 88% of cases. Consistency between DWI and DCE-MRI was substantial (kappa ≥0.757) for shape and margin and moderate (kappa = 0.505) for internal pattern. Interobserver agreement was substantial to moderate for all morphologic parameters (kappa ≥0.596). Morphology evaluated on DWI provided 83-84% accuracy in discriminating malignant from benign masses. ADC alone provided 90-91% accuracy. Both morphologic parameters and ADC were significantly associated with malignancy on multivariate analysis and provided 91-93% accuracy. DATA CONCLUSION: DWI might be used not only for ADC evaluation but also for the morphological evaluation of breast masses to characterize them. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:1668-1677.

A Case of Wernicke Encephalopathy Developing After Ileal Bypass Surgery.

Wernicke encephalopathy is an acute neurological problem resulting from thiamine deficiency and manifesting with mental confusion, oculomotor dysfunction, and ataxia. It is associated with alcohol dependence in adults. Preparatory factors include hyperemesis gravidarum, prolonged diarrhea, prolonged parental nutrition without vitamin support, absorption disorders, anorexia, cancer, and chemotherapy. Failure to consider the clinical findings and preparatory factors of this disease, which is rare in children, can delay diagnosis. This report describes a case of Wernicke encephalopathy developing in a patient with brid ileus and receiving total parenteral nutrition after partial ileal bypass surgery. The patient's clinical and cranial magnetic resonance findings were compatible with Wernicke encephalopathy. Although these are not widespread, typical ocular findings for Wernicke encephalopathy were present. Dramatic improvements were observed in clinical, ocular, and cranial magnetic resonance findings after treatment.

Diagnostic efficacy of the diffusion weighted imaging in the characterization of different types of breast lesions.

PURPOSE: To evaluate the diagnostic efficacy of quantitative Diffusion-weighted imaging (DWI) in the characterization of breast lesions of mass and non-mass enhancement (NME) types. MATERIALS AND METHODS: After the institutional review board gave approval, DWI exams of 267 women with 212 suspicious masses, 73 NMEs were retrospectively analyzed. Apparent diffusion coefficients (ADCs) of benign and malignant lesions were compared. Cutoff values were obtained by receiver operating characteristics analysis. Diagnostic accuracies of DWI for masses and NMEs were compared with the use of Chi-square test. The effect of the lesions histologic subtypes and size on diagnostic accuracies was evaluated. RESULTS: ADCs were significantly lower in malignants than in benigns for both masses (0.75 versus 1.21 × 10(-3) mm(2) /s,) and NMEs (0.79 versus 1.06 × 10(-3) mm(2) /s)(P < 0.001). Cutoff value was 0.90 × 10(-3) mm(2) /s for both lesion types. The accuracy of DWI was lower in NMEs (76.7%) than masses (89.2%) (P = 0.008) unrelated to lesion size. There was more overlap in ADCs of the benign and malignant NMEs due to the lower ADCs of the benign histologies of this group. CONCLUSION: Despite the lower diagnostic accuracy of DWI in NMEs, it could be helpful in the characterization of suspicious breast lesions of both mass and NME types.

Diagnostic value of qualitative and quantitative enhancement parameters on contrast-enhanced mammography

PURPOSE: To determine whether qualitative and quantitative enhancement parameters obtained from contrast-enhanced mammography (CEM) can be used in predicting malignancy. METHODS: After review board approval, consecutive 136 suspicious lesions with definite diagnosis were retrospectively analyzed on CEM. Acquisition was routinely started with craniocaudal view and ended with mediolateral oblique view of the affected breast. Lesion conspicuity (low, moderate, high), internal enhancement pattern (homogeneous, heterogeneous, rim), contrast-to-noise ratio (CNR), percentage of signal difference (PSD) and relative enhancement from early to late view were analyzed. PSD and relative enhancements were used to determine patterns of descending, steady or ascending enhancements. Receiver operating characteristic analysis, Cohen's kappa statistics and Spearman correlation tests were used. RESULTS: There were 29 benign and 107 malignant lesions. 64% of the malignant lesions exhibited high conspicuity compared to 14% of the benign lesions (P < 0.001). CNR values were higher in malignant lesions compared to benign ones (P ≤ 0.004). CNR from early view yielded 82% sensitivity, 72% specificity and PSD yielded 79% sensitivity, 65% specificity. Descending pattern and rim enhancement observed in 44% and 21% of breast cancers, respectively, and both provided 96% positive predictive value for malignancy. CONCLUSION: Diagnostic accuracy of quantitative parameters was higher than that of qualitative parameters. High CNR, rim enhancement, and descending pattern were features commonly seen in malignant lesions, while low CNR, homogeneous enhancement, and ascending pattern were commonly seen in benign lesions.

Evaluation of the height of the corpus callosum body region in fetal meningomyelocele malformation.

PURPOSE: To investigate height of the corpus callosum (CC) in order to describe the corpus callosum anomalies in fetuses with meningomyelocele (MMC) and compare these findings with the corpus callosum of healthy fetuses. METHODS: In this study, fetal MRI examinations were performed on 44 fetal MMC malformation cases. As the control group, 34 fetal MRI examinations, which were anatomically normal, were evaluated retrospectively. In the study group, lateral ventricle diameter, the level and diameter of the MMC defect, and CC height were measured. In the control group, CC height and lateral ventricular diameter were measured. RESULTS: The mean CC body height was 1.36 mm in the study group, and 2.48 mm in the control group. The height of the CC body region of the study population was inclined to be thinner compared with the control population (p<0.001). CONCLUSIONS: The fact that the height of the CC body region was found to be thinner in fetal MRI in cases of MMC compared with normal fetuses suggests that various callosal anomalies are uncertain, investigation of additional callosal anomalies may be beneficial in the decision for the continuation of pregnancy, and termination or intrauterine surgery in cases with MMC. Further large case group studies are needed.

High-resolution diffusion-weighted imaging compared with conventional diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging with regard to image quality and assessment of breast cancer morphology

PURPOSE: To evaluate the image quality and tumor morphology depiction ability of high resolution (HR) diffusion- weighted imaging (f-DWI) in comparison to conventional DWI (c-DWI) and dynamic contrast- enhanced magnetic resonance imaging (DCE-MRI) in the primary breast cancer setting. METHODS: The f-DWI, c-DWI, and DCE-MRIs of 160 malignant breast masses were evaluated retrospectively by two independent radiologists. Data on image quality [sharpness, distortion, and perceived signalto- noise ratio (SNR)], apparent diffusion coefficient (ADC) value, lesion size, and tumor morphology (shape, margin, and internal pattern) obtained on f-DWI, c-DWI, and DCE-MRI were compared. Consistency between the readers and imaging methods for morphological parameters was analyzed. RESULTS: The ADC values measured on f-DWI were significantly lower than those measured on c-DWI for both readers (P < 0.001 for each), whereas mean lesion size was significantly larger in c-DWI than in f-DWI and DCE-MRI for both readers (P < 0.001 for each). Higher consistency values were obtained for f-DWI compared with c-DWI when correlated with DCE-MRI for each morphological parameter. The least distorted images were obtained using DCE-MRI compared with c-DWI and f-DWI for both readers, whereas the highest distortion scores were obtained using c-DWI. Sharpness and perceived SNR scores were rated as significantly higher for f-DWI and DCE-MRI images compared with c-DWI by both readers (P < 0.001 for all). The concordance between c-DWI and DCE-MRI was fair to slight (κ = 0.15 to 0.41), whereas concordance between f-DWI and DCE-MRI was significantly better (κ = 0.68 to 0.87) for each reader and for all morphological parameters (P < 0.001). The highest concordance between the readers was achieved in margin assessment (κ = 0.87 to 0.89) regardless of the MRI method, followed by shape and internal pattern parameters (κ = 0.63 to 0.79). CONCLUSION: The results demonstrated that f-DWI produces higher-quality images than c-DWI, enabling the morphological features to be identified in similar detail to that offered by HR DCE-MRI. Accordingly, f-DWI, as a method that highly correlates with DCE in determining the morphological characteristics of breast cancers, seems to have potential in the evaluation of breast tumors in patients for whom the use of contrast media is contraindicated.

Outcomes of high-risk breast lesions diagnosed using image-guided core needle biopsy: results from a multicenter retrospective study.

PURPOSE: The clinical management of high-risk lesions using image-guided biopsy is challenging. This study aimed to evaluate the rates at which such lesions were upgraded to malignancy and identify possible predictive factors for upgrading high-risk lesions. METHODS: This retrospective multicenter analysis included 1.343 patients diagnosed with high-risk lesions using an image-guided core needle or vacuum-assisted biopsy (VAB). Only patients managed using an excisional biopsy or with at least one year of documented radiological follow-up were included. For each, the Breast Imaging Reporting and Data System (BI-RADS) category, number of samples, needle thickness, and lesion size were correlated with malignancy upgrade rates in different histologic subtypes. Pearson's chi-squared test, the Fisher-Freeman-Halton test, and Fisher's exact test were used for the statistical analyses. RESULTS: The overall upgrade rate was 20.6%, with the highest rates in the subtypes of intraductal papilloma (IP) with atypia (44.7%; 55/123), followed by atypical ductal hyperplasia (ADH) (38.4%; 144/375), lobular neoplasia (LN) (12.7%; 7/55), papilloma without atypia (9.4%; 58/611), flat epithelial atypia (FEA) (8.7%; 10/114), and radial scars (RSs) (4.6%; 3/65). There was a significant relationship between the upgrade rate and BI-RADS category, number of samples, and lesion size Lesion size was the most predictive factor for an upgrade in all subtypes. CONCLUSION: ADH and atypical IP showed considerable upgrade rates to malignancy, requiring surgical excision. The LN, IP without atypia, pure FEA, and RS subtypes showed lower malignancy rates when the BI-RADS category was lower and in smaller lesions that had been adequately sampled using VAB. After being discussed in a multidisciplinary meeting, these cases could be managed with follow-up instead of excision.

Contribution of MRI to ultrasound in the diagnosis of fetal anomalies.

PURPOSE: To evaluate the contribution of MRI to ultrasound (US) in the diagnosis of fetal anomalies. MATERIALS AND METHODS: After informed consent and institutional review board approval, concomitant US and MR imaging were performed for 184 fetuses with suspected anomalies in university hospital. Postnatal final diagnoses were obtained for 183 anomalies in 151 fetuses either by radiological examination, surgery, autopsy, or inspection. The prenatal US and MR diagnoses were compared with respect to postnatal diagnoses. Sign test was used to determine the statistical significance. RESULTS: Both ultrasound and MR imaging correctly diagnosed 93 (50%) cases and failed in 12 (7%) cases. Ultrasound was superior in 7 (4%) cases. MR imaging was superior in 71 (39%) cases (P < 0.001). MR contributed to the prenatal diagnosis by the confirmation of the suspected US diagnosis in 13%, by demonstration of additional findings in 31% and by changing the diagnosis in 56% of the cases. The contribution rates were 55% for the central nervous system (CNS) (P < 0.001), 44% for thorax (P = 0.016), 38% for gastrointestinal system (GIS) (P = 0.031) and 29% for genitourinary system (GUS) (P = 0.003) anomalies. In facial, cardiac and extremity-skeletal system anomalies, there was not a significant contribution of MR imaging over US. CONCLUSION: MR imaging can be used as an adjunct to US in the prenatal diagnosis of fetal anomalies of not only the CNS but also the non-CNS origin especially those involving the GIS, GUS and thorax.

Contribution of diffusion-weighted imaging to dynamic contrast-enhanced MRI in the characterization of breast tumors.

OBJECTIVE: The purpose of our study was to evaluate the diagnostic value of an imaging protocol that combines dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI) in patients with suspicious breast lesions and to determine if additional information provided by DWI improves the diagnostic value of breast MRI. MATERIALS AND METHODS: Eighty-four patients with breast tumors (37 benign, 47 malignant) underwent DCE-MRI and DWI before biopsy. Morphologic and kinetic analyses were performed on DCE-MRI and findings were classified according to the BI-RADS lexicon. Apparent diffusion coefficient (ADC) values were calculated from the DWI. The ADCs of the benign and malignant lesions were compared. For the combined MRI protocol, morphologic kinetic features and ADCs were evaluated together. Diagnostic values of DCE-MRI, DWI, and combined MRI were calculated. RESULTS: Median ADCs of the benign and malignant lesions were 1.26 × 10(-3) mm(2)/s and 0.75 × 10(-3) mm(2)/s, respectively. Cutoff value of 0.92 × 10(-3) mm(2)/s for ADC provided 91.5% sensitivity and 86.5% specificity. DCE-MRI alone showed 97.9% sensitivity and 75.7% specificity. The combination of DCE-MRI with DWI provided 95.7% sensitivity and 89.2% specificity. The specificity of breast MRI improved by 13.5% (p = 0.063) without a significant decrease in the sensitivity (p = 1.000). CONCLUSION: The combination of DWI and DCE-MRI has the potential to increase the specificity of breast MRI.

MDCT with multiplanar reconstruction in the preoperative local staging of rectal tumor.

OBJECTIVE: To evaluate the accuracy of MDCT with multiplanar reconstruction in the preoperative local staging of rectal tumor. MATERIALS AND METHODS: Thirty-seven patients with rectal tumor underwent preoperative MDCT. Two radiologists evaluated the depth of tumor invasion (T staging), regional lymph node involvement (N staging) and mesorectal fascia involvement on axial, sagittal, and coronal multiplanar reconstruction images in consensus. MDCT findings were compared with pathologic results, which served as the reference standard. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were assessed. RESULTS: Overall accuracy was 86% in T staging, 84% in N staging, 89% in International Union Against Cancer (UICC) Staging, and 94.5% in the prediction of mesorectal fascia involvement. CONCLUSION: MDCT with multiplanar reconstruction is an accurate technique in the preoperative local staging of rectal tumor.

Fungemia and renal fungus ball formation with Candida norvegensis in a child with acute lymphoblastic leukemia.

Invasive fungal infections cause significant morbidity and mortality in pediatric cancer patients. Candida species are the most frequently isolated pathogen. Candida species may cause bloodstream and deep-seated infection in neutropenic children with cancer. The gastrointestinal system, lung, liver and spleen are the most frequently involved organs. Isolated renal involvement presented as abscess formation has been reported rarely in children with cancer. Herein, we report a patient with acute lymphoblastic leukemia (ALL) who presented with renal abscess and fungus ball formation due to Candida norvegensis, which is an unusual cause of infection.

Qualitative characterization of breast tumors with diffusion-weighted imaging has comparable accuracy to quantitative analysis.

PURPOSE: To evaluate the applicability and accuracy of a new qualitative diffusion-weighted imaging (DWI) assessment method in the characterization of breast tumors compared to quantitative ADC measurement and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI). MATERIALS AND METHODS: After review board approval, MRIs of 216 consecutive women with final diagnoses (131 malignant, 85 benign) were retrospectively analyzed. Two radiologists independently scored DWI and dynamic contrast-enhanced MRI (DCE-MRI) according to malignancy probability. Qualitative assessments were performed by combined analysis of tumor morphology and diffusion signal. Quantitative data was obtained from apparent diffusion coefficient (ADC) measurements. Lastly, descriptive DWI features were evaluated and recorded. Cohen's kappa, receiver operating characteristic and multivariate analyzes were applied. RESULTS: Of malignant tumors, 97% were visible on DWI. Qualitative and quantitative DWI assessments provided comparable sensitivities of 89-94% and 88-92% and specificities of 51-61% and 59-67%, respectively. There was no statistical difference between the accuracies of qualitative and quantitative DWI (p ≥ 0.105). Best diagnostic values were obtained with DCE-MRI (sensitivity, 99-100%; specificity, 69-71%). Inter-reader agreement was moderate (kappa = 0.597) for qualitative DWI and substantial (kappa = 0.689) for DCE-MRI (p < 0.001). Agreement between qualitative DWI and DCE-MRI scores was moderate (kappa = 0.536 and 0.442). Visual diffusion signal, mass margin and shape were the most predictive features of malignancy on multivariate analysis of qualitative assessment. CONCLUSION: Qualitative characterization of breast tumors on DWI has comparable accuracy to quantitative ADC analysis. This method might be used to make DWI more widely available with eliminating the need to a predetermined ADC threshold in tumor characterization. However, lower accuracy and inter-reader agreement of it compared to DCE-MRI should be considered.

MR spectroscopic evaluation of psychomotor delay of unknown cause in children.

OBJECTIVE: The aim of this study was to use MR spectroscopy to determine whether the brain metabolism of children with psychomotor delay of unknown cause differs from that of children without psychomotor delay. SUBJECTS AND METHODS: Twenty children (10 girls, 10 boys; mean age, 8.65 years; range, 4-15 years) with psychomotor delay and 19 children without psychomotor delay who served as controls (nine girls, 10 boys; mean age, 8.79 years; range, 6-13 years) were evaluated with multivoxel MR spectroscopy of the brain. The Stanford-Binet test and Wechsler Intelligence Scale for Children-Revised were used to evaluate developmental quotient. Psychomotor delay was assessed as severe (developmental quotient, < 50), moderate (developmental quotient, 50-75) and mild (developmental quotient, > 75). The controls had a developmental quotient greater than 95. Spectra were acquired from eight specific voxels at the bilateral parasagittal frontal and parietal gray matter and the bilateral frontal and parietal white matter at the level of the centrum semiovale. The ratios of N-acetylaspartate (NAA) to choline (Cho), NAA to creatine (Cr), and choline to creatine were determined. RESULTS: Thirteen children had minor and seven children had moderate psychomotor delay. In the psychomotor delay group, the right frontal white matter NAA/Cho, NAA/Cr, and Cho/Cr ratios were 1.45 +/- 0.18, 1.95 +/- 0.33, and 1.36 +/- 0.27; in the control group the ratios were 1.46 +/- 0.23, 2.04 +/- 0.33, and 1.41 +/- 0.19. The ratios for the left frontal lobe white matter were 1.34 +/- 0.21, 2.01 +/- 0.33, and 1.55 +/- 0.26 in the psychomotor delay group and 1.42 +/- 0.15, 2.17 +/- 0.34, and 1.53 +/- 0.25 in the control group. The ratios for the right parietal lobe white matter were 1.80 +/- 0.38, 2.04 +/- 0.43, and 1.18 +/- 0.35 in the psychomotor delay group and 1.89 +/- 0.31, 2.16 +/- 0.30, and 1.17 +/- 0.23 in the control group. The left parietal lobe white matter ratios were 1.66 +/- 0.36, 2.08 +/- 0.35, and 1.35 +/- 0.29 in the psychomotor delay group and 1.81 +/- 0.29, 2.17 +/- 0.35, and 1.22 +/- 0.26 in the control group. CONCLUSION: Metabolite distribution varied with brain region in children with and those without psychomotor delay. No significant difference was found between the brain metabolite ratios of children with psychomotor delay of unknown cause and those of age-matched children without psychomotor delay.

Contrast-enhanced MR angiography of the breast: Evaluation of ipsilateral increased vascularity and adjacent vessel sign in the characterization of breast lesions.

OBJECTIVE: The purpose of this study was to investigate the role of evaluation of breast vascularity with contrast-enhanced MR angiography in the differentiation of malignant from benign lesions. MATERIALS AND METHODS: Contrast-enhanced 3D MR angiograms of the breasts of 102 patients with unilateral and histopathologically confirmed breast lesions were evaluated retrospectively. All images were evaluated for both ipsilateral increased vascularity and adjacent vessel sign, and the values of these signs in the diagnosis of malignancy were assessed. RESULTS: Histopathologic analysis of 102 patients revealed 50 malignant and 52 benign results. In 31 of the 50 patients with breast cancer and in 11 of the 52 patients with benign lesions, ipsilateral breast vascularity was increased. The resulting sensitivity and specificity of ipsilateral increased vascularity were 62% and 79%. The adjacent vessel sign was present in 37 of the 50 patients with breast cancer and six of the 50 patients with benign lesions. The resulting sensitivity and specificity of the adjacent vessel sign were 74% and 89%. The overall accuracies of ipsilateral increased vascularity and the adjacent vessel sign were 71% and 81%. CONCLUSION: Both ipsilateral increased vascularity and the adjacent vessel sign were found to be associated with breast cancer in a significant percentage of patients. The adjacent vessel sign is more practical and generally applicable. There is a borderline significance in favor of the higher accuracy of the adjacent vessel sign in comparison with ipsilateral increased vascularity (p = 0.043).